More Lifestyle Medicine & less Medication!

People visit doctors when they are unwell. This means they are likely to be ‘treated’, usually with medication. This also means they are followed up, given strict instructions such as how to take the medicines, when and with what, what to do during the course of the illness (rest, drink fluids) and so on. And then…. they hope to be ‘cured’.

End of story!

So what happens when they are not “ill”?

Mostly they go about their merry way, eating and drinking as they please, or worse, eating some latest ‘fad diet’ that promises incredible weight loss in ridiculously short periods of time. Or, they choose a really easy way out by buying into fat loss aids and unnecessary supplements. They refrain from regular exercise, rarely meditate and live on a prayer that their bodies will somehow continue to support their decadent lifestyles. Unfortunately, that’s just what it is, a Prayer.

Today we see more and more diseases that are related directly to how we lead our day-to-day lives. What we eat, how much we eat or drink, how physically and mentally active we are and if we exercise, practice relaxation and safe sex. If we take time out to nurture ourselves. If we are mindful and avoid substance abuse. All the above have a close, inextricable relationship with our Quality of life.

 I am not even referring to being just ‘thin’ or of a certain weight. In fact, I am not referring to weight on the scale at all. I am talking about being healthy and well enough to be able to do what we would really love to in life. To travel, work, play, to be creative, be special and see our kids grow.

All that is required to change a person’s course of health, be it improvement in a disease status, weight loss or simply her Quality of life is a change in ‘lifestyle’. Not medication, surgery or any other invasive intervention, but a genuine change in habits.

For instance, a woman with back pain, weight gain, difficulty in conceiving and low mood will benefit greatly from a ‘prescription’ of regular exercise and appropriate nutrition to strengthen the back as well as to lose weight. Instead, she is often put on painkillers, told to rest, with antidepressants added for good measure. She may be advised surgery. Or, she may be prescribed physiotherapy and passive assisted exercises, heat therapy, ultrasound, hot packs and other methods that provide temporary relief but are certainly not long-lasting remedies.

The patient is usually quite thrilled with this mode of management. This essentially means she is ‘ill’ and the whole wretched situation is quite out of her control. She can therefore safely assign responsibility to another, such as a person of medicine, to take care of her health. In fact, if she were told to come in for a review after six weeks of just a change in lifestyle with the incorporation of a simple strength training routine and a balanced, more sensible diet, she will probably never return. What sort of doctor doesn’t prescribe pills?

The truth however is that several of the diseases we see today benefit far more from lifestyle interventional change and rehabilitation than from drugs. The change has to be well orchestrated. If you are not guided properly, especially in the initial stages of a ‘change in lifestyle’, much could go terribly wrong such as injury and or nutritional deficiencies. If you don’t have a supportive environment to make that change, it is going to be a steep uphill climb for an already difficult task.

 

Change has to be Slight, Significant and Sustainable.

Slight so your body does not protest violently and doesn’t see it as a threat to its very existence. For example – A 20-30 minute walk every day to begin with for an inactive person or, cutting down portion size gradually for someone used to consuming large quantities.

Significant enough for the human body to be forced to make the necessary internal adaptations to the change. An overweight individual who has never exercised will benefit even from a slow a5 minute walk. A fairly fit, young person will need to be pushed harder to for her body to register change.

Sustainable in clever ways so results are long lasting. If for instance you are told to eat a diet that leaves you hungry and irritable half the time, the likelihood of you being unable to follow through is very high. If you are made to exercise so hard on your first attempt that your body goes into minor shock, it’s likely you will begin to detest exercise.

The problem with most attempts at exercise or healthy eating is that they are seen as closed ended methods of management. They are viewed like a prescription for, lets say, Antibiotics – to be taken for an X number of days at a stipulated time and dosage and then stopped. This may work for an acute illness. Lifestyle diseases unfortunately, cannot be managed this way. The ‘prescription’ for lifestyle management is on-going, for life! The actual methods used to stay fit may be altered with age and time, but they still need to be in place to keep us agile, strong and fit along with being disease free.

Medication, surgery, intervention are absolutely necessary. But not all the time! Being an Obstetrician, I intervene everyday to ensure the safety of the mother and child at childbirth. At times one has to step in with the necessary armamentarium available to us in modern medicine. I do believe however that a healthy dose of “lifestyle Medicine” will go a long way in not just enabling one to be disease free for as long as possible, but in improving Quality of life. DSC02573 

Taking Responsibility, Staying Accountable

I have seen too many women fall prey to clever marketing and advertising that promise the perfect body. That’s what sells. Of course, we contribute to this walk down fantasy lane too. We choose to take the easy way out and not question these miracle claims. We make excuses for ourselves and play the victim, thereby relinquishing control of our bodies and health.

I believe we need to be more proactive about choices that concern our bodies. We need to be more discerning about long-term health, not just short-term cosmetic results. We should protect ourselves from falling prey to societal pressure to ‘look’ a certain way. It is not always possible to get to a ‘certain size’. Much depends on genetics and environment, especially lifestyle, stress, work and so on. Comparing oneself with another who is perceived to be ‘beautiful’ or ‘slim’ is a futile exercise.

Every woman is beautiful in her own way. She can also be the best possible version of herself physically and mentally by applying some basic principles of diet, exercise and healthy living. By challenging herself intellectually and creatively, she can live a fuller and more fruitful life.

We are more likely than men to allow emotional challenges to affect our eating, weight and health. Crisis in relationships or work can lead to abuse of food and ultimately, the body. Binge eating, anorexia, bulimia are all psychological disorders with a foundation in lack of self-esteem and a troubled consciousness. We are also more concerned about how society views our physical appearance. This always translates into trying to ‘look’ a certain way.

We need to understand that we are truly more than our ‘weight on the scale’. We cannot evaluate our entire lives by a mere number. Being fit is not just about being a certain size, but an improved level of performance of the body and a superior quality life. It is the understanding of this journey that keeps us experimenting, progressing and enjoying the process enough to persist with it for as long as we can. Regular exercise and healthy eating becomes a way of life, so much a part of our day that it is no more an ordeal. It is our way of saluting our bodies. Of respecting it. Rewarding it for being there for us!

We should also love our bodies more (whatever the size or shape). We can love it and still want to get fitter and better. We need to stop abusing it with food or lack of exercise. To accept, deep within that we are already beautiful but can always become even better versions of ourselves.

From “Gain To Lose”

Twitter – @drsheelanambiar

Facebook – https://www.facebook.com/tfl.trainingforlife/

 

Choosing our influences well.

From the time we are born until we die most of us are surrounded by stimuli. Be it parents, peers, colleagues, friends, relatives, neighbours or employers, we are always within a circle of influence. Early in life it may not be possible to choose who we spend time with, for how long and at what level. We can hardly choose our parents or where we were born for instance. We have no control over siblings or relatives. Teachers in school are a given. However as we grow, we learn to recognise that we can actually choose the people we associate with and who therefore influence us.

If we are lucky, we may have more than one mother! By this what I mean is that older women of influence may come into our lives. It may be an aunt, grandmother, friend’s mother and so on. I was very lucky to be associated with some very strong women from a very young age. The alpha-women in my youth probably shaped a large part of what I am today. What I took away from each of them is special and selective. My relationship with them has also changed as I age as equations transform and the connection needs to be re-defined.

One may for instance admire and appreciate the kindness or large heartedness of a maternal aunt or the driven passion of a friend’s mother. We can imbibe both if we so wish to. We can actually choose our influences.

Friends tend to be a significant influence in most peoples lives. Choosing ones friends carefully is crucial. With time, we may even need to step back from certain relationships as we come to terms with their fruitlessness. We’ve all been there. We recognise that a certain relationship is not good for us and may struggle for a while contemplating what to do. This does not necessarily mean one is being heartless. We must do what is best for ourselves and also what brings out the best in our own personality (and surely better for the other as well).

Draining, toxic relationships are not constructive. There’s really no time to waste in this short life on such angst. We have to find better use for our time & energy

We do not move through the world alone. Being aware of things & people we allow into our lives is important. It’s a mark of wisdom to choose to spend time in those places that inspire & energise us and associate with those people that uplift us. Whether at work or in our personal lives these positive influences will inspire us to be our greatest selves and lead our largest lives.

Here’s what I believe – If we seek and receive empowerment from another, we have to “give” in return. This may not necessarily be related to that very person, but, I think we have to complete the circle of giving! That’s the law of nature. We may choose to inspire, support or benefit someone else. The opportunity will always present itself. We just need to be open to it.

 

Dr. Sheela Nambiar MD. Obgyn

Fitness & Lifestyle Consultant NAFC (USA)

Author – Get Size Wise, Gain To Lose

 

 

Are you endangering yourself with your workout?

Is your workout working for you?Or are you doing yourself more harm than good with it?

The fitness industry has no doubt undergone revolutionary changes over the last decade in our country. The appearance of gyms in every street, the availability of jobs for trainers, fitness managers, physiotherapists and so on has created an increasing awareness about the need of the hour. The easy accessibility of a fitness facility for most people particularly in the cities has encouraged them to start exercising, or so I would like to believe!
Are the Gyms keeping pace with advancement in science and training techniques? Are trainers qualified enough to make informed choices about the exercises they choose for you? Are gyms offering the right kind of training or could these very exercises be harming you?

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“One size does not fit all” is an axiom that holds good for fitness training as for everything else in life. Each individual has to have a specific goal in mind and train accordingly taking into consideration age, gender, medical history, lifestyle, fitness level, time available for fitness and a host of other variables.
Training – There are hundreds of exercises that are demonstrable, but do you need to try all of them? Which ones are safe? Which ones are required? Which ones are relevant? How does one make that choice? Ideally, a trainer should be able to. I am not sure all of them do however. Sometimes, clients are made to go through unnecessary even damaging exercises in the hope of producing quicker results. The consequences are faced by the client. Sometimes injury or even over-training.
Most often, we find the repercussions of incorrect and inappropriate exercises do not become evident immediately. It may be years before your knees show wear and tear after incorrect squatting or running technique. This is not to say one has to avoid performing these exercises altogether. What it means is that before trying these potentially injury causing moves, training specific muscle groups involved and strengthening them and while executing these moves, watchful training, correction and advice as to how to prevent injury is required from your trainer.
Some clients need to be trained even to walk or run correctly. One would imagine that walking and running comes naturally to us humans. Apparently not! This is especially so of those individuals who have never participated in any kind of physical activity in their childhood or youth. The muscles seem to have forgotten how to function optimally. As a result, they tend to injure themselves even with the simplest of exercises. They need extra care and a vigilant approach to training to prevent such injuries and further set-back.
– If you are new to weight training, ensure you are taught all the basic exercises by a qualified professional before moving on to the more advanced ones.
– Request assistance whenever required.
– If something does not feel right, stop. In your anxiety to see quick results, don’t be lured into gimmicks and unhealthy strategies.
– Ask questions. It’s your body, you need to understand exactly which muscle you are working. Understand how to execute the exercise perfectly and how you could possibly do it wrong.
(For instance, the Squat is a wonderful exercise to tone, shape and build the lower body. There are several ways one could do it wrong however, particularly if one has weak thigh muscles. A tall person will have difficulty in performing the squat while keeping the ‘knees behind the toes’ (as s the traditional instruction for a squat) due to his anatomical variation. Being tall raises the center of gravity and increases the length of his levers (the legs, in this case). This tends to cause the knees to travel beyond the toes and the body to tilt forward to compensate for balance and an attempt to lower the center of gravity while performing the squat. How do you circumvent this problem? The solution is multifold. Besides constant supervision to ensure correct form, it is important to first strengthen the leg muscles in isolation before attempting an exercise like the Squat. Performing selective quadriceps, hamstring and gluteus muscle strengthening exercising before incorporating a compound exercise like the squat will prevent injury to the knee-joint.
The add-ons – Massage, sauna and steam do not help you reduce fat! If fat loss is your goal, work hard, include cardio and weight training into your routine and watch your diet. Lying around, being massaged may be wonderfully relaxing but it certainly does nothing for your fat however tempting it may be to believe so.
Diet – You need to include a well-balanced, nutritious diet to get the best benefits from your fitness routine. Extreme low-calorie diets are not sustainable and often have adverse effects. The fat will come back as soon as you start consuming more calories. You need to understand food from a holistic perspective and how to eat as a lifestyle not as a temporary weight loss strategy. You don’t need someone planning out menus for you. What you need is to understand food and implement your own choices.
Supplements and fat burners – What’s wrong with healthy wholesome food? Protein supplements are almost the norm in every gym these days. Get a nutritional analysis done to ascertain how much protein you actually consume and only if insufficient, and you are unable to include protein from natural foods should you supplement protein powders. A recreational exerciser definitely does not need it. Understand how to include various protein and fat options in your diet. Consuming protein powders does not directly translate as an increase in muscle mass. Sensible training is what does. Creatine, glutathione and other isolated amino acids have been widely propagated. Long-term safety has not been confirmed. Randomly taking supplements and fat burners does more harm to your health or fitness. Besides, they are expensive. Investing in healthy holistic food is a more sensible option especially when one thinks of it as a “lifestyle”.

A Change In Attitude

So you want to lose weight. Half the world does. Obesity is a worldwide epidemic so it’s only natural that every second person you meet is keenly seeking the holy grail of weight loss. Dinner conversations invariably return to feelings of guilt over indulgences. The Internet is flooded with clever advertising to lure vulnerable individuals into buying some product or the other with the promise of ‘losing ten kilos in ten days’ or similar fantastic claims.
You may not be thrilled with your body right now, in fact, you may view it with a good deal of distaste. Let’s ask ourselves a question, how did we get this way? How did we pile on the pounds? Where is that slender teenager? No doubt there are some who struggle with obesity all their lives. Over weight as children and teenagers, they are often faced with ridicule and marginalized. A large percentage of the population however, grows obese with age. A certain amount of weight gain with age is acceptable. But to become obese and as a result develop various obesity related complications like pain and discomfort, diabetes, heart disease, anxiety, depression, indigestion and so on, is not.
Take stock of your lifestyle.
– Are you physically active all day or does your job entail a lot of sitting behind a desk?
– Do you exercise regularly?
– Do you stay home and watch a lot of television and do little physical labor?
– Do you deal with an inordinate amount of stress? More importantly, are you one of those people who does not handle stress well? Do you develop acidity, anxiety or insomnia as a result of your stress? Do your work and relationships suffer? Do you become an insufferable boss or mother?
– Do you go on eating or drinking binges?
– Do you starve yourself often with the hope of losing weight only to go back to binge eating?
– Do you get enough sleep? (Six to eight hours a night of uninterrupted sleep is recommended.)
– Do you eat well-balanced meals with plenty of vegetables, fruit nuts, protein and healthy fats or are you loading up on the bread/cereal group (rice, rotis, bread, etc.), refined, processed, packaged food with additives and sugars out of packets as is common and convenient?
– Do you eat home cooked meals or depend on canteens and hotels and takeaways?
– Do you travel a lot, subjecting yourself to different time zones, food, lack of sleep and stress?
– Does your life involve a lot of socializing with indiscriminate eating and drinking?
– Are you addicted to sugar and need to eat something sweet ever so often?
The list of poor lifestyle habits is endless. These are some of the reasons you could be steadily gaining weight. Each problem has to be addressed independently with a combination of life skills, dietary advise and regular exercise. There is no way around it. Whatever the reason for the weight gain, the solution is to eat better, exercise and change your lifestyle.
Here’s the problem – most people think an hour of exercise alone will solve everything. It takes more than that, although that’s a good place to start. Your lifestyle (as shown above) is important. What you do for the rest of the twenty-three hours counts far more than one hour of working out. This means change. A change in attitude towards your lifestyle and not just one aspect of it.
A new mind set and not just a new menu is what is required.
The real secret to losing weight and more importantly, keeping it off is your attitude. The ability to look at your lifestyle with a certain amount of objectivity and a critical eye and then take the necessary steps to change what needs to change. The ability to get the necessary professional help when required. It’s not easy to change a whole lifestyle. There are other people involved – family, friends, colleagues and boss who are probably helping you preserve the current lifestyle. Change may involve others and this is not always welcome. For change to be sustainable however, it has to be holistic.
Adopt a slow and steady approach. Help your body and mind gradually learn to eat better, exercise more, live healthier, sleep earlier, relax and breathe. Most importantly, learn to appreciate yourself and your efforts. Learn to respect yourself and your body.
Dr. Sheela Nambiar MD Obgyn
Fitness & Lifestyle Consultant, NAFC
Author – Get Size Wise & Gain To Lose (Published by Rupa)

Growing With Your Fitness Routine.

When I was younger, I loved cardio. You might say I was the archetypal ‘cardio queen’. Anything to get the heart racing. I walked, ran, cycled, did floor aerobics, stepper, kick-boxing etc. Weight training didn’t feature and I did yoga because I had learnt it as a child and wanted to keep up the rhythm. Not because I enjoyed it.

With age (and hopefully wisdom!), the body yearns for something else. Yes, the cardio is still definitely a part of my routine. But, I don’t spend as much time on it now. Instead, weight training and yoga have become essential.

You feel stronger, more in tune with your physical self , more limber. You also feel calmer More in control. More accepting. Your changing body requires it. Weight training for strength and muscle mass and Yoga for flexibility, increased body awareness and calmness seem somehow right to focus on. This is not as if to say one should not train with weights or do Yoga while younger, its great if one does. It’s just that, t becomes more urgent with age.

Yes, weight gain is a dreaded side-effect of ageing! I was never slim as a teenager, (in fact, I was told I was ‘pleasantly plump’), but I was athletic, loved sport and running. Staying physically active later and then growing to imbibe fitness as part of my medical profession has made it easier for me to stay fit. Making time, or having the motivation for fitness is not an issue for me. Not everyone is so fortunate. They struggle with time and motivation. To them I say, there’s nothing as important as ‘feeling good’ about yourself. Exercise, with it’s discipline, sacrifices, the growth, empowerment and energy is the best thing you can invest it. One hour in twenty-four is not asking for much. It is one of the most satisfying hours one will experience. I find those who have grown up being physically active, and/or come from a physically active family, usually find it easier to incorporate it into their lives even after a hiatus. However, even if you don’t have these advantages, it’s never too late to start exercising at any age. Celebrate our body! It’s the only place you have to live in!

My second book

GAIN TO LOSE

An Essential Guide to Losing Fat by Gaining Muscle

that’s the title..and …. It’s dedicated to …

All the women I have treated, taught, trained and counselled  who have allowed me an insight into their lives. 

So…I am done with my second book. I mean, I was ‘done’ in January this year. I excitedly sent in the manuscript to my publisher, very pleased with myself. Four weeks ago I got the edited version. My anxiety levels skyrocketed as I saw the zillion coloured ‘correction’ text boxes that I was supposed to go through. It was arduous and quite frankly, killing. I could not believe there wet so many “mistakes”. Anyway, I slowly went cross eyed as I scanned  every word labourously and made several more corrections of my own. 

Last week I received the PDF of the typeset version of my text. There are more errors!! How is that even possible? I feel frantic with worry. It seems like there is no end to this.

Apparently the brain auto corrects as we read. So I am reading – ‘Muscle is very important tissue that is critical for ones functionality’. When actually I have written – ‘Music is very important tissue that is critical for functionality’. Interesting! And mind you, I have read that sentence several hundred times!!

I am so very grateful to my editor. She is a gorgeous girl, very patient with my never ending queries and suggestions. My copy editor was very thorough with the first edit too. He has even gone through every single reference I have quoted and quizzed me on the article, author, journal and so on. This made me review everything again. But apparently, he was not thorough enough with the text as there were several other, different kind of  errors that I am discovering as I go through the PDF.

So we go back and forth. More corrections.  More editing.

Wish me luck. It’s going to be many more long sleepless nights of reading, re-reading & re-writing. If there are errors in the final text, well, what can I say ? We did our best and will keep improving in the next editions.  I have to remember that the ‘Afterword‘ in my book is called

Wabi Sabi

Nothing is perfect, Nothing is permanent and Nothing is finished………… 

Listening to your body

“Eat well now because you won’t get anything till lunch time” I overheard a mother tell her 10-year-old who was insisting she was ‘full’ after eating just a little something for breakfast. The little one had been lazing around, not too much of physical activity so clearly, she wasn’t too hungry. I don’t think they had to fear a shortage of food in the near future and the little girl could easily choose to have a snack/ fruit a little later if she was truly hungry. The mother however was concerned that she hadn’t eaten ‘enough’.

These are some of the confusing messages we are inundated with as children. We are told we have to eat, we are told when to eat and often how much to eat. Children are force-fed at an early age. They are often given ‘treats’ to keep them quiet or entertained. As a result – we stop ‘listening’ to our own bodies, disregarding signals of fullness & hunger because we believe we ‘have to eat’ way beyond what we really require. We are taught to disregard such valuable indicators from our body as feelings of fullness, discomfort, thirst as opposed to hunger, fatigue, sleepiness, anxiety and so on. Over time the body stops recognizing these signs for what they are and we struggle with an endless loop of overeating, lack of physical exercise, pills to sort out anything from indigestion to anxiety and a constant struggle with our weight.

 ‘Listening to our bodies’ is a skill that seems to be lost to us as adults. Our physical and emotional selves are inherently very clever, telling us when we need to stop eating (we feel uncomfortably full), move more (we feel lethargic, full, bloated) or low on energy (we may be eating unhealthy, eating too little, or too much, exercising too much, sleeping too little and so on). This skill needs to be nurtured from an early age.

It’s not easy! Children can be fussy eaters, throw tantrums and so on. It’s a fine line between allowing a child to gauge her own hunger levels and stop eating when she needs to and allowing her to run wild, disregarding food on a whim. I don’t suppose parenting was meant to be easy!

How often have we told our kids, ‘Behave well and you will get a chocolate/ pizza/ burger?’ Food has always been used as a form of emotional blackmail and persuading tactic. The result? As adults we tend to seek comfort in food. We see food as our safety blanket and turn to it in times of stress, boredom, low mood and anxiety. We use it for more than just mitigating hunger.

 Take a buffet for instance. How many of us can actually walk away from a buffet table feeling comfortable? How many of us wish later we had stopped just before than last piece of quiche or pudding? Our bodies do indicate to us when we have had enough, but we blithely eat ‘just a little more’, ‘just to taste’ something different or new. Children are encouraged to ‘try everything’ as we pile our plates astonishingly high and totter to and from the buffet table.

Problem occurs when this kind of behavior becomes a habit. When we continue to eat ‘just a little more’ on a regular basis as our senses get blunted to our real needs. When we tell our children that they ‘have to eat now’, almost indicating that food will run out shortly.

Survival strategies –

  • Eat mind fully. Be fully aware of what you are putting on your plate and in your mouth.
  • One of the ways of preventing weight gain is to stop eating when you are just 80% full and leave the table. You can always snack later if absolutely necessary. You don’t have to undo your jeans button in order to feel you have eaten well.
  • Serve yourself on a smaller plate. You will feel like you have a lot more food on it!
  • Don’t eat in front of the TV or when distracted. You don’t register what you are eating.
  • Make mealtimes pleasant and social with the family/friends when possible and keep it about having interesting conversation just as much as eating.
  • If you are done with your meal, get up from the table and walk away. Sitting around will tempt you to serve yourself more.
  • Stop telling yourself you are eating to please someone else. Whether it is your host, mother or in-laws, they cannot tell if you are full. Only you can ascertain that.
  • You will also need to be educated and teach children about food groups, proteins, carbs fats and micronutrients so you and they can make informed choices about food. That is more important than encouraging children to just ‘eat well’.
  • Be careful what you tell your kids. It’s the programming at an early age that leads to difficulties with weight, food & body image later on.

Dr Sheela Nambiar MD, Obgyn

Fitness & Lifestyle Consultant NAFC

Author – “Get Size Wise”