Positive Affirmations — Helping Us Move to Action

Every healthy lifestyle tip that I give is in striking distance for each of us. I recommend starting with really small changes — things like eating one more vegetable per day, writing three things we are grateful for every morning, or putting our smartphones in another room for dinner with family. These are basic interventions that are transformative over time, yet many of us still struggle to implement them. So what is the solution? How do we move ourselves to action once we have the knowledge?

While I teach many strategies to help people become consistent with their desired action, today I want to focus on the importance of self-belief. We must truly believe in our heart of hearts that we are capable of making meaningful change. This concept was beautifully summarized by Henry Ford who said, “Whether you think you can or you think you can’t — you’re right.” However people tend to think this only applies to our big life goals; that self-belief drives our ability to pursue advanced degrees, start companies, or follow our most compelling dreams. However, it also plays a pivotal role in making healthy changes in our lives. We simply can’t transform ourselves from someone who gets 4,000 steps per day to one who gets 10,000, if we perceive ourselves as lazy. In the same way, we will never gain the peace that comes with a regular meditation practice if we believe our minds are too anxious to benefit from this intervention.

Whatever change you have been struggling to make in your health or your life, consider this question: Do you honestly believe you can be successful at it? If the answer is no, then first ask yourself if you have broken the goal down to the smallest possible part? For example, don’t aim for eight hours of sleep every night if you currently get five. Set a goal of getting five hours and fifteen minutes per night. You will build from there and anyone can go to bed fifteen minutes earlier without completely changing their routine. Once you have made your goal so small that it must be achievable (think- could my nine year old do this?), do you still struggle to believe you will be successful? If so, your problem is a limiting belief that you have about yourself. Thankfully, there are actions we can take to change those beliefs and thereby change what is possible for us.

The simplest place to begin is through affirmation. Get on paper a brief sentence that reflects your core values and what you are seeking. If eating a healthful diet has been challenging for you, perhaps write, “I am grateful for my healthy body and I nourish it with nutritious food.” Then read or recite it several times a day. Maybe you stack this exercise with something you already do. For instance, following my daily gratitude list, I write, “I love myself. I love my life. With God I will help millions of people.” This trains my brain to remember that I am comfortable with who I am, I am thankful for the gifts in my life, and that I have Help with my mission. This is extremely personal to me and vulnerable to share, but I do so in the hope that it may help you to write something that resonates with your unique values and goals.

Now if you aren’t quite ready for a daily mantra, then at least spend some time affirming your personal values. Write about what matters the most to you in this life. This activity has been shown to help marginalized students achieve higher GPAs (1) and to help sedentary people become more active (2). On fMRI of the brain, it led to increased activity in regions associated with reward when participants reflected on their values in the future. (2) Writing on paper or at least reflecting on who we want to be in this life is something that every one of us can do today. It is the key to living intentionally. And in this case, it may very well begin to rewire our thought patterns, helping us to believe we are capable of change, and allowing us to become who we were always meant to be!

References:

1. Cohen GL, Garcia J, Purdie-Vaughns V, Apfel N, Brzustoski P. Recursive processes in self-affirmation: intervening to close the minority achievement gap. Science. 2009 Apr 17;324(5925):400-3. doi: 10.1126/science.1170769. PMID: 19372432.

2. Cascio CN, O'Donnell MB, Tinney FJ, Lieberman MD, Taylor SE, Strecher VJ, Falk EB. Self-affirmation activates brain systems associated with self-related processing and reward and is reinforced by future orientation. Soc Cogn Affect Neurosci. 2016 Apr;11(4):621-9. doi: 10.1093/scan/nsv136. Epub 2015 Nov 5. PMID: 26541373; PMCID: PMC4814782.

Humor and Health: Why We Should Lighten Up

I’ve always valued the role of humor in my most cherished relationships and in the way I process adversity. Come to think of it, my love of laughter even creeps itself into my everyday speech. When referencing a good time, I might say, “We had a lot of laughs.” When explaining why I love talking to a person, I may tell you, “She gets the joke.” While I don’t consider myself particularly funny, humor is key to my sense of joy (and to maintaining my sanity.) For this reason, I was happy to oblige when recently asked to dig into the research on humor and health. I’m excited to share a bit of what I found and offer some action items as well.

Physiologically, laughter improves mood by raising our “feel good” hormones serotonin and dopamine, and decreases our experience of pain by releasing endorphins, our bodies’ natural opioids. It lowers our levels of the stress hormone cortisol and boosts immune function by raising levels of our antibodies and natural killer cells (immune cells that destroy infected and cancerous cells.) Laughter is thought to improve cardiovascular function by causing relaxation of the lining of our blood vessels, improving the flow of oxygenated blood. One study even found a link between sense of humor and longevity, showing a decreased risk of death from all causes in women and death from infection in men with higher scores in the cognitive component of humor. (1)

In terms of cognitive processing, research shows that laughter is associated with improved creativity and problem-solving. In fact, one study showed that college students who were asked to solve word association puzzles following a funny video were more likely to solve them than those who watched a scary or boring video beforehand. Furthermore, they were significantly more likely to solve them by sudden insight compared to an analytical approach. Other studies looking at brain imaging illustrate that cognitive humor and insight problem solving seem to originate in the same area of the brain, with humor having the ability to “prime” this area for insight problem solving. (2) This makes sense, given that we need to remain mentally spacious, relying on our looser connections to both identify the incongruent elements in a situation (aka “get the joke”) and have our best insights or “Aha!” moments.

Whether you want to focus on the data that having laughter in your life strengthens your immune system or that it may lead to your next epiphany, at the end of the day, it’s clear: laughter makes us happy. And always remember, happy people are healthy people. So what’s the call to action this month? Lean into the things that bring us levity! They are different for all of us but we know what ours are. Have dinner with a friend who cracks us up. Watch an old Seinfeld. Or maybe we start keeping a better lookout for the small laughs in our daily lives; the things we miss while preoccupied. For instance, I recently asked my five-year-old why he wasn’t wearing underwear and he told me “It’s complicated.” I am still laughing. Does it get more basic than wearing underwear? Thank God I was present for this memorable one-liner!

Perhaps the most important strategy is to laugh at ourselves and unwind how seriously we take everything. In this way, humor serves as a form of spirituality by reminding us that things aren’t as dire as they seem and we aren’t as important as we once thought. There’s a much bigger Universe out there and we aren’t the center of it. Isn’t that refreshing and doesn’t it take the pressure off? I feel better already! Have a great month, my friends and please remember to lighten up!

Addendum: I wrote the majority of this article sitting in the Las Vegas airport. If you are absolutely out of material, please spend some time here. ;)

References:

1. Romundstad, S., Svebak, S., Holen, A., & Holmen, J. (2016). A 15-year follow-up study of sense of humor and causes of mortality: The nord-trøndelag health study. Psychosomatic Medicine, 78(3), 345–353. https://doi.org/10.1097/PSY.0000000000000275

2. Carey, Benedict. “Tracing the Spark of Creative Problem Solving.” The New York Times, December 6, 2010.

Three Tools to Grow Your Loving Relationships

We know from a host of scientific studies that the quality of our relationships affects our health and happiness in a very real way. We know that chronic loneliness or being in a toxic marriage can put us at risk for premature death. With this in mind, it makes sense that we should prioritize growing our loving connections in the same way we seek to improve our nutrition, exercise, or sleep. 

In this month’s article I’m going to present you with three suggestions on how to do so from the authors of The Good Life: Lessons from the World’s Longest Scientific Study of Happiness, a recent book by the directors of the Harvard Study of Adult Development. These researchers  present the findings of their astounding research  of almost one hundred years. They followed participants from adolescence to death, studying every aspect of their lives, and found that having secure relationships with people they could count on helped participants to live longer and to be happier. 

Here are three tips they provide:  

1. The Power of Generosity - They urge us to be of service to the people in our lives, citing both neural and practical links between generosity and happiness. But in terms of the relationship dynamic in particular, they explain how this tool can help us gain a sense of autonomy. One of the most daunting aspects of relationships can be a sense of powerlessness, not being able to control how other people engage with us. However, by bringing a spirit of generosity to our connections, we lean into the aspect of the relationship we can control — our own behavior.  

This suggestion resonates with me because it reflects what I know but constantly forget— that I am happier when I think more of others and less of myself. Secondly, it frames relationship growth in the empowering way that I love, shifting our focus from what we can’t control (another person’s behavior) to what we can control (our own actions.)

2. Learning New Dance Steps - The authors encourage us to find new ways to connect with the people in our lives, noting that since we are constantly growing and changing as human beings, it only makes sense that our relationships also grow and change. 

For me, this tip serves as a reminder to do for my adult connections what I intuitively do as a mother of small children. I don’t relate to my nine-year-old the same way I did when he was three. His love of surfing has long replaced his obsession with garbage trucks and the questions I ask him and the way we spend our time together reflect this shift. In my relationship of twenty years, my husband and I have (I hope) evolved as well. Trying new hobbies together (like my new favorite stand up paddle) has proven a really fun way to experience each other with fresh eyes.

3. Radical Curiosity —The authors encourage us to get radically curious about the thoughts, feelings, and experiences of others. They discuss how asking people about their lives brings us joy (again by taking the focus off of ourselves) but it also grows the strength of our connections by helping us to understand them more deeply. 

I love this suggestion because it reminds me to take time to ask the questions. This is something I naturally enjoy — getting to know what makes people tick. However, in my busy life, I can tend to skip asking the real questions and then miss out on the real connections.

What I love the most about this book and the authors’ message is that, no matter our age, our genetics, or our personal histories, we can find ways to improve our relationships. This theme is consistent with my message — that by knowing who we want to be and keeping that up front, we can make small changes in the way we think and act to start becoming that person. The call to action this month is to choose a relationship in your life and then find one way you can help that person, a new way you can connect with them, or one question you can ask to understand them a little bit better. As Esther Perel says, “The quality of our relationships determines the quality of our lives.” Let’s start here my friends!

Waldinger, R. J., & Schulz, M. S. (2023). The good life: Lessons from the world’s longest scientific study of happiness (First Simon&Schuster hardcover edition). Simon & Schuster.

Intention - How We Move To Action

People often ask me how I ended up a speaker on lifestyle and health from a career in Emergency Medicine. It’s a fair question. Emergency physicians are the most clinical of clinicians, trained to stabilize sick patients, treat acute issues, and get people where they need to be (e.g; home or admitted to the hospital.) In many cases, we lack the time and bandwidth to talk to patients about how their lifestyles can improve their medical problems or where they are headed if they don’t make changes. However it is what I have seen in the ER that compels me to talk about it. I have taken care of the elderly with dementia who don’t recognize their own children, for patients with advanced diabetes who face amputations, and for persons with severe depression who are considering harming themselves. My heart has been broken by the countless people suffering from diseases that might have been avoided or could be improved by small changes in lifestyle. These are things like eating better, moving more, sleeping enough, and improving our thought content and the quality of our relationships. I find that most people want to do better but struggle to make change. In my mission to empower them, my greatest tool is to help them live intentionally. Since this concept is more popular in yoga studios than health articles, I will explain what I mean and how to make it actionable.

When I say to live with intention, I mean to get clear on your purpose in life and who you want to be, then ensure your choices align with that. The easiest way to start is to see if you can write the purpose of your life in one sentence. Consider it a mission statement of your own little company. How can a business be successful if it doesn’t know its goal? The same is true for us. We need to define what is important to us so we can say “yes” to more things that support our mission and “no” to the things that don’t. Once you’ve got your sentence down, I challenge you to start putting words to who you want to be in every aspect of your life. Whether it’s as a parent, spouse, friend, or professional — describe the best version of yourself and start letting this vision inform your decisions. The research tells us that people who know the purpose of their lives tend to live longer and to be healthier. Wouldn’t it make sense that we should develop our sense of purpose just as we work to improve the other facets of our health?

No matter where you are in the process of hashing out these big questions, I have an exercise that will help set your course. I start my workshops with it and return to it myself when my habits have gone completely sideways. Get a pen and paper and describe your ideal life at eighty-years-old. In other words, depict the life you want — not the one you think you must have. Visualize in detail how you want to feel physically and emotionally and how you hope to function mentally. Who are the people you will spend time with and what will you do?

My vision is to be a strong wife, mother, and grandmother, and my days are to be spent moving, laughing and loving those around me. I keep this image up front every single day; often it’s the last part of my morning reflection. Without this North Star, I struggle to prioritize things like leafy greens, going to bed on time, and sticking with a daily meditation. When I look back to receiving my diagnosis of breast cancer at age forty, I first remember feeling deeply sad, a glimpse of what I had seen in the eyes of many of my ER patients over the years. Then I recall a gnawing regret that I hadn’t done as well as I could have in terms of my nutrition, sleep, and stress management. As in any illness, I will never know how big a part these factors had and how much was driven by my genetic profile and other unknowns. However, this clarity of intention helps me to move forward to the best of my abilities, reducing the risk of future disease and putting me in a better place to undergo treatment if it does strike.

None of us is exempt from a bad diagnosis. I know that with even the healthiest of lifestyles, there are factors outside our control. However, my point is that we can still optimize the things we can control, making our chance of disease less and making us more resilient if we do face one. By getting clear on our purpose and the vision of our later years, we gain the motivation to make those simple but often difficult changes. By doing so, we just might find ourselves becoming who we were meant to be all along!

Assigning the Right Meaning to the Events of Our Lives

In the title of my keynote address, “Seek— How We Take Ownership of our Health and Happiness,” I use the word “ownership” because so many of us lack this sense of responsibility in both of these purviews. Certainly there are circumstances out of our control, but we can make tremendous progress when we focus on the things we can control. When it comes to physical health, my job isn’t too hard. I present the scientific data linking lifestyle to a host of chronic diseases and folks start to get the picture, jotting down simple ways they can do better. But when it comes to happiness, people often resist the “ownership” concept, stuck believing that their experiences dictate their happiness. While I teach many tools to begin chipping away at this philosophy (e.g; gratitude and mindfulness practices), today I want to focus on the importance of assigning the right meaning to the events in our lives. We are the ones who give our experiences context and we get to choose whether they drive us closer or farther from who we want to be.

As a pivotal example in my life, when I was a teenager I lost my mother to cancer. While I still work through the devastation of this event, I know that witnessing her doctor’s compassion and the comfort it brought her drove me to pursue medicine, enabling me to do the same for others. I can still see her weak smile in response to his kind words and remember clinging to that moment of peace in the sadness of it all. I am eternally grateful for the direction this brought me, assigning a meaning to losing my mother that empowers me rather than victimizes. In a much lighter scenario, I was recently reminded of this tool by a complete stranger when I drove my kids thirty minutes to a soccer clinic only to find out it had been canceled. Right when my irritation was peaking and I started repeatedly stating “but I called to confirm that it was on,” another mom smiled and pointed out that it was Valentine’s Day and now we would have more time with our families. It was brilliant. Neither of us could change the circumstances but she had settled on a meaning that brought her joy. I then adopted her perspective because it turns out that living a joyful life is part my intention.

The formula for this kind of work begins right there: the decision to live with intention. The next step is gaining clarity on our value systems and the kind of people we want to be. This might vary in different facets of our lives (e.g; work, family, friends.) In my case, patience and joy are two of the qualities I am working to cultivate as a mother. If you knew me personally, you might laugh, as my default state is incredibly impatient and intense. And if you saw me around town, patient and joyful would not be the first words you choose to describe me. I am by no means there but that’s okay — the mere decision to put words to the kind of people we hope to become gives us the grace to see opportunities to grow in that direction. It enables us to start assigning the right meaning to the events of our lives and begin taking back some ownership of our happiness.

One of my closest friends underwent aggressive treatment for stage three breast cancer when she was thirty-five-years old. At the time, her children were ages five, three and one. She still struggles with the residual damage that her treatment (chemotherapy, radiation, and multiple surgeries) had on her body. However, she refers to her diagnosis as “the best worst thing that ever happened to me.” She explains that she now has a clarity about what matters in life that she never had before. She prioritizes differently, she worries less and about different things. She finds herself living truer to her personal value system and to the intentions that she sets for her life. In her case, she has taken this game-changing bit of adversity and used it in her favor to become the best version of herself. I don’t wish any of us this kind of challenge, but I do know we will all end up with something that doesn’t go our way. When this happens, I hope we choose to assign it a meaning that brings us closer to our stated intention for our lives. It just may be one of the most important decisions we make!

Intentional Attention and Why It Really Matters

My mother passed away when I was fifteen-years-old, leaving me to cherish every memory of her beyond words. In one, I am about nine-years-old and waiting to start our checkers game. The board is set up at the kitchen table and her kettle whistles. (My mother poured herself a cup of tea before she did just about anything.) When she finally sits down to play, the phone (an off-white landline circa 1990) rings. As my mother picks it up and says hello, I get nervous. It’s Rita, her dear friend who loves to talk and can easily derail our entire afternoon. The chatting begins for a few minutes and just when I am about to give up hope, I hear my mother say, “Okay Rita, I gotta hang. I promised Coll I would play checkers with her.”

I share this memory because it illustrates the kind of attention I received as I child while I try to tackle the issue of my fractured attention as a mother in a new world. My mom was by no means the type who felt she needed to entertain a child. (Most of my non-school memories are of being sent outside to play with neighborhood kids.) She was also incredibly busy, running my two older siblings to sports and managing my grandmother who had dementia, among other responsibilities. However, this story highlights the magic behind the attention she gave me: It was intentional. And by that I mean that my mother purposefully gave me her full attention at intervals I can’t even recall at this point. But I know that they left me feeling loved, secure, heard, and seen. And in this challenging game of parenting, that is a win.

As I write this article, I have four children of my own, ages nine, eight, six and five-years-old. I too am busy with a host of personal and professional commitments. However, I also walk around with a device designed to distract me from anything and everything, my iPhone. The way my life is currently set up, I need it to function. It houses my calendar, an app for the ever-changing soccer schedule, the GPS to find my way around, and even my Sonos to play music. These functions are in addition to the standard incessant text messages, emails, and addictive social media feeds that most of our phones have. Whenever I glance at it (which I do over one hundred times a day according to its count), it has the power to completely distract me from whomever I am interacting with, often my children. I worry that over time, this will have an affect and it won’t be as positive as my own mother’s attention was in my life.

I had been grappling with this issue for a while and trying different hacks with varied success, when I picked up a book called Digital Minimalism (1). Its author Cal Newport suggests that we only use the apps that strongly support our deep values. And for those that we must use (e.g; work email, social media for business), we devise ways to prevent them from interfering with the life we want to live. To summarize what this looks like for me, I turned off all my notifications, including those for text messaging and email. Now I look at my messages a few times a day and reply in batches without being constantly interrupted. I also moved my social media apps off the home screen and only open them occasionally to post high quality content for my business. And for the times that I don’t need my phone (e.g; out to dinner with my family) — I leave it home.

As with every change we make to try and become better versions of ourselves, we really don’t know what effects it will have down the line. In this case, I can’t be sure that this little tweak has left my children feeling more loved and secure. However I do know that I feel more relaxed and engaged with them them, so I’m taking that as a good sign. My call to action this month is that you take a minute considering whether your technology use is moving you closer or farther from what is most important to you. Then start making changes accordingly. Remember — we only get one chance at this life and we don’t want to miss the games of checkers that really matter to us!

1. Newport, C. (2019). Digital minimalism: Choosing a focused life in a noisy world. Portfolio/Penguin.

Mental Health: What is Our Part?

We are in a mental health crisis. More people are suffering from anxiety and depression than ever before and doctors are churning out prescriptions at an unprecedented rate. In 2016, antidepressants (e.g; Prozac) were the most common prescription medication taken by adults, ages 20 to 59. (1) In early 2020, prescriptions for antidepressants rose 18% while those for anti-anxiety medications (e.g; Xanax) rose 34%. (2) Years of taking care of patients with psychiatric emergencies taught me how devastating these illnesses are on a clinical level. Watching some of my own loved ones struggle has done the same in a personal way.  Thankfully, we seem to realize the importance of removing stigma and improving access to care. But I don’t believe we are looking closely enough at the connection between lifestyle and mental health.  As doctors, we do our patients a huge disservice when we fail to teach them ways that they can improve any disease through the simple habits of their daily lives.

Mental health diagnoses are no exception. Here are five simple interventions that have been shown to improve anxiety and depression. Start moving. Taking a walk or bike ride floods our brains with a variety of mood-boosting hormones, the “natural” versions of many substances people take to feel better. We raise our serotonin levels (the “happy hormone” targeted by SSRI antidepressants), our endorphins (homemade opioids), and our endocannabinoids (that activate the same brain receptors as marijuana), to name a few. We also shift the flow of blood away from our amygdala (the fear-center of the brain) and toward the prefrontal cortex (the center for critical thinking), giving us a chance to consider our problems in a new light.  

Sleep more. When we constantly skimp on the seven to nine hours needed for nightly sleep, we put our bodies in a state of chronic stress. Our cortisol and norepinephrine levels are elevated and our minds process the resulting “fight or flight” feeling as anxiety. We also miss out on the array of benefits that sleep and dreaming have for mental health. Leading sleep researcher Matthew Walker PhD refers to dreaming as “overnight therapy”, allowing us to process the difficult experiences of our lives so that we can later recall them without a severe emotional reaction. (3)

Eat better. Diets that consist of highly processed and sugary food shift our bodies into a state of inflammation. Just as an inflamed ankle results in ankle pain, an inflamed brain contributes to anxiety and depression. In a landmark study, researchers showed that 32% of  depressed patients who received nutritional training (in addition to their other psychiatric care) had improved symptoms compared with only 8% of those receiving social support.(4) They were taught a Mediterranean diet, focused on eating more whole foods such as fruits, vegetables, nuts, and beans. 

Get grateful. Research tells us that, left to our own devices, we tend to have at least four negative thoughts for each positive one. In other words, we are experts at looking for the bad in any situation. A gratitude practice is our simplest tool to dismantle default negativity and take ownership of our thought patterns. By writing down three things that are going well in our lives every day, we teach our brains to look for the good in other areas of our life. This practice not only alleviates symptoms of anxiety and depression but it very really shifts the way we experience our lives. 

Live intentionally. We must remember that this is not a dress rehearsal. We have one crack at this life and we get to choose how we spend our time. Perhaps we decide to put down our phones for an afternoon and connect with a friend for a hike. While scrolling social media is associated with increased risk of anxiety and depression, face-to-face connection with friends and spending time in nature are both shown to boost mood. Perhaps we say yes to a volunteer opportunity or call someone that we know is struggling. By helping others, we not only feel better, but we gain a sense of purpose in our lives. 

Whenever I share suggestions, I like to highlight the one tip that has helped me the most. In this case, it’s difficult to say because all of these tools are critical to my happiness. My default mindset is one of worry (the kind of person who assumes you were in a car accident if you are five minutes late.) At times this can be just part of my quirky energy and at others it can be debilitating. I try to do all of the things on the list every day because I don’t know which one is the most important, but together they work. Whether you struggle with a severe mental health diagnosis or just the ups and downs that are common to the human experience, I hope you find one thing on this list that helps you! 

References: 

1. Martin CB, Hales CM, Gu Q, Ogden CL. Prescription Drug Use in the United States, 2015-2016. NCHS Data Brief. 2019 May;(334):1-8. PMID: 31112126.

2. “America’s State of Mind Report.” (2020). Express Scripts, April 16. https://www.express-scripts.com/corporate/americas-state-of-mind-report .

3. Walker, M. P. (2017). Why we sleep: Unlocking the power of sleep and dreams (First Scribner hardcover edition). Scribner, an imprint of Simon & Schuster, Inc.

4. Jacka, F. N., O’Neil, A., Opie, R., Itsiopoulos, C., Cotton, S., Mohebbi, M., Castle, D., Dash, S., Mihalopoulos, C., Chatterton, M. L., Brazionis, L., Dean, O. M., Hodge, A. M., & Berk, M. (2017). A randomised controlled trial of dietary improvement for adults with major depression (The ‘smiles’ trial). BMC Medicine, 15(1), 23. https://doi.org/10.1186/s12916-017-0791-y

The Science of Habits: How to Make Your New Year’s Resolution Stick

As we ring in the new year, most of us can’t help but take stock of ourselves and our lives. In some cases, this manifests as a formal list of New Year’s resolutions. In others, it results in a general sense of how we would like to do better. Either way, when we find ourselves pausing (even for a moment) to consider who we are and who we want to be, we are winning. In that vulnerability, we become willing to make small changes that ultimately transform our health and happiness. These changes happen in the habits of our daily lives. They are things like going to bed twenty minutes earlier, snacking on apples instead of chips, prioritizing a walk with a friend, or writing a daily gratitude list. They may be easy enough to do today but the real magic happens when we do them consistently day after day, week after week. It’s the consistency piece where most of us lose track of our ideals. In this article I will outline four simple tools to help us get consistent. Research shows that it takes about 66 days for a new habit to become automatic.(1)  In other words, we only have to work hard for a couple of months and then our desired action becomes instinctual.

The first suggestion, as outlined in Atomic Habits by James Clear, is that we answer two questions about our new behavior: when and where are we going to do it? (2) If this seems like a trivial exercise, just try to pin yourself down for five minutes in your daily life and see how essential it becomes to carve out the time and space in advance.  For example, if you are aiming to develop a daily meditation practice, you might decide that immediately after you drop your children at school but before you walk into your office or home is best. (Yes, it’s okay to sit in your car and meditate if that is your protected space- I’ve been there!)

Secondly, set yourself up for success! By that I mean to add or reduce friction in order to make your new behavior the easy choice. For example, when I was trying to get more sleep, I invested in lightbulbs that automatically dim and turn off at a specified time. Now, it takes more work to walk around turning lights back on than to just listen to my body and go to bed; this is adding friction. When I was focused on trying to eat a greater variety of whole foods, I bought mason jars for my fridge. Now I chop my veggies in advance so they are easier to grab when I’m in a hurry; this is reducing friction.

Third, use your current routine to cue your new habit. This is called habit stacking. You want to perform your new behavior along with something you do every day. For example, a written gratitude practice takes about two minutes to complete and can change the experience of your entire day (and life.) I was never consistent with this until I stacked it with my morning tea. Now as I have my tea, I write down 3-5 things going well in my life (and teach my brain to look for the good things the rest of the day.) Or how about taking a five minute walk every day after lunch? If you’ve struggled to get enough movement in, stacking a walk with a meal means you're more likely to remember it plus you get the added benefit of avoiding a spike in blood sugar. (3)

Finally, get your head right. (This applies to anything you want to accomplish.) In order to be successful, you need to believe that you are capable. Sit with your resolution. Own it. Visualize it. Feel the feelings of  work and accomplishment. Let’s say you want to run a half-marathon this year. Register for a race now and start mentally walking yourself through the process from buying new sneakers, to short training runs, to longer runs. Feel how proud you will be the day you complete it (even though it is many months away.) Whatever your goal is, set a very clear intention on where you want to go and what you need to do to get there. See it in your mind first and before you know it, you will be living your way there!

References:

1. Clear, J. (2018). Atomic habits: Tiny changes, remarkable results : an easy & proven way to build good habits & break bad ones. Avery, an imprint of Penguin Random House.

2. Lally, P., van Jaarsveld, C. H. M., Potts, H. W. W., & Wardle, J. (2010). How are habits formed: Modelling habit formation in the real world. European Journal of Social Psychology, 40(6), 998–1009. https://doi.org/10.1002/ejsp.674

3. Buffey, A. J., Herring, M. P., Langley, C. K., Donnelly, A. E., & Carson, B. P. (2022). The acute effects of interrupting prolonged sitting time in adults with standing and light-intensity walking on biomarkers of cardiometabolic health in adults: A systematic review and meta-analysis. Sports Medicine, 52(8), 1765–1787. https://doi.org/10.1007/s40279-022-01649-4

Hormesis: What Doesn’t Kill You Makes You Stronger

Ever wonder what intermittent fasting, high intensity workouts, cryotherapy, and turmeric all have in common? It’s hormesis, the scientific theory that a little bit of physiological adversity will make us stronger in the end. I love this idea! I’ve always been a “…a smooth sea never made a skilled sailor” kinda girl and this seems to be the cellular manifestation of that philosophy. Let me take you through the science.

The theory stems from the idea that we are all a little bit too comfortable in Southern California in 2022. As a species, we started as organisms that had to work for survival. We needed to hunt or forage for food (and may have gone hungry now and then.) Our shelter situation was touch and go (and we may have been exposed to the elements once in a while.) We have evolved into a species that lives a life of relative leisure (in lovely homes with stocked refrigerators and thermostats set at 72 degrees.) The hormesis enthusiasts suggest that by stressing our systems (just a tad), we will trigger a cascade of cellular pathways designed to repair damage, and ultimately put us in a position of improved health and vitality.

On a cellular level there are several mechanisms at play and they are still being elucidated in the research lab. What they all tend to have in common, though, is that a short term stressor triggers what is sort of a “spring cleaning” of the cell. In other words, the pathways that recycle old proteins for future use, that repair DNA damage so that cancer cells aren’t born, and that scavenge for free radicals to minimize oxidative damage are all stimulated. When you look for human data, it’s hard to find proof that any of these interventions will definitely add years to your life. However, the research is underway and there was one study published in in JAMA showing an association between sauna use in middle-aged men and decreased mortality risk. (1) Sothey may be onto something here!

My takeaway on this hot topic is that the science is really cool and I’m happy take part as long as it’s not putting me at any major risk. For example, you can always count me in for a dip in the cold Pacific. (I mean, have you ever had a bad day after getting into the ocean?!) I have also been dragging reluctant friends to hot yoga for decades. My latest hormetic hobby is drinking steamed almond milk with turmeric all winter long. I recommend that you also find a way to get out of your comfort zone and (safely) induce some hormesis this month. Even if it’s just checking out that HIIT class your friend told you about, a little bit of stress just might make you stronger! Thanks for reading and as always, keep seeking!

1: Laukkanen, T., Khan, H., Zaccardi, F., & Laukkanen, J. A. (2015). Association between sauna bathing and fatal cardiovascular and all-cause mortality events. JAMA Internal Medicine, 175(4), 542. https://doi.org/10.1001/jamainternmed.2014.8187

Intermittent Fasting - It’s About More than Just Weight Loss

One of my favorite “jobs” as physician is to respond to the many questions my friends and family have about the latest health trends. Very often, I must reluctantly report that there is no science behind the new fad, but as long as it isn’t harmful, feel free to carry on! In the case of intermittent fasting, however, I have been pleasantly surprised by the data and even more impressed by how this practice goes beyond weight loss and can improve important aspects of our physiology. First, let’s get our definitions straight. The research on intermittent fasting focuses on three common protocols. One is alternate day fasting and two is 5:2 fasting (meaning that a person eats normally five days per week and fasts for two nonconsecutive days.) In these cases, fasting days are defined by a severe reduction in calories (typically 500-750/ day.) The third protocol (and likely the easiest to implement) is time restricted feeding, meaning that a person only eats for a certain period every day (often eight hours), for example between 12 pm and 8 pm. This is also known as circadian fasting because it takes advantage of the hours we are sleeping to accrue fasting time and helps to reset our circadian rhythm on the cellular level.

It has always seemed obvious to me that one of these protocols could lead to weight loss because it puts some structure around our eating and facilitates cutting calories in those of us who tend to eat all day. However, it wasn’t until I looked at the research that I found the vast array of other benefits we gain from “flipping the switch” metabolically, and choosing to spend time in a fasted state. Most of us, by twelve hours after our last meal, run out of glucose stores and start breaking down fat for energy. In this process, we create “ketone bodies” which happen to have some incredible effects on the cellular level. They boost multiple pathways involved in cellular repair, reducing inflammation, and even increasing neuroplasticity (i.e; the ability to make new brain connections.) On a clinical level, people practicing intermittent fasting over the course of months have shown some impressive changes such as better insulin sensitivity, lower blood pressure and heart rate, and decreased abdominal fat. They also have improvements to their liver health and the diversity of bacteria in their microbiome. Anecdotally, people report having improved energy and focus, favorable results that I too have experienced!

So what is my point in presenting this data? That we should all immediately cut back our eating to an eight hour window every day? Of course not! The “perfect” manifestation of intermittent fasting might not be a great fit for all of us. (In fact, my ability consistently adhere to a sixteen hour fast varies with the ebbs and flows of my life.) However, I do hope that you will consider closing your kitchen at 8 pm and holding off on breakfast until 9 or 10am. If this is easy for you, then maybe you extend your fast by even a few minutes every day. Each minute that we spend fasting beyond twelve hours gives us the chance to reap some important benefits. My take on the current research is that this simple intervention has the potential to be a game changer in improving our metabolic health and possibly more. Remember, it’s the small habits of our daily lives that most determine our wellbeing. Let’s start focusing not just on what we eat, but on when we eat! It doesn’t have to be perfect. It just has to be moving in the right direction!

Disclaimer: Persons with a history of an eating disorder such as anorexia nervosa or bulimia or persons on certain medications for diabetes or who are pregnant or breastfeeding should not engage in intermittent fasting. Please consult your doctor before starting this practice.

References:

de Cabo R, Mattson MP. Effects of Intermittent Fasting on Health, Aging, and Disease. N Engl J Med. 2019 Dec 26;381(26):2541-2551. doi: 10.1056/NEJMra1905136. Erratum in: N Engl J Med. 2020 Jan 16;382(3):298. Erratum in: N Engl J Med. 2020 Mar 5;382(10):978. PMID: 31881139.

Emily N C Manoogian, Lisa S Chow, Pam R Taub, Blandine Laferrère, Satchidananda Panda, Time-restricted Eating for the Prevention and Management of Metabolic Diseases, Endocrine Reviews, Volume 43, Issue 2, April 2022, Pages 405–436, https://doi.org/10.1210/endrev/bnab027

Keeping Perspective

Do you remember the end of “It’s a Wonderful Life”? In my favorite Christmas movie, the protagonist George Bailey (when going through a personal crisis) gets a glimpse of what things would look like if he never existed. He gets to feel the emptiness that comes when his life and his loved ones vanish in a moment. Then he returns home in the final scene to find his little world unchanged but himself completely transformed.

I feel like George Bailey. As I shared last month, I was recently diagnosed with breast cancer. I am incredibly fortunate that it was found early and my treatment was completed with a double mastectomy. I only traded my usual life of mom and doctor for that of a patient, watching her children be cared for by others, for a short while. However I pray that I never lose the gratitude and perspective that it gave me.

So I’ve been wondering - how do we do that? How do we bottle the feeling that all is well in our lives and we don’t need a single thing? The stoic philosophers suggested that we contemplate our death on a daily basis to bring us to this place of gratitude. While that may sound extreme, it can certainly put our daily stressors into a different context. Marcus Aurelius said, “When you arise in the morning, think of what a privilege it is to be alive, to think, to enjoy, to love.” Is there a better way to start your day than that?

And then I think it comes down perspective. Not a single person reading this article is exempt from life’s hiccups. Whether your brand of adversity comes in the form of a health crisis, financial, relationship, or other — there is probably something that’s not going your way somewhere along the line. That’s when we have a choice. We can focus on what we don’t have or what we do have. It might just be that simple. In my experience, it’s these unwelcome detours that have the power to remind us how incredibly good we’ve got it!

Keep seeking, my friends!

Finishing - The Ultimate Accomplishment

I was milling about at the start line of the Surf City Half Marathon a couple of weeks ago when I spotted something that really struck me. I saw a man wearing a T-shirt from the Iron Man competition in Kona, Hawaii. He had competed in the world championship of a race that most people wouldn’t even consider attempting. Yet it wasn’t this man’s incredible accomplishment that spoke to me - it was how he perceived it. The word “FINISHER” was printed in large letters across his back suggesting that this was the part of which he was proudest.

His message resonated with me that morning because I was standing in line to run a race that I had committed to run, in spite of the fact that I was diagnosed with breast cancer earlier that week. (Thankfully, I am incredibly lucky to have found it very early and I will be just fine!) I share this personal bit of adversity to illustrate in a vulnerable way how showing up for our health often means simply doing what we set out to do. Answering the bell. It requires different things on different days - but it always requires finishing.

Through my writing, I educate on the importance of good nutrition, frequent movement, and adequate sleep. I emphasize growing our spiritual lives and our loving connections. But perhaps most importantly, I try to cultivate in you a sense of purpose - an understanding of why you are here on this planet. It requires an inquiry into what gets you out of bed in the morning and what brings you a sense of joy and meaning. For me, that purpose is my motherhood and this work. For you, it may be similar or entirely different. It is perfect as long as it is authentically yours.

Your call to action today is that you spend a minute or two considering your purpose. Once you’ve got your “why” written on your heart, I want you to think about what “finishing” looks like for you today. What do you need to do so that you have the best possible chance to be alive and keep writing your story? It might be as simple as having a salad with your dinner when you’d rather have a pound of pasta or going for a walk when you’d rather watch Netflix. It might be forgiving a friend when you’d rather stay mad or scheduling that mammogram when you’d rather procrastinate. Finish your work and be who you were meant to be.

Fake It Until You Become It

In her famous TED talk “Your body language may shape who you are”, Amy Cuddy presents her fascinating research on the psychological effects of body language. She explains how purposely choosing to stand in a power posture (up  tall and arms open) versus an insecure posture (arms folded and shoulders hunched) can literally alter our hormonal state and how people respond to us. Her research shows that people who were randomized to two minutes of a power posture before walking into a mock interview performed better than those randomized to two minutes of an insecure posture before the interview. She summarizes her recommendations with the title of this article “Fake it until you become it,” noting that the more famous cliche “Fake it until you make it” results in a feeling of fraudulence — that even if you are successful you still feel like an imposter.

I loved her talk and thesis on many levels. The first and most obvious rides on the coattails of my insistence that we have to monitor our thoughts. We need to be so careful about our default thinking (i.e; focus on gratitude and joy over fear and complaints.) By doing so, we can change our hormonal state and literally alter our physiology, becoming happier and healthier. She takes it a step further, demonstrating that if we choose to take up space with how we stand, we lower or stress hormone cortisol and we feel more powerful. Thus we can add our posture to the growing list of things that we do have control over and that can positively affect our mental and physical health!

Additionally, she champions the idea that we don’t have to have everything figured out to become our best selves. We can “act as if…” This is one of the simplest suggestions that I often give clients and I use myself in every area of growth. Figure out who you want to be and start taking actions that align with that vision. For example, when I wanted to improve my nutrition, I considered that the healthiest people in the world eat lots of leafy greens and I started to make a salad with every dinner. Even if I only have a few bites, I am cementing my identity as a person who eats healthily and it sets the stage for future good choices. When I wanted to get back into running after many years off, I thought about what a runner would do. I decided to buy new sneakers and sign up for a race. Even though I only started with a couple of miles every day, these actions helped me mold my vision of myself into the runner I ultimately became.

So the call to action this month is to do something that speaks to the person you want to become. Stand up straighter, order that side salad, or join that tennis league. Even if it’s doesn’t feel authentic just yet, trust that it will in time! As always, it is by seeking that we transform! 

https://www.ted.com/talks/amy_cuddy_your_body_language_may_shape_who_you_are?language=en

Connection Is An Action

In the spirit of love and friendship during this month of February, we will focus on connection with fellow human beings as a vital aspect of our health. We know from the medical literature that people with secure connections to others tend to be happier and live longer. Furthermore, in spite of our world becoming ever more “virtual” over the last two years, research and our own experience show us that phone calls, texts, and zoom cannot fully replace face-to-face human interactions. (1) Yet even before the global pandemic, public health experts had begun addressing the rates of human loneliness as an “epidemic” here and around the world. Scientists think that the deleterious effects of loneliness stem from chronic inflammation, similarly to how eating lots of sugar or failing to exercise negatively impact our physiology. One study, in fact, noted that loneliness is as harmful to our health as smoking fifteen cigarettes a day and increases our risk of premature death by thirty percent. (2)

Now if you read my column regularly, you know that I wouldn’t cite these incredibly dismal statistics if there wasn’t a solution and if I didn’t have a call to action for you. I lay out this problem so that you will begin considering connection as important to your health as your nutrition, sleep, and exercise. Furthermore, I need you to see loneliness as a problem that is not unique to you but that you are responsible for addressing. Just as you would take an antibiotic prescribed for an infection, you need to begin proactively seeking social connections if they are not occurring naturally in your daily life.

Somewhere along the line, we started to believe that feeling isolated reflects a deficit in ourselves — that we missed some basic memo on relationships. This perspective is both inaccurate and self-defeating. If we are honest with ourselves, there are times when we have had many natural connections and times when we needed to create them. I know that this has been the case in my own life, when working lots of hours in residency and moving across the country with a newborn are two times when I can recall feeling quite lonely. So what is the solution? As always, it is action. Call an old friend and put a coffee date on the calendar. Join that pickleball  league that you have been considering for months. Sign up for a “new moms” group.  Download an app to meet up with local people who have similar interests as you. Reach out to others as if your life depends on it, because it does. You will find that when you take that first step (i.e; you seek connection) the rest will be easier than you think!  

1.        Alan Teo, M.D., M.S. Does Mode of Contact with Different Types of Social Relationships Predict Depression Among Older Adults? Evidence from a Nationally Representative Survey. Journal of the American Geriatrics Society, October 2015

   2.       Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspect Psychol Sci. 2015 Mar;10(2):227-37. doi: 10.1177/1745691614568352. PMID: 25910392.

Turning Resolutions Into Habits

Happy New Year! I expect that many readers currently find themselves in a familiar place this January, recommitted to their physical and mental health after a busy holiday season. It’s so natural for us to have at least a few intentions when we turn the page on another year. While these sorts of “new year’s resolutions” often get a bad rap, I believe that any occasion which causes us to reflect and aim for better is a welcomed one. In fact I will be celebrating this annual custom by sharing some tips to help you turn your resolution into a sustainable part of your life.

My first recommendation is to set up your day to make your new habit the easiest option. In psychology literature, this is called “reducing friction.” The idea is that when we first commit to a new practice, nothing will stop us because we are so excited! Often our enthusiasm wanes within a few weeks and we find ourselves again pursuing the path of least resistance (which incidentally doesn’t include eating more salad, meditating more, etc.) Therefore, we need to set up our lives so that the default action is our new healthy habit. For example, if we want to eat more life-giving food, then we should only keep whole foods in our kitchen. Even if we are craving potato chips, we will find ourselves snacking on fruit and nuts if there are no processed foods to be found. If we want to attend a morning yoga class but struggle with consistency, then perhaps we should make plans to join a friend and pay for the class in advance. Then it will be easier to attend than have to cancel and get our money back!

The second tip, as recommended by James Clear in his book Atomic Habits, is to answer two specific questions about whatever habit you hope to acquire. Where and when will you complete them? Until we provide these details, our resolution is largely theoretical. However, when we decide, for example, that we will journal every morning in our bedroom after brushing our teeth, our new habit has a real place in our lives. I used this strategy to gain time for medical education podcasts. Once I decided that I would listen to one lecture every weekday afternoon when driving to school pickup, I found myself quickly caught up on my queue.

Lastly, I want to remind everyone to not give up! New healthy habits can be challenging at first, but not forever. The science tells us that it takes about 66 days of consistency for something to become part of our fiber, an action we simply take without having to think about it. I encourage everyone to go ahead and use every trick of the trade and all the discipline that you can muster for the next couple of months. I promise it well get easier as long as you stick to it! As always, keep seeking!

Mindfulness - How We Lean Into Moments

As I write this piece, it is the week before Halloween and I’m reviewing in my mind whether we have a complete costume for all of my children. By the time you read it, it will be the first week of December and we will be wondering how to squeeze in shopping and wrapping as our schedules become jam-packed with holiday activities. While this kicks off my favorite time of year, I do feel as though I am currently on the first part of a rollercoaster, slowly clicking up a steep hill, knowing what is coming and suspecting that no amount of preparation can help prevent a crazy rush in the end. You December readers are just about at the peak of that hill and in a few more days, you will be cruising downward on that wild ride that is the modern holiday season.

It is during these busy times that I often prioritize my mile long “to do” list over my mental health and wellbeing. I find myself saying that I will focus on mindfulness or serenity once things slow down again. Yet this strategy is fraught with error. If we postpone our practice of being in the present moment, then we risk missing the very moments that we cherish so much. We are constantly focused on our next chore or event until we pop our heads up in January and realize we missed the whole thing. And what’s even worse - we sometimes feel relieved because our incessant thinking of the future was so very exhausting.

The good news is that it doesn’t have to be that way. I’m here to tell you that allotting ten, five,  or even two minutes a day to a mindfulness practice is enough to transform your December and your life. It doesn’t have to be perfect. You can download any of the popular apps (e.g; Headspace, Calm) and follow the prompts. If your mind cooperates for only a fraction of the session, that’s okay! The very seeking to be present is enough. Medical research shows us that this effort at meditation can reduce symptoms of anxiety and depression and makes us more resilient during the rest of the day when adversity strikes. It also makes us more efficient with our time so busyness is a poor excuse!

Getting Grateful

At last it is November, and we will focus on my favorite tool for improved health and happiness! You’ve guessed it- GRATITUDE! The science of gratitude is exploding and there are studies showing benefits that range from decreased anxiety and depression to improved sleep and emotional resilience. There is data suggesting that gratitude protects us from cardiovascular disease and lowers our markers of inflammation. However, instead of inundating you with scientific research, I’m going to teach you three easy tools that you can implement today. Performed on a daily basis, these simple practices will change your life long after Thanksgiving has come and gone.  

The first is a daily gratitude journal. What I mean by this is exactly how it sounds- keep a small journal and a pen either at your bedside or where you have your coffee and open it every morning when you first wake up. Write down at least five specific things that you are grateful for every single day. These can be big things like a new job opportunity or an upcoming vacation or simple things like having clean water and a bed to sleep in. It doesn’t matter what you list as long as you put pen to paper and start your day by focusing on what is actually going right in your life. Within a day or two, you will see that your brain has been primed to notice the good things during the hours to come as well.

The second of these tools is embracing the phrase “I get to…”. These three words should replace “I have to…” in both our spoken language and our thoughts whenever possible. For me this might look like, “I get to take my kids to soccer, then I get to cook dinner tonight. Tomorrow I get to go to work.”  This subtle shift reminds me what a blessing it is to have children, what a privilege it is that they can play sports, and how lucky I am to have a job. I use this phrase to keep me attuned to the gifts in my life, constantly recognizing the overwhelming abundance.

Lastly, I invite you to begin a practice of appreciation. This is the application of gratitude to our relationships. Choose one or two things that you appreciate about your spouse or loved one every single day and then actually tell them. This is one of the unique interventions that has the power to favorably shift the mindset of both the compliment giver and recipient. In a short time, you will see how this simple action grows and deepens any important connection in your life.

As the adage says, “Where attention goes, energy flows.” Of course, life throws us its (sometimes big) challenges but undoubtedly, we all have things that are going amazingly well. I invite you to start focusing on the good stuff today and every day. You will find that choosing to do so will change how you experience the rest of your life.

“Traction” As The Key To Attention - How We Grow Our Connections

When I work with people to grow their loving connections, I often quip that the formula comes down to appreciation and attention. We will dive into the appreciation piece next month but today I want to convince you of the importance of attention - the creation of space and time for our relationships to thrive. This, like all my recommendations, is a conscious choice and requires that we are living intentionally.

Whether it’s with our children, our partner, or our friends, we find that love is already present in our relationships. The challenge is that our perpetual busyness and culture of distraction often prevent us from holding space for the connection to happen. How often do we sit to have a conversation only to be interrupted by a text message? Have you ever picked up your phone to put on some music only to be sidetracked by a push notification? Or how about the ability to take phone calls in the car altogether? The car was once a sort of sacred space, where both spontaneous and planned discussions could happen without interruption. Now even these talks are cut short unintentionally.

But before I go on too long about the dangers of technology and the scientific evidence that it limits our connections, let’s focus on the solution. Many of us aren’t getting rid of our smartphones any time soon and our calendar invitations don’t seem to be slowing down either. So how do we empower ourselves to give our relationships the proper attention? I came across one interesting theory in the book Indistractable by Nir Eyal. Rather than blaming our constant state of distraction on modern technology, Eyal believes that the root of our problem lies within us. His solution is getting in touch with how we really want to spend our time and ensuring that it aligns with our own value systems. He proposes that the opposite of “distraction” is not actually “focus” as many believe; it is what he calls “traction” - any action that pulls you towards what you want to do.

So what does traction look like  on an average day? It requires that we decide how we want to spend our time and then we set up our lives accordingly. Want to connect with with your spouse? Mark your weekly dates on your calendar as you would any commitment. Want to facilitate conversation as you drive your child to practice? Put your phone on “Do not disturb.” Do you find yourself running from one social event to another all weekend? It’s okay to decline an invitation in order to make time for your most valuable connections. These are just a few ideas that I have used to get you started but you will find that when you get in touch with your “traction,” you will be making similar decisions on your own. Your connections will get the attention that they need to grow, a tremendous benefit of living intentionally.

Knowing Your Purpose - How Change Becomes Sustainable

As a physician and health coach, I am always interested in encouraging healthy habits that are supported by the medical literature. In some areas, the mechanism behind my recommendation is intuitive or at least easily explicable. For example, vegetables provide powerful antioxidants, movement  enhances metabolism, and adequate sleep allows repair on a cellular level. The science behind these interventions and associated benefits is easy to grasp. But when I encourage people to identify the purpose of their lives, it might seem that my science has gone out the window. This month, I want to illustrate that knowing our “why” is essential for vitality and theorize the etiology behind it.

The data shows us time and again that people who know the reason for their lives tend to live longer and be healthier. When I first came across this type of research, I assumed that it was limited to the elderly population, perhaps people who had lost the discipline of their earlier years while in retirement. Then I saw studies suggesting that knowing one’s purpose lowers the risk of death at all stages of adulthood (1) and I became more intrigued. In fact, one recent paper found that whether a person had a strong sense of purpose was more closely associated with their risk of dying than was drinking, smoking, or regular exercise. (2) These findings are so compelling for something that often seems like a “soft” health recommendation.

In an effort to understand why knowing our purpose is so critical, I borrow from Simon Sinek in his popular TED Talk “How great leaders inspire action.”  He discusses why companies that know the “why” behind their brands are more successful than those that don’t - because “why” they do something inspires people more than “what” their product does or even “how” it does it. I believe this model also applies to our our personal health. Strategies that focus on the “what” such as “how to lose belly fat” or “how to improve heart health” will only ignite change for a short period because they move us only superficially. Yet when we get in touch with our own personal “why”, we find we can sustain often challenging lifestyle changes. With our purpose up front, we start to develop our “how”  and then we are living intentionally.

For me, a big part of my “why” is the mother I want to be. I aim to be active and present with my children now and with my grandchildren one day. Once I am clear on this vision, I find myself making small but meaningful choices that align with the life I hope to build. I can intentionally choose fruit instead of chips, walk instead of drive, and stick to my meditation practice in spite of distractions.  So I invite you to do some reflection this month on what is the important work of your life. There are no right or wrong answers and our response can grow and change just as we do. The most important thing is that we start asking the question.

1.     Hill PL, Turiano NA. Purpose in life as a predictor of mortality across adulthood. Psychol Sci. 2014 Jul;25(7):1482-6. doi: 10.1177/0956797614531799. Epub 2014 May 8. PMID: 24815612; PMCID: PMC4224996.

2.     Alimujiang A, Wiensch A, Boss J, Fleischer NL, Mondul AM, McLean K, Mukherjee B, Pearce CL. Association Between Life Purpose and Mortality Among US Adults Older Than 50 Years. JAMA Netw Open. 2019 May 3;2(5):e194270. doi: 10.1001/jamanetworkopen.2019.4270. PMID: 31125099; PMCID: PMC6632139.

Movement - It Will Change Your Brain And Your Life!

When I first began my personal heath journey, I knew movement was important but I didn’t realize it was transformational. I exercised on most days primarily intending to burn calories and lose inches around my waist. Beyond that I was not likely to add movement as I do now —  the walk to a friend’s house instead of a drive, a standup paddle date instead of a dinner out, swimming with my children instead of watching a movie. Like most of my readers I was busy (limited time) and tired (needed rest) and I considered movement only necessary for physical health. Then I immersed myself in the science of wellness and learned that movement actually changes how your brain functions and can improve the quality of your life. I now move to boost my mood, become a better version of myself, and solve the problems that weigh on my mind. Let me take you through some physiology!

Movement can improve our mental health by alleviating anxiety and depression. (1,2) As a physician, this makes perfect sense to me. Movement raises our levels of serotonin, the same chemical we increase when we prescribe SSRIs (selective serotonin re-uptake inhibitors), a common treatment for depression. Movement also causes release of endorphins and endocannabinoids, our natural opioids and cannabinoids - two other chemicals that give us a sense of ease and wellbeing. In a world where many of us might find ourselves somewhere on the spectrum from mild rumination to debilitating anxiety or from feeling a bit down to to being depressed, getting out for some movement can only help!

The second fascinating piece of neuroscience is that movement literally changes our brain physiology by activating the part of our brain called the prefrontal cortex. This is the area involved with our “executive function”— the constellation of abilities that distinguishes us as human beings. This brain region enables us to make complex decisions, feel love, develop empathy, and be the best versions of ourselves. By moving more frequently we become more motivated by our higher selves and less driven by the amygdala, the area of the brain that processes fear.

The third benefit of movement is something that many of us have experienced but perhaps couldn’t explain - the boost in creativity that accompanies movement.  Exercise increases our neuroplasticity (the ability to form new connections between neurons) and research shows that going for a walk can improve a person’s ability for to generate creative ideas and explore many possible solutions to a problem. (3) This is completely in line with my personal experience of struggling with a challenge for some time,  then going for a jog or bike ride, and suddenly having my answer.

So what does this mean for you this month and what is your call to action? Of course, continue your usual exercise routine for your physical health. It will decrease your risk of developing cardiovascular disease, cancer and dementia just to name a few. But perhaps more importantly,  move because it will also help you become a better version of yourself and position you to enjoy this beautiful life a little bit more!

1- Kandola A, Vancampfort D, Herring M, et al. Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety. Curr Psychiatry Rep. 2018;20(8):63. Published 2018 Jul 24. doi:10.1007/s11920-018-0923-x

2 - Carek PJ, Laibstain SE, Carek SM. Exercise for the treatment of depression and anxiety. Int J Psychiatry Med. 2011;41(1):15-28. doi: 10.2190/PM.41.1.c. PMID: 21495519.

3 - Oppezzo, M., & Schwartz, D. L. (2014). Give your ideas some legs: The positive effect of walking on creative thinking. Journal of Experimental Psychology: Learning, Memory, and Cognition, 40(4), 1142–1152