Reboot Program
The trappings of modern life have a way of sneaking up on us. One day we’re in our late 20s or early 30s trying to hit the gym, eat right, and generally take care of ourselves. Snap your fingers and suddenly we’re 40, slightly overweight, exhausted, a bit broken and struggling to find the time or structure to get back to “the good ol’days.”
If this sounds like you, and you’re motivated to get the cart back on the rails then there is hope, but you need to face a truth. You can be fit, healthy, and generally content in your life with enough focus and effort, I feel confident most people can find a way. Unfortunately that 25 year-old that could crush two hour gym workouts, run a six minute mile and bench #300 lbs all while never being sore is dead, and they are likely never coming back. Every midlife crisis is to some degree fed by a delusion to get back to an early form of vitality, or at least a hallucination of what that once looked like. Best to drop it. This doesn’t mean that we can’t have good days, be fit and happy, but that will look different for everyone, which brings us to the first step.
Define the Problem
In order to define the problem, we have to have a way to see the issues. I have a simple approach I’m developing that borrows from the work of Aaron Antonovsky’s Salutogeneis model to hopefully assist with this.
Simply put, we are the cumulative output of several intermeshing systems. These systems push and pull on each other creating a continuum of ease or dis-ease. The sense of stability and coherence that we feel in relation to the world we live in and goals we want to achieve are determined by where we fall on this continuum, and the harmony that exists between these systems. It is worth taking some time to think about these individually and understand how one influences another.
There are six rudimentary systems, three are internal, and three are external. The three internal energy systems can be defined as musculoskeletal, metabolic, and mental. The musculoskeletal system encompasses not only classic ideas of strength, but also balance, mobility, posture and how you generally move through space. The metabolic system is the aggregate summary of all chemical processes of the body. From a fitness standpoint this would include things like endurance conditioning and Vo2 max, but it would also include body mass, nutrient consumption and GI health. The mental or emotional system is often more abstract, but at least in the margins we can label this as concepts of wellbeing or distress and anguish.
There are plenty of easy examples how these three systems can push on each other. The mind-body connection can be experienced by taking a few deep and calming breaths and feeling muscular tension melt away. If someone for example injuries their knee from poor body mechanics that may lead to less physical activity, which could lead to depression, which could lead to poor dietary choices. You can see the multitude of combinations in how these systems are interlinked. Most people have heard of the biopsychosocial model of health after all. What most people don’t do is dive into that model to try to find the root causes of their ailments and understand how these systems influence each other.
Next are the three external systems. I define these as community, currency and finances. Starting with community, this can be thought of as the people in our lives both in terms of family, but also our day-to-day interactions with anyone such as work colleagues, neighbors, online social networks, etc. Our community can be supportive to our sense of coherance with the world, or a hinderence.
Currency is not necessarily about money, but the way we give and take from the world and those around us. Currency as a medium of exchange can be many things including time, love, or labor. What are you giving to the world, and what are you taking in exchange? Are these balanced?
I hesitated adding the financial system, but it is undeniable that our wealth and overall financial health have huge leverage points on nearly every other system. Thinking about the financial system is not necessary about how much money is in your bank account, but also about how you make money, the sense of pride and purpose that you derive from that work as well as how you spend it or don’t spend it.
As an exercise get six pieces of paper, one for each system. You’re going to do something called a SWOT analysis of each system. Draw a four quadrant square, the left sided quadrants will be labeled Strengths and Weaknesses. The right side will be labeled Opportunities and Threats. The left sided sections are current facts while the right side is more future orientated. Go through for each system and write down the elements of the SWOT analysis for them. Here is an example of a metabolic SWOT.
- Strengths: Relatively healthy, no chronic diseases such as diabetes or need for medication. Fairly healthy body fat percentage.
- Weakness: Low energy most days, poor sleep, less than optimal nutrition
- Opportunities: With improvements possibly more energy, increased physical appearance, and overall increased longevity.
- Threats: Poor monitoring of physical and chemical health parameters such as cholesterol, colon cancer screening and blood pressure. Strong family history of diabetes.
The idea here is to do this in as much detail as possible, you’re really trying to take an inventory of your life. Afterwards give some time comparing the different SWOTs. Try to understand how there might be connections in one analysis that is actually the cause of another. On another piece of paper write out any insights that were developed from these connections. Save all of this and repeat it yearly.
Develop Systems
Now that you have an inventory and have defined some aspects of your life that you want to work on it’s time to develop some systems to get there. Notice how I’m not saying goals, in life I believe that having sustainable systems are more important than goals. Goals are either missed resulting in disappointment, or when achieved result in eventual slippage back to a previous set point. In life, we don’t rise to our goals, we fall to our systems.
The systems you put in place will be unique to everyone. They should as a basic concept address weaknesses and threats discovered in your SWOT analysis as well as being sustainable. It’s also important to not be too hard on yourself if you get it wrong. A lot of this is a shot in the dark, if you develop a system that is not sustainable or too difficult come back to it and recalibrate, have compassion for yourself in this process.
Resources
Scroll around on the internet enough and you’ll easily find “The Program” that for some cost probably claims to fix everything in your life. Unfortunately, these one-size fits all approaches hardly ever achieve the maximum of the advertised results, or may work for a while, but for various reasons are not sustainable. My goal here is to provide some high level resources and programming to help guide you in your journey to being a better you. Some of these will make sense for you, some won’t, you will need to chose your own adventure based on what you set down to work on. As a physician and general explorer of wellness I’m discovering new resources all the time, what I’m sharing our some of my current favorite tools.
Fitness
Getting back in shape is more about carving out sacred time in the day than it is any one program. Some people might pay for a gym membership or buy a fancy online program that forces them, often through financial guilt to carve out the time, but when you distill it down the most important thing is having a dedicated block of time that is protected and staying consistent to it. That is step one, it doesn’t matter if you’re just talking a brisk walk, or tossing around barbells, if you can’t make the time it can’t happen.
If you’re looking for a generalized program that dials into multiple modalities of strength, conditioning as well as being science based one of the best templates I’ve found is laid out in a podcast by Dr. Andrew Huberman which I summarized here. This template gives a full seven day approach that encompasses nearly every aspect of strength and conditioning. It is absolutely worth a listen, but the general concept is as follows.
Day one: long, slow endurance
Day two: Legs
Day three: Rest and active recovery
Day four: Chest, back, and neck conditioning
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Day five: Faster and medium time length cardiovascular conditioning
Day six: Short and fast interval training
Day seven: Arms and neck conditioning
The podcast is a wealth of information about how to execute on the above, but don’t be afraid to modify it based on your available resources or injury patterns. For example, I only use bands for resistance training as I’m on the road often. I also loathe running so I do a lot of body weight metabolic conditioning. I’ve found Ryan Fischer’s programming to be helpful to pick and chose from. His site is mostly subscription based now, but here are some samples of his bodyweight programming.
Some key points when starting any new fitness journey to keep in mind.
- Take it slow, expect to be sore, but don’t push through any injuries.
- It shouldn’t be terrible, if you dread the time you carved out for fitness, you’re doing it wrong. People say “make it fun” but I don’t really buy that either. It should be like brushing your teeth. You don’t really hate it, but you just do it every day without thinking too much about it. If you can have fun doing it great, but I think we get too caught up in the mentality that fitness should always be fun. What would your dentist say if you stopped brushing your teeth because you got bored and it was no longer fun?
Another program that I would recommend offers less variety, but thrives in simplicity. The book is called Simple and Sinister Kettlebell training by Pavel Tsatsouline. The general idea is to teach you perfect form in kettlebell swings and kettlebell getups along with some simple warmups, and that is all you need. When these two movements are performed correctly with perfect form and enough weight it’s hard to deny that it couldn’t rival any top-tier strength and conditioning program.
Regarding mobility and stretching I’ve really come to enjoy the paid subscription called Pliability previously known as ROM-WOD. I would describe this as guided long held yoga poses geared more towards crossfitters. As we learn more about tissue elasticity and stretching it’s becoming apparent that longer held postures incorporated with breath work are much higher yield. Doing there daily videos for 20 minutes before bed is a great practice.
Nutrition
Like fitness, diet can get complicated quickly, so I want to simplify this as much as possible. Before getting into specifics it’s worth taking a 30,000 ft. view of nutrition. What we are really talking about is three things. What goes in our mouth, how much of it goes in, and when it goes in. We can think about this like three levers on an X,Y,Z axis. You can pull on none or all of these levers at any given time.
Developing a diet plan is also very personal. A lot of people can count calories and carbs all day everyday without issue while meal prepping every Sunday afternoon. Others, myself included in this camp, would rather just pay to have balanced slop thrown in my mouth and not have to ever think about it. Whatever direction you chose what will always be relevant is somehow being mindful of the three levers.
For those who want to grip the wheel a bit tighter, don’t mind counting and meal prepping one of the best programs I’ve found is again part of Ryan Fischer’s work. This program is based on cycling carbs while being very calculated in macronutrient consumption. Although it takes work, it is easy to understand and can be adjusted based on individual goals.
If you just want to eat healthier and don’t want to think about it I recommend a trial to a meal-ready delivery service such as Factor. I’ve been personally using Factor for years, what I like about their meals is you get more calories for the dollar than most other meal services. I just think if I’m going to pay $12 for a meal it better be packed with nutrients and not a 150 calorie salad. I also found a hidden secret with Factor. If you’re on the road or traveling you can simply change your home address in the settings and the shipment can be re-directed all over the country. For a while I was living in three states and had one Factor subscription that would follow me around. They have a variety of dietary options such as vegan and keto and I’ve been fairly impressed with the freshness of their ingredients. There are other services out there now that offer a similar service, but this is just the one I’m familiar with.
Other Nutrition Pearls
- Drink a gallon of water a day, preferably practice the Ayurvedic principle of Ushapan, or “dawn water” and drink 32 oz of warm water immediately in the morning.
- Make sure you’re getting enough protein, especially if trying to lose weight. If you hate counting calories, maybe just consider counting protein.
- As a fellowship trained Integrative Medicine Physician I can tell you the wild world of supplements can get complicated fast. Keep it simple, a broad-spectrum micronutrient (multivitamin) and good probiotic will take care of 90% of everything.
- Introduce intermittent fasting. Start pulling on the ‘time’ lever. There are a variety of ways to ease into this. Take some time and learn about fasting. Here is a good intro.
Sleep
You can toss a stone at the internet and find any number of mindfulness resources from meditation to breathwork. Like fitness programs, they are all useful, and should be incorporated into your life. They are however highly personal and rarely are there one-size fits all programs. I’m not downplaying the importance of a mindfulness practice, but for the sake of offering high yield resources I think there are three pillars that should garnish most of the attention. We’ve already mentioned fitness and nutrition, the last foundational brick I would offer is sleep. I just feel if you’re well rested, well fed, and well exercised it will be much easier for other things to fall into place.
There are three resources I’ll offer for getting a better nights sleep. The first is a podcast, again by Andrew Huberman called his sleep toolkit. In this nearly two hour episode various evidence based approaches for optimizing sleep are discussed along with a variety of resources.
There are also three supplements I have been taking for about a year for sleep that have made a tremendous difference in my ability to fall asleep and stay asleep. These are also discussed on the podcast, but can be purchased here. I have found these indivdiually on Amazon for cheaper and the links are below.
Note that melatonin is not on this list. I’m a bit skeptical of the longterm use of melatonin and its possible hormonal disruption. However there is a school of thought that subscribes to its use due to our fairly ubiquitous exposure to blue-light in the evening. I would just offer that if you do choose to use nightly melatonin attempt to replace its physiologic dose which is around 300–600 micrograms (mcg) in an extended release form and not the massive milligram (mg) doses found over the counter.
Finally there is a book I recommend for sleep to keep on the nightstand called Hush by Dr. Rubin Naiman. Dr. Naiman is the director of the Arizona sleep and dream center. I’ve had the pleasure of listening to him speak several times and the way he approaches sleep can only be described as poetic. This book is a treasure trove of cues and thoughts about sleep to help cognitively reprogram our circuits around sleeping. It is thoughtful and hypnotic at the same time.
