Archive for the ‘Weight Management’ Category

Part Five – Brain Transmitters and Food Craving – The Role of Addiction in Weight Control

“Keep things as simple as possible not simpler”     – Albert Einstein

This isn’t rocket science but it is a little complicated. To really understand craving and other issues regarding eating and weight control you have to have a sense of how the brain works. Serotonin is one of the neurotransmitters that enables brain cells to communicate with one another. Brain transmitters are mostly made from amino acids (building blocks of protein). Some of them the body can make but some have to come from the proteins that we eat – another reason that our diets need to include adequate healthy protein.  In response to stimulation nerve cells release various transmitters. These transmitter are like keys that cross the synapses, spaces between nerves and other cells, which plug into receptors, like locks on other brain cells. Sometimes transmitters activate other cells.  While other times they plug up plug up the receptors preventing other transmitters from activating them.  

Serotonin, the oldest and most primitive brain transmitter, is found in single cell organisms. If you recall Maslow’s Hierarchy of Needs and Motivation, you know that the first level is our basic biologic needs. Of these biologic needs, air is the most urgent need, but water and food come in second and thrid.  Produced in the brain stem, serotonin’s primary responsibilities include maintaining homeostasis, or balance, of temperature, blood sugar and many physiologic systems. Serotonin raises when blood sugar increases, and this increase in serotonin stimulates satiety receptors and decreases craving for carbohydrates. Conversely, low serotonin or low serotonin activity due to certain medications working certain receptors leads to carbohydrate, or sugar, craving.  Don’t get between someone with carb cravings and sweets.  It’s dangerous, because the next level up on Maslow’s hierarchy has to do with safety and interaction with our environment.

Another neurotransmitter, norepinephrine (Noradrenaline) releases when changes occur, especially dangers in the environment. Norepinephrine activates our Cortisol stress system muscles for “fight or flight” while releasing adrenaline in the body. This has to do with avoiding danger and basic survival.  Adrenaline causes us to dump sugar from the liver into our blood stream, because sugar provides emergency fuel for muscle activity and is the only fuel for brain cells.  Muscles burn fat and carbohydrate (sugar), but the brain can only burn carbohydrate (sugar).  Norepinephrine increases arousal while decreasing appetite and libido, so it is not surprising that some appetite suppressants work by increasing norpinephrine levels.

Once our basic biological needs are met, and we feel safe, the next level up on Maslow’s Hierarchy is well being.  The next brain transmitter, dopamine drives us to pursue well being.  Every addictive substance increases dopamine.  Dopamine should not be confused with endorphins, which make up the pleasure system, but dopamine activates us and enables us to pursue the things that provide the feelings of pleasure and well being.  Experiments with male dogs found that their first experience with female dogs in heat or their first T-bone steak didn’t release dopamine but did stimulate the endorphin system. The next time they were given a T-bone steak or a female in heat, their dopamine release was off the chart. In other words, Mother Nature provided a brain system that learns where fun and well being are driving us to pursue this pleasure when future opportunity arises.  In another experiment, male rats had all their brain dopamine depleted. They were then given female rats in heat and an All-the-Cheese-You-Can-Eat buffet.  The rats acted completely normal, though, making passes at the females and chowing down on cheese. This meant dopamine wasn’t necessary to enjoy something pleasurable that’s put in your lap.  However, when a barrier was put up separating the food and females on one side and the males on the other,  the rats without the dopamine said, "Screw it, I can’t do it," and the normal rats with dopamine went right over the wall.  

Addiction is a process where the brain is hijacked by some substance(s) or activity and the individual loses control (dyscontrol).

The other primary symptom of addiction is denial to self and/or others.  A book title on alcoholism tells you everything you need to know about addiction: I’ll Quit Tomorrow. Other books, The Selfish Brain and The Craving Brain also paint the picture. The need for well being and the pursuit of pleasure can drive us to love and creativity or lead us down a path of self destruction. Losing a patient to an addiction is a painful and sobering experience. Mother Nature wants us to do things that are pleasurable like eat and have sex.  Though, not necessarily in that order and the survival of the human race depends upon these activities.  

People with ADHD need more stimulation, because their dopamine systems are not as naturally reactive.  People with addictions are low in dopamine in the area of the brain that is activated during pleasurable pursuits, the Nucleus Accumbens. One of the technological advances in the past decade enables us to look at not just brain structure but brain activity. Functional MRI’s are being used more often now because they don’t require radioactive material to be injected. PET scans using radioactive glucose were previously the most useful. Compare the PET scans of a normal individual on a normal day. Notice the dramatic difference between the normal brain and a chronic cocaine user. The cocaine user’s brain is like the rats with their dopamine systems depleted. They are useless unless pleasurable things are put in their lap. They need cocaine or some other powerful stimulant to turn on their brain.

The alcoholic brain is not as bad but still reflects low motivation and drive. The surprising finding is the low brain activity in the Nucleus Accumbens in the individual with obesity. What turns on their brain? The answer is food and especially carbohydrates.  Many experts now show that sugar can be as addictive as alcohol, speed, and cocaine and that addictions overlap to some degree. Periods of abstinence from addictive substances increases cravings, and the longer the abstinence the greater the craving. Sugar addiction increases response to amphetamines and visa versa. Some food addicts eat when bored, others eat when stressed.  Addiction occurs when you lose control meaning: You don’t control it, It controls you.  That’s why the first step in AA is admitting powerlessness, but change starts with awareness. The next step occurs with the decision to change and finally the hard part comes on the day you decide to start the process of change.  Fortunately there are things to help. See Part Six

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"Part Two – What Do We Mean by “diet”?"

When people say they’re on a diet they usually mean restricting calories. But the word diet comes from the Greek word diaita, which means “way of life”. The first definition in Webster’s is “what a person or animal usually eats or drinks”. While there is minimal value or even harm to fad diets there is value in changing the way you eat and what you eat.

Dr. Robert Atkins devoted most of his career to research and education about the problems with excess carbohydrates, especially those with high glycemic index (usually sweet and quickly digested) that rapidly raise blood sugar especially when consumed alone (without fat or protein). Rapid increase of blood sugar causes release of large amounts of insulin. This causes two problems. First, insulin results in part of the carbohydrates being converted to fat and second, over time high insulin levels can lead to insulin resistance. The Atkins diet was frequently but erroneously referred to as high protein but is most importantly low carbohydrate. When we eat a meal or snack of primarily protein/fat, (e.g., cheese, eggs, nuts, meat, chicken, fish), instead of releasing insulin we release a hormone called glucagon. Glucagon releases fatty acids from our fat stores as though to say we’re not getting any/much carbos here so we need to burn more fat and/or convert some of the fat to carbos.

Good Diet vs. Bad Diet

Now with additional research we have an improvement on the Atkins diet – the South Beach diet. The South Beach diet emphasizes “good carbs” and “good fats”. Like the Atkins it starts out with more restrictions – not primarily in calories but in carbohydrate choices. The reason both diets start low in carbs is that we have to stimulate our bodies to metabolize fat. Carbohydrates are easier to burn and if they are always available to excess in our diet we don’t fully develop the enzyme systems to burn fat. Once we achieve our goal weight then our selections can be expanded.

A good diet is high in nutritional quality and doesn’t generate increased fat storage. A bad diet is either a short term fad crash program – doing more long term harm than good, or calorie restriction that actually increases our body weight set point in our brain. When in doubt, think about how our ancient ancestors ate for thousands of years – good carbs, unrefined natural grains, fruits and vegetables. They ate good fat, like wild meat that contained Omega 3 fatty acids. We eat fast foods, highly processed foods and fattened up meat high in the bad fats like Omega 6 fatty acid. Unless we live on a farm we should all use supplements to insure adequate quantities of basic vitamins, minerals, and Omega 3 fatty acid. Remember, the original concept of diet is “way of life” and needs to be a balance of good carbs and good fats and adequate protein.

Weight and Fitness: "Let’s Get Physical"

You might be thinking, “I recently read an article that said the number of deaths due to obesity has been exaggerated and that being over weight is not really as bad as we’re being told.” The problem with that article is that it didn’t distinguish between big gut and big butt. Abdominal fat (40”+ waistline for men and 35”+ waistline for women measured at the umbilicus) is a heart risk factor. But even more relevant in that study concluding obese people are no worse off than thin people – the thin people included those that were thin due to chronic illnesses like lung disease and cancer. Studies have proved it is better to be a little overweight and physically fit than thin and out of shape.

One study at the Aerobic Center/Cooper Clinic in Dallas, Texas concluded after extensive testing that people who were over weight but physically fit (i.e., worked out regularly and could walk a brisk 2 miles) were healthier.  Another study by physicians at Johns Hopkins Weight Center found that physically fit overweight individuals were less likely to have high blood pressure or diabetes than overweight individuals who were sedentary. Other studies have found obesity to be a risk factor independent of fitness level.

In general for most people to improve their fitness level they need to lose a significant amount of weight. One technique that I have found useful in disciplining myself to workout every day is keeping a record in my day timer. I convert everything to miles – based on effort level (reflected in estimated average pulse) and duration. For example, tennis singles counts as 4 miles/hour and tennis doubles 3 miles/hour. On days I don’t exercise I put a “R” for rest, which to me means lazy – I hate “R”s. Since I’m competitive, I run in at least 2 races per year, and every day I feel like I’m either staying the same, getting better, or losing ground, which I gauge from my log. Knowing that I’ll be competing in the future provides motivation and discipline for those times when I’m not in the mood.

For me, having a treadmill and other machines in front of a TV is better than driving to a health club.  I tape sporting events or other programs I’m interested in and watch them while I work out. It also helps that my wife and I can work out together – on different machines at different effort levels but still getting to talk and share. Committing to meet someone for any kind of workout helps to prevent last minute procrastination or excuse making.

To be continued…bright light, genetics, meds that help and meds that hurt. See Part Three

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Part One – Weight Control – Why is it So Hard? The Answers Will Probably Surprise You!

We can put people on the moon but we can’t help them control their weight. Our population is growing – faster in total mass than in total numbers. A lot of people spend a lot of time, money, and energy dieting – mainly restricting calories. Guess what? They end up heavier than the people who don’t even try to diet. Some people have gone to the extreme of having fat removed by liposuction. Guess what? They gain it all back. What’s the problem? It doesn’t seem fair.

If you are trying to lose weight you have two powerful forces against you: mother nature and your brain. You have almost no chance – unless you understand what’s going on with your basic physiology and survival instincts. The medical problems associated with obesity are too big to ignore. Pardon the pun. In this weeks prestigious Lancet Medical Journal they report a study that obesity (presumably mainly abdominal obesity) causes us to age faster. This results on average in 9 years shorter life span. Obesity is associated with:

  • 2 Greater Risk of High Blood Pressure (40% vs. 20%)
  • 2 1/2 Times Greater Risk of Diabetes (23% vs. 9%)
  • 2 Times Greater Risk of Arthritis (39% vs. 19%)
  • 2 Times Greater Risk of Insomnia (30% vs. 15%)
  • 2 Times Greater Risk of Depression (26% vs. 12%)

    Of course with insomnia and depression it’s a chicken and egg problem. Insomnia increases cortisol which can increase weight, but obesity also can cause sleeping problems, especially difficulty with breathing. Remember, to understand the way things work with our bodies and minds you need to understand immediate causality, e.g., carbohydrates increase serotonin and protein decreases it. But even more important than immediate causality is ultimate causality. Why does this phenomenon exist in the world? What is its purpose?

    I hate to use the word evolution because for many people – ironically especially in this country – it causes a defensive reaction. It is as though to believe in evolution is to not believe in God. But evolution has nothing to do with religion or faith. Evolution is the process of adaptation over time. This is the same process that leads to resistant strains of bacteria or viruses. If you really want to understand the problem of obesity and weight control you have to understand its role in our adaptation over the millennia.

    What exactly is fat?

    Why do we have a lot more of it – again especially in this country? Unfortunately one of the reasons is that we Americans diet more than other people anywhere else in the world or in all of recorded history. Fat is the main way we store energy. We also store energy as glycogen made up of glucose (sugar/carbohydrates). But glycogen is stored in water and for every pound of this stored energy we store 4 pounds of water. Not very efficient is it? But because it is more quickly accessible in an emergency we need to have some.

    Our total energy stores of glycogen would only get us through one day. If we burn glucose (glycogen) anaerobically (without enough oxygen) as in sprinting or hard weight lifting we burn it many times faster because we’re only partially breaking down the glucose molecules (to lactic acid). Breaking down big molecules to small molecules releases energy. Building up bigger molecules requires energy. A sprinter in a 100 meter dash uses up all their glycogen in 10 seconds. So most of our stored energy is fat, and gemerally women have more of it than men. This is presumably related to hormones and the fact that women provide the nutrition to their babies. In the old days women were usually pregnant or nursing following puberty all the way to menopause.  There is a story, possibly apocryphal, about a group of pioneers traveling to California. They became trapped for months by an avalanche, and of all the pioneers, only the women survived.  

    Why do some people store more fat than others?  Why does it matter where you store it? It starts with genetics, and the concept of polymorphism. The survival of the group is enhanced by having a variety of traits. It is better if everybody is not the same. Some people are more naturally lean and therefore more mobile. Other people store more energy as fat – protection against scarcity of food.

    What is our “weight-o-stat”?

    It seems like simple math: calories in vs. calories out. Too many calories taken in and you gain weight. Burn more calories than you take in and you lose weight. 3,500 calories equals one pound, so 500 extra calories taken in per day (e.g., 3 cola drinks, 3 beers or glasses of wine), and you gain 1 pound per week. An extra five miles or so walking, jogging or the equivalent per day and you lose 1 pound a week. The problem is the formula is wrong. Just as a thermostat will turn an air conditioner or heater on and off to maintain a preset temperature, we have a rheostat (or “weight-o-stat”) in our brain – in the hypothalamus – that adjusts our appetite and metabolism to maintain a preset weight.

    You can change the setting but guess what, dieting (in the context meaning calorie restriction) raises your weight setting. It’s all about homeostasis (meaning same state). Our brains maintain our body to electrolyte balance and many other things including our weight. When we restrict calories our survival brain mechanism assumes it means there is not enough food available – if that’s the case we better turn down our metabolism to save energy (i.e., fat) and when food becomes available we better eat as much as possible. This process is also activated when we go several hours without eating. One solution is to eat smaller more frequent meals. Eat at least 3 times per day. If you take in the same total calories in 4-6 meals/snacks you will increase your metabolism. Research has found that people who don’t eat breakfast end up weighing more. Solution – eat breakfast including protein and fat, not just carbohydrates.

    Another concept in brain physiology is plasticity. The brain changes in response to experience. Our ancestors were outside all day every day and they were physically active. We on the other hand are mostly indoors and relatively sedentary. We are much more mentally active – which generates a lot of stress. Stress causes release of cortisol (stress hormones) and insulin, both which cause weight gain. Because our exposure to bright outdoor light is miniscule compared to that of our ancestors, the survival brain thinks a lot (or most) of us are hibernating.  What does hibernation mean? To the survival brain it means the environmental conditions are not suitable for productive activity, such as food gathering. The natural response is again to turn down our metabolism to save energy (fat) and when food is available to eat as much as we can.

    Low brain serotonin levels cause carbohydrate craving and eating carbohydrates raises our brain serotonin, dopamine, and endorphin levels – we can become food addicts. Bright light and carbohydrates increase serotonin, and vigorous physical activity increases endorphins. So is bright light one of the answers?  Yes. This means being outside more without glass between you and the reflected sunlight (you don’t have to be in the direct sunlight) contributes in keeping your metabolism healthier. If it is impossible for you to incorporate sunlight into your daily routine, full spectrum artificial light can be substituted. (More about this later).

    Another behavior that causes weight problems is getting inadequate sleep. You need 7-8 hours of quality sleep per night. Even one night of inadequate sleep raises cortisol levels which can increase weight, so another solution to weight control is getting good sleep every night even with a sleeping pill. (See my article on best sleep meds)

     How do we lower our “weight-o-stat”?

    Probably the most important component is physical activity. “But I hate to exercise”, you might say. Well don’t call it exercise, call it work – vigorous house/yard work or call it play – go dancing, but having a vigorous life style tells your brain that you are a mobile person.  Being physically active is the best way to reset your “weight-o-stat” lower.

    As hard as it is to lose weight, maintaining weight loss is even harder.

    Studies at UCLA and the University of Colorado found that the only thing that correlated with maintaining weight loss was 30-60 minutes per day of vigorous physical activity.  Most individuals have to work up to the ability to sustain physical activity for a period that long at a vigorous intensity.

    How do I Start to Become More Physically Active?

    First, you need to be checked out by a physician, especially if you have risk factors for heart disease, including high blood pressure, diabetes, high cholesterol, smoking, abdominal obesity, etc. Second, you need to start slow.  One of the most common reasons for failure is too much too soon leading to extreme overuse, soreness and even injury.  Walking is probably the best activity, because it is easier on joints. You don’t have to do it all at once. You can walk around your house or outside while talking on your cell phone, or you can park further away at work or at the mall.

    How to Keep the Weight off

    A very disenhartening statistic is that 95% of people who lose weight gain it back.  Fortunately someone had scientific curiosity to do a study to find out what is different about the 5% of people woh maintained weight loss.  Dr. Jim Hill at the Center for Nutrition at the University of Colorado has established a National Weight Control Rigistry for the 5% of individuals able to maintain significant weight loss.  To qualify for the study, participants had to maintain a minimum of 30 pounds for at least one year.  There are over 6,000 individuals registered who have maintained a 67 pound average weight loss for an average of 5 1/2 years.  What is different about this uniquely successful group?  CNN did a special report on these individuals in a program called "the 7 Habits of Highly Sucessful Dieters" and here is what they said:

    1. Expect Failure and KEEP TRYING! 90% of the Successful Group had failed several times.

    2. Don’t Deny Yourself.  This means if you are craving chocolate have some chocolate.  Moderation is the key, and having a little of the things you crave most can prevent binges.

    3. Weigh Yourself Often.  For maintenance purposes it is probably helpful to weight yourself at least 3 times per week, but when trying to lose weight it is better to weight somewhat less often.  For example once a week or once every 2 weeks. 

    4. Exercise or be Physically Active for 1 hour per day.  This may seem tough, but learning to incorporate physical activity in you life is vital to no only maintaining a healthy weight, but preventing chronic disease and living a higher quality of life.

    5. Add Little Bouts of Activity During Daily Routines.  This means taking the stairs instead of the escalator. Pacing the house while you talk on your cell or cordless phone or taking a 5 minute walk on your lunch break.

    6. Eat a healthy Diet.  Among other things, eating healthy means decreasing the amount of saturated and trans fat in your diet and eating fewer foods high in simple carbohydrates and more foods high in complex carbohydrates.

    7. Eat 5 Times per day Starting with Breakfast.  Eating smaller portions more frequently keeps your metabolism active while maintaining a more stable level of blood sugar which not only keeps you burning more calories, but results in feeling better too. 


  • More about genetics, the best quality foods to eat, and medications that can help will be discussed in Part Two. See Weight Do’s and Don’ts

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    Not Just Apples vs. Pears: Now It Is Metabolic Syndrome

    Metabolic Syndrome was the headline issue at last week’s annual meeting of psychiatrists (APA). What is it? Do you fit the criteria? What can you do about it? What Is It? Metabolic Syndrome is common and it increases your risk of dying from a heart attack by 3 1/2 times. If you or a loved one meet the criteria you can do something about it. I’m sure I have been embarrassing people lately when I whip out my tape measure and measure their waist – at the level of the umbilicus. It turns out that abdominal fat is much more of a health problem (the apples) as opposed to hips and butt fat (pears) which has no increased heart risk. In fact, recently the big "booty" has been in fashion. But a waistline of 35" or more in women or 40" or more in men is one of the 5 criteria for Metabolic Syndrome. (If you have any 3 of the 5 criteria you get the diagnosis). The 2nd factor is increased blood pressure and the standard now is tougher, 130/80. If either systolic is >130 or diastolic is >80 you have elevated blood pressure. The other 3 criteria require a fasting blood test (8 hours with nothing but water). Fasting blood sugar should be 100 or less. Triglycerides should be less than 150 and good cholesterol (HDL) should be 40 or more in men and 50 or more in women. These tests are simple and inexpensive and everyone should know where they stand. A family history of any of these problems increases your risk. Metabolic Syndrome and Psychiatry Why are psychiatrists taking a lead role in expanding public awareness? It turns out that some of the medications we commonly use can increase the risk of any or all of these factors. Three commonly used antidepressants used long term can cause weight gain. Some antidepressants can increase blood pressure but most striking is the group of mood stabilizers called Atypicals. Some of these medications can seriously increase risk of weight gain, increase fasting sugar, increase triglycerides and increase bad cholesterol. A consensus panel including members from the American Psychiatric Association and Endocrinologists convened in November of 2004. They concluded that the medications Clozaril and Zyprexa have a significant risk of causing Metabolic Syndrome. Seroquel and Risperdal have a lesser risk and Geodon and Abilify have the lowest risk. But the FDA is cautioning doctors to screen for these problems and to monitor patients that are on any of the medications from this category. Doctors consider the benefits vs. risks of all the medications that we prescribe. Ironically the "Atypicals" are among our most useful medications. At higher doses they treat the most severe symptoms of mania and schizophrenia, but they are also used for refractory depression and anxiety disorders, including hair pulling and skin picking. In fact, they are the most versatile of any group of medications used for stress disorders. Although we can’t say with absolute certainty that some of these medications are a lot safer than others, the consensus panel and clinical experience strongly suggest that this is the case. It will take large comparison studies to prove it. What Can You Do About Metabolic Syndrome? If you meet criteria for Metabolic Syndrome and you are on one or more of these medications you shouldn’t just stop them. You may want to consider changing if you are on the higher risk medications. Or you may discuss with your physician some of the behavioral and medical options to help reduce your risk. Of course the main cause for the Metabolic Syndrome is our fast food, sedentary life style. Dieting is not the answer – I will address that issue in my next article. Heart disease is by far the most common cause of premature death in men and women. Even if it doesn’t kill you it will lower your quality of life. Don’t wait for your doctor to pull out his blood pressure cuff and measuring tape. Be proactive! Take action now to find out where you stand on all 5 criteria.

    Metabolic Syndrome Criteria (If you answer “yes” to 3 or more of these questions you could be diagnosed with Metabolic Syndrome.) 1. Is your waistline 35" or more (for women) or 40" or more (for men)? (Measured at the belly button, not under the gut!) 2. Is your blood pressure above 130/80? (either systolic is >130 or diastolic is >80) 3. Is your fasting blood sugar above 100? 4. Are your triglycerides above 150? 5. Is your HDL cholesterol less than 40 (for men) or 50 (for women)?

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    Habit 3: First Things First

    You have to take care of your biological needs first. This includes a good diet plus basic vitamins and supplements. It also includes good sleep, ideally 7-8 hours of quality sleep every night and blood pressure in the normal range. Hormones like thyroid, estrogen, testosterone, and blood sugar, cholesterol, triglycerides, iron, and B12 are important. To be ideally healthy you have to be physically fit. “First be a good animal.”

    According to Ken Cooper (aerobics) this requires a minimum of 30 minutes of vigorous physical activity three times per week for cardiovascular health. To help with depression or to control weight you need to exercise 6-7 days per week. The effort level required is equal to a brisk walk (2 miles in 30 minutes).

    A lot of my patients say, “I hate to exercise.” That’s okay. Don’t call it exercise. Call it work. Vigorously vacuum, mop and clean house, or wash the car – an effort that gets your heart rate up to at least 120 to 144. Or you can call it play. Go dancing, play basketball.

    But whatever you do make sure to get off your butt and get fit. It’s a lot easier when you find something that you enjoy doing and for many people it’s easier to do with a friend or loved one. One of the easiest ways to stay fit is to have a treadmill, elliptical trainer, or stationery bike in front of a TV where you can exercise while watching the news, sports, or a favorite show. Don’t put it off – you have to do it!

    One thing I do is keep a log of my workouts in my day timer. I convert all exercise to miles and I keep a weekly total and an ongoing total. By running competitively at least once or twice a year I keep myself motivated to work out even on days that I don’t feel like it. To feel good and to be optimally productive you have to be fit! You have to take care of your body, and the most important part of your body is your brain!

    Being physically healthy obviously means not smoking – that includes second hand smoke. It means not drinking excessively or abusing drugs or medication. It means being smart and wearing your seat belt.

    Although not as essential as physical fitness, a good sex life enhances quality of life. Since stress inhibits sex drive and can interfere with sexual functioning and since we live in a high stress world, a lot of people have a sex life that they are not completely happy with. Thankfully we now have many effective treatments for sexual problems and you need to be able to discuss this openly with your doctor. I will discuss all the specifics of sexual dysfunction in men and women and all the current treatments in a future article.

    In addition to your physical well being you have to address your spiritual, emotional, and intellectual needs.

    What’s next? Your basic biological needs are being met and you are not in any acute danger. Should we focus more on love (relationships) or work (productivity)?

    Actually you can go either way. By focusing on education, training, and work you become independent and self sufficient. That enables you to be in relationships interdependently. You are not needy and you are not manipulative. There is give and take. You can focus on relationships first, especially if you had a healthy family and had “good enough” nurturing. This means you feel good about yourself and your uniqueness. Having a lot of emotional/social support can make it easier to build your career and become self sufficient. Most people alternate between these two major needs.

    Stephen Covey describes these levels in Maslow’s hierarchy as “to live, to love, and to learn.” The highest level then is “to leave a legacy,” or what he now refers to as the 8th habit – “find your voice and help others to find theirs.” Your deepest most personal, most passionate driving force or motivation is somewhere inside of you. You may or may not know what it is – you may need help in being able to understand what it is or how you can fulfill it. For me, writing this is expressing my voice and if I can help one person to find theirs my life will have meaning. Find your voice!

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    Holiday Weight Gain

    What do we do about all the food? A recent survey found that 75% of people gain an average of 10 pounds during the holidays. It’s more effective to have a plan of what you are going to do not a plan of what you’re not going to do.

    Increase activity – ideally at least 30 minutes a day of vigorous physical activity. Walk briskly – park further away from the store. Take the stairs. The most effective for many people is some aerobic equipment at home in front of the TV or with music or a reading rack. Get into the habit. You have to schedule work-outs, not wait until you have nothing to do. It helps if you do it with someone – make a commitment to a specific time.

    Do not eat sweets or starches (fruit, bread, pasta, vegetables) without protein – meat, cheese, nuts. Eat slowly and savor the taste and limit the quantity. Take another piece of cheese instead of another piece of pie. Eat more meat, less potatoes, breads.

    You can’t eat it if it’s not there, so be careful what you keep in the house. If you over do it, compensate with increased activity – like walk around the mall for 2 hours (you may want to leave your credit cards at home.)

    Feeling stressed is associated with increased cortisol (the stress hormone) that increases appetite and weight. 71/2 – 8 hours of quality sleep every night is essential for good stress management. Recent research shows that inadequate sleep increases a hunger hormone (Ghrelin) and decreases the satiety hormone (Leptin). Make sleep a priority.




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