Aiming for Optimal Health: Getting started on my personal journey

In the years since completing my formal medical training, I have frequently been confronted with the fact that most* of the treatments I was trained to administer are focused on controlling already existing disease processes. Rarely was there an expectation that I would be helping a patient optimize their lifestyle with prevention of disease being the end goal. I think about some of the statements of those who served as my teachers, remarks about "non-compliance" or patients needing to "take the initiative" and "make changes on their own" because the amount we could accomplish in the very limited time we actually spent together at each office visit would never create change. They were rather resigned to this. And I was starting to feel the same. 

(*I say "most" because I also perform osteopathic manipulation as part of my practice and this hands-on healing modality is something I often use to help restore optimal body structure and function.)

In the fall of 2022, a few things happened that started to shift my mentality dramatically. The first, is that I had suffered a violent assault from my former domestic partner a few months prior and was experiencing a tremendously difficult time moving beyond this trauma and loss of the associated relationship. In an effort to pursue my own healing, I was trying to re-engage with modalities that had served me in the past and decided to register for a 200-hr Yoga Teacher Training to get reconnected with my practice. The second occurrence that pushed me to become more focused on my own health, is that I noticed my clothes were no longer fitting properly. I established with a new PCP and went for a wellness visit for the first time in many years as I reckoned with the fact that I was now solidly middle aged. I was surprised getting on the scale and finding my weight was 10lbs higher than I'd ever known it to be before. No wonder most of my pants were feeling snug, if I could even get them on in the first place. 

Applying my doctor-brain to myself and considering what advice I would give to a patient, I knew I had to make some changes. It was essential for me to deal with the trauma for what it was so that I could escape from the emotional paralysis it had on me. With respect to the added weight, I could accept it as a fact of life in getting older and buy new clothes - which actually seemed viable given that I still wasn't considered overweight by BMI or even an "unhealthy" weight by any medical standard. Or, I could recognize what I see so often in my patients was slowly happening to me too and start to make some changes to keep it from getting out of control. 

A statistic I had come across in my training, is that adults in the United States gain an average of 2lbs of weight every year. Two pounds on its own may not seem that significant and could easily be ignored or taken as a small fluctuation that any one of us may have during the course of a week just due to things like hydration status, menstrual cycles, bloating, etc. But what I cared about was that 2lbs continuing to build, becoming 10lbs in 5 years or 30lbs in 15 years. I know with a certainty that losing 10lbs is a lot easier than letting it go and later trying to lose 30lbs, so I concluded that I needed to take this seriously and lose the weight. 

In mid-December 2022, I began tracking my calories. I decided to use an app called FatSecret as I had learned about it a few years prior as part of a research study that I think was actually looking at the effects of meditation on lifestyle habits. The reason I preferred it to other apps I was aware of is that the free option was rather robust, it felt far less commercialized and less emphasis on trying to push their paid features (though there are some of these available). I used the in-app calculator to determine my RDI in order to achieve slow weight loss. My personal goal was 1-2lbs a month to allow my body to also gradually adapt to this change rather than get to goal quickly and struggle to maintain it. At the outset, I was tracking my caloric intake and expenditure through activity, but really wasn't attempting to modify what I was eating in any way other than to cut myself off if I was at / near / over my limit for the day. 

An additional change I started to incorporate around this same period was time-restricted eating. A lot of attention has been paid to the concept of "intermittent fasting" though the interpretations of what that is and how to utilize it vary widely. For me, my aim was to try to optimize my metabolism in line with circadian cycles and cut out eating late at night. In particular, I was working frequent overnight shifts at the hospital and eating while at work was a pretty normal thing because these are lengthy 12-hour shifts. But I came across a study that indicated night shift workers weigh on average 11% more than our peers who follow the same diet but are working during the day. That was all the evidence I needed to know that the night shifts were working against me. Being unable to change my work schedule, I knew I had to change my consumption patterns instead. On the nights that I worked, I was frequently up during the day as well either seeing clinic patients or attending to tasks at home on the weekends, so it wasn't difficult to shift calories to earlier in the day. I would deliberately cut myself off and stop eating prior to going in to work around 6pm. Initially, it was absolutely challenging to consume nothing but water during those shifts. But gradually, my body adapted and I can honestly say that I no longer feel hungry during my overnights until I'm finishing up around 7am and I'm ready for breakfast as usual. 

With respect to physical activity, I got back into the habit of some amount of regular exercise most days. Most often, this was vinyasa yoga as I was simultaneously going through my teacher training program. I had videos that I followed along with as part of my course but would also do self-guided practice as my additional goal was to get stronger and with greater endurance as a few months later we would have an intensive week of at least twice daily practices and I wanted to feel capable of participating at a high level throughout. My additional go-to for exercise was using a rowing machine at home, usually no more than 15-20 minutes at a time. I appreciate this as an energy intense full-body workout that is also low impact, offers resistance, and allows you to really accomplish a lot physically in a compact period. 

The initial loss was slow going and even though that was my stated plan, I think it is still so common to get wrapped up in the numbers and wondering if what you are doing is really working. It took me a solid 3 months to achieve and sustain the first 5lbs of weight loss, remaining very diligent with my tracking, activity, and time restricted eating. I kept up the daily tracking for another 3 months thereafter (so 6 months total) at which point I had achieved a sustained 7-8lb weight loss. Although this was only half of my original goal, I also realized I could be really happy sustaining at this weight. I was pleased with the physical changes in my body and my clothes were fitting again without the need to buy new pants. Tracking was feeling burdensome and by this time, I already had a pretty good idea of the caloric content of the food I consumed regularly without having to input anything, so I transitioned over to autopilot on that front. I kept up the time-restricted eating, even on the days I don't work overnights, deliberately aiming to stop consuming any calories by about 7pm to allow for at least a few hours to metabolize before bed. My physical activity fell off a bit, though I do still make time for structured exercise at least 2-3 days each week. And I am happy to say that 18 months later, I have sustained this weight. 

Interestingly, it was only through the process of trying to lose weight initially that I eventually started to look more carefully at my lifestyle habits as a whole and my food intake with a greater eye towards optimal nutrition and chronic disease prevention. Within my tracking app, there are breakdowns for macro-nutrients that I started to pay attention to, realizing I was rarely hitting their pre-populated goal ratios for Carbs - Fats - Protein in my daily intake. Additionally, in trying to counsel patients and friends about what I personally did, I became a lot more aware of the barriers for how an approach focused solely on calories in / calories out really isn't hitting the mark for most people. This also drove me to exploring more about nutrition science, impacts of our diet on chronic disease, and the integration of our modern understandings with the ancient practices of Ayurveda. 

I plan to write about more of these concepts in detail over the next few weeks along with my personal experience trying to make additional lifestyle changes and the challenges I have encountered. I know the amount of information out there can be incredibly overwhelming, so it is my hope that seeing the imperfect journey and struggles of even a seemingly "healthy" physician may make it all feel a little more accessible. 

This is a topic I really enjoy discussing with people and am constantly learning more about myself, so please feel free to reach out or post any comments or questions you may have for me. 

Breaking away from the limitations of yoga asana practice

Like many people in the United States, my first introduction to yoga was through studio classes. More specifically, at a studio that specialized in heated power vinyasa flow. Think sweaty people moving through a sequence of poses in rapid progression, attempting to synchronize our breath with the movements and if we were really on fire that day, to those around us as well. From the outset, I recall that my classmates all appeared to be relatively fit and flexible - and seemingly physically capable of WAY more than I could handle in those early days. But I committed to trying to get on the same level, went to as many classes I could possibly squeeze in during my initial 30-day "trial" period (paying for it with student loan money felt extra motivating), and it quickly turned into a regular part of my routine I continued to prioritize for a long time thereafter. 

Interestingly, over those first few months of becoming a yoga student, I noticed everyone seemed to be aiming for increasingly "advanced" postures. Amping up their athleticism with inversions (thinking headstands and handstands) or ever more challenging balances and bends. Unfortunately, at that time, I noticed it only in as much as I was becoming part of it. If someone around me was elevating the level of difficulty, then it gave me something to reach for and I absolutely wanted to do it too! 

Fast forward 10 years with a good amount of personal and professional experience later and I now look at all of this entirely differently. The COVID-19 pandemic and some other personal factors completely took me away from studio classes, which I know was such a common experience it even precipitated many total studio closures. However, for some time before that, I was already relying much more on my individual practice rather than class instruction largely because some of the satisfaction I used to get from those classes had evaporated. 

In the past year, I finally felt capable of completing a 200hr-YTT (initial yoga teacher training certification course) and chose to do it with the owners of that original studio that started me on my yoga journey. This was a very deliberate move on my part, largely because I had watched their approach to yoga transform in those intervening years too. Now, substantially more focused on what we can individually gain from yoga rather than it being treated as a primarily physical pursuit far removed from the roots of what this practice is supposed to be all about. 

Going through that 200hr-YTT, I can confidently say that I ended up doing WAY more than the required hours as every assignment or reading seemed to take me down another rabbit hole to try to learn and understand more about this ancient practice, of which asana is a relatively recent addition. I also became an avid listener of various podcasts with topics ranging from yoga history and philosophy to modern day asana teaching. But the deeper I dug and the more I learned, the less confident I felt about how I had been practicing all along, despite previously striving so hard to be the ideal student and do everything "right." 

I began to FINALLY shift how I was using asana (the physical postures many of us in the West would consider as "yoga"). Rather than treating it as an end game of achieving perfect, physically beautiful alignment in challenging postures, every movement - no matter how slight - began to take on significance. How I moved within my body, how I constricted or permitted the movement of my breath, and how my mind responded to any feelings of imperfection all held significance. And it wasn't just about my time on the mat, but it was a reflection of how I showed up in life every day (and vice versa). 

Maybe this all comes across as incredibly basic to someone who grew up with yoga as part of their household tradition or even others who just managed to grasp these concepts much earlier in their yoga journey than I. But I am truly humbled by how long it took me to FINALLY make some of these connections. And more, that I am just now getting to the point of truly "living my yoga." I am showing up better for myself and others on a daily basis, as a physician, friend, and partner. I am also finding ways to spread this wisdom with patients, largely without any asana practice at all (though I do always recommend it to those who are open to the suggestion). 

Within the past year, I did also make the conscious effort to get back to studio classes. Because within my training, it was becoming apparent that all of us could really benefit from continuing to expose ourselves to different styles and instructors rather than feeling dogmatic about the particular way we were taught or are most comfortable with. Not to mention, on this side of the pandemic, I think all of us could use a little more socialization. I found a new studio that I have been largely really happy with as it has a great vibe, supportive sense of community, and enough diversity in teaching styles that everything felt freely acceptable. Sadly, I'm noticing that same focus on increased athleticism and physical perfectionism beginning to creep in. This time though, I am hopeful that I now have the knowledge and confidence to continue practicing MY yoga, allowing my progression through asana to be the embodiment of how I am attempting to consistently live, remaining mindful and noticing all the small things to my ultimate benefit.