August 23, 2016

Dear Patients,

I hope you had an enjoyable summer! I'd like to take this opportunity to let you know that you'll be seeing a new face in my office. My new assistant, Stacey, has an extensive health and wellness background and we are thrilled to have her. Her email address for routine issues is Stacey2DrOken@gmail.com. I'd like to thank my long-term assistant, Lisa, for her good care provided to you, our patient. Lisa is not going far; she is right down the hall working with my colleague, Dr. Fish. Thank you, Lisa, for your kindness and caring disposition.

Before I get started with my topic, here are a few administrative reminders:

Flu shots will be available by mid-September. A separate email with details will be sent out in a few weeks.
Like last year, 2017 re-enrollment forms will be sent out in mid-November. You'll again be given the option to receive yours by either email or snail mail. This information will go out in October.
For routine calls during normal office hours, please call my office, 410-910-7500; it's difficult for me to answer my cell phone when I'm seeing other patients.
At night or during the weekend, please feel free to call me on my cell, 443-324-0823.
For clinical issues by email, please use my email address, HarryOkenMD@gmail.com. The email addresses for my assistants are not monitored at night or on weekends.

Weight Loss: Reality vs. Reality TV

I have been asked a number of times about a recent New York Times article regarding the popular TV show, "The Biggest Loser." The article chronicles the journey of the winner of Season 8 who managed to lose a massive amount of weight -- 239 pounds over 7 months -- attaining a weight of 191 pounds and winning the title of "Biggest Loser." Researchers followed the Season 8 contestants for 6 years after the victorious night. Sadly, researchers learned that the winner -- and, it turns out, most of the other contestants -- had regained most, if not all of the weight that they lost. They discovered that contestants' metabolism had slowed, and that their satiety signaling hormone, leptin, became so low that it failed to quell their appetite. If you are interested in reading the NY Times article, it can be found at the link below:

http://www.nytimes.com/2016/05/02/health/biggest-loser-weight-loss.html?_r=0

Many people who read this article have grown disheartened, concluding that their weight loss efforts are futile because their weight will inevitably come back.

WRONG! And here's why:

First, let's take a look at a day in the life of a "Biggest Loser" contestant. The participants are on an ultra-low calorie diet, and exercise is their one and only job. For 9 months, the contestants over-exercise -- without any time for recovery -- and effectively starve themselves. Their bodies sense profound famine; the insult can be so dramatic that their internal signaling systems buckle and break. So after the show, when they begin to eat normally, the contestants' insulin levels skyrocket, and there is no leptin to tell them they have had enough. Effectively, their brains are making them believe that they are always hungry.

In reality, attaining a healthy weight is all about moderation, and focusing on The Big Four. The Big Four, listed below, strengthen your immune system.

Nutrition
Exercise
Healthy sleep
Controlling emotional stress

Getting healthy is 80% about what you eat. The core therapy for cholesterol management -- and for many other issues such as blood sugar, blood pressure, gout, sleep apnea and pain associated with osteoarthritis -- is attaining a weight that is healthy for you. Often, a small reduction in weight (just 10-15 pounds) will translate into a remarkable improvement in health. A reduction in weight of just 1 pound unloads 4 pounds/square inch on your weight-bearing joints, including the lower back.

Attaining and maintaining a healthy weight is a constant process of making adjustments. It is a challenging process, and it can take several weeks to modify the neurological networks that reinforce our cravings for unhealthy foods. Here are a few tips to healthy eating:

Eat in a low glycemic fashion, keeping daily carbohydrate intake to less than 50-60 grams/day. This can be liberalized once the craving center of the brain calms down.
Minimize gluten-based foods such as pasta, cereal and bread, as well as other complex starches such as rice, and corn- and potato-based foods.
Eat a predominately plant-based diet. Try to get 5 servings of vegetables and appropriate serving sizes of fruit. Avoid dried fruit.
Avoid concentrated carbohydrates such as candy, cookies, cake, pudding, ice cream, juices, etc. Avoid soda which is basically liquid candy.
Eat good fat; it is filling and will not elevate your insulin levels. Examples of good fats include avocados, nuts, nut butters, olives, and healthy oils such as olive and coconut.
Ingest the correct amount of protein for your ideal body lean weight -- 0.5 grams of protein per pound of your ideal body lean weight.
Keep a food diary, or use a cell phone app such as "Lose It!" or "Calorie Counter & Diet Tracker by MyFitnessPal" to track your daily intake.

Exercise and restorative sleep also help to restore your immune system and control stress. During the day, try to minimize your sitting. Get up every hour and walk around, or do some stretching, lunges or squats. Work standing up if you can. Try to walk 10,000 steps every day. In addition to cardiovascular exercise 2-3 times per week, consider adding stretching and weight training 2 times per week.

Want to learn more? Consider joining BOOM -- which stands for Boost Our Own Metabolism! -- an 8-week program that I developed that teaches key nutritional points and provides tips for improving sleep and stress levels. The next session of BOOM begins on Wednesday, September 14 in the cycling studio at the Columbia Athletic Club. We do group exercise on the studio bikes to music using a High Intensity Interval Training (HIIT) format. We will meet for eight Wednesday

mornings from 7:15 - 8:00. My assistant, Stacey, will be leading the spin portion and this is followed by my brief talk on the topic of the week. We hope to see you there! If you're unsure whether or not you are healthy enough to participate, please send me an email.

Please watch this video https://youtu.be/kbnhzxjN3YE if you have any questions (please note that the details regarding days and dates in the video do not pertain to this upcoming session). Sign-up instructions can be found on page 21 of the Columbia Association's Fall Activity Guide:

https://www.nxtbook.com/columbia/caactivities/2016fall/index.php

So put your health first and believe in yourself. In keeping with my Newsletter tradition, please enjoy this YouTube from Rock of Ages -- "Don't Stop Believin'." https://www.youtube.com/watch?v=-yuhiCKRetw

Wishing you good health,

HAO

Harry A. Oken, M.D.
Clinical Professor of Medicine
University of Maryland School of Medicine
Office: 410-910-7500, Fax: 410-910-2310
Cell: 443-324-0823

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