WHAT WAS SO SPECIAL ABOUT UNIVERSITY OF MIAMI SCHOOL OF MEDICINE CLASS OF 1985?

Those of you who are UM alumni may have read the article in the UM 'Medicine 'magazine Spring of 2008 about the UM Medical School Class of 1985. This single class would wind up producing more Miller School faculty members and attending physicians than any other class has before or since. 11 of them remain at the medical school-almost all department heads.It was actually 14 total that stayed as faculty but 3 of these have recently moved on. When questioned as to why this year was so special the 11 doctors unanimously felt it was the energetic faculty that year and the outstanding residents who lead them in 1985-their internship year. "We had excellent resident supervision,so that gave us a lot of responsibility." said Dr. Marilyn Glassberg Associate Professor of Medicine, Division of Pulmonary and Critical Care. Not coincidentally, Dr. Gabriel Valle was the Chief Resident of this class( 1985-86)at UM Medical School, in charge of every intern in the Dept. of Internal Medicine. Dr. Valle remembers them as a class that stood out early on. "They had a thirst for knowledge, embraced challenge and worked tirelessly," said Valle,"I am not surprised they did so well. It was a pleasure to have a chance to teach them."

LOWER YOUR BLOOD PRESSURE

An article in the Baltimore Sun recently summed up the link between salt and high blood pressure. Nearly 1/3 of American adults have high blood pressure according to a recent study at The University of South Carolina. It found that most of us consume 2 to 3 times the recommended level of 1 teaspoon of salt per day. Most of the salt doesn't come from the shaker but rather from packaged foods.(See part 6 of a weight loss series for more on this topic) Here are some tips to limiting your salt:
Don't salt food before you taste it.

Eat more fruits and vegetables and fewer prepared foods.

Read the label to check the sodium in the serving.

Reduce or eliminate salt in any recipe.

Order low-sodium foods in restaurants.(even if not on the menu-ask to have your food prepared salt free!

MAINTAINING YOUR WEIGHT LOSS(Part 5 of our Weight Loss Series)

Ok,folks-here's where most people veer off course. Truth is almost all of us can(and have-many times over)lose weight. We just don't keep it off. Fully 95% of those that lose the weight gain back every ounce and then some! Why??
Again-the "SECRET" is very obvious yet seldom exercised by most dieters who "diet",lose the weight and then slide right back to their old habits. THAT WILL NEVER EVER WORK. NEVER.
Drop the concept of "diet" as anything other than a lifelong change. Below we list the things the 5 % who lost and kept off the weight-sometimes over 100 pounds-for good.

ACCEPTED SETBACKS AND STILL KEPT TRYING

WEIGHED THEMSELVES EVERY SINGLE MORNING

EXERCISED AN HOUR AT LEAST 5 TIME PER WEEK

ATE COMPLEX CARBOHYDRATES(WITHIN REASON) AND DID NOT DRASTICALLY REDUCE THEM EXCEPT AT THE INCEPTION OF THE DIET

ATE SMALL, FREQUENT MEALS WHEN POSSIBLE

LOOKED FOR WAYS TO INCREASE THE ACTIVITY IN THEIR DAILY LIFE

WHEN DINING OUT CONSISTENTLY MADE THE BEST CHOICE POSSIBLE

KEPT TRACK OF THE CALORIES CONSUMED PER DAY(OR POINTS)

It is also important to assess your weight loss goal once you reach it. Maybe you once weighed this weight when very young but does it suit you now ? Is your face more attractive with 5 more pounds and is that still within an acceptable BMI range?(see our earlier blog to calculate your BMI). Once you are at your goal do you feel you can safely strive for a lower weight-again while maintaining the guidelines for a healthy BMI?

Any wonderful thing-a garden,a relationship,a hobby-requires tending. So does maintaining your goal weight. But isn't creating a healthful life and future worth it. What could taste better than that?

Kidney World: BURN CALORIES IN 20 MINUTES-HERE'S HOW

Kidney World: BURN CALORIES IN 20 MINUTES-HERE'S HOW

BURN CALORIES IN 20 MINUTES-HERE'S HOW

The following everyday activities all burn calories. Here's what 20 minutes will get you:
Making beds-45 calories
Shopping with a cart-52 calories
Carrying groceries-57
Throwing a ball for a dog-64
Bowling-68
Weight -lifting-68
Walking- 2.5 mph-68
Walking -3.5 mph-86
Moderate housecleaning -79
Gardening- 90
Bagging leaves and grass(heavy yardwork)-91
Hiking hilly terrain -159
Jumping rope, moderate-277

Remember while daily activity contributes to your overall fitness, it does not take the place of regular, sustained aerobic exercise.

ONE MORE THING

No, to answer the question I got 10 times today alone-it is not exercise to clean your house or work in your garden(unless you mean heavy yard work(doubt). This is not sustained aerobic activity and is therefore not what we mean by an exercise program. Having said that-I do notice that trimmer persons tend to be more active..perhaps that seems elemental. But think about it. Getting up and down to get things, taking out the garbage, walking your dog-all these contribute to your overall fitness quotient. They are just not enough. Persons who suffer from paucity of movement tend to be the most overweight-you know..they will avoid movement at all costs. The more inactive you are..the more your joints hurt. It's a round robin. I appreciate your questions. Hope this answer helps.

FINDING THE EXERCISE PROGRAM THAT WILL WORK FOR YOU!

There is no one exercise plan that is essential for everyone to follow. The right one is the one that you can actually stick to. IT HAS TO WORK FOR YOU! Otherwise after a grand start and much preparation-you will abandon it as you have so many times before. Why does that happen so often?
First of all an exercise program does not have to be the complicated, hard-to-understand mystery many "experts" would have us believe. It is a very simple equation: Your calories expended(exercise/activity) must exceed the calories consumed(food intake)by a sufficient margin for you to lose weight. I think it is important-particularly if you haven't exercised in some time-for your physician to give you the okay to start a program. That accomplished, lets look at why you have not been able to stick with the program before and HOW we can circumvent that problem this time.
As far as exercise goes, I truly have seen and heard it all-every plan and every excuse. I know what works and what won't. Let's look at common stumbling blocks people encounter by reviewing 3 patients who began a program and who disclosed to us why similar programs have not worked in the past.
Patient 1 claims she has no time. Her job and family responsibilities literally leave no time for exercise. She barely has time to do her chores what with kids and the rush to get to work by 8am. She did try to go to a gym at night but was sidelined by parental commitments that provided constant interference. The only solution is to create an hour where it did not exist. This patient began a plan of rising 1 hour early 4 days a week and exercising on a treadmill prior to the family rising. She also worked with free weights to build muscle mass. Some days she worked out with a tape that she followed for floor exercise. Combining this with her weight watcher program she has lost 18 pounds in 3 months which is 50% of her goal. While, like all of us, she values her sleep, she had no other choice due to her crowded schedule. She reports she is going to bed 30 -45 minutes earlier now so actually is losing little sleep overall.
Patient 2 had begun an exercise program last year of jogging, something he enjoyed as he was a runner as a young man. He had stopped jogging 6 months ago when he re-injured his knee. When we saw him again he was up 11 of the 22 pounds he had initially lost. Upon review we discovered he also like swimming. His orthopedist had also recommended stationery cycling-which he had not tried. He agreed to try swimming 3 times a week at an area lap pool as well as cycling 2-3 times a week while watch the financial shows he enjoys at night. When we saw him next time he had lost 6 of the 11 pounds he had regained and reported that he found the swimming very enjoyable and that the cycling-because he did it during his favorite shows-was something he looked forward to.(Swimming for exercise involves sustained strokes(laps)and should not be confused with wading around a backyard pool.
Patient 3 had joined a gym 1 year earlier and had lost 16 pounds in a year by combining it with a healthy eating plan. She was dismayed that her progress had "stalled" and that while she was several dress sizes thinner-she felt flabby and was contemplating plastic surgery to reduce areas she felt were not toned. On review we were made aware that she did not include any component of weight training-which is important to build muscle(which also burns fat), prevent osteoporosis, and tighten and tome the muscles.)She agreed to work briefly with a trainer at her gym to learn the equipment and reports after just 6 weeks she has lost 4 lbs
and sees a big difference.
What made the difference for these patients. Why-unlike 90%-of new years resolutions-did they stick to the programs and actually lose weight?
1. Made a commitment and did not expect overnight results
2. Combined it with a sensible diet plan
3. Developed an exercise plan that worked with their schedule and didn't fall back on the universal "I have no time" excuse. People in great shape have no less of a schedule then you-in many cases. Make it work.
4. Adapted the plan to their own physical and orthopedic needs.
5. Combined both aerobic and weight training exercise to promote cardiovascular and muscular fitness.
Exercise can be done indoors or out, day or night, with a trainer or without-with expense equipment or with simple 3 and 5 pound hand weights and walking outdoors when the sun is not high.( A simple plan for walking is to measure 1 mile with your car. The walk that distance in 15 minutes and return that distance to your home in another 15 minutes. You will have walked 2 miles in 30 minutes. Quick, efficient and excellent for your cardiovascular health.) Of course, you may need to work up to the 15 minute pace but it is one you can strive for-providing your doctor has said it is safe for you to do so.
If you have another other excuses, let us know and we will be happy to tell you how you can work around them.
Where there is a will, there is a way. Go to it!

THE SECRET TO LOSING WEIGHT

Prior to working for the Kidney Group I was in charge of a large hospital's exercise and rehab program. Desire to lose weight was a common theme, as it is with many kidney patients and the population at large(no pun intended). I find a frequent mindset is the search for the perfect diet..perfect pill..perfect surgery..that will produce fast,safe and long lasting weight loss. Many patients spend years of frustration and excuses searching for these answers...convinced that if only they knew this secret then..finally..they could achieve the weight they covet and have postponed so much joy in looking fruitlessly for it. Many times patients have implored me..begged me..to teach them this secret.(I have maintained my same weight since age 16 and while I do not consider that the big deal some do let me assure you that absolutely I work at it. Every single day. Anyone past a certain age(with rare exception)who is at their ideal body weight(BMI)works at it. Some harder than others.. sure. But folks if I drop you off today on a deserted island and come back in a year(while you live off the land)I guarantee not a one of you would fail to lose every extra ounce. Stop with the "I can't" and the thyroid story(again RARE) and my special favorite excuse"my metabolism".
I have thought this over very carefully..revealing this secret. However, this secret is so upsetting and unnerving to many patients they refused to believe it.Once you are told the secret..you will will know it is true because it is very obvious..so obvious that most of us overlook it.
Ready? The secret to losing weight effectively is that there is no secret. IT'S ALL HARD WORK.
Think about it for a minute. In the United States alone people spend 34 billion dollars a year searching for this answer. Do most of them find it? Well sit on a bench at say Disney World and watch people walk by-do you think they found the secret?
People who accept the premise that it will be hard work-those are the 10% who get somewhere-who achieve their weight goal(see last week's blog)and keep it off.
Okay-say you expect hard work and agree to give it a try. What do you do first?
Well, if there is a diet plan,pill,gimmick or surgery that exists that I haven't seen tried(really)then I'd sure like to know what weird thing that might be. I am familiar with every low fat,sugar free, low carb,buy-the-food,pill taking and stomach shrinking surgeries big new thing plan. Do they work? Yes(many are expensive) they can all work to varying degrees but as to keeping it off I give alot of them an F(even the last ditch gastric bypass..not unless big lifestyle changes follow). . Why? A diet must be REAL LIFE and forever. FOREVER. Now you will eat more once on maintenance..but eat the way you do now? You cannot.
I am going to fly in the face of conventional wisdom. I am not subscribing to the radical low carb diet. Do I think we need to avoid processed foods and foods made with white flour. YES!! But am I signing on to never eat fresh warm bread again? No pancakes ever? No birthday cake at a party? A beer at the ballpark? Well, how absurd. I want to be able to do those things. Occasionally everything should be allowed. There should be no "nevers" or you will crave it all the more. When I started in this business I discovered Weight Watchers(with whom I have NO affiliation)and brought them into the program I ran. I watched people learn how to eat anything they want..anywhere. How to handle the occasional splurge(that happen to us all). Many had dramatic weight loss success stories. The people who teach at the meetings were once overweight themselves. They just learned the secret and want to teach it to you. Today I still prefer it. Do I think low carb can jump start the diet-yes. Do I think a reduction in carbs is warranted? Yes. Do I think we can radically cut our carbs long term. ABSOLUTELY NOT.... NOT THE VAST MAJORITY OF US!! Our desire for carbohydrates will win out and you backslide and give up in disgust and then begin your search anew.
Weight Watchers teaches that all foods have a point value. Carbs and such cost more points so we are "penalized"for eating alot of them and you will learn if you don't watch such indulgences and you do stick to the program you will be hungry. It teaches you to make smart choices to promote satiety(feeling full). It works..it works even if you have a 100 plus pounds to lose. It can be used anywhere even in a fast food restaurant(hey you stop to eat on the turnpike-what do you do?) Real life. It has handy point counters and guides to all foods,brands and restaurants. No more"I didn't know."..and you can buy many of their brands and other brands that list the point value on the box(you will also learn to figure out the point value of any food.)So you're not sulking at a restaurant or carrying your own food. REAL LIFE.
Now I do have more specific food recommendations.(more on that later..what I like to call "clean eating") I like the website "Hungry girl" which features many low calorie and delicious food suggestions/substitutions as well as point conversions (IE what do I order at Starbucks that's not black or plain tea??) Real life.
Of course as you lose weight, food will become less of a focus-a little more routine. More about sustenance that pleasure. That's the only way to do it. Never enjoy food again? Of course not. But live to eat? You can't. Sorry but that's the secret.
One of my favorite quotes is by Thomas Edison.."Most people miss opportunity because it usually comes dressed in overalls and looks like hard work".
This is your opportunity. Why not start RIGHT NOW?
Next time we will talk about the exercise component.