Refuse To Regain

Novak Djokovic: The Diet That Conquered Tennis

by Barbara Berkeley, MD

For those of you who don't spend your days watching Tennis Channel, let me bring you up to date.  

Since the current professional men's season began last year, Serbian tennis phenom Novak Djokovic has dominated his sport in a way that is nothing short of astounding.  He has won 64 matches (including last week's U.S. Open) and lost only 2 and has ascended to the number one spot in the world  (view Djokovic's website here)  What makes this so incredible?  He's done it in the very midst of the dominant era of unbeatable superstars Rafa Nadal and Roger Federer.  Federer and Nadal have controlled the two top rankings in tennis since 2005 and, until recently, Rafa appeared poised to claim his spot as one of the greatest ever as he took over from a slightly slower 30 year old Federer.        

Before this season began, Djokovic sat in the number three spot.  His tennis was strong and sharp, but he often struggled with breathing problems, what seemed to be an episodic de-conditioning, and a mental attitude that made him prone to frustration and breaking things. 

That Djokovic could so completely turn things around in one short season is mind-blowing.  Sports writers chalk this up to a new confidence, a stronger serve, and a better mental game.  Less frequently discussed is another intriguing factor:  before this season began, Novak Djokovic gave up carbohydrates.

A piece written in May for the Wall Street Journal (see previous link) mentioned the diet change in its title, but gave it short shrift when discussing possible reasons for Djokovic’s near-miraculous improvement.  Surely the change must have occurred because he gained confidence.  Surely the dietary contribution is nothing more than a placebo.  

The article quotes David Levinksy, a nutrition professor from Cornell: 

Levitsky said a gluten-free diet might have benefits for those with mild allergies, or even no allergy at all. "The other part of the story is, if you believe in a cause of your disorder, it becomes the cause," he said. "We see this in many different studies. If you believe it, you change your behavior in the direction of being cured."

This explanation seems odd, considering that it appears in an article entitled, “Starch Madness: Novak Djokovic’s Domination of the Sport Has Coincided with His Gluten-Free Turn”.   It’s as if the writer posed the question, but didn’t dare go after the answer.  Is it possible that, in fact, cutting out carbohydrates made Djokovic into a better athlete?  Is it possible that everything we've believed about the importance of loading our muscles with tons of starches is untrue?  Is it possible that we can play endlessly taxing endurance sports without jamming ourselves full of pasta and potatoes?  And is it possible that we might be better off for it?

It seems that world number 4 Andy Murray thought so.  He has adopted the Djokovic diet.  How much do you want to bet that others follow.  By the way, Murray just became the second person to beat Djokovic this year (although Djokovic did have a shoulder injury and was forced to withdraw after a set).  Commentators for the match remarked repeatedly about Murray’s fitness and ability to move around the court.  Coincidence?

I have held a consistent view on diet and it is a view that I believe holds up when one examines Djokovic’s transformation.  Rather than worry about individual dietary elements, we should attempt to eat foods that are most like the ones are bodies understand genetically.  Since our genes are thousands of generations old, we need to look at the foods that were prevalent in those times:  lean proteins, fats that come from natural sources (and thus have higher omega 3-6 ratios), vegetable and fruit matter, seafood, nuts and other naturally occurring plant foods.  Sugars and starches (including grain) were not a part of that original diet and are processed poorly or even cause overt harm in those of us who are more “original” genetically.  In addition, our body has certain fuel expectations.  Large amounts of carbohydrates as fuel seem to me to be inconsistent with what our body was fine-tuned to expect.  

In my own practice I treat many tennis players and runners who are significantly overweight despite many hours of intense exercise.  When they change their diet to one that is primarily Primarian, they not only lose weight but they become more efficient at their sports.  For those who are interested in pursuing very taxing endurance exercise like triathalons or marathons, I suggest reading the book Paleo Diet for Athletes by Loren Cordain and Joe Friel. This addresses the particular needs of those who require some additional carbohydrate when training for specific endurance events. 

In my own life, I attribute the ability of my 63 year old body to run a 5K, play hours of tennis, and do aerobic exercise at high capacity to the right mix of fuels.  I have no doubt in my mind that it is Primarian eating, and not placebo, that has kept me lean and strong. 

Dietary beliefs die hard and unfortunately, our unwillingness to give up the conventional wisdom leads to real death, the death of those who develop diabetes, heart disease and cancer as a result of the profligate consumption of insulin stimulating carbohydrates.

Is the Djokovic diet phenomenon real?  You bet it is.

 

 

 

 

 

 

 

The Tag-a-Long Phenomenon: A Healthy Contagion

by Barbara Berkeley, MD

 You may have read the headlines awhile back in your local newspaper.  Obesity is contagious. 

Based on data emerging from several large scale clinical studies, researchers announced that those of us who socialize with, or live with those who are obese have the tendency to "catch" it, making obesity into a sort of fatty measles.

This news made all the major papers and media outlets and of course led to the obvious and unfortunate conclusion that obese people were to be avoided just as we might give those with strep throat a wide berth.  As with many pieces of research that are trumpeted with great fanfare, this one is now being called into question.  Unfortunately, the media spotlight rarely catches up with the reviews and criticisms that occur after an announcement is made.

A  recent article in the New York Times  pointed out the shortcomings of this research.  Basically, it's extremely difficult to separate contagion from other phenomena.  Perhaps overweight people tend to cluster together because they choose friends who have similar lifestyles or because watching the behaviors of close friends and family tends to normalize those behaviors in their minds, making them more acceptable.  

The jury is out.  

However, I think that this controversy gives me the perfect opening to discuss one of my favorite related phenomena:  the fact that those who develop new, healthy, lifestyles seem to have a strong influence on those around them.  In fact, a large percentage of my successful patients report that someone in their life,  a spouse, friend, or child, will have lost significant weight and changed behaviors as a result of watching their progress.

I call this the Tag-a-Long Phenomenon and I believe it demonstrates the same principles documented by the researchers on obesity contagion:  but in reverse.  

A friend of mine developed an autoimmune disease and was overweight.  As a result of knowing and observing me, she adopted a grain-free diet and became a 90% Primarian.  She lost all of her excess weight and had a marked decrease in the symptoms of her disorder (which had reached the point where she was about to begin steroid treatment).  About a year later, her overweight son adopted the same diet and normalized his weight.  Sometime after that, her husband, who had been highly skeptical of dietary change, began to eat the same way. 

Our practice treated a man who had been told he needed gastric bypass to control a new case of diabetes.  After losing all of his weight and becoming a Primarian eater, his wife came to us for similar treatment.  We then treated their children.  Friends who knew the family turned out to have been influenced by their results.  Some came to us and some adopted similar eating principles on their own.  This single man's food conversion has now effected upwards of a dozen people.

We work with the president of a major company.  After losing significantly and becoming a runner and primarily Primarian eater,  our patient noticed that members of his management team began to show similar inclinations.  One became a marathoner and others lost and maintained weight.  The change in their lives has led to an interest in new programs and healthy initiatives throughout the company.

What is contagion?  In my view, its definition is clinically unimportant when it comes to behaviors.  Whether we call it contagion, influence, or modeling, it is obvious that human beings closely observe one another and learn from what they see.  If eating too much is the norm in your circle, it will be harder to avoid it.  However, if you make the effort to be someone who changes and has a true shift in belief and behavior, there will be many people around you who will watch and perhaps mimic your efforts. 

Because behaviors get into the cultural atmosphere and have the ability to spread "virally",  it is important to create an environment that values health more and relies on medicines less.  We all have a bit of the lemming in us.  But given the chance, it's as easy to follow the one who's ascending to the mountaintop as it is to pursue the one who's headed off the cliff.

 

 

 

 

 

 

 

 

 

 

 

The Too Busy Brain: Implications of Decision Fatigue

by Barbara Berkeley, MD

When I was younger, I could never understand people who went to the same place for vacation year after year.  Wouldn't they want to explore the world?  Have new adventures?  It seemed very uninteresting.  But as I've gotten older, my family has found themselves returning to the same beach in Caribbean for over 20 years.  It's a place that provides complete peace and rest.  I've often wondered why.

This particular island paradise is not all that perfect.  There is escalating crime, an unacceptably high rate of poverty and AIDS, and, at the moment, an epidemic of Dengue Fever.  But after my recent return from a trip that my younger self would have cheered:  a complicated, stressful and stimulating trip to Asia, the appeal of our Caribbean retreat suddenly came into focus.  It is a place that removes all need to make decisions. 

Our island has no malls, no big box stores, and no glut of restaurants.  From the moment our plane touches down, we have very few choices.  Pool or beach?  Dinner at five or at seven?  Watch a movie or go to sleep? While away, we stay mostly disconnected from our jobs and our cell phones.  This, combined with a soaking of sun and sea breeze, makes for a wonderful, restorative retreat.  

Vacations (aside from adventure travel) have always had this element.  Whether it's the sand and a good book or a cozy fire at your favorite ski lodge, vacation has traditionally meant down-time; a time that the brain as well as the body goes on holiday.

Just prior to leaving for the Asia trip, my brother-in-law convinced me that I should buy an IPad.  He had become addicted to this little piece of technology and assured me that it would be the perfect travel companion.  It was.  This tiny wafer of a computer held all my books, connected me to the internet, took photos for me, made phone calls and stored the six movies I wanted to watch during 20 hours of flight time.  It even let me play Scrabble with daughter and listen to all of my music.  It was great!

But the entry of the IPad into my life, along with my recent decision to switch from a PC to a Mac, has plunged me into a sea of choice that has been dizzying and disconcerting.  Just holding the IPad triggers a low level wave of anxiety.  Read the headlines?  Finish the next chapter in that book I'm reading?  Go back to that other book I started?  Check Facebook? Answer email?  It's all a moment away, and I find myself flipping from one to the other in a way that feels more like a rat trying to find its way through a maze than a person accessing needed information.

So I was particularly intrigued to read a lengthy, but extremely important article on decision making in today's NY Times.  Entitled Do You Suffer From Decision Fatigue?, this is a must-read piece that confirms what most of us already know:  we are paying price for the abundant choice in our world.  

Constant decision making wears us down and deteriorates our ability to make good choices.  Essentially, after being asked to decide on everything from the elements of our latte to the features we want on our phones to which of the thousands of items in our supermarket we choose to buy, we revert to default or to making the easiest choice. We lose our willpower, which is another way of saying that we lose direction.  I can feel the pressure of this decision fatigue every day.  It feels very real to me, particularly when I juxtapose my life here with my life in vacation mode. 

Obviously, the issue of willpower is of prime importance to those who want to control weight.  This article is in agreement with my belief that limiting choice is essential for keeping willpower intact.  

When you read this article, I hope you'll take the section about glucose with a grain of salt.  The authors of some studies appeared to show that giving people sugar helped restore their willpower.  I haven't looked at all the data, but it doesn't seem that they tried other restoratives, like feeding people a healthy meal or having them take an exercise or meditative break.  While a shot of glucose does recharge the brain (and this is one of the reasons that sugary foods are so attractive), we pay for it with hunger and cravings later.

This caveat aside, I think that you will all relate to the data presented in this article.  I'd be interested to know if others feel similarly overwhelmed by the need to choose.  I loved this quote, which closes the Times piece:

“Good decision making is not a trait of the person, in the sense that it’s always there,” Baumeister says. “It’s a state that fluctuates.” His studies show that people with the best self-control are the ones who structure their lives so as to conserve willpower. They don’t schedule endless back-to-back meetings. They avoid temptations like all-you-can-eat buffets, and they establish habits that eliminate the mental effort of making choices. Instead of deciding every morning whether or not to force themselves to exercise, they set up regular appointments to work out with a friend. Instead of counting on willpower to remain robust all day, they conserve it so that it’s available for emergencies and important decisions.

This view dovetails with my own.  In order to keep our lives on track and preserve our will to move in the directions we desire, we need to limit our exposure to needless choice.  Doing this is a personal task and the ability to tolerate decision making may vary in individuals, but the research cited in this article suggests that most of us are vulnerable to a world that fatigues our brain.  While we work to make ourselves healthier in body, let's not forget that the brain and body are part of one entity and both need our care. 

 

Foods That Control: Mile Markers on the Road to Our Tech Future?

by Barbara Berkeley, MD

Are you an optimist or a pessimist about the future of mankind?  There's a question to start your day.

In May, the Gallup Poll announced that optimism for the future of American youth had reached an all time low.  When asked whether they thought that young people in the US would have a better life than their parents, 55% of those polled answered no.  Pollsters commented: 

The large majority of Americans expressed optimism about the future for U.S. youth when Gallup first asked this question in January 2008, as the recession began to take hold. They continued to do so even as the economic crisis unfolded and unemployment ballooned. Hopes for U.S. youth declined to the 50% level in October 2010, however, before dropping to a new low in the April 20-23, 2011, USA Today/Gallup poll.

Of course, this pessimism reflects doubts about our economic future.  But what about the larger future of our species?  Is there a connection between the helplessness many of us feel politically and the general trends happening in our world?

On my recent trip to southeast Asia, I had approximately 60 hours of enforced down time (travel and layovers).  It was a great opportunity to read, catch up on missed movies, and watch The Godfather, (Parts I and II for the hundredth time ...still fabulous!).  One of the movies I watched was a documentary called Transcendent Man.  This is a film about futurist Ray Kurzweil, a brilliant, eccentric scientist who has predicted something called "The Singularity".  The Singularity refers to the point at which humans and technology will effectively merge, changing the course of human evolution.

 As Kurzweil points out in this film and in his written work, the pace of human techological advancement is moving so quickly that we will soon have artificial implants that will enable us to access the internet and other sources of the world's knowledge. Our bodies may soon be enhanced by injectable mini-computers and chips, making us into the bionic man. Essentially, we will eventually cease to be competely human, at least as we define that state today.  While this could lead to wonderful improvements in health and longevity, the asymptotic growth of technology has more sobering, and ultimately more frightening, aspects.  These relate to the seemingly inevitable development of artificial intelligence.  In the not too distant futures, computer intelligence will multiply itself to the point where it exceeds out own. Once computers become smarter than man, the future looks nothing like any we might have envisioned and the place of man in the universe becomes uncertain.  While many scientists believe that Kurzweil is incorrect in the timing of his predictions, no scientist who is quoted in the film doubts that we are headed in this direction.  

When we imagine a world of endlessly expanding intelligence, we realize how limited we humans are and how vulnerable these limitations make us. If we look at our behavior, our literature, our art, we are fixated on a few basic themes: tribalism (war), love, and the search for spiritual meaning are the most obvious.  Similarly, we are highly motivated by one very simple thing: our brain's system of rewards.  Endorphins, endocannabanoids, and other brain chemicals are what keep us coming back for more.  And more. Whether it's the pleasure created by food, the colors and noise of a gambling casino, the smell and feel of a cigarette, the rush of alcohol, sex or drugs, we are led around by these ancient responses, often to the point of our own destruction.  Advances in technology have already shown how vulnerable we are.

Modern science has made it easier to deliver hits to our pleasure centers.  Whether these come from the bright colors of video games, the instant access to pornography, or destructive foods masquerading as wonderful fun, we are easy to lure.  It is not hard to imagine a future in which many of us will opt to live in a virtual world, full of colors and sensations that cannot be obtained on good old Earth.   This tendency to give in to the enjoyable without regard to consequence is what gives me grounds for pessimism.  Just today, for example, I saw a new patient who had been uttterly destroyed by food.  He weighs over 300 pounds, is riddled with pain, is losing function in his eyes and kidneys, has had several heart attacks, is injecting insulin multiple times a day and yet he describes an utter passion for junk food, fast food, and sweets. Perhaps it is judgemental to say that this is a tragedy.  We all have the freedom to pick the way we want to live.  But my worry stems from a suspicion that we aren't choosing so much as being manipulated by ever-heightened pleasure experiences.  The modern production of food may be one of the best examples of this unfortunate phenomenon. 

Our inability to see that our country is being weakened by tehnologically enhanced food and our sheer willingness to embrace these products as harmless fun makes me worry for our greater future. If we are willing to be killed by food, how easy will it be to offer us other kinds of pleasurable "enhancements"?  How simple we will be to control.  Unless we start looking at our changing world critically, it will take no more than a sweeter, brighter, more colorful drug to destroy us completely.   Now that's pessimism. 

The Politics of Fried Butter

by Barbara Berkeley, MD

Has anyone been watching the coverage of the Iowa Straw Poll?  This early indicator of national election trends is held in conjunction with the Iowa State Fair.  If you have been following reports on CNN or any of the news networks, perhaps you've noticed that political reporters feel it necessary to make continual (and completely gratuitous) references to the junk food at the fair.  It seems that nary a reporter can deliver his lines without describing the deliciousness of the fried Oreos, fried Snickers or Fried Butter!  And each time, the conversation revolves around how bad-for-you but really great this all is and how everyone at the Fair and all of their kids are chowing down in the good old American way. 

As someone who has to mop up the medical damage created by our ha-ha attitude toward bad food, it's easy to see that toxic foods are no different than cigarettes.  They kill just as many people in this country and take an awful toll in non-fatal misery.  Just in fun you say?  Well, perhaps in the 1940s a similar reporter might have enthused about the pleasures of a tent that offered multiple kinds of yummy tobacco. In those days, anyone who suggested that a smoker quit might be laughed off or called a killjoy.  We've gotten past that today for the most part.  Killing yourself with cigarettes is no longer PC.   But we still think that eating Fried Butter is cute.  

For me, it's particularly galling to see this kind of reporting coupled with political commentary. Our continued blindness to the link between poor health and our national fiscal dilemma is unfathomable. We have the highest per capita health care spending in the world, and health care costs currently account for 16% of our GDP, a doubling of expenses over the past 30 years.  If things go unchecked, projections suggest a further doubling to 31% in the 25 years to come.  While these costs have many sources, practically no one is willing to look at the responsibility that we, the American public, bear for failing to take better care of ourselves. We've become a country where diabetes, hypertension and high cholesterol are the norm and where we've bought into the belief that pills can fix everything that ails us.  They can't.  And they don't.  And as a result we are being bankrupted by an ever increasing health care bill.  

The fact that we can still enthuse about deep fried Twinkies in a world so filled with obese and diabetic citizens shows us that we are very far indeed from correctly indicting unhealthy food as we have tobacco.  In a way, we shouldn't be surprised.  The current motto of our country-in-crisis is "Give Nothing Up."  No one appears willing to give up his or her pleasures even if it means sacrificing for the greater good.  The rich want to keep their tax cuts, Congressmen choose to re- ensure re-election rather than take the bold steps needed to get us out of our fiscal mess, liberals want to preserve funding for every known social program, and the citizenry wants to pretend that it's still ok to eat whatever and wherever they want.  

The world is changing and it seems that we don't want to know.  I just returned from Asia where the airport in Singapore looks like a 5 star resort complete with orchid gardens, movie theater, Rodeo Drive style shopping and ponds full of gorgeous, fat koi.  The people are slender, the airplanes sleek and new, the roads seamless, the buildings spectacular.  I then flew home to New York, where the airport was decayed, the roads lined with garbage, the people overweight and wheezing, the bridges rusting and the buildings along the way covered with graffiti.  

Once upon a time, in the lean and healthy years of America, Fried Butter was fun.  We wish it still could be.  But, sadly, it's time for America to grow up and take responsibility for itself.