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& 100 Other Things Your Mother Should Have Told You The GoodDoc, BadDoc Guide To Mens Health and Grooming By Valerie Eckard, M.D. Donald Eckard, M.D.


THIS IS A GOODDOC BADDOC, LLC BOOK PUBLISHED BY KINDLE DIRECT PUBLISHING First Edition Copyright 2012 by Valerie Eckard, M.D. and Donald Eckard M.D. ALL RIGHTS RESERVED. No part of this e-book may be reproduced or transmitted in any form whatsoever, electronic, or mechanical, including photocopying, recording, or by any informational storage or retrieval system without the expressed written, dated and signed permission from the author. LIMITS OF LIABILITY / DISCLAIMER OF WARRANTY: The authors and publisher of this book have used their best efforts in preparing this material. The authors and publisher make no representation or warranties with respect to the accuracy, applicability, fitness, or completeness of the contents of this program. They disclaim any warranties (expressed or implied), merchantability, or fitness for any particular purpose. The authors and publisher shall in no event be held liable for any loss or other damages, including but not limited to special, incidental, consequential, or other damages. This manual contains material protected under International and Federal Copyright laws and Treaties. Any unauthorized reprint or use of this material is prohibited. Manufactured in the United States of America Library of Congress Control Number: 2012948170 ISBN 9780988234307 (kindle book)


1. Please dont be stupid and kill yourself. It would make us both quite unhappy. Consult a doctor before doing anything in this book. 2. The material in this book is for informational purposes only. As each individual situation is unique, you should use proper discretion, in consultation with a health care practitioner before undertaking the diet, exercises, and techniques described in this book. The authors and publisher expressly disclaim responsibility for any adverse effects that may result from the use or application of the information contained in this book. 3. The information presented in this work is by no way intended as medical advice or as a substitute for medical counseling. The information should be used in conjunction with the guidance and care of your physician. Consult your physician before beginning this program as you would with any exercise and nutrition program. If you choose not to obtain the consent of your physician and/or work with your physician throughout the duration of your time using the recommendations in the program, you are agreeing to accept full responsibility for your actions. By continuing with the program you recognize that despite all precautions on the part of Val and Don Eckard and GoodDoc BadDoc, LLC, there are potential risks of injury or illness which can occur because of your use of the aforementioned information and you expressly assume such risks and waive, relinquish and release any claim which you may have against Val and Don Eckard and GoodDoc BadDoc, LLC, or its affiliates as a result of any future physical injury or illness incurred in connection with, or as a result of, the use or misuse of the program.





This is book about health, fitness and grooming. It is based on the way that we live our lives. There is a boatload of conflicting information on what is healthy and what is not healthy. Utilizing our extensive medical background, we have sorted through the information and the bullshit, to come up with advice on health, fitness, diet and everyday living. You may not agree with everything in this book, but we believe if you follow the guidelines that we set forth, you will live a healthier, longer and better life, while still having fun and enjoying yourself. So, cheers! To life! To YOU!


INTERVENTION SUNDAY!! What the hell is that? With the great weather we have in San Diego, many of the bars and clubs have come up with a Sunday afternoon party, held out by the pool at many of the hotels. The one at the Hard Rock Hotel goes by the name Intervention Sunday. Hot girls in bikinis, ripped guys and, of course, plenty of adult beverages (in moderation of course). Are we advocating this? HELL YES! This book is about living healthy, looking good at any age and having fun. So why am I, Dr. Don starting off with a story about Intervention Sunday? It is because when I go to the door to enter the party, the bouncer asks for my ID. Of course he knows I am over 21, but it is a requirement to check everyone. When he looks at my ID, he looks at me and then back down at my ID and says, No way! I want to look like you when I am your age. Not only that, but I see him later as he patrols the party and he high fives me and tells me several times, Dude, I want to be you when I grow up! Well, we want you all to be healthy, look good and feel good and we want to help you do it.

The Docs Party On!

Do you want to be the guy that people say seriously? YOU are 55? You look 15 years younger! Or the guy behind whose back people say, hes a heart attack waiting to happen! If you are not concerned about this now, you will be someday. It is never too late to learn and implement the things we are going to tell you, but the younger you start the better.

So who are we, and what makes us qualified to tell you anything?

GoodDoc and BadDoc, in order of appearance

As two physicians in active practice, we have long had an interest in health, fitness and grooming. Because of our interests, we have spent a great deal of time researching health, wellness and longevity. We are not just sitting on our asses behind a desk telling you how you should live we are in the gym, in the kitchen and living fantastic lives by putting into practice what we preach. The results speak for themselves. This information needs to be shared. We want you to be able to benefit from our knowledge and experience so that you will feel better, look better and get more out of life. Dr. Don is the conservative doc, also known as the GOODDOC. Would he normally go to a wild and crazy party on a Sunday afternoon? No. That is where Dr. Val comes into the picture. She is the wild and crazy doc, also known as the BADDOC. She would not only be at the party, but she would be one of the bad girls at the party. Between the two of us, we have found a happy medium where we not only practice a healthy lifestyle but we also have tons of fun. We want to share with you how you can be healthy, look good, feel good and still have a blast. It is the best of both worlds. IT IS POSSIBLE, and we want to show you how to do it.

Living healthy pays off. The Docs in a pace line in New Zealand.

What make us uniquely qualified? We are living proof. You want to see our pedigrees? Really? Then go to our website at and you can bore yourself with our CVs. First we are actual doctors. Not people who call themselves doctors, people with a mail-order degree from the West Indies or even people with a medical degree whove never practiced medicine in their lives. After receiving Bachelors degrees in college, we both went to 4-year medical schools to receive our MDs. Dr. Val followed this up with a 4-year radiology residency. Dr. Don completed a yearlong internship, 4-year radiology residency, and then spent 2 additional years in fellowship for neuroradiology and endovascular neurosurgery. Show off. This book is about the way we try to live our lives. Healthy and fun! Eat well, exercise and dont do stupid shit. Then be active and enjoy! We have run marathons, done multiple century bike rides, white water rafted and hiked on multiple continents, done mountain climbing, skydiving and have recently gotten into fitness competitions. In fact, Val has placed several times in INBA and NPC bikini competitions. The point is we want you to be able to participate in life and enjoy life. To do that you need to be fit and healthy. This book is your guide!

Dr. Val in the Tournament of Champions, Los Angeles.

By reading this book, youll learn how to: Get into the best shape of your life Lose the weight youve been wanting to lose Look younger Feel younger Live longer Be more attractive and get more attention Have more fun Understand string theory and quantum physics* Achieve things you never thought possible *Ok, so maybe you wont understand string theory. We just always wanted to use string theory in our book. And who doesnt love quantum physics?


Ever since medical school, Dr. Don has wanted to write a book on how to take better care of yourself. Of course that is easier said than done. Life seems to get in the way. There are so many things that people can do to be healthier, feel better, live longer and enjoy life more, but they just dont seem to know how to do it. We want this book to be your guide.


When I told Val about my idea, she said: That will be boring as hell. Her goal is to not only impart valuable information, but to spice up the book to make it interesting to read. She is also appalled and occasionally revolted at the way men look after their personal hygiene and wanted to add that to the book. She is shocked to this day by the poor hygiene of some physicians in particular. Certainly you would expect physicians to know how to bathe, brush their teeth and dress appropriately, right?

Is that a swimsuit or a diaper?


Before I came into the picture, Don didnt think that how he dressed mattered. First of all, and I hope most importantly, it matters to me. I like it when we go out and other women (and men) notice him. I want to be seen with a guy who is confident, stylish and successful just like guys want a hot date on their arm when they roll into a



The guys always notice Val!!!!! IM OK, YOURE NOT OK* *At least if you do not take care of yourself

GoodDoc? BadDoc? How about HotDoc?

Sorry, but we disagree head-on with the touchy-feely trend that it is ok to be fat, to be unhealthy, or to let your personal appearance slide. It is NOT okay. Accepting yourself for the dazzling individual you are is one thing, but using it as an excuse for being overweight and unhealthy is something else. In fact, like it or not, you are being judged on all of these criteria, all the time by potential mates, by the boss eyeing you for a promotion, by everyone you meet. Quite frankly, we get tired of seeing one fat ass after another. At the extreme, these people are gross. They arent healthy, they have yeast growing in their creases and they smell bad. Dr. Don has even found coins and food items underneath the rolls of fat in some patients. They are not able to enjoy life the way that it should be lived. But even if you are only a little overweight, you are not as healthy as you should be. We want to help you get back on the right track. Do you want a long life? To feel good? To have rock star sex? Then you need to worry about your health, fitness and grooming. Paying attention to these things will give you a

lifestyle improvement. You get to do stuff. Try new things. People will even wish they were you! THE CARROT WHAT YOU GET FOR TAKING CARE OF YOURSELF

Motivation is in the eye of the beer holder.

When you think of all you stand to lose, it just makes sense to take care of yourself. Take care of yourself, and People will treat you differently. You will feel better about yourself and be more confident. You will be more likely to get promoted and get a higher salary. You will live longer. You will spend less time in the doctors office or hospital. You will have less aches and pains. You will spend less money on health related issues. The list, of course, goes on.

Ever seen South Park? Cartman comes home from school, upset about being teased for being fat. Hey momall the kids at school say Im fat. His mother tells him Dont worry youre not fat! Youre big-boned. Thats bullshit. Cartman isnt big boned hes fat. Lets be real!

First and foremost YOU ARE RESPONSIBLE Do you smoke? Do you have high blood pressure? Are you overweight? Do you have high cholesterol? Do you wear your seatbelt? Do you do stupid shit? These are all things you can control and for which you need to nut up! There are both genetic factors and environmental factors that account for the way you look and feel. Some people are luckier than others and are born with bodies like a Lamborghini. Others feel like maybe they drew the short straw and got the VW bus. Genetic factors can be difficult to overcome or modify. Therefore we need to make the most of the environmental factors that you can control. Plus, with proper care and attention, you can even the playing field. You can do well with either type of body.


Dont do stupid shit!

Many people smoke cigarettes, have high blood pressure, high cholesterol or diabetes secondary to being overweight. All of these things are extremely detrimental to your health. They are also all factors that you can control with lifestyle modification, proper diet and sometimes medications. Dr. Val recently saw a 38-year-old patient with diabetes, high blood pressure and high cholesterol. The guy was too busy or too irresponsible or too lazy to take his medications. It had been documented again and again by his primary care doc that this patient refused to take his meds and to be responsible, EVEN THOUGH he had been warned about the consequences! By the time Dr. Val saw him it was too late. He had suffered a brain stem stroke. Devastating. No messages could travel from his brain to the rest of his body creating what we call a locked-in syndrome. He is awake and aware of his surroundings, but he is totally unable to move his arms or his legs or to speak. He can move his eyes, but that is it. This is an extreme example, but it is also something that did not need to happen to him had he only taken care of himself. THERE IS NO EXCUSE! Sadly most of the diseases we see are preventable. Many people just dont know how to take care of themselves or have given up. Of course some people just dont give a rats ass (even though they should). Why live a wretched existence when you dont really need to live that way? Unfortunately there are a large number of people who DO care but get the wrong information. The amount of misinformation available in diet books and on the Internet is abhorrent. There are scammers everywhere you look, trying to profit from your insecurities. How would you know what to believe?

WE CAN HELP There is tons of information out there. It is hard to know what to believe even for us. We have sorted through the information and come up with what we think is the best possible plan. Not everybody will agree with everything we say, but overall, if you live your life the way that we suggest, you will be much better off. We have found that there are a few things that matter lots, and lots of things that dont really matter that much. Often times the media will get hold of a story and it will get blown way out of proportion. For example, there has been some controversy over whether cell phones cause cancer. The media reports the story BREAKING NEWS! CELL PHONES LINKED TO CANCER. However, frequently these stories are based on one small clinical study that may not even be correct. The latest, and largest study to date on cell phones actually reports that they DO NOT cause cancer. Naturally, as this news wont make people run shrieking and leave them shivering in a corner, it doesnt get much airtime. What should you believe? Who knows? The bottom line is that even if cell phones do cause cancer, it is probably very, very rare. There are a hell of a lot of things that are more likely to kill you, so keep reading. We have found that this is true with much of the information reported by the media and on the Internet. So we try to emphasize the things we think are important. There are lots of little things that get a lot of attention, but in actuality arent significant and you dont need to waste your time and energy worrying about them. We can help, but you are going to need to meet us halfway. Make no mistake, your health and wellness is your responsibility. ITS YOUR RESPONSIBILITY not that of your mother, your therapist, your trainer or McDonalds to monitor your health and make changes in your diet/lifestyle to prevent or help alleviate potential health problems. Stop blaming other people for your situation and take charge. Studies have shown that being overweight compromises your ability to get a better job or a better salary. Do you really want your worth to be based on your waistline instead of your education or experience? By the way, being attractive to the opposite sex doesnt just apply to the single crowd. Why should you look like shit and be unhealthy just because you are married? This especially applies to the married crowd because people get complacent. Youve seen it your buddy gets married or his girl moves in and BAM! He puts on 20 pounds. We want you to see your grandkids grow up. Not be six feet under in a pine box. Being responsible also means using some common sense and not doing stupid shit. And

if you do, be sure and own up to it. If not to your co-workers, at least to your doctor. Take for example the guy who came into the ER with vague abdominal pain. His first CT scan was read as normal. A week later, he had another one we thought maaaaybe there was something in his colon. Plastic, as it happens, is translucent and difficult to see with CT scan. The surgeon later confirmed that it was, in fact, a glitter pen. In his colon. And the patient had NO IDEA how it might have gotten there. But if he had fessed up initially, it would have saved him a week in the hospital and a lot of trouble.

Notice that the sign doesnt specifically tell you not to do this. You can if you want to. Use your head to think with, not to land on.


OK. Now you know you have some work to do and we are going to help you get there. But, we dont want you to be some freak. You are going to do healthy things but still be normal. A few years back, we briefly subscribed to a meal delivery service. They provided premade, fresh, calorie-controlled meals daily. As an aside, this is a good thing to do if because of your schedule you are not able to have healthy meals at work or home. We personally think it is better to learn to make your own meals or eat properly at a restaurant because subscribing to a service will not actually teach you how to eat well As part of the service, there was a weekly newsletter suggesting ways you could improve your health and fitness and to stay on track. One week the newsletter discussed the topic of eating away from home. The suggestion was to take your meals with you. WTF? Part of traveling is interacting with colleagues or friends over dinner. Toting around your own oatmeal and brown rice is not how real people live. We have to hand it to the author though. At least he was honest. He describes a road trip to Las Vegas -- a bachelor party. He made his meals before he left (!) and packed them in the trunk of his car in a small cooler. It consisted mostly of chicken, brown rice and fresh vegetables. However, he made one big mistake. He neglected to refresh his cooler with ice. By the time he got to Vegas, his meals were no longer refrigerated. But he ate them anyway, rather than risk ordering at a restaurant. So by the third day, you guessed it, food poisoning. Stomach cramping, vomiting, diarrhea. Seriously. Who does that? To be that obsessive about eating your perfectly measured chicken that you would risk food poisoning rather than making a smart choice at a restaurant? We are going to say this again, WE WANT YOU TO BE NORMAL. The key is MODERATION. As long as you eat well most of the time, you can break the rules some of the time. While we dont advocate going hog wild, it is ok to go out and eat stuff that you would not normally eat and that you may not think is healthy. Just dont do it all of the time. There are some things that are obviously not ok in moderation like shoving a glitter pen

up your ass, smoking and doing stupid things. Likewise, if something is good for you, dont go overboard with it. You can certainly take diet and exercise too far. Diets too low in calories can cause damage to your bodies even lead to death. Even too much water can be bad for you extreme over hydration can result in water intoxication. Betcha didnt know that.

Dr. Don overhydrates in Cambodia.

Our advice is to follow the plan outlined in this book 80 to 90% of the time. Eating right, exercising and enjoying life on our plan is easy. However, occasionally (like when we travel or have a big night out), we dont worry as much about the plan. We may party a little harder or not worry about the details. Remember everything in moderation. Dont go totally overboard, nobody likes feeling like shit.

Having your cake and eating it too.


One of the most confusing and frustrating things is trying to determine your ideal weight. The Skinny on Fat So what if youre fat? Youve got a great personality, right? Its all about who you are on the inside. blah blah blah. While that may be true, fat isnt just about vanity. There are many health risks related to obesity including, but not limited to, type 2 diabetes, high blood pressure, high cholesterol and triglycerides (elevated levels are linked to hardening of the arteries, heart disease and strokes), coronary artery disease and heart attack, stroke, sleep apnea, gallstones, liver disease, gastroesophageal reflux (heartburn), infertility, and musculoskeletal problems like arthritis. Additionally, it increases your risk of many types of cancer. These diseases cannot only make your life miserable, cost you money in health care and lost time at work, but they can kill you. On the average, obesity reduces life expectancy by 6 to 7 years. Severe obesity decreases life expectancy by a decade or more. Obesity and being overweight also limits your quality of life. You want to live well right up until the end to be the octogenarian running marathons, or at least the guy with all the ladies following him around the retirement village.

So, whats your target? Maybe the right question to ask is, what is your ideal body composition? Body fat percentage is the percentage of your body composed of fat. Duh. Fat storage was key in the hunter/gatherer period, where you could go for days or weeks without a good meal. Without food sources, you could rely on energy produced from fat stores. Its not so helpful today, when there is a fast food restaurant on every corner and youre trying to tame a raging beer belly. Lest you think all fat is bad, you need to remember that fat also has important functions with regard to cushioning your organs, insulating you from the cold, and more importantly, has many hormonal functions. Therefore you need SOME fat, but not too much. It goes along with our philosophy of everything in moderation. We know that too much

fat is bad for you, but we know too little fat is bad as well. Better health has been associated with 10 18% body fat in men and 18-25% in women. JUST SO YA KNOW: Whats up with the difference between men and women? There is a certain level at which body fat gets too low for the organs of the body to continue to function. This set point known as essential fat is different for men (3-5%) and for women (10-12%). Women have a higher set point because it is believed that they need a higher fat percentage for reproductive purposes. Rather than concentrating on your weight, you should be concentrating on your body fat percentage. We give you some options to roughly calculate or measure your body fat percent below. You often hear that muscle is a calorie burner. A pound of muscle can burn about 6 calories/day at rest compared to 2 calories/day for fat. Plus, muscle takes up less space and therefore looks better than fat.

Dr. Don adding some muscle with an incline shoulder press.


Beauty and fitness magazines, personal trainers, and even TV physicians repeat so much misinformation! Makes me CRAZY! Sure muscle burns more than fat - but only about 3 times as much. Not the 50 times as much (as Dr. Oz would have you believe in his presentation to the National Cosmetology Association in 07 as reported in an article from the LA Times in May 2011). And certainly not 50 calories per pound another figure we see repeatedly, including in the San Diego paper recently! Do the people who write this shit even THINK about what they are saying? In training for my bikini contests over the past year, I have put on about 8-10 pounds of muscle. That would amount to an extra 400-500 calories/day that I could eat. Wow. If I eat that much more per day, Ill be adding 10 MORE pounds, and it wont be muscle!

Dr. Val ripping out some chin-ups in Point Loma, California.

Every tidbit that appears on the Internet gets propagated as fact by the uneducated and the lazy. After a while, it is repeated in so many places that people accept it as fact. Look into the scholarly articles and journals to find the real information. For a real-life example Don, weighing in at 165 pounds has a body fat of 11 percent. If he were to work his ass off to get down to 8% while maintaining his weight, that would mean an increase in about 5 pounds of muscle. So at 6 calories/day/pound for muscle compared to 2 calories/day/pound for fat, thats going to buy him 20 calories. Thats about a Starburst candy. So, be realistic adding muscle isnt going to make you into a calorie-burning machine like the fitness magazines would have you believe. But dont be discouraged, muscle is lean and sleek it looks better. Someone with more lean muscle mass and lower body fat will look thinner than someone who weighs less, but has higher body fat. And as we said before, its the excess fat that leads to disease and even death.

Biking in New Zealand (where they drive on the left side of the road).

Remember, dont obsess over the scale. Body fat percentage is much more important

than what you weigh. Men should be in the range of 10 to 18% body fat and women should be in the range of 18 to 25% for ideal health. MEASURING UP There are multiple ways to evaluate your level of fat-ness. They all give estimates and are not completely accurate, which is something to keep in mind. CHECK YO SELF BEFORE YOU WRECK YO SELF* (* from the song by ICE CUBE Check Yo Self) The Bathroom Scale The bathroom scale is a good way to track your weight, but it tells you nothing about body fat percentage that we think is more important. Mirror or photo test: Take a look in the mirror. You may already have a pretty good idea that you need to lose some weight. Photographs are another good measurement. Have you been shocked at how you looked at your friends party after she posted the pictures online? Did you think that photo makes me look fat.? Maybe the camera doesnt lie.


You want 6-pack abs? Its not about the crunches; its about the diet. Guys will need to get down to about 10% body fat and women will need to get down to about 15% body fat.


A number of years ago, I thought I was pretty buff (and so did everyone else thanks to my loose-fitting scrubs that I wore to work everyday). I remember coming back from a beach vacation in Mexico and showing my coworkers the photos. One of the technologists said, Eeeew! She didnt realize how fat I was. And apparently neither did I.

Clearly a before picture.

Circumference Measurements Another useful way to check yourself is by using waist circumference measurements. Men tend to store fat in the abdomen, not only under the skin but also deep in the abdomen around the organs. Women tend to deposit it in the hips and thighs. Abdominal fat around the organs (called visceral fat) is especially unhealthy and is associated with higher risk of disease and death.

Our trainer Joe Lenihan ( correctly measures Vals waist.

The World Health Organization has established criteria for waist circumference (at the level of the belly button) with level of risk for disease such as diabetes, stroke and heart attack

If you fall into the latter two categories, you definitely need to get off your ass and get started. Body Fat Estimation We feel that knowing your body fat percentage is the best way to evaluate if you need to lose weight or can just maintain. Body fat measurements are estimates. In the following paragraphs, well show you some ways to estimate and then give you our recommendations. YMCA Not Just a Song By The Village People: Probably the easiest way to get an estimate of your body fat percentage is to use a simple equation like the YMCA Formula. It is not perfect, but it is a place to start. All you need to know to use the equation is your weight and your waist circumference measured at the belly button. Male body fat % = ((-98.42 + (4.15 * waist circumference in inches) (.082 * weight in lbs))/weight in lbs = Female body fat % = ((-76.76 + (4.15 * waist circumference in inches) (.082 * weight in lbs))/weight in lbs = Go to our web site to easily calculate your body fat % using this formula by plugging in your weight and waist circumference. Calipers Calipers measure the thickness of skin folds. Someone who has been properly trained, such as many personal trainers or dieticians, measures the skin fold thickness in several different spots. Those measurements are then plugged into a formula (and there are over 100 to choose from) that yields an estimated body fat percentage. The accuracy depends on the person measuring and results can vary widely.

Here is Joe using calipers to measure belly fat (or lack thereof).

Our recommendation is to find someone who knows what they are doing and have them measure you consistently. Its a cheap, easy, and effective way to track your progress. BIA Bioelectrical Impedance Analysis With BIA, electrodes can be attached to your hands and feet, or you can stand or hold electrode pads. You can buy a scale or hand-held device with the pads too. Small electrical impulses are sent through your body to measure how fast they travel. Unfortunately, this can vary based on your level of hydration. So if you were on a bender the day before, had a few glasses of wine, or even have a full bladder, it can alter the results. These scales can be wildly inaccurate, but CAN be used as a way to track your progress, if you measure yourself consistently on the same scale under similar conditions (time of day, last meal, etc) and consider the hydration factors discussed above. Air Displacement measurement or BOD POD/Hydrostatic Testing Underwater

Both of these methods use displacement methods to estimate body fat. They both require a facility with the proper equipment and can cost anywhere from $20 - $100 for testing. DEXA Dual X-ray Absorptiometry DEXA is the most accurate way to measure body fat and is the gold standard. Its a fullbody x-ray at very low-level radiation. Its safe and only takes a few minutes, but can cost between $65 to a couple of hundred dollars depending on the facility. While we like this for accuracy, its too inconvenient and costly to use to track your progress. BMI Body mass index (BMI) gets a lot of press these days, so we will talk about it for

completeness sake. BMI was developed as a way to study large populations so that the statistics evened out over large numbers of people. For individuals, the number is not as valuable. It gives a rough indication of body fat percentage, but grossly overestimates fat in athletic individuals and underestimates in very obese people. To determine your BMI, you can plug in the numbers to the equation: BMI = (mass in pounds x 703)/(height in inches) squared You can go to our web site to more easily calculate your BMI. Underweight less than 18.5 Normal 18.5-24.9 Overweight 25 30 Obese over 30 It will give you a little bit better insight into your body composition, but can often times be misleading. Its really just a weight to height ratio. It doesnt take into account whether the weight is because of fat, muscle or dense bone. For purposes of calculating body composition, the body is comprised of fat and lean body mass (LBM). LBM is everything else bones, muscle, organs, etc. Unlike Cartman, if you are African American or Pacific Islander you might have denser than average bones, which will give you a high BMI. Similarly, weightlifters and other athletes will have a higher BMI because of muscle mass. Take for example a man, 5 10 tall who weighs 175. He is overweight by BMI standards, regardless of whether he is a muscle-bound meathead with a 6-pack or a doughy, sedentary blogger with a 6-pack. Of Milwaukees Best. SO NOW WHAT? If you are athletic or relatively lean, keep up the good work. We advise getting a body fat measurement using one of the methods above to establish a baseline and make sure that your really are fit. We know lots of guys who think they are fit but are not. Remember too that as your life changes (like getting married) and as you age you tend to put on more body fat. Therefore you need to continue to monitor by using the mirror, the bathroom scale (we recommend weighing a few times a week) and how well your clothes fit with occasional body fat checks. When you follow your weight, try to weigh at the same time each day since your weight fluctuates throughout the day. It is usually lowest first thing in the morning and then increases throughout the day. If you are slightly overweight or need to get into better shape, keep reading. Determine your body fat percent using one of the methods above and follow our plans for diet and

fitness. If you have significant weight to lose, its even more critical that you get started today. Dont wait until you have irreversible health issues to realize that its a problem! We still advise a baseline body fat measurement with occasional follow up measurements to track your progress. Plus, your lean body mass is going to be used later to determine your calorie and nutrient intake. Our advice? Get started right now by using the YMCA formula (because its easily done at home in only a couple of minutes.) We also like the DEXA scanning method, as it is believed to be the most accurate. Dr. Val is a fan of measuring with calipers, as long as you have someone who knows what they are doing. Its more affordable, and for people who are trying to track progress over many weeks and months, its easy to check it frequently. Our main message here is not to get obsessed with the number on the scale. Body fat percentage is more important. Plus, there can be stalls or plateaus with weight loss. We talk in more detail about weight loss plateaus in our book on dieting The GoodDoc BadDoc Guide to Healthy Eating. Dont throw in the towel! Look for other signs that your fitness regimen is working for you, like loss of inches, clothes fitting better, visible gain of muscle, and of course the attention you are getting when you run into old friends. Remember, muscle weighs more than fat. Therefore, if you are working out hard with weights and putting on muscle you may not be losing weight, but rather replacing some of the fat with muscle, but you are still becoming healthier.


Your vital signs are your heart rate, blood pressure and respiratory rate. They are critically important in seriously ill or injured patients. But they are also important in normal healthy people and can give you a snapshot of your health. Heart Rate Your resting heart rate is an excellent way to monitor the state of your health. Your resting heart rate can be obtained by finding your pulse, measuring how many times it beats in 15 seconds, and then multiplying by 4. This gives you the number of times your heart beats in a minute. The average resting heart rate in a male is approximately 70 beats per minute (bpm). A better than average heart rate is in the 60s and even better is a resting heart rate in the 50s. A well-conditioned athlete may have a heart rate in the low 50s or even in the 40s. Another way to measure heart health is by determining your recovery rate or how quickly your heart rate drops after intense exercise. To determine your recovery heart rate, take your pulse immediately after intense exercise and then take it again 1 minute later. The faster your heart rate slows down, the better. Studies have shown that if your heart rate slows down at a rate of less than 12 beats per minute, you are at a definite increased risk of death. Heart rate monitors are an excellent way to monitor your heart rate while working out. You may want to consider one. There are also pretty accurate heart rate monitor apps available for smart phones.

Its ridiculously easy to get your heart rate using a smart phone app.

Blood Pressure Blood pressure is the force exerted upon the walls of the arteries by the circulating blood. The higher the blood pressure, the harder your heart needs to work to pump the blood and the harder it is on your arteries. The blood pressure varies during the cardiac cycle. The measurements usually provided are the maximum blood pressure during the cycle (systolic) and the lowest pressure during the cycle (diastolic).

A sphygmomanometer is used to measure blood pressure.

The risk of cardiovascular disease increases progressively for values above 115/75. As a general guideline, make sure your pressure is under 130/85, but the lower the better. Your blood pressure is measured with a device called a sphygmomanometer. It is best to have somebody that knows what they are doing check your blood pressure. The machines found in malls or drug stores are not always accurate. If your blood pressure is normal, then you should check it at least once every year. If your blood pressure is elevated, you should see your physician for treatment. OTHER IMPORTANT NUMBERS YOU SHOULD KNOW Cholesterol Cholesterol is an important steroid-like substance that is used to produce hormones and is important in the structure of cell membranes. The body manufactures most of the cholesterol that it needs in the liver and intestines and absorbs a smaller percentage through the foods you eat. High levels of cholesterol in the blood are strongly associated with atherosclerosis (hardening of the arteries) and heart disease. As a general rule, try to get your total cholesterol under 180 mg/dl. It is very hard if not impossible to control your cholesterol levels through your diet since if you eat less, your liver tends to make more. Therefore, if you have a genetic predisposition to high cholesterol (which many people do have), you may need medication to control it.

Cholesterol is transported through the blood via substances called lipoproteins. The lipoproteins you hear the most about are very low-density lipoprotein (VLDL), lowdensity lipoprotein (LDL) and high-density lipoprotein (HDL). VLDL and LDL carry cholesterol from the liver to cells in your body. HDL carries cholesterol from cells in your body back to the liver. In general, high levels of LDL are considered bad and high levels of HDL are considered good. The American Heart Association recommends that LDL be below 100 mg/dl or less than 70 mg/dl if you are a person at risk for heart disease. If that last part read like, blah blah blah cholesterol to you, just remember this: You will need a blood test that you can obtain at your doctors office to measure your cholesterol. HALL PASS: We have a friend who thinks that being on a cholesterol lowering medication gives him a pass to eat like crap. This guy thinks sausage is the new black. News flash!! Having low cholesterol is important, but being overweight and eating unhealthy foods is still bad for you. Sorry, no hall pass on this one. C Reactive Protein Inflammation is the basic way the body reacts to irritants, injury or other harmful stimuli. If you stub your toe for example, white blood cells and other chemicals rush to the site of injury to begin repairing and protecting the site of injury. The toe becomes red, painful and swollen as a result of these inflammatory changes. This type of reaction is known as an acute inflammatory response and is a part of the bodys natural healing process. There is also another type of inflammation known as chronic inflammation. In chronic inflammation, the bodys immune system is turned on and silently and slowly damages the body by attacking itself. Smoking, obesity, chronic gum disease and repeated or prolonged infections can all cause a chronic inflammatory state. It is likely inflammation has an important role in heart disease, stroke, diabetes, cancer, cognitive decline and all of the diseases of aging. In an inflammatory state, the body releases many biochemicals including one known as C-reactive protein (CRP). In an acute inflammatory response, levels of CRP become markedly elevated and are easy to measure. However, in chronic inflammation, the levels are not nearly so high. A test we recommend which will give you an idea of your state of inflammation is a high sensitivity CRP (hs-CRP). Ideally, you should have 2 tests done 2

weeks apart since your C reactive protein could be elevated from a benign reason such as a minor injury. Studies have shown that hs-CRP levels correlate with your risk of cardiovascular disease. hs-CRP less than 1.0 mg/L = low risk of cardiovascular disease hs-CRP between 1.0 and 3.0 mg/L = average risk of cardiovascular disease hs-CRP greater than 3.0 mg/L= high risk of developing cardiovascular disease If your levels of CRP are high, you will definitely want to adhere to the principles in this book to help lower your level of chronic inflammation. You may want to start on a statin type cholesterol-lowering drug even if your cholesterol levels are not elevated as there is strong evidence that this will prevent much of the damage caused by inflammation. You can have your doctor draw your CRP. Glucose and Insulin When you eat a candy bar or an apple or many other foods, you are eating types of carbohydrates. Your body breaks all of these carbohydrates down into glucose (blood sugar), which is the type of sugar that the body uses for fuel. Glucose gets removed from the blood by a hormone called insulin. Persistent high circulating levels of glucose or insulin are bad for you. If you have high blood glucose, it means that your pancreas is either not producing enough insulin (type 1 diabetes) or more commonly that your cells are not responding to the insulin appropriately (type 2 diabetes). Insulin resistance, a term you may have heard, refers to this inability of your cells to respond appropriately to the insulin. Measuring your fasting glucose levels and your fasting insulin levels will tell you if your insulin is adequately removing glucose from your blood. If not, there are lifestyle and diet modifications that you will definitely need to make. If these things do not control the glucose levels, then you may need to take medication to help keep the glucose levels in your blood under control. The bottom line - Too much circulating glucose and insulin in the bloodstream is bad for you, as it results in damage to your organs and your blood vessels. You want to keep your fasting glucose level between 70-100 mg/dl. Ideally your fasting insulin level should be less than 10 mIU/ml. Again, these tests will require a blood test from your doctor. Dont worry all of these things can be done at once, and wont require multiple visits (or multiple needles!) Vitamin D It turns out that many people are deficient in vitamin D. Vitamin D can either be consumed or made in the skin when the skin is exposed to UV light.

Dr. Val loads up on Vitamin D.

People that do not get much sun exposure or people with darker skin are at increased risk of deficiency. Many experts believe that levels of vitamin D should be at least 50ng/ml or greater. If you use this number, approximately 90% of people are deficient in vitamin D. Therefore, we recommend getting your vitamin D level checked and supplementing with a vitamin if necessary.



Like a whole lot of America, I have spent countless hours slogging it out on the treadmill and in the kitchen counting calories, trying to lose weight. And like a lot of people, I figured that if eating less and working out wasnt getting me the results I wanted, I had better eat even LESS and work out MORE, right? And if you dont get the results you wantyou get the idea. But this doesnt always seem to work in the real world. Your body adapts and when faced with famine-like or stress conditions, it hangs on to all that it can. (over time, if you stayed in a caloric deficit you would gradually lose weight of course, but people tend to either give up or give in even if just for a vacation which puts you back to where you started) Plus, you end up making yourself AND those around you miserable. So how did I get into the best shape of my life at 42 years old? exercising less. Seriously! Eating more and

Eating more, exercising lessreally!

The answer lies in knowing exactly how many calories and what types of macronutrients you need. This should be based on your body weight, your level of exercise and your fitness goals (NOT on your blood type, your astrological sign, or whatever Gwyneth Paltrow is eating). Diet is an incredibly complicated and controversial subject so much so, that our chapter on it really took on a life of its own. So to keep this book manageable, weve boiled it

down to just the basics. For more detailed information on our recommended diet plan, see The GoodDoc BadDoc Guide to Healthy Eating. Eating/dieting really is about calories in vs. calories out. Whatever you eat is either used to keep your body functioning or stored for future use. We go into much greater detail on this in our Healthy Eating book. For maintenance calories in an active individual, you should aim for 14 16 calories per pound of body weight. For an average 175-pound man, this would be around 2,600 calories per day. If you need to lose weight, start at 10 - 12 calories per pound of body weight. Give yourself 2 3 weeks adhering to this. If you are losing weight at roughly 1 2 pounds per week, you are probably right on track. No weight loss and you might have to adjust down a little bit. Many folks give up too early, so give it some time. We will give some suggestions on super easy ways to track calories shortly. Dont forget when you jump into a diet, you may initially see a dramatic drop in the scale. This is usually due to water weight (particularly if you are decreasing the amount of sodium or carbohydrates youre consuming). This is the basis of many rapid weight loss diets but it was not fat that was lost. After this, the weight loss will slow a bit to a more reasonable one or two pounds a week. To lose a pound, you need to cut 3500 calories from your diet. For a 5-pound weight loss this amounts to 17500 calories. That is why your goal should be 1 or 2 pounds of real weight loss/week. Be warned, after you initially lose some weight, you may go for a while without seeing results and then suddenly * poof * the scale will show a dramatic change. This frequently has to do with water shifts, but can be frustrating whey you are trying hard but not seeing results. People often fail when dieting because they underestimate the amount of food they are eating, the caloric value of the food, or they dont account for it at all. Studies consistently show that overweight and obese people underestimate their food intake by 30 to 50%. The handful of M&Ms you snagged from your co-workers desk on the way to the copier might have 75 100 calories or more. That stuff adds up. Believe us.

This handful of peanut M&Ms has a whopping 250 calories!


Pull your head out of your ass. We have a friend who wants to shed a few pounds prior to his next birthday. Hes in pretty good shape and spends enough time working out and thinking about what he is eating to make it happen. But in talking with him the other day, he mentioned that he eats a lot of almonds and walnuts. Yeah, they are healthy good fats! But one handful (particularly for our buddy, who is a big guy with big hands) is close to 200 calories. He admitted he probably eats 4 or more servings a day --- so thats an additional 800 calories. In a week, that is 5600 calories over a pound and a half. Wow. That kind of thing goes a long way to understanding WHY you might not be losing weight and WHY you have to record everything and be accountable. You need to track what you eat. In fact, this is the key to being fit while not being a freak. We have a friend who has been phenomenally successful with her diet and workout she has lost 40 pounds over the last 9 months! Recently, she was invited to tailgate before the Chargers game and her date suggested they bring bratwurst. She told him that was fine, but could he bring a piece of chicken to grill for her instead? He just didnt get it but a brat has about 21 grams of fat in just one serving, and 260 calories. Thats almost her whole days allotment of fat! But if you are tracking what you are eating you can make a choice if you really crave the brat, have the brat! But you will know you have to eat lean the rest of the day. OR, you could have half the brat, or you could choose chicken or low fat chicken sausage and save your fat and calories for something that really rocks your world! Tracking what you eat has actually become ridiculously easy and fun. Gone are the days of tallying all that crap in your head or writing it down on a piece of paper. There are tons of smart phone apps and online programs to help you track calories and macronutrients. A tracking program that we especially like and use is available as a smart phone app it is called Lose It! and we highly recommend that you Use It. It is super quick and easy. It

even has a bar code scanner so that you can scan foods you like into your food log. MyFitnessPal is another excellent app that we recommend for tracking.

Lose It! Tracking app for the iPhone

When you cook at home, we recommend that you weigh your food or measure your food using measuring cups or spoons. This only takes a few seconds and will give you a much better idea of what you are eating.

Lose It! also helps you track macronutrient data!

When you eat at restaurants, you will need to estimate roughly what you are eating and then check for similar foods online or on your tracking app so that you can get fairly accurate caloric data. Dont worry, after you do this a few times it gets really easy. We give you some tricks on ways to track your foods on our website

WHAT THE HELL IS A MACRO? Nutrients are chemical compounds used by any organism to sustain life and growth. Macronutrients are the three types that humans consume in significant quantities. Macronutrients are protein, carbohydrates (abbreviated as CHO or carbs) and fats. You need all three of them for a healthy, balanced diet. Protein is necessary for building muscle and tissue repair. Second to total caloric intake, the amount of protein is the most important part of your diet. After you determine your daily caloric requirement, we believe you should start with calculating how much protein you should have each day. A good rule of thumb for most individuals is to estimate your protein requirement based on your lean body mass. Go back to the section on body fat for ideas on how to calculate your body fat percentage. If you weigh 170 pounds with 20% body fat, that means that 80% of 170 pounds is your lean body mass. So your LBM is 136 pounds. Protein is necessary for building new muscle of course, but when you are trying to burn fat, its also essential to preserve the muscle that you have. Your body would preferentially breakdown your existing muscle to use for energy rather than your fat stores because muscle tissue is easier to mobilize for fuel. So having adequate protein in your diet will help prevent muscle loss. In addition, protein helps to keep you full longer giving you more bang for your buck. We recommend 1.0 1.5 grams/protein per pound of lean body mass per day. The amount should be toward the lower end (1.0 g/lb) if you are female or significantly overweight. Aim for the mid to higher range if you are lifting and trying to add muscle mass. So again, for our 170-pound guy with a LBM of 136 pounds, he should get 136 - 204 grams of protein per day. Somewhere in the middle of that range would be about right for most people. Protein has 4 calories per gram, so thats around 540 800 calories from protein. Too Much Protein? The belief that too much dietary protein can cause kidney failure is another example of the media propagating incorrect information. Recent studies have shown that if you have normal kidney function, high protein diets do not damage the kidneys. In fact, they have also shown that even very high protein diets (greater than 1.5 g/lb) do not appear to impact kidney function in healthy individuals. However, if you have impaired kidney function, you should consult a physician and/or nutritionist who can help you with your diet, as a high protein diet may not be appropriate for you.

The best sources of protein are lean animal meats like turkey, chicken, pork or lean beef; fish; eggs or egg whites; and low-fat dairy products like Greek yogurt. If you are vegetarian, soy products like tofu, beans and lentils are amongst the best sources of protein, but do not contain nearly as much protein as animal based products.

Sushi is a great option for lean protein. Even Don has learned to eat the raw fish!

We actually find it can be challenging to get enough protein per day just eating whole foods. Therefore, we also recommend taking a protein supplement. A protein supplement can be especially good as an addition to a quick breakfast, can be used to make great tasting shakes, can be incorporated into various recipes and can also be convenient pre or post workout. Protein supplements are derived from a variety of whole foods including milk, eggs, soy and even foods such as peas, hemp and rice. In general, we recommend a protein supplement derived from milk. The 2 major proteins in milk are whey (20%) and casein (80%). The milk based protein supplements are also high in calcium. Whey is a good pre-workout protein since it is digested rapidly and does not leave you feeling full. It also mixes very easily. The disadvantage of whey protein is that some people experience digestive issues such as gas and bloating after eating it. If you have a problem with this, using a whey protein isolate (a more purified form of the protein) may help with this problem. If not, make sure your spouse or roommate is understanding and/or has a bad sense of smell. Casein is a protein that is more slowly absorbed. Because it is more slowly absorbed it keeps you feeling full longer which makes it especially good for people who are trying to lose weight. The main disadvantage of casein protein is that it does not mix as well. We like best the mixed whey and casein supplements. Watch out for the shysters. All you need is a basic supplement. Many of the supplements are over- hyped as to their

benefits. Dont believe them. You just want a basic protein supplement. At the end of the day, its just protein, not jet fuel. Does this fat make my ass look fat? Gone are the days (we called them the 80s) when fat was evil. You need fat in your diet! Rejoice! Does this mean Ben & Jerrys for everyone? Nobut still ok in moderation! There are 4 basic types of fats: Monounsaturated Fats Polyunsaturated Fats Saturated Fats Trans fats Monounsaturated fats are liquids at room temperature, and they are considered a relatively healthy fat. The best examples are olive oil, canola oil, nuts and avocados. The people in the Mediterranean consume a fairly high quantity of olive oil, which is probably partially responsible for their excellent health.

Avocados are a great source of healthy fats.

Polyunsaturated fats are liquid at room temperature and are found in nuts, seeds, leafy greens, krill, fish and algae. They are broken down into two major types of fat omega-3 and omega-6 fatty acids. Both of these types of fats are considered essential fats. In other words, your body needs them but you cannot make them. Therefore you need to eat these types of fats. We all get plenty of omega-6 fats in our diets. However, most people do not get enough omega-3 fatty acids. The omega-3 fatty acids have been shown to be beneficial to human health in multiple studies. In fact, it is one of the few topics that we discuss in this section on which there is very little debate. Suggested benefits include reduced depression, improved blood lipid

levels (cholesterol and triglycerides), reduction in cardiovascular diseases such as heart attack and stroke, improvement in joint pain and arthritis, and improvement in overall inflammation within the body and in various inflammatory diseases. You probably need to be eating (or supplementing) to increase your intake. The best sources of omega-3s are cold-water fatty fish such as salmon, herring, mackerel, anchovies and sardines. Since most people dont eat large amounts of these fish, supplementation is required for optimal health. Free-range meats are another potential source although the amounts are small compared to cold-water fish. Saturated fats are solid at room temperature and are found mainly in animal products, palm oil and coconut oil. There are a variety of different types of saturated fats including stearic acid, lauric acid, palmitic acid and capric acid to name a few. Some of these saturated fats have very negative effects and others probably do not. There is quite a bit of controversy regarding saturated fats and their effects on your health. Our advice is to limit saturated fats by mainly eating lean cuts of meat and low fat dairy products as much as possible but not totally stressing out about them. Trans fats are composed of fats (usually vegetable) that have been altered by a process called hydrogenation. They are semisolid and favored by food companies because they are stable and less likely to spoil which gives them a long shelf life. There is no debate, however, that trans fats are bad for you. Trans fats increase LDL, decrease HDL and increase heart disease. Since it is becoming widely known that these fats are bad, the food industry (sometimes because of laws or fear of laws) has been eliminating them in many foods. You may find trans fats in commercially baked products like cookies, doughnuts, pizza crust and hamburger buns; stick margarine and vegetable shortening; fried foods like French fries, chicken and breaded fish; candy bars; potato, corn and tortilla chips; microwave popcorn; cake mixes and pancake mixes. Check the food labels before you buy and avoid foods with trans fats OR that list hydrogenated or partially hydrogenated vegetable oils in their ingredients. Be aware though, that if a food has less than 0.5gms of trans fat per serving, it does not need to be listed on the label, and they can STILL claim 0 trans fats. We recommend that you get 25 35% of your daily calories from fat. So for the average guy on maintenance at 2600 calories, thats about 780 calories. To find the amount of fat in grams that you can consume, divide by 9 (there are 9 calories in each gram of fat). So roughly 87 grams of fat. You want to try and eat the good fats, like those in olive oil, nuts, fish and avocado. These foods contain healthy mono- and polyunsaturated fats. Eat saturated fats in moderation, like those found in full-fat dairy products like ice cream and butter and in fattier cuts of red meat. The American Heart Association recommends that you limit your saturated fat intake to no more than 7% of your daily caloric intake, which would equate to no more than 20 gms for a person consuming 2600 calories/day.

Stay away from trans fats/hydrogenated fats altogether.

A SPOONFUL OF SUGAR So whats left? Carbs, baby! Subtract the calories from fat and protein, and everything else you should consume in carbs. Carbohydrates are sugars or chains of sugar molecules. Their main function is to provide energy to the body, but excess carbohydrates can be turned to fat. Carbohydrates can be divided into 4 main types. Monosaccharides Disaccharides Oligosaccharides Polysaccharides Monosaccharides and disaccharides are smaller molecules and are also referred to as sugars. The common monosaccharides are glucose (blood sugar), fructose (fruit sugar) an d galactose (milk sugar). Common disaccharides are sucrose (glucose + fructose), which you know as common table sugar, lactose (glucose + galactose) that is found in dairy products, and maltose (glucose + glucose) found in malt beverages. Oligosaccharides and polysaccharides are longer chains of sugar molecules. Polysaccharides are sometimes referred to as starches and can contain 1000s of sugar molecules strung together. (In the body, these long chains of sugars are called glycogen which is the way the body stores sugar for breakdown at a later date). Fiber is another type of polysaccharide that for purposes of nutrition gets divided into soluble or insoluble. Soluble fibers go into solution in a liquid and insoluble fibers do not. Common sources of soluble fibers are oats, peas, beans, apples, citrus fruits, carrots, barley and psyllium. Common sources of insoluble fibers are whole-wheat flour, wheat bran, nuts and many vegetables. Some fibers are also fermentable which means they can be fermented into other things like short chain fatty acids, CO2 and methane. Therefore, they can cause gas. Methane is one of the things that give farts their wonderful smell! If you have not been eating lots of fiber, increase the amount slowly which will help to alleviate the gas problem. In spite of the gas problem, there are many reasons to consume an adequate amount of fiber. Although fiber is not digested by your body and is passed relatively intact it is still a very important nutrient.

The role you hear about most often is that it helps with constipation. If your stool is hard and dry (making you constipated), fiber pulls water into the stool making it softer and bulkier which helps you to go. If you stools are loose, gooey or sticky, the fiber may help to solidify the stool. Fiber is also a great help if you are trying to lose weight. Fiber makes you feel full longer, decreases calorie absorption from other food that you eat at the same time and helps to stabilize glucose levels. Fiber has also been shown to decrease cholesterol and likely helps to prevent colon cancer. Shoot for 30 to 60 gms/day, which you should get by eating whole grains, fruits and vegetables. Again, this is one of the things that you can easily track with your smart phone app. Like protein, carbs weigh in at 4 calories per gram. There are all kinds of great tasting carbs pasta, cereals, rice, breads and candies are what we always think of and those are great if you dont overindulge. Keep in mind though that the calories can add up pretty fast a plate of pasta at an Italian restaurant can have upwards of 1000 calories!


Wait! Who said we were limiting sugary carbs? WTF? I want my Hot Tamales, man. Ok, so refined sugars arent going to help you add muscle, and high sugar foods can have a big impact on people with diabetes or insulin resistance. However, if your weight is under control and as long as you keep an eye on your total caloric intake and ratio of macronutrients, youll probably be ok. Skittles, anyone? DR. DON SAYS: Keep in mind, however, that it is very easy to overindulge in carbs. Many processed foods have tons of carbs and tons of calories and you need to exercise caution when eating these types of foods. In fact, if you have elevated levels of fasting glucose or insulin, prediabetes or diabetes, you may want to cut back on carbs. This is something you should discuss with your physician. Fruits and vegetables are ideal sources of carbohydrates. Fruits and vegetables are loaded with phytochemicals and other nutrients that are believed to play a role in good health.

Try to get 9 servings of fruits and vegetables per day.

Therefore, you want to try to emphasize fruits and vegetables in your diet. Go for at least 9 servings of fruits and vegetables/day. Each serving is approximately cup. Phytochemicals why do I care? Phytochemicals are biologically active compounds that are found in plants. There are estimated to be over 10,000 different phytochemicals. The phytochemicals play different roles, but many are felt to be important in reducing inflammation and others are felt to be important in various metabolic pathways. Salicin is the chemical from which aspirin is derived and was extracted originally from the white willow bark tree. Phytochemicals likely play a strong role in reducing cancer and vascular diseases such as stroke and heart disease. Low-fat dairy products like milk and yogurt are also good sources of carbs, in addition to being good sources of protein. RECOMMENDED FOODS: Healthy Fish especially fish like salmon because it is high in the omega 3 fatty acids that have been shown to be really good for you. Lean Proteins help maintain muscle and help to keep you feeling full. Vegetables great low calorie, high fiber food with healthy phytochemicals. Fruits another great food source that is packed with fiber and phytochemicals. Green Tea contains a group of phytochemicals known as polyphenols that are felt to be beneficial in reducing inflammation and promoting health. Dark Chocolate (greater than 60% cacao) - packed with antioxidants and is believed to

contribute to cardiovascular health. It is high in calories and has saturated fat though so beware. We usually have 20 or 30 gms/night. Avocados contain healthy monounsaturated fats, high in fiber and potassium and have been shown to lower levels of LDL cholesterol and triglycerides. Olive Oil is high in healthy monounsaturated fats and antioxidants. Go for the extra virgin type that contains the highest levels of antioxidants. Nuts are an excellent source of healthy fat, plus they are rich in phytochemicals, fiber and antioxidants such as vitamin E and selenium. Dont overdo it though. Nuts are packed with calories. FOODS TO AVOID (or at least to eat only in limited quantities) Fried Foods high in unhealthy fats (often trans fats) and high in calories Foods containing trans fats and hydrogenated fats Sugary Sodas and Drinks including most fruit juices these drinks are packed with calories. Canned Soup too much sodium Processed Foods and Prepackaged Meals processed foods are frequently high in sodium and preservatives and the processing of the foods often robs them of their nutrients and important phytochemicals. Whenever possible eat whole foods to get the healthiest food. Eating whole foods that you cook yourself doesnt take all that much more time than eating shit out of a box or can and its a whole lot healthier.

DR. VAL SAYS: Why is drinking bad for your diet? IS drinking bad for your diet? The whole topic of alcohol consumption, what it does to metabolism and diet, and what you should do about it is enormous in scope. You could write a whole thesis on it we dont want you to get bogged down in the details either. Alcohol is fun, dammit! Plus, it has been shown to be beneficial (particularly red wine) in moderation. This is all about being a normal, real person, right? So our recommendation is to drink one or 2 servings, preferably red wine, a night. Can you have a beer? Hells to the yeah. Moderation, baby (one or 2). Just watch the calories sure, a Bud Light has 110 calories for a 12 oz. serving. But a Sierra Nevada

Bigfoot packs in 330! Knock back a few of those while youre watching the game and youve added a ton of calories.

One or two servings of red wine per day has been linked to better health. Don't overdo it though, as there is a law of diminishing returns!

While a little alcohol is a good thing, and a little more than that might sound like an excellent idea sometimes, there is no argument that too much can be detrimental to your health. In the short term, it can cause impairment in your coordination, judgment and thinking. While this CAN be amusing when it involves public pantslessness or dance floor disasters, driving while intoxicated is always the wrong decision. Plus, we frequently see injuries and fractures as a result of bar fights and drunken assaults. In the long term it can lead to addiction, liver disease, pancreatic disease, cardiovascular disease, neurologic impairment, cancer and other diseases.)

Dr. Don enjoys a cold one after cycling through southern Utah.

And speaking of DRINKING


What about water? You often hear that you should drink 8 glasses of water/day. I dont know many people that do that. Quite frankly, drinking tons of water makes me nauseated. Well, I have some good news. Every non-alcoholic drink that you consume

counts. Your goal is to have 5 relatively clear urinations per day. Drink a diet coke, low calorie beverages, coffee or tea or whatever you want. Every magazine article that you read saying that sodas, etc., dont contribute toward hydration is pure bullshit. Read the back of a can of coke. First ingredient? Water. Alcohol does not count in this category though since it is a mild diuretic and will make you a little dehydrated. DR. DON recalls being at Scout Camp with his kids several years ago. It was hot and humid. I remember the Scoutmaster and Camp Directors telling the kids: No soda or juice. You need to stay hydrated. The message came out over the loudspeakers: HEAT ALERT. STAY HYDRATED. NO SODA. DRINK ONLY WATER!!! WTF. This was wrong advice and your goal is to drink enough to have clear urinations. (Sugar free/low or no calorie beverages preferred).


Another myth I see propagated again and again (and sometimes by doctors) is that diet soda or the artificial sweeter sucralose somehow impairs fat metabolism. There have been NO studies that show this! There have been epidemiologic studies that have linked diet soda to type 2 diabetes and metabolic syndrome (which is a catchy moniker for the constellation of risk factors for vascular disease that include high blood pressure, central obesity, high triglycerides and blood sugar among other things). But there has been nothing established that shows a causative link. In other words, people who have these risk factors tend to drink diet soda, but there is no evidence that supports diet soda resulting in these problems. Instead, experts believe the link may be because these individuals overcompensate for the calories saved with diet soda and think they can eat more of something else, or that these individuals drink more diet soda as part of an attempt to control weight. Similarly, studies have shown that drinking an artificially sweetened soda doesnt cause a significant change in insulin levels as compared with carbonated water. Will you find someone who ADAMANTLY disagrees with us on this? Of course. Someone who SWEARS their (mother, great aunt, guy at the club) had something adverse happen to them. There are also people who swear that Elvis is alive and people who think Britney can sing. You have to know your source. SUPPLEMENTS We are not going to go into detail on supplements in this book. Check out our web site and our Guide to Healthy Eating for more advice.

However, there is one supplement that has been shown to have so many positive benefits, that almost EVERYBODY should be taking it. If you could take a supplement that helped reduce inflammation throughout the body, helped reduce heart disease, lower cholesterol and triglycerides, helped to prevent some kinds of cancer, helped reduce the risk of depression and gave you healthier skin, WHY WOULD YOU NOT? You need to be taking fish oil supplements. Fish oil contains the omega-3 fatty acids eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) which are precursors of the eicosanoids that are known to reduce inflammation throughout the body. We recommend a dose of between 1.8 to 3 gms/day of the active ingredients EPA and DHA. You will usually need to look at the back of the bottle to figure out how much EPA and DPA is within the supplement, since the front of the bottle will list the total amount of fish oil per dose and not the amount of EPA and DHA.

Fish oil capsules. They may be big, but they're worth the trouble. FYI if you have issues with the giant fish oil capsules, you can also get it in a liquid form. MICRONUTRIENTS Micronutrients are nutrients required for a range of functions in your body that you cannot yourself produce. Vitamins and minerals fall under this category. While most people in developed countries probably get enough vitamins and minerals through the food they eat, many people do not. Therefore we also recommend a multivitamin every day as a way to make sure that you are not deficient in the micronutrients. VITAMIN D Many people are deficient in vitamin D, and therefore, we recommend that you have your

blood level checked. If you are low in vitamin D, then you need to take a supplement. MYTHS Things that get repeated enough, even when wrong, have a way of seeping into the conventional wisdom of society. Flat Earth ring a bell? 6 meals a day myth There is a common belief that you need to eat frequent small meals to keep your metabolism revved up. Not true. Your metabolism does not slow down in a matter of hours. You can eat when you want to eat. It comes down to the number of calories consumed, not how frequently you eat during the day. Protein damages your kidneys Not true. Eating fat makes you fat. Not true. Eating too many total calories makes you fat. If I exercise, I can eat what I want. Exercise does increase the number of calories you burn, but not nearly as much as most people think. A 30-minute workout does not equal a cheeseburger. Late Night Snacks cause weight gain. Nope. Count and track. If you are eating 2100 calories a day, its 9pm and you have 400 left? Eat up. Diet soda impairs fat metabolism. No link. See above. If you cross your eyes, theyll get stuck. YOU CAN DO IT This may all sound difficult, but it is actually very easy once you start to do it. If you want to eat healthy but still enjoy eating out and doing normal things, you need to keep track of what you eat. A great way to stay motivated is to find a friend or family member to participate in the plan with you. You can make a wager out of it with your friend. A workout and diet buddy provides motivation and moral support. Forty-five minutes on the stair climber goes much faster when youve got someone hanging out with you. And when everyone else is telling you, oh cmon man, just order the fries, they will be there to say, nah were both gonna stick with the vegetables instead. You can share ideas and recipes as well as sharing your success.


For a printable worksheet to help you calculate your calories and macros go to our website A. Calculate your maintenance calories. 14 16 calories/day/ multiplied by your weight (lbs.) to maintain your current weight 10 12 calories/day/ multiplied by your weight (lbs.) if you want to lose weight. B. Calculate your protein requirements. 1). Get a rough estimate of your body fat percentage using the YMCA formula: Male body fat % = (-98.42 + (4.15 * waist circumference in inches) (.082 * weight in lbs.)/weight in lbs. = Female body fat % = (-76.76 + (4.15 * waist circumference in inches) (.082 * weight in lbs.)/weight in lbs. = 2). Lean Body Mass = Multiply your weight by (1 body fat %) 3). Grams of protein to eat/day = Multiply your lean body mass by 1.2 (you can go slightly higher or lower on this number depending upon your goals as discussed in the main chapter.) 4). # of calories from protein/day = # of grams of protein/day x 4. C. Determine Fat Calories 1). Fat calories = Total calories/day multiplied by 0.3 2). # of grams fat to eat/day = Fat calories/9 = D. To determine carbohydrate intake: 1). Calories from carbs = Total calories calories from protein calories from fat 2). # of grams carbs to eat/day = calories from carbs/4 E. Track to make sure that the number of calories/day that you are actually consuming is allowing you to meet your goals. If you are on a maintenance diet and you are either gaining or losing weight, adjust your calories down or up respectively to maintain your weight. Similarly, if you are trying to lose weight, make sure that the number of calories you are consuming/day is allowing you to lose weight. You may see a quick drop initially, but the goal is 1 to 2 pounds/week after that.

F. Recalculate monthly if you are on a weight loss program as the numbers will change as you lose weight. G. Track your calories and macronutrients with your smart phone app to see where you are. H. The most important things to track are the total calories and the amount of protein/day. Make sure to track these things and try to come close to your total calorie and protein requirements. Fats and carbs are less important to track, but it is very easy to track them as well.


Many studies have shown that too much or too little sleep is detrimental to health and longevity. Most studies show that sleeping about 7 hours per day is ideal. It is our recommendation to sleep about 6 to 8 hours per day for ideal health. Naps count. If you nap, it is best to nap for a period of only 10 to 45 minutes. Otherwise, you are too groggy when you try to get back up and a longer nap can also interfere with sleeping at night. If you are feeling tired during the day though, a short nap can help you to feel better and give you more energy. Plus, some studies have correlated adequate sleep with increased leptin (a hormone that suppresses your appetite) and decreased ghrelin (a hormone that makes you hungry). Occasional problems sleeping are normal and nothing to worry about. If you suffer from chronic insomnia (trouble falling asleep, staying asleep, or waking up too early and not being able to fall back asleep) there are some things you can do to try to help. First of all, analyze the problem. Why do you think you are having problems sleeping? Are you stressed? Are you depressed? Do you have poor sleep habits? Are you overweight? Do you have pain or discomfort at night? Are you on medications that might interfere with sleep? In other words try to figure out why you are not sleeping. If you can pinpoint a particular problem perhaps you can fix the issue. If you have trouble sleeping, we have some recommendations listed below that may help. If these things do not help, and you continue to have ongoing sleep problems, it may be advisable to see your physician. Make sure your room is dark, quiet and cool. Blackout shades, eye masks and white noise machines can help to block out light and background noise if necessary. Avoid large meals late in the day. Avoid caffeine after lunchtime. Avoid alcohol late in the day. While alcohol can make you feel sleepy, it interferes with the quality of your sleep. Do not smoke.

Avoid stimulating activity and stressful situations before bedtime. We recommend not working out vigorously at least 4 hours before bedtime. It may help to avoid TV, video games and computer use just prior to bed. Read a book before bed. Relaxation techniques such as deep breathing exercises or progressive muscle relaxation may help if you are stressed. Many people find a warm bath relaxing and find that it helps them to sleep. Dr. Don hates warm baths before bed I like a nice cold bed. If I am hot, I cant sleep. Turn clocks so that you cannot see the time or the glow from the digital display while you are in bed. We have found this to be a common problem in hotel rooms. Get rid of the ticking alarm clock. Let your natural biological clock work for you. Establish a routine. Support your biological clock by going to bed at the same time every night and waking up at the same time every morning. Melatonin is a hormone produced in your brain that helps to regulate the sleep wake cycle. Melatonin is controlled by light exposure. Not enough light during the day can make you feel sleepy at the wrong time and too much light at night can suppress melatonin and make it harder to sleep. Increase light exposure during the day (Take breaks outside during the day and open blinds and curtains during the day) and decrease light exposure at night (use low wattage bulbs, avoid bright TV and computer screens at least one hour before bed and make your bedroom dark). Avoid naps if you have chronic sleep problems. If you nap (especially for too long) you will not be sleepy when it is time to go to bed. Use the bed only for sleeping or sex. Dont get stressed if you are having trouble falling asleep. If you dont sleep so well one night you can make up for it the next night. In fact, as physicians in our old jobs, we were often up for over 36 hours at a time. Nothing feels better than being super tired and finally letting your head hit the pillow. Maintain an ideal weight. Being overweight is a common cause of sleep apnea, a condition characterized by abnormal pauses in breathing during sleep. It can cause insomnia or cause sleepiness during the day. See your doctor if you have snoring loud enough to disturb others or yourself, shortness of breath that awakens you from sleep, intermittent pauses in your breathing during sleep or if you have excessive daytime drowsiness.

Work out every day. It will help your sleep. Melatonin, as we discussed above, is produced by the body to help with the sleep cycle. It can also be purchased in pill form over the counter and used as a sleep supplement. Studies have not been done to determine the ideal dose. Ranges we have seen reported as being beneficial range from 0.1mg up to 10mg. If you want to try melatonin as a sleep aid start with a low dose like 1mg for a few nights and see if it helps. If not, go up a bit on the dose until you decide if it is worth taking or not. We are generally against prescription sleeping pills, but if used sparingly for short-term situations they can be helpful. For example, they may be helpful when traveling across multiple time zones or after surgical procedures. Make sure you have enough time to get a full 7 to 8 hours of sleep after you take them though. Also be aware that there may be side effects.


I once took a sleeping pill on the airplane while traveling to Thailand. I slept well on the plane (at least as well as one can sleep sitting up on an airplane), but was still super drowsy when I arrived mainly from the lingering effects of the sleeping pill. The sad part though is that I dont even remember the first 2 days of the trip as one of the side effects can be amnesia. DR. VAL SAYS we had fun.


It was a race to the top of the hill. But it was not just any hill. It was an 11-mile long hill to the top of Mount Figueroa just outside of St. Ynez in the Central California wine country. It is the same hill that we were told Lance Armstrong had trained on before some of his big races. It was ridiculously steep in parts. Nothing for the faint of heart.

The Docs conquer Mt. Fig.

But we did it. It took standing up on the bike in places pushing as hard as you could just to get the wheel to turn, but we did it. And it was fun! And the reason we could do it and it was fun is because we are fit. We work out almost every day. HABIT. Like brushing your teeth. It is something you need to try to do every day. YOU NEED TO BE FIT. You will feel better, look better and you will have more fun. It is part of being healthy, living longer and staying active until you are old. You will have a lower heart rate, lower blood pressure, lower cholesterol level and decreased inflammatory cells. Who knows, the girls may even come on to you!

Sadly, as many people age they lose the ability to adequately take care of themselves.

The goal is to function at a high level throughout life.

If you are young and healthy, you want to stay healthy and functional. One of the keys is fitness. If you are older and not as healthy you can make things better.

Even if you are not in great shape now, you can make things better. Get started today.

What does it take to be fit? To be the best at any sport, it takes sport-specific training and years of practice. But we are not talking about that the scouts arent looking for you, sorry. We are talking about general all-around fitness. You can be good at a lot of different sports if you are fit. You can play some pick-up with your friends, try out surfing when you are in Hawaii or climb a volcano in Costa Rica and not have to worry that you arent gonna make it. We think this is a healthier, and certainly a more realistic approach.

The Docs' first time surfing

Of course, if you are really into a specific sport and want to be really good at it, you need to train for that sport. We think the best overall fitness requires: CARDIO TRAINING to include INTERVAL TRAINING STRENGTH TRAINING FLEXIBILITY BALANCE Our recommendations for most people are: 30 60 minutes of cardio 3 or 4x/week depending on your level of fitness the above cardio might include interval training 1-2x/week 30 60 minutes of strength training 2 or 3x/week. Stretching is incorporated into the pre and post workout. Balance is incorporated into the other movements. We understand it may be difficult to find time to work out this much. Do the best that you can. Trust us, its worth finding the time. CARDIO TRAINING You absolutely need cardio training. The major benefits are better heart health and longevity. You will feel better and live longer. You need to tailor it to your ability. If you are overweight or in poor health start slow. Walk. Obviously if you are young and healthy, you can do much more. You can double check that you are exercising at an appropriate level of exertion by monitoring your heart rate. You can check your pulse or use a heart rate monitor.

The traditional formula used to monitor your heart rate is 220 minus your age. However, this is only a rough estimate and your maximum heart rate could be as much as 20 beats per minute faster or slower than what the formula tells you. The formulas to calculate maximum heart rate are only estimates, so you need to keep this in mind. For example, if you are 40 years old, your maximum heart rate would be approximately 180 and the 70 to 85% zone would be 126 to 153 (plus or minus 20 beats per minute). There are different levels of cardio: Light cardio is an exercise that can be performed for a long time at a slow pace (up to about 65% of your maximum heart rate). It is good for endurance, burning fat, and overall health and peace of mind. Who doesnt love a walk along the beach, a hike to a favorite lake or a nice bike ride through the country. We live about 3 miles from the San Diego zoo and like to walk up there once or twice a month. Dr. Don is especially fond of this because he loves the soft ice cream at the zoo and uses that as his reward!! If you are not fit, this is definitely the way to start. It is the kind of exercise you can keep up for hours at a time. Moderate cardio is more intense exercise. It is the type of exercise you usually think about when you think cardio or aerobic exercise. You want to aim for 70 to 85% of your maximum heart rate to see the best benefits. We recommend this range for most of your cardio. It will make you stronger, faster, more energetic and you will feel much better. (At least after you are done.) You should aim for 2 or 3x/week.

Add cardio to your routine 2-4 times/week.

High intensity cardio takes the intensity up another notch. Its also known as anaerobic exercise because you deplete the oxygen in your muscles and use non-oxygen dependent

pathways to generate energy. You can only perform this type of exercise in very brief spurts maybe a few seconds up to 2 minutes max. Its a fantastic way to get into peak shape. We recommend this type of activity occasionally ideally, one of your weekly cardio sessions should be high intensity. Sprints or intervals on the stairs are good ways to get intense in a hurry.

What goes upmust come down.

INTERVAL TRAINING Interval training is a type of cardiovascular workout that mixes bursts of high intensity work with rest periods. You often read about High-Intensity Interval Training (HIIT) in the fitness magazines these days. Unfortunately, a lot of what they offer up as HIIT, doesnt really fit the bill. True HIIT should be 30 60 seconds of intense exercise (think 75 100% of your maximum intensity) followed by 30 90 seconds of rest, or of low intensity exercise. The magazines also tell you what a great calorie burner interval training is but surprise, its not that simple! Ok if you are only going to do 15 to 20 minutes of cardio, you might actually burn more calories with intervals. But, as we mentioned above, you have to do it right with maximum effort. You can get more bang for your buck in a shorter time period. But, we arent talking about melting away the calories its the difference in just a handful of calories. Plus, done right, its a hell of a lot harder! For longer periods of exercise, (45 to 60 minutes) you will actually burn more overall calories doing steady-state cardio. So why drag your ass up the stairs 10 times? The benefit of interval training is that helps to increase fat oxidation (i.e. fat burning), its a good conditioning exercise and it can break up the monotony of your other cardio sessions. You really have to push yourself to see a true benefit from interval training. If youre going to half-ass it, stick to half-assing steady-state cardio. Youll see a greater overall calorie burn.

Many researchers have shown that this type of exercise may be equivalent in cardiovascular benefit to more prolonged but less strenuous training. Examples: 5 minute warm up 30 to 60 second interval of high intensity pedaling on the stationary bike, at the highest level that you can maintain, followed by a 60 second low intensity rest period, bringing the resistance back down to a more gentle speed (repeated 6 to 10 times) 5 minute cool down Even more extreme is High Intensity Interval Training (HIIT) that might consist of : Warm up with stretches and to speed sprints 10 to 20 second all out sprints followed by a walk back to the starting line with a brief rest. (repeat 5 to 8 times) Cool down We love to go down to the San Diego Convention Center and run the stairs about 80 stairs in total. We warm up by vigorously walking or jogging down to the Convention Center and then run up the stairs as fast as we can, walking down, and repeating about 10 times. FANTASTIC!! Whats really impressive is when we see the firemen come and run the stairs with their tanks on their backs. Rock on, guys!

Dr. Don using stairs for HIIT

We like to use interval training for one of our workouts each week. At a maximum, intervals should only be done twice a week. Like everything moderation is key! More isnt better. Its just more.

If you cant get formal workouts in every day, do what you can. It all helps. Start taking the stairs instead of the elevator. (It always really annoys us when some out-of-shape slob gets on the elevator and then goes up 1 floor). Dont use the elevator if you only need to go up a couple of floors. TAKE THE STAIRS. If all you can manage is a Saturday morning Zumba class, DO IT!! Its a start. Quit being a lazy ass and looking for the parking spot closest to the door. PARK IT AND WALK.


At the hospital where I used to work, there was a woman I saw every morning in the gym. She came 5 days a week to walk briskly around the track for about an hour. And then she would get in her car, drive to a handicap spot 10 feet from the entrance of the hospital and go to work. Now, before you go accusing me of being insensitive to people with physical handicaps, I overheard her saying that she had a disabled permit because of her chronic lung disease and difficulty breathing. WTF? She didnt seem to have much difficulty during her workout. Save the spot for someone who needs it. Unless you are training for a specific event, mix it up. You want to do different things so that you are not constantly pounding the same joints. We love running, but it is not something that most people can do day in and day out for their entire lives. Good exercises include incline walking (walking on an inclined treadmill), stair machines, cycling, swimming or the elliptical. We recommend warming up by starting slow and building up gradually to full speed. Simple. Ideally, the cool down is the time to stretch because your muscles are warmed up. You will want to do some stretches for the muscles you worked.

Rectus femoris stretch after running the stairs.

GO HEAVY OR GO HOME! Strength Training!!! The benefit being able to do what you want to do at any age. The older you get the more you need this. It helps prevent osteoporosis, helps to keep muscles toned and protects your joints. Hmmm, maybe younger guys really need this too. How many people do you know, young people, who have had knee surgery? No guarantees, but it will help. Plus if you really want to look good RIPPED - you need strength training. Hit the gym 2 or 3 x/week. The primary goal of strength training is obviously to get stronger. The benefits are numerous if done correctly. Stronger bones, stronger ligaments and tendons, healthier joints, (yes this will help you if you have arthritis), less chance of injury to your joints/knees/shoulders, etc., better tone, better posture and therefore less back problems.

Dr. Don doing curls. Strength training is critical.

Strength training can also mean body sculpting. Can you spot reduce the fat off your abs or the back of your arms? NO! Can you try and build better deltoids to increase the size and definition of your shoulders or pecs to increase the size of your chest? Absolutely. Plus with improved muscle tone you will look way better.

If you look pretty while lifting, you aren't working hard enough.

The myth of bulking:

I hear people, mostly women, say they dont want to lift weights because they dont want to bulk up. Give me a break. First, show me a woman that bulked up and Ill show you a woman who put on fat and thought it was muscle. Testosterone is the hormone that allows men to build muscle. Women have a small amount, but lack the necessary amount of testosterone to really add significant size. If you need proof, look at any of the professional figure athletes who try to build muscle. They work at it like a full-time job, some of them lifting weights over 20 hrs a week, and choking down protein powder like its going out of style. And they still end up looking lean, not bulky. End of story.

Bulky? You be the judge.

You need to do it correctly. If you dont have the right form, you arent working the right muscle and can actually be doing more damage than good. The best way to do this is to get a good trainer. Somebody who can show you how to do it properly, tailor your workout and correct your mistakes. You think you know your way around the gym? Even Phil Mickelson needs a golf coach, so you can probably use a trainer.


If you are paying a trainer and his idea of training is watching you on the step mill or bicycle for 30 minutes, find another trainer. I see this ALL THE TIME at my gym and it blows my mind. You can handle it on your own after your session. Also, if your trainer isnt buff and in absolutely fantastic shape, find another one. It would be like going to a dermatologist with zits. Technique is incredibly important for several reasons. 1. You want to avoid injury. 2. You want to train the proper muscle or muscle group. 3. You want to achieve the proper balance. While most guys concentrate on the glamour muscles -- chest and biceps -- you also need to work even harder on the less glamorous muscles such as the rhomboids (muscles in the upper back) and serratus anterior (muscles along your sides). These muscles help not only with strength, but stability and will contribute to your overall health and athleticism. 4. Your posture will improve, you will be less prone to injury and you will feel much better. Most adults have back pain. Many times, the problem is muscle imbalance. Proper training can alleviate back pain in many, many people. Learn to do it right. Sadly, even a lot of physicians dont understand that back pain is frequently a result of muscle imbalance, strain or spasm. The problem with this is twofold. First, they arent going to get you the right kind of help or treatment that you need to alleviate your problem. Second, people with back pain often get imaging such as CT scans or MRIs as part of their initial workup. However, there are a lot of things that we as physicians can find as incidental findings (things that are seen on a CT or MRI that have nothing to do with your current complaint) that could be erroneously interpreted as the offending agent. For example you might have a bulging disk in your spine that isnt actually causing you any problems at all. But you have back pain. 2 + 2 = 4. You get treatment for a disk, just because it was there. Another great example, Dr. Vals mom was recently complaining about leg pain. An MRI of the lumbar spine, hip and knee were ordered by her physician for evaluation. The studies revealed a small tear in the cartilage in the hip joint of the OPPOSITE leg. This incidental finding led her doctor to believe maybe because of the tear, she was favoring the other leg causing it to hurt. He then referred her to an orthopedic surgeon. In the meantime, she sent Val the films and told her about her pain. Dr. Val thought it highly

unlikely that the hip was the problem her symptoms sounded more like Iliotibial Band Syndrome (a common complaint) and instead suggested she see a physical therapist. Voila! After 4 weeks of PT, the pain was gone. The moral of this story? Many abnormalities visualized on imaging tests are asymptomatic and not causing you a problem. Before undertaking radical procedures to fix musculoskeletal problems like this, you may want to get a second opinion. GUESS WHAT You will not be fit in 10 minutes a day. You will not get rock-hard abs while watching TV. If someone tells you that, they are lying. If you believe that, youre an idiot. You need to work hard and consistently to get fit, especially early on. Warm up to loosen up the joints so that you are flexible enough to use proper technique. Also start with a light set before going heavier. Cool down stretch the muscles you have been working. FLEXIBILITY Flexibility is Dr. Dons least favorite component. Like a lot of guys, he is really tight. Women are naturally more flexible. We incorporate stretches into our warm-ups and cool downs. If you have spare time or really have a problem with your flexibility, it might be worth it to devote a little more time to stretching. BALANCE We try to incorporate balance into the flexibility training and weight training. works on balancing her margarita glass so that she doesnt spill. NUTRITION Peri-workout nutrition (nutritional requirements before, during and after the workout) is an important topic that we will discuss in our GDBD Guide to Healthy Eating chapter. Dr. Val

Rocks with salt, please

POSTURE Posture may seem out of place in this chapter, but it has more to do with fitness than you might think. Bad posture isnt just bad manners or laziness. It can reflect a muscle imbalance. You hear you should sit up straight, keep your spine aligned and your shoulders back. Sounds good in theory, but guess what, how often do you see people do it. RARE. It is because in most people, front muscles are dominant. Our back muscles are weak. If you want to look better, have better posture and have less chance of developing back pain or if you need to improve your back pain, you need to strengthen your posterior muscle bundles. DO IT. You need it. You will feel better, trust us. At a recent body building competition in LA, we noticed that a lot of the male competitors in the physique category had phenomenal bodies but horrendous posture. Heads down, shoulders slumped, rounded backs essentially hiding the pecs and abs! So why bust your ass in the gym and not really show off the fantastic body that youve built? Stand up and get noticed! A WORD OF CAUTION We sincerely hope that this book lights a fire under your ass to get you out of your La-zboy and into the gym. But understand your limitations. Recently, while Val was lifting at our gym, someone ran in asking if anyone was a doctor. A man was unconscious on the leg press. Other members lifted him onto the floor where she then checked for breathing and a pulse. She started CPR and used the gyms AED (Automated external defibrillator). To make a long story short he died, likely of a heart attack. As it turns out, he was a tourist, visiting from Arizona, just stopping to get in a workout. He was older, around 60, overweight and obviously a smoker. The take home message from this is NOT hey Im gonna die anyway, so leave me alone, but rather if

you are overweight, older, and/or have other risk factors for cardiovascular disease, be sure to check with your physician prior to starting ANY exercise program.


What you dont tell the doctor, the doctor doesnt know.

Take 2 and call us in the morning.

Should you see the doctor? It is a good idea to see the doctor occasionally even if you are healthy. The doctor can: Screen for diseases or problems such as high blood pressure or high cholesterol Update vaccinations Get to know you so that when you really need him/her you have a doctor you know and trust to care for you. Advise you on additional preventative measures you could be taking Age Specific Guidelines Age 18 45 Testicular self-exam monthly. Seriously. Feel your nuts for lumps or masses. Do one side at a time preferably after a hot shower. We recommended this for men 18 35, anyone with history of testicular cancer or family history of testicular cancer, or anyone with a previously undescended testicle (one in the groin, not in the scrotal sac). Most lumps or masses are benign, but if you find one, you should see your physician as soon as possible. Additionally, if you have a sudden onset of severe pain in your testicle, you should see a doctor immediately as this can be a sign of a medical emergency. Unless of course it was preceded by a swift kick to

the crotch, in which case youll probably be ok. In about 15 minutes. Flu shot yearly. (The CDC recommends that everyone over 6 months of age with rare exceptions get a yearly flu shot.) They are usually available in the fall. Visit your doc for: Height and Weight Physical exam every 2 or 3 years BP Screening every 2 years if healthy Cholesterol Screening every 5 years if at normal levels Immunizations tetanus-diphtheria booster every 10 years Eye Exam every 2 years if you have vision problems or wear corrective lenses Yearly dental checkup with cleaning 2x/year. Our dentist advocates cleaning 3 4 times a year. Most people dont realize that the health of your teeth and gums can be directly related to the health of the rest of your body. Inflamed teeth or gums result in an inflammatory state, as discussed previously, that can affect the heart, blood vessels and your entire body. Age 45 65 Visit your doc for: Height and Weight Physical Examination every 1 or 2 years BP Yearly Cholesterol screening every 1 or 2 years if within a normal range. Colon cancer screening with colonoscopy beginning at age 45 to 50 Prostate Exam yearly beginning at 45 to 50 Osteoporosis Screening depending on risk factors Immunizations Flu Vaccine yearly Pneumococcal Vaccine discuss with doctor Tetanus-Diphtheria booster every 10 years Shingles/herpes zoster vaccine once after age 60 Eye exam every one or 2 years even if you do not have eye problems. Need to have exams done to check for glaucoma, which should be part of any routine eye exam Dental exam once/year and cleaning at least twice/year


Dr. Don was less than enthusiastic about having a prostate exam at age 45. At his yearly

physical, his physician (also a friend of mine) said, well, do you want me to do a prostate exam? Don said, No, but Val will kill me if you dont. To which the doctor replied, yeah, and shell kill me too. Dr. Dons fear of prostate exams is not entirely unfounded. However When he was a medical student, he was told by the resident to go into the exam room and perform a comprehensive exam, including a prostate exam. Don gloved up and asked the patient to assume the position. Man, did he have trouble trying to insert his finger into the guys anus! The patient was yelling (Don specifically remembers the little hairs getting stuck on the glove and pulling) but finally, mission accomplished! He went back to the resident and recounted the story and told him about the difficulty he had. The resident physician said, You used lube, right? Right??? Age 65 and older: Visit your doc for: Height and Weight Physical exam yearly BP yearly Cholesterol every 1 or 2 years Colon cancer screening Abdominal aortic aneurysm screening at least once Prostate screening Osteoporosis screening with a DEXA exam at least once over age 70 Immunizations: o Pneumococcal vaccine o Flu shot yearly o Tetanus-diphtheria booster every 10 years o Shingles/herpes zoster vaccine if you have not had one Eye exam yearly with glaucoma checks Hearing exam yearly Dental exams yearly and cleaning at least 2x/year LALALALA I CANT HEAR YOU SYMPTOMS AND SIGNS NOT TO IGNORE Symptoms that may require immediate attention (Go to the ER): Chest Pain Shortness of Breath Weakness, dizziness, vision changes, confusion

Severe sudden headache Severe abdominal pain Severe trauma and burns Symptoms that need fairly prompt evaluation: Persistent high fever Unexplained weight loss Blood in your stool New lumps or bumps Dark colored or pigmented skin lesions that are new or growing If you think something is wrong, trust your gut and get it checked.



Im judging you. Thats right. I probably shouldnt be, but I am. If you just walked into the bar or the meeting and you are unkempt, scruffy or wearing clothing that doesnt fit, some people have already disregarded you as a potential date or hook up. This applies to boardrooms and job interviews as well. I know a lot of men who believe that their CV speaks for itself, but you need to trust me on this one. It doesnt. Women and men alike are making a judgment call on your intelligence, your income and your education based on your appearance. This is the old you never get a second chance to make a first impression argument comes into play. But its worse than you think you could even have rolled up in your Mercedes SLK, but if you get out of your car wearing dad-jeans, the ladies are going to assume that you are neither very hip nor very fun. So, does this mean you need to drop a small fortune on your wardrobe and show up in your Armani jacket? Not necessarily. Start with clothing that fits. Sounds basic, but youd be surprised how many men are wearing stuff thats not suited for them. Most egregious offenders? Pants that are too short. Kills us every time For the underinformed (if you arent a clothes horse or dont follow Fashion Week, this probably means you), a medium break is probably the best choice for you. Thats all you need to tell the tailor. This will have your pants hitting mid way between the top of your dress shoe and the top of your sole. Shirts that are too big, usually but not limited to T-shirts. No you probably arent an XL. If you are, go back to the chapter on diet and read it again. Buy a shirt that fits. Your shoulder seam should be ON your shoulder, not 2 inches below it or halfway to your elbow. Heres the before

Note Dr. Don's XL shirt and Dad-pants.

and heres the after.

Now THAT'S what I'm talking about

Hopefully you have at least one nice sports jacket in your arsenal. If not, invest in one that you can dress up or dress down with jeans. Spend the extra cash and get someone who knows what they are doing to tailor it to fit you. You dont want to look like a kid borrowing his dads jacket, nor do you want to look like you are stuffed into a sausage casing. Which brings us to another point. If you have a really nice jacket or suit that youve been carting around for years because you spent a lot of money on it, turn a critical eye to it. Does it still fit? Is it still in style? Probably neither. Donate it and come to terms with the fact that you no longer fit into the suit you bought for medical school interviews (We meant law school. Or business school. Dr. Don wouldnt be guilty of that, right?) Lastly, if you are wearing running shoes outside of the gym, think again. If you are doing something active like playing Frisbee in the park or taking a long walk or hike, you are forgiven. If you are drinking beers and watching the game, pushing a shopping cart at Costco or touring Paris by foot, find a more suitable alternative that proves you dont have your head up your ass. Even a pair of Converse sneakers or slip-on Toms would be a big improvement. Nothing says suburbia like a guy in dad-jeans with running shoes. Its like

proclaiming to the world that you only have sex once a week. If youre lucky. If you think this describes you, or worse still, if you DONT think it describes you, but someone else mightask for some guidance. Swallow your pride and ASK a female friend or co-worker (or gay guy) to serve as an ad-hoc appearance coach. Preferably, this individual would represent the age group and demographic profile you are trying to, uh, penetrate. The reality is, a lot of guys have no clue when it comes to style and appearance and could probably benefit from a womans perspective. FACE IT There is a huge industry based on skin care. Although women are the primary target, you guys should pay attention too. Use a moisturizer on your face daily, preferably one with SPF. It will help keep you looking younger longer, not only from the moisture but also by protecting your skin from harmful UV light that will age you prematurely. Speaking of the sun, if you really want to look good when you get older, try to avoid the sun and always use a broad-spectrum sunscreen. While were at it, dont forget your shades. Its not just a fashion statement. Protect your eyes from the UV rays and prevent crows feet formation from squinting. We dont expect any man reading this to go get a facial, although its not a bad idea. But, DO pay attention to zits and blackheads. We notice them on sales clerks, wait staff and on plenty of patients, so believe us your date sees it too. We are here to encourage you to do it, particularly if you are going to be sitting across from us at dinner. Similarly, a lot of men suffer from folliculitis in their stubble. Pustules (zits) form from an infection of the hair follicle from normal skin bacteria or more uncommonly a fungus. You can also have pseudo-folliculitis from ingrown hairs. This can be remedied by using an electric razor rather than a blade, or by massaging your skin with a warm washcloth prior to shaving. This usually will go away on its own, but can require antibiotics or antifungal medications. If you have a persistent problem with any of these things, go see a dermatologist. Lastly, exfoliation isnt just for women. Get some facial exfoliator and keep it in the shower. You dont need to tell anyone. Little bits of dry skin are pretty gnarly. Dr. Val used to work with a guy who always dressed to the nines, but had dry skin and little flaky bits all over his forehead. Yuck. BACK TO BASICS We shouldnt even have to tell you this, but for Gods sake, brush and floss. We knew a physician who was so scatterbrained he had to tie his toothbrush to the doorframe so that

he would run into it on his way out the door. Halitosis can make the best looking man or woman downright unfuckable. It may be as a result of negligent brushing or flossing, but it might also be due to bacteria growing on the base of your tongue. If you know you have bad breath and cant seem to cure it with brushing, consider a tongue-scraper. If you arent sure ASK someone. Youve got a buddy you can ask, right? Even your best friends girl, or your sister. Your dentist or hygienist can also help you out, and may have other recommendations. Speaking of, if you arent seeing your dentist regularly, you need to be. You should have your teeth cleaned at least 2 times a year. Personally, we hate going to the dentist and can think of better things on which to spend the money. But dental health (including your gums, etc) is paramount to the health of the rest of your body. The inflammation from chromic dental disease or periodontal disease contributes to inflammation that contributes to heart disease, stroke, and cancer. Additionally, if you have smoldering dental infections, the bacteria can spread to your heart, your spine or your brain. Finally, yellow teeth are not cool. There are plenty of good teeth whiteners on the market. If you need to whiten your teeth see your dentist or use one of the commercially available products. ITS GETTING HAIRY Ok we promised and we will deliver. Excess hair is a problem. This goes back to looking like you dont care, or worse still, looking like you arent clean. The dreaded unibrow. Nobody, and we mean NOBODY rocks this look. Either tweeze or get it waxed. Additionally, as you get older, your eyebrows (along with a lot of other hair) will grow to unfathomable lengths. Think Walter Matthau. They need to be trimmed. One day youre going to look in the mirror and see your granddad if you dont pay attention to this stuff. And if your date wakes up next to Walter Matthau, thats going to be a problem. You need to be conscious of and trim your ear hair (this means inside and along the pinna which is the big cartilaginous disk part) and your nose hair. Whoever cuts your hair should trim/shave the hair on the back of your neck and on your ears. If they dont, ask them to. Nose hair is distracting if someone is talking to you and you have protruding nose hair, we guarantee they arent thinking about what you are saying. They are looking at your nose hair. Buy a trimmer. Use it once a month, minimum.


Body hair is controversial. I myself like a guy with some body hair it means virility, maturity, etc. I dont want to sleep with Justin Bieber. But like anything, you gotta keep it under control. Groomers are available with variable attachments so that you can choose your length. And as for the balls? Yes, shave them. Its not just for the gays. First, shaving your nuts and trimming your pubic hair and particularly the hair at the base of the shaft makes your penis look longer. Bonus! Plus, if you get lucky enough to have a wife/GF/hook up who likes to give you oral, its a complete deal breaker to get down there and find a forest. Its just like cleaning up your living room before she comes over make it look nice and smell good, K? Hair traps odor, which wont help your cause. Plus, trying to pick hair out of the back of your throat doesnt make us want to come back for seconds.

Phallic symbols are common in rural Bhutan. They could use some man-scaping.


Insider Tip: If you are going to be doing anything where you get a little sweaty, remember the antichafing powder or cream. You dont want your balls sticking to your leg like a bare ass on hot vinyl. SWEET SMELL OF SUCCESS It seems like a no-brainer (Ms Max had to talk to our 7th grade class about it, but I thought by now wed all have it figured out) but for Gods sake shower and wear deodorant. We worked with a physician whose funk was so funky, there was actually dialog about who was going to have to confront him about it. Of course, the other side of the coin can be just as bad. Another physician at the same hospital wore so much cologne that you could walk down an empty hallway and know that hed been there.

KEEP IT UNDER WRAPS This is a public service announcement. If you are sporting man-boobs, love handles, muffin top, bad tattoos, bad skin or excess body hair alone or in any combination, think twice before taking off your shirt. There are really very few venues that are appropriate for shirtlessness, and those usually involve water or sex. If you are walking your dog, moving a sofa, riding your bike or lifting at the gym, just keep it on. Again unless you are really sporting a great physique, taking off your shirt is only going to detract points from your overall score. A manicure doesnt make you a princess, but if the tiara fits. If you cant adequately trim and shape your nails (or remember to do so) pay someone else to do it. Its really not a bad experience. Well-groomed nails may not get you noticed, but snaggle-toothed toenails in your flip-flops sure as hell will. And if you scratch a chick with your machete-shaped big toenail while in bed, shes gonna remember it. And like I said, were all judging you.


All lightness and frivolity aside, this is a book written to address some really important topics that we feel dont receive enough attention. One topic that really gets ignored is safety. There are certain things that seem fraught with risk hang-gliding, chain saws, diving into the shallow end of the pool. In fact, youd be surprised by the amount of stupid shit that we see in our jobs on a day-to-day basis. Like the guy who shoved a rubber ball up his ass. And that wasnt the problem, really. It was that he tried to use a metal coat hanger to get it out. But there are less inventive ways to get yourself in trouble.

Dumbshits happen.

In emergency radiology, there are repeat offenders auto and motorcycle accidents, bar fights, firearms, and anything involving drugs/alcohol and motor vehicles or other things with moving parts. The inherent danger in these is fairly self-explanatory. O u r trifecta of things to avoid that you might not think about? Horses, ladders and ATVs In our practice, we see an astounding number of serious injuries as a result of ATVs and ladders in particular. ATVs are hazardous because people dont seem to have an appropriate level of respect for the damage that can be done. They seem safe and stable because they are on 4 wheels and low to the ground. Dr. Don once had a patient who was thrown from his ATV. He landed on a sharp stick, which penetrated his neck exiting out the other side. Luckily for him the stick missed all of the important arteries and the patient survived.


Its beyond me why people think ATVs are safe for small children. So thinking about safety also means thinking about the safety of your kids or kids around you. Its not a teeny little car its a motorized vehicle and a 3 year old shouldnt be riding one. Ladders on the other hand are so simple and commonplace, people dont think twice about cleaning the gutters or changing a light bulb. We see loads of spinal injuries and head injuries with both of these.

Creative ladder stacking in Peru. We didn't watch to see how it ended.

Dr. Don was working late one evening just before Christmas. A 40-year-old man had been on a ladder hanging Christmas lights from the roof. Unfortunately he slipped off the ladder and hit his head on the cement driveway. He developed a large hemorrhage in his brain and never recovered. While injuries involving horses arent as common, horses can be unpredictable even with the most skilled riders. Look at Christopher Reeve. The results can be devastating. Our advice stay away from these if you can or at the very least, exercise a modicum of caution. A dead squirrel in the gutter isnt worth a lifetime in a wheelchair.


A few years ago, I met another radiologist who had a fantastic tale about male stupidity. When he was in medical school, a guy came into the Emergency Department wearing a trench coat over his shoulders, accompanied by his brother, who could barely stand up. Because he was laughing so hard. Seems that the man in question had been cleaning the engine on his motorcycle. While

doing so, he exposed an opening that was, well, penis-sized. So clearly, he had to see what it might be like. What he didnt count on, was the increase in blood flow and increase in size to his penis while, uh, servicing his engine. His dick got stuck in the engine. He called his brother who drove him to the ER. Under the trench coat he had both arms carrying the engine block, still firmly affixed to his member. Clever boy! Avoid confrontation/bar fights. It is absolutely amazing how many people we see every night we work that were involved in bar fights. Lots of pain and broken bones. You dont need it. Edward Norton and Brad Pitt bounce back pretty readily, but real people end up with real damage. We like active sports. However, you need to make sure to follow proper safety precautions. When biking, rollerblading or skiing be sure to wear a helmet. If you participate in an activity be sure to take proper safety precautions.

A friend involved in a ski accident with a head injury in 2002.

The Docs wear ski helmets.

Wear your seatbelt. We mean it. Speaking of automobiles and driving, DO NOT DRINK AND DRIVE. You know that. Take a cab. Avoid distractions while driving. That would include not talking and certainly not texting

on your cell phone. If you smoke, we dont expect this book to change your mind. Similarly, if you use cocaine, meth or heroin. You know this shit is bad for you. However, the book would not be complete if we dont at least mention this kind of stuff. Our only advice is: DONT. OK. We want you to enjoy life. That includes sex!! However, if you are not monogamous, you need to use a condom. You dont want an STD. In fact one of our friends sent us a CT scan for review on a patient the other night that had multiple genital warts that were so big they looked like broccoli florets growing off of his penis. One last thing, since this is a book about health, fitness and living longer, if you are depressed get help. Suicide is one of the leading causes of death. It is preventable.

Highway sign in the foothills of the Himalayas in Bhutan.


You can do this! It isnt that hard. You can have the body and the life that you want, without totally giving up the things that you enjoy. We hope that weve shown you that maintaining an ideal weight and being fit isnt just about vanity. It is the key to health, longevity and being able to participate in life. And being hot is pretty cool too. You need to take responsibility for you own health, and you need to do it NOW, before any problems arise. Almost everything in this book (nut shaving and prostate exams aside) applies to BOTH men and women. So if you are a guy reading this book, share these tips with your wife or girlfriends. If youre a chick, hoping that you can talk your man into shaving his balls or buying some pants that fit, think about how you can apply this to your own life. Soraise a glass preferably of red wine, loaded with antioxidants to your health, to your life, and to the new, better YOU! THE GOODDOC BADDOC TOP TEN 1. Be responsible 2. Dont smoke 3. Eat right 4. Be fit, get off your ass and exercise regularly. 5. Monitor blood pressure and cholesterol 6. Everything in moderation 7. Take your fish oil 8. Get some sleep - 6 to 8 hours/night 9. Drink up - 1 or 2 glasses of alcohol/day 10. Wear your effen seatbelt

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