The Sticky Note Diet

Chapter 1: The World’s Shortest Book  

I have been threatening to write the world’s shortest book for many years, so here it is: The Sticky Note Diet page This is one simple page that says:

“Don’t eat wheat, corn, rice, barley, rye, white potatoes, cane sugar (or “don’t eat grain, cane or white potatoes” is the other version that I write all the time).

This is it, you can quit reading. Write this down on a sticky note (or 2 or 3). Put one in your wallet. Put one in your kitchen. Give one to everyone you like or love. Then follow its advice.

The rest of this chapter – if you have not taken the short version and quit – is some overview about The Sticky Note Diet as a concept.

Many different questions about nutrition have reappeared in my mind over the years of practicing medicine. I want to share some of these issues with you to give some background to how this Sticky Note Diet was born.

Unfortunately, Labels are misleading. They contribute little to meet with the need for a simple but effective eating guideline. I have been embarrassingly confused by analysis of the nutrition content of foods on labels. My favorite illustration is to point out to patients that the exam table paper under their legs would be labelled 100% carbs but would certainly not be digestible

I kept thinking “this doesn’t make any sense” and “if this doesn’t make sense to me, who does it help?”. I now highly recommend keeping all focus on the ingredients and, more or less, skipping the nutritional information. When foods are highly processed, you will notice that there are a lot of ingredients. This situation should be a red flag that this preparation may need to be replaced with a less processed food.

The percentages of nutrients on the packaging of food is not intentionally misleading but it does not tell you what you NEED to know. It reports sugars that exist in milk , for instance, on par with those found in jelly beans. Such comparisons can lead you to a state of extreme frustration. The paper on the table at your healthcare provider’s office is 100% carbohydrates but completely indigestible. The nutritional information cannot tell you that. You need to know what to eat in order to look and feel terrific. Start reading labels of foods with which you are familiar then advance to some more complex labelling to see what I mean.

To give credit where credit is due, some of the information, such as sodium content, can be helpful to folks on salt-restricted diets or who have other specific dietary limitations. I still advocate reading the label on everything and anything, just take it for what it is and recognize its limitations.

• A calorie is not a calorie. Everyone used to be told that he or she would lose weight by simply eating fewer calories. Whoops, it is NOT that simple. I have seen people eat as little as a cup of tea with sugar and a few saltines each day without losing weight.   The combined effect of calories and exercise has to be taken into effect to make this a more fairly stated scenario. That malnourished, yet obese, group I mentioned above was also completely sedentary.   Chosing food that doesn’t immediately break down into the simplest sugars is really important as is the role of exercise in how you use your food fuel.

You also need to know which foods break down to the right kind of fuels for you you. A lot of folks have lost weight on low fat diets but the low-glycemic (low simple sugar) diets are best for reducing waist fat and preserving muscle mass. Basically, the simple sugars don’t make muscles! Simple sugars are immediately snarfed up and made into fat. Imagine a five pound bag of sugar as five pounds of yellow globby fat on your abdomen.

Trying to do both extremely low fat and low glycemic/low sugar is frankly too difficult. The idea is too keep eating right as simple and effective as possible. The Sticky Note Diet provides a simple list of avoidance to keep more of the body fuel as ketones, which helps improve diabetes, high cholesterol, athletic training, metabolic syndrome, polycystic ovary disease, attention deficit disorder, attention deficit hyperactivity disorder, autism, arthritis and a number of other problems (including middle aged waistline spread).

My sister is also a physician and is the one who helped me pinpoint the limitation of measuring calories.   A food calorie, by definition, is the amount of heat needed to increase the temperature of a kilogram of water by one degree celsius. Scientist use a device called a calorimeter to measure calories in food by the first removing all the water from the food and then burning it. (A drawing of a calorimeter)

Think about this: how does this burning process take into account all the complexities of our digestive enzymes? The answer is that it doesn’t. The very method of defining a calorie assumes all matter is equally digestible and that is just not the case. The paper on my exam table would dehydrate and burn quite nicely but is completely indigestible to humans. The goats living next door to me would be able to feast on this material but we don’t have their digestive enzymes to break it down. Not all of us have the exact same set of digestive enzymes and we can have variations in all of our fuel-making pathways linked to our genetics. No single test of “real” caloric content exists that truly reflects what happens from ingestion to final metabolism, so we need to take that into account when “counting calories”. A calorie is just an approximation of food as a fuel.

The Sticky Note Diet was put together to help health-conscious people make better choices with information that the nutritional information on a package is not able to provide. In some cases, measuring how much you eat can be helpful to adjust portion sizes but I think you now understand why I mostly shy away from focusing on calorie counting as a useful health tool.

Two rules of weight loss: A diet is what you eat every day is rule one. This is not a “temporary” commitment. It is a new way to revise your old routine and end up leaner and healthier. More importantly, rule number two is : No beating yourself up! I feel so sorry for the folks who come into my office almost hating themselves for not getting results and too “down” to keep trying.

My mother is responsible for my love of horses, although my family could not afford one. As a result, I ended up riding horses that other people did not always want to ride. My mother also taught me the importance of immediately getting back on the horse in the event of an unplanned visit to the ground (“get back on the horse that threw you”). Likewise, as you work to change your habits, treat the experience as a gradual improvement process. Examine the times that you eat the wrong things and do the detective work to figure out why in a self-loving way.

I also learned that constantly correcting a horse without praising it makes it quit trying to cooperate, so GIVE YOURSELF A BREAK and don’t give up on yourself. Motivation comes from within. I can give you all kinds of good advice but you have to have the commitment to and love of yourself to do it.

Why BMI. Although you may not be making changes for weight loss reasons, I recommend the Body Mass Index as a way to measure whether or not you are at a healthy weight. It is based on good evidence and gives a range of calculations from 18.5 to 25 that is associated with improved health and reduced death rate. Use a body mass calculatory (on-line) to make it easier. It is a formula that turns your body parameters into a cube, so it has its limitations, just like the poor calorie. It makes a “Bell Curve” where most people fit under the recommended guidelines and a few percent are at their correct weight either lower or higher than the cutoffs. I cannot emphasize the following enough: Attaining and maintaining a healthy weight is not a stand-alone goal, it is part of a whole health picture. I believe that the BMI, in general, gives a good guideline to help you set the right goals.

 

Chapter 2: Sticky Note Basics

This system was developed for corporate wellness. I have been a physician for nearly 27 years. Working in the emergency room and intensive care units was exciting- too exciting. My heart belongs to wellness and sports medicine for all ages and stages. I have worked with quite a number of large and small companies over the years (IBM, Nortel, Bell Atlantic, Progress Energy, Acroprint, etc.). I have had the privilege of working around some amazing folks who are committed to wellness.  Between these corporations and my own medical practice, I have also had the advantage of working with large numbers of people and been able to get a pretty good idea of what works and what doesn’t work.

Out of these experiences, figuring out what to eat and how to manage weight has been one of the biggest challenges. Don’t you get frustrated by being told to do different things with your eatinge every time you turn around? Diets to cut fat, diets to cut carbs, diets to eat grapefruit, diets to eat manufactured/synthetic food and a host of other programs have assaulted our senses over the years. I looked across a variety of participants and their goals. Folks trying to lose weight, athletes in training, diabetes, those trying to lose their middle age spread, arthritis victims trying to feel better, people trying to get fitter and leaner, food allergy suffers trying to get relief, and those with high cholesterol were some of the categories.

Here is my disclaimer. Most of the thinks I will discuss in this book are my opinion and personal observations. Lots of folks may disagree but I am going to share things that seem to work for myself and my patients. I don’t pretend that I am presenting material for an elite medical journal here. I want you to take a look and see if this stuff makes good sense for you. I really believe in good sense. I also intensely subscribe to the belief that you should never do what seems wrong or illogical for you.

I kept coming up with the same core list of things to examine when folks had trouble with getting to their optimal weights. I knew I had to make dietary recommendations simple. Next I had to look at the medical roadblocks (besides food choices) that can keep people from getting to weight loss goals. To my surprise, I was able to get the magic seven general categories, which can explain failure. You will find these to be

1. medications,
2. eating (diet),
3. exercise,
4. endocrine (your hormones and metabolism),
5. behavioral,
6. sleep,
7. gastrointestinal (your digestive tract).

I also found that going through these categories helped the people who weren’t trying to lose weight but wanted to feel healthier.

• series of meetings. As though you don’t have enough to do, I am scheduling you for a series of important meetings. Take the time to go through the results of these meetings regularly to ensure that you are attaining your optimal health picture.
• While examining your “big picture” be mindful that the majority of factors standing between you and your optimal health are genetic in nature. The future looks like genes and the chemistry they create. Don’t take your genes personally, they were handed to you the day you were born. Becoming aware of you genetic makeup gives you a bit of a “crystal ball” to know what might be in store for you (healthwise) in the future AND gives you a chance to help yourself and family members be better prepared. Pay a lot of attention to your family history. I don’t think that a drop of blood in the computer is ever going to identify genes to a useful point for most problems because we are too good at mutating are genes and having hundreds or thousands of variations of a single gene. When you understand the role of genes and chemistry in your life, you will be less likely to spend unproductive time beating yourself up for things that you really cannot control.
• When you are planning wellness and prevention strategies, I encourage the use of the proven guidelines set forth by the United States Preventive Services Task Force. These guidelines help you take your genetic makeup and match it to age-appropriate screenings. A lot of snake oil salespeople are out there in vans peddling costly tests to people who don’t need them. Having a test done incorrectly can lead to additional testing that can be costly and/or dangerous.

 

Chapter 3: Meet Your Metabolism

When people can’t get in shape or lose weight, they often blame the mysterious black box known as their metabolism. While genetic variations can account for how fat is stored in the body and how much fuel is needed for a given task, there are a few areas worth considering to make certain that no weight loss “road blocks” come from this meeting group.

By far, the commonest metabolic problems are related to genes for diabetes. What does sugar and insulin have to do with having a healthy physique? Inappropriate insulin release can cause problems. Insulin tells your body what to do with the fuel glucose. Too little insulin and glucose floats around in the blood, ending up in places that are harmful. A healthy balance can keep glucose from becoming sticky fatty substances that block arteries (triglycerides and cholesterol), causing imbalances in joint fluids (not helpful for arthritis), depositing as fat in the liver and fat in the abdomen. How your body handles glucose with insulin and insulin receptors is genetic.

Often, simple sugar causes the body to release too much insulin. This lowers your blood glucose too much and harms the brain. The response is sudden craving for more sugar to relieve the low blood sugar and the vicious cycle starts. More sugar, more insulin over-release, glucose going to all the wrong places.

In type I diabetes, the pancreas does not work and insulin is absent. These individuals are rarely overweight. They still have lots of problems with sugar going to the wrong places. They have to take insulin in just the right amount at just the right time to match what they eat.

In type II diabetes, the most common type, the body has insulin but the receptors ignore it. Early on the folks often over-release insulin in response to simple sugars. Late in the disease, the insulin supply can “poop out” and extra insulin must be given. The number of individuals with this gene is rapidly growing. Whether you get one copy (from one parent) or two copies of the gene (from both parents) can determine the severity of the diabetes type II.

Women with polycystic ovaries (which can include symptoms like multiple cysts forming on the ovaries, acne, irregular ovulation and central weight gain) and everyone with metabolic syndrome (abdominal obesity and lipid disorder) are more likely than not to have some diabetes II-like issues.

There are lots of variations of diabetes besides this grossly oversimplified model but we won’t delve into those. The point is that a lot of folks have the gene and don’t know it. Almost everyone benefits from eating, sleeping and exercising as though they are diabetic.

Steroid disorders are pretty rare. In Cushing’s disease, the adrenal gland have a tumor that overproduces various steroids. Special lab testing can identify the overproduction. Certain supplements can mimic the effect of steroids and need to be carefully evaluated before being added to your routine. Chronic fatigue results in the adrenal gland making a variety of “emergency response” chemicals, including steroids. This why people who are chronically fatigued often look like they have Cushing’s disorder.

The thyroid gland is often a scapegoat for failure to lose weight but it is very rarely the problem. A complete panel of thyroid tests can be run to rule out any role for this gland in apparent metabolic stalemate. The presence or absence of antibodies to the thyroid gland does not always keep it from producing a perfectly good amount of thyroid hormone. Some individuals who need thyroid supplements feel better on certain types of replacement but this is not predictable. Sleep disorder can perfectly mimic all of the symptoms of low thyroid (hypothyroidism).

When the thyroid makes too much thyroid (hyperthyroidism), most people lose weight but I have seen the opposite effect, as well. Too much thyroid can make you just as sick as too little, but the symptoms are different.

Sexual health is underrated in importance. The human sexual response has various components that can point to serious medical conditions. For example, a normal libido is important regardless of sexual activity and loss of libido is most often linked to serious sleep disorder. Sexual health is not a matter of preference, it is

a part of the total health picture. Erectile dysfunction in men is equivalent to having had a heart attack! Pay attention to this part of life and get checked out if something is wrong. Don’t be bashful and don’t miss out on this important part of your wellbeing. Testosterone deficiency is increasingly common after the age of 40. The likelihood increases with the presence of the gene for diabetes type II (the commonest one), obesity (men make estrogen in their fat) and with the presence of obstructive sleep apnea (one in five people will have this in their lifetime).   Testosterone can affect muscle mass and body fat distribution. The need to treat asymptomatic testosterone deficiency is not proven.

Menopause occurs with the cessation of ovarian function. With it can come a storm of undesirable effects – changes in lipid profile (for the worse), hot flashes, which can cause a sleep disorder, tendency to lose bone mass, drying and thinning of the skin, vagina, lining of the gut, eyes, nose and mouth. The disruption of sleep pattern in menopause is the likely culprit for weight gain. Lack of efficient sleep slows the metabolism, hypes up the appetite and causes cravings for the glycemic foods that go straight to fat storage.

Treating the symptoms of menopause is important to quality of life. Hormone replacement therapy is not always the answer but take time to look for answers. All approved hormone replacement therapies care similar risks but not all women need the same balance of hormones to alleviate their symptoms. Compared to men, women have lower rates of death until after menopause, then women have an increase in disease and death that matches that of men. The benefits of various treatments must be weighed against the costs/risks.

Your metabolism was designed for more primative times. It is designed to slow down when food is not readily available and to be a bit less frugal if food is plentiful. The end result is that you want to eat multiple small portions throughout the day. Starving yourself is counterproductive. Similarly, when you are under a lot of stress, your metabolism will try to overstore energy (fat). You want your body to feel like times are happy (low stress) and bountiful (lots of little meals) to avoid abdominal fat storage.

Those folks who are waiting all day to eat, then have a large meal are tricking their bodies into storing the food as fat. Waiting until late in the day causes the body to crave the undesirable glycemic food choices, which increase body fat, not muscle. The same amount of food, eaten in small increments throughout the day, will result in less fat storage and a leaner body.

Similarly, starving yourself with low food intake for days, then eating a lot more will result in increased fat storage and weight gain. This is why very low intake diets are not a good idea for anyone and do not, in fact, “jumpstart” weight loss. Instead, this approach reduces your metabolism and your ability to lose weight.

 

Chapter 4: Meet Your Medications.

Everyone is genetically engineered to handle medications in a certain way. As with allergies, the scientific evidence that is the most important is “cause and effect”. If you are taking any prescription or supplement that is giving you side effects, take it up with your healthcare provider. Careful looks at the side effect profile can help substantiate what you have observed but you do not need to have a documented side effect if you note it with a medication/supplement and eliminate it when that substance is discontinued.

I confess to be lazy about taking supplements and also believe we are better off to get your nutrients in our foods.

A lot of over-the-counter products are marketed for weight loss. The absence of proof in controlled clinical studies is pretty important. Chromium has been touted for weight loss but has never “panned out”. Magnesium helps prevent migraines, muscle cramps and is a cofactor in a most of your body’s metabolic reactions. The group of medications called tricyclic antidepressants have often been associated with weight gain. Nonetheless, some of these improve sleep and and have helped certain patients go on to successfully lose weight.

Look to see if you are taking any medications that can cause drops in your blood sugar. A certain class of diabetes medications called sulfonylureas is an example. When your blood sugar drops too fast, you will be hungry and will crave the foods that become sugar quickly for your body. These are exactly the foods that put weight on your midsection.

Medications that make you drowsy, whether they are prescription or not, can cause you to crave caffeine and sugar to stay away. These should be avoided during the day and are best when taken at night as you are going to sleep. Likewise, medications that diminish your sleep can make you feel hungrier than you are and will drive you to the caffeine and sugar foods, as well.

Certain birth control medications have been associated with weight gain but I have not seen that much of an effect for any of them. Because of our genetic uniqueness, some users may exerience more of a weight gain effect than others.

Medications that irritate you stomach should be examined for effect on eating habit. The entire group of steroidal and nonsteroidal anti-inflammatory drugs are an example. The group can encompass various oral steroids, ibuprofen, aspirin, naprosyn and similar drugs. The genetic make-up of the user determines the tendency to have digestive irritation up to and including ulcers. An irritated gastrointestinal tract can hinder proper diet and weight maintenance.

Everything you take, prescription or not, needs to be regarded with the same scrutiny. Does it meet the criteria of risk/benefit analysis? Does it help more than it hurts. Pay attention to clinical studies of supplements. Looks like calcium and iron as pills didn’t end up being a good idea in post-menopausal women (they had more hardening of the arteries). Turns out that both vitamin C and vitamin E offered no general benefit and may have been associated with increased cardiovascular events (heart attack, angina, stroke).   On the other hand, humble fish oil performed pretty well in recognized clinical studies for lowering triglycerides and for improving depression and anxiety.  It also happens to be great for you skin, too. Most people probably need extra vitamin D because most of us are avoiding sun with coverings or sunblock to avoid skin cancer. Those with higher levels of skin pigment generally don’t absorb vitamin d. You muscles and bones need vitamin d. A lot of milk is vitamin d fortified, but not all of us can drink it. In general, I think that advice to get your vitamins from your diet is excellent.

A lot of claims for “studies” are made but all studies are not created equal. A study that is published in a peer-reviewed journal (where reviewers have appropriate expertise on that subject have scrutinized the study design and conclusions) is usually a good bet. A study with fewer than 100 subjects is usually not a good bet (it probably doesn’t represent enough subjects to avoid false results).

 

Chapter 5: Meet Your Amygdala…hey it’s part of your brain.

A very simplified view of this part of the brain puts it as a primitive core that contains the sleep center, the primitive emotion center and the small fiber nerve tract. Huh, what? The small fiber nerve tract was discovered in 2000 or 2001. It runs from the brain down to the dorsal column of the spine (you will have to look for a map of that body part). This small fiber nerve tract gets hyperactive with stress and sleep deprivation. It is the cause of the infamous “crick in the neck”, stress back pain, fibromyalgia and a variety of other ailments. It makes “noninflammatory pain”, the kind that aspirin, ibuprofen and naprosyn don’t help. When sleep and stress are out of balance, the pain fibers go off and make us all MISERABLE. I suspect it is some kind of warning system. The effects of disordered sleep and stress are potentially lethal, so the pain might get our attention to do something about it all.

• Wow. I didn’t know this in medical school but most of my time there should have been spent studying sleep. As far as anyone knows, humans are the only animal that deliberately sleeps less than it should. If sleep isn’t right, nothing else in the body works correctly. Not sleeping correctly damages brain function and predisposes sufferers to dementia later in life, along with death and disability from accidents. The muscle pain from fibromyalgia can be disabling – burning stabbing pain that opiates and anti-inflammatories can’t help. Depression and anxiety are difficult to treat if sleep is not corrected. Poor sleep causes dysfunction to the lining of the arteries, stroke and heart attack link up with this.   Disordered sleep makes the platelets (blood components responsible for clotting) not work correctly, which can cause problems from bruising to stroke and heart attack. Disordered sleep causes the adrenal gland to overproduce adrenalin and steroids, causing weight gain, increased blood pressure (I can’t tell you how many times out-of-control blood pressure didn’t respond until the sleep was corrected), striae of the skin, muscle to fat transition, glucose intolerance up to and including diabetes, dry skin, fat pads on the neck and above the collar bones. Poor sleep cause acceleration of inflammatory processes like arthritis and cancer, dysfunction of T-lymphocytes which ae body cells that fight viruses and cancer.   Every symptom associated with low thyroid is mimicked by sleep deprivation. Name me a body part and I can tell that poor sleep damages it directly or indirectly. The Epworth Sleep Scale is available online and helps identify people likely to have one or more type of sleep problem. If you are able to find a genetic sleep disorder, share it with your family members. When children are recognized and treated for sleep disorder early, it improves their brain development and learning abilities.
• The hormone that tells the brain to stop eating, leptin, is reduced by sleep deprivation. The hormone that tells the brain to eat more, ghrelin, is increased by sleep deprivation. Without good sleep, you are literally driven by your brain to overeat. To make matters worse, low leptin levels slow down your metabolism and the body burns less energy and stores more fat.
• I have broken sleep down into three basic “pieces” that have to be correct. Sleep initiation (how fast you fall asleep) should be 15 minutes or less. No joke. Sleep duration should be eight hours, even in adults. Longer for children. You should be refreshed upon awakening. If you can’t say “sure fine” to all three of these areas, start doing the detective work to figure out what is going awry.
• Not everyone needs a sleep study to determine what is wrong with their sleep. Those on shiftwork are pretty well guaranteed to have difficulty changing their sleep times back and forth. This is unsurpisingly called “Shiftwork Sleep Disorder”. It is recognized as a cause of accidents and illness in industry, police force, firefighters, the military and many other sectors. The frequency of schedule changes influences the severity of the symptoms. Medications and strategies have been increasingly introduced to help minimize the risk.
• One in five people will suffer with obstructive sleep apnea (OSA) over a lifetime. Accelerated high blood pressure that doesn’t seem to respond to medications can be a tip off to it. Diabetics and men with hypogonadism (low testosterone) have higher incidence of it. It is genetic and often gets worse with weight gain. This is unfortunate because sleep apnea is a cause of obesity in and of itself. A sleep study should be done to confirm it and get the treatment started. Anyone who is a loud snorer, wakes himself/herself up snoring or gasping for air or has an observed period of not breathing during sleep should be studied. A lot of OSA patients drop their oxygen levels very low at night and can suffer cardiac events up to and including sudden cardiac death.
• Estimates say that close to 10% of the population may have the restless leg syndrome, also known as periodic limb movement disorder. This prevents efficient. Sleep. I have noticed that people who do not get drowsy with benadryl or similar drugs usually have restless leg. This is genetic, too. You only need one copy of the gene from mom or dad. A lot of these folks have trouble falling asleep and thrash around in their sleep. OSA patients also tend to thrash around, so a sleep study may be needed to differentiate these problems. Plenty of people have both of these genes. I have noticed a lot of people with Scottish/Irish ancestry have a version of this gene.   I go so far as to tell people diagnosed with RLS “kiss you you’re Irish” and most of them laugh and tell me about the pertinent part of the family tree that probably gave them the gene.
• Narcolepsy, in its most severe form is not that common but milder variations of this gene can present as sleep walking, sleep talking, night terrors and bedwetting. Cataplexy is a symptom of the most severe form, where narcoleptics suddenly lose consciousness. This disease is being increasingly recognized and more treatments are being developed all the time. Being on the wrong medications can really aggravate the symptoms of narcolepsy spectrum sleep disorder.
• Low delta wave sleep/light sleep. This is often a characteristic of people with ADD/ADHD and bipolar depression. It is often seen in people with higher IQ’s. These folks tend to be able to fall asleep but wake up way too easily because they don’t get into the deeper phases of sleep.   Likewise, this is genetic.
• Menopause is more often than not associated with sleep disorder from hot flashes and with exacerbating genetic sleep disorder. The damage to sleep could account for the rise in morbidity and mortality once women hit menopause.
• A word or two about fibromyalgia is due here. Increasing, this problem is being recognized as a sequella of disordered sleep. Some studies have shown that fibromyalgia can be induced in just about anyone by making his/her sleep abnormal. If you have fibromyalgia, you better figure out what is wrong with your sleep and do whatever it takes to fix it. Only then do you have a fighting chance to re-regulate all of the body systems that become dysregulated with fibromyalgia. If you know much about fibromyalgia, the consequences of poor sleep described above pretty much describe the things that happen to fibromyalgia suffers.
• stress kills. News flash. You can have a heart attack even if you coronary arteries are pristine and clean. Hope that scares you. I can tell you that I have been on the brink of the stress-induced heart attack myself. It is a bad place to find yourself.

The burgeoning (bludgeoning) flow of information is our best friend and our worst enemy.

I can remember in 1990 when I was a corporate medical director for Bell Atlantic. The guys brought in a machine to my office and said “Dr Davis, this is your PC”. I said “Great. What does PC stand for”. It was all DOS back then. Next there was windows and on and on…. I also remember the good folks at Bell Atlantic introducing me to the then-new product of call waiting. They asked me what I thought. I told them I thought it was incredibly rude. I mean the very idea of interrupting your conversation with someone to bring in a new, unexpected conversation and making someone else wait while you put another call ahead of theirs. Well, you all know the history of this.

The point is that the information age has been here for more than a couple of decades and bombards our senses constantly. We must set limits with information, the way we must set limits with relationships (see the stuff about Princess/Prince training). Enough is enough and it is okay to say so.

I hear a lot of people confess that they put their stress into their mouths. The effect of stress is so serious and pervasive that the overeating isn’t the half of it. We all have to draw that line in the sand about how much we can take. Creating then managing expectations is a primary life goal. A lot of therapists say that they would be completely unemployed if everyone had realistic expectations in life.

Figure out what balances you. Pets, travel, book clubs, art work, etc. Find out how to check yourself when you are not in balance. Self-examination, friends, family, co-workers, therapists, may all provide needed sources of measurement. The further out of balance you get, the harder getting back to center becomes. Balance keeps your amygdala happy.

Love what you do for a job/vocation/avocation. Don’t let yourself feel trapped. The inability to get out of a no-win situation maximizes the stress experience and we need to minimize it. The concept that you are stuck with a crummy job or a crummy situation is a killer. Don’t fall for it. Studies over the years have shown that the experience of stress is the highest in situations that give a person low or no control over his/her environment. Similarly, being asked to do a task without the resources to competently perform it creates the highest level of stress. Stress is a killer.

Plan for your retirement aside from government or company plans. Stable finances through your life will greatly reduce your stress. Don’t stretch yourself to cover the needs of others without looking out for your own future first.

Two observations from the most miserable patients (and friends) I have seen over the years: 1.   Let your children become adults and make their own mistakes. If you can’t afford college or graduate school, let them find a way to achieve their goals. You may be surprised. I think something you pay for yourself actually means more anyway.   2. Try to find a good safe environment for your elderly relatives without becoming the overtaxed, even angry caregiver. Your best role is the loving family member, that is more important.

Be your own hero. Don’t say “no” to yourself and don’t quit trying. All kinds of stressful setbacks are inevitable but reach for the big heart inside you and believe that you will figure out a pathway to your goals.

Likewise, when things have gone wrong, avoid endless self-critism or you will never try again. Self-correction is one thing but it needs to have a point and an endpoint. Forgiveness is a necessary part of a health operating system. Staying positive creates a better chemistry for your brain from the inside out.

 

Chapter 6: Meet Your Pantry.

The easier you can make it, the better. So start by just reading ingredients and not worrying too much about the mind-bending nutritional information. If you can go through your freezer, refrigerator and pantry, you are likely to be surprised at how much of the “no” list is sneaked into food. The Sticky Note Diet helps minimize processed foods. The general rule of “the fewer ingredients the better” is a pretty good one.

Whatever you do, stop reading the “nutritional information” on food and stick to reading the actual ingredients. You will drive yourself crazy otherwise. The Sticky Note Diet is about making life simpler, not more stressful.

I don’t “ban” artificial/alternative sweeteners because they are dietary “saints” compared to cane and corn sweeteners.

Once you look at what is in your food choices, you have to figure out a new routine. I suggest that in place of grain-based food, a vegetable or fruit improves the meal. My beloved macaroni and cheese is now an even tastier dish with cut green beans in place of the macaroni.

As a good friend of mine found out, having someone come and sort through your food is a big help. I went to San Francisco to visit my buddy Dave Cook. He had put on some weight around his mid-section, which was really bugging him.   Dave is a former gymnast and has always been a fit person. He just wasn’t feeling well and wasn’t feeling like himself.   He gave me permission to sort through his food and spices. I took him shopping and made some sample meal plans for him to get started and he took it from there. A couple of weeks later, he called to tell me how much better he felt and that he was getting back to running. He noticed a big improvement in his endurance, which is pretty important if you are going to try running those massive hills of San Fran.

A number of patients came back after trying the Sticky Note system and told me about improvements in their children’s ADD and autism. While this is not a controlled clinical study, those results make a lot of sense because the brain works much better with the fuel of a low-glycemic diet than one laden with simple sugars. I also suspect that the reduction in processed foods helped eliminate dyes and preservatives from their tables.

Life isn’t made up of “always” and “never” but the closer you stick to avoiding grains, sugar and white potatoes, the easier it becomes. You develop new habits and ways to deal with various situations. I used to dread going to an italian restaurant. I quickly found out all my favorite sauces could be served on a bed of spinach or vegetables instead of pasta. I even got one restaurant in Raleigh, NC – Manchesters – to sautee their calamari instead of breading and frying it. I got so many people to sample it that the dish is now on their permanent menu.

Meetings are often a bit challenging with limited lunch choices. I typically eat two sandwich “insides” and toss the bread – easy enough. Pizza is a bit messy but I have been known to peel the cheese and mushrooms with a bit of tomato sauce clinging. Holidays are actually the easiest because there is so much food variety to pick and chose. I actually had one patient who did her Sticky Note Diet on a cruise and can back even leaner than when she left plus she had a great time “Eat the lobster, skip the cracker” became her motto. A lot of people get nervous when I am coming over to eat. I try to let them know that most food is in the A-Okay category and not to fret.

I have noticed that a lot of women do not eat enough protein, so sometimes I suggest adding protein powder to daily meals. I also find that men tend to miss out of essential fatty acids, so I remind them to have olive oil and nuts.

I have to say that I will always be a lifelong fan of butter over margarine. Just don’t overdo it. You can hardly use enough olive oil.

Don’t fall for labelling. It can say “gluten free”, “fat free”, “heart healthy” and be just full of stuff you don’t want to be eating. Be smart enough to read the ingredients and ignore the label. I like the rule of avoiding anything that has more than a few ingredients. “Sugar free” is worth paying some attention to on a label but still read the ingredients.

When I was a teenager, I was blessed with the opportunity to spend some summers out in Wyoming. Betty and Bob Matthews were very healthy eaters and always said to eat a wide variety of things. I have come to believe this is really great advise. It keeps meals interested and also keeps nutrients better balanced. This is a lifelong system, not just something temporary, so it needs to be good and gourmet.

Have fun with flavors. If you happen to be salt-sensitive, look into using lime juice, lemon juice and celery salt. Use your nose and learn what the different spices taste like, then find an excuse to use them.

Don’t eat standing up. Don’t eat in the car. Take the time to savor you good food. It deserves your full attention.   Use small plates and small utensils to eat. Take little bites. Smell your food as though it were a rose or a lovely glass of wine before you eat it. Make each meal or snack an event of enjoyment. Be a foodie and have a foodie moment every time you eat.

True confessions: I leave dark chocolate on my permissible list. It does have a little sugar in it but not enough to really mess up the big picture.

Learn to cook if you don’t already know how. Use a microwave, use a crockpot, try something new. Have a good time with your kitchen. Get fresh new spices. Look up recipes on the internet and practice adapting them to be healthier for you and your family. Have a “competition” for the best new Sticky Note Recipe. It is fun to see teenagers tackle this one. I enjoy handing out a cookie recipe that can be made with lots of variations to get people started thinking about changing their cooking habits AND enjoying some great food at the same time.

Since you asked, here is the Cara’s Cookies recipe:

• ½ cup of soy flour, buckwheat flour or chickpea flour
• ½ teaspoon baking powder
• 1-2 teaspoons cinnamon
• Mix the dry ingredients
• Add 2 tablespoons vanilla, rum , frangelica or other flavoring liquer
• 2 eggs
• 1 stick of butter melted

The filler ingredients can vary according to your taste and mood: miniature dark chocolate chips, hazel nuts, almonds, pecans, walnuts, raisins, coconut (unsweetened), dried cranberries, dried pineapple, chopped dates (I almost always use these for the sweetness), dried apples, dried mangoes, dried cherries, etc.

I add filler until the mix is solid then bake spoonfuls on a cooking stone at 350 degrees until they begin to brown. I tend to carry these little cookie balls with me as a fill –in for missed meals or to keep me from eating junk.

 

Chapter 7: Meet Your Inner Athlete.

In my mind, “Life Athlete” is the ultimate prize title for each of us. Developing and maintaining the ability to be active every day is the pathway to this prize. Along with feeling wonderful when you are fit, being able to stay in touch with your “inner otter” (your playful self) is just great. We are creatures who were meant to be constantly active and to play, not just live a droning, grueling industrial existence. Droning, grueling exercise isn’t something you will continue to do, so you better pick something you just love to do for activity. Pick YOUR sport.

Just like love, you get what you give. Be active every single day. Don’t settle for exercise two-four times a week. Make a weekly plan of what will work best with each day. Just like love, the “C” word come up.

The theme of “c”ommitment via setting priorities repeats itself throughout your various meetings. I have a friend who realized he could not work all the time and have friends, fitness, romance and things he valued. He took a long look inside himself and decided which things made him happier and committed to making a change in his habits. Because he did what was right for himself, his friends, girlfriend, family, and work associates ended up benefitting.

This was no simple matter, he had to work hard to change lifelong patterns ingrained into him by his family culture. The example he had grown up with was one where the man of the house worked long hours to provide for the family. Doing less than that was dishonorable to his heritage. All else was sacrificed to the work hours. Throughout the years, his lucky employers benefitted wildly from this culture. When it came time to try to change this behavior, he had a big fight on his hands – with himself.

The changes he made may not have looked big to anyone around him at work, in his family or with his friends but they were huge to him. He isn’t really less productive or effective in his life but he sure is happier being the owner of his own calendar now.

The best part of the story is that he “got the girl” but it is no “fairy tale” Change is a whole lot more complex than anyone gives credence. Taking control of your plate and your schedule will require looking at how you were programmed growing up, what culture and belief systems come into play as you decide what the best things for you.

As you exercise, do learn to monitor your heart rate and blood pressure. If you have a parent with hypertension, you have at least a 50% chance of getting it yourself, so start monitoring early. You will avoid damage to the heart, brain and kidneys particularly by getting a head start on high blood pressure. Your home monitoring is infinitely more helpful in finding out what is going on than a measurement taken after you come mad-dashing into the medical office. When you take your blood pressure, remember to breathe in and out. My riding instructor noticed that I help my breath when I was concentrating on something my horse was doing. I took that observation and found that a lot of us do that under certain circumstances and that holding your breath can make you blood pressure measure on the high side. Make sure your blood pressure cuff is the right size for you arm because that can make measurements inaccurate, too.

Back pain affects most people sometime in their lifetime. It disrupts sleep, which leads to weight gain and lots of other problems throughout the body. Chronic pain can cause depression. It can come from injuries and arthritis associated with aging. Those with extra-aggressive arthritis can be candidates for new treatment modalities. Some families have a gene/genes for very soft cartilage that tends to result in lots of herniated discs and problems in large joints, like knees.

If you have back pain before you are 21 in the absence of identifiable trauma, something “structural” is going on (probably those darned genes at work again). At any rate, get it worked up and keep looking until the answer is found. Note that sometimes back problems can generate pain felt remotely. This is called referred pain and can make for a bit of detective work to trace the source of a pain. I have a patient come to mind. She had a vague abdominal pain since she was a young girl. She even had exploratory abdominal surgery to find the source of the pain. I examined her, took a simple back xray and found a congenital back problem. My crackerjack chiropractor, Dr. Gary Gruber worked with her and she is now able to use fitness to control her symptoms quite nicely.

 

Core strength is the support for your back. None of use can do without a good strong set of core muscles. Some of us have abdominal hernias and similar issues that make keeping the abs strong a lot harder. Don’t give up. I have an umbilical hernia since birth. It is not large but I was doing incline crunches and felt a bad “tear”. After that I have adapted to other types of exercises (pilates and yoga-based ones) to compensate.

 

I really hate the guilt trip a lot of athletes are put on. When they start having joint problems, like arthritis or cartilage problems of other kinds, they are told they never should have played sports and they would have been find. This (excluding specific injuries) is almost entirely untrue.   Most of this would have happened if they sat on the sofa watching reality shows and soap operas for their entire lives. In fact, they probably would be worse off if they weren’t fit. I can think of two amazing women I know who had incredible scoliosis but were such awesome athletes that they never required surgery until they were in their 50’s. If you saw their xrays, you would think they wouldn’t be able to sit up but they were out there in the gym, on the track, on the tennis courts and in the pool.

 

Try to spend time outside. You will probably find that you get sick less. On the other hand don’t leave your windows open, let the air come through the filters, so you don’t have a bunch of trapped allergens in the home.

 

 

chapter 8: Meet Your Digestive System

If all is not well in your digestive tract, weight loss won’t happen. Stomach ulcers, esophageal (swallowing) problems, heartburn, gastro-esophageal reflux, diarrhea, constipation. You gut is very complex and almost has its own version of a brain. Many discoveries about the complex system of hormones and electrochemical signaling within the gut lie ahead.

Constipation is ofter another case of “genes” and “chemistry”. Familial constipation can get worse with medications and simply as people get older. Some sufferers improved with fish oil and magnesium supplements, others need more complicated treatments. With age women, more so than men, can have relative drying of the mucosal lining of the gut, which can make constipation a lot worse. I have noticed this as one possible side effect of menopause. Increasing fluid intake is sometimes helpful with this too.

Eating frequent small meals is a good policy. Quantity of food can affect your stomach receptors. These receptors respond to how distended the wall of the stomach becomes during meals. Stretching the stomach repeatedly can limit your ability to feel full. I like the rule of not eating more volume than the size of your fist with each meal. Some folks do well with drinking water prior to eating to help avoid overeating. Over-stretching the stomach with fluids is not a good idea, either. You want to keep your stomach used to (and happy with) smaller volumes.

• food allergies Your gut is your body’s largest allergic organ. If you eat something you have an allergy to, you can get a wide variety of symptoms, including bloating, heartburn, diarrhea , constipation, and pain. These are pretty much the most common reason for reflux/heartburn. Food allergies can cause colitis (bowel inflammation), damage to the esophagus and gastritis (stomach irritation). These can happen at any age. I had one family tell me that their old father/grandfather did not develop clear symptoms of food allergies until the age of 83.
• The commonest allergy groups are grass (wheat, corn, rice, barley, rye, cane sugar, oats) and ragweed (cross-reactions occur with cucumbers, kiwi, bananas, chamomile and melons). Allergy testing with blood and skin tests are not as scientifically strong as “exposure” and “response”. In other words, your own observations about what foods give you trouble trumps these test results. Sometimes food allergy testing can be helpful to help identify unsuspected culprits. One patient I had got rid of all of her food allergens but couldn’t quite get rid of every last symptom. Allergy testing revealed that she was allergic to apples and she ate them every day. The wonderful Raleigh, NC -based allergist, Dr. Karen Dunn, helped me really understand that some of the environmental allergies could be clues to food allergies.
• If you don’t like a certain food, odds that you are allergic to it increase dramatically. As with so many other areas, trust your body intuition. It is a marvelous guide to keep you out of trouble.
• My suggesting that you should not settle for simply treating digestive tract symptoms. If possible, get to the bottom of things and figure out what is really going on. This can take time and patience. Certain inflammatory bowel diseased can take years to finally pin down the diagnosis. Having frequent diarrhea is not “okay” and don’t quit until you figure the cause out. Sometimes we doctors label something as “idiopathic”. First of all notice that it kind of resembles the word “idiot”. Idiopathic means “we don’t know”. Why can’t we just say “we don’t know but we need to keep looking”?
• The gallbladder can slowly stop functioning for a variety of reasons and should be kept in consideration when persistent discomfort after eating occurs. Not all “bad” gallbladders have gallstones, so several tests may be needed to determine if the gallbladder is the source of symptoms.
• The incidence of liver disease due to fatty livers is rising at an alarming rate. The liver is needed for processing toxins, drugs, hormones and degraded blood cells. We die without a functioning liver. The Sticky Note Diet has been used for individuals with fatty liver disease to help them lose weight and many of them have been able to improve their liver functioning.
• Bariatric surgery. Color me a big fan of the results for these procedures when done in a properly selected population. My hope is that you get your Sticky Note system going before you end up with the degree of dysregulation that can only be resolved with the help of bariatrics. These techniques can save lives and reverse a lot of disease processes.

 

Chapter 9: Meet Your Master

• “Believe in something or you will fall for anything” is something my father often said. Trust the body instincts God gave you. If you get advice that doesn’t “sound right”, question and investigate. Drive your own health “bus”. A lot of studies say that giving people sound information then letting them choose the right treatments for themselves results in the optimal outcomes. Pray every day. Do what works for you but do it regularly. Even the power of prayer has been clinically studies and consistently comes back associated with positive outcomes. This always kind of tickles me. It is right up there with some study that cracking knuckles is annoying but doesn’t really harm anyone. We knew that, right.
• Meditation is better than medication. I love to say that every chance I get. Pray alone, pray with someone. I love to pray while I am riding my horse. It just feels so glorious to be out there on this beautiful animal with a lovely day (or evening).
• “There are but three things that last…but the greatest of these is love” and don’t forget it for a New York minute (even if you come from there like John). Men are often terrible about making time for friends. Get out your planners and make appointments for the ones you care about in your life. Everyone, tell others how you feel about them. Do this early and often. In some cases, use appropriate diplomacy. Find ways to be expressive with this wonderful positive emotion.   Go around smiling at people you don’t even know. The effect is pretty amazing. Bet your blood pressure goes down, too. Hug your dog. Cuddle your cat. Learn to be a good recipient of love. My wonderful friend, Betty Smith taught me about “the gift of give”, which made me realize that people who gave me gifts were getting tremendous joy out of the act of giving.
• We are meant to be happy. If you are not happy most of the time, do something about it.   Life is short and precious. You are precious, too, and darned, you deserve to be happy. Look at your genetics. Mental health is very genetic. When folks have problems with mental health, they often are shamed into ignoring it. Don’t fall into that trap. Generations before us did not have the benefit of good treatment options with therapy and medications that we enjoy now. Take advantage of this.
• You should know what your eating habits, your sleeping habits, you social habits and all your habits are. We all have them. Life is truly a balance, not black or white but in the shades of gray. Choices and priorities have to first reflect and then achieve this balance. My cousin’s darling daughter (yes, Cassie, that is you) is a smart, fun athlete. She is devoting lots of time to her quad, rollerblade and ice skating racing. She is just awesome at it but she misses her friends. She is smart enough to sometimes miss her friends BUT sometimes she misses parts of her rigorous training to keep up as a scholar and a young woman with good life relations. She pays attention to balancing her life just as much as she pays attention to balancing on her blades.
• Pay attention to you cravings.   Craving glycemic foods most often indicates non-restorative sleep. Fatigued people want sugar and caffeine to “keep going”. Soy and peanut cravings are often seen in women around menopause because of the phytoestrogens, which help compensate for their own falling estrogen levels. Cherries are a natural sleep remedy and tired people may crave these. Nuts give magnesium to depleted eaters. Anemic people may crave ice (or clay).
• Drugs and alcohol don’t do any of us any favors. Try to keep alcohol to a minimum. If you drink and drive, get a breath alcohol meter and test yourself. Monitor yourself for routine alcohol overuse. Make rules like never drinking alcohol when you are alone and never having more than two drinks on any day. Get help to kick out the tobacco, marijuana, cocaine, etc. These don’t belong in your body but chemical dependency is genetic. If you have it in your family, you are more likely to suffer with it yourself. Don’t think you can deal with this by yourself because you cannot and should not.

Depression and anxiety that is not simply secondary to a life disaster is most likely genetic. Finding out about your family members diagnosis is very helpful, as is finding out exactly what helps get them “levelled out”. Not treating depression and anxiety early on makes it very hard to treat later. Anyone who has this prior to the age of 21 is most likely experiencing a genetic-based problem.

I have noticed that a lot of people with higher IQ’s (over about 120) tend to have a gene complex that includes minor depression episodes (dysthymia), anxiety, low delta wave sleep (where you don’t sleep deeply), and variations of Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder. Two copies of that gene seem to result in the more severe diagnosis of bipolar disorder. This is not documented in any clinical studies that I know of, I just have a very large practice with lots of family members to let me compare histories. The sooner recognized, the better for all of these things. They are increasingly treatable as many advances have been made with therapy and medications.

If you have ADD/ADHD, the less glycemic (sugar-producing) your diet is, the better. The brain works better with ketotic fuel and it gets that when the body is fed less sugar. Vigorous exercise also really helps your brain chemistry. Organizing your self externally, rather than trying to remember appointments/schedules frees up a smart, fast, creative mind to accomplish more. Do something about the “light sleep” you are prone to. The same brain needs serious rest to do its best.

• Obsessive eating and eating disorders are serious medical illnesses. The incidence of these is probably highly underestimated despite efforts to “decriminalize” them. Overeaters Anonymous is a find organization that strives to help sufferers get identified and into recovery. Anorexia and bulimia strike hard in the younger population but are also present in middle aged people too. These disorders are very difficult to treat but varies therapies are out there to help. Predilections for these are often genetic. Shame is the enemy in getting sufferers identified and on the way to good health. In general, mental health is an opportunity for wellness. Dollars spent on mental health help reduce the cost of healthcare in all areas. Do you hear that Washington?
• prince and princess training.   When you do what is right for yourself – independent of everyone else in your existence- you do what is right for everyone. I have to remind myself of this every day and I have daily opportunity to say it to others. This simple concept could put a lot of therapists out of business. The trick is putting it into practice. I spoke to a close friend of mine on the west coast. His lovely mother is suffering with the late stages of dementia. He knows she needs to go into hospice but having someone else “coach” him to do the thing he knew was right and best helped. When you help someone else out with princess/prince training, you help yourself stay committed to it, as well. Putting yourself first is being centered, not being self-centered. Children, partners/spouses, business associates, assorted relatives, pets, church members, pets, customers and all sorts of living beings in your world can pull you off center. This doesn’t help them any more than it helps you.

As a corollary to Princess/Prince training, don’t put up with negativity in your life up to and including abuse. Don’t get in the complacent state of “putting up” with mental or physical abuse, telling yourself “you can take it” or even worse, “you don’t have any other place to go”. Take time to learn the definition and characteristics of abuse. It can sneak into your life easier than you think. It takes an enormous toll on you. The truth is that a lot of people are begging for someone to place solid limits on their behavior. Saying “yes” to yourself, which sometimes means saying “no” to others is very likely to be beneficial to them, too.

• When you go through seriously stressful life events, put time in with a therapist of some type. The economy is often lousy, so invest in yourself. It can be a licensed clinical social worker, a minister or priest, a PhD psychologist, a life coach or a variety of other trained, qualified individuals. The surprise is that they are not there to”analyze what is wrong with you”. They are there to help make you life better and help you make great plans to have an amazing time on this earth.
• Death is an inevitable part of living, yet it wreaks havoc on those facing it and on those left behind. No one gets to skip experiencing the stages of grief except those who simply never progress through it. You need support to deal with this. I actually have to tell some patients that they simply cannot go to one more funeral until they process the ones they have already attended. Get the help to find out how to get through the stages and even learn to celebrate life through the experience of death. Then you have done the best you can do.
• Divorce or equivalent break ups pretty much guarantee that some therapy is a good idea. This is a terrific time to learn more about yourself and how you make your life choices. You may be able to detect some patterns that may be keeping you f rom being a totally healthy and happy person.
• Job changes are a sneaky entrance into a grief process. Yes, changing a job can be like having a death in your family. Don’t make the mistake of underestimating the impact to your being that this event can create.
• Financial disaster up to and including bankruptcy can crush your very soul. Finding a way to feel whole again may require external resources. Find them. It is only money and you really can’t take it with you. Until you can feel that from your core as you come out of a big financial mess, you cannot be healthy.
• Family dynamics can take a person apart or keep a person together. A family is a business. Invest in your family and how it works to make it a long-lasting successful business. Get the “organizational consultant”, i.e., your therapist, in the picture early to keep things running smoothly. Don’t wait until there is a big crash.
• Exercise your brain. Using all the parts of the brain you can access helps keep it working better and longer for you. Read, do math challenges, do crossword puzzles, play and instrument, sing, draw or paint, write/eat/draw with your non dominant hand. Do these things regularly and you will have the ability to have backup pathways, should injury or disease strike your brain.

 

Chapter 10: Meet Your Lifestyle

You have now completed most of your meetings. Hopefully you can now see that The Sticky Note Diet is not just about losing weight. The truth is that focusing on weight loss is not the right approach. Having a good life, feeling well, doing the right things in your life are what matters. “There are but three things that last” “The greatest of these is love”. Love your life.

Recap: The most important three meetings are the pantry, the inner athlete and the amygdala (sleep). Be active every day, stick to the Sticky Note Diet eating system, get at least 8 hours of good quality sleep and you should have a normal weight, feel great and live longer. Regularly go throughout the key areas relating to keeping a health body mass index.

Manage risk. Keep away from negative people in your life. Examine risky choices you may be making. Make certain the cost of potential failure is worth the potential gain with your life choices. Clean up your act to protect yourself physically, mentally and spiritually.

Live someplace you like. You need a healthy environment – smoke-free, mold free (it really does make you sick), acceptable noise levels, good neighbors, etc. If you don’t get along with the climate, move. It may be a cost at the time but it’s your life and you need to enjoy it.