I’m sitting outside my favorite coffee shop and it is just starting to look like spring here in Kansas City.  The weather conveniently cooperated for my spring break, which is a pleasant surprise after months of bone-chilling weather.

I thought my break would be filled with fun activities I can never do while in school, like reading books, practicing banjo, and working out at “normal” hours (instead of 5am which is the only time I can fit in with my medical school schedule).  So far I have just been a lump on a log, sitting in various places doing practically “nothing,” which is far from my dreams of being productive and hitting the gym.

Admittedly, I have not been that good at getting up in time to work out in the mornings the past few weeks.  I like to blame it on medical school and not my motivation.

But the ugly truth is, I just have not been motivated.

It is such a funny thing, motivation to work out.  I am always amazed at how something that makes me feel energized and beautiful is so easy to walk away from.  If I found a guy that did that for me, I would never let him go.  No seriously,  I would chain him to the bed.

So why can’t I get out there to work out?

The temptation of watching a movie and eating potato chips, uh hem,  I mean fat free popcorn, is just too strong to compete with putting on work out clothes and feeling like a fool on a treadmill in front of lots of strangers.  Recently, I suppose I should not kid myself, I am not watching any movies.  Rather I study for hours but that “fat free popcorn” is still there.

Studying for medical school is a good excuse not to work out, right?  Unfortunately for me, that defense doesn’t fly because I am actually a better student and learn best when I am working out regularly.

Yet another failed attempt to justify my absence from the gym.

So hopefully writing this will help me chain that motivation to the bed and never let it go.

Shannon Stevenson studies medicine and osteopathy at Kansas City University of Medicine and Biosciences.

How do we get hungry?

We all wonder what drives people to eat when they have so much extra energy (the nice way of saying it) and really do not need to eat to survive.  But if you strip away the social and emotional aspects of food, it is just a package of protein, fat, and sugar, and we respond differently to each nutrient as far as hormones, enzymes, and transporters in the body that deal with each one.

When we have not eaten for a while a hormone (Ghrelin) is released from our stomach and travels to the brain.  In the brain, ghrelin stimulates the release of two other hormones (AGRP and NPY), which stimulate another part of the brain to tell us to eat.  (In addition, we have receptors in our brain for glucose, those will be important in a minute).  You can already see this is a complicated system, which is likely why people are so confused about food, and it only gets worse.

So, once you follow your brain’s signals and eat, a whole new hormone released by the small intestine (CCK) travels through the blood to your brain, wherein you get a feeling of satiety.  It is important to note that this hormone is normally secreted in response to fats specifically.  The other satiety-stimulating hormone comes from the brain’s glucose receptors referenced earlier (glucostats).  When activated (by glucose) they release serotonin, which creates satiety and also makes us happy, hence why food can makes us feel so good.  These are the only satiety signals that come directly from the act of eating.  The others come from leptin, but since leptin is still a mystery to scientists, I will not even approach that subject here.  It is a hot topic, and as I learn more I will certainly share.

Now, how can we increase satiety?  After all, this is what will help us feel satiated throughout the day and prevent “slip ups”?

First, eat whole grains.

Those glucose receptors release that wonderful serotonin, which gives us satiety and a happy feeling after eating glucose rich foods.   But the amount of glucose released in your system after a meal rich in processed carbohydrates is immense (stimulating glucostats) compared with the slow release of whole unprocessed carbs.  This is not unheard news, but now you know more about why that is such a bad thing. Flooding the system with glucose at the beginning of digestion and then returning to fasting levels quickly gives your glucose receptors nothing to work with a short time after eating, thereby decreasing your satiety signals in the brain.  This is exactly the reason behind campaigns to increase your “whole grains.”  These grains are processed longer, thereby initiating the release of glucose to the blood gradually, in turn maintaining a more constant glucostat stimulation and serotonin release.

Second, eat fat.

We as a nation have decided that fats are the enemy— think of all the “fat free” products on our grocery shelves (though it is now being replaced by “whole grain” and “low sugar” claims).  But fats are very important for your body; your cells need fat to function properly and your brain is approximately 60% fat.  If you significantly reduce, or worse eliminate, fats from your diet you are doing a disservice to yourself and your body.

Rather, add the healthy fat.  Remember what I said earlier about the hormone that produces satiety (CCK): it is stimulated by fats in your small intestine. This is why eating a handful of almonds, adding oils to your salad, and cooking with fats makes us feel fuller.  So use oil in all your cooking; it will make your meals taste better and satiate you longer.  The reason to avoid trans-fats and saturated fats (found in processed foods and red meat) is that your body easily incorporates those into your system without much work (i.e energy expenditure) thereby making them more potent than poly- and mono- unsaturated fats like that found in oils (processed oil, nuts, avocado, fish etc.).  Of your total daily caloric intake, 25-35% of that should be from fat and 20-30% of your daily fat intake should come from mono- and poly- unsaturated oils for the most health benefits.

Lastly, I cannot stress enough the studies behind fish oil (namely DHA and EPA Omega-3 fatty acids) and its broad benefits to the body from weight to heart and brain health.  Try to find a good source that provides at least one gram of fish oil per serving and take it daily.  (Note: flaxseed oil is not a good substitute for fish oil because it is mostly the precursor oil (ALA) to the oils in fish oil (DHA and EPA) and the body does not process it efficiently enough so you would have to consume an immense amount each day for the same benefit).

Much more information is to come regarding health, nutrition, daily caloric needs calculations, and how to use food to make you healthier and happier rather than a chore or something that you are constantly running away from for fear of the wobbly midsection.

Stannon Stevenson studies medicine and osteopathy at Kansas City University of Medicine and Biosciences.

Jamie Dreyer is off today.

I started medical school this past August and since that time my body image, activity level, and desire to treat my body with the utmost respect has exponentially risen.  For the past decade or more I have struggled with accepting myself “despite” my faults or being totally awash with anger and resentment at this body I have to “deal” with.  Admittedly, I still have moments of that sort, but more and more I look at my body as this amazing work of biological art and want to help my body and all its wonderful parts be at the optimum of health.

I have yet to fully let go of the notion that health and thinness go together, as most of America (and the world to some extent) fervently believes.  However, as I learn more and more about the body, I am driven to the understanding that health is attainable while weight loss like that on The Biggest Loser is generally not.

First it was Anatomy and Histology (the microscopic study of tissue) that inspired me to truly appreciate my tissues and see that they remain healthy all my living days—  a.k.a. I started “working out” again because once I saw how “cool” muscles are and what each one is designed to do, I couldn’t wait to see what my muscles and tissues could do.  As I ran or lifted weights, I thought about every muscle strand that was helping me accomplish my goal.

Second it was the body’s physiological and anatomical responses to exercise that inspired me to stick with my crazy schedule of getting up at 4:30am so that I could be a medical student and work out.  I learned that when we exercise several aspects of our individual cells change.  Everyone knows about the hypertrophy of muscles, but on an even smaller scale we actually change the inside of our cells and their surface receptors depending on what type of exercise we are engaged in, e.g. aerobic, anaerobic or a mix.

Without getting too “medical schooly” the more aerobic exercise we do increases the number of energy producing parts of our cells (mitochondria for the dorks out there) especially in muscle tissue.  In addition, we also increase the receptors for glucose (GLUT4 mainly), which make us more efficient at maintaining homeostatic glucose and insulin levels (hence the reason we are satiated longer after meals when we are active).   This latter finding is the reason that lack of exercise accompanied by overeating of glucose rich foods can lead to diabetes and why people with diabetes who exercise can not only reverse their diabetes (if it is diet induced) but also make controlling their insulin/glucose levels easier.

On the other hand, when we do more anaerobic exercise (e.g. lifting heavy weights, sprinting) our body increases our storage of energy (glycogen) rather than energy makers (mitochondria).  Please do not take this the wrong way to mean storage of energy as storage of fat.  I mean that our body makes glycogen which is the second most readily accessible form of energy that our cells can house.  Our body’s energy sources from easiest to hardest to burn are: glucose (food), glycogen (created by the liver when we eat too much food and need somewhere to store the good stuff for later), and fatty acids (fat post “breakdown”).  There may be some I have not included and when I get to the gastrointestinal section in Week 7, you can all be on the lookout for more gut-wrenching information to come.

My response to this information I am attaining in medical school makes me wonder:

If people were more educated about what makes up the body, how the body moves and responds to movement, and how amazing the body really is (a work of mother nature’s most intricate art), would they too have a greater appreciation for their bodies and stop eating heavily processed foods and find ways of making their bodies move that excites and invigorates them?

As for me, I am back to loving “working out” which is generally such a negative term for me.   Now I crave and can’t wait to see how my body changes and adapts to my newfound energy and excitement.  I no longer look to the scale or the mirror for my acceptance and “right” to be who I am.  I love the way that I feel every day and as long as that is positive, amazingly, my mirror always screams,

You are awesome.

I love it!

Shannon Stevenson studies medicine and osteopathy at Kansas City University of Medicine and Biosciences.

Jamie Dreyer is off today.