text:
Anti-Aging Medicine: What Works
March 8, 2008
Host: Anti-Aging Psychologist Dr. Michael Brickey
Expert Guest: Dr. Nicole Flora, Anti-Aging Physician
Broadcast: 2-24-08 on webtalkradio.net where the latest shows are broadcast and posted as podcasts
Medicine has focused on treating diseases. What we call healthcare has mostly been disease care. Anti-aging medicine emerged in the last ten years or so to ask what can doctors do to be proactive in preventing aging and diseases. As a new discipline, it has attracted both very dedicated physicians and frankly a few hucksters. Today's expert is clearly one of the best anti-aging physicians, Dr. Nicole Flora. Dr. Flora was Board Certified in family medicine, obtained a Master's degree in Public Health, and later specialized in age management and anti-aging medicine. She has been active in research and is on several policy boards. In the first part of the program, we will focus on what anti-aging medicine is and what it has to offer. In the second part of the program, we look at the pros and cons of different anti-aging treatments. Her websites are www.CincinnatiAgeManagement.com and www.Cenegenics-DrFlora.com
TRANSCRIPT ©Michael Brickey–excerpts permitted with attribution
MB: This is Dr. Michael Brickey with Ageless Lifestyles Radio, cutting-edge thinking for being youthful at every age. On each program I interview experts on what it takes to live longer, healthier, and happier. Our program takes a holistic approach in addressing anti-aging psychology, medicine, alternative medicine, fitness, nutrition, and wellness. Our emphasis is on innovative thinking and practices that have solid data and results.Medicine has focused on treating diseases. What we call healthcare has been mostly disease care. Anti-aging medicine has emerged in the last ten years or so to ask, what can doctors do to practice preventing aging and preventing diseases? As a new discipline, it's attracted both dedicated physicians and, frankly, a few hucksters. Today's expert is clearly one of the best anti-aging physicians, Dr. Nicole Flora. Dr. Flora was board-certified in family medicine, obtained a masters degree in public health, and later specialized in age management and weight management. She's been active in research and on several policy boards. In the first part of the program, we'll focus on what anti-aging medicine is and what it has to offer. In the second part of the program, we'll look at the pros and cons of different anti-aging treatments. Dr. Flora, after years in medical school, what prompted you to get a masters degree in public health?NF: It was part of the career path that I had chosen. After I came out of medical school and residency, I joined a group that was providing indigent care in the southern part of the state, southern Ohio. And we really took care of about 57,000 patients that had no insurance and had no access to good healthcare. And so as part of that path, they pursued the public health arena and then took over a lot of the quality assurance and some of the government programs to help people that couldn't get good care.MB: So working with indigent patients got you interested in chunking up to a higher level of, "How can we solve some of these problems on a policy level and get a better system?"
NF: Absolutely. We saw some of the epidemics of disease and some of the cultural ills that affected these people, and it really – while I wanted to certainly impact people's lives on an individual basis, I felt like there needed to be a broader approach.
MB: And then what got you into age management and weight management?
NF: It was kind of an extension of that. You know, after seeing – unfortunately, in the poorer populations, obesity, diabetes, heart disease, poor nutrition and poor lifestyle choices are rampant. And that really was what I wanted to tackle. And in age management, that's exactly what we approach are all of those things, and how do we prevent those things, and how do we get people to think proactively about their health and about their lives.
MB: So you were working with the other end of the extreme, people who are aging very fast?
NF: That's right. I would have young people in their 30s – you know, the most extreme examples were the 10 or 11-year-olds that came in and they were already obese and had diabetes. I probably diagnosed 50 preteens with Type 2 diabetes because of poor lifestyle choices. And those kids were not going to live very long.
MB: Was there something specific that got you to go from public health to the age management, weight management?
NF: It had a little bit to do with the system. Unfortunately now, the way healthcare is structured, in order for it to be financially feasible, you have to see a huge number of patients. And I was averaging, on a lot of days, 40 patients a day. And it really became an ethical dilemma to me. I knew I could treat them well. I was treating them at the standard of care, but I knew they needed something better than that, and I wanted to be able to provide more than that. The system as it's structured now just doesn't allow for that. So it really kind of became an ethical dilemma – do I give them another pill and I expect to see them in about three months when they come in for the side effects from the pill I gave them last month. I just wanted to have greater contact with my patients and hopefully have a great impact long-term.
MB: So now are you working with kind of a cross-section of social classes and lifestyles?
NF: Well, unfortunately I'm not. Age management medicine, because it is relatively new and because insurances don't cover it in most cases, right now my experience is relegated to those people that can afford to pay out of pocket, and that's certainly fine for them but it does leave out a huge portion of the population right now.
MB: Personally, I don't have any problem with that because it blazes the trail, and what's the ideal standard of care now becomes the standard of care maybe ten years from now.
NF: Well, that's absolutely right. And that's certainly my hope, is that as we get better and better at this and as we hopefully do get rid of, as you said, some of the hucksters in the arena, that it will become standard of care and will be more acceptable to people. And that's certainly my hope for the long term, and some of the things I do with the physician advisory board and things are to promote those type of things.
MB: And in the long run, it's going to be cost effective by preventing a lot of health problems, and a lot of medications.
NF: Absolutely, certainly.
MB: If a 50, 60-year-old person comes into your practice, what do you do that's different than if you were a mainstream family practitioner?
NF: First thing is that I get to know them. Instead of spending 15 minutes, and two or three of that is looking at their chart and seeing what the nurse wrote and having a brief conversation about what's ailing them today, they're in my office for their first visit usually between six and seven hours – between meeting with the nutritionist and meeting with any additional people in the office, and they're usually face-to-face with me for two to three hours. And most people have never had that type of experience with a doctor. And you get to know what's affecting them, what pressures they're under, how they eat, how they exercise, what are their support systems, certainly what are their medical issues in the past, what really do we need to fix now and what are going to be hurdles in the future to keep them healthy. So it really is that close connection that is the biggest difference to start with. In the long run, it really is the fact that we work together so closely, maintain a very close relationship. I work with their other physicians, if they have specialists that they work with. It really is that quarterback mentality that I think primary care was originally supposed to tackle, and it ended up just being a paperwork job where you just do referrals for everybody. But it really is keeping the patients educated on everything that's going on in their lives from a health standpoint.
MB: So right from the start it's holistic and it's about a relationship.
NF: Absolutely. And that's what makes it most rewarding.
MB: I suspect some of your patients are shocked to have so much one-to-one time with the physician.
NF: Oh, that's the first thing. They're like, "Really? Are you serious? You need six hours of my time?"
MB: We've all spent six hours of our time going from one test to another, but to spend a couple of hours face-to-face with a physician is a real treat.
NF: That's right. And instead of wasting your time, at least we're getting educated and getting to know each other.
MB: So we've had this first session – then what?
NF: Well, certainly after that it varies, depending on the person and what their individual needs are, what their goals are, what we're trying to fix and kind of what the short-term issues are, as well as long-term. But certainly, just a general overview is we want to get them eating better, we want to get them moving, we want to – if they need medications, and whatever they need. If they need specialists, if they need therapists, we'll facilitate it.
MB: I gather that it's not everybody needs to be at this level of hormones and this level of exercise and, you know, get with the program, but extremely individualized.
NF: Absolutely. And that's one of the problems we've had with mainstream medicine is that we have over-generalized. And a lot of the things that you will see come down the pike as problems are because we took some research point that sounded good and tried to apply it across the entire population, and we abdicated the thought process, I think, in some cases. And so everybody's very individualized. I do certainly have people on hormones. I certainly have people on blood pressure medicine. I have the whole gamut. But it really is very individualized to each person and their needs and their health and what's the best combination for them.
MB: How many of your patients come to you and say, "Dr. Flora, can you get me some of that HGH? You know, is it legal? Is it going to make me a he-man?"
NF: Well, I have a small percentage that actually come and say that. I probably have a bigger percentage that think that in the back of their mind. Honestly, about 7 or 8% of my patients are on HGH, but a lot of people, that's what they hear about and so that's what they think it's all about. And certainly HGH is a wonderful medication when used appropriately in appropriate patients with the right expectations. But unfortunately, there is a ton of misinformation regarding it. It is not the cure-all for everything. It won't make you live forever. It won't make you beautiful if you're not beautiful to start with. But it has its place. And it's a very safe medication and it is certainly appropriate in some people.
MB: So who are the 7% that benefit from it?
NF: The people I specifically prescribe it to are people who have developed a deficiency, so they have stopped producing it naturally – they have no levels. And those people are usually experiencing things like a lot of muscle loss, weakness, tiredness, and a lot of quality of life issues. Growth hormone really affects your ability to kind of appreciate life and mood. And those are the people that really end up benefiting from it the most, are the ones that have that combination. The other thing with human growth hormone is it rarely is a problem by itself. When I see human growth hormone has declined, it's usually declined in combination with other hormones. And so a lot of times when we balance the other hormones, it will help you produce human growth hormone, and a lot of people will improve their human growth hormone that way, as well.
MB: So you rarely recommend using human growth hormone to enhance; you're usually using it for people who have deficiencies?
NF: That's right, yes. I do not.
MB: What about testosterone? I see all these charts about how men's level of testosterone declines with age dramatically. Is that something that should be enhanced? Or again, are you just concerned about deficiencies relative to a person's age?
NF: It does decline dramatically. And not only does it decline dramatically, if we look at population studies from as little as about 20 years ago, the average testosterone level of men in our society now is 17% less at any given age, and we're not quite sure why that has occurred either.
MB: All these metro males, huh?
NF: Yeah, certainly I do recommend we replace it, and I do take men to an optimal level, not for their age.
MB: My understanding, one of the problems with replacing testosterone is that it often gets bound and can actually turn into estrogen and have the reverse effect. How do you control for that?
NF: That's why if you're going to deal with hormones, you need somebody that's very well-educated on how to do it. I'll see a lot of people come in and they've gotten testosterone from one source or another and it's not being managed well. You have to – before you start that medication – you have to measure all of those things. It'll give you a pretty good picture of how an individual man or woman will metabolize the hormone. It doesn't always give you the whole picture, but it'll give you a good starting point. And then you monitor those as your start therapy and continuously throughout. If men start putting out too much estrogen, then certainly we can sometimes change the route of administration of the testosterone, you can sometimes use prescription medications that block the conversion, and you can sometimes use herbal preparations to stop the conversion, as well.
MB: With women, they practically stop producing testosterone after menopause. Are you doing any testosterone supplements with them?
NF: I do. And honestly, my experience with women is I will see women drop their testosterone usually in their 30s. We always think that the hormone production stops at menopause, but truly, I will generally see women who drop their progesterone, drop their testosterone in the early 30s, up to 10 to 15 years before they actually stop producing enough estrogen to stop having cycles. I will even replace it in some women before menopause if we see that it has declined beyond a normal range.
MB: Top of your head – what percentage of women in our country would probably benefit from hormone replacement after age, say, 40?
NF: After 40? Well, if we say after menopause, I would certainly say a majority, but not – you know, it's not 100%. There are still other risks to be considered. After 40, though, it really depends on where they're at in the perimenopausal cycle. But I do see a lot of women in their 40s have a lot of PMS type symptoms, have a lot of weight gain around the middle, develop more fatigue, those type of things. And so – and those are the women that usually seek me out. So of the people coming through my door, it's a huge percentage. It's probably 90%. In the general population, I would probably guess at age 40 that it's probably about half of the women.
MB: So is weight gain a red flag that something's probably going wrong?
NF: Something is wrong when you start gaining weight. Unless you're someone that walks through my door and tells me that, "I eat McDonald's three times a day and I never exercise," that's generally not the case. Those people – certainly it's a lifestyle issue, and everybody has lifestyle issues. But when we start seeing the kind of weight creep, I like to call it, where it's just every year you're adding a little bit and you're adding a little bit, and then all the sudden you'll see it, about 20 pounds in a year – that tells me that there is a metabolic issue going on. And the fact that we tell women, "You know, just eat less and exercise" – certainly that is good advice, but it is missing a whole component of the picture of what's going on, and it really is a little patronizing to people that have had weight issues. I've dealt with weight issues, and until I personally fixed the metabolic issues, the hormonal issues, it was impossible. I craved food, my appetite was much higher than it is now, and I had no energy to exercise, and it became very mentally daunting when you went to the doctor and they said, "Well, just exercise." And once all of those thing were fixed, weight for me in the last seven, eight, nine years really hasn't been an issue.
MB: So for you personally, the weight management became a lot easier?
NF: Oh, absolutely. I wasn't, you know, five pounds overweight. I lost about 65 pounds when we fixed the hormones. And you know, I still go out to – I ate at an Italian restaurant last night and I enjoy myself. So I'm not depriving myself, but it just became much, much easier.
MB: I keep seeing the term "estrogen dominance" in the press. Is that a useful term, and are you seeing a lot of it?
NF: I do see a lot of it, and I think it's under-diagnosed, and especially in a 40-year-old that you asked about, estrogen dominance is a big thing. I'll see it in men, as well, but in the younger women, in the 40-year-old women, what has happened is the ovaries have slowed down so that the progesterone and the testosterone are declining; the estrogen production is still relatively high. And therefore that's where they end up with some of those more PMS type symptoms. They're more moody, irritable, the weight creeps up, they tend to retain fluids – all of those type of things. With the men, they gain weight, they put weight on in the middle, they can't maintain the muscle mass that they had. They get moody and irritable, as well.
MB: For women who are going through menopause, how many of them do you recommend some kind of hormone replacement?
NF: For the people that come to my office, it's about 90%, because that's kind of why they're coming to see me. And they usually – the people that I'm seeing are well-educated, they've done their research in this arena, so most of the people that come to see me, I do recommend it. People that I specifically don't recommend it for – and we can't lump all of hormonal therapy in one bushel, either – there's very few people that, given blood work results, that I would say, "You just aren't somebody that I would give hormonal replacement to." Certainly if all the blood work is normal, they don't need hormonal replacement. Most women or men that come to see me will have one abnormality or another. Places that it is a very complicated decision for me are women with a history of breast cancer or endometrial cancer or certain ovarian cancer; women that have a very high risk, so they've got two people in their family that have had breast cancer; men with a history of prostate cancer or certain other melanomas and things like that are also big flags for me that, you know, we really need to proceed very, very cautiously. The breast cancer issue is the one that almost invariably comes up in women. They come to me and they say, "I've got all these symptoms, my quality of life has declined, but I'm afraid if I take hormones, I'm going to get breast cancer." The fact of the matter is, at this point – there is a lot of research, and at this point it is not conclusive that hormonal therapy caused breast cancer. It actually is pretty evenly split that it's very safe, it can lower your risk, versus it increases your risk. And the relative risk increase on the studies that have said that is extremely small. But that is related to estrogen. What women forget is they still have progesterone, they still have thyroid hormones, they still have testosterone, all of these other hormones. So we can't lump them all in together. So if women are concerned, they're worried about estrogen, sometimes we'll use some of the other therapies first, see how we get them feeling – base it on their risk, base it on their blood work, and then maybe add that down the road, once we feel more comfortable and they feel more comfortable about it.
MB: For women who are having that creeping weight gain, how often is thyroid a factor in that?
NF: More often than what we're led to believe. I'm the perfect example. I was tired, my weight was up. I went to my primary doctor, went to my OB/GYN, went to an endocrinologist – they all said, "Your thyroid is fine." And that was all based on a screening test. Back in the 1970s, this new screening test came out. It's called the TSH. The insurance companies pay for it; that's the only thing that they recommend if you want to look at thyroid. And that's what all of us doctors that went through medical school since the '70s had been trained on, and so that's all we look at. But thyroid is a very complicated gland. There are multiple hormones involved. There are absorption issues that a lot of doctors just fail to look at. And we like to treat it as a disease, too, like to wait until it's really bad before we treat it. So I don't know. So in my case and in patients that I see, probably about 30 to 35% of women will have a thyroid issue that, when corrected, it helps them tremendously. Whereas if you look at the statistics nationally, they say between 2 and 4% of people with weight issues are thyroid-related. And we really have, again, given the whole clinical responsibility – and we like to look at that number on the paper and say, "Oh, the number on the paper is fine," and we forget about physical examinations, our skin texture and fluid retention and basal body temperatures and examination of the thyroid. All of those things go into the diagnosis, as well.
MB: If a woman's having weight gain and suspecting thyroid might be a problem, what kind of tests should she ask her physician to do, to make sure that he or she catches it?
NF: It's a tough thing. Most physicians are going to order the TSH, again because that's what the insurance companies – and they were told to do. There are multiple other tests that you can do. You can do what's called a T3 or a T4. The thyroid gland that's in your throat is controlled by a hormone that comes from your brain and tells it to make thyroid hormone, and that's called TSH and that's what the screening test is for. The thyroid gland then puts out a hormone called T4 which floats around in the bloodstream and eventually gets broken down into T3. The T3 is the active form of thyroid hormone and that's what actually goes into the cells and makes your cells metabolize energy. There's also, in your bloodstream, there can be antibodies, things that block that T3 or that T4 from working. So you need to look at all of those things. Additionally, you can have issues of absorption of the T3 through the cells, which we don't really have a good test for. So the biggest thing I tell people, if they're concerned about thyroid, is to find a doctor that knows what they're doing with the thyroid. Honestly, most doctors don't. There's a couple of very good books on thyroid that I will oftentimes refer patients to, to get educated on it and allow them to help themselves a little better.
MB: And what are those books?
NF: There's a Dr. David Brownstein who is wonderful – he's in Michigan. And he has a book called Overcoming Thyroid. And it talks about things from a physical exam standpoint, things that you can do at home to see if thyroid is potentially an issue, see if iodine absorption, which is what makes thyroid hormone active, is an issue. And plus, it gives you symptoms to look at that might tell you if it's an issue, as well as here's the test that should be done. So it's a good quick read that gets you well-educated. And in a lot of cases, my patients will read that and go to their primary doctor and they'll know a lot more about it than their primary doctor. We can point them in the right direction if they need to.
MB: Other than anti-aging specialists, are there physicians who, because of their specialty, would be knowledgeable about thyroid?
NF: Endocrinologists are the hormonal experts in the medical field. And they are very well-educated and very well-meaning, but unfortunately they treat diseases. Their philosophy right now with thyroid and the way they're educated and their policies that are put out by the Endocrinologic Society is for thyroid, if the screening test – the TSH test – is elevated to 10 – TSH is an inverse number, so the higher the number, the less thyroid function you have. So with over 10, you treat thyroid. But when you're going to treat it, you're going to treat it down to a 2. Where I see a lot of people falling into thyroid issues are between that 2 and that 10, which the Endocrine Society says, "You don't treat those people. It's obvious that they have a problem, but we'll wait until the problem gets worse before we treat it." And that's where philosophically I differ from them. I think if you know you have a problem and you have symptoms – you're gaining weight, you're tired, all of those things – then we need to treat it more aggressively. If you come in to me and you have abnormal blood tests and it seems elevated but your weight's perfect, your energy is good, you're not losing hair, you don't have any symptoms, then I agree, we should watch it. But our goal in age management is to be more proactive and not wait until you're in a disease state to fix things.
MB: It sounds like medicine as a whole – and I hope anti-aging medicine takes the leadership in this – needs to define new standards of what's healthy instead of just what's unhealthy and disease.
NF: And that's right. That's where medicine has been focused for decades now is illness, and nobody knows what it means to be healthy.
MB: Are there boards that are working on that issue?
NF: Oh, absolutely. There are a lot of people that are approaching Congress, approaching like the AMA to try and push things into this direction.
MB: Good.
NF: Certainly there is resistance. Doctors are the slowest people to change their mindset on anything, of any group I've ever seen – which is good and bad. But so there is certainly resistance within the system to that. There are also some inherent problems with things like research. Research funding is usually focused on, you know, how do we cure a disease, or it's coming from pharmaceutical companies which are trying to sell us patentable products. And so there are some problems with getting funding for good research from that standpoint, as well. As well as, you know, there are certain biases, especially in the nutrition field. There are certain – we've gone from "Fat will kill you," to "Carbs will kill you," and back and forth for decades. And you know, a lot of that is there have been a lot of political shenanigans that have gone into those positions, unfortunately. And it's probably going to persist for some time, just because – and part of the reason for that is that there's not one universal answer. We want an answer that says, "Here is what everybody in the world should eat and you will be healthy." The fact of the matter is not that straightforward. Again, back to where we like to generalize everybody. We are individuals. We are genetically different. We are metabolically different. There is not going to be a right answer for everybody.
MB: Everything you're talking about is talking about how it's not easy and it's very individualized.
NF: That's right.
MB: Let me take a break here. You're listening to Ageless Lifestyles Radio on Webtalkradio.net and we're talking with anti-aging physician, Dr. Nicole Flora. She practices anti-aging medicine and age management, weight management in Cincinnati, Ohio, and she's associated with Cenegenics Medical Institute in Las Vegas, with affiliated physicians around the country. Her website is http://www.cincinnatiagemanagement.com/, and the Cenegenics Institute site is http://www.cenegenics.com/. For information on anti-aging psychology and my books, Defy Aging and 52 Baby Steps to Grow Young and my free Defy Aging Newsletter is at http://www.drbrickey.com/ or you can just to http://www.notaging.com/ and it'll take you to http://www.drbrickey.com/ . Dr. Flora, how much does it cost to get a good workup in anti-aging medicine?
NF: Certainly individual doctors charge different amounts. I don't think there is a set fee. It really depends on what you're dealing with.
MB: So for a typical person that says, "I'm feeling rundown and want you to work it up and put me on a program of nutrition and exercise and hormone replacement, if that's needed," are we talking a few thousand dollars, several thousand dollars?
NF: We're talking in general, to start with, all-inclusive – between a good blood work panel, which unfortunately is the majority of the cost – probably a couple of thousand dollars. I mean, blood work – we do exercise testing, fitness testing, bone density, body fat, all of those things, plus consultations with a nutritionist – all of those types of things are included.
MB: I'm surprised that it's not a lot more than that. Sounds like a bargain to me. I mean-
NF: Honestly, if you compare what you would go and pay if went to the hospital and got those things, you're right. It absolutely is a good bargain.
MB: Considering what we spend on cars and stereos and plasma TVs – well, it's the cost of a fancy television set – which is more important?
NF: Absolutely. It is an investment. It's how much do you know about your body, which is – you know, a car is going to last you, on the outside nowadays, 10-12 years. You have to live with this body for a very long time.
MB: You're engaged in some research. Can you tell us about that?
NF: Through the Cenegenics Foundations, we work with two medical schools, the University of Miami and the University of Nevada, and we do multiple research programs yearly. And the latest one involves weight and particularly hormone replace, specifically growth hormone and testosterone. And that came out through Cenegenics in November. It's being submitted for publication in March.
MB: Are you allowed to share with us the gist of it, or is it under wraps?
NF: It's been presented at the national meeting, so I'm assuming I can tell you a little bit. But that we did see, particularly in women, we saw a significant weight loss when hormones were balanced. With men, the weight loss was less significant, but the body fat content came down significantly. So they gained more muscle mass and lost more fat, where women kept their muscle mass consistent and lost fat. So their actual number on the scale, which we women like to focus on a lot unfortunately, changed more so with the women than with the men. But it was statistically significant weight loss.
MB: Well, speaking for men, we'd be happy to have it translated to muscle instead of fat. That's okay.
NF: Exactly, exactly. So it made people happy on both fronts.
MB: Well, wonderful. I gather your approach to anti-aging medicine is fairly Western as opposed to someone who emphasizes Ayurvedic medicine, colonics and fasting and that kind of thing?
NF: That is true. You know, I am a traditional doctor. I went to traditional medical school and I trained to look at the scientific evidence. So I am more comfortable in that realm. I certainly am open to my patients using other approaches, but I won't certainly present myself as an expert in those realms. I get, particularly with chiropractic and acupuncture, I get patients that have tremendous response. But certainly I will work with other practitioners if that's their choice. But again, I just don't present myself as an expert in those fields because that's not where my training lies.
MB: It seems to me like there's three schools: what you're doing, which is very Western integrative; there's the more Eastern approach; and there people who are just emphasizing the hormones and the shots and the cosmetics but not asking people to do the exercise, to take a look at their eating, and that kind of thing.
NF: I think you're correct in that assumption. My personal opinion is that really to have the best outcomes you need a combination of all those things. People like to go to the doctor and be given pills and shots and creams or what have you because that's what they've been taught to kind of expect. But it really – we cannot under-emphasize the other components. You know, the psychological components – and you're the perfect expert to talk about that. There's a huge impact on, you know, the diet and the nutrition. If you are going to put – if you want to know what the side effects to this pill that you're putting into your body are, you certainly ought to think about the side effects of what the food you're putting in your body are and how we change those. I mean, that – you eat three meals a day. You may take one pill a day. What is going to have the bigger impact on your life long-term? And people like to forget about that component. Eating is unconscious in a lot of cases. Our activity level is unconscious and it takes a lot more work. It's easier to take a pill or a cream or a shot and not have to do that component. So my opinion is certainly it needs to be a comprehensive program. It has to address all of those things. It is hard as a practitioner to put all of that together, but that's where the challenge lies.
MB: What do you think is going to happen in anti-aging medicine the next 10, 20, 30 years?
NF: I think we're going to get better at it, and I think we're going to get better at doing research at it, I think we're going to get better politically getting people to support our position that we want to promote health and avoid disease, as opposed to just treating disease. I don't know in the next ten years where the traditional medical community or the insurance communities are going to be on that front. In 20 years, I think they will be onboard, but it's going to be a rocky road between now and then, unfortunately.
MB: Do you see huge changes from, say, genetic engineering and tissue engineering that's going to get integrated into the anti-aging medicine at the practitioner level?
NF: Absolutely. Right now, genetics are – there are a lot of problems with the genetic component, from a decision-making point. But the genetics I think will be the next big mover. However, we have to remember that probably 45 to 50% of what happens to you, you are predisposed to, from your genes. The remainder is lifestyle. So we can't expect genes to come in and cure everything. We still are responsible for our health and our environment and our psychological wellbeing. So it will never come in – and a lot of people are waiting for it – "Hey, if I get the genes right, I won't get heart disease and I won't get this, that, or the other." But it's never going to be that simple.
MB: "And I can go to the restaurant and eat everything."
NF: Right! "And if I've got the right genes, my jeans get on fine." And I actually had a gentleman that called yesterday and said, "Hey, I heard about this genetic testing. Can I get it done to find out, you know, do I need to do this?" And you know, my take to him was that right now, at least, it can sometimes give you a false sense of security. If you have a genetic test that tells you you're at low risk for heart disease or you're at low risk for diabetes, does that mean that you don't need to know what is best to prevent those things? And my position is no, I'm going to treat everyone like they're at high risk for heart disease and diabetes, because still, the vast majority of heart disease cases and probably 85% of new diabetes cases, Type 2 diabetes, occur in people with no genetic risks. So we can't rely on a blood test to tell us we're safe.
MB: One of my pet peeves is statins. I think they have so many nasty side effects; I hate to see so many people taking them. What kind of alternatives do you tend to get into with patients to see if they can get off the statins?
NF: I have a problem with the statins, as well. I feel the same way. Cholesterol – certainly diet is important, but diet – if we're honest with ourselves and we look back at the medical literature for the last 30 years, diet – and I hate to say this because it will tell people they can go every fried food they see – diet has a very small impact on cholesterol levels, maybe 10% if you're very good – which is important. Diet has other impacts, though. It affects inflammation, which the statins also decrease. So we can't just look at the cholesterol number. But diet is important. Exercise is important. Looking at hormonal levels – I never, never treat someone's cholesterol number unless their thyroid is optimal. Thyroids will impact your cholesterol readings, as will testosterone levels, as will estrogen levels. And so a lot of people, when we get the hormones balanced, we get them eating right, we get them exercising, they don't need the statins. The statins, I think, are so over-prescribed. If you actually follow the American Heart Association's recommendations now for cholesterol levels, in my personal practice, my primary care practice – if I followed that, 75% of the patients that I saw on a daily basis would be on a statin. And honestly, that is – in my mind was a big turning point. Common sense has to come into play. There's either something wrong with our society, with our lifestyle, with how we're eating – that didn't come about – you know, that isn't a genetic issue that all of the sudden 75% of people need a pharmaceutical. It's either our position as doctors and as researchers is wrong, or there's something going on culturally with our diet. Something has changed that has made that occur. And that's why I think, as a doctor, you really, really have to step back and step outside of the box and not just read the recommendations, but go back and look at the individual research that has been done to date.
MB: I'm hearing that public health perspective there.
NF: Absolutely, sure.
MB: How does a person tell whether somebody is a well-qualified, competent anti-aging physician?
NF: It's tricky. There are a lot of people out there that are dabbling, that are not well-educated on the subject, that have gone to classes that may not have been the best classes, that have gone to seminars or have been pitched products that are not well-supported by research. And so honestly, it is a tough position as a consumer. My biggest thing is that you need to find a physician that you can talk to, that you're comfortable with on a personal level, that can give you supporting evidence to their opinion, and who is willing to have that conversation, and also who doesn't treat you – not a cattle call at their office, and they're not going to treat you – everybody that comes through the door gets this treatment or that treatment. That is, for me, the biggest thing. You want certainly someone who has some experience in the field. You probably need someone who has been doing it – and I hate to, you know, give time cut-offs, but multiple years, five years or more. And you need somebody that, in my opinion, does this as their primary focus. The guys that are doing it one day a week out of their office unfortunately can't keep up with the amount of medical and other sources of information at this point. You can't keep up with your regular practice, let alone a whole other field. You wouldn't go to a gynecologist that did gynecology one day a week and had some other job on the side. You really need somebody that this is their primary focus.
MB: Are there any board certifications yet that would tell you that you had this kind of doctor you're talking about? Or are we not there yet?
NF: Some doctors will promote a board certification and there is a program out there that they can go take classes and get a board certification. To date, though, that board certification has not been recognized by the AMA. So the AMA has looked at the protocols and they have not given their stamp of approval yet. They may in the future – I'm sure they are continuing to work on that. So right now, board certification is – while it does indicate that they have taken a significant amount of education, at this point we don't know specifically what that entails.
MB: What's the patient to do, other than interview the doctor and find out whether they're full-time in the business?
NF: I wish I could answer that. You know, the other thing that I will tell patients to do that aren't local to me, is I will tell them to go to a local compounding pharmacist – if they're women. Men a lot of times will use FDA-approved medications that you get through a regular pharmacy. But honestly, the pharmacists in the area know the good doctors. They really do. If you are an age management doctor and you're doing hormones, you have to be working closely with a good qualified compounding pharmacist, almost on a daily basis. And I have a lot of patients come to me from a local pharmacist because that's where they're asking questions, and I think they're a good resource.
MB: Oh, I love that strategy. That's cool. The Cenegenics Medical Institute that you're associated with, are they certifying people who have comparable credentials to yourself?
NF: Well, we do – at Cenegenics they train physicians and they are actually AMA-accredited to do training. They don't offer a board certification but they do offer a certification through Cenegenics. They train – they have to be MDs or DOs and they have to go through – they have to see patients with the doctors there and their clinical knowledge is assessed. Certainly they do testing, they do home studies, they do ongoing monthly educational seminars to maintain that certification.
MB: Do they teach the kind of individual time-intensive holistic approach that you do? Or is that more a personal choice?
NF: They do. And that's where I got my original training. I've done training from multiple different sources. But absolutely, they advocate the approach that, you know, you have to spend – to get a good idea of what's going on with a patient, you have to spend minimally two to three hours with them on the first visit, and then close follow-up is really the key to success.
MB: Is there anything else that you would like us to know about, or some hints or advice that you'd like to share with us?
NF: I think the biggest thing, for people in general, is to not stand by and expect health as a given. You do have to, in our culture today, with the dietary stresses, with the environmental stresses that our body is under, and with the epidemic of disease that is out there, you do have to be proactive and you need to take some responsibility to get well-educated on it. It will make a huge impact in your life and your family's life and your kids' life. You'll be around longer and you will enjoy life more. The biggest thing that my patients want to avoid is living to be 90 and spending the last 20-25 years being sick. And we know, with good medical evidence – this is not new things that we have made up or that there's some new product – we know, looking at good medical research, that we can prevent probably 65 to 70% of disability that you see in the elderly population, if we start early and if we're proactive and if each individual takes responsibility for their health, for eating well, for exercising. They don't need to end up in the nursing home like their parents did. They don't need to end up living with their kids because they can't live independently.
MB: My role model is the Energizer Bunny on alkaline batteries. You know, with regular batteries, they just kind of wear out gradually, but the alkalines, you get the steady energy level and then when they die, they just die.
NF: Right, they just fall over.
MB: So it just keeps going and going and going. There's a gentleman in the news, Mr. Rabinowitz, who recently, at 104, broke his 100-yard dash record at about 30 seconds, which is pretty good for 104!
NF: Oh, my goodness.
MB: And then I noticed he had a stroke a couple of months later. To me, that's a good role model.
NF: Absolutely. You know, we don't need to cure a lot of these diseases. We just need to delay them coming on. If I get cancer when I'm 94 and die from it, great, you know. But if I'm healthy until that point – you've got to die of something. My thing is that I just don't want to be sick and tired and accept this unfortunate situation that we see so many seniors in now. And I don't want us as a population to think that's how it has to be, because it doesn't. But you do have to work hard and you can't wait until you're 80 to do it. When you're 80, we can still have good impact, but you're going to do much, much better if you start when you're 30 or you're 20 or you're working on your kids to get them to eat right and to get them outside and get them moving, and ingrain that as part of their lifestyle. You're going to have much better outcomes. They're going to have a better life.
MB: Dr. Flora, I just wish we could clone you.
NF: Well, thank you.
MB: Thank you so much for being on the show. I really appreciate it and appreciate all the information you shared with us.
NF: Well, you are so welcome. It has been a pleasure.
MB: As you've probably gathered, I'm a big fan of anti-aging medicine. True, it is having its growing pains and there are people who are emphasizing profits as opposed to the kind of careful planning and individualization and holistic health that Dr. Flora talks about, but I think it is destined to become the family practice medicine of the future. And Dr. Flora is a wonderful example of what an anti-aging physician should be like and what an anti-aging physician can do. I like to wrap up programs with a baby step that hopefully will help you live longer, healthier, and happier. In the business world, we place a lot of emphasis on starting with the end in mind, being very clear about the outcome you want, and then figuring out what it takes to achieve that outcome. In our lives, it's even more important because it's our lives! And the outcome we want is to be Energizer Bunnies, at 100, 110, 120, maybe even 150, to still be going strong with a snap in our step and a sparkle in our eye – passion and enthusiasm and a zest for life. The alternative might even be a nursing home. So we need to picture in our mind's eye vividly ourselves as that Energizer Bunny and just see it so vividly and want it so badly, we're almost salivating, saying, "I've got to have that, whatever it takes. That's what I want. What do I need to do?" What do you need to do? Well, fortunately I think we got a lot of ideas today from Dr. Flora. You've been listening to Ageless Lifestyles Radio on Webtalkradio.net. Our expert guest has been Dr. Nicole Flora, an anti-aging physician who practices in the Cincinnati area. Here Cincinnati office website is http://www.cincinnatiagemanagement.com/. Her Cenegenics Institute website is http://www.cenegenics-drflora.com/. Information on anti-aging psychology and my books Defy Aging and 52 Baby Steps to Grow Young, and my free Defy Aging Newsletter is at DrBrickey.com, or you can just go to http://www.notaging.com/ and it'll take you to DrBrickey.com. This is Dr. Michael Brickey with Ageless Lifestyles Radio, wishing you a very long, healthy, happy life.
How to Prevent Diabetes
March 8, 2008
Host: Anti-Aging Psychologist Dr. Michael Brickey
Expert Guest: Steve Freed, Pharmacist and Diabetes Educator
Broadcast: 2-17-08 on webtalkradio.net where the latest shows are broadcast and posted as podcasts
One in three Americans has or will develop diabetes—and in the vast majority of cases, it could have been prevented. Today's guest expert, Steve Freed is a Registered Pharmacist and Diabetes Educator. His Diabetes in Control newsletter reaches 88,000 medical professionals. His Steps to Health program has been used by a quarter of a million diabetics. He has given thousands of seminars on diabetes, produced numerous training materials, and currently is co-producing a full-length documentary, Conquering Sugar Mountain. The first part of today's seminar will focus on how you and your loved ones can prevent getting diabetes. Part 2 will focus on new treatment options. His websites are: http://www.diabetesincontrol.com/ http://www.diabetes911.net/ and http://www.a1ctest.com/
TRANSCRIPT ©Michael Brickey–excerpts permitted with attribution
MB: This is Dr. Michael Brickey with Ageless Lifestyles Radio, cutting-edge thinking for being youthful at every age. On each program I interview experts on what it takes to live longer, healthier, and happier. Our program takes a holistic approach in addressing anti-aging psychology, medicine, alternative medicine, fitness, nutrition, and wellness. Our emphasis is on innovative thinking and practices that have solid data and results.One in three Americans has or will develop diabetes. This is absolutely tragic because in the vast majority of cases, it could be prevented. Today's guest expert, Steve Freed, is a registered pharmacist and certified diabetes educator. His Diabetes in Control Newsletter reaches 88,000 medical professionals and 1,000 more laymen. His Steps to Health Program has been used by a quarter of a million diabetics. He has given thousands of seminars, produced numerous training materials, and currently is co-producing a full-length documentary, "Conquering Sugar Mountain." The first part of today's seminar will focus on how you and your loved ones can prevent getting diabetes, and then part two will focus on new treatment options and the controversies. Steve, you are so passionate – I think you eat, sleep, and breathe diabetes education. How did you get so passionate about this?SF: I used to own my own pharmacies for over 25 years, so I had four pharmacies in the Chicago area. And I woke up one morning, put the covers over my head and said, "That's it, I'm out of here." I wasn't doing anything that I'd learned in school to become a pharmacist. I was talking to insurance companies, I was selling Beanie Babies – you know, nothing I was doing was related to the knowledge that I had. And I have a lot of diabetes in my family, Type 2 diabetes, and my grandparents on my father's side, all my uncles, all my cousins, my sister. I've seen the worst and I've seen the best. So I always was concerned that I was going to get diabetes, so I started to educate myself. And the more I got educated, the more I wanted to share that information with patients. I saw that there was a program to become a certified diabetes educator and I worked towards that, took the exam, and became a certified diabetes educator in 1995 and started working with patients, and realized that there's about 25 million people with diabetes, that I could probably personally help 24 millions, but I needed help with the last million. So we started a newsletter, myself and my partner, who's also a pharmacist and a diabetes educator, to educate the medical profession about diabetes, because there it is completely lacking.
SF: Well, it's not the doctor's responsibility, per se, to educate the patient. 95% of the care of the patient has to come from the patient. You know, they have to know what foods they can eat, they have to be able to count carbs, they have to be able to read a food label, they have to understand the numbers when they get their blood sugar results back or when they test their fingers. So 95-98% of the care of a patient with diabetes has to come from the patient, because the doctor is not with them when they're eating the wrong foods or when they're not being physically active or not checking their blood sugars. So in order for a patient to control their diabetes, they have to become educated. If they're not educated, they will fail 100% of the time. The doctors get five to fifteen minutes. It's not their responsibility. They can't get reimbursed for it. That's not their responsibility. Their responsibility is to get the patient educated. That is their responsibility. And that's where they fall down. They think they can write a prescription, give it to the patient, tell them to come back in 90 days, and it doesn't work. It fails. And we know for a fact that it fails because the average blood sugar in the United States is close to almost 300, 250 to 300 mg per deciliter, which is completely out of control. And those people will all get the complications of diabetes, but it's 100% preventable. That's why I have a passion, because with a little bit of education, when I sit down with a patient for an hour or two, I can change their lives. I will prevent them from losing their eyesight, their kidneys and their limbs, and prevent strokes and heart attacks, Alzheimer's, cancer, every disease known to man I can prevent, because we all know that diabetes is related to elevated blood sugars. We all know that Alzheimer's is related to blood sugars. We all know that dementia is related to blood sugars. Our quality of life is directly related to our blood sugars. And they just did a study that they published and they said that if you get diabetes by the time you're 50, you 're going to die 12 years early and you're going to be miserable for the last 15 years of your life. And that comes from the CDC. So I can prevent all that, just with educating my patients and getting them motivated to make lifestyle changes.
MB: Not everybody can sit down with you. To whom should the doctors be handing off the education piece to?
SF: Well, first of all, there's a lot of information out there. The problem is there's a lot of misinformation out there. I see it all the time. People – there's so much different information out that people get confused. You know, the best thing, though, that people can do is to find out where their education programs are in their area. Usually they're hospital-based, and you can call the local hospitals and see if they have a diabetes education program. You can certainly get a book and read or you can get CDs and listen. But if you don't do that, you are doomed for a miserable life.
MB: Where is the bad information?
SF: Well, I hate to say this, but the bad information – and I know that I'll get in trouble for saying this, but the bad information comes from the American Diabetes Association.
MB: What are they saying that's off?
SF: Well, what they're saying is that you should have 60% of your nutrition should come from carbohydrates. All carbohydrates turn to sugar – good, bad, complex, simple – it all turns to sugar. Anybody realizes you don't give people with diabetes who have sugar problems 60% of their diet being sugar – does that make any sense? Why do you think that the most, 90% of the people out there, or certainly at least 75% of the people out there, are out of control? Because they're eating too many carbohydrates. They don't understand it. And if they really understand diabetes, they really understand it, they're going to know that you can't eat any many carbs as they would like.
MB: What about people who don't appear to have diabetes. Is the 60% carb also a bad idea for them?
SF: Well, if you're not susceptible to diabetes, okay, and you're eating 60% carbohydrates in your diet, you're going to get fat – unless you're running five miles a day, you're going to get fat. And you know that we have an obesity epidemic in this country. You know, we said, "Don't eat fat, don't eat fat. Go on a low fat diet; it's healthy for you." Well, we did that for the last fifteen years and now everybody's fatter, so obviously that didn't work. You know, it's the carbs – the carbs turn to sugar, sugar turns to fat, and we get fatter. It's that simple. And people just don't see it. And it's a crime, too. And ADA just two weeks ago came out with a statement that low carb diets are okay. Before that, they were adamantly against it, but the studies are showing that people that are on low carb diets can control their diabetes much more effectively than eating high carb diets. It just makes so much sense.
MB: So if people are on the low carb diets, what do you want them eating instead?
SF: Well, I want them to stay away from some of the carbohydrates – the rices, the pastas, the breads, you know, all of those things that basically turn into sugar. I have a question that I ask my patients, and I say, you know, your grandmother calls you up and she says she wants to invite you over for dinner and she's making this fantastic dessert. She wants you to stop at the grocery store and pick up some sugar wafers – and they both have diabetes. So you go into the store and you see two packages of sugar wafers. One package says "sugar wafers" and that has 20 grams of sugar per serving. The other one says "sugar free sugar wafers." That has 0 grams of sugar per serving. You know, it's not a trick question. Which one would you buy for your grandparents that have diabetes? Would you buy the one with the 20 grams per serving or the one with 0 grams per serving? Which one would you think you might buy?
MB: Well, the sugar free one.
SF: And you'd be wrong. And why would you be wrong? Because you're only looking at the sugar! If you'd turn the package over and just read the label, you will see that the sugar free has more carbs than the one with sugar. So not only are you killing your grandparents, you're paying three times as much to kill them. That's where the education comes in. I get people to read food labels. You go to the store, you pick up two bottles of salad dressing. One is Caesar salad dressing, has 0 grams of carbs per serving, the other one is thousand island. And you look and it says there's 5 grams of carbs per teaspoon. Well, how many people eat one teaspoon of dressing on their salad? Most people have 3 tablespoons, so you have to multiply it by 15 times 5. So one's got 75 grams per serving and the other has 0. Well, if you just take the one that has fewer carbs, you're going to lower your blood sugars – just by doing that, just by reading a food label. You can make a difference in your life just by reading it, because you're going to make intelligent decisions, if you understand.
MB: Are there other big mistakes people are making?
SF: Well, certainly. You know, there's one thing – and we developed a whole program around it. We all know that physical activity is good for you. Every person on this planet knows physical activity prevents every disease known to man, and it keeps you healthy, it gives you energy, it improves your memory, it gives you a better sex life, it grows hair, it gets wrinkles out of your skin. Okay, it prevents colds and flus and yeast infections – everything you could thing of, you know, by increasing physical activity – we all know this. Everybody on the planet knows it but nobody does it. Figure that one out. When you go to the hospital, okay, right in front, all the front parking spaces, it says "Reserved for the Chief Surgeon." You know, your doctors, okay, don't want to walk, so they park their cars in front. If they were smart, they would put a sign up saying, "All our doctors park in the back of the lot. The front spots are for people that don't understand."
MB: Great idea.
SF: So physical activity, along with counting your carbs and understanding of good nutrition, you know, will not only have an impact if you have diabetes, but it'll have an impact for everybody – not just for people with diabetes. I tell patients, if you want to live healthy, live like a diabetic.
MB: I think you had a statistic that we've got millions and millions of Americans who have diabetes and don't even know it. How do we miss it so often?
SF: Well, 25% of the people that have actual diabetes, okay, are undiagnosed. There's another 60 million people that have the metabolic syndrome, but now we – you know, diabetes wasn't bad enough, we had to give it a new name called pre-diabetes. That's like being a little bit pregnant, okay? There's no reason for people to have that diagnosis of pre-diabetes. Why not just call it like it is? It's diabetes. The definition of diabetes used to a fasting blood sugar of 180. Then they reduced it to 140. Then they reduced it to 126. and now, instead of reducing it to 100, we came out with a new disease called pre-diabetes, and the reason we did that was pretty much because if we called it diabetes, those 60 million people, okay, that are self-employed, would lose their insurance all in one day. And if 60 million people lost their insurance in one day, it might cause a little uproar. So we gave it a new terminology called pre-diabetes. But the reason that we miss it is very simple – and I teach this to medical professionals all the time – diabetes starts out as an after-meal elevation of blood sugar. It's called postprandial. Postprandial is a two-hour blood sugar after you eat. That's when it's the highest. So you go to the doctor for a physical, like most people do, and he has you do a fasting so that he can do your triglycerides, because we have to be fasting to get our triglycerides. So you go to the doctor's office, he does a venous draw, and he sends it out to the laboratory, and it comes back that your fasting blood sugar is 85. Now, if it's under 100, it's normal. If it's 100 to 125, it's pre-diabetes. Anything over 126, it's diabetes. It comes back, it's 85. So you don't have diabetes. He doesn't even make a note of it. Okay, that same day, you go out for dinner and you have a big pasta meal with three pieces of garlic bread and a piece of cake and your blood sugars are 350. Well, the definition of diabetes, two hours after you eat, is anything over 200 is diabetes. 140 to 199 is pre-diabetes. So you've got a blood sugar of 350 – you have diabetes. Now, who knows that? The doctor didn't say you have diabetes so you're not checking your blood sugars. You won't see that 350. This goes on, time and time again. Next year, you go back to the doctor and your fasting blood sugar is 98. Well, that's still normal. He's not going to say that you have diabetes or pre-diabetes. And that same day, you go out for dinner, you have a big pasta meal, and your blood sugar's 450. Well, you have diabetes but nobody knows it. So we're not looking at where we should. Now, there is a test called the glucose tolerance test. If you're overweight, if you have diabetes in your family, they give you 75 grams of glucose in a cola. You drink it in the doctor's office, you stay there for three hours, and they check your blood sugars every 15 minutes, and you're putting as much pressure as you can on your pancreas to have it spill over. And that's how you can tell if you have diabetes, by taking the glucose tolerance test. And then there's another test called the A1C test-
MB: Okay, but most doctors aren't going to do that unless you're at high risk, though, right?
SF: Absolutely. But those people that have diabetes that are not at high risk, because the doctors – you know, they may not be that much overweight, those people are 25% of the 25 million people that are walking around with diabetes and don't have a clue, because you don't get the symptoms for years. By the time you go to the doctor and your fasting blood sugar is over the 126, when you're diagnosed and you have a fasting blood sugar over 126, you've already lost 80% of the cells that make insulin in your pancreas. Now you're running out of time. Now, if we catch it early, we can make small changes in your life and have a huge impact. But when you get it – when you're diagnosed with a fasting blood sugar over 126, you're running out of time, and that's what happens with people with diabetes.
MB: Why aren't doctors routinely doing the A1C test during annual physicals?
SF: Honestly, it all boils down to dollars and cents. You know, they're not going to do a test that they don't feel is going to give them the results they're looking for. First of all, the A1Cs are not – according to the ADA – are not recommended for diagnosis, and that' because not all A1Cs are standardized. And what I mean by that is we know that a standardized A1C is 6%, it's a single digit number which represents your blood sugars every second of the day for the last 90 days. I call it the quality of life test. That test not only determines whether you're going to live or die, that test actually represents how smart your doctor is. Because if you have an elevated A1C of above 7, certainly for a year or two, then I don't care who he is, I don't care what his title is, I don't care what his education is, okay, you change doctors immediately. Don't ask questions, just do it. Because in this day and age, with all the knowledge, with all the technology that we have, with all of the medications we have, there is no reason why anyone in the United States today should have an elevated blood sugar of above 6, and certainly I would hope not above 5, 5% A1C.
MB: When a person goes to their family doctor for that annual physical, what should they say to him to have their doctor give them an A1C test and do it correctly?
SF: Well, they should ask the doctor – if they have any diabetes in their family, okay, if they're a few pounds overweight or their cholesterols are elevated or their blood pressure is elevated, those are all symptoms – okay, tell the doctor you want him to do an A1C test. This is not an expensive test. I mean, I think the labs charge 25 bucks for it or something like that. But pretty much, that will give the doctor a good idea. So if it comes up that it's somewhere between 5.5 and 6.1, there's a good chance that you have pre-diabetes. And if it's over 6.1, there's a good that you have diabetes. Now he can do a glucose tolerance test to double-check that. But certainly, ask the doctor to do an A1C. They did a study, by the way, called the EPIC-Norfolk Study. It was done about a year and a half ago. And they took, I think it was 15,000 people, and they compared the A1Cs of those people with a 5 and those people with a 6%, so they compared 5% versus 6%, irregardless of whether they had diabetes or not. And what they discovered was those people that had a 6% A1C compared to those that had a 5, had a 28% increase in cardiovascular death. So irregardless of diabetes, it's a good cardiovascular risk test also, because if you think about it, the higher the percentage of sugar attached to the red blood cell, the stickier it is, and the stickier it is, it increases your risk for stroke and heart attack because it's clogging your blood vessels. So the A1C is also indicated in cardiovascular risk factors, whether you have diabetes or not. A normal A1C, for someone who does not have diabetes, who is in good health, who is not overweight, is 4.3 to 4.5. According to the ADA, if you have diabetes, your A1C should be below 7. According to the Endocrinology Association, it needs to be below 6.5. But to me, I tell my patients, do you want it at 6.5 or do you want it at normal?
MB: It's like, how overweight do you have to be to decide it's too much?
SF: You know, so that's another misinformation. They never talk about the normal A1Cs. The ADA says it needs to be below 7. Well – and then I ask doctors all the time, and they say, "You know, I can't even get my patients below 7. You're talking about 5, 4.5. I mean, that's crazy. I can't do that." Well, of course they can't, because their patients are not educated.
MB: Did I see where you go into businesses and have the businesses do A1C testing?
SF: We have an A1C test that we help distribute. It's an instant test. It takes five – one finger sticker in five minutes, and you get the result. So we go into offices and we do A1C testing, and we do diabetes days in pharmacies, where we'll do A1C testing and let people know. And I did a program for 150 pharmacists, oh, about a year ago. And when I got up there, I said to them, "You know, by the time tonight's over, I'm going to find two people in this room with diabetes and I'm going to find ten people that have pre-diabetes that don't know it. And what we did is we checked their blood sugars before they ate, and then I did my program, which was two hours, and we checked their blood sugars two hours afterwards, and then we checked their A1Cs. And lo and behold, we found that none of the pharmacists that were there had diabetes with an A1C, and they said, "Steve, I guess you were wrong. But we did find ten people with pre-diabetes." And I said, "No, you're not wrong. I said we were going to check everybody in this room." There were about ten Hispanic waiters, so we checked the waiters. And we found two waiters that did not know they had diabetes. Because I can pick them out – they're overweight, you know. So it's a great test to see what your risk factors are. And 75% of the people out there and the people that are listening to this, 75% of them do not know what an A1C is. And it's in their doctor's records. They have to do it if you have pre-diabetes or if you have diabetes – it's in the records. And you need to ask for, okay, because that is a life and death number. We know our driver's license, we know our license plates and our Social Security Number, which have nothing to do with our health. But the A1C number, you know, you get the result, you post on the refrigerator door, and then maybe you won't open the refrigerator as much.
MB: You mentioned Hispanics. Which ethnic groups are particularly prone to diabetes?
SF: Well, what we've discovered is Hispanics, Native Indians, Pacific Islanders, Mexican-Americans – all those people, you know, one in two will have diabetes. Any child born that's any ethnic background – African-American, all those different backgrounds – anybody who has that, one in two will have diabetes. Not one in three, one in two. And that's because we have a gene called the thrifty gene. And I've discovered that most people in those geographical regions where they lived on hot climates in the Mediterranean – we're going back 1,000, 2,000, 5,000 years ago – where they lived in warm climates. They developed darker skin to protect themselves. Those people that had light skin died out and the genes didn't pass on. So the people with darker skins were able to protect themselves from the ultraviolet rays, so they survived. But one of the other things that happened to them, they would go through periods of famine and feasting. You know, they'd kill an elephant and they'd have enough for a month, and then they wouldn't have any food for maybe two weeks at a time or a week at a time. So we developed a gene called the thrifty gene. And what that is, is that when we have food, it turns it into fat. So when we're eating all this food, it turns it into fat. And then when we go through periods of famine, that fat turns back into sugar, which gives us energy. So we developed that gene to protect ourselves so we could live and become part of the human race. What happened is that we don't go through any periods of famine anymore. I can walk out my door, walk about two blocks, and walk into a grocery store. I can go into a 7-Eleven. I mean, how far are you away from food? So obviously our bodies are not meant for it, so obviously we get fatter. And because we get fatter, we become more insulin resistant. And then when we're – insulin is a fat storage enzyme, so insulin takes our food and stores it as fat. So the fatter we get, the more insulin we have to have. So our bodies make more insulin. And the more insulin we have, the fatter we get. And that continues until something breaks. In order to stop that, you've got to break the cycle. How do you break the cycle? You don't eat as many carbohydrates.
MB: Let me take a break here. This is America's Anti-Aging Psychologist, Dr. Michael Brickey, with Ageless Lifestyles Radio, your source for cutting-edge thinking in being youthful at every age. Today's expert guest is diabetes educator Steve Freed. His website is http://www.diabetesincontrol.com/. It's packed with information for lay people and medical professionals, including information, educational materials, and the latest news and developments and controversies. And that's the source for your newsletter. You also have a website, http://www.diabetes911.net/ . What is that for?
SF: I work with a number of physicians, very well-known physicians that basically have the same philosophy that I do. And when I find physicians that have the same philosophy, I kind of promote who they are, and if they've written any books. And the philosophy that I kind of lean towards is that there's no reason why anyone should have an elevated blood sugar above normal. And if a doctor can agree with that, then we promote his works. And I work with Dr. Richard Bernstein, who is the father of blood glucose monitoring, the first person to ever use a blood glucose monitor in the United States. And he's written a couple of bestselling books, The Diabetes Solution. He's in New York, very unique story. Here is a guy that was an electrical engineer, had Type 1 diabetes and was out of control. This was before blood glucose monitors. And he found one in a magazine because he was an engineer in Germany from the Ames Company. And he wrote away, spent 750 bucks – this was back in the '60s, so this machine that – you wore it in a backpack – it was huge. It had two lead acid batteries. And he would check his blood sugars 10-15 times a day. He would measure his food, figure out how many carbs there were, how much insulin he would need, and all his complications went away. And he wrote a letter to the New England Journal of Medicine and the AMA and the ADA, and he said, "You have to let people know about this machine called the blood glucose monitor. It saved my life." And they sent him back letters – and I have copies of these letters – they said that was "the most ridiculous thing that we've ever heard, that people would check their blood sugars two or three times a day and adjust their own medication. On top of that, we're not going to print your letter because you're an electrical engineer, and we don't print letters from engineers, carpenters, and plumbers. We only print letters from doctors." So in order to get his paper published, he went back to medical school at the age of 47 and become an endocrinologist, and has written two bestselling books. That's why we promote his philosophy. Anybody who reads his book will drop their A1Cs a full point, and if they read it three times, they'll drop their A1C two points.
MB: Wonderful. So that's http://www.diabetes911.net/ ?
SF: Right. And we also developed a set of six hours of educational CDs with Dr. Bernstein and we've produced and put those out for Type 1s and for Type 2s. And you can listen to the information while you're in your car. And we guarantee that if you don't learn something new and improve your life, you've got 50 years to return them, no questions asked. I've never had anybody return them.
MB: Steve, let me back up a little bit. Could you give us a good metaphor for what diabetes is and how it works?
SF: Yeah, sure. First you have to distinguish – there's really two kinds – actually three, but we'll talk about two. There's Type 1 diabetes, which is completely different than Type 2 diabetes. Type 1 diabetes is an autoimmune disease. We usually get that at an early age where our bodies – our T-cells in our bodies attack the cells in the pancreas that make insulin and destroy them. And before 1920, before the invention of insulin, people would just die of starvation, because all of the food that they ate could not be turned into energy. Therefore, they basically – their muscles deteriorated, their organs deteriorated, and they actually died of starvation. And along comes insulin, and those people now can have normal lives, if they have their blood sugars normalized. So that's an autoimmune disease and that's really genetic – we think it is. It's partially genetic; it could be partially environmental. Type 2 diabetes – now, it used to be called adult onset because you had to be an adult to get it, but we changed the name about eight years ago to Type 2 diabetes, because kids are getting Type 2 diabetes because of obesity. Type 2 diabetes is really a lifestyle-driven disease. You know, we'll have a cure for Type 1 diabetes in a very short period of time. There's billions and billions of dollars going into it. I see all the research – we're so close, really so close. We know exactly what we're doing, we know what we've got to find, we know what we have to do, so it's just a matter of time.
MB: With the Type 1, then, is that likely to be a genetic engineering or medication, or what do you think the cure will be?
SF: Well, the cure is going to be – we know what we have to do, and what that is, that the beta cells are dying off when you have Type 1 because the T-cells, the killer cells, are killing those beta cells. So if we find a way to turn off those specific T-cells that are killing the beta cells, we now believe that those cells will regenerate themselves if they're not destroyed. So – and we also found that there's precursor cells in the liver duct that we can turn into beta cells. So there's a lot of exciting stuff going on. I mean, really exciting stuff, but that's for Type 1s, and that's great, but only 10% of the population has Type 1. 90% are the Type 2s. Now, we already have a cure for Type 2. Nobody knows it, and please don't repeat this to anyone because we're going to patent it, and it's called duct tape.
MB: Okay.
SF: Okay, you put it over your mouth so you don't eat. Okay, so Type 2 diabetes is really lifestyle-driven, which means that it has to do with your lifestyle, your physical activity, and your eating. That's pretty much what you – and you have to have it in your genes. A lot of people have it in their genes. And when you overeat and you become fat around the waist, your risk for diabetes keeps going up and up until eventually your body just can't handle all the carbs that you're eating and eventually you become diabetic. So we know if you have pre-diabetes or you have diabetes in your family, we can prevent you from ever getting it, by 99%.
MB: I was just reading in Life Extension Magazine that if we come up with a pill that raises everybody's metabolism so they can eat more without getting as heavy, that actually would be kind of a disserve because we would have these high levels of fat and be converting more and more sugar, and would just aggravate diabetes and cardiovascular problems.
SF: Yeah, there's no question about that. And let's be realistic. Any pill that does that is going to have some tremendous side effects. You know, right now we know the best therapy for diabetes is nutrition and physical activity. And insulin – that's the number one best therapy, because it's a natural hormone. Our bodies make it, so it's not something that is foreign to our bodies. But every drug that we – almost every drug that we have in the marketplace are foreign bodies. You know, they're carbon molecules that our bodies were not meant for. There's side effects and contraindications and all kinds of problems with every medication because, you know, our bodies don't produce it. It's not natural to our bodies. So you know, people have to understand, with Type 2 diabetes, you just can't go to the doctor and get a prescription and expect that's going to take care of it, because it won't. It's a progressive disease, no matter what you do, as we get older, our bodies slow down and your diabetes will always get worse if you don't stay on top of it.
MB: So when somebody has a certain level of diabetes, even if they take ideal care of themselves, is there any hope of reversing some of the damage?
SF: Absolutely. If you can get your blood sugars normalized, you can reduce the neuropathy, your eyes improve. If you have protein in your kidneys, which is a sign of kidney failure, that'll go away. It improves your memory, it improves your skin, it improves your sex life. Yeah, if you control your blood sugars in the normal ranges, what we're discovering is that the beta cells that make the insulin cannot live in an environment of high glucose. We call that glucose toxicity. And they can't survive, and they die. When we change the environment in your body to normal levels of glucose, they can come back and regenerate, is what we're discovering. So you can actually reverse diabetes. You'll always be at risk for it, but you can actually reverse it, provided, you know – as I tell people, you know, if you lose your eyesight and go blind and they come out with a cure a week later, what good is it to you? You know, so yes, absolutely, by controlling your blood sugars and being educated – because you're the one that has to do it, not the doctor – you can actually reverse most of the complications from diabetes.
MB: I know it sounds a little silly, but you know, the sticking yourself with a needle several times a day is one of the things that really makes people reluctant to monitor diabetes. Are there tests that people can do on a daily basis other than finger pricks?
SF: You know, there has been billions of dollars spent trying to find a noninvasive way to check your blood sugars, okay? And if you realize that the first blood glucose monitor, the one that Dr. Bernstein was using, used 50 microliters of blood, 50 microliters of blood to check your blood sugars. Today we use 0.3 microliters – 50 microliters to 0.3. There's no pain, if you know how to do it. You can do it on your arm, you can do it on your palm. There's absolutely very little, if any, kind of pain. The old monitors that used 50 microliters of blood, you needed a box cutter to get the amount of blood that you needed, instead of a little prick. But here's a device that can actually tell you if you've eaten too much, if you've eaten the wrong foods. There's no way to control your blood sugars on a daily basis without testing. And they've had devices, infrared devices that you stick your arm in and they tell you what your blood sugars are. They had a device once called Sugar Track where a thing on your ear, and it shines a light through the skin and it can see the color of the blood. You know, none of these things have come out pretty much. We do now – we have continuous blood glucose monitors. Those are very unique for people that are very proactive, that need to know. They have a monitor that checks your blood sugar just about every three minutes and it's wireless. You know, so technology changes about every three to six months when it comes to this. So there's really no pain involved if you know what you're doing. But you know, monitoring your blood sugars without knowing what to do when you see a reading, what good is it? You know, the average person checks their blood sugars in this country 0.6 times a day. That's less than once a day, you know – what do you expect to learn from monitoring less than once a day? You're not going to learn anything. Why even bother? You know, you need to know when you need to check and that's where the education comes in again. You know, when do I check and what do I do with that information? How can I get my blood sugars down? It all comes from the education, not from your doctor.
MB: For a person who doesn't appear to have diabetes but wants to make sure they don't get it, what kind of education do they need? What would you recommend they do, besides the A1C test, to make sure they don't get it?
SF: Well, I would suggest that they get a book on diabetes, a good book like the one Dr. Bernstein writes, on our website, that tells them about how to control your diabetes. If you read the book and you understand it, you can prevent from ever getting it, because you're going to live like a diabetic. You're going to be healthier. Isn't that the goal as we get older? I have my first grandchild – she's two years old today. Today I took her to ballet school. I had a ball! That's what life is all about. And if you have diabetes, that life is not going to be available to you. One of the things I do with my patients, I give them a blindfold, a sleeping blindfold, the kind they give you on the airlines. And I say, "I want to wear this tonight when you go to sleep, and when you get up, I want you to keep it on. Do not take it off. I want you to keep it on for 20 minutes. And I want you to shave, I want you to shower, I want you to cook, I want you to go the bathroom, even if you wet the floor. I want you to wear this thing, okay, and then I want you to take it off and I want you to call me." And the reason I do that is not to scare people. I want them to realize what they have to lose and what they have to gain by changing their nutrition. When you woke up this morning, did you look out the window and say, "Oh my God, I can see! Look at the sun, the snow, the sky. This is fantastic. I'm going to have a great day!" Or did you get up and put your shirt and pants on and go to work? So we don't appreciate what we have until we don't have it. I want people to have that image in their mind so that when they go to the refrigerator or they go out – okay, I want them to tell me that that piece of pie is worth losing that eyesight. Name me one food that you're willing to give up your eyesight for. Can you do that for me?
MB: No, not even carrot cake.
SF: Right, but that's what they're doing! I just want people to realize what they have to gain and what they have to lose, the quality of life as we get older. You know, there's people walking around in nursing homes, most of them walk around in walkers. Why do they walk around in walkers? Not because they have arthritis. They walk in walkers because they lost their muscle mass and they don't have the energy. Well, you know, physical activity can prevent that. You don't have to be in a walker or a wheelchair. These people that get the battery-operated carts they advertise on TV – okay, for sure they're going to deteriorate, if they won't even get out of the go-carts to go around the house – they won't even walk. And Medicare pays for it. You know, we don't pay for prevention. We would rather treat diseases, give people new hearts and kidneys and limbs. You know, that's the way our medicine is practiced. We don't pay for prevention. And eventually we'll have to because right now diabetes accounts for 33% of the Medicare budget. That's with about 7% of the population. What happens when that's 40% of the population? What percent of the Medicare budget will be diabetes? Well, there won't be any Medicare budget because there's no way they can pay for all those kidney dialysis machines. If you want to invest in a company, find you a company that makes these home dialysis machines, because dialysis right now is the number one payout for Medicare and it's going to explode.
MB: With your pharmacy background, are there medications that are contributing to diabetes?
SF: No, there's not medications – well, I shouldn't say that, you know. We have a pill-fixing culture. You know, if there's something wrong, there's a pill for it and we go to the doctor. When it comes to the quality of life issues and diabetes, you know, that's really not the issue. The issue is education and understanding your nutrition and physical activity. There are certain medications out there that are very beneficial for people with diabetes. You know, we've come a long way, from 1950 to '95, 50 years, we only had oral drug for diabetes. It was called the sulfonylurea. The first one was called Orinase. Now it's called Glucotrol or Micronase or Amaryl. And what that drug does is it forces your pancreas to produce more insulin. And that was the drug we had for 50 years. Well, what do you think happens to your pancreas when you keep forcing it to make more and more and more and more?
MB: Goes on strike?
SF: Yeah, it burns out. And you become a Type 1. All Type 2s eventually, if they live long enough and they're not in control, all Type 2s will turn into Type 1, because they will lose the cells that make the insulin. And it's 100% preventable. So yes, there's good medications out there. And the combination with good medications, knowing which medications are the best for you – and I educate my patients, they know about all the medications. They go to the doctor and they tell the doctor what medicine to prescribe. They don't wait for the doctor to tell them, because the doctors see them for ten, fifteen minutes. These people know which ones, according to their lifestyle, work best. And they tell the doctor pretty much what drug they should be on.
MB: Steve, I'm also fascinated with the documentary you're doing, "Conquering Sugar Mountain."
SF: Yeah, I'm working with a director and a filmmaker up in Canada. And basically he's done all the filming. He's looking for some support, financial support, and it's going to be called "Conquering Sugar Mountain." It should be out some time this spring. And basically, it's a full-length two-hour feature document – a regular film with a story, but he built in educational components into it. He talks about A1C, he talks about Dr. Bernstein, my partner is on the film talking about diabetes. So he's put educational components in it, and he hopes basically that it'll be on public broadcasting TV on a series or something like that. And we helped him – put him in touch with Dr. Bernstein, and we gave him some ideas on getting more information out there, rather than just making it a film. It's about ten kids with Type 1 diabetes that can climb Mount Kilimanjaro. And they filmed the whole sequence. And it's a great film. You know, I've seen some of the cuts. There's a lot of good information in it. And like I said, people can watch for it. It should be out some time this spring. It's called "Conquering Sugar Mountain."
MB: Sounds great. Is there anything else that you'd like to share with us?
SF: Well, certainly people should be aware. One of the things, when I talk about physical activity, we developed this program called "Know Your Healthy Steps." It's been used with 150-300,000 people in four languages, it's so successful. And what we did is we came up with this idea that because physical activity – you know, every time you move a muscle, you basically burn sugar and you burn excess sugar if you have diabetes. So we really need to come up with a treatment that builds in physical activity. So we came up with this idea of how to teach people how to use a pedometer. A pedometer is a little device – you can buy them in any store – they cost 10, 15, maybe 20 bucks – and it monitors your physical activity because it tells you how many steps you get every day. And we've discovered that people monitor their blood pressure, they monitor their cholesterol, but how do we monitor our physical activity so we can document it and see? So I can correlate your steps directly to your blood sugars. So when someone sits down with me, they talk about, "Let's get a baseline. Let's find out what your average daily total is." And then from that, we increase it gradually. And my patients are responsible for reporting back to me their daily steps every single week. And I can directly see that their blood sugars go down the more steps they take, and it goes up the less steps they take. So it's a way to monitor to see exactly what we're doing. So I teach people, during a football game, a three-hour football game – we know a football game takes one hour, four quarters, 15 minutes. What if you just got up during those other two hours, walked around in circles in front of the TV, not miss anything except the commercials on how to lose weight. You can walk five miles during a football game rather than sitting on the sofa, eating potato chips. So that's what we teach people, you know. And when you go to the store, park your car in the back of the lot. That may be 100 steps. Well, both ways it's 200 steps. Well, if you did that five days a week for ten years, that's probably over 15,000 miles. Do you think you're going to burn any calories if you walk 15,000 miles? Well, of course you will. Does it have to be in one day? No. 20 here, 30 here, 10 here, 5 here. You know, take your pajamas and bring them to your neighbor's house so you've got to walk over to your neighbor's house to get your pajamas – whatever it takes. It's a way to monitor – it's been very successful. Have you ever owned a pedometer?
MB: No.
SF: Send me your email address, I'll send you one. I like to give pedometers away because I will personally add ten years of quality of life on to your life if you read the manual which I send with it, along with the pedometer. And it's nice to be able to improve somebody's quality of life for ten years, rather than give them a business card.
MB: Wonderful. When you were talking about physical activity, if we do have a weak moment and have that big pasta dinner, should we get physical right afterwards? Would that help?
SF: Well, it doesn't really make any difference when you get physical. The point is you need to do something on a daily basis. You know, the Surgeon General says you need to be active 30 minutes a day, five days a week, and that's baloney. You know what I tell people? If you eat on any particular day, you need to be physically active and get your steps. If you don't eat, if you starve yourself for the whole day, you can sit on your butt and not do a darned thing. But if you're going to eat, you've got to be physically active. So that's seven days a week you need to be active – not five, not six, but seven days. It doesn't mean you have to walk 50 miles. It could mean that you'll only go out and walk for two miles, maybe ten minutes here, five minutes there, 30 minutes there. That's why the pedometer is so effective, because people will wear it, they'll look at it, and they'll see, "I need to get a few more steps." So when you go to your dentist and he's on the 10th floor, take the elevator to the fifth and walk five floors, okay? If you're on a bus, get off two stops early and walk. There's ways that we can find things that we don't have to change our lives to increase our physical activity. Instead of sending somebody an email that's in the office next to you, you know, print the darned thing and walk over – you'll surprise the heck out of them. You know, "Why didn't you email it to me?" "Well, I need to get my steps in." You know, little things like that. Yes, you can overcome. If you're going to cheat, if you're going to eat that piece of chocolate cake that you know you shouldn't, go ahead for it, eat it, but know that that piece of chocolate cake is going to cause you to have to walk four miles. Now did that piece of chocolate cake taste that good that you're willing to walk four miles? If it does, go for it. If it doesn't, don't eat it.
MB: So it's like putting a price tag on each of the foods we eat.
SF: Yeah, think about the foods – the bad foods that you want to eat, and say to yourself, "You want to have those french fries? Go for it, but you're going to have to walk an extra 15 minutes." Okay, I'm willing to do that, so I eat it – because if not, it's going to be turned into fat around your waist, which increases your risk for cardiovascular disease and diabetes.
MB: Steve, you're a wealth of information. Let me wrap things up here. This is America's Anti-Aging Psychologist Dr. Michael Brickey, with Ageless Lifestyles Radio, your source for cutting-edge thinking on being youthful at every age. We've been talking with diabetes educator Steve Freed. His website is http://www.diabetesincontrol.com/ where you can get the free newsletter. And he also has http://www.diabetes911.net/ which has lots of information about books and resources. And what's the website for the test?
SF: And if they're interested in doing their own A1C test at home, they can do it with a very unique monitor and it's very inexpensive. It's about $12 or $13 per test. And that is http://www.a1ctest.com/ . And it gives you all the information on how to do your own A1C test at home. So if you have diabetes or your family members are susceptible to it, you know, have everybody in your family do an A1C test. Find out what it is. Make it a contest. Give out a prize to whoever has the highest number. Make it fun.
MB: And the test kit's only about $10 or something?
SF: Well, it comes in ten tests – you have to get a ten test. And you can do it about every month, because 50% of the result comes from the last 30 days, even though it's a 90-day average. And the way that works is the blood attaches to the – the glucose attaches to the red blood cell. The red blood cell lives for about 90 days, so we measure the amount of glucose attached to the red blood cell. So that's how we do that. And a 6% is equal to about 135 mg per deciliter on your blood glucose monitor, and it goes up and down about 35 points per the single digit of the A1C, so you can compare it to your blood glucose monitor. And again, that's at A1Ctest.com.
MB: Okay. And information on Anti-Aging Psychology and my free Defy Aging Newsletter is at http://www.drbrickey.com/ or you can just go to http://www.notaging.com/ and it'll take you there. I'd love to get your feedback and comments. You can send them to firstname.lastname@example.com.
Lose Weight Without Dieting
February 24, 2008
Host: Anti-Aging Psychologist Dr. Michael Brickey
Expert Guest: Michelle May, MD
Broadcast: 1-19-08 on webtalkradio.net where the latest shows are broadcast and posted as podcasts
Dr. May knows how to get people off the yoyo diet treadmill and losing weight for good. She is a Board Certified Family Physician and author of Am I Hungry? What to Do When Diets Don't Work, and the CD Stop Dieting, Start Living. Her website is http://www.amihungry.com/
TRANSCRIPT ©Michael Brickey–excerpts permitted with attribution
MB: This is Dr. Michael Brickey with the Ageless Lifestyles Program, cutting edge thinking on being youthful at every age. Today's show: Lose Weight Without Dieting, with the Am I Hungry? physician, Dr. Michelle May. Dr. May knows how to get people off the yo-yo diet treadmill and lose weight for good. She is a board-certified family physician and author of Am I Hungry? and What to Do When Diets Don't Work. So Dr. May, how do diets often end up making us fat?
MM: Well, it's ironic. But you know, if diets were the answer, we would not have an obesity problem in America, because almost everybody that I know who's overweight has been on at least one, if not dozens, of diets. The thing is that we know that diets aren't just doomed to fail, they're doomed to backfire, because what happens is we have these primitive survival mechanisms in place, and so when our body is chronically under-fueled, it begins to set up adaptive mechanisms that will prevent it from starving to death. It somehow doesn't realize we're doing it on purpose. So when people lose weight, they begin to lose hopefully a little bit of fat. They certainly lose a lot of water, especially at the beginning of a diet, and they also lose muscle. Unfortunately, when people gain their weight back, they get back just their water and their fat. They don't get the muscle back that they lost. So a lot of people, after many years of dieting off and on, will actually have a higher body fat percentage and a lower metabolism because they've given up some of their muscle mass over the years. So that, on one physical level, causes diets to fail. And I think you've probably seen this with people you've talked to. But diets also fail psychologically and socially. It's very difficult for people to maintain the level of energy and time that it takes to weigh and measure and count and write everything down. And when we deprive ourselves of certain foods, we actually begin to crave those foods, we think about them more, we give them special value, so we want them more than we did even before the diet. And then when we give in and have them, it's hard for us to stop because we feel like, "Gosh, I've already blown it. I might as well just keep eating it. I'll get rid of it and then I won't have to deal with it tomorrow and I'll start over again." So ultimately this yo-yo thing that we see so often is really an expected outcome of deprivation, restriction, and under-fueling our bodies.
MB: So we both have a physiological program that says, "Hey, this is an emergency," and compensates for it, and psychologically we have a tough time with diets.
MM: Absolutely.
MB: One of the things that you emphasize is how oftentimes we eat for emotional reasons. How does that play into dieting and weight loss?
MM: The thing is, is that most of us have learned to use food to cope or to distract ourselves or to feel better. In fact, food actually has some physical chemical properties that make us feel a little better temporarily. Now, of course, the operative word there is temporarily, because when we use food to, for example, entertain us when we're bored or comfort us when we're sad or keep us company when we're lonely, we do feel better for a short period of time. And that's what drives us back to it again and again. But food really doesn't meet those needs very well, so those triggers, those stressors, those emotional reasons that we eat come back again and again and again, so people begin to feel somewhat powerless around food. Now, it is important to say, though, that not everybody who struggles with their weight or struggles with their eating has deep, dark psychological issues. Most of us don't. I mean, I personally had a lot of emotional type links to eating, but it was really more about trying to deal with stress, trying to deal with being very busy – you know, maybe some perfectionism, some of those kinds of things that are very common. And really, all I needed was some new skills, some new ways of taking care of myself.
MB: How much would you say the emotional needs are dealing with stress, and how much of it is "I'm depressed," "I'm lonely," "I'm anxious," and those kinds of emotional needs?
MM: Well, it's different for different people, and that's one of the keys to solving weight issues is to really start to figure out what it is for you specifically. So those of us who work in this area, our job is really to help give you the realm of possibilities and some ideas and some tools and some skills to help you deal with those, once you establish exactly what it is for you. And in fact it's interesting because, for some of the people I work with, it's really not so much emotional but it's environmental – it's a lot of this "learned" behavior. So for example, in our culture, we're fortunate – we live in an abundant food culture. We have more than we need. And so consequently, people who sell food – restaurants and packaged goods, and even sometimes grandmothers and mothers – try to sell it to us by promoting it as something that will make us feel better or something that we deserve or something that's interesting or that it's a good value. And so a lot of people that I work with, they're not just emotionally attached to food, but they've learned to use food in a way that it really gets to excess, where they eat much more than they need because that's what they've been taught.
MB: So you've gone from being a physician to being a detective and you teach other people how to be a detective, as well?
MM: Yes. I like the way that you put that, Dr. Brickey. In fact, it's really about teaching people to become their own expert. A lot of the diets that are out there now, some expert or some diet or some guideline tells you what you should and shouldn't do. But the truth is that we were all born experts in our own bodies. When we're born, we're born with the ability to indicate to our parents when we need to be fed. We cry, we fuss, and then when they feed us, we stop eating, even if there's food left in the bottle. When we're done, we're done. But over time, we unlearn that ability. So a lot of the process that I teach is about helping people recognize their own inner expert, their own ability to recognize when they need food and when they don't, and to use those other triggers, that so-called head hunger or emotional hunger, to help them figure out what else they need, so that they can take care of those needs better.
MB: Are there are a lot of people that are just so out of touch that that's really not a good way to try to lose weight again?
MM: You know, that's a great question. I think a lot of people are very disconnected from their bodies. I think that this is true not just in terms of weight, but in all sorts of ways we're very disconnected from ourselves. And so this process is amazing because it not only helps people manage their weight more effectively, but it helps them recognize their other true needs. So definitely people who struggle with their weight are likely to say things like, "But Dr. May, I'm hungry all the time!" Well, a person that's very overweight probably isn't truly hungry all the time, but they're confusing physical hunger with other reasons that they feel like eating. I'll sometimes have people that'll say, "But Dr. May, I'm never hungry!" And what they're telling me is that they're eating for so many other reasons that their body never needs to give them the cue to eat. So I don't think that there's anybody that's so disconnected that they can't relearn this. In fact, in my work – we teach workshops, and by the second week people are coming back, just amazed at how easy it is to reestablish those hunger cues and to really get in touch with their body again. The harder part, of course, is not eating even though you know you're not hungry. That's really the hard part for most of us.
MB: When you work with people, is it more getting them to take their own histories and figure it out for themselves? Or is it more clipboard and the doctor's taking the history and coming up with the diagnosis?
MM: No, it's very much about skill-building. It's much more of what I would call a coaching model. So I am only the expert in asking the right questions. The real expert is the patient or the participant in the workshop. And so what I do is I teach them how to ask themselves a series of questions so that they'll come up with the right answer. Unfortunately, a lot of people that struggle with their weight, they are moving through their lives on autopilot. They feel like eating; they put food in their mouth. They see something that looks yummy; they're eating it before they realize it. They sit down to dinner, flip on the TV, the plate is clean before the first commercial, and they don't realize it. So what I really want to do is help people become conscious or mindful or wake them up to the decisions that they're making. So it's not about being bad or good. It's about being aware of what it is that you're doing and why.
MB: Are you pairing this with relaxation training or some kind of meditation or something that slows them down in getting them living in the here and now? Or is it more focusing on just understanding their eating patterns better?
MM: No, those are great skills. For example, one of the tools that we use is called a mind/body scan. And you would probably recognize it from mindfulness training or maybe meditation training. But in essence, we'll – one of the very first steps that we take is to help people learn to slow themselves down, take a couple of really deep breaths to reconnect with their body, close their eyes, shut out the external environment, and then scan their body from head to toe: "Do I feel discomfort? Do I feel hunger? Am I tired? Is there pain? Is there a concern, a medical concern that my attention is drawn to?" And then to begin to scan their thoughts and feelings: "What am I thinking about? What am I feeling?" Not with judgment, not with the idea of, "Oh, I shouldn't eat this," or "Oh, I'm terrible for wanting to eat this." But really just seeking to understand and see what's there. So this mindfulness, this slowing down, this relaxation is a very important part of it. And it serves double-duty because, as you're well aware, a lot of the triggers for many different problems – medical problems, psychological problems – really are this inability to slow down and relax and relieve stress effectively. So it sort of serves those to help connect people so they understand why they want to eat. And at the same time it also serves as a way of calming themselves to maybe deal with some of those triggers in the first place.
MB: Is there an ideal diet or an ideal way to eat, or is it very individualized?
MM: We use an all foods fit approach, and in fact that's the approach that the American Dietetic Association takes, as well. So I'm very adamant that there are no good foods or bad foods. In the context of an overall diet, even something as empty as a Twinkie may have a place, you know-
MB: Even a dry Twinkie?
MM: Exactly. As long as people are practicing the basic principles of balance, variety, and moderation. So we want to balance our macronutrients. We want to balance our eating for pleasure with eating for health. We want to eat a variety of foods, across the food groups and even within a single food group. And we want to practice moderation in all things, not just those things like saturated fats and sugary foods, but also moderation in our exercise, in the way that we approach any food that we eat, because ultimately we can undo any specific decision by how we balance and moderate the remainder of the food that we eat that day or the next couple of days.
MB: Yeah, kind of the flipside of moderation is any time you take something to an extreme, you tend to get into problems with it.
MM: That's right, that's right. And I think that's kind of what I've been seeing going on in our culture over the last several decades. We have one extreme of overeating, eating mindlessly, eating too much, valuing quantity over quality. And then we have the supposed answer for that, which is the other extreme, which is counting and weighing and obsessing and depriving and feeling guilty. Those two extremes don't work for people. And people naturally seek balance and they seek moderation. So the moderation part will cause them to – or the balance part will cause them to swing from one direction to the other. And really, all I'm offering people is a way to find that middle ground, a way to balance eating for health with eating for pleasure, a way to understand your hunger cues so you eat what you want, but you eat it in order to meet your physiologic needs, a way to recognize what your emotional needs are, so that you have an opportunity to really meet them, instead of trying to stuff them down with chocolate cake.
MB: You talk about a lot of myths of dieting. One of them is it's a good idea to eat every three or four hours.
MM: Well, here's the thing. That myth is a myth because it's based on observation that people who don't struggle with their weight tend to eat frequent small meals. But they don't do it by checking their watch. They do it by eating when they're hungry and stopping when they're satisfied. Well, it turns out that your stomach is really only about the size of your fist, so it comfortably holds about a handful of food. So if you eat when you're hungry, when your stomach is empty, and you fill it with just about a handful of food, that's not going to last very long. So a person will get hungry again in maybe two hours, four hours, six hours, depending on how much they ate, what they ate, and how active they are. So when we take an observation about something that people do naturally and we make a rule out of it – "You have to eat every three hours" – we're not teaching people to reconnect with their own ability to do that. So what'll happen is people will come in to me, to a workshop, for example, and they'll say, "Well, I heard that I'm supposed to eat every three hours. But should I do, because I'm just not hungry at 3:00 in the afternoon? Should I eat?" Well, no. And then the flipside of that is people will say – on these diets, they'll say, "Well, whatever you do, don't let yourself get hungry." And I think what they're talking about is this problem that some people get into where they don't eat for way too long and then they're too hungry. That's not a good place to be because when we're too hungry, we're not likely to think through our choices. We're likely to eat too fast. We're not likely to feel satisfied right away and so we'll polish off more food than we really need and then we'll feel stuffed. So I think really a better rule of thumb would be to check your watch, and if it's been three hours since you've eaten, stop what you're doing for a minute and look for hunger signals. See if you're hungry. If you're not, remind yourself to check in again in a half-hour or so. But don't automatically eat just because the clock says to.
MB: Well, it's fascinating the way you're teaching people to learn to trust their bodies. What about the advice to never eat after dinner or after 7:00 pm?
MM: That's another really good one, and very, very common. And I think that that rule, that "Don't eat after 7:00" is, again, based on a logical observation. What we know is that a lot of people who struggle with their weight tend to eat late in the evening. But they're not doing it because they're hungry. They're doing it because they're sitting in front of the TV or they're bored or they're lonely or they're stressed, or this is maybe the first time all day that they've had to reward themselves – they've finally got the kids in bed, the ironing done. And so people eat after 7:00 for reasons that have nothing to do with hunger. But your metabolism doesn't shut off at 7:01, so if you were hungry at 9:00 because you ate your dinner at 4:30 or 5:00, then there would be no reason that you couldn't have a little snack. On the other hand, if you feel like eating at 9:00 and you're not hungry at all and you know you just ate dinner a couple of hours ago, then there's a pretty good chance that that desire to eat is coming from something else, and that's the kind of eating that causes the problem. So I just encourage people, rather than setting these arbitrary rules, try to figure out what your triggers are. What is it that's causing you to feel like eating, even though you know you don't really need the food right then?
MB: So if somebody found that one of their triggers is automatically eating while they're watching television, would you set up a rule that – no eating while watching TV?
MM: Well, now, that's a really great question. I would never personally tell somebody they shouldn't eat after 7:00 or you should never eat in front of the TV. But certainly people can set guidelines for themselves that work for them. So let's say that a person was consistently asking themselves if they were hungry in order to try to resolve their weight problem, and they realized that whenever they sat down in front of the TV at 8:00 to watch their show, they want to have that bag of chips right next to them, because that's what they've always done. They've created a habit. They've built a trigger for themselves. So they might say, "You know what? This habit isn't serving me very well, and instead of trying to fight it, let me see if I can change into a new habit." So, for example, I had one patient; he said that he had sat in the same place on his couch for so many years that he actually had a butt-shaped divot in the cushion. So he said he moved from that couch, where he always used to have plenty of space to lay out all of his goodies and snacks, into a recliner chair next to the couch, and he said immediately he created a new habit. There was no trigger associated with that particular new chair; in fact, for him it was symbolic of moving on and moving to a new place. So again, if a person felt that there was a particular problem for them and they wanted to create some structure or some guidelines that would help them manage that, that's perfectly appropriate. But it's not appropriate for me to tell them what to do, because then it's my rule, not theirs, and they don't own it.
MB: My math teacher would be thrilled with all the calorie-counting and point systems and how that's helping people's math skills. What do you think of it in terms of weight loss?
MM: Well, I think you've hit on a good point. A lot of us don't love math that much, and we don't have that much energy to be counting and weighing and measuring anyway. Calorie counting is an artificial external means of controlling intake. Now, don't get me wrong – weight loss is about calories in and calories out. There's no question about it. But most of us don't need to count calories. Again, we were given the gift of a natural ability to know how much our bodies need. Babies don't count calories, toddlers don't count calories, children don't count calories. And many of the thin people that you know – spouses or friends who've never struggled with their weight – don't count calories. If we can tap in again to our intuitive or instinctive ability to know how much we need, we don't need artificial means like that.
MB: What about the people that just say, "Hey, weight loss is a matter of willpower. I just need more willpower."
MM: Don't we all? And you know what? You do need a lot of willpower to follow a diet. It takes a lot of energy. It takes a lot of time. In fact, many people say it's really about "won't power" – what I won't do. And here's the thing. I want to make changes that are going to last forever. I want to help people learn to do something because it feels good, not because they're being good. So let me give you an example of this. A lot of people struggle with overeating. Whether they're hungry or not, when they sit down to eat, they eat more food than they need. And one of the things that we do, and one of the things that the book talks about, is helping people recognize that when you eat that much food, you feel very uncomfortable. So I'll have people visualize a balloon. So as you're thinking about this, visualize yourself blowing up a balloon. And as you first blow it up, it's very easy to blow up. You get to sort of a little stage where it kind of reaches that little tension. That's how full your stomach is when you've eaten about the right amount of food. But in order to blow it up big, you have to take a big deep breath and force that air in. That's what happens when you fill your stomach with more food than it needs. The walls of your stomach begin to stretch, so you being to feel uncomfortable. And then visualize that full balloon pressing on your belt buckle, pressing up on your diaphragm, pressing on your intestines, making you uncomfortable, maybe hard to breathe, maybe a little bit of heartburn. Well, what about any of that sounds good? Not very much of it. Most of us would say, "Oh, my goodness! That's not a very comfortable feeling." I remember that old antacid commercial: "I can't believe I ate the whole thing!" Well, that's a miserable way to feel. So what I teach people is, rather than trying to be good, try to feel good. Stop eating when you're totally comfortable still, when you're energetic, when you don't feel drowsy and like you need a nap, when you don't have to unbuckle your belt, when you don't feel regretful. And then remember – remind yourself that you'll eat again when you're hungry. So if the food's tasting good and you really want to have a few more biters, put it away in a container, and in a few hours when you're hungry again, pull it back out, because it's going to taste great. It doesn't taste that great at the end of eating it. At that point, you're really just eating the memory of what it tasted like at the beginning.
MB: So, noticing how you're stomach feels is just one more aspect of listening to your body and heeding what your body is telling you.
MM: Exactly.
MB: I hear a lot of people say, "Well, if I just exercise enough, the problem would be solved. I can just continue eating the way I'm eating."
MM: Well, and you know, the problem with that is that a lot of people have learned to associate exercise with punishment for eating. So they eat and then they punish themselves with the treadmill. Or they overeat, and so now they have to pay penance by going to the gym. And here it is, is this negative relationship with exercise: "I do it because I was bad." Well, nobody likes to do anything because they were bad. We want exercise to be something that makes you feel good, that you do because it gives you more energy, it helps you sleep better, it makes sex better. You certainly are more fit and more active and more vibrant and more flexible and stronger and more functioning in your life. It's not about weight. It's about how you feel. And so I really urge people to ignore those calorie-counting charts. I want people to really focus on how great it feels when I move my body, how great I feel when I eat the right amount of food, and not use exercise as a way to earn the right to eat.
MB: Is part of that having an image of what you look like and feel like when you are the weight that you want to be?
MM: I think that's true, but again, when you talk about – earlier you mentioned this idea of mindfulness and being in the present. When we are always striving for what we looked like in high school or on our wedding day, or when we're putting off living our life until we lose that 10 or 20 pounds, or 50 pounds, or 100 pounds, we're not living in the moment. And you know, honestly, this moment that we have right now is the only moment we have guarantee of. The rest of it's gone and we don't know what's going to happen in the future. So when people live in the past or postpone living their life until the future, it's going to actually make it harder for them to manage their weight. I think when people really go out and live their full live that they deserve and they're intended to, then ultimately food becomes a way of fueling that life. It doesn't become the whole reason for living that life.
MB: That's a fascinating distinction, because so much of the achievement and success literature is about, "Well, set your goal and imagine how great you're going to feel when you're a millionaire" or whatever the goal is. And this is a very different philosophy of being in the present and being very aware of what's happening. In case readers are tempted to think that, "Well, it's easy for Dr. May to say this stuff. She doesn't know what it feels like."
MM: You know, any time somebody is really passionate about something – and I hope that you're hearing my passion in my voice-
MB: Yes.
MM: When somebody is really passionate about something, it usually is because they have some personal connection, and that's certainly true for me. I struggled with yo-yo dieting from really about age 11 or 12 into my early 30s. I really – I even remember during medical school – I had just finished medical school, I was in the first all-night call of my residency at the hospital. And I remember standing in the salad bar line, filling up my plate, debating everything I was putting on there: "Should I have cheese? Dressing on the side, no sunflower seeds. Okay, more tomatoes, more cucumbers, more lettuce." And then I remember seeing the malted milk balls over in the corner. And I remember, for the first time, realizing that I could actually hear them calling my name. And at that moment I thought, you know, I am connected to food in a way that I didn't realize that other people felt. And I continued to struggle with that food. I continued to struggle with overeating and dieting and all of that for many, many years. And in my practice, I saw people over and over again, people with very serious diseases – heart disease and diabetes and cancers and other things – who really wanted to make changes in the way that they ate, but they would swing back and forth from that overeating to dieting to overeating to dieting. And I just knew that it wasn't just me that was struggling with this. The whole paradigm doesn't make sense. And in fact, there's very few things in medicine that we recommend, even though we know that they're going to fail most of the time, and there's hardly anything that we recommend that we know it's going to fail and then we blame the patient when it does. Diets don't work. We know they don't work. And it's about time for people to say, "Well, what does?" What does is learning how to use food appropriately, learning that it can be enjoyable, it should be enjoyable – we should love the food that we eat, we should love eating with other people. But we shouldn't have to obsess and think about it every hour of every day in between. So ultimately, the reason I'm so passionate about this is because it gave me a sense of freedom. It gave me an ability to enjoy food. I didn't mention this earlier, but my husband is a professional chef. My parents own restaurants. I love to eat, and I don't like having to weigh and measure and count and punish myself for it. But I also don't like overeating – I don't like how I feel. And I want to have the energy to live my life and do the other things that I enjoy in addition to eating.
MB: So it was your triumph and joy over your own eating problems that motivated you to specialize in helping others with these problems?
MM: Absolutely, absolutely. It's been such amazing work, because when people learn to slow down and listen to themselves, and when they learn that food cannot take care of all their needs, but there are other things that can, they begin to just blossom right before your very eyes. Now all the sudden food isn't controlling them. In fact, I say to people, "It's not really about being in control at all. It's about being in charge, which means making choices." And sometimes the choice is to have a couple of chocolate chip cookies – done, it's wonderful. Sometimes the choice is to say, "You know what? I need to call a friend." And whatever that choice you make, it's not about being perfect; it's about choosing to be intentional about taking care of yourself.
MB: Let me take a break here. This is America's Anti-Aging Psychologist, Dr. Michael Brickey, with the Ageless Lifestyles Radio Program. Today's guest is Lose Weight Without Dieting physician, Dr. Michelle May. You can learn about her books, workshops, and coaching programs at http://www.amihungry.com/. And her flag ship book, not surprisingly, is Am I Hungry? Information about Anti-Aging Psychology is at DrBrickey.com, or you can just go to NotAging.com and that will transfer you to DrBrickey.com. Dr. May, there are a lot of diet experts that advocate to just keep your blood sugar levels stable and everything else will fall into place. How important are blood sugar levels?
MM: Well, blood sugars are really important, because we've been talking – we've been kind of talking around this concept of hunger, so maybe this is a good time to stop for a minute and talk about what hunger really is. Hunger is your body's physical way of telling you that you need fuel, and predominantly caused by two things. It's caused by an empty stomach, so when your stomach is empty it might grumble or growl or you might get hunger pangs or it might feel empty. I almost get like a hollow feeling right in the center of my belly. On the other hand, a falling blood sugar will also give signals of hunger. And when your blood sugar is dropping, you don't have blood glucose molecules or sugar molecules for your brain and your muscles and your red blood cells to function properly, so you might begin to feel a little foggy-headed. It might be hard to make decisions. A lot of us feel irritable and kind of cranky. It might be hard at that point to think of anything but eating. In addition, people might feel a little shaky or low energy because their red blood cells are running out of glucose. So this idea that we need to keep our glucose level is right on the mark. But we can't do that unless we're connected with the symptoms that our body gives us to tell us that we need to add more fuel to our system. So just like on our car, we have this little fuel gauge, and if we're smart, we keep on eye on it so we don't run out of gas. Same thing with your body. You've got to check in with your fuel gauge periodically and see how you're feeling. When it starts to get low, you want to tank up a little bit before it hits empty. What people are doing right now, Dr. Brickey, is they're driving down the road and stopping at every gas station they see, regardless of whether their body actually needs fuel or not. So we just have to think about how we really function our best.
MB: You know, one of my pet peeves is you go to a restaurant and they bring out the bread, and they do that because it distracts them and people don't get so irritable waiting for their meal to arrive, and because you eat the bread and it gives you a spike in blood sugar and it feels good. When we're talking about blood sugar levels – I know you normally don't like rules, but do you encourage people to eat the proteins or fats first, or…?
MM: I don't – I really don't like rules and I don't like to teach people things like that. However, you're pointing out something that's really important. And you know, we often hear that people should write down everything that they eat. Well, I don't like to do that from a counting-weighing-measuring perspective, but I think it can be really helpful for somebody who's trying to figure out what's going on and how their body functions best. So let's say, for example, that I've decided that I want to take charge of my eating. I don't like the way that I feel, I don't like the way that my clothes are fitting, and I want to have more energy and I want to be healthier and improve my blood sugars. So if I decide that and I begin to log what I eat – not every calorie, not weighing and measuring, but just generally: "Okay, I ate a handful of crackers, I ate an apple, I ate a couple of pieces of hard candy" – whatever, just keep writing it down. And then I happen to notice that on that day that I went out to lunch with my friends and I ate that big, huge platter of pasta that they brought out, and then by 2:00 I was nodding off at the bridge table – very embarrassing. And I note this to my self and I realize that when I overeat these refined carbohydrates like pasta, I feel sleepy. I get this big spike. If I happen to have diabetes and I'm logging my blood sugars, too, I notice my blood sugar went way up and out of control during that time. Well, now I can say, "Look what happened when I did this." I wasn't bad. I just have now a little bit of new information that I can use to help me make decisions in the future. So the next time I go to that restaurant, I'm going to order maybe some whole wheat pasta in a half-serving, or I'm going to share it with somebody, or maybe I'm going to choose the chicken breast with the veggies and just a little side order of pasta instead. And then when I do that and I notice that I was more energetic and I felt better and my blood sugar was more level, now I say, "Ah, that worked better for me, and in the future I'm going to choose that." So again, it's not about me telling a person what to do; it's about helping them figure out what works best for them so that they can make those decisions long-term. Because, you know, I'm not going to be with you on your cruise or at your daughter's wedding, and so ultimately you have to be able to make those decisions on your own, without having to think of what I would say.
MB: So you want the primary information coming from our bodies, but it doesn't hurt to get a second opinion from sometimes logging what you eat or taking a look at some of the rules.
MM: Well, exactly. And nutrition information, and so many of us have resources and sources available to people to help educate them about the effects of food. But nutrition information should be a tool, not a weapon. We want to ultimately use that information to help us make decisions, but we don't want to beat ourselves over the head. We don't want to tell ourselves that "I can't have this," and "I can't have that," and "This is bad," and "If I eat that, I'm bad," because ultimately that only results in rebellion. These feelings of deprivation are so powerful that they will actually begin to create cravings that drive us back to eating the very thing that we didn't want to eat in the first place. So again, it's not so much about controlling ourselves around certain foods, but it's about being in charge of how we feel and how we want to feel.
MB: Being in charge is a great feeling. You say that eating right can be fun, and that's probably for a lot of people to believe. How can it be fun?
MM: It's true. People have such a love/hate relationship with food. But one of the things that I love to do – I do a lot of speaking at professional organizations and associations and corporations – and one of the things I love to do with them if I have the opportunity is a mindful eating meal. And essentially I teach them about just some of the things that we've talked about here and a lot more. And I sit down with them and we eat together, and I show them when they aren't distracted by the television or reading the newspaper, when they really smell their food and see their food and give thanks for their food, and when they choose their every single bite and they chew it carefully and notice every taste, every aroma, every seasoning as it's going down, and then choose the next bite just as carefully, noticing how their body is feeling, noticing when they're becoming satisfied and when the food isn't as flavorful anymore, which is a signal that they're not hungry, those kinds of little things will bring such an amazing sense of pleasure. One of the ways that I compare it is if you have a young grandchild and that grandchild came over to visit you and you were working on the internet and you had your back to that child and you said, "How was your day? So good to see you," and you kept typing along and not paying any attention to that child, that child wouldn't feel very loved, and you certainly wouldn't feel very connected and wouldn't enjoy that relationship. Well, food is very much the same. We need to pay full attention to get every morsel of enjoyment out of it, instead of shoveling it down while we're driving or talking on the phone or watching TV. So ultimately this idea that food can be joyful and wonderful and we can have fun and cook with other people and eat with our fingers and talk and enjoy it – that's really that healthy relationship with food. We don't want to be sitting our dinner talking about how many calories are in it or how bad we're being or how many minutes we're going to have to spend on the treadmill tomorrow, which just takes all the joy out of it, doesn't it?
MB: So you're into getting people to be very sensual about their food.
MM: That's a great word. I love that word. Maybe I'll call my next book Sensual Eating.
MB: I like it.
MM: It's a good feeling and I think food should be that way. It's intended that way, and I think it's really our current culture that has turned it into such a battle. I don't think it needs to be that way.
MB: When people are clearly obese and they say to you, "It's got to be genetic. My body just doesn't work the way everybody else's body works," what do you say to them?
MM: Well, I think there is genetic variation. Even before we had McDonald's and such readily available food and so much automation and mechanical society, there still were overweight people way back in history. So I think there is genetic variation that makes some people more prone to that. But we've seen such an epidemic that we know that there's no way that there's been a genetic drift in the last 20 or 30 years, and that's just not possible. And so clearly what's happening is we've taken people who might have a propensity for gaining weight and put them in a really abundant food environment, and then allowed them or taught them or helped them become disconnected from their eating. So I think that, rather than saying, "This is just the way I am, it's never going to change," I think a person can be in charge and say, "I might be heavier than the average person, and in fact, for now, I'm not even going to focus on my weight as the issue. I'm going to focus on eating in a way that feels better to me. I'm going to focus on eating in a way where I can really enjoy my food. I want to eat in a way that doesn't leave me feeling stuffed and uncomfortable and regretful. And I want to move my body in a way that I can function fully in my life and run with my grandchildren and go get into an airplane seat if I want to." Those are very real, tangible, exciting, fun things to think about. It's not about a number on the scale. It's about how I'm living my life right now and how I'm feeling with every decision that I make.
MB: I'm sure you have a lot of pet peeves about some of the popular diets. Which ones would you say are the worst?
MM: I'm reluctant to point fingers because, in fact, any time anybody teaches you "This is the way you must eat," it has a tendency to backfire. So even for example, what I've been talking about with hunger, some people that are listening to this are saying, "Okay, so the rule is I can only eat when I'm hungry." Well, as soon as they make that the rule, they're going to rebel against what I'm saying, too. I never said that. What I said was: Ask yourself if you're hungry when you feel like eating. Connect with your body and then make a choice. So ultimately, any time some outside expert tells you what you should do, it's very likely that there will eventually come a time when you stop doing that. So I often tell people, if what you're considering doing isn't something that you can imagine doing every single day for the rest of your life, no matter what else is going on, then don't bother doing it for a day, because as soon as you go back to what you were doing before, you will gain the weight back. That's what we've been seeing. And unfortunately, a lot of people gain back more. So I don't think one diet is worse than another one. Some of the worst ones medically or physiologically, they're so hard for people to stay on, they can't really be on them long enough to injure themselves, you know. They just can't stick to it because it's so hard, so…
MB: The "Am I Hungry?" Program is certainly one of the most comprehensive. Are there prices of some of the popular diets that get it right?
MM: Yeah, I think you're starting to see more people talking about hunger as a cue. I think a lot of even popular diets – for example, I've noticed that Weight Watchers, their big New Years push this year has been, "Stop dieting, start living." And I just have to laugh because that's actually the tagline on my website and on all my materials. So it's funny that even some of the very popular diets are using phrases about not dieting. The truth of the matter is that even Weight Watchers is a way of weighing and measuring and counting in order to come up with a point value. So I don't think that just because we call it a lifestyle change means that it's not restrictive in nature. But a lot of people can learn really good information about nutrition. A lot of the people that I've worked with, including myself, who've been on Weight Watchers lots of times, we have a lot of information about nutrition. And so I think there's something to be gained from that. It's the restriction part of it that gets people into trouble. It's the, you know, "Okay, so this food has a lot of sugar in it, therefore you have to exercise X-amount more minutes if you want to eat it," or "If you eat it, you have to eat less of something else." I mean, those kinds of things, in the long run, tend to backfire.
MB: For people that want to use physical fitness to help them become healthier and lose weight, are there some physical activities that are more helpful than others?
MM: I think really, for most of us, where we see the most benefit is when we increase from where we are to that next level. So what I mean by that is that if a person is very sedentary and not doing anything at all, and now they choose to get up and go get their own mail, maybe walk their dog around one single block, they're going to see remarkable improvements in their energy level and how they feel. So I often tell people that the place to start is exactly where you are. Instead of, again, focusing off into the future of, "Oh, I should exercise 30 to 60 minutes every day, like the government says," how about, "Look, I'm doing nothing right now. I'm going to exercise for five minutes every day this week." Well, you know what, that may not seem like very much, but it's huge. It's a 500% increase over what you were doing before. And that little door opener helps you see that it is possible to be more active. And then next week it might be seven minutes, and the week after that it might be ten. And who knows, by the end of the year maybe it is realistic to do 30 minutes. So I encourage people to start wherever they are. Now if they're really physically active and they're enjoying it and all they're doing is walking, they're going to get huge benefits by adding strength training. If people are doing walking and strength training and they're not taking the time to stretch afterwards, they're going to notice a huge improvement when they begin to take a yoga class or a stretching class. So there's always more that we can do, but the point is that you start exactly where you are and not avoid it because it's too hard or the goal is too far off in the future.
MB: I love the way your philosophy just all fits together and it's so consistent. There is a rule I want to ask you about – the business about drinking eight glasses of water a day. I've also had some very bright physicians tell me that that's not necessarily so. Is that important?
MM: You know, that's a great question, too. When we wrote Am I Hungry? I also had a dietician and a psychologist that worked on the book with me, and we didn't put anything in that book that we couldn't find researched evidence for. We looked everywhere for data and studies that showed that that was the right amount of water, and we couldn't find it. And so the truth is, is that that's been some dogma that's been passed down from year to year to year, diet to diet to diet. There really is no apparent physiologic reason to drink eight exact glasses of day. And in fact, what we know is that people who are overweight actually need more water. I live in Arizona; people who live out here need more water. People who are exercising or ill need more water, or on certain medications. So here's what I tell people. Instead of following an arbitrarily rule about how much water you should drink – any more than following an arbitrary rule about how many calories you should eat – try to connect with your body. And here's how you do it with water. Whenever you pee, stand up and look into the bowl and see what the urine looks like. If it's very dark, that usually means that your body is concentrating the fluids in your body. It means it's not getting enough fluid. When you start increasing the amount of water you drink, your urine will look lighter and more dilute. Now, the exception to that, of course, is certain medications and certain vitamins. But for people who aren't on those vitamins, that's a really handy cue for how well they're doing water-wise.
MB: So again, it's listening to your body and noticing your body instead of following arbitrary rules.
MM: Exactly.
MB: People who go on your program or other programs – I'm sure even your people sometimes blow the – what they were supposed to do, and maybe are embarrassed and just want to give up on the whole thing. What do you say to them at that point?
MM: You know, I think that every mistake that we make is a learning opportunity. Every time I screw something up – and I do it myself and I've been eating this way for a dozen years now – every time I screw something up, I learn something about myself. I learn a little bit more about what would work better for me. What got in the way? What happened today that I ate so much more than I meant to? And when I approach any situation, particularly around learning to eat healthier and be more physically active, with a sense not of judgment and failure, but a sense of learning and openness to this journey, then I can improve, I can get better. That's why earlier when we were talking about how much people eat, you didn't hear me say that I would feel guilty when I ate too much. I said you would feel regretful. Because guilt means you were bad; you did something that you shouldn't have. But regret means that you did something that you wish you hadn't. And because of that, you can take that information and learn from it and choose a different path next time. That's how we learn. That's how children learn. If children felt guilty and gave up every time they fell down as they were learning to walk, we'd all still be crawling on all fours. But we get back up, we learn from our mistakes, we brush ourselves off, and we try it again until we get it right.
MB: I like that. Now, you have CDs, you have books, you have workshops. How does a person know what is the best fit for them, or whether a book or CD would sufficient, or whether they need the whole treatment of a workshop?
MM: Oh, that's a great question. You know, we have lots of formats because, as you know, people learn differently. They learn at different paces. So somebody who's just trying to get an idea whether this is right for them might not want to spend a single dime. On our website we have a little quiz that they can take. They can actually download the first chapter of the book for free, just clicking on the links in our shopping cart. So, you know, we want people to have the information. And so I would first encourage anybody who's thinking to themselves, "You know, this makes sense for me. I've done a lot of dieting. It hasn't worked. I've always believed there could be another way." I would encourage them to just roam around on AmIHungry.com, read a few articles, download the first free chapter – don't spend a penny, just spend a little bit of your time. And if it feels right, pick up the book or maybe click on one of our workshop links. We have facilitators all over the country and we have facilitators that teach by telephone for people that don't have a facilitator near them or don't like to travel or don't like to go out of their house. And so they can take a workshop by telephone if they wanted to. So I ultimately think, just like the approach of managing your weight, just as different things work for different people, so can we learn this approach in different ways – listening, talking, reading, whatever works for you.
MB: You are so individualized about everything you do. Is there any last piece of advice or comments you'd like to share with us?
MM: Yes. I would say that you are never too old to take care of what's happening in your life. If something hasn't been working for decades and decades, that's all the more reason to try something different. Don't try the same old thing over and over again, expecting it to turn out different. It's time to really say, "Is it possible that I could go back to learning how to eat instinctively again? Can I learn how to take care of my body and listen to my body and trust what it's telling me? And can I restore a joyful relationship with food and physical activity that serves me well?" I think it's possible. I've seen it happen hundreds and hundreds of times. And I hope that your listeners are learners and people that want to make changes, because ultimately it's only when we do the same thing over and over again that we get stuck.
MB: Dr. Michelle May, you are a jewel. The program you developed is just so beautifully consistent and common sense and is just such a great philosophy – as a matter of fact, a philosophy that could spill over into a lot of other aspects of life.
MM: Oh, I agree with you completely. That's the joy of it. You see it showing up all over the place.
MB: This is America's Anti-Aging Psychologist, Dr. Michael Brickey, with the Ageless Lifestyles Radio Program, and today's guest is Am I Hungry? doctor, Dr. Michelle May, and you can learn about her books, workshops, and coaching programs at http://www.amihungry.com/. Her flagship book is Am I Hungry? And information on Anti-Aging Psychology is at DrBricky.com, or you can just go to www.NotAging.com.