Sunday, September 26, 2010

Fools Rush In: Saving Two Lives

I started another Blog, 'Snippets Of My Life', here is a sample.  If you like it go to this link and follow that Blog also.  Also please leave comments.

We were living in Vienna Va. and I was working at the American Red Cross Blood Research Laboratories at the NIH campus. The director of industrial design for the Am Red Cross was the regional director of the Industrial Design Group. They arranged a trip to the Amish area of Pennsylvania to tour the John Deer design facility. We had great tour of the design facilities and saw some of the first 3-D CAD systems in the world. We then all had dinner at a family style Amish restaurant. And we left to drive the two and a half hour drive back to DC at about 8 P.M.

We started driving on route 83 from Pennsylvania toward Baltimore. There was a detour and we had to leave the highway and go on a small two lane road that went through a very mountainous area near Hereford MD. Margie was driving and I was sleeping in the passenger seat. All of a sudden Margie stopped short thrusting me against the seat belt. I quickly awoke and looking out the windshield I saw in front of the car before us a tractor trailer laying on its side having rolled over between 120 and 150 degrees, about halfway between being on it's side and being on it's top. There was fuel spilling out of the tank onto the road. I rushed out of the car to the tractor and climbed up to the drivers window.

I climbed up the twelve feet to the window on the drivers side and looked in. I could see the driver trapped by the steering wheel and climbed through the window. He groaned "my brother". All I could see was a massive amount of chains in the back seat of the cab. I quickly realized that his brother was under all those chains. I quickly started to dig out the brother from under out. He had been sleeping in the back seat. Fortunately, I was able to get his head exposed. Neither of them were conscious at this time. It took almost 17 minutes for the local volunteer fire department to arrive. During that time I was keeping the neck stable on the brother in the back seat (I suspected a severe neck injury from having hundreds of pounds of chains fall on him (they were in the compartment under the matress he was sleeping on). Also he was unrestrained and likely to have injured his neck. While I was doing this the driver, his brother vomited. When the Hereford volunteer fire Dept arrived I refused to leave until someone with at least comparable training to myself arrived. I had worked seven years with the FAST team of western NY, was an EMT, had three years of surgical residency behind me. I explained I was already in the best position to render aid and the best skilled at the scene. They explained it was a highly dangerous situation because of the hundreds of gallons of fuel that had spilled. I told them you take care of the fuel and hand me two cervical collars and IV catheters and bags. I started an I.V on each. BTW there was not enough room for anyone else to come into the cab. I was doing this all upside down.I placed an cervical collar on each of the men. Several times I had to clear their months from vomit. I was given the Menaris France Award For Valiant Service in Emergency Medicine at their annual dinner in January 1984.

The Go team from Baltimore Shock Trauma Center was just recently organized and had not flown a mission yet. This rescue was their maiden rescue. The unique aspect of the team was that they had a surgeon, anesthesiologist, trauma nurses and carried O-negative blood for field transfusion. They could set up a full field surgical unit. They arrived about 45 minutes after the fire department and I allowed them to take over from me. I slowly backed out of the cab and was helped down by several of the firemen. It took them nearly 2 hours to get the men extracted. They had to get a crane to lift the cab. They first got a twenty ton crane and it was not enough finally they got a 45 ton crane and were able to get the men out of the tractor cab. We were finally ablee to get on our way about 2:30 in the morning. I took thee next day off from work and slept in. I was given the Citizen Award by the Baltimore County Fire Department. The two men both survived after weeks in critical care and months of rehab.

This Blog Snippets of my life, is going to be a daily blog for at least one year. I will tell stories about me that I hope you find interesting. If you like them please do two things: click to become a follower; and post on your Facebook page or twitter them. I hope to have 10,000 followers by years end. Some stories will be very personal. I will try to remember the correct names of those involved, however, I have a terrible memory for names and some names will be completely fictitious. The stories however are completely truthful as far as I can remember. Hope you enjoy. Some of these blogs may seem mundane. However, they

Sunday, September 12, 2010

95 lbs Off Seven Months Ago and Not a Pound Added.

Tomorrow is the seven month anniversary of completing my nine month and one day weight loss program that totaled 95 pounds of weight loss. I went from 293 pounds to 198 pounds and previous posts have both how I did it and the metrics of the results. I am shouting out that I have not gained a single pound of my weight back. I am almost more proud of that then the initial weight loss (which I am very proud of). I will examine why I feel I was successful at keeping the weight loss off were most (98%) in every study put back a significant portion of that lost if not all of it and even more.

First I designed a diet that did not depend upon meal replacements or pre-made meals that you get shipped to you. These do not work. My diet a modified Mediterranean diet was a diet I could eat the rest of my life. I still eat 5-8 fruit a day, a large salad daily and limit meat to 6-8 ounces a day. I still limit the quantity of the condiments (usually 25% of your calories a day) and drink only non-caloric drinks (mostly Ice tea or Crystal light Lemonade).

Second, I have continued my daily exercise. I have only missed 9 days in the 16 months since I started my diet and most of those were days I was sick. Yes that is seven days a week.

Third I way myself daily. If I gain any weight I modify my diet for a few days and get back to 198-199.

You work hard to loss the weight and you need to work to keep it off. The results are worth it. I feel twenty years younger.

Thursday, March 11, 2010

Weight loss: hit my goal 90 pounds in 9 months.

Sorry I didn't blog sooner. I was busy with my trip to Haiti to do emergency medical mission ( I'm going back this next week). Well I hit my goal of 90 pounds in nine months and 1 day. I just could not hit it exactly on the nine month date February 12th(I am probably the only person to gain weight{1.5 pounds} on an emergency medical mission).

The final numbers:
  • went from 46 waist to 37 inch waist
  • 288 pounds to 198 pounds
  • BMI=35.2 to BMI=24.5
  • 2X-large shirt to large shirt
  • 2X-large scrubs to medium or large scrubs
  • Resting Blood Pressure= 128/88 to resting Blood Pressure 108/68
  • Resting Pulse= 91 to resting Pulse=58
  • recovery time after exercise for pulse rate 20 minutes to 2 minutes
  • maximum exercise pulse rate >140 to 118
The results on my daily life
  • I have stopped snoring (Margie likes this)
  • No more knee and back pain (it is not age related it is weight related).
  • Don't get short of breath with minimal exercise.
  • sit more comfortable in plane and movie theater seats.
  • Sleep much better without waking up or waking up early
  • fall asleep faster and deeper.
  • never hungry
  • no cravings
  • easy to transition to regular diet(to be blogged on later).
  • less padding when I sit down.
  • post exercise orthostatic hypotension (I get dizzy if I go from crouching to standing after exercise)
  • less cold tolerance.
  • I just feel GREAT
Thank you for all that have followed me. Here is my diet again:

With these rules you will have a 1200-1500 calorie diet without having to count calories. But it only works if you follow them. I'm down 74 pounds as of this morning, six months and two weeks into my program. Please let me know what you think.
  1. Eat as much fresh or lightly cooked/steamed (no oil or fat) fruits, vegetables and legumes as you want. I eat five to eight pounds everyday.
  2. Eliminate condiments (butter, ketchup, mayo, fat based) except vinegar, lemon juice, mustard and spices.
  3. NO!! fried foods.
  4. four ounces of meat or fish or three ounces cheese max twice a day.
  5. Cut down to close to none on all traditional white things, i.e. bread, potatoes, rice (all colors) and pasta. Limit it to two to four ounces a day.
  6. At a restaurant replace starch with second vegie or double vegies and either plan on splitting dinner with someone else or have wait staff split it in kitchen before bringing it to you and pack the second half to go.
  7. Eat fruit for dessert or at most take a single (moderate) fork full of someone else's dessert.
The extra rule is: Tell EVERYONE you are dieting to lose weight. This creates a social contract with all.

Sunday, November 29, 2009

My Seven Rules of Calorie Reduction: The Whole List

I have been slow in getting a post up for each of the seven rules. So I promised many I would post all seven rules this weekend. With these rules you will have a 1200-1500 calorie diet without having to count calories. But it only works if you follow them. I'm down 74 pounds as of this morning, six months and two weeks into my program. Please let me know what you think.
  1. Eat as much fresh or lightly cooked/steamed (no oil or fat) fruits, vegetables and legumes as you want. I eat five to eight pounds everyday.
  2. Eliminate condiments (butter, ketchup, mayo, fat based) except vinegar, lemon juice, mustard and spices.
  3. NO!! fried foods.
  4. four ounces of meat or fish or three ounces cheese max twice a day.
  5. Cut down to close to none on all traditional white things, i.e. bread, potatoes, rice (all colors) and pasta. Limit it to two to four ounces a day.
  6. At a restaurant replace starch with second vegie or double vegies and either plan on splitting dinner with someone else or have wait staff split it in kitchen before bringing it to you and pack the second half to go.
  7. Eat fruit for dessert or at most take a single (moderate) fork full of someone else's dessert.
The extra rule is: Tell EVERYONE you are dieting to lose weight. This creates a social contract with all.

Thursday, November 12, 2009

Weight Loss: Sixty-Six Pounds in Six Months of My Weight Loss Program.

Well today is the six month anniversary of my weight loss plan. Sixty-six pounds in six months, not to bad. Though the last eight pounds have been the slowest. To recap on May 12th I began my calorie reduction using my seven rules and began walking in the local mall. I am going in this post talk about how I have changed with the weight loss. I plan to take off twenty-four more pounds for a total of 90 pounds, which will bring me down to a BMI of 24.5.

The obvious one is how I look. It is interesting that it wasn't until the last 10 pounds that people really started to notice and it is rare these last four weeks for someone who knows me not to comment on it. I lost seven inches in my waist size from 46 down to 39 (I'm on my third belt). Two to two and a half inches off my collar. I fit into large shirt instead of double extra large. Most people tell me I look ten years younger, I feel twenty years younger(more on that later). I lost almost all my fat from everyplace except my chest and abdomen. I hope when I reach my goal I will get rid of all my excess stomach. I'm waiting till I get within ten pounds of my goal to go out and buy a new wardrobe, so It will work out that I can take advantage of all the after holiday sales.

Physiologically I am a knew man and in the best shape I have been in ever. To recap I started walking and could only go 20-30 minutes at first. Several weeks into it I could do a full hour and covered about 2 to 2.5 miles. By six weeks I was doing 3 miles in one hour. At twelve weeks I was doing the 3 miles in 40-45 minutes. I added stair climbing (10 double flights up and down, as I passed the stairs with 38 steps) at the twelve week point. At eighteen weeks I began jogging up and down the stairs. Currently I am walking 3.5 miles and jogging up and down twenty flight of stairs in 58-63 minutes.

When I started my: resting pulse rate was 90-92; resting blood pressure was 128/88; my pulse hit 140 with only 20 minutes of walking at 2 .5 mile per hour; it took me twenty minutes for my pulse rate to return to my baseline. I began sweating within five minutes and would sweat for 10-15 minutes at the end of my workout; I could not talk on the phone until 5 minutes after I finished (I would sound out of breath and like I was having heavy sex). Now my values are fantastically better, my: resting pulse rate is 58-62; resting blood pressure is 108/68: pulse during exercise doesn't go over 118 (I recently ran up six flights of stairs and my pulse was only 118 and recovered in less then two minutes); My pulse rate always recovers within a couple minutes; I can talk on the phone during my exercise, including while jogging up stairs and my voice sounds normal.

Sleep is totally different for both Margie and I. Before the weight loss I was snoring all night long. Margie said I would begin snoring before I was completely asleep. We were both sleeping poorly and not feeling rested. Now I sleep like a log and get a full 7.5 to 8.0 hours and Margie says I hardly ever snore anymore, and she is sleeping better. It is amazing how much more rested I feel and how much more energy( more about that below) I have compared to before I began.

People say they don't want to exercise because they do not have enough time. Well I have not missed a single day since May 12th doing my exercise. The really important thing is that I have become much more productive, despite taking 90 minutes out of everyday. I mentally am much more focused. I work much more effectively and productively. The last three to four months have been amazing in how much I have gotten done and the projects I am working on.

Emotionally I have been much calmer and have notices I am giving more time to my patients. I have been in a much better mood. It is hard to describe, but I imagine it is what they call runners high (yet I not doing any running). I can only tell you it has totally changed my emotional demeanor.

I am eating between a 1200-1400 calorie diet. Yet since the second week I have never felt hungry. I am not sure why. Some theories include : fats and sugars increase your appetite and I am eating much less fat and sugars; the exercise moderates the hormones making you hungry; the hungry fat cell theory; I eat 6-10 pounds of fruits and vegies each day and just that mass of bulk fills me up. I am not sure the reason and there is scientific evidence for each of these theories. I can only tell you that I am never hungry while eating a 1200 calorie diet.

I hope this gives you inspiration to begin your journey to a healthier, happier, more rested, more energetic you.

Wednesday, October 21, 2009

Weight Loss: Exercise University

One of the most common excuses I get about exercise is the lost time during the day that an hour of exercise, plus the time getting there and back, and the time to clean up, takes out of the day. Well my exercise time is some of my most productive time of the day, and not simply what the exercise accomplishes to improve your life(more about that in a later post). In a year of exercising five days a week you could complete eight full college courses or the equivalent of a full year of college.

Several weeks ago I went to a motivational seminar and Zig Zigler was one of the speakers. He talked about many years ago proposing something he called Auto University. What he meant by this is that the average person in the US spends over an hour a day in their car. Most people either listen to music or in Zig's words 'even worse they listened to talk radio.' He told people instead of listening to the radio they should listen to college courses on tape. Ones which I have listened to for the last fifteen years have been the courses from the Learning Company. I have bought and listened to over 90 courses over the twelve years from 1995 to 2007. On average listening to eight or nine complete college courses each year. These were courses on every subject imaginable including: History, Philosophy; Astronomy; Literature; Bible studies, biology; Law, Economics and many others.

The point Zig made and that I have lived for many years is that you can turn almost wasted moment into valuable learning that can have long term benefit. Now while you exercise your mind can be occupied similarly to what Zig recommends and I have done while driving.So my suggestion is turn your exercise time into learning time, Exercise University, so to speak. The tools are available now to do it very inexpensively if not free. All you need is a computer, Internet access and a MP3 player of choice(I use an I-pod).

To start with from your Internet browser go to apple,com (whether you have an Apple computer, an I-pod or not). From this page click on the I-Pod button along the top row. On the new page you go to on the right hand side there is a button to click to download I=Tunes. Go ahead and download it. It will ask for your e-mail, however, you do not need to give it, it still lets you get the software. Go ahead and install I-tunes on your computer. Here is the best part the two areas you will download from are completely free. Literally millions of hours of downloads that are completely free. Every Podcast and every course in I-Tunes University are absolutely free. Let me explain what podcasts and I-Tunes University are and how they got started.

Podcasting began in 2002 but really took off in 2006. Think about the typical NPR radio show and that will give you a little of the feel of a podcast. They can be any length from one minute to several hours. Most of them are under one hour and even many under ten minutes. Initially in the early age of podcasts they were produced by people sitting in there home and on almost any subject that the producer was interested in. I use to challenge people to give me any topic and I have never been stumped of not being able to find a podcast on that subject. Since the early age of podcasts two other common forms have come along. One is radio and TV shows will podcast the audio portion of the show as a podcast. So you can listen to the show at your convenience. Now almost all radio shows are podcast, usually within a day of the original broadcast. Many TV shows also, for example the three main News Cable Networks podcast the audio of a;ll there shows, Comedy Central podcast the audio of both the Daily Show and Colbert Report and many more. Many organizations that have internal lecture series, like the Long Now Foundation, will podcast the audio of those lectures and sometime the video also as a separate podcast.

A podcast is a series of shows and there will be many episodes. In I-tunes you would subscribe to a podcast and then whenever another episode is released it will appear in your podcast section of I-Tunes. I subscribe to around 200 podcasts ( will post these in a Note on my Facebook page). Some are released daily, some weekly and some less often.

Prior to two years ago a few universities would release the audio from college courses and I began listening, in 2006, to whole college courses that were released for free. The Learning Company lost me as a customer at that point. Then in 2008 I-tunes began a separate section in there store (but all free) I-Tunes University. They started with courses from about a dozen universities, they now have over one hundred. Some universities , such as Harvard as an example, record and podcast through I-tunes University nearly every course taught on campus. Using Harvard as an example, they have a webpage for each course. On this webpage the Professor will be listed with his e-mail, All the course handouts will be linked. The reading list will be given. I have gotten the books for many of these courses and have e-mailed the professor with questions and I have never not received and answer and always in less then a week and most of the time in a few days I listen to a complete course on average one per month, plus catching up on my podcasts. Lets say you are a busy exec, you could have your subordinates prepare their reports as dictations that you could listen to. So don't use the 'I don't have enough time' excuse, do what I'm doing. Now I am not getting college credit, I don't need it. But I am getting the knowledge and experience. Also I'm making my exercise time doubly productive.

Sunday, October 11, 2009

Weight Loss and Healthy living: Good Food MOST of the Time

Dr Eduardo Sanchez Vice President of Blue Cross/Blue Sheild of Texas and chair of many national and international commities on preventive health, gave rousing opening remarks to start the 'Commodity to Community' conference, the 13th annual Community Food Security Coalition Conference. He definitely set the tone of what looks like a wonderful conference. For this Blog he made two points. The first is that you should "eat good food MOST of the time." The second, "always chose water over soda."

"Eat good food Most of the time", is a great message. When I present my six rules for calorie reduction and later when I present my rules for sustainable weight and health, this is an important message to remember.

We cannot always be angels. There is occasionally that little devil sitting on your shoulder when you see some special food. This will be especially true in 6 weeks when Thanksgiving comes around. The important thing to remember is that if you eat well most of the time an occasional treat and not so healthy selection will be O.K. You just have to ensure that the eating well is most of the time and doesn't slip to being some of the time.

So consider yourself, as Dr Sanchez said, in training for the next six weeks for thanksgiving. Then go back into training for the holidays coming 4 weeks later.

I give talks all the time to community groups and I say all the time: "I feel like I practice a form of child abuse by letting my kids drink soda all the time." It took almost 2 years to break my kids of that habit. All three of them drink almost exclusively tap water. This leads to about 400-600 empty calories per day they were downing. Dr Sanchez's message is the same, you should always drink water instead of soda (or pop for you mid-westerners),

His third recommendation was to check out a report from the National Institute of Medicine, that he Chaired.

So take his suggestion to heart and live a healthier happier life.

Sunday, October 4, 2009

Weight Loss: Exercise - Care of our Feet

When I started exercising, which consisted of walking and stair climbing. I realized how important good foot care was. I developed blisters on the bottoms of my feet and sores on the ends of my second toe (more about that later). So I felt it is important to talk about this so you are not incapacitated by foot problems and fall behind in your exercise.

When I started I quickly realized that it is easy to have problems with your feet. I had an old pair of walking shoes and it had some wear spots. I first tried one of those gel sole inserts. I was still having some sore areas on my feet after walking. So, I got a new pair of shoes, New Balance Walking Shoes. I have a history of plantar fasciitis so I need a high arch and the insert that came with the shoe was not giving me enough support. So I got

an insert that gave me good arch support. As you can see from the pictures, you take out the insert that comes with the shoe and place the new one in. If you have plantar fasciitis you should get and use an insert with a large arch. This will cure many cases of plantar fasciitis.

Now many people
have the problem that I have of your second toe being longer then your great toe. Once I started stair climbing I developed sores on both of my second toes. As a matter of fact, I developed a subungual (blood clot
under the nail) hematoma on my right second toe
and actually lost the nail (it has
grown back). In the foot care section of your local pharmacy you can find these foam tubes, like in the photo. You can cut this down to the size you need. I have not had any problems with my long second toes since wearing them.

I can not emphasize enough the importance of good socks. I discovered that old socks because of wear have slight variation in thickness and in shear stress that they apply to your foot. This uneven shear stress can also lead to blistering and sore spots on your feet. I developed blisters on both of my feet (how I treated them below). I realized that it may be from my socks so I bought very thick white socks and have not had the problem since then.

As I mentioned above I developed blisters on both feet. However, I didn't want this to stop me from walking. So I got a product called Moleskin. This is available in the foot care section of your pharmacy. I would cut it so it covered the sore area with a wide margin. Were I could hardly walk at a regular pace without the moleskin on. Once I placed it over the blister or any sore area I could not only walk, I could both power walk and stair climb (including jogging up the stairs).

So take good care of your feet when you do rapid walking, jogging or stair climbing. They are the only feet you'll ever have and I should know unfortunately I have to occasionally amputate the leg of a diabetic with gangrene. With the precautions I presented here you should be able to do any type of exercise. These are also great suggestions just for routine foot care.

Saturday, October 3, 2009

Weight Loss: The Second of Six Rules for Calorie Reduction.

No condiments or cream sauces except Vinegar, Mustard, Lemon Juice and oil free salsa. This rule is mostly directed at oil and mayonnaise based products and dairy/fat based pasta sauce/gravies or sauces/gravies for meat. These dressings and sauces can double or more the calories of a portion of food and not add anything toward making you feel full. There is actually evidence that high fat food can make you more hungry. I can tell you that since I have been reducing my calories to 1200 per day with eliminating all these condiments I have actually been less hungry then I was.

For salads I have converted to vinegar. There are so many gourmet vinegars out there. I particularly like balsamic vinegar but the various wine vinegars are also good. To take this as an example a large dinner salad (the type you would get at Applebees, without meat) may have 100-400 calories (mostly from croutons, eggs and cheese) before you add the dressing. The typical dressings will have 40-80 calories per tablespoon if not reduced fat and 20-40 per tablespoon (go to this sight and search 'salad dressings' or what ever you would like calorie count of). Typically 4-6 ounces will be used on a large salad so 320-720 calories for non reduced fat dressings and even 160-480 calories for the reduces fat dressings. Balsamic vinegar will add essentially zero calories. The funny thing is almost all the taste of a dressing is the vinegar and spices and very little is from the fat. I have been doing, while eating a salad almost everyday, and have not missed the fat based dressings at all.

Tuna fish and egg salad is many a carrier for mayonnaise. A typical sandwich will have 1/2 cup of tuna (120-150 cal) and 2-3 tablespoons of mayonnaise (200-300 cal) so 2/3 of you calories will be from the mayonnaise. Going to low-fat mayo (60-100 cal) you can be much more reasonable. Most tuna fish made in commercial locations use real Mayo or equivalent, so ask before you order a tuna, chicken, egg salad or any thing with mayo when you are out.

When ordering a sandwich you are faced with what to add as a condiment or cheese. Typically 2-3 tablespoons are placed on a sandwich again adding 2-300 calories to a 300 calorie sandwich doubling the calories and then adding cheese will add another 100-200 calories. So adding cheese and mayo to a turkey sandwich will make a 300 calorie sandwich 600-700 calories. Instead add veggies, lettuce, tomatoes, and others. For condiment add mustard or sprinkle on some vinegar or if you have to add a thin smear of low-fat low-cal mayo (1Tbsp = 30 calories).

All of those cream sauces and heavy gravies do make your food taste better. Have them occasionally (once a week at most). However, for the period of your diet try to avoid them. They cam double or triple the calorie count and again not make you feel less hungry but more hungry. Have a spoon full to get the taste if you want but instead use a tomato based sauce or gravy.

So think about the hidden calories that we forget to count when we try to figure how many calories we are eating. My recommendation is that for the period of your diet just avoid them.

Next Rule Three.

Wednesday, September 30, 2009

Weight Loss: Why Is Exercising Important?

The first thing you need to realize are the un-refutable facts about exercise and weight loss. The first is that every study that has looked at exercise and weight loss have shown that those that exercise are twice to four times more successful at weight loss. Also those that do not exercise during weight loss almost to a person put on all their lost weight within a year. Of those that do loss weight with exercise if they continue exercising 75% of them keep off their weight, while those who stop exercising 95% put back all their weight. Also when you loss weight and then put it back on almost everyone gains back more then they lost.


Now I am going to tell you the other benefits to exercise that I have experienced

The most common comment I get when people hear I am doing both calorie restriction and exercise is "doesn't that wipe out your energy and make you tired all the time." Well look at my facebook page and the postings for the last 4 months since I started this program. That is not the postings of someone with lack of energy and tired all the time. I can tell you that since I have started this program I have had more energy and get much more done in a day. My increased energy level and the more focused my mind has been have allowed me be more productive despite taking one and a half hours out of my day. Plus I get one and a half hours of what I call Exercise University ( a later Blog), listening to my I-pod, so even this time is used to a benefit in addition to the other benefits.

Prior to exercising I was sleeping very erotically, I would wake up during the night and lay awake for an hour or two until I feel back to sleep. I was more tired during the day but this didn't translate into sleeping better. Since the fourth or fifth week of exercise I have found that I am sleeping like a log. I get a full seven to seven and a half hours then wake up very refreshed. Some of this may be due to my weight loss having cured my snoring (so my wife can also sleep better). The most common cause of snoring and sleep apnea (a potentially life threatening severe form of snoring) is obesity. A study just published this week on sleep apnea demonstrated that 65% of those who lose 15% of their weight cure their sleep apnea. So loss that weight and not only you but your spouse will sleep much better.

Obesity is the most common cause of type II diabetes. This is a disease in which the muscle cells (the largest cell mass in the body) become resistant to insulin. Well multiple studies have shown that even as little as 15 minutes of strenuous or 30 minutes of moderate exercise five days a week will prevent or reverse to some degree insulin resistance. The condition you have before you become diabetic is a condition called Metabolic Syndrome or Syndrome X. This is characterized by a waist to hips ratio greater then 0.9, high blood pressure, high cholesterol, low HDL (good) Cholesterol, high triglycerides and elevated fasting blood glucose >100. Exercise and weight loss will improve all of these.

Earlier this week I posted this update to my facebook page.

Alan Koslow
is down 58 pounds today at 19 weeks of exercise and calorie restriction (1200 cal/day). But the big news is the condition I'm in. Had insurance physical last Weds. and BP was 106/67 and pulse 58. So, I tried jogging up 6 flights of stairs and my pulse went to 118. Before I started my resting pulse rate was 92/min and BP was 128/85. the first week with 20 minutes of walking my pulse went to 138 and it took 20 minutes to recover. I'm in best shape I think I have ever been in.

What else can I say. The proof is in the results and the literature confirms this. I at 56 years old and after only 19 weeks of exercise of only walking and stair climbing am in the condition of an elite athlete.

As a physician who treats patients with vascular disease I find one of the greatest challenges is to treat elevated Triglycerides and low HDL (good cholesterol) medically. The drugs we have do not work well and they have significant side effects (not health threatening, but bothersome). However, we know that regular exercise of 30-60 minutes per day 5-7 days per week will correct both of these conditions.

I feel 15 years younger compared to 19 weeks ago when I was 58 pounds heavier and in much worse condition. Now I cannot say that you will have the same results. However, i can say you will feel much better with the combination of weight loss and physical conditioning.

It is hard to state except as euphoria the entire package of how I feel. I have never used any mind altering drug except alcohol when much younger (a totally different issue), but I can tell you I have been feeling a sense of euphoria since six or eight weeks into this program.

I hope that this convinces you that any weight loss program should include exercise. In a later post I will discuss a simple exercise program that almost anyone can do and how you need to ramp it up slowly as you progress. Then I will discuss post weight loss exercise programs.

Sunday, September 27, 2009

Weight Loss: Common Reasons for Weight Gain.

There are many reasons that you can control that may lead to weight gain. I am just going to list them here and in the future I will Blog on all of them:
  1. Lack of sleep
  2. Stress
  3. Use of antidepressants
  4. Steroid use
  5. Many other drugs, ask your doctor or pharmacist (but not the PILL)
  6. Hypothyroidism
  7. Menopause
  8. Cushing Syndrome (excessive cortico-steroids produced by your body)
  9. Polycystic Ovary Disease
  10. Smoke cessation

Wednesday, September 23, 2009

Weight Loss: The First of Six Rules for Calorie Reduction

I have six rules for calorie reduction. If you follow all six rules with almost no exceptions I almost guarantee that you will be down to a 1200-1500 calorie diet.

The first rule, and I feel the cornerstone of any calorie reduction plan, is to eat as much fresh raw fruits and vegetables (except potatoes) as you want. This is the most critical because by doing this you both remain full during the day.

The reason this also works is that you replace high Glycemic foods with low glycemic foods. What is the Glycemic Index? The Glycemic index is a way to tell how much a food you eats effects your blood sugar and how fast that food raises your blood sugar. A high glycemic index food such as; white sugar, most breakfast cereals and almost all candies and sweats; lead to a rapid raise in you blood sugar and almost 100% absorption and utilization of the calories in the food. While low glycemic foods such as; fresh fruits, vegetables, whole grains and certain rices; take a long time to get absorbed and to raise your blood sugar.

I emphasize raw vegetables and fruits because of the difference between eating raw and cooked foods. Now I am not asking you to do a complete raw food diet or only eat raw fruits and vegetables, but what I am saying is that you can eat as much raw fruits and vegetables (except potatoes) . There are several factors that explain this. First, fruits and vegetables are composed of a high portion of water. Most of this water is lost with cooking so you get filled up more when raw then when cooked. Second is the issue of the calorie content. I need to explain how calories are measured in a food. The food is placed in a calorimeter, a device that incinerates the food to ash, and the amount of heat released above the heat applied is measured as the calorie content of that food. As you can see this assumes that all the stored energy in the food is absorbed by the body. This is not the case for several reasons including: that the body needs to expend energy to break down the food; the fiber in the food carry many of the calories away (need I tell you); and the fiber itself is part of the calorie count. The estimate is that you only process and absorb 50% of the calories of raw fruits and vegetables.

My experience has been that with this as the cornerstone of my diet (but don't worry I eat a very balanced diet, more of that in later blog) , I am full most of the time and hardly have hunger urges. The first two weeks were the worse but I quickly got over this. There are some days I eat 5 pounds of raw fruits and vegetables a day and I still have lost 1/2 pound a day consistently for the 18 weeks so far of my diet.

Tuesday, September 22, 2009

Weight Loss: How Much Exercise Do I Need To Do?

To loss weight you need to burn more calories then you ingest. It is actually that easy. You also need to exercise to prevent diabetes and to improve your heart health. If you burn the same amount as you ingest, you keep a stable weight. If you ingest more then you burn, you gain weight. However any amount of exercise can help your health.
If you follow the headlines it is very confusing. In the last year I have seen something similar to all of the following headlines:
  • Science proves you only need 15 minutes three times a week to prevent diabetes.
  • 300 minutes of exercise required weekly.
  • Stay healthy with 30 minutes strolling walk per week.
All of these headlines are true. How can that be? Popular press reporting of these stories usually leave out two very important points. One is what group of subjects are you starting with and two is what are the end goals you are hoping to obtain.

You need to first decide what is your goal for exercise. It may be one of the following or a combination:
  • Weight Loss
  • Weight maintenance
  • Heart health (discussed in a later post)
  • Diabetes control (discussed in a later post)
  • Reversing pre-diabetes (discussed in a later post)
Let me first say that you can loss weight without exercising. However, there are three facts that you should realize. One, without exercise your weight loss will be much slower if you are successful at all. This is because you loss weight based upon your calorie deficit and without exercise you loss weight (for example I've consistently lost 0.4-0.5 pounds everyday, if I had not exercised with the same calorie restriction I would have at most lost 0.25 pounds per day or less.) Second, studies of large numbers of people on diets show that only 50% or less of those who do not exercise loss weight and if they loss weight it is much less then those that do exercise. Finally, multiple studies have shown that zero percent, yes none, of those that diet and loss weight and did not exercise during weight loss and continue exercising after weight loss maintained it. Actually 100% were back to their pre-dieting weight or usually above it within 1 year unless they did an exercise program post weight loss.

So lets look at your goal. Remember that you can always modify these suggestions. So first for weight loss. You need to burn about 700-100 calories. Here is a calculator|hco|ns|calories|PPCA7FBa|c which you can use to see how many calories you burn for a given activity. You will see that your weight effects how much you loss. Also an important point is that walking on a level treadmill vs walking the same distance for real you burn much fewer calories as much as only 40% of walking for real. The same is true of stair climbing and stationary bicycles. This is simple physics If you are not moving yourself through space you do not use as much energy. You can compensate by inclining the treadmill or increasing the resistance on the stationary bicycle. The amount recommended to exercise is about 40 minutes to one hour daily to have a sustained steady weight loss. You may need to start slowly. When I first began, I was only able to walk 20 minutes before I pooped out. At the end of two weeks I was up to 40 minutes and then by 4 weeks I was walking a full hour. Walk till you feel like your significantly winded. Tomorrow you will walk more. (In a later post I will talk about exercises for those who cannot walk.) (I will also blog later on stepping it up as you get into condition.)

Next, how much exercise do you need to do to maintain your weight after a weight loss program? This is much more tricky. It depends upon lots of variables. How much are you eating? What is your metabolic rate? How active are you? There is no one right answer. However, I can say with out reservation that you need to keep exercising to maintain your weight loss. I recommend based upon my reading that you do at least 30 minutes fives days a week. This can be a rapid walk (about 3.5 miles per hour rate). You can increase of decrease this based upon your weight. The important thing is that you continue to exercise. Some experts recommend after you do you hour a day to lose weight you then continue an hour a day but alternate cardio with strength training. This is up to you. Please do the 30 minutes five days per week.

Please post your exercise stories. I want to hear both successes and failures. Please be frank. I also would like to hear if you went against this advice and were successful.

Monday, September 21, 2009

How Do I Start Exercising, and How Do I do It Safely

This is one of the most important questions especially since many obese persons may have medical problems. The simple answer is that you should have a full physical and talk to your physician before beginning any strenuous exercise program. I have to stick with this advice, however, many people will try to exercise without seeing their physician. Additionally the truth is that unless he does a stress test on you it is still important to do these recommendations.
So these recommendations are after you get a clean bill of health from your doctor you still need to follow these recommendations to stay safe.
Now the main reason why people get into trouble while exercising is that their heart requires more blood then they can pump or then can get through clogged arteries. The faster the heart beats the more oxygen and therefore the more blood it needs. If either the heart doesn't pump enough blood or not enough blood gets through the arteries to the muscle of the heart you can have either a heart attack or angina (chest pain without a heart attack from an oxygen hunger of the heart). Let me state clearly that if you get chest pain, pain radiating into your arm or neck or severe shortness of breath you should stop exercising and either call 911 or see your physician.
So, how can you know your limit so you are less likely to get into trouble. Well there is a rule of thumb that your maximum safe heart rate is that rate calculated by subtracting your age from 220. For example my age is 56 so my maximum safe heart rate is 164 beats per minute. To be safe you then take 85% of this number which is 139. So my maximum safe heart rate is 139. You can also use this calculator to calculate your max. safe heart rate: .
You also need to know your target heart rate. This is the heart rate you should strife to hit to get maximal aerobic advantage. You should attempt to be above this number for most of your exercise program to get both maximal calorie burn and maximal conditioning. This target heart rate is 80% of your maximal safe heart rate or for me 115 beats per minute. When you use the calculator linked above you get two numbers. The first is your target heart rate and the second is your maximal heart rate.
If you do not have significant heart disease your body will find this range. If during exercise you go above your maximal safe heart rate there may be a significant underlying medical problem and you should stop exercising until you see your physician.
If you are not hitting your target heart rate you are not obtaining the maximal benefit you can obtain from your exercise regiment.

So how should you check your heart rate. The simple way is to take a momentary break and count your pulse for 10 seconds and multiply by 6 to get your heart rate per minute. An even simple way is for approximately $30 you can get a ring or wrist device that measures your heart rate and some also do your blood pressure (more about that in a moment) . I strongly recommend the later. I recommend that you use this every day you exercise for the first two weeks and then when ever you increase the intensity of your exercise.
In regard to blood pressure. When I started to exercise I wore a wrist band that measured heart rate and blood pressure and got scared the first reading I did. I had a reading of 170/110. What was the problem? Was I in that bad shape? Did I need to see my doctor right away (I called him on my cell right then)? We realized I had my wrist at my waist adding 21 inches between my heart and my wrist level. This is over 500 mm distance. That would be 40 mm of mercury (13 times heavier then water) so my blood pressure was actually 130 over 70 and when I retook my blood pressure with my wrist at my heart level that is the value I got. Science and physics is wonderful! It always works out, you just need to know all the variables.
As you exercise you will find two things. First, when you begin it may take a long time (15-20 minutes for me) till your heart rate returns to normal and as you get into condition a very short time (2-3 minutes now) for your heart rate to come down to normal. Second, you need to exercise harder to get your heart rate to target (I am now jogging up 25 flights of stairs {two flights at a time}). Faster recovery and need for harder exercise prove you are getting into good condition. Congratulations.

Sunday, September 20, 2009

My Weight Loss Odyssey

My weight loss odyssey began about 18 months ago. It was then that I realized I was massively over weight. I hit 260 ponds and at 6'3" I had a BMI (body mass index , here is the URL to calculate yours: of 32.5, obese by definition. I started to diet and I did several things I had heard were important. At my wifes urging I stated eating a full breakfast every day (I typically have no breakfast except my supplements {more about that in later post} and my daily dose of fiber with small amount of orange juice {again more about this in later post} , and not eating for last three hours before bed (Oprah's favorite method). Well 6 months and another 15 pounds added so I was 275 with a BMI of 34.4. I realized this wasn't working. So I tried exercise. I began mall walking. The problem was I walked erratically and did not make the commitment to doing it regularly or even everyday. I also did not control my diet. Well nine months after that and 13 more pounds I hit my maximum weight 288 pounds with a BMI of 36, I hit the criteria for Morbidly obese. It was not this landmark weight though that got me motivated (I actually did not weight myself until I decided to get serious). It was a friend of mine who was several months into his successful weight loss that got me motivated. He actually was diabetic and began an exercise and calorie restriction program that essentially cured him of diabetes {more on that in a later post}. So on May 17th of this year I got on the scale, found out I was morbidly obese and began my committed plan to loss 90 pounds with a goal of getting to a BMI of 24. I realized I would need to do three things: 1) reduce calories to 1200-1500 calories per day; 2) exercise one hour per day; and 3) tell everyone I meet that I am working on losing weight. I also realize that you never refer to it as a diet but as a weight loss program. Well today is the 18th week anniversary of starting and I am down to 234 pounds down 54 from my start and only 36 more to go. In this blog I plan to cover many topics some of them are:
  • Why are americans so overweight (at least 4 blogs)
  • My six rules to reducing calorie intake (one blog for each)
  • How to start exercising and how do you do it safely.
  • What exercise should I do
  • It takes a community to loss weight
  • Don't forget to ramp up your exercise as you loss weight
  • Going out, what to do.
  • Supplements: What are they, should I use them?
  • Fiber: Why is it important?
  • Myths about dieting (many blogs)
  • Gastric reduction surgery, is it for me?
  • Diet drugs. 1) Over the Counter 2) prescription
  • I lost the weight now what?
  • Plus many more
So you can see this will be a very complete coverage of weight loss. I hope you stay with me a subscribe to it at this URL: That way you will get an e-mail notice when ever I do a new post.