I saw Mrs. C. last week. She’s a long-standing patient in her 60s who has proactively approached her complicated health issues which include:

Mrs. C experienced a period of depression after her husband left her. During that time, she didn’t focus on her health. Since then, she’s been well disciplined about exercising, eating nutritious food, and getting her blood pressure and blood sugar under control.

To help regulate her blood sugar, we used medication. Through trial and error, we moved from a prescription that had a significant side effect to one that appropriately managed Mrs. C.’s condition.

Should Your Employer Health Plan Dictate Your Health?

The medication regimen that has been effective for her was going to be disrupted, and this could affect her ability to control her risk factors.

Mrs. C’s employer recently started using a chronic disease management clinic to monitor the use of expensive prescriptions. However, the employer also changed their formulary, and the medication that she has positively responded to was no longer covered. Understandably, Mrs. C was distraught. The medication regimen that has been effective for her was going to be disrupted, and this could affect her ability to control her risk factors.

In addition, Mrs. C’s blood sugar has been creeping up. She admits that she hasn’t been eating well. It’s possible that even with her prescription, she would continue to have elevated blood sugars. It’s also possible that her diabetes has progressed to where she has become partially insulin dependent. In this case, we may have to use insulin to control her blood sugars. However, we would prefer not to for several reasons:

  1. Insulin can cause weight gain and more than likely, Mrs. C has too much insulin in her system because of her insulin resistance. Given her stage of diabetes, once we place her on insulin, it’s unlikely we’ll ever be able to take her back off of it.
  2. She probably would not only need a once-a-day insulin pen but also likely need mealtime insulin as well. The cost of insulin pens is significant. Monthly it can range 400-$600, and if you have two different types you’re using, then you could be looking at nearly $1,000 a month.
  3. The effective medication she has been taking is nearly $300 a month. If she is forced to use insulin, we’ll be increasing her total medication costs, plus placing her on medication that may negatively impact her ability to continue to maintain her weight and follow the nutrition program that has worked for her.

We agreed that the best course of action was 1) keep her on her current medical regimen, and 2) resume a nutritious diet. If this approach is not useful, then we can reevaluate her regimen and make changes.  

healthy green salad in white bowl with shaved cheese and beets

Who Should Tell You What Medication Is Best For You?

Unfortunately, it appears that her employer-based health plan is going to be inflexible. Remember I mentioned a medication that caused a detrimental side effect? They would like her to switch to that same drug. When she explained that she had a side effect that required a treatment intervention, they asked for supporting medical documents.

It’s frustrating that the manager of the health plan doesn’t trust my patient and me enough to believe that this side effect occurred. In actuality, the way we managed her side effect saved her employer health plan a significant amount of money in the cost of visits.

Remember I mentioned a medication that caused a detrimental side effect? They would like her to switch to that same drug.

When I suggested to Mrs. C. that based on complicating factors, perhaps the chronic disease management clinic should help manage her diabetes for her, she indicated they wanted me to handle it. This is a frustrating dilemma. We have a clinic trying to control access to medications on behalf of the provider that’s unwilling to manage the conditions of the patient. In fact, they are making it difficult to provide the patient with the best care possible by creating boundaries for me as her physician.

healthy senior attractive woman portrait

Health Care Should Be Team Effort

Sometimes, those managing the health care dollars, step into the way of those entrusted to provide the health care. I understand the need to scrutinize the use of expensive medications, but our first priority is the patient. It’s an all too common example of the difficulties your primary care physician faces when trying to provide you with the best possible care.

We all should insist on a more integrated and transparent system: one where the payers, meaning the individuals and businesses who pay all the cost, have more influence on their individual treatment plans.

At Health Shepherds, we understand the importance of integrated healthcare. If you have questions about a more personalized approach to your wellbeing, contact us. You also can like us on Facebook and follow us on Instagram.

I just saw a patient this past week, and it made me think about the concept of sending our brain the right message for weight loss that I think is really important for you to grasp. The book, Authentic Health, describes this in a little more detail in the chapter on what it takes to keep a body healthy. I would encourage you to read that, and really think about what I communicate there, because it is the truth.

A Case Study

The gentleman I saw was middle aged, and he’s a little overweight, and he doesn’t feel as good as he’d like to. Again, it’s a really common scenario I’ve come across. He was in for a general checkup and we both agreed that losing a little weight would help him feel better. I asked him what plan he thought he may consider for this, and he said, “Well, I’m joining a gym.”

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photo by Victor Freitas

Now I get this a lot. People like to join a gym. Gyms love this because they get a lot of memberships and oftentimes people don’t end up following through. If a gym is the best place for you to pursue exercise, then go for it. I’m all for that. I’m not here to discuss the ins and outs of the gym industry. My main issue is a consistency of movement for you.

My point is this: his answer to losing weight was to go to the gym.

I want to make it clear that I like the idea of him getting exercise. I have an entire chapter about the importance of physical activity and movement in my book. Strength training is a great message for the body. It strengthens:

  • Bones
  • Muscles
  • Upregulates hormones
  • Improves metabolism
  • Lowers insulin resistance

It really is a great treatment for feeling good. I also think that regular aerobic or interval training, and mobility exercises are all really good for the body. Those are powerful messages that produce responses in your body that give you back physical and mental health. You feel good when you use your body. I’m a big fan of that.

Primary Weight Loss Tool

But that is not the primary way to lose weight. When we’re talking about losing weight, we’re talking about a change in our body composition. We’re talking about reducing the amount of fat stored on our body. If your amount of fat stored is actually at your genetic baseline, your basic genetic profile for your body composition, then losing that fat is going to be very challenging. It’s going to take ongoing maintenance. Unless it is a very specific goal for you to get as lean as you possibly can, I don’t recommend that for people who are at their healthy genetic weight.

In this case, this gentleman is 30 lbs heavier than he ought to be, and we both know it, and his laboratory data shows it. I do agree with his plan to lose weight. I just didn’t agree with his primary mechanism of doing so, which is to go to the gym. I agree with going to the gym, but that’s not going to produce weight loss for him. Yes, he will burn calories, and yes, that’s good. Of course, if you burn more calories than you take in in a given day for a period of time, your body will shed body weight.

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photo by Anna Pelzer

However, we stress in our teaching how your body weight and body composition is regulated hormonally, and this is determined by a set point in a region of your brain. Ultimately, the primary messengers about this body fat are hormones. Hormones are messengers that respond to stimuli.

  • How you eat
  • How you move
  • How stressed you are
  • The levels of nutrients in your system

These things evoke a hormonal response. It’s all about what message you send your body so that your internal messages—meaning your hormones, and in your brain, your neurotransmitters—will produce the response you’re looking for. In this case, this gentleman wants to get leaner.

I had to point him back to his approach to nutrition. If he wants to lean out, it’ll come through how he approaches nutrition. The movement is great, but it’s a tiny part of the overall equation.

Nutrition is the primary message for weight loss.

Of course, that’s not what he wanted to do because that’s more challenging for him, as he himself stated. He really enjoys food, he enjoys his current pattern of eating, and he doesn’t really want to change that. It’s uncomfortable. Whereas going to the gym is an actual long-standing, positive habit for him. He falls out of it occasionally, but when he returns to it, he feels good, and it’s very familiar to him. It’s something that’s easy for him to do. He has the circuitry in his brain grooved for going to the gym on a consistent basis for a certain amount of time each year. There’s not much resistance to it, so it’s easy for him. It’s his default mindset.

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photo by LUM3N

But changing his eating is a much harder thing. He does not have consistent circuitry in his brain that is grooved to help him achieve that. In the past, he has typically not had success. He could perhaps do a 30-day program, feel a little better, but then he reverts back to his normal eating habits. There are many reasons for this, and we discuss them in our various documents.

Ultimately, the challenge for him is to permanently alter his approach to food if he wants to lean out. I was able to give him that news and keep it positive, and tell him how slow he can go. He doesn’t need to lose 30 lbs in three months like he’d like to. He can lose this 30 lbs over the next year, and it won’t be that hard to do, and he will improve his health and how he feels. But it’s going to involve not just a temporary change in his nutrition, but a consistent change.

Your approach to eating is the primary driver of how your body regulates its stored energy: namely your fat.

What Is Your Approach to Eating?

If you’re trying to get strong, or build muscle, do strength training. But if you’re trying to lose weight, you need to change your eating behaviors. We have a lot of materials with different ways of accomplishing that, which can help you build a strategic mindset to increase your chances of success. In this case, this gentleman agreed the easiest thing for him was to not think about it, so he agreed to an intermittent fasting protocol that I developed for him. I suspect by following that program, we’re going to see him losing that 30 lbs over about 6 months.

If you want to get stronger, strength train. If you want to lose weight, change your nutrition. Send the right message to your brain, and you’ll get the right response in return.


If you need help with an individualized program, please contact our office, or come to our Facebook page and see how others are doing, or read some of our other materials. The main issue is, you are getting back the version of yourself that you are messaging to your brain. If you need to change that, you need to get the messages right.

Steven’s health case is very different from those of Beth, Joe, and Melissa.

Steven had opened a Pilates studio in my town and was a health nut. He was fanatical about what he ate and how he exercised and how his body felt and looked. He had lots of tattoos and piercings. He was a very passionate man.

Steven had a couple of chronic conditions that were beyond his control, including asthma that would flare up from time to time and for which he required treatment. Other than that, he was in pretty good health—but he would occasionally experience symptoms including headaches, palpitations, and nervousness, and he would become afraid that he was about to have a dangerous asthma attack or even a heart attack. His stress levels accumulated with this mindset. Steven sometimes came to my office for help. We’d run tests to check his heart and lungs, and then we’d reassure him that he was okay. This pattern went on for several years. And once he got his reassurance,  he was back out there teaching Pilates and running and doing his usual thing.

External Uncontrollable Events Affect Our Stress and Health

During this time, Steven also experienced some difficult and stressful circumstances in his personal life. His son, whom he loved dearly, suddenly moved across the country to be with a woman he’d met on the Internet, effectively removing himself from Steven’s life. Steven had an on-again, off-again relationship with his spouse. He had a strong sense of abandonment and was deeply affected when those he cared for seemed to reject him.

Then his business ran into financial trouble during the recession, and his number of visits to my office increased. I began to ponder what the real issue was for Steven. I started to ask him about his feelings of stress and anxiety. He acknowledged that he had a lot of fear. It was clear that those conditions were affecting his health.

Creating a Healthy Mindset By Rebuilding The Foundation

We began to dig into his foundational belief system about himself and about life and death. As it turned out, he had a lot of feelings of insecurity left over from his childhood. He had grown up in a faith system that was dogmatic and punitive, and he continued to believe that his ultimate destiny would be in a bad place and that he could never be forgiven for the things he’d done.

Though my role was not to be Steven’s counselor, I did recommend some books that I thought might open him up to the ideas of compassion and forgiveness. Steven then went out and met with a faith leader from the denomination in which he grew up, but he chose a person who was compassionate and committed to the teachings of unconditional love, forgiveness, and hope. Years later, when Steven came into my office for a check-up, he had a new tattoo. This one was very subtle. It was symbolic of the fact that he was loved, he said, and he began to cry as he told me about it. He said he felt completely forgiven for his past mistakes and that he had begun to feel truly alive and present for the first time in his life.

When Fear Is Diminished, Purpose and Peace Are Found

The most astonishing thing about Steven’s story is that all the things he feared then actually came to pass. His son died of a drug overdose. His wife left him permanently. When he came in to see me after those things had happened, he was grieving and depressed.
“Do you need medicine for anxiety?” I asked him.
He shook his head. “No,” he said. “I don’t.”
The old Steven surely would have been wrecked by these events, but this new Steven was resilient. He said that he didn’t feel abandoned; even as his worst fears came true, he was able to remember that he was
loved. “I’m not afraid,” he said.

But that’s not the end of the story. A while after that, Steven came in to see me with severe chest pain. He’d just had shoulder surgery, but the pain didn’t seem to be the result of that. So I ordered some tests. It turned out that the bones of his spine, his scapula, and his ribs were riddled with tumors. He was treated for the cancer, and for a while he went into remission. I saw him periodically over those years as he tried to fight off the disease. And even through this horrific period, his outlook remained positive.

“I lived all those years healthy but afraid,” he told me. “Which means that, really, I was unhealthy. Now, here I am. I’ve lost the people closest to me. I’m dying of this incurable disease. And yet every day, I’m alive and I’m well—and I’m not afraid.”

Steven had gotten one more tattoo. Its essential meaning was that perfect love casts out fear. He no longer had panic attacks or palpitations; he had left all that behind. When the cancer finally took him, he went without fear.

Melissa is the office manager at a busy doctor’s office. She is short in stature and has been severely obese for years. Her work is sedentary and very stressful, so she doesn’t get much exercise. She’s gone through a number of significant family stressors over the past several years that adversely influenced her health. Melissa has multiple sclerosis (MS) and has been treated for it with various medications.

Constantly Sick Is No Way to Live Life

When I first started working with Melissa, she was frequently sick, often coming in for sinus infections and other maladies. She was generally tired, her body hurt, and she could not lose weight. Though she had always been heavy, she said she was athletic as a child and exercised, and her current physical health was nothing like it should have been, based on her own history.

Despite her chronic disease and other challenges, she continued to work hard and to engage in life in a meaningful way. She had purpose, but she lacked the physical health to engage with her purpose in the way she wanted to. She was committed to working on her health until she got better.

Off The Couch, With Willpower

The last thing you would have predicted for Melissa was that she would take up running as a way of addressing her issues. She was significantly overweight, with poor posture from her sedentary work, and on medications for a serious chronic autoimmune disorder—hardly an obvious candidate for running. But she decided to enroll in a “couch to 5K” program as a way to exercise. She followed the step-by-step process: first walking, then jogging, until at last she completed her 5K. At that point, she felt so good that she began to use Weight Watchers to track her nutrition. She also drew on some of the resources my office gave her to help her choose foods wisely.

Today: No Infections, Improved Energy, A Sense of Purpose

When I saw Melissa recently, I learned that she’s now in a running club and she’s planning for races of longer distances.

  • She’s no longer on her medication for reflux, and we had to stop her blood pressure medication because her blood pressure has decreased so markedly.
  • We haven’t seen her for an infection in months.
  • Her pain is far less than it was, her energy has improved, she’s sleeping better, and her mental clarity is great.

She feels alive. She also feels determined to continue to improve her health, and even potentially to reduce the impact that MS has on her body and her daily life. Melissa has lost fifty pounds through exercise and diet. Her BMI still suggests that she’s still significantly obese—but we’re not really worried about that. We’re focused on the fact that she feels good, she’s healthier, she has good conditioning, and she’s eating healthy foods. She just needs to keep doing what she’s doing.

Joe was a middle-aged mechanic with about forty pounds of extra weight around his belly when he first visited my office. Joe said he had chronic low-back pain and felt tired a lot of the time, although he’s tough and not one to complain about his ailments.

He was drinking six beers every night to relax, but he’d never had any problems arise from his drinking; he tried to be very responsible and had no criminal issues. He also used tobacco.

Joe said he didn’t eat breakfast or much in the way of lunch. At dinner, though, he ate a whole lot of food, and generally not very good food. He was open about that.

He said he felt angry about the state of the economy and the elections and various laws that he felt invaded his privacy. He had high blood pressure that was not well controlled, high triglycerides, pre-diabetes, and chronic reflux, for which he had to take powerful acid suppressors regularly. He was also on a pain medication that didn’t help him a whole lot. Overall, Joe didn’t feel good at all.

The Pain of Managing Pain Medication

One of his previous doctors had prescribed him hydrocodone for pain. When he’d switched doctors, the new doctor refused to continue the prescription. Joe doesn’t trust doctors. “I don’t want more hydrocodone anyway,” Joe had said when the doctor refused him the prescription, “because it wasn’t working. I just want my pain to go away.” Joe can’t even take basic ibuprofen, because it gives him stomach ulcers.

When Joe came into my office, one of the first things we looked at was the role of his diet in his physical discomfort, and the fact that his reflux medication—which allowed him to continue eating unhealthy foods—was potentially causing painful side effects. We also talked about how the six beers each night were keeping him from getting
restorative sleep. I told him that, if he could cut back even to three beers each night, he would probably sleep a bit better and lose some weight.

What Joe really wanted was to ease his back pain. We explained that the forty pounds around his belly—which he was carrying around all day in his physical job as a mechanic—were the primary cause of his back pain. After taking X-rays, we concluded that there was nothing about his condition that wasn’t reversible, because he was mainly
suffering from muscle strain.

After his initial appointments, Joe started to believe that his diet and drinking, as well as his lack of sleep and body habits, might be the source of his problem. He started to believe he actually could feel better, and he started to want that for himself.

Still, he was slow and deliberate in making changes to his life and habits.

In the first year, Joe slowly reduced his beer consumption from six to three a night, though he often drank more on the weekends. He started trying the exercises we gave him to stretch out his hamstrings and hips and to strengthen his core. He also started to improve his eating habits. Instead of eating only dinner, he began eating two meals a day, and he changed some of his choices to source his foods a bit better. Joe even brought his wife into our office—because she’s the one who does the grocery shopping—so we could tell her how to shop for him. Since Joe is a meat-and-potatoes guy, we showed him how to eat in that way while still getting the right kinds of nutrients.

Joe started to sleep a little better. His mood improved. He started exercising more.

12 Months Later…

One year after he began making these changes, he was still on blood pressure medication and a prescription for his reflux, and he was still using muscle relaxers for his back pain. He was still frustrated and angry about the state of the world.

Two years later…

Two years out, Joe rarely drinks beer anymore. He’s realized that it actually doesn’t make him feel any better and that it was just a habit. He’s lost twenty of the forty pounds he needs to lose. His back pain is a lot better. Every morning, he does a fifteen-minute workout with his wife that’s designed to stretch their bodies and improve their core strength so they can both be healthier.

Joe is now eating in a much healthier way, and he says that his energy has improved. He’s cut his reflux medication in half. He’s no longer pre-diabetic and he has normal triglycerides. We still treat his blood pressure, though, and he hasn’t quit tobacco yet, though he hopes to one day.

Looking ahead to the future

Next year, we’re hoping that Joe can lose ten more pounds, quit tobacco, and come off his reflux medication altogether. But in the meantime, he reports that he feels a whole lot better. In many ways, Joe is a different person from who he’d been when I first met him.

When Beth first came into my office, she described her ailments as pain in her muscles, joints, and back, and well as daily headaches and frequent migraines.

She also slept poorly, suffered from low-level depression, and felt chronic fatigue. She was on a constellation of medications to reduce pain and improve sleep because she had previously been diagnosed with fibromyalgia, migraines, tension headaches, insomnia, and moderate persistent depression. The medications helped her some, but not a lot.

  • Beth works in an office at a computer and is mostly sedentary.
  • She enjoys her work.
  • She also has a supportive family with whom she enjoys spending time, though there are various stressors associated with her family that occasionally trouble her.

When I first met with Beth, we reviewed her medications and concluded that although the prescriptions had helped her at first, they seemed no longer to be working. We reviewed some of the new options on the market, but for various reasons, including undesirable side effects, we decided the newer pharmaceutical options were not a good fit for her.

We started talking about her habits. Her diet consisted of a lot of processed foods, poorly produced meats, and mass-produced vegetables. She had tried a few times to reduce her consumption of sugar and gluten, but that hadn’t left her feeling any better. She said she didn’t exercise because she felt too tired and her body hurt too much. She didn’t have any particular stress-management techniques except to try to spend time with friends and family.

Beth’s routine was to wake in the morning, eat cereal, go to work, snack throughout the day, do her computer tasks to the best of her ability, come home, be with her family, watch television, and then try to sleep, though she usually slept fitfully and woke up often.

The Power of Restorative Sleep

We began to talk about the importance of restorative sleep to ease her migraines and fibromyalgia and how studies have shown that restorative sleep is one of the most effective interventions. We talked through a basic regimen for improving her sleep.

We also discussed the specific foods she was consuming and identified that many of them could be contributing to inflammation, fatigue, and the fact that she was overweight. We talked about how even ten minutes of very simple physical activity and becoming biomechanically aware could engage her muscles in such a way that she might
have less pain and greater strength. We talked about how muscles that are inactive can actually signal to the brain that they’re sore or weak, and how that might be part of her discomfort.

So Beth started on some basic interventions.

She began a daily ten-minute program of stretching and breathing. She started sourcing her foods a little better. And she started to work on some controlled breathing techniques to help her relax and sleep.

12 Months Later: Sleeping Well, Improved Energy

One year later, Beth reported that she was sleeping well. She now rarely had migraine headaches, though she still had tension headaches. She had improved her posture at work. She was having less neck and back pain. She was definitely more flexible and mobile, and she was capable of exercising thirty minutes a day; she said the exercise definitely helped her to feel better. Her energy levels had improved, though she frequently felt tired. And while she was still lacking motivation and energy, she said she felt a bit more hopeful.

At this point, we were able to reduce some of her medications. We also further improved her nutrition plan and got her into a healthier rhythm of eating at meal times with less snacking. We advanced her physical activity routine, and I encouraged her to practice more controlled breathing. We also talked about focusing on a sense of purpose.

2 Years Later: Low To No Muscle Pain, Great Sleep, Fewer Medications

Now, two years after that initial visit, Beth reports a much lower level of muscle pain. She has infrequent headaches. She sleeps well most nights. Her energy is good. She has reengaged in many community activities that she enjoys. She’s still a little overweight and still deals with intermittent flare-ups of fibromyalgia, but she combats her discomfort with healthier routines. She’s on minimal medications.

A couple of years ago, Beth thought that there weren’t any solutions out there for her—but her life looks entirely different today. She’s satisfied. Her family has observed a major difference in her mood and her positivity. Beth describes her quality of life as very good.