Finding Fit in a Fat World

I recently happened upon a lecture by obesity experts James Hill PhD and Keith-Thomas Ayoob, EdD, RD, FADA entitled Energy Balance in an Obese World. (1) There, I found a fresh approach to our most pressing public health problem - the sedentary and overweight American. Their reasoning and strategies stimulated me into personal action and reexamination - so I thought I’d share.

The facts are well known; you know this stuff. But they wrapped it up into a neat little burrito that I could get my teeth around, availing bite-sized pieces of action - and that is useful. Let me set the stage.
Two-thirds of American adults are considered overweight, obese, extremely obese or beyond. This fact has predictive value for where we are headed both personally and nationally given that the leading causes of chronic illness (i.e. disease, pain, suffering, early demise) are weight related and preventable. 

We gloss over disease, pain, suffering and early demise like its no big deal. Take a moment to ponder what that would mean for you personally if you experienced: knee or foot pain with each step, bending to tie or put on a shoe was difficult, shortness of breath made walking a hardship and stair climbing impossible, extreme fatigue at the end of the day, increased incidence of injury/illness, lost work and lost pay. Life becomes prematurely restricted - think about it. But I digress, as I am wont to do.

What does overweight, obese or extremely obese mean and how do we measure it? BMI= body mass index is the most commonly tool used today. BMI= weight (kg)/[height  (m)]2. While not terribly accurate for athletes, weight lifters, those with lots of muscle and very little fat, that ain't us, so BMI is a useful tool in knowing where we are. Go to http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html to plug in your numbers and calculate your BMI.

	Weight Status	Avg USA Man = 70”	Avg USA  Woman = 64”
less than 18.5	Underweight	less than 132#	less than 110#
18.5 - 24.9	Healthy Weight	132 - 173#	110 - 139#
25 - 29.9	Overweight	174 - 209#	140 - 173#
30 - 34.9	Obese	210 - 242#	174 - 203#
35 - 39.9	Extremely Obese	243 - 277#	204 - 231#
greater than 40	Morbidly Obese	greater than 277#	greater than 231#

Remember that as we age, our body composition changes, we lose muscle mass and carry more fat. So even at a good weight, we still carry more fat. I see this in my own body. I weigh less than I did in high school but I was running track then, had more muscle mass and was very lean. Now I have more fat - and it seems to be accumulating around my waist! Egads! But I digress - yet again.

We have found that the “Caucasian” BMI charts do not work well for Asians. Asians are one of several ethnicities that poorly tolerate abdominal adiposity (fat) which quickly leads to diabetes. I see this in my Chinese family - where even 20# of extra weight has tipped my middle-aged cousins into diabetes. My own fasting blood sugars are rising despite the fact that I’ve lived my life in the far left columns of the BMI chart. Based on that, the Asian BMI scale follows. (2)

BMI	Weight Status	Avg Asian  Man =  67”	Avg Asian  Woman =  61”
less than  18.5	Underweight	less than 118#	less than 98#
18.5 - 23.9	Healthy Weight	118 - 152#	98 - 126#
24 - 26.9	Overweight	153 - 171#	127 - 142#
greater than  27	Obese	greater than 172#	greater than 143#

My family rolls their eyes at these figures but hey - don’t shoot the messenger.

What about kids? Twenty percent of America’s children are overweight or more. Rather than outgrowing this state, data shows they will grow into overweight and obese adults. Fat kids are not cute. They are headed down a difficult path where ridicule in grade school is but the beginning.

We cannot expect our children to follow a course different from that set by their parents. If we want our children to eat better, we have to eat better. If we want our children to be physically active, we have to set the example. You know the old adage… the apple does not fall far from the tree.

So what was new and compelling in this lecture? 

The authors looked at energy balance as the interplay between energy intake (calories in), energy expenditure (calories burned) and energy stores (body fat). Additionally, they urged tracking these factors and taking baby steps, small behavioral changes, one small change each month toward the goal. 

Measuring provides insight. Measure food intake, measure physical movement, measure caloric expenditure. All of this can be done easily and painlessly with new and very inexpensive tools.

We want to blame our obesity on low thyroid or incretin (gut hormone) insufficiency or insulin use or any number of things. And while these conditions do affect metabolism, they will be accounted for in one’s personal energy balance formula. Understand that we’ve not changed genetically. Our burgeoning waistlines do not signal changes in the genome. In nature, genomes change very slowly. When we examine the triad of energy intake, expenditure and stores, our ability to store is basically unchanged (unless enhanced by insulin, for instance), while our energy intake and expenditures are markedly altered.

Let’s break this down: energy balance as the interplay between energy intake (calories in), energy expenditure (calories burned) and energy stores (body fat). When weight is stable, there is energy balance. Metabolic rate, food intake and physical activity affect our energy balance. When exercise increases - increased food consumption usually follows. When energy intake is restricted, energy stores are mobilized or hoarded. Changing one component affects the other two.

Nothing new or compelling here LB. But wait - there’s more!

First: Energy Intake = calories in. You know this - our diets have changed and we eat more processed foods. They are calorically dense and nutritionally deficient, our tummy does not get the “enough” signal and we keep eating,  unconsciously looking for nutrients. Some foods are engineered to be “addictive” - like soda for instance. Hidden beneath that sweet fizz, is lots of salt - which drives thirst - that 7-11 hopes will result in the purchase of another Big Gulp.

As weight increases, so does energy expenditure to move that larger body - fueling the Fit-Fat myth. That myth has been busted in a longitudinal study looking at the 10-year consequence of living obese.

One of my colleagues is on a one-month challenge to eat every meal at/from home - no take-out, no eating out, no meals on wheels. Homemade meals - what a concept. His shirts are looser after just ONE WEEK!

Track energy intake. The easiest ways to make a change is to first examine what you are doing. Study after study demonstrate the value of food logs. There are numerous, free, food APs for phone and computer that make tracking as easy as pushing a button - literally. My personal favorite is MyFitnessPal - an AP that lets me easily track proteins, calories, salt, and phosphate. Visit: http://www.myfitnesspal.com 

Notice if you are feeling resistant and resistance right now. What says the chatter in your head? That chatter likely says nothing new has previously stopped you.

Second: 
Energy Expenditure
= caloric burn. 

I will outline four easy calculations resulting in the approximate number of calories required to maintain weight and the number of calories required to lose weight. Bear with me; it will be worthwhile.

Let's do the numbers
Basal metabolic rate (BMR) is the number of calories burned at rest. BMR is different for each person and largely related to height, weight, sex and age. I am a small, active woman. I notice that consuming 1200 calories/day will maintain weight and more than that results in weight gain. To lose weight, I must cut calories down to about 1000/day. Out of curiosity, I used a BMR calculator and it confirmed my experience and what I just reported here. My BMR = 1091 calories/day. You know - it doesn’t take a lot of calories to keep this crotchety little carcass cruising.

How is this helpful?

Step 1: Go to http://www.myfitnesspal.com/tools/bmr-calculator  , plug in your numbers to calculate your BMR.

Step 2: Calculate your metabolic factor (MF) according to the table below. 

But first, some definitions to help distinguish slow, moderate and fast metabolism. 

Slow Metabolism: You look at food; you gain weight. You can gain weight eating salads and have great difficulty losing weight. You take diabetes medications or have low thyroid.

Moderate Metabolism: You can gain or lose weight if you try. Maintaining a stable, healthy weight takes intention and conscious eating but is not a problem.

Fast Metabolism: You are the skinny guy or gal who can eat ANYTHING. Gaining weight is difficult. Losing weight can happen overnight. You seem to shed pounds watching the X-Games on TV. 

Over 40 years old: 

Slow Metabolism- use 20% as your MF

Moderate Metabolism- use 30% as your MF 

Fast Metabolism- use 40% as your MF

I put myself in the moderate metabolism category: stable weight, no hardship in gaining or losing weight. So I use MF = 30%.

Putting it all together.

Step 3: 

BMR X MF

 (My BMR)1091 X 30% (my MF) = 327 calories

Step 4:

BMR + (BMR X MF)

(My BMR) 1091 + 327 (# calculated in step 3 above) = 1418 calories (intake to maintain current weight)

These calculations tell me that theoretically, I need 1418 calories to maintain my current weight with my current activities. That is not my experience of self. So… I must be eating more than I think - a common malady. Rx: food logs.

I noticed that every year it becomes harder to eat with impunity,  more difficult to stay slim and svelte because BMR decreases as we age. This occurs in part because of decreasing muscle mass. At rest, muscle burns more calories than fat. Want to increase BMR and burn more calories, even at rest? Build muscle. Likewise, depriving oneself of calories (by extreme dieting) in hopes of losing weight, lowers BMR - and the body hoards every calorie its fed, foiling the best laid schemes o mice an’ (wo)men.

What has changed in energy expenditure? 

We get older, lose muscle mass and move less. 

As a society, we are more sedentary. Bassett DR et al. studied an Old Order Amish community - who continue to live as they did at the turn of the 20th century and where obesity is nonexistent. He had them wear pedometers and found that in the course of their normal day, the men logged 18,000 steps or 9 miles/day. The women logged 14,000 steps or 7 miles/ day (3).

In modern times, knowledge-based jobs have turned our labors from physical to mental. Daily energy expenditure has decreased dramatically. The average office worker walks only 2000-3000 steps/day. Denizens of Colorado, the trimmest state in the union, walk an average of 6,500 steps/day. Despite that, they are seeing a rise in BMI.

Blue Cross of California - San Francisco installed two walking workstations about 18-months ago. My girlfriend started working on one for 2-hours/day. Her steps/day skyrocketed from 2000 to 20,000 and she lost 70# in 12-months. Every time we talk on the phone, her side of the conversation is mostly laughter… she laughs… incessantly.

Track energy expenditure. A simple $10 pedometer will do. A $60 FitBit will track your movement, calculate caloric-burn based on your personal data and allows you to log caloric intake onto their website. Their software will crunch your numbers. MyFitnessPal and FitBit can also be paired. (MyFitnessPal's food database is superior.)
I’ve been wearing a Nike FuelBand for just over one year; this is what I’ve learned. In the course of a normal workday: parking at the far side of the parking lot, always using the stairs, walking 1.6 miles at lunch, I take only 5,000 steps/day. On the days I eliminate my lunchtime walk, my steps drop to a dismal 2500/day. That’s useful information. I am more sedentary than I ever imagined! The FuelBand makes me keenly aware when my energy intake exceeds my energy expenditure. No secret - that will result in weight gain. None of this information is useful or valuable for information’s sake alone. Its only valuable if I use it as a change agent. I am more conscientious now about attending evening yoga or taking a short run on those days of minimal movement/steps.

Notice if you are feeling resistant at this time. But I can’t walk, my knees hurt or my hips hurt or my back or… Most bodies feel better when they move. According to our triad of energy balance as the interplay between energy intake (calories in), energy expenditure (calories burned) and energy stores, one must move - daily. A regular exercise routine can increase BMR, improving health and fitness as the body's natural ability to burn energy gradually slows. There are myriads of workouts: for people in wheelchairs, in water to support joints, gently for the pregnant, stretching for the injured, etc. There IS an movement program for you - FIND IT! 

Move in a pool, move on a mat, 
Move in a chair, move with your cat, 
Move on the stairs, move down the hall, 
Move while you can or you won’t move at all.

Third: Energy Stores 
The dominant strategy of the last few decades is to eat less, matching low caloric intake to low caloric expenditure and thereby depleting energy stores (fat). There’s lots of evidence that as a long-term, solo strategy, caloric restriction does not work. Why not?
Hunger. We can only calorie restrict so much before we become hungry. When I eat 1000 cal/day - I’m hungry.  My tolerance for that is finite. Medical fasts like OmniFast / MediFast = 996 cal/day. (This is that magic number below which our bodies switch into starvation mode and lowers BMR to hoard every calorie, making weight loss very difficult.) People lose weight on these fasts but don’t keep it off unless they add energy expenditure (caloric burn = exercise) to their program.
Energy expenditure decreases with weight loss (depletion of energy stores). What does that mean? It means, that as weight drops, it will burn fewer calories at rest and caloric intake will need to drop in unison to maintain weight loss. 
Let’s say I drop six pounds, my BMR will also drop and my maintenance caloric intake will drop to 1390 calories/day - a drop of 30 calories = 1 small piece of dark chocolate.
A 10% reduction in body weight requires a permanent, daily, 200 calorie restriction to keep the weight off. A 15% body weight loss requires a 300 calorie restriction. Try restricting calories by 300, every day, for the rest of your life. Its difficult to do and we get hungry. Weight maintenance can be achieved by eating less, exercising more or both. The people who have been most successful in keeping the weight off, have made up the difference not in continual restriction, but by increasing physical activity. 
Data tracking provides up-to-the-minute feedback that can keep you on target. I can evaluate foods before I eat them. Am I still on track or should I alter the portion size? Can you see that simply stepping on the scale each day is only one part of the equation and an after-the-fact metric? Tracking energy intake and expenditure in real time is easy and exponentially more powerful and meaningful.

Fourth: Baby steps or small behavioral changes
Big changes have not been shown to be sustainable for the masses. Hill and Ayoob recommended making one, small change each month.

Purchase/obtain the two basic tools: some sort of pedometer and a food log AP. Start wearing the pedometer and filling in your food log.

To stop or prevent more weight gain, burn 100 cal more/day than you currently do. This is a good first strategy and great place to start. How would you learn your current energy expenditure? Pedometer, FitBit, FuelBand, etc.
Theoretically, burning or restricting 3500 calories/week = 1-pound of weight loss/week or 4-pounds/month. That’s 500 calories/day and that’s a lot. That could be a combination of burning 250 more calories/day AND restricting intake by 250 calories/day.
Weight Watchers (the most successful program in the US) recommends weight loss of 2-pounds/month. That’s 250 calories/day - some combination of burning 125 more calories each day and reducing intake by the same amount… that is VERY doable.
Walking 2000 steps/day at a moderate pace is approximately 1-mile and 57 calories (for my height and weight). I would need to walk 2-miles each day AND decrease my calories by 130/day to achieve a 2-pound weight loss in 1 month.
Stop drinking sodas/juices.
Clean out then restock your refrigerator and pantry with healthier default snacks/foods.
Planned eating. Plan menus - studies show spontaneity is not your friend and grabbing take-out on the way home is rarely good for you or your waistline.
Planned physical activity: park in the farthest parking spot, take the stairs, walk at lunch, go to Zumba, Boot Camp, yoga, run, etc.
Find your Tribe: Join with others - its more fun and you will be more reliable if you are accountable to others.
Change in attitude: not if but WHEN am I going to be active today?

Don’t want to do the math? Use the default below. 
Women: start at 1500 cal/day including five fresh fruits and/or vegetables. 
Men: start at 1800 cal/day including five fresh fruits and/or vegetables. 
When was the last time you ate something raw and fresh?

Last year Kaiser North Valley (greater Sacramento and Roseville) extended an invitation to employees to participate in an exercise pilot program. Each employee would be given a FitBit and be asked to log food and exercise. Of course I applied and was summarily refused, “We are looking for people who are less active.” Harumph!
Apparently the pilot went well. You know, when you measure - you gain insight. Measure energy intake, measure energy expenditure, that’s what the FitBit does. Last week, North Valley Kaiser kicked off a larger exercise pilot program to include every willing, clinic employee. Those who registered were given a FitBit. 
Coincidentally, I’ve been thinking about willingness these days. Am I willing? Am I willing to be: kind, work hard, compatible, generous, thoughtful, loving, motivated, active, responsible, encouraging, supportive, bitchy, mean, snarky, spiteful, vengeful, etc., etc., etc. Willingness seems to be at the crux of everything. What and who am I willing to be?
I am willing to be a partner in vitality and health! I’m hoping to join a Kaiser FitBit user group with lots of friends and cheerlead them into moving more and smarter eating. Move More; Eat Smart!

Parting shots: 

A healthy lifestyle is nothing more than a series of healthy habits practiced over time. 

Its not difficult - its different.

Insanity: doing the same thing over and over again 

and expecting different results. ~ Albert Einstein 

1 http://www.advancedpractice.com/energy-balance.aspx

2 http://aadi.joslin.org/content/bmi-calculator

3 Bassett DR et al. Med Sci Sprts Exercise 2010:42(10)1819-25

Glass of Wine? - Rethinking Drinking

Americans Drink Too Much, my online medical journal simply stated. You’re telling me? I live in California where wine is poured like water.
“I am shocked at the number of elderly that drink daily,” I said during my recent trip home. “They come into the Memory Clinic concerned about their memory and they drink alcohol daily.”
“So? I drink daily,” someone said.
“Here’s the problem with that,” I said. “People develop a habit and then when they are 70, their liver is 70 and can’t detox the alcohol. Daily alcohol consumption can mimmic dementia. And drinkers have a higher incidence of dementia. My friend’s wife fell and broke her hip after several glasses of wine. That’s a preventable injury and subsequent surgery. Now she’s unstable and more prone to future falls - and she still drinks! A habit of daily drinking leads one-way.”
“That’s not true,” another defended. “What about all those European countries where people start drinking at an early age? And Germany, where they drink beer instead of water? They don’t have problems.”

Buddha said comparison is the source of all suffering and such comparisons are ludicrous in my mind. Nonetheless, I had to concede I had no knowledge of Europe’s alcohol problems excepting caricatures of Russians with Vodka and the brawling Irish. The topic is one of personal interest and angst - so it niggled and gnawed, begging to be plucked like the burr beneath the saddle.
After 35-years in nursing, (yes, University of Hawaii 1979), I realize my perspective is skewed. I have worked daily with the carnage of poor choices and unfortunate missteps. I know my lifestyle choices and judgements are shaped by the pool of human suffering in which I wallow.

Let’s start with defining the standard and the problem. Alcoholics Anonymous (AA) defines an alcoholic as one who cannot stop or one who drinks to physical, mental or social impairment.
The diagnostic medical criteria for alcohol dependence follows. A maladaptive pattern of alcohol use leading to impairment or distress as manifested by three (or more) of the following occurring at any time in the same 12-month period:
1) tolerance = need for increased amounts of alcohol to achieve intoxication or desired effect, diminished effect of alcohol with continued use.
2) withdrawal symptoms when alcohol is stopped or… the inability to stop.

A standard drink is defined as 12.0 oz of beer, 5.0 oz of wine, or 1.5 oz of liquor. A commonly cited standard developed by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommends that healthy adult men aged 65 years or younger have no more than 4 drinks per day and no more than 14 drinks per week and healthy adult women and all adults older than 65 years have no more than 3 drinks per day and no more than 7 drinks per week. [2]
Contrarily, The Centers for Disease Control and Prevention, defines heavy drinking as consuming more than one drink per day for women and two drinks for men. Their definition of a standard drink is consistent with that stated above.
The way to use such recommendations is as a benchmark against which to measure one’s self. Adjust alcohol consumption down to the recommendation. Why? Because there is good data that you are cruisin’ for a bruisin’ if’n you don’t.

So what about Europe?
There are countries that drink socially and moderately and there are countries that ritually binge drink. Binge drinking or heavy episodic drinking or getting shit-faced is a modern epithet for drinking alcoholic beverages with the primary intention of becoming intoxicated by heavy consumption of alcohol over a short period of time. [1] 

An almost exclusively Y-chromosomal activity favored by the collegiate, binge drinking is the source of alcohol intoxication resulting in well publicized, frat-house deaths. (As an aside, the upcoming Superbowl Sunday will provide a magnificently sanctioned opportunity to view this arm-chair, sideline sport by those well beyond frat-house pubescence.)

The Organization for Economic Co-Operation and Development assesses per capita alcohol consumption around the globe, detailing consumption of alcohol in liters per year. The most current and complete data set is from 2009. All but one of the top 16 countries are European. The US is outside the top 20. Such measures are considered non-medical determinants of public health. [3]

Luxembourg 15.3 (down from 17.7)
France 12.3
Austria 12.2 (down from 12.9)
Czech Republic 12.1
Estonia 11.9
Germany 11.7 (down from 12.4)
Hungary 11.5 (down from 13.2)
Spain 11.4 (up from 10)
Ireland 11.0 (down from 13.4)
Slovak Republic 10.7 (down from 11.0)
Slovenia 10.5 (down from 12.2)
Australia 10.3
Poland 10.2 (up from 9.1)
Portugal 10.2 (down from 12.2.)
UK 10.2 (down from 11.4)
Denmark 10.1 (down from 12.7)
Russia 9.29 (2006 - no current data)
US 8.7 (up from 8.4)

So what about Europe?
The current downtrending of alcohol consumption across Europe may be attributed to economics (Eurozone crisis and failing economies) more than any movement to curb drinking. Notice that no third-world countries appear on the list. Economically challenged countries, whose citizens have limited discretionary funds, buy food and consequently have low rates of alcohol consumption.

Alcohol abuse is considered one of the biggest social problems in Germany, where beer is about the same price as water and public imbibing is common as well as legal. Their drinking age is 14 (if drinking beer or wine in the company of parents) - one of the youngest in the world. Further, German laws regulating alcohol use and sale are some of the least restrictive worldwide. Has the ease with which people can consume cheap alcohol created a harmful drinking culture?
Alcoholism is a significant problem in Germany, according to Peter Lang, head of drug prevention and abuse at the German Center for Health Education. "A common misperception, both in Germany and the US, is that if you only drink beer or wine, you cannot be an alcoholic," he said. "This seems to be an even more prevalent attitude here in Germany where one in five Germans has an alcohol problem.”
The deaths of 73,000 people aged 35 to 65 could be traced back to “alcohol-related health problems” annually, which is about one fifth of all deaths. For men, the figure is roughly one in four.

The reputation that the French drink in moderation appears misleading after a report revealed alcohol is responsible for around 49,000 deaths in France each year - that's 134 each day. The report was published by the European Journal of Public Health.
Catherine Hill, one of the authors of the report summed up the findings simply by saying "the French drink too much”. The stats, based on the year 2009,  revealed that three times as many French men died as a result of an alcohol related health problem than women.
Forget defending American libations with European impunity. Dat dawg don’t hunt.

“Alcohol consumption is the direct cause of nearly 80,000 deaths in the Americas each year, according to a new study.”
Published in the journal Addiction (January 2014), researchers looked at alcohol as the cause of death by examining death certificates, over a two-year period in 16 North and Latin American countries. Men accounted for 84% of alcohol-related deaths.
Maristela Monteiro, study author and a senior advisor on alcohol and substance abuse at the Pan American Health Organization, says people are drinking too much and "it's killing people before they should be dying. These deaths are all 100% preventable,” she says. 
“This is just the tip of the iceberg,” Monteiro said. “Of course there are many more alcohol-related deaths from injuries, traffic accidents, violence, and also chronic conditions – where alcohol has a role but is not the only cause. But the data does not cover that.  We’re only getting the most severe cases.”
Get that? The data does not capture deaths caused by trauma related to vehicular manslaughter or homicide or suicide or chronic conditions (liver failure, cerebral encephalopathy) where alcohol was a contributor but not the primary cause of death.
Excessive drinking is associated with a profound social harm, economic costs as well as increased disease burden.
“We know how to reduce mortality – with population-based policies, controlling availability and increasing price,” Monteiro said. “We need to prevent people from getting to that stage where you have alcohol dependence or you die.”

Alcohol flows through my bloodlines. My Chinese gung-gung (grandfather) is remembered by all as a happy drunk (but a drunk nonetheless) who slept when his guzzling exceeded his liver’s capacity to detoxify. His son, my Uncle, was similarly inclined, singing and strumming his ukulele until he slept and met his early demise, the cause of which rested in his tightly clutched bottle. 
Tales tell, when drunk, my paternal grandfather was meaner than a junk yard dog. My father hated his father - who was no father to his kids, the unfortunate byproducts of another favored activity. I never met one Bacon with a kind word for Grandpa Bacon. And as hungry as his children were, they do remember Pa was never without cigarettes and booze. Fact is, moonshine killed his eldest son at the age of five and his daughter, my aunt, died prematurely from liver failure related to cirrhosis and alcoholism.
I come from a family of alcoholics - both living and dead. Any wonder why I am a controlling shrew in this regard? My past colors my future and while I am no teetotaler, I am measured and careful. I resent being handed an alcoholic beverage without consent and I have been known to return an untouched glass of wine to the bottle.
While neither of my parents were alcoholics, they were raised with alcoholic fathers and learned accommodating, enabling (co-dependent) behaviors… and passed them down. We learn these behaviors at mother’s knee and carry them into adulthood. I was a safe, accommodating place for an alcoholic to land… and I suffered. I didn’t see it for years, sometimes still don’t. More recently, I have worked diligently and methodically to remove the alcoholics from my inner circle. I find I swiftly judge people based on drinking frequency and/or impairment.
At a recent Christmas party, I met a woman who became more verbose with the hour. Toward the end of the evening, with just five people remaining, when meaningful conversations were both possible and probable, this woman hijacked every sentence into a story about self, frequently rising from her chair to enact parts of her tale. After 60-minutes, when it was clear that we were naught but the audience for her monologue and that dialogue was unlikely, I excused myself. She invited me to join her for a future evening of dancing. I don’t think so. I don’t know how much she drank nor do I care. Tis a harsh reality that I am beyond welcoming another into the fold.

People do not decide their futures, they decide their habits and their habits decide their futures.  ~ Frederick M. Alexander 

Next steps:
If you drink daily, stop. I am not instructing you to stop drinking, I am instructing you to stop drinking DAILY. If you can’t stop - get help.
Men, if you drink more than two drinks/day or 14 drinks/week - cut back. If you can’t cut back - get help.
Women, if you drink more than one drink/day or 7 drinks/week - cut back. If you can’t cut back - get help. [4]

A healthy lifestyle is nothing more than a series of healthy habits practiced over time. Its different - not difficult.

Who I am is vitality at every age and any stage 

- for me, for us, for all of us. 

Ask me how.

[1] Renaud, SC. (2001). "Diet and stroke". J Nutr Health Aging 5 (3): 167–72. PMID 11458287.
[2]http://pubs.niaaa.nih.gov/publications/RethinkingDrinking/Rethinking_Drinking.pdf
[3] http://www.oecd-ilibrary.org/social-issues-migration-health/alcohol-consumption_alcoholcons-table-en
[4] http://www.aa.org/?Media=PlayFlash

YuleTidings 2013

Season’s Greetings, Mele Kalikimaka e Hau ‘oli Makahiki Hou!

I hope the Season finds you in high spirits and good health.

LBz year in review: Quite simply, I have been consumed with learning a new job, home projects and yoga.

Job first: our Memory Clinic is only one of two in all of Kaiser Permanente, Northern CA. Locally, UC Davis and Sutter also have memory programs and the field grows with demand. Ours is a multidisciplinary team including neurologist, nurse practitioners, social workers, pharmacists and medical assistants.

As the bearers of bad news, we often find ourselves convenient targets for anger and frustration - particularly surrounding the issue of driving. I remember my Uncle Bill selling his car with little fanfare, following his first accident. Wise man he, he had the good sense to know that in his early 80’s, driving perhaps required more dexterity and reflex than he possessed. 

But hey - we are not equanimous and sagacious Chinese men. We are American cowboys and we intend to ride our Mustangs into the sunset… or oncoming traffic, whichever comes first. Nor do we well suffer the indignation and sequestration of keys to said horseless carriage.  

Its… difficult and a daily opportunity to bring equanimity to our Memory Team. I can more quickly identify those situations that raise my hackles. “Its not about me/us,” I say, “Don’t take it personally.” Our team Neurologist Dr. Wong, is terminally joyful and a constant source of inspiration in this regard. Remember the idiom: like water off a duck’s back? Like that.

Of Kaiser Permanente: I recently attended a presentation to educate all employees about the ACA (Affordable Care Act) and our positioning in the ACA marketplace. We celebrated what we do well and looked at areas for improvement. 

I was shocked to learn that outside polling reveals non-Kaiser members view our care as substandard and doctors as mediocre. They falsely believe they cannot choose a Primary Care Doctor and that care will be fragmented and disjointed because they will see a different doctor at every visit. This could not be further from the truth.  

Conversely, our members (including employees) consistently rank KP the best place to work and receive care. Medicare concurs, ranking us tops in providing care for seniors. It is no mistake that Kaiser Permanente, Mayo and Cleveland Clinics are models for a new healthcare system. 

The Leapfrog Group, a national, employer-based organization that recognizes breakthrough improvements in safety, quality and affordability in healthcare named my workplace, Kaiser's Roseville Medical Center, “Top Hospital” for an unprecedented fourth year in a row. We are one of just 90 hospitals nation-wide to receive this recognition. 

So why does our poor public persona persist? Its a good question and one we are challenged to tackle. You know, Kaiser Permanente is the water I swim in - wearing rose-colored goggles, no less. I’d be very interested in the opinions/perceptions of those who drink no Kool-Aid. 

(Tap the pictures to expand.)
Home projects: For the last decade, I have straddled two healthcare systems and worked two, part-time jobs with split days off. Now I work a single, full-time job with two, consecutive days off. I find I have the energy to tackle home projects: painting, cleaning, sorting and discarding. 

I’ve had a vision of replacing my carpets with travertine tile. In October, my friend and gen. contractor Wade replaced 2/3 of my flooring with a “mosaic pattern” of travertine. The seemingly random puzzle of stone is, in actuality, a nine-foot-repeating-square. Its more beautiful than anticipated and lends a look of unexpected elegance. The acoustics are completely changed; like singing in the shower, egging me on - pity my neighbors.

After completing the floors (the remaining stone sits stacked on my lanai), the next big home improvement project will replace the back wall of my house with glass - inviting the outside in. I live against a greenbelt and wildlife preserve. Opening my home to the preserve will alter the space like nothing else. Can I just say - it feels sooo good to have my home become an expression of self.

Summer’s backpacking trip: This year, we hiked the Pacific Crest Trail (PCT) from Sonora Pass south into Hetch Hetchy Reservoir (Yosemite), just weeks ahead of the Yosemite Rim fire - California’s third largest wildfire ever. The trail was hot and dry, full of kindling, making for heavier packs as we carried more water.

Hetch Hetchy

A “fire ban” prohibited all fires excepting camp stoves but that did not stop some from starting and stoking camp fires. (Not unlike hunters that similarly started the Yosemite Rim fire weeks later.) We left the PCT to follow the water as it dropped directly south into Hetch Hetchy and were treated to stunning vistas of granite and water and deserted campsites on pristine lakes. Worth every aching muscle - eh Moose?

I am already registered for 2014’s trip of a lifetime. I am hiking the Haute (pronounced “oat”) Route through the French and Swiss Alps - from Mont Blanc to the Matterhorn. This is a bucket list trip for me and I am sooo excited. The actual hike is eleven days at altitude. Then I’ll to fly to Norway for the last of their hiking season in the fjords. I’ll be in Europe five-ish weeks. Lotsa walking, no tours - my kind of trip. I did find a Norwegian base camp  with intriguing/inviting tree-yurts. I’m opting instead for a hotel in Stävän’ger. No falling from tree-yurts!

"Crow"

Handstand

"Running Man"

Yoga: I’ve been practicing yoga regularly for 20-months - gaining strength. Leap (and the net will appear) Yoga is three-blocks from home. I practice 6+ hours/week and most Sundays for 3-hours. The practice at Leap is lightly spiritual. 

There, I’ve learned to arrive on my mat, letting go of the day. Sufficiently strong, I no longer struggle through the poses. That allows for appreciating yoga as a moving meditation - bringing focus, stillness, equanimity and peace. There, I have found a community striving to live in the present with kindness and acceptance - a like minded community of many vegetarians with many tattoos. (No pressure to tat-up but I do feel conspicuously un-inked.) There, I am confronted with my aversion to touch and people in my space - and another lotus blossom petal falls. (The yogic equivalent of peeling an onion.) Its all a practice. “Practice makes  practice,” they say.

Jadalyn & Papa Nick

Davin's Honu (sea turtle) & friends

Ohana (family): Nephew Nicholas and wife Lindsey birthed baby girl Jadalyn last December and I am excited to attend her first birthday party. Great nephew Davin is quite the artist, a bent nurtured by his Popo (grandmother), my sister Gina. Niece Lael and longtime partner Darth became engaged with nuptials to follow in 2014. Mom moved into Craigside, an extended living facility, where she is surrounded by many church friends and new friends.

Betrothed: Lael & Darth

That’s my year in a nutshell. Follow my shenanigans on my blog Lorinz Muze at: http://lorinzmuze.blogspot.com. Should you want to be notified when I post, send an email requesting addition to the notification list.

I would LOVE to hear from you - for richness in life comes not from things - but delightfully gift-wrapped in relationships.

At this new year, I pray thee abundance. Abundance of health and wealth and love and joy and compassion and peace - now and always.

Ho’opōmaika’i (blessings) ~ Lorin