By Pamela Peeke, MD, MPH, FACP
WebMD Weight Loss Clinic - Live Events Transcript
Event Date: June 29, 2005
We only get one body, so take good care of it! Are you giving your body the nutrition, exercise, and attention it needs? What steps can you take to improve long-term health and vitality? Pamela Peeke, MD, shared information on nutrition, exercise, and healthy living for women on June 29, 2005.
If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
MODERATOR: Welcome to WebMD live, thank you for joining us today.
PEEKE: This is great. I'm really looking forward to the discussion.
MODERATOR: Could you tell us how your program is different from Body for Life by Bill Phillips? What needed to be changed to make this program work specifically for women?
PEEKE: Bill wrote the book, the original book, in the mid-'90s. Much has changed since then, especially the emergence of gender-specific medicine. Therefore, my book, Body for Life for Women , is customized and individualized for the specific needs of a woman, which includes her hormonal milestones as well as her specific and very unique hardwiring, psychologically and physically.
MODERATOR: Can you explain that a little bit more -- what do you mean by a woman's hardwiring?
PEEKE: Scientists have now found that women have specific tendencies, for instance, psychologically. Women are ruminators; not all women clearly, but we're looking at the bulk of women. Women tend towards rumination, perfectionism, stress-overeating as well as a need to caregive, oftentimes without boundaries. Therefore, they have the tendency to drop off their own radar with regard to self-care. Men are excellent at compartmentalizing. But women tend to blur many of those boundaries and therefore continue to caregive 24/7 and forget their own self-care. These things are specific to women and need to be taken into consideration when developing programs.
Finally, during a woman's hormonal milestones -- which includes the onset of her menses, pregnancy, perimenopause, menopause and beyond -- a woman's psychological hardwiring may also be directly and oftentimes significantly impacted. This too must be honored as one develops programs for women's self-care.
MODERATOR: Dr. Peeke, women, normally are the caregivers and we don't take care of ourselves. How do you get past that hurdle?
PEEKE: What I normally do is, tell women that it's wonderful that they are excellent caregivers but the best caregiver is a healthy caregiver. I also remind them of the science which now clearly shows that women who do not take care of themselves actually end up being sicker and sometimes die before the very people who they are trying to caregive. Therefore, it's like investing in themselves and their caregiving by incorporating balance into their lives -- a little for you and a little for the people you care about. When women hear the "balance" word, I find that it really resonates with them, and they get it.
MODERATOR: You take a holistic approach to a woman's health, stressing not only the physical but also the mental health. What are the key elements to this?
PEEKE: The template involves three elements -- mind, mouth and muscle. Mind obviously also involves a sense of spirituality, so it's sort of mind spirit. I'm trying to do something somewhat revolutionary here. I'm asking people to stop doing things like just looking at their eating or just looking at their exercise or just looking at their psychology. Instead what I'm trying to do is to have people incorporate all three elements.
For each individual, it turns out that certain elements resonate better than others and are easier to incorporate and that's all right. You're not expected to get it all at one time that way. However, when I do it this way, I'm able to show how all three elements are essentially interconnected for life. All must be honored and the greatest benefit is gotten when they are honored.
MODERATOR: You say mind, mouth and muscle. What do you propose we do with the mouth?
PEEKE: Use it well. What I'm asking you to do is to learn to nourish yourself physically by eating smarter, and by doing so you also remember that interconnection, nourish your mind as well as your body.
When it comes to mouth template, I'm looking at three essential points -- quality, quantity and frequency:
- Quality addresses the issue of what I refer to as the smart foods. The smart foods are those foods in each category of fat, protein and carbohydrate which allow you to be able to optimize nourishment.
- Quantity clearly addresses the issue of portion and serving size which is what I consider the greatest challenge. Many people say they eat high-quality foods, but eating mountains of it is not helpful.
- Frequency is a new concept for many people. We have found in science that to be able to optimize your body composition -- that is to minimize body fat and maximize lean mass or muscle mass -- it is very important to eat roughly every 3-4 hours. You would have breakfast, midmorning, lunch, midafternoon and dinner. And if they are up for a very long period of time, potentially a small feeding prior to retiring at nighttime.
This is important because by doing so, people actually end up eating fewer calories, higher quality food, and are satiated throughout the day so that overeating is minimized if not eliminated. This is especially important for women who underestimate the power of the balance of these smart foods, especially protein. Protein is very important in decreasing the craving for refined sugars, especially around the times of a hormonal milestone. Protein also enhances satiety throughout the day.
Understanding this and putting together quality, quantity and frequency, you have a smarter, easier, and doable way to maintain excellent nourishment 24/7.
MODERATOR: Could you tell us some of these smart foods you're talking about.
PEEKE: Smart foods include lean protein -- range-fed red meat for instance. But keep this at an occasional rather than a daily intake. Poultry. Fish -- a very smart food because of the omega fatty acids which are so cardio protective. Skim dairy foods. The vegetarian option in the fat category -- extra virgin olive oils and canola oils. Also, carbohydrates -- here we're looking at fresh produce, vegetables, fruits and whole grains. Eat a balance throughout the day while trying to be attentive and mindful to minimize or eliminate processed carbohydrates or sugars.
Any combination utilized in cooking and eating throughout the day in appropriate portions.
MEMBER QUESTION: I get really bad cramps and can't work out when I have my period. I tend to eat less, but I tend to eat junk. I feel like I'm starting all over every month. Is this yo-yo dieting?
PEEKE: Women are very sensitive to changes in appetite around the time of their menstrual cycle, some worse than others. It's important to know your own pattern and be prepared for it.
One of the most important things you can do is to supply yourself with foods that will answer your need for sweetness but in a smarter way. Doing fruit parfaits with yogurt is a wonderful way to be able to fill yourself up and yet get that sweetness and decrease that craving because you are getting protein with yogurt. You could even add some protein powder, just mixing it in, and increase the protein intake for the feeling of satisfaction.
Also, as you do this, remember that you're not supposed to be running to the gym with cramps and expecting the same workout you have when you're not on your menstrual cycle. Instead, why not do something more gentle like yoga or Pilates or a combination thereof? How about a walking meditation instead of pounding out a run on the treadmill when you have cramps?
I can assure you that when you have PMS or cramps, that you can expect a greater benefit by working with them, not against them.
MEMBER QUESTION: I have a great salt craving. Why does this happen?
PEEKE: Every person is unique and in your case, you are hardwired to crave salt.
There are alternatives to this; you can actually find seasonings which will take the place of salt and make you feel as though you have gotten exactly what you wanted without the extra salt intake. Go to your favorite store and look closely in the seasonings section, and you will find at least several brands of seasonings which will work perfectly fine as a substitute for the salt.
Remember, you want to watch that salt intake carefully because:
- Women are the ones, not men, who are prone to bloating.
- This occurs even at a higher level during your hormonal milestones, especially perimenopause.
- Be really aware of the salt intake on many of the packaged items you may wish to buy, because they can be very high.
MEMBER QUESTION: I know what to do -- eat less, exercise more. I sometimes feel like my hormones sabotage me. I'm going through perimenopause and the mood swings really affect my eating and exercise. Is there anything I can do to even my life out?
PEEKE: In my book, Body for Life for Women , I have written down 10 power mind principles. In these I have incorporated a woman's unique psychological foundation and its relationship to her hormonal milestones. You are actually in much greater control of this whole process of eating and taking care of yourself than you think you are. What you need to do is anchor yourself with what I call a bull's-eye motivation, which is "principle two." There is an exercise in the book where you learn to write down and use this specific motivation to be able to arm yourself when you're feeling moody or in distress. In addition, by adopting the entire healthy lifestyle template, your symptoms, especially the mood swings, will decrease over time.
Here is a quick tool: Remember, women tend to overthink while men tend to be more action oriented. In this case, say to yourself, "Just do it." When you get up, take that walk, don't ruminate about it, but take the walk . You will feel so much better and your mood will be elevated. You will be able to continue your healthy lifestyle -- trust me. There is healing in action.
MODERATOR: We're talking about a healthy lifestyle, but the book describes a 12-week program. What can someone expect to accomplish in 12 weeks? What can a woman do in 12 weeks?
PEEKE: In Body for Life for Women , I offer a 12-week segment which means that you will have an eternal number of 12-week challenges. For instance, you will find yourself in a weight- removal segment, and I use the word remove because in my book, I say, don't use the word 'lose'. If you lose your keys, don't you want to find them again? Instead, how about permanent removal? So, you will be in a 12-week weight-removal segment, or you could be treading weight for 12 weeks, meaning that things have happened in your life and you're not going forward or backwards, you need time to rest and stabilize. Or a weight-sustaining segment, which you can actually carry on forever. So each 12-week segment is a challenge.
What can you expect realistically? It depends upon your level of effort. If you give it maximal effort, then a woman, up to the age of 65 or so, can expect to remove one half to two pounds per week of excess body fat. Now, the goal here is not a specific weight -- for that matter, my whole theme is to throw out your scales because you can be misled by body weight. Instead, I would like you to concentrate on what is under the hood -- your body fat, muscle and bone.
During your challenges, what you're trying to do through the healthy lifestyle, is minimize body fat. Why? Because excess body fat increases a woman's risk for breast cancer. And if the body fat is located primarily deep inside her tummy under the abdominal muscle wall, which occurs very frequently after the age of 40, then she will also increase her risk for diabetes, heart disease and cancer, which also includes colon cancer. So body fat is the key here, not total body weight.
Also, a woman needs to hold on to that muscle which will keep her strong and able to continue her caregiving well into her 80s and 90s. But she can't do that if the muscle is weak. Therefore, paying attention to strengthening muscle and maintaining that is essential. Here is the great news: Everything she does to strengthen her muscles strengthens her bones, so you get a real triple win. You get a minimizing of body fat and saving her life, optimizing her muscles as best she can to stay strong and independent throughout her life and maintaining those bones that are so precious so that she can continue to live well.
MEMBER QUESTION: You talk about strength training in the book. I was always told not to lift weights, that it would hurt me internally.
PEEKE: Strength training is absolutely essential to a woman's overall mental and physical well-being. The stronger a woman is physically, the stronger she is mentally. It's a beautiful mind-body connection.
Current science clearly shows that strength training is nonnegotiable and essential to maintaining and optimizing a woman's body composition. She needs this to be able to decrease the risk of falling and breaking precious bones, especially after the age of 50, with all of the subsequent problems. She also needs this to be able to fend for herself and at the same time she needs strength training to increase bony strength and integrity so that she can continue to ambulate, mobilize and caregive throughout her life. Therefore, there is absolutely no evidence what so ever that strength training is deleterious.
MEMBER QUESTION: A question about stress and cortisol and weight gain around the middle -- what can help with this?
PEEKE: I have spent most of my career studying the stress-fat connection. It was actually the topic of my first book, Fight Fat After 40 , and I expand on that in Body for Life for Women .
The bottom line is that women tend to hold on to stress deeply and find it difficult to let go. When they do this, they maintain chronic elevation of cortisol levels. What does this do? It stirs up an appetite for the stress fuels, which by the way are never tuna on a bed of greens. It's always fat and carbohydrate; it's that big spoon and pint of ice cream you have sitting with you in bed late at night.
How to get around this? No. 1, something is not stressful unless you agree it is stressful. So you have to learn stress resilience, which means learning to, as I said in my book, embrace adversity, which is the first "power mind principle," and then continue on, as you learn stress resilience, to become a "master regrouper," which is "principle eight." What does this mean? That means that no matter what happens to you in life, that you are able to show flexibility, to work with it, to negotiate. If plan A doesn't work, plan B, C and all the way through Z. How creative can you be? Women are superb at doing this for other people but when it comes to themselves, they don't want to put out that effort.
Please put out the effort to take the time to learn how to be able to see life for what it is, embrace that adversity, and say, "Yeah, I accept it." Then use all of the tools and resources that you have in your wonderful and complex lives to be able to create new plans of attack, new ways to be able to navigate the challenges of your life. When you do this, your cortisol levels are lower, remain more stable, and therefore stress-overeating becomes a thing of the past.
MEMBER QUESTION: Doesn't exercise help reduce stress by releasing endorphins?
PEEKE: One of the tools that you will be using to increase stress resilience is physical activity. It doesn't even have to be a gym business. Instead, get up, take a walk wherever you may be, even if it's around the building at work -- because it works. You could make this a walking meditation. Simply allow your mind to be able to rest a little bit at the same time.
As you're walking, you're stirring up the best chemicals in your brain to help neutralize the effect of cortisol, which is the endorphins. The endorphins inhibit cortisol, bringing it down to manageable levels, giving you a sense of well-being, modulating your mood and allowing you to be able to come up with an answer, a solution, or just a way of being able to say, "it is what it is," without doing the one thing women do quite often, and that is to self-destruct with behaviors like overeating.
MEMBER QUESTION: How can you calculate how much exercise it takes each day to lose weight and also maintain weight?
PEEKE: In my book, I have made it clear that there are some simple ways to be able to find out how much physical activity works for you.
Here's a very easy template: If you are someone who has at least 20 pounds of excess body fat, (meaning have that body fat percentage checked now) then it would really be helpful if you could burn 300 to 400 calories per day in physical activity. Gosh, what does that mean? Well, walking a mile, which is 2,500 steps on your pedometer, usually burns about a hundred calories. So, if you're aiming for that wonderful 10,000 steps a day that we always encourage on your pedometer, you have your 400 calories right there. Doing this every day that you can, but a minimum of five days a week, really does the trick. In addition, you can cross train as much as you wish -- if you want to bike, if you want to use a stair-stepper, if you want to use an elliptical -- all of these things are wonderful cross-training options, but the key is consistency, and that is very important.
Women are perfectionists, and I have a little one-liner for you: perfectionism is the enemy of done. Meaning that you can't get off first base, you're paralyzed. If you can't get your exercise in one day, if your physical activity is somewhat curtailed, take a deep cleansing breath and say, "it is what it is and I'll just get right back on it as soon as I can." Be kind to yourself.
Don't forget that strength training. I'm encouraging you to do that twice a week, separated by two to three days, so that you allow yourself to have that balance of strength training as well as physical activity, which involves aerobic or cardio activities.
MEMBER QUESTION: I am 63. Is it too late for me to start a program like this? I'd like to get more energy and I don't want to be an old lady. In my mind I'm still many years younger, but in the mirror I'm older than my years.
PEEKE: The National Institutes of Aging have clearly shown that there is absolutely no time in life when it's, and I quote, "too late." This is glorious news for someone like yourself who asks the perfect question.
One of my most successful patients started with me when she was 69. She is now 76 years old. She has lived through breast cancer, she has hiked mountains, she has gone to areas of the world she dreamed about but never thought she could do because of perhaps lack of strength. Boy, is she strong now! I have never seen someone so invigorated. She is, if anything, an inspiration for everyone else.
So I encourage you, at your very youthful 63 years old, to get up right now, put on those sneakers and take that first walk. Remember, every step of the journey is the journey.
MODERATOR: What can we do to help our daughters as they are maturing to help them living healthier lives?
PEEKE: When I wrote Body for Life for Women , I meant it to be an intergenerational book, meaning that women are giving it to their daughters, daughters are giving it to their moms, women are giving it to their sisters and their friends. Why? Because in it I have what I call "heads ups." These heads ups were things that I wished existed when I was growing up. That is, if I was 18, what is going to go on when I'm 28? What happens to me when I'm 38, 48, 58, 68? It's nice to see the full panorama of what's going to be happening.
The great news is we have enough information now to be able to give our daughters essential data to allow them to build a strong foundation for healthy living. For instance, one of the most important things is never to think that you don't have to worry about anything until you're 50. That's kind of what I was taught in my generation. Instead, right now, teach your daughters the fundamentals of eating well just at the time when junk food is all they really want. Show them through example -- think right now. I remember what my mother was doing when I was growing up. She was an example to me. Well, you are an example to your daughters. It's not enough to say to them, eat more fruit and vegetables if you yourself are not doing that. It is important, therefore, to live as a mentor and to help them through examples.
The same thing goes for physical activity. Ask them to take a walk with you, go to the gym with you, if you live together. When they come to visit, go out for some glorious bike rides. Show them that this is an integral piece of their lives.
Also, laugh right along with them about the stories of how our hormonal milestones can get to us. Show them that healthier living habits help them navigate those challenges and speed bumps, presented by the hormonal milestones.
MODERATOR: Doctor, we're almost out of time. Before we wrap up for today, do you have any final comments for us?
PEEKE: I want women out there to understand that the new philosophy for self-care is not only holistic and integrative, but it no longer cuts a woman up into little bites of "learn to eat well," exercise programs, and psychological issues. Instead, it is time now to pull it all together and to offer women a simple, straight forward, doable and most importantly, sustainable way of living throughout their wonderful feminine lives. Success equals sustainability.
I care more about where you are and how you are five years from now than I do five weeks or five months from now. If you are able to sustain this and refine it for a lifetime, then you have learned tools and techniques that are meaningful and valuable. That means I did my job well and that is the definition of happiness.
MODERATOR: Our thanks to Pamela Peeke, MD for joining us today. For more information, please read the book, Body for Life for Women: A Woman's Plan for Physical and Mental Transformation by Pamela Peeke.
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