It's All in Your Head

By Joseph D. Pianka MD

Despite remarkable insight regarding our understanding of metabolism and physiology, astounding advances in fitness technology and the availability of countless so-called revolutionary diets and fitness programs, each promising immediate and sustained success, relatively few individuals seem to achieve and maintain their intended goals. In fact, data continues to suggest the prevalence of obesity, the world's "other pandemic," and recently overshadowed but quietly accelerated by the COVID-19 crisis, continues to rise. The future combined impact on the overall health and prosperity of society as we enter the dawn of the "new normal" raises many valid questions and concerns. The stakes may have never been higher to start finding some answers.

As opposed to targeting a small subset of young, highly motivated, advanced fitness enthusiasts, as many current popular programs seem to do, It's All in Your Head was written with the rest of us in mind. Rather than another "how to" manual, it is a "why to" inspirational guide and navigational tool in what has become the complex space of fitness and nutrition. Join me on a retrospective, psychological journey back to the origins of the unhealthy behavior patterns defining who we have become and explaining why we struggle to achieve our health and fitness goals. Incorporating a basic understanding of the fundamental principles universal to every successful diet and fitness program in existence, and learning how to develop adequate self-motivation skills, doors to previously unrecognized potential and the ability to reach and sustain success are unlocked as fitness dreams become reality.

• Language: English
• Publisher: Page Publishing, Inc.
• Release date: Feb 25, 2022
• ISBN: 9781662453168

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It's All in Your Head

Joseph D. Pianka, MD

Copyright © 2022 Joseph D. Pianka, MD

All rights reserved

First Edition

PAGE PUBLISHING

Conneaut Lake, PA

First originally published by Page Publishing 2022

ISBN 978-1-6624-5315-1 (pbk)

ISBN 978-1-6624-5316-8 (digital)

Printed in the United States of America

Table of Contents

Preface

Who Am I?

Yellow Brick Road

A Walk Down Memory Lane

Lent

Who Do I Think I Am?

Jigsaw Puzzle

Running Away

Getting to Know You

Goals and Inspiration

On Addiction

What People Think

You Are What, How, and Why You Eat

All Diets Work

The Next Step

So Many Diets

Taking Things Too Far

The Microbrew Generation and Overrewarding

Exercise

Where to Begin

Who Is Gym Dad?

Just Press Play

Beachbody

The Next Level

Whatever It Takes

On Injuries

Working Out Injured or with Preexisting Medical Conditions

Working Out Sick

I'm Too Tired to Work Out Today

Stuff

Supplements and Hormones

Yesterday You Said Tomorrow

Inspirational Moments

More on Inspiration

Time Deprivation and Content

Vacation

Deep Thoughts

In Conclusion

References

About the Author

For Kelly, Caitlin, Ryan, Emily, and all the patients in my practice, past and present, who have blessed my life in so many extraordinary ways.

Preface

You got your nice shades on

And the worst days are gone

So now the band plays on

You got one life, blaze on.

—Phish Blaze On, Anastasio/Marshall 2015

One stormy night in March 2020, rivulets of rain cascading down the outside of our kitchen windows mirrored tracks of tears flowing on my side of the glass. The moment seemed surreal yet oddly familiar, perhaps foreshadowed by science fiction stories I read as a child. Continuous news coverage emanating from the living room television and cell phone updates warned of the impending arrival of a novel coronavirus that would forever be known as COVID-19. Thousands of related deaths already occurred globally with an unfathomable number of additional lives expected to be lost in the months ahead. For survivors and those uninfected, life would never be the same. As a physician who dedicated the last thirty years to tending the sick and those in need, I felt powerless against what would eventually prove to be one of the worst pandemics in human history. In fact, as a procedural-based gastroenterologist, I was informed by powers that be that with the exception of dire emergencies, my practice would essentially need to shut down for an indefinite period of time. I was told it was to aid the effort in minimizing potential exposure and transmission of the virus while conserving preciously scare personal protective equipment. Since I've never taken an actual sick day, this all seemed inconceivable at the time. In the weeks that followed, like many, my savings and retirement accounts appeared to evaporate in the initial global economic meltdown, and I wondered how we would eventually make ends meet. In addition, the possibilities of me or my loved ones getting sick and losing my practice, the only life I have ever known, were very real. Funny, when I was young and informed people I was pursuing a career in medicine, I was often told it would always remain a financially stable, recession proof career. Irrespective of the status of the economy, I would always have job security. I guess those individuals didn't read much science fiction. I then did what I have always done in times of crisis, prayed. First, I prayed for those in the world already infected, followed by a prayer for those at risk for infection, which was essentially everyone. Then, in a moment of regression, like some college freshman who drinks too much at his first campus party, promising that if he made it through the night, he wouldn't drink again, I made a deal with God. I promised that if he saw me through this crisis, I would not only be more appreciative of the life I have currently but also devote my remaining years to unraveling the web of complexity that seems to surround the pursuit of optimal health and fitness. If successful, I would vow to dedicate the rest of my career to teach others the same. Just then, perhaps in answer to my prayer, my life and practice experiences not only flashed but seemed to shatter before my eyes into a countless number of disconnected pieces. The shards of my existence came crashing down before me. Initially wondering if this was God's wrath and how I would muster the strength to sweep up the scattered pieces, I noticed they formed a fascinating, vaguely familiar pattern. It was at that moment I began to view life from a very different perspective, even entertaining the possibility that the life I previously considered average and admittedly took for granted in so many ways may have actually been more spectacular than I realized. Reflecting upon other dark moments from my past, I pondered the possibility that what awaited at the eventual conclusion of this segment of time, in the new normal to come, may be better than imagined. The rain suddenly stopped. Gathering up the scattered pieces strewn before me, I went to my laptop and started typing. Before I realized it, I typed through the night. Exhausted yet oddly elated, I peered out the window, noticing the beautiful glow of dawn. The sun had risen again.

If you consider yourself a successful fitness and nutrition expert, this may not be the book for you. If you've already found yourself reaching the mental and physical levels of balance and harmony most seek but few achieve, the following was not written with you in mind. It was written for the rest of us. We, who are committed to making the world a better place, especially for others, often sacrificing our own needs in the effort. We are the majority, and most of us have yet to reach a level of overall health and fitness we not only deserve but owe ourselves. We are often seduced by the promises of the fitness elite as well as the testimonials of their disciples, who offer their secrets to success in a few easy steps, yet we seem unable to achieve them ourselves. The reason may simply be a matter of style or lack of resonance, hence limiting our own ability to relate, and effectively apply their valuable insight to our own lives. Nonetheless, we are left feeling defeated, lost, and discouraged without fully understanding why. We acknowledge nothing comes easy, yet, as hard as we try, we struggle to overcome the challenges of the lives we live outside the gym, thereby limiting the time we have available for the gym. We admire the levels of dedication, insight, consistency, motivation, and success of our fitness idols and celebrities, yet they remain intangible to us. A few will eventually prevail, achieving long-term success. Unfortunately, for most, success proves transient, inevitably resulting in progress plateaus, gradual loss of hard-fought gains, and recurrent failure. It's easy to blame our circumstances, but the reality is even those more successful have faced and overcome challenges of their own, so what makes us different? To protect our psyche, our minds attempt to rationalize what went wrong, providing us with numerous excuses but little gained insight. Without insight there is no possibility of personal growth, progress, and ultimate achievement of our goals. Many admirably try again (and again) without a breakthrough. Eventually, we give up, shelving our plans until it's time for the next New Year's resolution, perhaps longer. What's most frustrating is, as intelligent as we are, and despite the wealth of scientific information, expert advice, proven programs, and online tools available at our fingertips at any given moment, we seem unable to dial in. With the passage of time, we begin to accept the idea that some goals just aren't attainable. With this acceptance, motivation begins to fade, and dreams become lost. We redefine the goals and aspirations of our lives, settling for less, at the expense of our optimal health and overall sense of well-being. Lowering the bar of nutrition and fitness goals seems to be something society has been more willing than ever to accept. Current trends in medical statistics pertaining to increased obesity reaching epidemic levels and related health issues not only question whether this trend is acceptable, but sustainable. We are an intelligent species. Our insight and survival instincts conflict with the choices we are making. There exists a contradiction between what we are becoming and what we were meant to be. As we continue to attempt defying evolution in this fashion, a void is created in the fabric of our beings, ultimately leaving our minds, bodies, and souls unfulfilled. Then comes an unexpected event, perhaps in the form of a pandemic, a face-to-face encounter with our own mortality, and realization that something must change, starting with our own health and followed by the health of our precious planet and its inhabitants.

So, what differentiates the successful from the rest of us? What hurdles prevent us from achieving similar results? Is it simply a question of time, or are there multiple factors? What limits us from applying existing, proven programs to our own lives successfully? It's certainly not a lack of resources. Modern-day fitness experts and nutritionists have an understanding of physiology on a molecular level surpassing my knowledge as a physician in their areas of expertise. Their methods work, period. In fact, just about everything they write in articles or post on their websites is backed by referenced, reputable scientific research. Yet, as immortalized in the movie Cool Hand Luke, what we have here is a failure to communicate between the enlightened minority and unenlightened majority. Without resonance, essential connections between the source of information and receiver fail to be properly established. This compromises trust, belief in possibilities, and the probability of future success. Another way of stating this is if you can't relate to someone else's situation, no matter how successful they are, their insight becomes more difficult to appreciate and apply to your own life. Perhaps that's why contemporary nutrition and fitness gurus seem to have so many followers on social media, but statistically, relatively few of their disciples achieve and maintain the long-term success of the prophets.

In writing this book, my intent is not to suggest for a moment that I am a fitness or nutrition guru. In fact, I'm not even a writer! Full disclosure, I'm over fifty and well beyond my physical prime. I have kids the age of today's most popular online fitness experts. My metabolism just isn't what it used to be. If the saying Age is just a number holds true, it seems to me the math equations in life seem to be getting more difficult to solve over time. My frequently aching joints and muscles are a testament to that. As I learned in my youth, I'm also not particularly athletically gifted in any way. Yet despite my numerous limitations and insanely hectic career, I happen to be a physician with a fascination regarding fitness and nutrition who has found much personal success in this space and assisted numerous patients in discovering the same. My method begins with the concepts of defining and appreciating self and individual goals. This is followed by becoming and remaining inspired by the individual who will eventually turn out to be the most influential one in your life, yourself. Then you will learn to navigate, comprehend, integrate, and personalize already existing, successful programs rather than continue on an endless merry-go-round searching for new ones. Once existing insight becomes relatable and applicable to your personal situation, magic happens, and your life becomes transformed. Your life and goals are unique and cannot be defined by anyone but you. Others can guide you, but you alone have to be the designer and user of your own life program to achieve success. You must ultimately be and remain your own greatest influence and source of inspiration to achieve, maintain, and improve upon the results you envisioned. Being realistic, fair, and appreciative of self are essential. It is amazing how these things are intuitive to parents raising children, but when it comes to our own lives, we come up short implementing them. It may have taken a pandemic for some of us to truly grasp these concepts, but now that the worst days are gone, let's realize we have one life, so let's blaze on.

Who Am I?

My life has been a fifty-year journey, half of it practicing medicine. Like most, I am constantly pulled in many directions simultaneously. In addition to expected work and family obligations, I am frequently on call for medical emergencies often adding an element of the unexpected. At those times, I am prepared to drop everything at a moment's notice, including meals and workouts, to answer the call, day and night. Spending unlimited time in the gym, grocery store, and kitchen, preparing balanced meals for the week to come, are just a dream. In my reality, life seems to run off the rails far more than it remains on track. I constantly shift gears and my schedule just to make it through a twenty-four-hour stretch, nonetheless a formal three-month fitness program. Yet I have recently come to feel incredibly blessed, committed to preserving my health for many years to come and doing whatever it takes to make it happen. To my advantage, over the years, I heard and observed thousands of patient experiences regarding health and fitness. This includes the success stories, as well as failures, of everyday individuals like myself, gathering practical insight along the way. Combined with easily accessible expert advice relevant to my specific goals and lifestyle, I created a successful life program and so can you. Through continuous experimentation, if I found something that worked, I added it. If it didn't work, I dropped it and replaced it with a more suitable element. I immediately shared newly discovered knowledge and ideas I felt valuable with interested patients, anticipating and readily accepting constructive criticism and advice. This in turn led to incremental improvements of fitness routines and my diet over time resulting in continued and sustained progress. In retrospect, it's been an incredibly enlightening journey.

At the risk of sounding cliché, it all began with self-introspection. In essence, I became reacquainted with myself as a person, defining where I came from, who I was, and who I wanted to be. Ironically, I quickly realized I had no desire to emulate the fitness models I previously idolized online and in magazines. I most desired to be an improved version of myself, someone I unfortunately lost touch with over time, and needed to start appreciating. I also discovered, despite prior feelings of inadequacy relative to the impossibly high standards of a modern-day, photoshopped existence, I love my real, unedited life. Faced with the possibility of loss during the pandemic, preserving that which was rediscovered and cherished became my top priority. My so-called average existence, past experiences, and, at times, chaotic career suddenly became my greatest assets as well as primary sources of inspiration and motivation. The patients I advise and wonderful people in my everyday life have become my greatest mentors. With my priorities and goals reset, on my own terms, I can no longer see failure as a possibility. There may be times I press the pause button of life, but when I do, I will be more understanding and forgiving of myself. After all, as recent events have demonstrated, life can be unpredictable, and the unimaginable can happen. Realizing this is true for everyone makes me more apt to press play sooner, knowing I have been blessed with the opportunity to complete my journey, no matter how long it takes. Unfortunately, not everyone in the world recently fared as well. What was once pessimism is now replaced by optimism. Reflecting upon the possibility of losing everything, I now see things with enhanced clarity, and all else seems doable, almost easy in comparison. In my mind, I now relate to the character Neo at the conclusion of the original Matrix movie (minus Keanu Reeves's good looks and charm). I entered the Matrix of my own life program utilizing the vast knowledge base existing in the web customized to suit my needs. I haven't lowered the bar defined by others but raised my own for all the right reasons, and there is nothing more inspiring. Despite frequent reflection, it's not about yearning for the past or trying to turn back the hands of time. It's embracing the present while ensuring a long, healthy future.

Like a fine wine, quality of life can improve over time. Many comparisons can be made between wine making, also known as vinification, and our growth and development, both mentally and physically. In both pursuits, creating a desired product is the ultimate goal. Yet, there's something to be said about the actual process. Wouldn't it be ideal if we enjoyed and derived satisfaction from the journey itself? If achieved, might this also keep us motivated to continue and increase our chances of success? I happen to have a patient who is a master winemaker. He once shared with me his passion for the trade, which is a true labor of love, and this partially stems from the anticipation and eventual satisfaction experienced when the fruits of his labor meet expectations. It's the feeling of a vision coming to life as well as a job well done. What fascinated me more was his attempt at describing a sense of euphoria brought about by the labor itself. He described his continuous exposure to earthen scents including soil, pressed grapes, barrels, and wine cellars that stimulate his senses. The physical labor in this environment is accompanied by a type of primal satisfaction only experienced with this type of goal-directed and labor-intensive work. It's the culmination of his love of the game rewarded by the end result that continually drives and inspires him. He tells me anyone can learn the process which is fairly standard. Envisioning the ideal product, creating an aesthetically pleasing work environment, selecting ideal ingredients, and developing this love of the game is the real secret to success. Like wine making, health and fitness goals begin with a vision or dream of what's possible. The dream is nurtured, fed, and propagated with knowledge enabling a program to evolve. The love of the game begins and is maintained by internal and external sources of inspiration. Patience is essential while the dream buds and slowly grows into reality. Deep introspection followed by an honest definition of self in the present should precede a realistic vision of the improved self of the future or the final product. Identification of one's already existing qualities to be improved upon is far preferable to changing or discarding that which is already wonderful. These defined qualities are the grapes, key ingredients essential to the character of the final product. As the process unfolds, magically, information initially confusing suddenly makes sense. As positive results begin to occur, so does inspiration, increased commitment, and the desire to learn more, constantly adding newly discovered knowledge to your approach. Before you realize what's happening, you start to love the game, and goals are reached in what seem like the blink of an eye. Once reached, you reflect on the past with no desire to turn back, only to blaze on. How do you envision your final product? Perhaps something subtle and pleasant to take in at casual affairs? Or will it be something bold; an eventual award-winning selection that critics acclaim? Maybe it will be something in between. Just realize, whatever the result, if a creation of your own and to your liking, it will be wonderful. I take that back, it was already wonderful—it will be more wonderful. Worst-case scenario, if not what you hoped for, or your tastes change over time, adjustments can be made. You can even begin again, learning and enjoying your journey while continually improving along the way. If you need to occasionally press pause, do so, then press play again when ready. What's the rush? It took a lifetime to get here, and you have a lifetime ahead of you to get it right. I guarantee, this time around, you won't pause as long nor wait for New Year's to arrive.

As mentioned, during the recent COVID-19 pandemic, social distancing and time home allowed much time for reflection. Daily news of the rising number of global cases and related deaths were sobering. Every life is so fragile and precious. High rates in first responders and health care providers hit me particularly hard. Thoughts of my colleagues and friends on the front lines, in emergency rooms and hospitals, kept me awake at night and on edge during the day. There were times I admittedly became depressed and with nothing but time for contemplation, memories of other dark moments through my life were revisited followed by familiar feelings of self-doubt and despair. Just as I started to get lost in an abyss, my wife Kelly threw me a lifeline in the form of an internet information session by Dr. David Price, a critical care physician at Weill Cornell in New York. He was at the epicenter of the epidemic on March 22, 2020. I never met him but wish to thank him for providing not only a light in a very dark moment but also providing me a valuable lesson on empowerment. We are not only able to take control of our own lives but can also pay it forward guiding others to do the same. We can do this not only in times of crisis, but in the years that follow allowing us to live better, longer lives while preparing us for whatever unimaginable surprises the future has in store. As I reflected on some of the other dark moments in my life, I realized, like Dr. Price's video, how many similar inspirational experiences occurred when I needed them most. Thinking back, I now realize the take-home messages guiding me toward the light were all quite similar and provided by individuals I now view as guardian angels of sorts. We all have guardian angels in our lives, past and present, sharing similar messages in our times of greatest need, inspiring us, desiring the best for us, and encouraging us to share with others once we find our own way. Perhaps without our realization, we all hold keys, unlocking doors to happiness and fulfillment we discover aided by others, and in doing