Both... And

At 89 years old, my Grandfather ("Pappy") died this week. For him and for me, his death was a welcome end to the suffering he had endured. With a myriad of health issues, he had been completely dependent on others to feed, dress, bathe and move him. He spent these years living in my Dad's house and, gratefully, was surrounded by family and remained a constant presence in our lives.

Pappy was very special to me, and as the first Grandchild, I enjoyed all of the magic of being the apple of his eye. My response to every quandary was, "My Pappy will fix that" and so I believed without ever a doubt. I am very fortunate to have had nearly 44 years with him and am ever grateful for the example he set: be kind, help anyone in need, have some fun, go on any adventure you find, and meet every challenge head-on. He was my hero.

As we live life, we are often faced with situations accompanied by utterly conflicting emotions. Peacefulness comes from learning to accept what is. Learning to accept what is comes when we learn how to "dance" with two opposites pulling on us at the same time.  Embrace life and live in a world where "both... and" can exist at the same time.

I am very sad my Pappy is gone. I am so very glad he is free.

Chemistry for Dinner

One of my favorite summer recipes is Spinach Quesadillas from Vegetarian Suppers by Deborah Madison. This is a quick dish and as long as you don't use too much cheese and sour cream, a pretty healthy one. With the fresh salsa and corn from the Sunday Farmer's Market in Baltimore, the meal is something we look forward to every time it appears in the weekly menu plan.

When it was almost time to prepare dinner last night, I suddenly realized we didn't have any tortillas so I made a quick trip to the local Giant and given the array of tortilla choices presented to me, I started turning over the packages and looking at ingredients. I was about to buy a chemistry concoction with which to cushion my fresh farm spinach, onion, jalapeno pepper and cilantro. What has happened to our food?

A rhetorical question, of course, as I know what happened to our food and it makes me angry. I was angry last night and I'm still pretty angry about it this morning. Why is it impossible to go to the local grocery store and buy something without subjecting my body to this list of garbage:

Flour tortillas require a very short and simple list of ingredients: Flour, fat (some type of oil), water (or milk), baking powder and salt. I didn't make the tortillas last night - I bought this package and stewed about it all night. Yes, dinner was tasty but I can't help but wonder about the global impact of this kind of systematic and prolific poisoning that happens every day. I wanted to cook a healthful dinner. I wanted to do some thing simple and fast for a Monday evening. I wanted to enjoy the bounty from the weekend farmer's market while it was still fresh and bursting with flavor.

Why is it so darn difficult, if not impossible, to avoid ingesting chemistry for dinner?

Is our healthcare system making us fat?

The growth in healthcare costs and the growth in America's waistlines follow the same path. Up. Yesterday, I asked the question, "Is our healthcare system making us fat?"

Today, I will explain. To be clear, I don't blame the healthcare system for the growing obesity epidemic. I do blame the healthcare system for not making dramatic changes in the 1990s when we realized the managed care revolution wasn't actually helping people get healthier. I blame it again in the year 2000 when the trend was clear. By 2008, we have no excuse. We are spending more and more money for less and less health. We have more healthcare. We do not have more health.

The scary part, to me, is there is no end in sight. Much like the dual-eligibles that are plaguing state budgets all across the country, the obese and extremely obese are expensive. As they age (assuming they get a chance to age), I can't begin to fathom what it will cost to care for the extremely obese elderly. My Grandfather is nearly 90 and completely dependent on my Father and a team of aides for everything he needs. He is too skinny, honestly, as he continues on his slow journey toward death. If he were 200 pounds, my Dad couldn't care for him at home. A nursing home would costs thousands and thousands a year and we'd have no choice. 

The system is broken. We cannot continue to spend more and more money on worsening outcomes. We can't afford to give gastric bypass surgery to 40% of our population. We can't afford the risks and costs of whatever promised weight loss pill a drug company will come up with. While we have the Affordable Care Act (health reform), it will not fix the problem.

The problem, dear people, is all up to you and to me. To our neighbors, to our families, to our communities. We, the people, are the only ones with the power to "bend the curve" on healthcare costs.  We, the people, have to stand beside one another and help each other lose weight and get healthy.

We the people, when we work together, can do anything we set our minds to. Now is the time.

When Called to Help...

Do you know basic first aid? What about CPR? I happen to think both should be taught in all high schools and if you have not learned how it is a life skill worth having. And, I fear it might not be enough anymore. 


Yesterday, there was a gentleman doing some work in my neighborhood and he fell ill. Granted, it was very hot here in Maryland so any outdoor work was unpleasant for the youngest and healthiest among us, but this man was overweight and 64.


He looked to be having a heart attack (with which I'm very familiar) but he said he wasn't in any pain. Clammy, shortness of breath, could barely speak and was clearly in distress. We got him inside in the cool air and called 911. I learned from his co-worker that the man was diabetic so I asked him if he had eaten today. He said yes. Instant oatmeal. I asked if he needed something to eat, thinking his blood sugar was low and he said no. I asked if he had been drinking water and he said yes and that he had also had a gatorade. Gatorade? Odds were he wasn't suffering from low blood sugar with that in his system.


The best I could do while waiting for the paramedics to arrive was to try and cool him down with a cold compress, reassure him help was on the way and he was going to be fine. In the back of my mind, I was reviewing my CPR instructions just in case. The paramedics arrived and I reported to them what I knew. They immediately took his blood sugar and it was nearly 350. I knew that was very high based on my Grandfather's diabetes. I later read that a blood sugar reading over 180 is considered hyperglycemia. This man was very sick and needed insulin. He told us he only took medication which he had taken that morning and wasn't on insulin shots.

I likely won't find out what happened to him. Last I saw he was in the back of the ambulance being well cared for by the Baltimore City paramedics. I am sure he made it safely to the hospital and I hope his poor wife - who he had tried to call at the start of all of this - was able to calmly get to the hospital to be with him.

After my adrenaline subsided, I couldn't help but think... instant oatmeal and a gatorade? For a overweight, 64-year old diabetic going outside to work in 100 degree temperatures? Other than a box of donuts, I would have a hard time picking something more harmful for him to have for breakfast.

Today, I am still wondering about him. I know his name but won't share it to protect his privacy. I wonder if he had insurance... somehow, I suspect no. I wonder if he knew how to care for his health and eat the right things for his diabetes. Again, I don't know that he had ever been told. Or maybe he simply cannot afford something healthier for breakfast. Granted, the American Diabetic Association website actually suggests instant oatmeal as a quick meal-to-go option. It baffles me, but they do. The gatorade is almost entirely sugar and the same website says 1 cup of gatorade is okay for a diabetic who has the cold or flu. I don't think he had either and what are the odds he would have only had a cup anyway? Next to none, given the common bottle sizes. And, let me go on record to say neither option should be suggested by the ADA. 


The health coach in me wants to help this man change his diet and lose the 50+ pounds he needs to banish. The Granddaughter in me knows helping an older individual understand what they can and cannot eat requires a great deal of patience and creativity (I made a special "food count whiteboard" for my Grandparents when Pappy was first diagnosed as diabetic so they could easily keep track of his food). 


There are currently 350 million people worldwide with diabetes. The number of cases continue to grow exponentially. This impacts all of us - our economy and our healthcare system. It also impacts us as people in a community. Along with basic first aid and CPR, we need to learn what to do when someone with diabetes falls ill. I could have very easily given that man a piece of orange or candy thinking his blood sugar was low. I could have killed him.

Health happens in community. Unless you decide to lock yourself away and not venture outdoors, you and I, and all of us, need to come together to answer the call, and be able to render the right aid, when someone falls ill. We also need to come together and stop the growth of diabetes. Otherwise, we'll need Diabetes Care Stations next to the AED machines hanging on walls in airports and malls. 

The Power of Small

Loki and I rounded a corner on our walk through Druid Hill Park yesterday and we were suddenly overwhelmed by a sweet, flowery smell. Yes, even Loki raised his dog nose into the air for a few sniffs. It was remarkable. I peered around and didn't see any large flowery bushes or flower beds which would explain the aroma. Then, I looked down.

Spanning in all directions on both sides of the path were these tiny little white flowers. I will rely on any botanists to correct me, but I believe they are the flowers that come with clover. In many suburban expanses of perfect green lawns, the clover is much maligned as a weed. Yes, some people coat their lawn in chemicals in at attempt to banish this "weed." I'll spare you my feelings on lawn chemicals and the pursuit of the perfect green lawn - for now anyway - as I have another message.

The power of very small things. One of these flowers alone would not have the ability to create the amazing aroma we encountered yesterday. The hundreds and thousands of them together did something amazing.

In our pursuit of health, the ultimate body and the purist diet, sometimes we look for THE ANSWER. The big flowery bush in the garden of life, if you will. Maybe we can learn something from the lowly clover bud. Maybe we can finally recognize our real power really lies within the tiny, small choices we have each and every moment to better our wellbeing.

Crowded Exam Room

How many people are in the exam room when you visit your Doctor? You may be able to count one other individual, a nurse, though that doesn't happen so much anymore. 

What about all the other people you can't see but are there in force? Several people from your insurance company, at least. Maybe a human resources person from your work and your boss wondering when you'll get back to the office. There is usually a person or two from the state medical board, maybe someone from the AMA, an auditor. Could be a few Government people in there - Medicare, Medicaid. Maybe the front desk clerk from the doctor's office wondering why your doctor is running late. Again. There must be a lawyer or two - malpractice insurance. I bet you could count at least five or six local drug reps all with free pills to give away. Perhaps a few specialists, all thinking you now need to visit them for a test or two. Honestly, it is getting so crowded in there you might not even be able to see them all.

Who "owns" the relationship in that room? The trust between a doctor and his or her patient should be sacrosanct. It isn't very often anymore. It can be...

I've recently had a very different experience. Me and my doctor. He is different both in his practice of medicine and his approach to the business of medicine. He doesn't have front desk staff. When you arrive at your appointment time - you simply knock on his door and have a seat until he is ready. He is always on time. Your initial visit with him is 90 minutes. The follow up visits are 30 minutes. He actually takes your blood pressure, checks your pulse, eyes, tongue, heart. You actually talk and explore things in a collaborative way. He doesn't seek to mask symptoms, in fact he welcomes them as clues. He seeks to resolve problems. He has telephone consult hours each morning. He gives you his cell phone number for emergencies. He types up notes and instructions while you're sitting there - he prints them asks you to read them to be sure you understand. You both keep a copy. He doesn't take insurance. You write him a check when you're through. He writes the receipt by hand.

My Doctor practices medicine the way most people who go to medical school want to practice (based on my conversations with many physicians). I don't know any physicians that welcome the involvement and influence from the dozens of people all sent there courtesy of our current healthcare system.

What if healthcare could be like my experience? What if the relationship between patient and Doctor was an actual relationship versus a transaction? We wonder why there are reports of up to one-half of patients not following their doctor's advice (for diet, exercise, medication, physical therapy, rest). Who will listen to someone you spend an average of 7 minutes with? Who can possibly trust someone you don't even know. We have a populace that is very sick and getting sicker. All of the medical transactions in the world aren't going to make people healthier. And the cost pressures continue to mount which we still attempt to resolve through faster, easier, cheaper medicine.

When will we learn? Slower, meaningful, collaborative medicine could be the answer. When a Doctor and patient own the relationship together, good things happen.

Axis of Wellness

HBO debuted "Weight of the Nation" last night and the conversation continues today about the impact of obesity on people and our country. If you didn't get a chance to watch last night you can watch online now. Parts 3 & 4 will be on HBO this evening. It is worth watching.

Our challenge, as individuals and communities, is to find a way to lose weight and get healthy. It matters not if you are overweight, obese or of a normal weight today - this epidemic impacts all of us. Only 1/3 (or less) of people in this country are able to maintain a healthy weight. This is a community problem and it is very complex.

What is certain? Our healthcare system and economy cannot survive the pressures levied by the obesity epidemic.

Now here is the good news: there is no magic bullet - which means you can do something about it right now.  And, here is the bad news: there is no magic bullet - which means the only way to solve this problem is for you (and me and our friends, family, colleagues, neighbors) to do something about it and start right now.

What to do? Here are three things you can do today:

1. Drink plenty of water (and give up any drink containing sugar)
2. Move your body every day and several times a day (even 5 minutes a few times per day is better than nothing)
3. Cook at home more (using real food) and eat less processed food (which is most things that come in boxes)

Your goal is to get into the upper right quadrant of the Axis of Wellness. You can get there by making good choices each and every day. 

You can do it. I believe in you. 

Rule for Health. Rule for Life.

I did an interview last week for Entrepreneurial Fit radio and my parting tip was "Exercise before email." While I had initially written that tip back in 2010, I hadn't used it much lately and over the last few days it is really growing on me.

In the context of the radio interview, I was talking about first thing in the morning. It is far too easy to end up in a place where checking email (or other social media) is the very first thing you do each morning. It is particularly easy for those of us (I'm guilty here) who keep our mobile phone by our bedside. Many mornings before my brain is fully awake, I'm plugging back into the grid and running through my email, Twitter and the Cybercise and Move.Eat.Be. Facebook pages. Inevitably, I'll get distracted by something and end up getting up late and having to rush through my morning exercise to get on with my day.

This is stupid. 

If there was anything so earth shattering that had happened overnight, I trust someone would have called me. And, yes, I'd answer the phone because it is next to my bed.

The exercise before email rule is a great thing to implement first thing in the morning, at least. Even if you only have time for 10 jumping jacks, a five minute yoga or stretching routine, 5 pushups or a walk around the block - it is something for your mind and body and doing so will get your day started on a better foot.

If you want to get really crazy with it, implement the rule for each hour of the day. Many people are realizing that email is a giant time suck and those smart people are transitioning to a "check email once per hour" or (egad) only four times a day. If you are one of the wise, brave souls who has cut the email cords and started such a system you could easily add an exercise before email practice into your life. Every time you hear the email bells ring, you could stop and do five minutes of exercise before checking your inbox. If there is anyone out there brave enough to try this, I would love to hear how it goes.

Seriously, we (by which I really am also guilty here) spend far too much time in front of our computers and far too little time moving our bodies. In fact, I'm sitting in front of my screen writing this on a lovely Sunday afternoon (I'm doing it for you, dear people).  Every small practice you start for your health matters and exercise before email is a great place to begin.

This week, I am going to religiously follow the exercise before email rule each morning. And for now, before I fall victim to whatever email is now sitting there waiting in my inbox, I'm going outside to walk my dog.

Happy Sunday!

Local Cows are Sane

By now, you've likely read the story that the first new case of mad cow disease in the U.S. since 2006 was discovered in a California dairy cow.  I'm certain, you like me, felt safe and reassured in the subsequent news releases saying there was no threat to public safety, this cow's milk wasn't tainted and if it was people can't get sick from the milk, etc., etc. Maybe this is true, but I ask you, is it worth the risk?

Perhaps I have lost faith in the "patting on the head" public statements we often receive. "There, there dear. You don't need to worry your pretty little head about sick cows. Trust us, it will all be fine." Right now, the officials involved are trying to figure out how bad this might be and the meat and dairy associations are in full-blown crises mode working on strategies to prevent consumers from running away from all meat and dairy products. Yes, a consumer boycott would be devastating to their income and there are people and jobs involved here. And, yes, I don't want to consume any products that may have been exposed to bovine spongiform encephalopathy (BSE) (aka "mad cow disease") which is thought to be the cause of a fatal brain disease in humans called Creutzfeldt-Jakob.

Here's the deal. This sick cow was randomly selected for testing. From CNN, "Luckey [VP at company who tested the cow] would not divulge on which farm the animal was found. He said his company tests 1,000 to 2,000 animals a year, which he described as "a small percentage" of the overall number of animals it renders."

Basically, we consumers got lucky they picked a sick cow. The dairy and meat industry drew the short straw this time. This cow was about to be rendered and could have ended up in many, many places including feed for chickens and other livestock spreading the disease further. On in the US does the Government sanction the practice of allowing dead animals to be ground up and turned into feed for other animals. Disgusting.

Please don't ask me to believe this is the ONLY SICK COW IN CALIFORNIA. There are thousands of cows in California and they don't each get a customized diet. Whatever this cow ate that made it sick was also fed to dozens of other cows, at least.

Your best option? Eat local and know your farmer. My grandfather was a dairy farmer and he knew every single cow on his farm. If one of them started acting strangely, he would have quarantined it, called the vet and figured out what was going on well before it had the chance to produce tainted milk or sicken the other members of the herd. Small, local farmers treat their animals with care and respect. They are in tune with their animals much like we are with our kids or pets. Think I'm crazy? Go and visit a farm this weekend. When you talk to the farmer, ask him or her for the cows' names. I had two "pet" cows growing up and named the Cinnamon and Brownie. I was heartbroken when each passed.

In a giant industrial dairy farming operation cows are numbered, not named, they not allowed to roam the pasture and are instead fed a cocktail of drugs, chemicals and feed made from their dead cousins. A sick cow is something to be disposed of not something to be mourned.

You are your own best defense against mad cow. Talk to farmers. Know your food. Eat local. Now is the perfect time to start - farmer's markets are everywhere.

Chat and Challenge vs. Test and Treat

As the Supreme Court begins their debate on PPACA (aka health reform) today, I thought I would challenge us to think about how our healthcare system can be different. The health reform legislation doesn't go far enough to transition our disease-care system into a system which takes care of people's health. We need a self-care system which uses our health and medical professionals to help each person learn how to take the best possible care of their own health.

Our current "disease focused" system is all about treating the ill. When most of us visit our doctors, we do so to share a complaint and seek relief. Pain in the knee. Digestion issues. Trouble sleeping. For many of these issues, the standard operating procedure is to run a few tests and then write a prescription. In 2010, Americans spent over $300 billion on prescription drugs. I call this the "Test and Treat" system and it won't help us get healthy.

I am not blaming the doctors here. In order to cover the costs associated with complying with the rules of the disease-care system, doctors must see as many patients as possible each day. Most doctors did not go into medicine to become a manufacturing plant (see my earlier blog on the factory of medicine), they went into medicine to take care of people. But in our "test and treat" world, the patients want quick relief (without changing their habits) and the doctor needs to get onto the next patient.

There is another way. I call it the "Chat and Challenge" approach to health. As we all know, most of what ails us stems from lifestyle choices. Poor food choices and lack of exercise top the list and this isn't the focus of most of our doctor visits. We need to redesign the system so each person belongs to a wellness community. The wellness community includes personalized coaching, implementable plans for getting more exercise and eating well, classes to fill the gaps in personal health knowledge and medical professional (doctors, nurses, etc.) to take care of medical issues. During a visit, each person engages in a conversation with the members of their wellness team. The wellness team chats with the person and then challenges them to make small, specific, personalized and positive changes in their health (ala Tiny Habits by Dr. BJ Fogg).

Everyone's life is different and people, by and large, want to feel great. Let's have a chat and challenge ourselves, and each other, to imagine a different world.

Wellness for Road Warriors

I've been a road warrior for over 20 years. Some months I'm on the road every week and for some glorious months, I rarely travel. For those who also travel you understand the glamour lasts about 2 days... on your very first trip. After that brief honeymoon period is over you realize how difficult travel can be, particularly on your health. Let's face it - when we travel most of us don't get much exercise, we are forced to eat out and our sleep usually suffers. Since I'm on a mission to save the healthcare system by helping people get healthy, I thought I'd share some of the things I do while traveling to help me stay healthy.

Before Your Trip

1. Packing. I take workout clothes on every trip. I don't use them 100% of the time, but having them along is an excellent start. The invention of the Vibram five finger running shoes has made this so much easier. These little gems are great for shorter runs and barely take up any room in your bag (I never check luggage so space and weight is crucial). If you buy a pair, give your body time to adjust to them. If you're a regular runner, I would start with an easy mile or two run on the treadmill and build up from there. If you're not a runner, hop on the treadmill and walk in them. Start slow and soon you'll wonder what you did without them. 
2. Snacks. My go-to travel snack is unsalted, roasted, organic almonds. Akin to the phone charger for my body, these go into a ziploc bag and go along. Choose the travel snack that works for you but the idea is to choose something nourishing and healthy. Nuts and seeds are a great idea. For early morning flights I also may take a peeled hard-boiled egg in a little plastic container. Avocados travel well, as do apples. Whole, real, natural food is your best choice. While a few health bars are actually healthy, I still like to stick with real food while I have access at home. 

At the Airport

1. Water. I think the water bottling companies are in cahoots with the TSA since you can't carry even sealed bottles of water through security. Water, once through your strip, pat, and scan down, is very important. I drink at least 12 ounces on the way to the airport (and am sure to leave some in my car for the return trip) and I buy at least 20 ounces while at the airport. I also have a Vapur which is stashed in my bag and I'll sometimes fill that up at the water fountain. Do not rely on the airline to give you water. Period. Take some onboard. 
2. Walk. Once through security, I head to my gate (stopping for water along the way). Once at my gate, I confirm all looks well (flight on time, gate hasn't changed, either an airplane there or people who look like they expect one) and then I walk. Sitting and waiting for a plane so you can sit during your flight always seemed a bit silly to me. Use your waiting time for walking and get a little exercise. 

On the Plane

1. Drink water. You carried on board, now drink it. Your goal is to finish your last sip of water when the airplane door opens at arrival. 
2. Skip the Airline Snacks. You have also carried on your go-to snack of choice, so enjoy it. This will help you avoid whatever food-like items the airline is either giving away (not common any longer) or selling from the back of the in-flight magazine. For longer flights, I sometimes pack a little picnic. Yes, I get some strange looks from the people around me but I like to think I'm setting a good example for others by munching on my salad with quinoa. 

In Route

1. Find food. For my longer trips and if I have a rental car, I find a grocery store. iPhone is my friend and I do a quick search for a grocery store on my route from airport to office or hotel. My first choice is Trader Joe's. Once there, I buy non-perishable real food such as fruits and vegetables. If I have access to a refrigerator (or feel like getting ice at my hotel to keep things cool), I may expand my purchases. The idea is to have something for breakfast and snacks to help you avoid making bad choices in other places. Also, buy some water - likely cheaper here than anywhere else you'll be. If you have a water bottle along, buy a gallon jug. Cheap and good for the planet.

At the Hotel

1. Find the gym. Most hotels now have a fitness room. After check-in and on the way to my room, I do a little walk by the hotel gym so I know where it is and I know what kind of equipment they have, how much room, etc. This information helps me better plan my workout. If it is a small gym and I have flexibility in my schedule, I'll go there during off peak hours so I don't have to wait. 
2. Get more water (if you haven't stocked up in route). Yes, the in-room water might be outrageously expensive, but if your choice is nothing or that, spend the $5 and be hydrated. Your body will thank you. Better yet, find a convenience store nearby and buy several bottles and keep them handy. Drink water frequently - even more so than your healthy habits dictate at home. Flying is dehydrating. Hotels are dehydrating. Your body needs extra water while you travel. 
3. Workout. My schedule is different in each city so I have to plan my workouts. Sometimes the night I arrive, sometimes the next morning, if I'm lucky after work. The point being, look at your schedule and make an appointment with yourself to workout. Say you have another conference call if you have to protect the time from well-meaning invitations. Make the time. If you're a member, Cybercise.¹

At the Office

1. Skip the Breakfast. The universal office breakfast is donuts, bagels and other sugar-laden "food-like" items. You've had your fruit, nuts and water. You do not need the sticky bun. Just say no. 
2. Walking Meeting. If you're brave, suggest a walking meeting. This is a great way to have a chat with one to two people. If gets you all outside and you may find the act of exercising your body helps your mind get more creative. 
3. Lunch carefully. Lunch brought to you by the same people who tried to poison you during breakfast. Lunch is typically riskier as many companies have lunch brought in so you can have a working lunch (travesty of justice, I think). Most of these lunches are sandwiches and chips or worse yet, pizza (a big dose of thanks to my long-term clients who know I prefer salads for lunch and are sure to have something there for me). I'm sure your Grandma told you to eat what people make for you, so you may have little choice other than eating whatever is presented to you. Whatever it is, eat half of what you normally would. If you're doing the no-bread thing, split a sandwich with a vegetarian (you get the meat, he gets the bread). Skip the chips. Drink more water. And whatever you do, don't drink the soda. If you have your Vapur with you, find the water cooler. Every office has one. Or make a cup of hot tea. 

After Work

1. One Drink. The compulsory "let's go out and have a drink" post-meeting routine. I happen to enjoy a workout after work, but seldom have the chance. The "leave the office and head to the bar routine" is common so you may have to make the best of it. When I arrive at the bar, I'll order a sparkling water while I "think about what I want to drink." That gets a water in my system and takes some of the have a drink pressure off. When round 2 comes by, I'll usually have a glass of wine. If there are more rounds, I transition back to sparkling water. Sometimes people say something. If you're brave and know the people well tell them you have a one drink rule while traveling. If they'll think you're weird, make something up. As I said at the beginning, traveling isn't always glamourous and sometimes we have to lie to protect our own health. 
2. Sleep. Getting enough sleep is crucial. Particularly if you've traveled time zones. Get to bed early and get up early so you can exercise. The great thing about being in a hotel is there aren't any household chores nagging at you to finish before bed. Take 10 or 15 minutes and stretch or do a little yoga. I usually turn the AC fan on to make a little white noise. Have a drink of water, read something you enjoy, and get a good night of sleep. 

Hopefully, this list will help. I welcome other ideas from my fellow road warriors. And, if you see me on a plane eating a salad, please say hello (but please don't try to talk my ear off during the whole flight - I cherish my quiet airplane time). Remember, every moment you can make a choice that betters your health. Be strong with me - I'm cheering for you. Happy traveling!

¹My traveling life was, in large part, the inspiration for Cybercise. I created the company so I could workout anywhere - even if there wasn't a hotel gym or if I only had 15 minutes to grab a quick workout. Not a commercial - just part of my story!

P.S. I've started a group on LinkedIn called "Wellness for Road Warriors." If you're on LinkedIn, join us, won't you? 

A Dog Day Morning

This is Loki, our 7-year old lab. Most every one of his days starts the same and as I watched him this morning, I became more convinced he is the smart one in the family. I think we can learn many things from the animals in our lives if we only take the time to listen. Recently, I've been on a re-training regime, courtesy of Loki. He's teaching me to trust that he will listen when I call him to return to my side while off-leash walking. While conventional wisdom might say he is being trained since we are now living in the city and he no longer has his giant fenced in yard, I'm wise enough to say it is really me that needed the retraining. He is a patient teacher and reminds me to stay present when we're out walking together. If I pay attention to what is going on around us during our walk (and ignore what every silly thoughts are running through my head), he listens perfectly. When I get lost replaying previous conversations, rehearsing new ones or am plotting and mulling the to-do list, he is more likely to wander away. Lost in my head and a lost dog? Irony or truth?

As for the mornings, I think Loki sets a great example for exactly what humans should do to start the day. This is what Loki recommends:

1. Don't get up until you're ready. Granted, Loki doesn't have a job he must rush off to, but I've noticed if his humans are forced to get up early he keeps sleeping. He might rouse himself enough to leave the dog bed for the warm spot in the human bed but he'll quite happily snooze along until asked to get up, or until the time seems right. 
2. Stretch. Yawn. Repeat. Loki's first order of business when finally rising is to do a lovely looking downward dog. Then he gives a big yawn, as if to greet the day. Then he does another downward dog stretch, butt high in the air. 
3. Drink. Next a few slurps of water. He quenches any nightly thirst by enjoying his morning water. 
4. Shake. Yes, I've tried and I think it is impossible for humans to shake like dogs. You know the shake I'm talking about - from the tip of the nose in a wave to the tip of the tail. It looks like a great way to wake the body up, but I can't quite figure out how to do it (advice welcome!).
5. Walk. Next on Loki's agenda is a morning walk. In his previous house with a fenced in yard, he would go out and spend 10 or 15 minutes walking, sniffing and doing his business. In our new city life, it is a family affair. We leash up and head into the park for a morning walk where we all walk and sniff the morning air (he is still the only one doing his business outdoors). The morning walk truly sets the stage for the rest of our day. 
6. Breakfast. After the walk, breakfast is served. A wholesome combination of holistic dog food with a bit of pumpkin mixed in for extra vitamins.

The next step in Loki's day is a morning nap and while us humans might enjoy a morning nap, we really must get on with making the world a better place. Nonetheless, following Loki's six steps for a successful morning will help you start each day more centered, balanced and ready to face the day. If you have any questions, feel free to comment. Loki is almost always at my side so I'll consult him for the answers you seek. 

Factory Life

My better half, son and some friends attended a screening last night at The Creative Alliance in East Baltimore's Highlandtown neighborhood. The screening sponsored by the Johns Hopkins Center for a Livable Future included two films about food and a discussion about sustainable agriculture and Baltimore. The films were thought provoking and provided a good background of the local food economy. Kudos to all who made the event possible.

During the question and answer session a local teacher asked a great question about how to become a farmer today and while doing so related industrial farming to the current state of our school system. He didn't elaborate too much, for reasons which are clear, but the comment stuck with me. His question was are we churning our kids through the school system with little regard for their overall health, wellbeing and growth with our only objective being to spit them out on the other end and send them off to work? If I were to write an SAT question...

ANIMALS : SLAUGHTER :: Students : Graduation

My son received a respectable education in the Howard County school system but the idea of his time there being analogous to an animal in a factory farm struck a chord. At one point in middle school he lamented, "School is sucking the creativity right out of me." At the time, I responded like many parents might and said something akin to, "It doesn't matter. Get good grades so you can get into a good college and get a good job." It is something I look back on now and regret. First of all, I wasn't listening to him and second of all, what if I was wrong? 

If you want to see a great piece about creativity and the school system, see this video created by RSA based on a TED talk by Sir Ken Robinson. Watching it makes me also regret not pulling my son out of school that very day and figuring out something else to save his creativity. Alas. Have we industrialized our schools with the primary objective being graduation rates and forgotten the idea of learning and creating life-long learners? 

I will take the analogy one step further and relate it to my life's work - the healthcare system. In yesterday's WSJ there was an article about how some physician practices are struggling to survive. The managed care era brought with it a huge administrative burden to many doctors' offices. The staff and infrastructure required to comply with each insurance plans' rules and regulations is significant. And while EMRs have promised to make it better, the WSJ article made me wonder... Are we also industrializing the practice of medicine? 

Most doctors I've talked to want their patients to feel great. That is why they became doctors. Instead many of the doctors are lost in a morass of paperwork, rules, pre-authorizations, referrals, formularies, practice management systems and now EMRs. Combined with the glut of television advertisements which "sell" the latest drug to unsuspecting patients, I'm beginning to wonder if our healthcare system is beginning to look like "Doctors : Tests and Drugs"

I, for one, long for a simpler way. Walking through my grandfather's pastures collecting the cows for the evening milking. Building lego towns with my son and watching him draw his fancy future sports car designs while learning in the process. And, taking care of my own health in partnership with my doctor serving as a trusted advisor and resource in tune with holistic well-being, not the computer.

What have we done? 

Farmer to You

Farmer's Market season is about to ramp up across most of the country. Visiting a farmer's market each week is a great way to support your local economy while enjoying fresh, real foods. We're lucky enough to be in Baltimore where there are several farmer's markets each week. The food simply tastes better and we get to know the people who are growing and raising our food. Plus, our weekly market trip becomes a fun event to look forward to each weekend - and over time we have become better in tune with seasonal foods.

While reading "The Prince's Speech: On The Future of Food" I was struck by the many ways industrial farming negatively impacts many things. I understand industrial farming is some people's answer to feeding more and more people, but at what cost?

Each of us can make a difference and begin to ween ourselves off of the industrial farming industry by making a lifestyle change to do more shopping at farmer's markets this year. To help us remember, consider the following:

For a directory of farmer's markets near you, see this directory. Happy eating!

Over the Counter Drugs: Good v. Evil

Yesterday morning @shelleypetersen tweeted an article in the WSJ about the FDA considering to make more drugs available over the counter (OTC) [If you're not following Shelley on Twitter,  you're missing some good stuff - head over and follow her].

After the initial tweet, Shelley and I went back in forth in 140 characters and had a mini-conversation about the impact. I had to leave the tweet-fest for a meeting but wanted to finish the conversation and thought I'd do so here (and break free of the 140-character bind).  There are many stakeholders in such an idea. To take a balanced look at the issue, I'll declare a winner and loser for each perspective. All of this my humble opinion, of course, and I welcome other points of view.

Also, keep in mind, the specific drugs the FDA decides to make available OTC will have significant impact on the outcomes of doing so. While I don't think Oxycontin would ever be on the OTC list it would most certainly result in a vast increase in sales. Winner? Pharma

Other Winners and Losers

1. Most prescription drug plans do not cover OTC medications unless they are deemed medically necessary by a physician (typically via a prescription). By increasing the kinds of drugs available OTC, fewer people would be likely to buy them because they would have to pay out-of-pocket. It may also increase the demand on our already overburdened primary care system as people seek prescriptions for these drugs so they are able to pay a co-pay vs. cash (see likely increase in demand #4). The total benefit dollars paid from prescriptions plans would decrease. Some patients simply wouldn't take the drugs any longer.

Winner: The people who pay for prescription drug plans (Medicare, some Medicaid, employers)
Loser: The consumer (particularly those with less discretionary income) and PCMs

2. The reduction in the total spent in prescription plans could make the overall healthcare system look less expensive (in the short term). The headline might read, "Health Reform Saves Billions in Prescription Drug Benefits." The article is not likely to go on to say how many people aren't taking the medication their doctors think they need. 

Winner: Budget people and the supporters of Health Reform

Loser: The consumer (particularly those without a "medical home" and an established relationship with a physician who they know and trust)

3. The costs of people skipping their medication won't hit the healthcare spend line (at least not enough to be noticeable) for a few years. When people stop taking their high blood pressure medicine because they can no longer afford it (or, possibly, they simply refuse to use their discretionary dollars on something that provides little instant gratification), they won't start dropping dead in the streets. It would take a few years before we'd see the likely increase in strokes and heart attacks. By then, revisionist history will take over and people won't relate A to B. 

Winner: Budget people and supporters of Health Reform

Loser: The consumer

4. When current prescription drugs become available OTC, sometimes, the manufacturer makes a less potent version available that is "safe" for unsupervised use. A patient taking a prescription at 150mg may only be able to get a 75mg OTC. This would have two results: More sales as patients would have to buy more pills and more sales as there would be more product on the market. And, of course the drug manufacturers would have to let Americans know about the health issues (some they don't know they have) while showing photos of people really, really happy because they are taking drug X or Y.

Winner: Pharma
Loser: Everyone who watches television -- can you imagine the volume of commercials? PCMs who will be flooded with patients requesting specific drugs because they have suddenly developed the latest Pharma-invented syndrome.

5. There are several Federal agencies with a role in the health of Americans. A quick overview: USDA deals with meat, dairy, agriculture and the food policy, FDA handles drugs and other foods, DHHS oversees health insurance programs, DoEd teaches our kids about health, DOI handles parks and outdoor space, DOT oversees transportation. The point being we don't have a way to budget for, or even understand, the true costs of health. If the FDA approves an increase in OTC drugs which negatively impact the cost of healthcare programs like Medicare and Medicaid, the FDA doesn't really need to worry about it. The FDA and DHHS don't share a budget, or accountability, for the health of Americans.

Winner: The agency accounting for "saving" money
Loser: The agency accounting for increased costs

6. One of the concepts behind additional OTC drugs is to increase access to the drugs which claim to combat epidemics like diabetes (first of all, one has to believe drugs are the best way to combat lifestyle diseases... I happen to think lifestyle changes are better and cheaper). The "improved access" could be done by kiosk-like devices to help patients self-diagnose to determine if they need a drug. What an opportunity here! I have many questions about the kiosk implementation: Who will write the questions? Will there be drug advertisements on the kiosk or as a commercial spot before the questionnaire? What reading level will written for? Are we going to track outcome (i.e., how many people who go through the kiosk would end up with a drug vs. those who visited their doctor)? Tricky policy and implementation here. And, forgive me, but too many interesting ideas get completely ruined in implementation. What is certain? More drug sales.

Winner: Pharma
Loser: Physicians (whose professional judgement will be replaced by a kiosk). Consumers (who will be even less likely to make lifestyle changes when all they have to do is go to the ADM (automatic drug machine)).

As I wrap this up, I have to admit feeling a bit discouraged. Is our system really as bad as this? I'll leave that up to you and would love your thoughts. In the meantime, I think I'll switch on the television to see what ails me and what magic cure might be available from my pharmacy.

The Next Chapter

I've been blogging here for several years almost entirely under the Cybercise heading. My blogging volume has decreased of late due, in part, to my attempt to restrict this blog to Cybercise related topics. Doing so made me feel, well, restricted. All of who I am and what I'm working on is wrapped up not only in Cybercise but also in my consulting firm, Market Strategies, and my new book series, Move.Eat.Be., and the newest exciting thing I'll announce in a few months. All of my work is centered in one area: Improving Healthcare.

Doing so happens in various ways: Some of the very exciting consulting projects and programs I'm designing in the public sector. Cybercise and helping people get more exercise. Move.Eat.Be. and helping people find their own personalized approach to sustainable wellness. The Real Food Label project to help people make better food choices. I'm one of those people who thrives on having lots of  interesting stuff going on all at the same time.

Fixing our healthcare system isn't a "one walk dog." In other words, there isn't one single thing we should, or even could do, to fix our healthcare system. We need to do lots and, in my own small way, I'm moving lots of pieces around and are all related. The healthcare system itself needs to change. Our focus on "disease care" and "test and drug" is unsustainable and it doesn't help people stay healthy. The food system, farm policy, our education approach, special interests and politics is a huge mess which has a direct impact on people's ability to eat well on a budget. Our culture of "busyness" has driven us out of our kitchens and into the drive thru. We've forgotten the joy of a walk after dinner, climbing a tree and playing sports and we spend way too much time in front of a screen of one sort or another.

Ultimately, I'm working to create a national self care system where each of us has access to the tools, support and community to live long, healthy, and fulfilling lives. When people are healthy there will be enough providers and money in our disease care system to take care of people when they're sick. Plus, hopefully everyone will be happier and feel better.

Stay tuned for more!

The Lunchbox Patdown

An article on Huffington Post today described a recent incident where a 4-year old's lunch was inspected by the USDA and deemed "not nutritious enough" forcing the child to eat school supplied chicken nuggets instead.

I want to rant, really I do. And, doing so may not further the conversation so let's look at this for a moment. A few thoughts:

1. Does anyone at the USDA actually have children? (Yes, wee rant there). Every parent knows our kids go through weird food phases. I don't care how health conscious, organic, local-focused and wealthy you are, sometimes your kids will only eat one thing and one thing only. My son, now 23, went through a "ham sandwich" phase which actually didn't include any ham. White bread and mayonnaise. I wasn't happy about it, but I used it as a teaching moment (you can have your ham sandwich when you eat these banana slices - come on parents, half the job comes down to these moments). 
2. Did we need another way to further the phobia that "Government People Are Bad?" We already malign the people who work at the TSA, many teachers are not respected and police? In some urban areas, they are feared. Apparently we're not getting to kids early enough to teach them to fear public servants, now we have to take a 4-year old's lunch away? That poor little girl. 
3. USDA Meal Guidelines are not right for everyone. I hate to be the one to break it to you, but following the USDA guidelines would make a fair number of Americans sick. Dairy (in the form of  overly processed milk from cows dining on drugs and hormones), gluten run amok, GMO grains? Our kids (and we) deserve better.
4. Cheap does not equal good. The food supplied to school cafeteria's is done by through the award of competitive contracts. Low cost almost always wins. The people who win these contracts are incentivized to deliver the cheapest food that meets the minimum USDA guidelines. Are our kids eating sustainably raised, grass fed beef? Chickens who graze on bugs? No! They are eating the worst of the worst of the processed food system. The food is cheap and pumped with chemicals so it lasts a long time on a shelf. As a side note... there is a company, Revolution Foods, who are focused on doing better. There may be others I'm unaware of, please share if you know of them.

I could go on... but you get the idea. To round out the discussion, let's consider one defense of the idea of inspecting brought from home lunches: Some lunches brought from home are actually worse than what the cafeteria provides. I don't have data or numbers, but having been a parent and visiting during lunchtime, I can assure you some kids have soda and a snack cake in their lunchbox. 

What are we to do? Let's start with education! I know! A crazy idea considering we are talking about our schools here. Unfortunately, we have many parents and many kids who really don't know what a nutritious lunch looks like. We have taken much of the food and health education out of our schools in favor of the programs for "No Child Left Behind" so we have an absence of knowledge. How about bringing these classes back (and inviting parents) so we all learn together what makes for healthy eating? How about we recognize that there isn't a one-size-fits-all diet for every person in this country? How about we consider lunch as only one part of a day full of healthy eating? If I've had a big breakfast, I might not want a big lunch. Can we bring some humanity back into this? How about we use lunch as a teaching moment instead of a lunchbox patdown exercise. Just a thought...

Life as Paradox

Carrying extra weight makes exercise more difficult. In order to lose weight you need to get more exercise.

To fix our healthcare system we need less tests, drugs and surgeries (and more coaching on wellness). People in our healthcare system only get paid for tests, drugs and surgeries (and rarely for coaching on wellness).

(P.S. Wellness does not = low-fat milk)

Ironic, isn't it? Perhaps we shouldn't be trying to fix the problem, perhaps we should be finding peace among the paradox. Maybe this applies to all things like the economy and the environment as well as individual health and our healthcare system. Maybe, just maybe, if we can accept "life as paradox" we'd be better able to live in the space in between. After all if you run hard at a brick wall, you're likely to get knocked back a few feet and feel a bit of pain.

What am I really saying here? In the face of a big problem, do something (no matter how small) each and every day. 


If you want to lose some weight, walk five more minutes a day. If you want to fix our healthcare system, drink a glass water instead of a can of soda. If you want to help the environment, recycle the bottle (even if you have to carry it home to do so). You get the idea...

Sitting back and waiting for the paradox to change is a fool's game. Welcome the paradox. Then get up, take a step and give it a little nudge.

Role Models We Don't Need

Paula Deen has diabetes. With this diagnosis she joins the other 25.8 million Americans with this condition and is transforming herself into the diabetes spokesperson for a diabetes drug manufactured by Novo Nordisk AS.

I give her credit for encouraging people to cook more meals at home (even if those meals were less-than-healthy options). I give her credit for making her diagnosis public because it is always better to be honest with people. And yet, the whole thing doesn't sit right with me. Granted there probably wasn't as much money in her other choices. Going public with her diagnosis and starting a whole food and exercise regime on her show. Showing her fans there is another way instead of waiting for the quick fix of a pill to erase all of our bad choices.

Don't wait for the pill. Get up, get out and take a walk.

Five to Thrive

Today is the day! You're off to a new start. Ta-da! Look out world! You're ready to tackle your resolutions with vim and vigor!

Except, maybe you're not... As I've written before, I'm not a big fan of New Year's Resolutions. I think making huge resolutions on one particular day a year puts a great deal of pressure on us. Plus, most resolutions are black and white while we live most of lives in the spectrum of colors between black and white. In other words, change is good. Changing too much at once can be a challenge too far.

There is another way. Small, positive steps which add up and are easier to maintain. To help you get started, here are five things you can start today which will put you on a great path to better health and wellness in 2012.

1. Measure. Drag out the scale and the tape measure. I think it is important that we each know where we are today. After all, you can't get anywhere unless you know where you are to start.  Weigh yourself and measure your waist, hips, thighs and chest. Write the numbers down and today's date. This is for you and you don't need to share it with anyone.
2. Water: Start each day by drinking a big glass of fresh water. Our bodies can be dehydrated after sleep and giving your body the water it needs is a great way to start the day. Somewhere between 12 and 20 ounces will do the trick. 
3. Walk. Each and every day go outside and take a walk. Start with however much time you can comfortably enjoy. Be it five minutes or twenty five minutes, so be it. Ideally, you'll walk at least 30 minutes each day. Break it up into smaller chunks of time if you need to. 
4. Real Food. Consume at least one serving of real food each day. An apple, a handful of nuts, one-half of an avocado, a banana. If you need help identifying real food, consult the Real Food Hierarchy to show you the way. 
5. Goals. Write down five things you would like to accomplish in 2012. Start school, a new job, lose weight, exercise regularly, read more, spend more time with family or friends, learn a new language, travel somewhere new. Again, you don't need to share it with anyone but you can! In fact, you can share your five things here if you'd like. I'd love to be inspired by your goals for 2012!

There you go. Five simple things to help get your 2012 off to a great start. Good luck and, as always, I'd love to know how you're doing so don't be shy. Stay tuned for regular updates to help you build on this good start.

As for my 2012, there are many things in the works. A new Cybercise will debut in a few weeks. We are making things more simple and will focus on our roots of online exercise videos. I'll be publishing a series of Vooks with a fun new version of Move.Eat.Be. I'm working with a great organization in Baltimore City to help them innovate a new health paradigm for some of our most vulnerable neighbors. And, there is a whole, huge endeavor which I'll share more about soon. Very exciting!

Thank you for your support in 2011. I look forward to a fabulous, healthy and happy 2012 with you.