I had a session with my online fitness coach this week. After being away for months, I had gained 17 pounds, returning to the highest weight I’ve ever been: my sympathetic pregnancy weight, i.e., high-stress weight.
It was time to get back on track. And 80+% of what he talked about was stress management.
Yes, we touched on the Eck Diet, sending daily accountability logs of meals and exercises, and the virtues of strength vs. cardio. And I didn’t feel particularly stressed out: I still felt like my usual doe-eyed, sympathetic self in the exam room.
But when I described what I was juggling — my medical duties combined with family health downturns — I had to admit that, yes, some days I felt like I’d dragged myself out of a piranha-filled river to be attacked by a pack of chihuahuas.
Hence, the focus on stress.
A pointer to the missing link
I’m doing everything right, exercising like crazy and eating clean food in modest amounts with zero carbs, why am I not losing any weight?
Or dropping your blood pressure, or lowering your cholesterol, or getting traction on your depression and anxiety? When you’re doing what you’re pretty sure are all the right things, why aren’t things getting better?
We talk a lot about prescription medications in healthcare, and the more modern practitioners address different “prescriptions” of nutrition and exercise. But coping with stress is the invisible variable that we often downplay, when it should be Priority Numero Uno.
I’m reminded of the mystery around the exercise physiology of Michael Phelps, the Olympic swimmer. At one time he was consuming more than 5,000 calories a day, and not gaining a lick of weight despite NONE of his workouts totaling anything close to 5,000 calories of energy burn. The math only added up after someone entered water temperature into the equation: the coldness of the water! Of course! He was burning calories like crazy just keeping his body warm.
Stress is like the coldness of the water. You’ll burn a mighty stack of energy grappling with it and wonder, why is nothing changing?
What you’re not seeing is, in some cases, slowly killing you.
It works like this
Stress causes the release of hormones like cortisol and insulin. These accelerate fat production, stimulate the liver production of serum cholesterol, increase water retention and thereby blood pressure, and push you towards diabetes. The hormones are such amazing catalysts of these undesirable processes that it’s virtually impossible to overcome them by conventional diet and exercise efforts.
It is possible — you can absolutely lose weight by radically changing your diet and exercising for hours each day (or spending a lot of time in a cold swimming pool). But the more radical the changes, the less likely you are to sustain them.
As if the direct changes to your physiology weren’t bad enough, stress has secondary effects that further mess you up, like stress eating and breaking a good habit streak (the “ah what the heck hello ice cream/alcohol/lasagna” effect at the end of a long week). Stress also robs you of solutions: it’s hard to plan fixes when all you want to do is lay on the sofa, close your eyes, and mouth breathe.
Cherry-picking coaches and students
From my time as a sports medicine doctor, but mostly from being a student athlete and having kids who played sports, I’ve seen 2 types of athletic coaches.
There are coaches whose mission is to get the winningest team and the winningest season. And other coaches whose goal is to inculcate a love of the game, and the value of teamwork and consistent hard work.
The former tend to cherry-pick their star players, make no bones about skimming the cream, and devote their energy to polishing these nuggets to a high shine. Less skilled/gifted players get handed off to assistants.
The “other coaches” work with all their athletes, and everyone gets time in the game.
Who is the better coach?
A teaching analogy: there are the average students, who put in a decent amount of work to understand the material, and there are the star pupils, the ones that teachers dream of.
With the star pupils, you only have to tell them something once, and they get it immediately. They already have study discipline, they think nothing of grinding out 5 hours of study every weeknight, and double that on weekends. They do outside reading without being told, and if they don’t know something, you can share it with them and they’ll run with it.
Who is the better student?
Let’s talk healthcare
Some patients suffer from a knowledge deficit. But once you share the fundamentals with them — eat this not that, exercise these ways this many times per week, etc. — they apply the lessons and turn their health around in weeks. They come to the exam room poised for change; as a doctor, you point them and off they go, like arrows shot from a bow.
Other patients just suffer.
They theoretically know what they’re supposed to be doing. It’s not news to them, talking low-carb, Zone 2 cardio, strength training, or epigenetics. Yet knowledge and physician exhortation haven’t been enough, and they are mystified at their lack of progress.
Who is the “better” patient?
We have all of us been both kinds of coaches, both kinds of students, and both kinds of patients at various points in our lives.
In the long game, there is no either/or answer.
If you’re primed and ready for a change because of your life experience, perhaps that came from hard work (yay?) or maybe lots of suffering and abuse (boo?). And if all it takes is a little education to send you on your way, wonderful. Makes my life easier as the physician, but it’s not about making your doctor’s life easier, or your coach’s or your teacher’s.
“Better” is whatever helps YOU make positive progress. Whether it’s a simple comment or a lifelong 12-step program.
Most of us spend considerable time as the other kind of patient. I count myself in this group. I know what I need to do to get from A to B, yet somehow I’m stuck at A, or I find myself drifting back to A. Whatever is going on, it’s not because of a knowledge deficit.
Unless it’s like the invisible stress factor, the cold water thing. Being so turned around that you can’t even see that you’re always facing the wrong direction.
Maybe it’s time for a vocabulary change
Perhaps you don’t feel particularly stressed. I’d argue that if you’re like me, you’re juggling plenty of stressors but have long since accepted this as your semi-chill baseline. Not Feeling Stressed means nothing if you’ve turned off your internal stress sensors.
But stuck? That’s easy to identify: regardless of whether you “feel” stressed or not, if you’re not making progress, objectively you are stuck.
If you’re chronically stuck in an undesirable state, you’re missing something. You’re not seeing some facet of the problem, or there’s a solution you haven’t hit upon yet.
Or maybe you understand the situation just fine but the block is emotional — you can’t do what needs doing, because you believe you can’t, that you don’t deserve it, or that you’re not supposed to.
Being stuck implies you are grinding gears. Standing on the brake pedal while flooring the accelerator. Kind of stressful, right?
Stuck = stressed, and stressed = stuck.
But aren’t we all?
This is a very Asian “You’re one generation out from civil war, suck it up, kids” mantra: we’re all struggling, life is hard, so quit making a big deal of it and kick it into high gear. It’s not just Asian, it’s admirable in many ways and makes for some tough cookies. But it has definitely effed up several generations.
Because when you browbeat children into adopting this philosophy, they grow up ignoring whole sections of what is going on inside. From a systems theory standpoint, this is highly no bueno — training a complex system capable of harming itself to ignore parts of its own function without correction.
Do not accept being stuck and stressed. It’s not a badge of toughness — a dog that can’t stop chasing its tail needs help, not applause — and it prevents you from fixing matters of mortal importance.
X marks the spot
If there are parts of your life where you feel stuck in a loop, Here be dragons… and gold.
Guaranteed, correcting behaviors here would unleash significant change. How much further along would you be, if instead of chasing your tail for 100 cycles, you applied 100 cycles of productive corrections?
In the health and wellness arena, we’re talking about things like finally making changes to drop your risk of DYING from heart attacks and cancer, successfully losing 50 pounds and keeping it off, or being 1/10th as tired and twice as productive. But getting unstuck applies to other problem areas: being unable to get ahead financially, being drawn to the same toxic personalities in partners, and having the same emotional arguments — or avoidance behaviors — with family.
You need to have tactics: lift like this, eat like that, meditate thusly, take these pills and see me in 6 months. Actionable instructions can be put into play immediately, and positive results come quickly. Strategy is harder because it depends on understanding what’s going on, so you can make your own instructions and modify them as the situation changes.
Unwinding the mystery of stress, of being stuck, is a matter of strategy, of looking below the surface and understanding why your regular tactics aren’t working.
There is deep work to be done, on how you developed the behaviors and values that guide your choices, and whether they need to be improved. It’s not necessarily easy, but the payoffs can be enormous.