Refuse To Regain

The Menopause Myth: Why It Can Be EASIER to Lose Weight Later

by Barbara Berkeley, MD

It's always healthy to be skeptical, particularly where dietary pronouncements are concerned.  

In the past year, I've been asked dozens of times about HCG.  Everyone is talking. It's all over the media. Does it work?   The answer should be obvious to anyone.  If HCG was any kind of obesity cure, 3 out of 4 people you know would be taking it already.  The first pill or treatment that comes along and can really zap obesity will burn through America with such rapidity that we won't know what hit us!  Lesson?  Just because someone or some newspaper article says it's so, doesn't make it so.  Skepticism is healthy in the diet world.

What many years of obesity practice have taught me is that we should also be skeptical of what passes for conventional diet wisdom.  Alot of it is just plain wrong.  And because we accept it as fact, we lose out on many opportunities to change our lives.

One of my least favorite "wisdoms" is that weight gain is inevitable after menopause.   I wrote about this a couple of years ago in my post on weight loss after fifty.  As time goes on and I work with more and more peri and post menopausal women, I am more and more certain that lower weights can be maintained without difficulty despite age and hormonal status.  Further, I think it's often easier for women to get healthy when they are past 45. 

The key to weight loss and maintenance at any age is the same:  a complete overhaul of the foods you eat.  This seems so simple and obvious, but practically no one who goes on a diet does it.  The vast majority simply returns to a modified version of their original diet.  Because modern foods are addictive, this modified version becomes the full-blown version in very short order.

The key to weight control after menopause is the strict limitation of starches and sugars, and that includes grains, whole grains and the flour-based products made from them (pasta, breads, and so on).  As I explained in my earlier post, this is because we tend to be more insulin resistant as we age.  This causes us to make more insulin in response to these foods, which in turn causes easier fat storage and an inability for stored fat to be released.  If you can make the change to fruits and vegetables rather than grains, potatoes, breads and cereals (and you can learn how to do it in books like Refuse to Regain or others on Paleo or Primal diet) you will lose weight and your age will be immaterial.

But there are also reasons why weight loss and maintenance is actually easier for those who are post-menopausal.  

One of the major reasons is the empty nest.  Feeding growing children and ravenous teen-agers makes it extremely hard to adhere to personal dietary rules.  If you have kids but they are now out of the house, you will find it hugely easier to make your own plans and stick to them.  Most of my patients report (and this has been my own experience) that husbands are usually willing to be flexible about eating.  They will often follow along even if they've eaten differently at an earlier stage in life. 

A second reason that it's easier to make change is that social pressures begin to modulate.  A couple of years ago, Don and I took a trip to Las Vegas.  While sitting at one of the enormous breakfast buffets at the Mirage, I had to laugh.  All of the people under 45 were tucking into huge portions of bacon, eggs, danish, muffins and potatoes.  Those who looked to be over 50 were eating egg whites, little bowls of granola with skim milk, and prunes!  Getting further along in life puts you in mind of the final third of the journey.  You and your friends will start to be more conscious of health and longevity.  Sayng that you no longer eat foods that make you fat and that you want to reach 95 in good health will no longer elicit eye-rolls.  You'll be admired, not scorned.

Another factor that I mentioned in my earlier post is the greater ability to be yourself that comes at mid-life.  The opinions that others have of you matter alot less now, and your tendency to speak your mind and live life by your own rules increases.  Use this new freedom by declaring yourself and your rules for eating.  You've earned the right to make your own way.

If you no longer are feeding a family at home, it's a simpler task to clean your kitchen and vow never to allow fat-promoting starches, sugars and junk foods to enter.  The need to entertain and cook is often lessened.  You've probably had that role for many years and perhaps younger generations will take on all or part of it now.  Minimizing baking and complicated entertaining can be very helpful when you are trying to make permanent healthful changes.  Keep things simple for a while and see how much easier it is to control the food environment. 

Exercise is a vital component of health from mid life on.  You can get away with being sedentary when you're young, but it's for sure catching up with you by the time you pass 50.  The good news is that it's also a myth that exercise ability lessens with age.  While no one wants to get injured, many of us take to our couch at the first hint of soreness.  We are not as fragile as we think.  Unless you have a very real reason not to exercise, get out there and do activities that get you excited.  If this guy can run the marathon at 100, you can train to walk a 5K, shake your booty in a zumba class or conquer the downward dog.  

Finally, changing your life and eating habits requires belief in your ability to get things done.  That's not something many people have in their 20s and 30s.  But after you've built your career, your family, your life, you clearly know how to get things accomplished.  Make the same kinds of plans you did to get other important things done in your life and take on your goal with a passion.  This is an advantage for  mid and later lifers.  Use it.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Fat Trap: My Response

By Barbara Berkeley, MD

Once a month, in a small room off the lobby of Lake West Hospital in Willoughby, Ohio, a special group convenes.  For someone observing the group and unaware of its purpose, it might appear to be a simple mix of everyday people….young, old, racially diverse.  The members would seem to be old friends but with a particular seriousness of purpose, perhaps a community group attending a lecture or learning some new skill together.  What a casual observer would not guess is that each of these people was once obese, some having weighed over 100 pounds more than they do today. 

Our Refuse to Regain group is an experiment, a safe haven for maintainers who have lost weight in many different ways and now face the reality of reconstructing their lives.  We’ve had people from Weight Watchers, people who’ve undergone bariatric surgery, people I’ve treated in my  practice and others who simply did it on their own.  A weight loss diet is no different than emptying the trash.  It doesn’t matter which technique you use to toss out the garbage.   But learning how to avoid the reaccumulation of unwanted junk is a completely different skill.  There are many basics in this process that will be the same for everyone.  There are also many specifics that will vary from person to person and which must be individually discovered.  

Here’s some of what we’ve learned so far:

1. Weight maintenance is possible.  There is nothing in our group experience (or in my personal clinical experience) to suggest that the body “forces” one to regain.
2. Weight maintenance requires a separation from the world of “normal” American eating…which is not normal at all.
3. Some people are heavy simply because they are susceptible to the modern diet , no more no less.  Others are heavy because they use food for soothing or sedation.  Most people are a mix of both.   If psychological issues are a major part of weight gain—significantly beyond the common enjoyment of food for pleasure, they need to be addressed during the maintenance phase.
4. Weight maintainers are special people who live on a kind of food island.  It’s really nice to know that the island is inhabited, often with fascinating, determined people just like you.   Rarely do maintainers get to meet and talk with one another.

This week, I gave my group a reading assignment.  That was a first.  I asked everyone to read Tara Parker Pope’s article on weight maintenance called The Fat Trap.   This article is currently online and will appear in Sunday’s New York Times Magazine.   Our group will be discussing it at our January meeting, but I’ll give you a preview of my reaction here.  Many of you may be reading our blog because you read The Fat Trap and discovered Lynn Haraldson, my blogging partner on this site.  The fact that you got here likely means that you are interested in knowing whether we are bound to regain the weight we lose, so please, read on…leave comments and join the discussion.

For those of you who are new to this blog, you should know that I am a physician who has specialized in weight management since the late 1980s.  This is the only thing I do and that’s unusual.  Why?  Because most doctors are not particularly interested in obesity, and certainly weren’t back in the 80s.   Over the past twenty years, a continuing source of frustration for me has been the willingness of doctors and the general public to accept “truths” about weight loss that are the beliefs of everyone except those who actually work with overweight people.   

Scientific research needs to square with what we see in clinical practice.  If it doesn’t, we should question its validity.   “The Fat Trap” is an article that starts with a single, small research study and builds around it.   Its point?  That there are inevitable biological imperatives that cause people to regain all the weight they lose.

I don’t buy it.

Here is the opening paragraph of Ms. Parker Pope’s article:

For 15 years, Joseph Proietto has been helping people lose weight. When these obese patients arrive at his weight-loss clinic in Australia, they are determined to slim down. And most of the time, he says, they do just that, sticking to the clinic’s program and dropping excess pounds. But then, almost without exception, the weight begins to creep back. In a matter of months or years, the entire effort has come undone, and the patient is fat again.

At one time, this was my experience too.  But things have changed.  After years of focusing my practice much more on weight maintenance, writing a book about it, and trying to figure out how to teach and encourage it, I no longer see patients with an “entire effort come undone”.   Instead, I see more and more people learning how to become successfully anchored at their new weight. And these POWs (previous overweight people) are not from my practice alone.  They are people like Lynn Haraldson and her friends “The Maintaining Divas”.  They are the long term POWs who write to me via this blog, on Facebook and on Twitter.  They are the people I hear about with increasing frequency every day. 

I admire Ms. Parker Pope for acknowledging her own struggles with weight, but as someone who has not yet solved the maintenance problem I would submit that she is not the best person to rationally evaluate evidence that says that regain is inevitable.  After talking to a number of scientists who believe that the body fights weight loss, her concluding paragraph says:

For me, understanding the science of weight loss has helped make sense of my own struggles to lose weight, as well as my mother’s endless cycle of dieting, weight gain and despair. I wish she were still here so I could persuade her to finally forgive herself for her dieting failures. While I do, ultimately, blame myself for allowing my weight to get out of control, it has been somewhat liberating to learn that there are factors other than my character at work when it comes to gaining and losing weight.

Those of us who come from families which struggle with obesity can believe one of two things.  We can believe that biological and metabolic factors doom us to fatness or we can believe that we come from families who are very sensitive to the current food environment and perhaps need to live in a new and more creative way.  It has been my experience that all successful maintainers have learned how to live a life that exists outside the current food norms.   For some, this is a daily and difficult challenge and for others it becomes a simple and treasured way of life, but either way, it is not about some inevitable biological destiny.  Rather, these maintainers have come to terms with the fact that they are ancient bodies and souls living in a modern environment and that our food culture is capable of killing them.  Controlling that environment is their choice and their challenge. 

Where I do agree with “The Fat Trap” is in its assertion that obesity is much more difficult to deal with once it is established.  We would do well to focus intense and constant attention on healthful nutrition during pregnancy and in childhood.  I believe that we can do this much more easily than we believe, if we would only adopt the idea that we should eat more like we did originally as hunter-gatherers.  It has been my clinical experience that elimination (or major curtailment) of starches and sugars (including whole grains and the things that come from them, by the way) simply works.  And this clinical observation makes sense, since the ancestors whose genes we carry were not exposed to the large amounts of starch and sugar we now eat.  Along with consumption of real food…not things in boxes, cans, or packages.... this easy concept can change lives.  We could make things so much easier by teaching this lesson  to kids rather than endlessly focusing them on per cents of fat, protein and carbs and on counting calories.

But such approaches to weight maintenance are not easily sold.  Its far simpler to believe that weight must be regained.  I’m fond of using this example for patients:  If you were to tell your friends that you are becoming vegetarian and that you will no longer touch a drop of red meat, fish, or poultry, no one would blink an eye.  You’d probably be encouraged and congratulated.  If, on the other hand, you announced that you were giving up sugar and grain, the same friends would be horrified.  “You mean you’re never going to have another piece of bread???”

I believe that the resistance to finding the maintenance solution comes from the addictive nature of starch and sugar foods.  I also believe that most of America and other SAD (standard American diet) countries are operating “under the influence” of addictive carbs.  Life without them, or even with LESS of them, is too awful to contemplate. 

But I digress.  To return to my original point, I want to forcefully say that we must stop finding reasons we can’t maintain and start getting much, much better at teaching people how to do it.  Support networks, communication between maintainers, and many more books, advocates, and techniques that focus on maintenance are key.  

I believe I may scream if I see yet another book with a catchy title that touts yet another weight loss approach without ever talking about what happens in the after-diet world.   January is the month for those glossy little productions. 

Time to get serious.  Maintenance can be done, and if you want to meet the people who are doing it, hang around this blog. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is Willpower Overrated?

by Barbara Berkeley, MD

A little something to think about when you are headed for the holiday buffet.  How far will willpower take you?  I think it's much smarter and more effective to take a realistic look at the strength of your opponent: modern trigger foods.

 

What Causes Weight Gain? My Take

by Barbara Berkeley, MD

How do we lose weight?  The answer is--- cut calories until the body is forced to burn itself for energy.   This is so intuitively obvious that the converse would also seem to be true: if we lose weight by cutting calories, we must gain weight by accumulating them.  But is this true?  Perhaps weight loss has nothing much to do with weight gain.   Perhaps they are two quite different things.  '

For some time, I have been giving an introductory talk to new patients who enter my practice.  I wanted to record it so that they could hear the talk again if they chose, or share it with those at home.  At the same time, I thought that readers of this blog might find it interesting as well.  While I can't claim to know the ultimate truth, I have found that the model of weight gain I describe in these videos works well as a basis for treating most of the overweight patients I've encountered.  I hope you find it interesting.

 

 

 

Dietary Tribalism: Factionalism Goeth Before the Fall

by Barbara Berkeley, MD

 I started blogging about 3 years ago.  At the time I was a naive, starry-eyed newbie who couldn't wait to share my experiences and opinions with the world.  I had just written a book based on the experiences I'd had with patients over a period of nearly 20 years. As I sat, fingers poised over the keyboard for my first foray into the internet world, the prospect of getting my message out to a larger audience was thrilling.

Then....Whack Bam Boom!  Not a day after my first words hit the virtual page did I start reading that I was a useless dope, a fool who knew nothing and that my book and pretty much all of my thoughts were drivel.

I ran like a wounded puppy to my blog partner Lynn Haraldson who had been on the internet far longer than I.  She was sympathetic but slightly amused.  I got the message.  The internet is the wild west.  Better toughen up girlie.

So here I stand, ready to take your punches.  But really, why should we steel ourselves, waiting to be beaten up for ideas, beliefs and hypotheses?  The reason for these attacks is supremely ironic, especially for those of us who believe in Primal Diet, or returning to more of the behaviors we practiced in our ancient past.  This flinging of verbal barbs and arrows relates to an intense and ancient human desire to be tribal. Unfortunately, I fear that we will be destroyed by this same tribalism if we refuse to acknowledge and dismantle it. 

At its best, tribalism can be fun.  Cowboys and Indians. Color War.  We love nothing more than to divide ourselves into teams and cast the other group as the bad guys.  I can be playing doubles with one woman for two sets and hating the two ladies on the other side of the net.  Then we switch partners and suddenly my previous hitting companion becomes my sworn enemy.  And I really, really do want to sincerely beat her. 

Things ratchet up with professional sports.  Of course we know that Cleveland really doesn't hate Pittsburgh...(or do they??) Sometimes, it's hard to tell whether tribal enmities related to sports are silly or real.  When they explode into occasional violence at events or after championships, we see their actual potential for destruction. 

And then there's politics.  Why must all Democrats believe that all Republicans are useless idiots and vice versa?  We have all come to see the folly in playing the tribal game so intensely that not a single thing gets accomplished. 

Finally, we have the real deal.  Tribalism as it relates to countries, regions, religions and belief systems.  This is where we lose complete track of the idea that we are all human.  Each one of us might just as easily have been born into another culture and wound up on the other side of the fence...the enemy. But this never occurs to us.  For most of human civilization, indulging in our tribal nature simply meant losing a bunch or our men to spears, arrows and clubs.  As weaponry becomes more deadly and more available, the outcome of unbridled tribalism would seem to be obvious.  Yet we make no attempt to examine it or control it. 

Tribalism seems to be in our biology, but it is expressed as an idea.  The idea is that something about our tribe makes us better...more worthy.  It is usually connected to the belief that our tribe is in possession of the one and only truth.

So what does this rant have to do with Paleo/Primal diet?  In my recent forays into the world of Twitter, I've discovered a new and quite vocal community that believes in ancient diet.  Among this "tribe" I am dismayed to see that there appears to be a great deal of proclamation of truth and declamation against those who see things differently.  People with varying opinions are branded as "asshats" and "fools". This is not unique to the Primal Diet believers.  It is also on display in the writings of followers of other diets.  And yet, at least as I see it,  the truth about optimal diet remains the furthest thing from being settled.  It is as complex and elusive as a shadow that recedes into our endless human past. Does any group, whether it be the vegans, the vegetarians, the Primalists, the Mediterranean Diet followers...ad infinitum.... truly have the hubris to believe that they have completely solved the equation?   There is no diet on earth that does not eventually lead to death.  And if there is ever to be one it will have to come with the assist of modern science, since no living species has yet negotiated immortality.  Thus, we come full circle. We are each human and would benefit from listening to and respecting one another.  Of one thing we can be certain, no one of us has "the answer".  It is only together that we can create enough intellectual and spiritual firepower to push closer to real enlightenment.

 

 

 

 

 

 

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 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.