Dr. Topher Fox

Changing behavior can be hard

It can be really hard to change habits and routines, to live healthier lifestyle. Whether this means you don't exercise as much as you should, or you succumb to late night snacking, or you just can't seem to turn off Netflix and get to bed in time to give yourself a good night's sleep, know that we all have areas where improvement is theoretically possible but in practice quite difficult.

Personally, I've come to believe that our culture and our psychology work against us to thwart our very good intentions. We usually try overpower these forces with willpower, which unfortunately is a limited resource and usually runs out before we want it to. A better approach is needed.

If you ponder where you are having difficulty getting traction, my belief is that a few patterns will predominate. Personally I'm a bit addicted to exercise, so I have no problem getting in a workout even if it means I have to get up at 4 am to go for a run before my...

Atomic Habits

In his book Atomic Habits writer James Clear describes a study where researchers wanted to help 248 adults build better exercise habits. They divided the subjects into 3 groups. The first group was asked to track how often they exercised. The second group, the "motivation group," was asked to track exercise and also to read material about the benefits of exercise. The third group tracked and read motivational material, but also was asked to formulate a plan. Specifically they were asked to complete the following sentence: During the next week I will partake in at least 20 minutes of vigorous exercise on [DAY] at [TIME] in [PLACE].

Compared to the first two groups, where 35-38% of the subjects exercised at least once per week, in the group that completed the plan, 91% of people exercised at least once per week, more than twice rate of the other 2 groups.

Implementation Intention

The sentence the subjects completed is known as an implementation intention, a...

A Common Pattern

You start a new health program, full of enthusiasm and excited for the change it will bring. The first days and weeks go well, you are making all the right steps, and you see early signs of progress. You've been exercising for a week and feel a bit stronger or more energetic. You've stuck to your nutrition plan and have lost 7 pounds. So far so good.

But then something shifts. It starts to get harder. Maybe you don't feel like getting up early to exercise. Maybe you really want to order the cheesecake for dessert. Maybe you don't want to go to bed early, you'd rather finish binge-watching the latest Netflix show you are plowing through. Before you know it, you find your progress has stopped or maybe you've even lost ground. You start asking yourself, "Is this even worth it? Why am I even trying?"

Welcome to the messy middle.

The Messy Middle

The messy middle is that part of the journey where excitement and enthusiasm have worn off but the "new way" has not become...

When I was in medical school and learning how to perform basic tasks, like reading an ECG or a chest x-ray, I was taught very specific protocols for each process. For example, reading an ECG was RRABEIIM - rate, rhythm, axis, bundles, enlargements, intervals, ischemia, morphology. The goal was to make sure nothing was missed, nothing was inadvertently overlooked.

In other words, taking shortcuts - such as jumping to the evidence of a heart attack occurring - might mean missing a long QT interval, which could lead to serious problems if medication choice did not take this into account.

Pilots, auto mechanics, chefs, and in fact almost every profession uses checklists or SOP's in some form to make sure a vital process does not get short-circuited.

Supplements - Do They Work?

I have to admit, it seems logical to assume that if a substance is found to have health benefit in nature, it should have similar benefit if taken in the form of a supplement. But is this true?

It turns out...

This is Daisy. She's our "pandemic dog." You know, since the world is turning upside down, why not throw a new creature into the household mix? 

The Transition

She came to join our family a month ago, a one-year-old rescue from Texas, and when she arrived she was incredibly timid. She wouldn't come within about 6 feet of me without lots of coaxing (and food bribes), and she spent most of her time hiding under our bed.

Now that she's been with us for a month, she's starting to show a lot of personality, and there are lots of ways she brings me joy. I love how excited she gets for her food every morning, leaping about and quivering with excitement - it's like Christmas morning with a toddler every day! She likes to hoard toys. She'll find systematically take one item at a time to her bed until she's sitting on a pile of 8-10 bones, balls, and other assorted toys. When she's in a mellow mood, she'll follow me around and just rest peacefully nearby wherever I might...

I've noticed something interesting. When someone is diagnosed with type 2 diabetes, the doctor thinks about controlling risk factors. Control the blood sugar. Control the blood pressure. Control the cholesterol. All of this to reduce the risk of developing problems related to diabetes.

Most people when diagnosed, however, think about reversing diabetes. Make it go away. Get off medications. Punch diabetes in the face so it never comes back.

Unfortunately studies and experience have not suggested that people are likely to make and sustain the changes needed to reverse type 2 diabetes.

But could diabetes reversal be possible?

The "Twin Cycle" Hypothesis

Dr. Roy Taylor from Newcastle, UK, developed an interesting hypothesis about the cause for diabetes which gives hope that it can be reversed commonly, especially within the first 4-6 years after diagnosis. He published about the twin cycle hypothesis in 2012 after performing preliminary studies showing support for the idea.

Basically,...

Meet your river guide

Just before I got married, several of my friends took me on a guys' adventure day, which included a day whitewater rafting on the Arkansas River. As we signed in, we received instruction about river safety, got our life vests, and hopped on a bus that took us to our starting point.

On this day we would be hitting class 3 and class 4 rapids, which are not as big as they come, but plenty big for a novice like me.

And then we met our guide. He would be in charge of steering the raft, helping us to make our way down the river safely, showing us where to go, what to avoid, and how to get past obstacles. He was skilled and knowledgeable, a good teacher, and he delivered us to our destination safely. Along the way we had an amazing time together.

The healthcare system - a contrasting approach

In some ways, I believe that the healthcare system uses a very different approach. As you try to make healthy choices, overcome obstacles, and make progress, how often do you...

Yesterday I swept out my garage in the morning. It's amazing how quickly the dust and dirt accumulates in that space. Then I swept the kitchen. We have a new dog (our pandemic addition), doubling our canine count and apparently our dog hair production. In the evening, I sat on the front porch for my final Zoom meeting of the day and couldn't help but notice the cobwebs and old blossoms accumulating around the bench and front door. Sigh. I saved that cleaning for another day.

Debris accumulates

It struck me that just like debris seems to accumulate around my house, debris accumulates in my lifestyle. It's a slow creep, but little things start to show up. A bit more liberal with snacks in the evening after dinner. A bit less attention to getting enough vegetables. Even a bit less focus on staying connected with my wife.

Does this happen to you too? I suspect it does. And just like our homes need a periodic sweeping and dusting, our lifestyle choices would likely benefit from periodic...

"Eat breakfast like a king, lunch like a prince, and dinner like a pauper."

It's likely you've heard this statement before. Results from a new study add additional support for the idea that this might be the way the human body was designed to eat.

Bigger dinners may increase risk of metabolic disease

Researchers analyzed data from the NHANES nutrition survey, specifically from almost 4700 people with diabetes. Based on food recall questionnaires performed on 2 separate occasions, they broke people into 5 groups based on the amount of food eaten at dinner compared with breakfast.

What they found was that compared with the group the ate the least at dinner, the group that ate the most had an increased risk of diabetes-related mortality (1.9 times greater risk) and heart disease-related mortality (1.7 times). 

The authors of the study also created risk models based on their data, and concluded that:

• Moving 5% of energy intake from dinner to breakfast could reduce the risk of...

The Value of Exercise
You know that exercise is important. The body just doesn't work right if you are not moving. In particular, it becomes harder for you to efficiently burn fat when you are sedentary. But even though we know exercise is important, it can be really hard to get it done, right?

Two Stories
Let me tell you about two of my clients, each of whom has diabetes or prediabetes. I was struck by their stories, and I'd like to share a bit with you.

Matthew* uses insulin to control his blood sugar, and he tests his glucose regularly. Over the past year he has gone back and forth from being well-controlled, to not well-controlled, and back to controlled again. Now Mr. L will admit he doesn't like to exercise. It is hard for him to get out for a walk on a regular basis. But interestingly, the key factor we identified for when he is well-controlled is that during both of these periods he was remodeling his house - first his kitchen and then his garage. And he really...