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AHA2018- Cardiologists continue to lead the pack on big picture thinking

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This is a very busy week for us at 20Lighter, as we have our two biggest medical conferences of the year back to back. On Saturday, the American Heart Association Scientific Sessions kicked off in Chicago. The three-day conference has been very well attended with ~13,000 total cardiology docs taking time out of the office to spend time here in Chicago. Later today we fly down to Nashville for ObesityWeek, more on that as the week progresses.

I’ve been attending medical conferences for about 20 years, and in that time the norm has been that most specialist meetings stay in their lane… cancer conferences focus on cancer, neuro meetings focus on neuro topics, etc. However, the exception to that rule has always been the cardiologists, who, by nature are quicker to embrace new ideas and to adopt therapeutic options shown to improve outcomes and the lives of their patients. Historically I have found most other physician groups are slower to accept and adopt new technologies, procedures, and standards of care- it takes a lot of time and effort to sway them. At this year’s AHA meeting, the field once again shows they have a keen eye to the horizon where topics with less traditional direct relationship to cardiology may, in fact, provide important information in understanding disease processes and offer novel avenues to treat them.

Of particular interest to us were two special symposia, highlighted by conference organizers and prominently displayed in the daily attendee newsletter and on the conference mobile app. These sessions were held in major conference rooms and garnered lots of attendees, they weren’t token discussions held in small rooms far from the main action of the conference. The symposia focused on (1) the role of gut health and the microbiome (bacterial colonies that live in your gastrointestinal tract) on cardiovascular health and disease and (2) the role of circadian control of sleep and feeding in cardiovascular (CV) events and outcomes. These are pretty far-out topics for cardiologists, topics we at 20Lighter have been focusing on since our inception almost 4 years ago in an effort to use a bigger picture strategy in designing a truly effective weight loss and metabolic health program.

The symposia themselves are made up of between 3-5 different short presentations (often ~10-15m each) that have an overarching theme but can be very different from one another. As I sat in the audience and listened to the experts that AHA had invited to share new and exotic perspectives, I was excited to see the cardiologists were very engaged. The discussions after the talks were chock full of excellent ‘how should I think about implementing these new perspectives into my practice’ and to the credit of the presenters sometimes the answer was ‘I don’t know- this is new cutting edge stuff and we aren’t really sure what to do, but it’s important for you to know about them because they will likely be very important in the future’. Gutsy move by the conference organizers to consciously challenge their colleagues to begin thinking out of the box and towards the future on these particular topics.

The conversations we had with colleagues at our poster session were also very interesting. While discussing our visceral fat reduction data the cardiologists were vocally supportive and confirmed our feeling that reduction of visceral fat in particular was critical in reducing risk of disease and events (heart attack, stroke, etc). In general, the folks stopping by our poster to chat were incredibly well informed and seemed truly excited to find a weight loss program that was looking beyond the number on the scale to quantitate tangible benefits and measurable health improvements- especially in participants that were on medications for common comorbidities.

Tomorrow’s blog post will discuss the take-away messages from the ‘Reducing Cardiometabolic Risk by Improving Sleep’ and ‘You Are What You Eat: The Intestinal Microbiome and Cardiometabolic Disease’ AHA symposia. I’ll also discuss why and how the 20Lighter program has incorporated these important topics into the Flagship programs. Stay tuned!

 

 

 

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New Podcast Series!

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In his latest podcast series, 20Lighter co-founder Dr. Gerry Dembrowski discusses “What is Making Us Sick & Fat”. The three episodes cover a pretty wide range of topics including ‘The Obesogen Hypothesis’ that postulates chemical food additives (artificial sweeteners, preservatives, etc) seriously contribute to weight gain and health problems, evidence showing the food and beverage industry and main stream weight-loss industry collaborate to enrich themselves at the expense of our health, nutrient differences in organic versus non-organic foods and grass-fed versus grain-fed meat, and what we have been told for years causes weight gain is not actually supported by the scientific literature.
Listen to this new podcast series & others here: http://20lighter.libsyn.com/

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Let It Go: 5 Tips for Focusing on the Present & Maximizing Your Future

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Letting go is not always easy. Something you did (or did not do), ideas, expectations, desires, people, bad habits… the list goes on. Sometimes our struggles weigh heavily on our shoulders long after they happen, holding us back and preventing us from moving forward. There are many theories why people are unwilling or unable to let go and move on, but experts all agree that the most successful and happy people all have found healthy ways to make peace with their past, and focus their energy on being their best self in the present.


Here are 5 ways to help yourself let go of the past, focus on the present, and maximize your future.

1. Let go of the negative feelings you are carrying around

We spend too much of our precious time dwelling on the past. As much as you might want you cannot change the past, and allowing yourself to feel shame, guilt, anger, and other negative feelings does nothing but hurt the present. If your brain is focused on the past it can’t be focused on the here and now. Stop revisiting things you can’t change and stop allowing your mind to focus on the past because that time and energy is wasted on what will not help you right now. Yes, things in the past were difficult and decisions made were perhaps not ideal- take responsibility for your happiness now. Detach from the emotional component of past experiences and resolve to learn from them but not allow them to damage or prohibit your growth moving forward. Learn from mistakes, but do not be defined by them.

2. Re-evaluate your environment

It’s time to take stock of where you go and those you spend time with. Are the places you frequent contributing positively to the person you want to be, or are they holding you back? Are those around you elevating you? Letting go of your past struggles, old habits, people who aren’t serving your best interest, and anything else that is not helping you be your best, isn’t an easy task, because it requires leaving your comfort zone. This is why many people simply choose to maintain the status quo. They keep coming up with excuses as to why they shouldn’t let go of their past YET, rather than embrace change. Think about your goals, what is important to you and then ask yourself what kinds of things and people would help me towards that goal?

At the Run To Remember over Memorial Day weekend I overheard a runner talking. He was saying that in hopes of getting into shape for this event, he had joined a Facebook group about running on a whim. Turns out the support and motivation he received from people he didn’t even know shocked him. He found himself encouraging others and using the positive feedback he received to fuel his enthusiasm every week as he improved. He was so happy and so excited to participate in the Run To Remember not only because it would be the longest event he participated in but also so he could share his success with those in his group. Support is all around you, you just need to look.

3. Create space for new things & positive thoughts

As you let go of your past struggles, you create space for new things. As you stop focusing on what has been you allow yourself to consider what makes you happy. Look for people and places that help you be the best you, that provide support and encouragement. What calms your nerves… the ocean, mountains, good music, dancing, walking your dog? Who likes the healthy things you like? Ask around- hey anyone want to go for a walk at lunchtime? Use social media like the runner at the Run To Remember, join a walking group, a book group, a public speaking group. Create daily, weekly and monthly goals… attainable goals. Try new things, you won’t like them all but you will like some and those new things are opportunities learn about yourself and lead to other opportunities. Use those small positives to build momentum and share those accomplishments with those your care about and who care about you. The world is full of opportunities waiting to be discovered, divert time and energy away from negative and funnel them towards positive personal growth.

4. Know who you are not, at least as much as who you are

I would very much love to be musically inclined, to play one or two instruments with skill and precision, but I will not ever be able to accomplish that goal. And that’s ok, because I am able to enjoy the talent of other musicians and let music enrich my life through their artistry and dedication to their craft. This is a small example of using that knowledge of who you are not to open opportunities to who you are… I am not a musician, but a music lover. Sometimes knowing who we are not is extremely informative and guides us to who we are. It’s ok not to be everything, but it is important to use that information to help guide you to who you are. Again, reassess the places you go, the people you spend time with and make sure you are allowing yourself the freedom to not be something you are truly not. There is a great short speech by Matthew McConaughey where he speaks about the importance of this topic; about allowing yourself to focus on who you want to be by eliminating things that work against you attaining that best self. It’s 5 minutes that give great perspective and something to think about, and I strongly suggest you check it out.

5. Accept you will make mistakes, but have the discipline to learn from them and move on

Time and again I hear the Thomas Edison quote of ‘I have not failed. I’ve just found 10,000 ways that won’t work.’ None of us are perfect, and no matter how hard you try life will go awry and you will make mistakes down the line. But don’t allow those mistakes to become set backs and derail your path forward. Edison used his 10,000 ways that wouldn’t work to produce one that would, and changed the world. Only you control your happiness. Use the tools you have gathered and those around you for support to figure out what went wrong, why it went wrong, what you can learn from it, and then aspire to not make that mistake again. Accept you are not perfect, and provide a path forward not backward.

Every moment of every day presents an opportunity to be who you want to be, to make choices to work toward your goals, and to create that best self. You need have the courage to shrug off the emotional baggage of the past, and make choices in the present to fuel becoming that best self in the future. We all have a past and we are all shaped by it, but we are not bound to it. Only you have the power to define who you are and who you will be. No one can do that work for you; it’s up to you to accept you are not perfect and to seize opportunities that promote happiness in your life.

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Horse of a Different Color: The Importance of Data Impacting Lives

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We are often asked why we go through all the trouble of IRB protocol approval, put in the weeks of work needed to analyze data, write and submit abstracts, design poster presentations, and present data at medical meetings. It requires a lot of time, a ton of analysis and writing, and more than a little bit of financial investment. The answer to the question of ‘why’ is rooted in the scientific foundations of our program. The 20Lighter Program is not just another weight loss program. Our goal from day 1 has been to assist clients in rebuilding their overall health. Yes, weight is a part of that, but it is not the whole story.

Dr. Dembrowski’s long history of patient interaction taught him that wellness was not just a function of the scale being at a certain number, but the whole picture of how a person was feeling… aches and pains, medications (and side effects of medications), sleep (quantity & quality), mental clarity, mood and self image. We worked together to produce a program that, to our very best ability, could address as many of these parts of the whole as possible. And at every step in the process we would get feedback from colleagues that the ‘diet’ and ‘weight loss’ industry is one big gimmick and you will be classified as another ‘fad diet’, that it takes pharmacologic therapy to walk a person back from the brink of disease and tissue damage, that overweight people just lack discipline and don’t want real help, and that if people just learned to put down the fork things would be different.

But what we found to be true in our discussions with clients and our exhaustive review of the scientific literature on almost every aspect of weight, metabolic, and disease processes was that only ONE of those commonly held beliefs by our colleagues was partly true. The weight loss industry is for sure full of gimmicks, but we work every day to distance ourselves from the industry whose main goal is to generate money by keeping those consumers hooked on their diet products or group meetings or subscriptions.

Over the past 3 years we have seen with our own eyes that a cross-discipline approach that embraces a return to freshly prepared foods focusing on good nutrition and natural (homeopathic) means of reducing inflammation- not another pill being pushed by a pharmaceutical company- can have clinically relevant and long lasting impact. Our clients are educated and shown what needs to be done for them to see improvements in how they look, how they feel, and in their health overall. As they prove to themselves that they can have a dramatic impact in a relatively short period of time without adding more medications, without having weight loss surgery, and eating prepackaged foods and shakes that confidence builds and what may have seemed like an impossible journey previously is now looking do-able.

On our program we have proven that our colleagues are holding some pretty significant misconceptions. So while we work to spread the word to our clients about their ability to change their situation and their lives, we also work to educate our colleagues. Our labor of love in preparing data for presentation is important for many reasons with two being the standouts. First and foremost, we want to show our colleagues the progress and results that can be achieved when you take the time to put together a program that addresses issues underlying the cause(s) of weight gain and of metabolic disease, that teaches clients what those underlying issues are, what triggers them, and works to establish good healthy habits long after their program is finished. You would be surprised how many health professionals have come to our posters and been blow away by our data…

Them: Your attrition rate must be ridiculous? Us: No, over 95% of those who start our program complete it.

Them: You must have excluded a ton of people. Us: No, our only contraindications are pregnancy or breastfeeding, current treatment for cancer, major organ transplant with immunosuppressive drugs, schizophrenia, or being over 70 with three or more CV comorbidities.

Them: Wow, that’s a really average looking baseline demographic. Us: Yes, our average client is 54 years old with a BMI of 34, and takes 3 daily prescription medications. Our program works for the real average person.

Them: This is the first data I have seen at this meeting looking at reduction of visceral fat in a weight loss program. Us: Well, we thought it would be critical to gauge the important surrogates of disease as best we could. Makes you wonder what real benefit beyond weight reduction other programs are actually having, doesn’t it?

Physician or health professional referrals account for one third of our clientele. In almost all cases those referrals come from docs who have had other patients go through our program and be successful or those docs themselves have gone through our program and been successful. Nothing is more convincing than seeing results firsthand.

The second reason we do these analyses and presentations is because it informs us on how our clients have done on program historically. This allows us to share solid data-driven information with clients concerned or focused on specific aspects relevant to them. I have type 2 diabetes what can I expect for results? Will my antidepressant medication impact my ability to do well on 20Lighter? The more we understand how specific groups of clients do versus our clients as a whole, the better we can talk with prospective clients about how they will benefit from the program based on actual data, unlike other programs who rely on generalities and shrug off questions and addressing specific concerns with ‘oh yes our clients do great’ and avoid providing meaningful responses. 20Lighter takes the health and well being of our clients incredibly seriously, and we feel understanding- in a granular way- how our clients perform and what co-morbidities impact their ability to do well is of significant importance.

You might get the feeling that the 20Lighter Program is not like other weight loss program- perhaps we are a ‘horse of a different color’. You are 100% right- we actively work to NOT be like other programs. We feel being different, having unique goals and being vocal about that is just who we are. While the weight loss industry may be about those companies with household names doing well, 20Lighter is about doing good, with a strong focus on our clients doing well.

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Are You Leaving the Grocery Store Without These Four Items?

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There is considerable evidence linking the food we eat to a variety of illnesses. It’s not just a case of what we eat, but also what we don’t eat. So, in honor of #ShoppingCartDay here is a list of four must haves to add in your grocery shopping cart!


1. Shiitake & Button Mushrooms — A great source of vitamin D

Mushrooms are the only plant-based food that can make vitamin D when exposed to sunlight, in a manner similar to how your skin makes vitamin D. Place your mushrooms by a kitchen window for an afternoon prior to using them to get the best bang for your buck.

Research suggests that vitamin D intake can facilitate the absorption of essential trace minerals such as calcium, magnesium, copper, zinc, iron, and selenium. Healthy levels of trace minerals are required for all metabolic processes. There is literally no physiologic process, at the cellular or systemic level, that can operate at its best (or even operate efficiently) without trace minerals.

Vitamin D deficiency is common in teens and adults, so focusing on natural food-based options to help enrich your levels is a great (and easy) way to help ensure you are getting enough!


2. Bison — a complete protein, never exposed to antibiotics or growth hormone

What is a complete protein you ask? The difference between ‘complete’ and ‘incomplete’ proteins is that complete proteins contain all essential amino acids your body requires daily, and incomplete proteins only contain some essential amino acids. Your body digests proteins you eat into amino acids, the building blocks needed to repair tissues in your body, provide energy, and perform all body functions. Because bison is a free-range animal and isn’t grain fed like commercially raised cattle the meat is rich in the omega-3 fatty acids EPA and DHA.

Bison, by law, can’t be treated with antibiotics or growth hormones and feed on grass pastures. The incredibly lean meat is an excellent source of iron, zinc, and B vitamins. With a mild flavor and so many nutrients it’s a must try!


3. Parsnips — assist your body’s natural detoxification mechanisms

Parsnips are a root vegetable, which look a lot like white carrots. They contain nutrients and molecules known to support your body’s natural defenses against toxins. More and more we are seeing studies that show exposure to toxins has serious health consequences. The more you are able to assist your body in breaking down and removing toxins form your body the better, and of course natural means of assisting is the best!

Parnips, along with other apiaceous vegetables (veggies in the parsley family) are strong supporters of the first stage of detoxification- the inactivation of dangerous molecules that occurs in the liver. Looking for more options in addition to parsnips? Grab carrots, celery, parsley, and fennel!


4. Jerusalem Artichokes — Support a healthy gut

With a taste halfway between the nutty flavor of an artichoke heart and the savory flavor of a potato, the Jerusalem artichoke is a superhero for promoting gut health. Rich in what we refer to as ‘prebiotics’, this food (you are likely to find in the produce section of your grocery store) has a powerful ability to help foster growth of good bacteria in your gut.

Prebiotics are fiber molecules that are digested directly by friendly bacteria residing in our small and large intestines. The digestion of prebiotics by those friendly bacteria produces short chain fatty acids (SCFA) that are a major fuel source for the cells that line our GI tract, that promote good immune function and have anti-inflammatory effects. With all the research suggesting an interrelationship between our gut and brain function, immunity, skin, and disease it’s so important to use all natural means available to you- and you might be surprised just how tasty Jerusalem artichokes are!

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The Power of Possibilities

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On the heels of the #RuntoRemember event on Sunday, I thought a release of the next installment in a series of blog posts related to reducing stress and positive thinking made sense. It seems as I write each of these, a new topic of discussion comes to mind. The first Blog post entitled “The Necessity of Difficult Things” discussed how I learned over time to find something that helped me constructively deal with stress. The post was intended to engage readers to reassess how they deal with stress, ask themselves if it is working for them, and nudge one down the path towards understanding what things may work better for them. Today’s post is a bit different, but again has roots in running. Odd for me to admit that something I hated and avoided for decades holds both obvious and hidden meaning. But as they say, life is a journey…

This past January my daughter Summer told me her New Years Resolution was to run her first half marathon before the year’s end. For some folks, this New Year’s Resolution might seem par for the course, but for Summer this is a big deal- a very big deal. Back in middle school she struggled to conform and feel comfortable in her own skin (rough times as we all remember). I knew her to be a hard worker, a smart and friendly kid who easily made friends with all sorts of folks, young and old. She really has a wonderful gift of making people feel comfortable and liking her off the bat. But it was very clear she lacked confidence, she was unsure of herself despite her natural gifts and how she viewed herself was very different (much less positive) than how others viewed her. This was painful to see as a mother, but not something that was remedied with me telling her more often how great she was and about the skills and gifts that I saw her use in her daily life. This was a personal journey that she needed to travel, and I could assist and play a big role in that journey, but it was one she needed to decide to embark on.

So I started seeding some food for thought on different ways she might be able to start this self-improvement project, and one day in January of 2012 she finally came to me and asked if I would help her train for a 5k race that spring. I enthusiastically agreed, and told her I thought it would be a great opportunity for us to spend some time together no matter whether she decided to run the 5k or not (keeping the pressure low at this point seemed important).

I think it’s fair to say all of us have some ‘thing’ or aspect of our lives we might want or need to embrace a similar ‘journey’ to tackle. Professionally or personally there is always something we can learn to better ourselves. But often it’s scary, or seemingly too big a hill to climb (or even begin to think about climbing) and we put it off. Every day Dr. Gerry and I work with people who feel they have an insurmountable task ahead of them in losing weight and regaining their health. And we very strongly tell them, ‘hey taking the first step to even have a conversation with us about that task is the breaking point… it means you have acknowledged to yourself the possibility of change‘. This blog post is about the power of possibilities.

As a young child Summer was very active, but she had broken her arm a couple years prior to 2012 and had since not really engaged in athletics, opting for books and school work instead. So at the age of 11 she did not have much of a base of cardiovascular fitness and I am fully sure she was equally scared stiff and excited about the goal she had set for herself. We started off slow… SLOW… getting some good running shoes… talking in depth about each daily and weekly goal and putting it into perspective. Week 1: 3 runs that week with each run comprised of 2 total minutes of running broken into 4- 30-second intervals with 2 minutes of walking in between… (2 minutes doesn’t seem like a lot, mom! I can totally do that) …running meaning we go faster than walking but we are not racing each other. We kept an easy pace… nice and clear, seemingly easy -with very defined goals. And I did this on purpose because I remember vividly how much I struggled in the first weeks when I started running.

So our first day we were careful to make sure we had everything we needed. We had our headphones and music players charged up, I had my running watch to keep track of the time and we were off… and the first 30 seconds go by, not bad… the second 30 seconds is half way done and then it gets HARD. I offered some gentle support (almost there just a few more seconds!), big picture perspective (wow we are already half way done!!), and lots of positive feedback (I am so proud of you for pushing through!). That first week was an interesting combination of ‘oh boy what did I get myself into’ and ‘cool I did it’. And in this timeframe reassessment of the goal occurs… Can I really do this? Do I want to do this? And I tried very hard to provide positive feedback but not overdo it, while also actively knocking out any comments I heard about quitting (it’s been less than a week, I believe you can do this- so work with me for two weeks before you make any decisions).

When most people embark on a significant endeavor, one that requires time and energy and pushes you beyond your comfort level, that first week is the most critical. The small triumphs have not yet had long enough to build momentum and the discomfort is in the forefront of our minds. We see and feel the impossibilities… and have not yet allowed ourselves to be open to the possibilities. SOOOOOO many people quit in this first week, if I had a penny for every time I have heard clients tell me they tried to diet, or quit smoking, or exercise and couldn’t get through the first week. Change is hard, there is no doubt, but a shift in thinking is the key to success or failure.

So we are now about three weeks into our new endeavor, and Summer is pushing through- it’s not easy, but we are now running for 2-3 minutes at a time. She’s made it past the first two weeks; she has improved enough and shown enough resolve that now I can be a little tougher on her without fear she will flat out quit. In response to the ‘I have a cramp in my side I have to stop’ I can point out we have 20 seconds left in this 3 minutes and then we can walk it off and she trusts me enough to know I am not fibbing. I point out how far she has come in only three weeks and how she has completed every run we scheduled and followed through on her promise to herself to give it a shot… progress and positive reinforcement. Slow, but steady progress to build upon.

This is not all that different to what we see and hear with people on our programs. Some folks lean more on ‘I can’t’ and ‘I have to’ as a knee jerk reaction when the going gets tough. In any endeavor worth pursuing, the going ALWAYS gets tough. Instead of a reason to stop, look for a reason to continue. I’ve come this far; I CAN go a little further, and I trust that there is someone there to help me find strength to test my limits.

Each week Summer’s ‘I can’t’ comments are overtaken by ‘OK, let’s try’. In a subtle way Summer has PROVEN to herself that she is capable of more than she thought was. What a huge turning point. And this is really what this blog post is about. That time where something you were absolutely convinced you could never do becomes potentially possible. That door that was shut to you now is cracked ever so slightly open. Summer turned those three weeks into four months and we did our first running event, a one-mile run, on Mother’s Day 2012.

Summer was convinced that being a runner was not within her, yet she made it happen, slowly- with effort and setbacks- but she made it happen all the same. Once that limit had been tested and broken through I started to see her testing limits in all sorts of areas (school work, social settings, etc) and watched her confidence grow. She ran her first 5k in June of 2012, joined the track team her freshman year in high school, now she won’t bat an eyelash at a fun run 5k (even running solo when I am injured as the picture above shows), and she routinely kicks my butt when we run together. Once you prove yourself wrong and accept that maybe you can do more than you thought, the range of possibilities becomes endless because the world truly is your oyster.

With clients that go through our programs, we not only see a reduction of weight and improvement of health but we also hear them talk about renewed engagement at work, confidence that they can be successful in other things that they had been holding back on. Once you start testing your limits and find out you are stronger and capable of far more than you ever thought, the world looks different. You have proven you can do something you were so sure you could not do, so what’s next? What else have you closed yourself off to? Maybe it’s time to crack that door open just a bit and re-examine?

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The Necessity of Difficult Things

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Yesterday afternoon I was chatting with a friend about our respective plans for the remainder of the Sunday afternoon. I mentioned I was waiting for the thundershowers to let up, that the weather radar showed a good solid hour or so break from the rain that would allow me to go out for a run close to home. I had planned out my first dedicated hill workout for the season, and I anticipated a hard run. My friend suggested opting for an easy run given the weather and the lazy Sunday atmosphere. Our chat then moved towards a discussion of the need for and usefulness of hard and difficult things, and as our conversation progressed I thought it might make a good blog post to share.

Let’s face it, life is stressful. Some days are more stressful than others, and stress comes in all sorts of different flavors (personal, professional, acute, chronic). Learning how to manage it is an acquired skill, and what works for one person isn’t going to work for another. This is a discussion of what I have found works (and doesn’t work) for me in hopes of inspiring you to push your limits and find/try some things and strategies to deal with stress in your life that you may not have previously considered, or you thought were beyond your reach or capability.

First, let me share what I found does not work- some of the time or all of the time. I’m a co-owner of a small business, and as all small business owners know the work load does not end at 5pm, nor does it end on Friday. I have a terrible work-life balance, mostly I have a worklife and no balance, and I fully acknowledge that it is unhealthy and not sustainable. But yet I am unable to make changes that provide a better balance. And even before I was a business owner I worked in high stress- high stakes- high workload environments like Wall Street investment banks and cancer research where work responsibilities came first, second, and third, and everything else came after. So one coping mechanism to deal with stress was to work more and work harder. It helped me meet my deadlines, it helped me produce better quality product… BUT the more I accomplished the more I was handed. Funny how that works, the more capable you prove yourself to be the bigger the list of things you find yourself responsible for. So this strategy, while building a good reputation, did very little to reduce the stress level, and rather seemed like it added to it. Over time one can adapt to the increased workload… that heightened level of work becomes the new normal. But at some point it is not sustainable, and something suffers- health (physical & mental), sleep, relationships, hobbies & pastimes, etc.

Now as a small business owner, I am constantly changing hats to address all aspects of the business with some easier to manage than others. Business owners often find what they had been trained & educated for is only part of the job and they often have to learn on the fly the skills needed to successfully fulfill other duties. I am putting out fires at 8pm on Fridays, we have business hours on Saturday, and on and on. And I confess even during time I have to step away from the business I find my mind reviewing what needs to be done, or what I did not accomplish yesterday. So for me a stress reliever needs to be SO encompassing it forces me to push aside any urge to think about work and focus only what I am doing at that time. For me right now, running is that stress reliever. I don’t really like running, it’s not something I have done since I was young like many people who grew up with running – I started running in 2009 at the age of 35. I have an unstable right knee and history of back issues (thanks to carrying my two beautiful daughters!) so running is challenging.

Now back to that hill workout… I have established a reasonable level of fitness over the past three months so I felt it was time to rotate in my first hill-focused run of the year. And frankly yesterday with the lazy Sunday atmosphere I was not overly excited to be looking at a hill workout… but I knew I needed it. The hill (part of it) is in the picture above, it’s close to my place and gives me a safe (few fast moving cars) half mile the equivalent of about 15 floors of elevation. In the discussion with my friend we went back and forth about needing to accomplish something we individually felt was hard, because the feeling of pride and achievement (and exhaustion) is worth it.

While running those three hills reps I had to focus 100% on getting to the top each time, and the worry and thoughts of work just stop- as there is no room for them during that time. It’s refreshing as much as it is exhausting, to step outside the omni-present responsibility for even just 45 minutes. And after a shower when I sit down again to re-engage on work stuff I am able to look at what needs to be done and triage better than if I had not stepped away. So in life there are difficult things, some helpful and some not so much. One key to managing stress can be finding some hard things you can constructively use to help shift focus away from the stress in your life. Difficult things that you can derive some satisfaction from, can be an important part of stress management. And understand that ‘difficult’ has distinctive meanings for different people- and for the same person at different times. Three months a go running one mile would have registered as VERY HARD on my difficult-ometer, but I chipped away at it over time and adapted to it. Once I adapted, and consciously made myself acknowledge that the improvement over time was an accomplishment in it’s own right, I set my sights on upping the ante, so to speak, all in an effort to provide myself with a healthy outlet, a stress reliever that truly works for me.

As you think about how this might apply or not apply in your life, think about the stress that you have and think about what you personally need to feel relief from it. Is a change of scene adequate for you? Can you go outside, visit a park, lake, or beach and find relief? Do you need to occupy your mind? How about a book, magazine or crossword/sodoku puzzle? Do you require something more all-encompassing, like me? Run, bike, boxing class, etc. Spend a few weeks trying a couple of different options and see what for you provides the best respite. This is not meant to eliminate the stress, but to provide your body and mind a break from it in an effort to re-energize, and manage it better. Coach Lou Holtz- no stranger to stress really nailed in when he said “It’s not the load that breaks you down, it’s how you carry it.”

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American Psychiatric Association 2018 Annual Meeting Review

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Why We Attended
The American Psychiatric Association’s Annual Meeting (APAAM18) is this year’s largest gathering of mental health professionals in the world. This year the APA expected over 12,000 attendees to the conference that offers educational sessions and the latest research into all aspects of mental health including assessment, treatment, epidemiology, management of side effects, etc. This medical conference was a great venue for us to share with providers the benefit 20Lighter Programs offer their patients who have been prescribed drugs for depression and struggle with weight gain as a result. It also gives us the opportunity to get feedback directly from providers on what unique needs their patients prescribed antidepressant drugs may have that are different from our other clients. Overall our goal at 20Lighter is to help all our clients achieve success as they move towards a healthy lifestyle both from a mental and physical perspective.

What We Shared
Our presentation at APAAM18 came about as prospective clients asked us about their chances of being successful on 20Lighter even though they were taking antidepressant medications. With ~15% of our clients taking at last one prescription antidepressant at the start of their program, we felt it was important for us understand how this group of clients do versus clients who are not taking antidepressant meds. We reviewed all client data (all data was blinded and the study was approved by an Institutional Review Board to ensure ethical procedures and confidentiality) for those completing a 40Day program between June 1, 2016 and June 1, 2017. We analyzed the changes for each group (clients on depression meds or not on depression meds) from baseline (Day 1) to the end of the reduced calorie portion of the program (Day 40) in body weight, BMI, body fat %, visceral fat rating, and body water %. We found that the mean change from Day 1 to Day 40 in reduction of weight, BMI, body fat %, and visceral fat and increase in body water % were all clinically relevant and statistically significant. So each group- both clients taking and not taking depression meds both showed great changes in all body composition measures between Day 1 and Day 40. Next we wanted to learn if those changes from Day 1 to Day 40 were equal… did either group perform better? To see how the groups compared to each other we calculated the mean % body weight lost, reduction in body fat %, BMI, and visceral fat and the increase in body water % for both groups and then asked if those means were clinically or statistically different. We found that both groups of clients, those on depression meds at the start of their program and those not on meds did equally well, and that the improvements did not differ clinically or statistically.

What We Learned
We had great traffic to our poster, and lots of providers from all over the world stopped by to look at the data and ask questions about it. Some practitioners offered anecdotes from their own clients’ experiences, and some shared info they had learned at the meeting sessions they had attended. We will be expending this discussion into it’s own blog post as some specific new research providers shared is incredibly interesting to us and fits pretty smoothly with the overall tenets of our program. Very excited to share that blog post over the next week or so as we also share some video from the meeting itself.

Why This Matters To You
Some clients ask us why we go to these meetings, and how it benefits them. The answer to this question is really two fold. First the research that we do to submit data to the meetings for presentation informs us on how our clients have done on program historically. This work allows us to share solid data-driven information with clients concerned or focused on specific aspects relevant to them (I have type 2 diabetes what can I expect for results? Will my antidepressant medication impact my ability to do well on 20Lighter?). The more we understand how specific groups of clients do versus our clients as a whole, the better we can talk with them about how they will benefit from the program based on actual data, unlike other programs who rely on generalities and shrug off questions and addressing specific concerns with ‘oh yes our clients do great’ and avoid providing meaningful responses. 20Lighter takes the health and well being of our clients incredibly seriously, and we feel understanding- in a granular way- how our clients perform and what co-morbidities impact their ability to do well is of significant importance.

Additionally, every time we share our data with medical and health care community the feedback we get helps us make 20Lighter programs better. From adding new assessments to monitor progress from a different perspective to finding new products that offer our clients benefits on and off program, we always leave a medical conference with more knowledge than when we arrived. APAAM18 was no different; our exposure to the most cutting edge research into the causes and neurological mechanisms of depression allows us to further tailor our programs to help address the shared underlying physiologic issues that contribute both to weight gain and to depression. In short we want to learn and stay abreast of cutting edge research so we can make 20Lighter programs even more effective for our clients.

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