TOM RIFAI MD – FACP CEO, REALITY MEETS SCIENCE

If we get caught up in words like “guilt” and “cheat,” we won’t end up having a healthy relationship with food. Jordan Levin’s guest today is Dr. Tom Rifai, Assistant Professor of Medicine at Reality Meets Science®. In this episode, Dr. Tom discusses with Jordan how the term “diet” has a lot of negative connotations because it implies short-term restrictions. What we need to achieve a healthy relationship with food is to undergo a lifestyle change. Where to begin? Surround yourself with more wholesome and plant-rich food. Want more tips on having a healthy relationship with food? Then this episode is for you. Join in!

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TOM RIFAI MD – FACP CEO, REALITY MEETS SCIENCE

When I think of Dr. Tom Rifai, I think of the famous Migos lyrics, “Walk it, like I talk it.” He is truly a doctor of healthy lifestyle habits. He is the Founder and CEO of Reality Meets Science. He is a Harvard Medical School Lifestyle Medicine continuing medical education online course director for type 2 diabetes protection, nutrition and metabolic syndrome, among many other admirable and inspiring ways to instill health. It’s safe to say that Dr. Tom Rifai is a health guru. Welcome to the show. It’s an honor to have you.

Coach Jordan, it is an honor to be here with you and to see you again.

What’s one of the most important things people need to understand when we’re talking about health? The way I look at is there are two different definitions of health. People get confused about those two words. I’ve always wanted to get a better understanding of what health means, especially when you’re dealing with Reality Meets Science. Let’s talk a little about that.

There’s a physiological state of health and a psychological state of health. Without those two mind-body that are in unison but if we want to think about them separately, they have to be thought of as a unit. There are people I have seen who are physiologically healthy and they are not very psychologically healthy. In all honesty, I know people who are well psychologically but we may find physiological issues whether it’s pre-diabetes and things that are coming down the pike that are not yet ready for a lifestyle change. That is a challenging scenario where you and I would know all of these things are coming down the pike and how great you feel now is something that could be at risk without sounding judgmental and not wanting to take over their journey. It’s their journey. As coaches, we can only present evidence, facts and risks. They have to judge for themselves what they’re ready for.

Through the years, even though I’m generally fit and healthy and all that stuff, I’ve always tried different types of healthy nutrients. I hate using the word diet because it sets people up for failure. I’m trying to remove that word so that we can get a better picture of what needs to happen.

I agree with you, our relationship with food or nutrition, two words that I prefer to use than diet which implies some restriction and often sets up deprivation psychology. It makes people want something more. It is an important psychological mindset to take on. Our relationship with food is the issue. Dieting is typically not associated with a healthy relationship with food. It’s a word in the dictionary. I respect that it’s in Merriam-Webster dictionary, but the common understanding of the word means that I am on something for the short-term. It’s going to be restricted and doesn’t imply a long-term plan. It just implies a short-term tactic rather than a lifestyle strategy.

We’ve discussed it privately, Coach Jordan. I have been challenged with binge eating disorder. I almost lost my life to binge-eating disorder. I lost my youngest brother to binge eating. I can tell you that it never helped him when anybody sent him a message that you can’t eat this or you can’t eat that. It’s also an open secret that I like the band, Kiss. Kiss is a great rock band. Beyond the music, one of their cofounders, not the one that gets all the attention, that’s Gene Simmons. Paul Stanley was born deaf in one ear. He had a malformation microtia, which made his ear look like a cauliflower. He was deaf on one side. His sister was a full-blown schizophrenic.

It’s their journey. We, as coaches, can only present evidence, facts, and risks, and then they have to judge for themselves.

There were a lot of challenges he was faced with. Incidentally, he never found happiness despite physiologically being healthy and psychologically healthy into his 40s. He put a two-minute video together when he was interviewed in Hawaii that I thought was this beautiful example of discipline without extremism. He comes out talking about, “Yes, of course, as you get older you have to have some discipline.” He mentions discipline again and he talks about how he goes to exercise with his wife. He has more accountability in groups. He mentioned in a conversation with a doctor about his cholesterol and the doctor said, “You can never eat ice cream again.” I will not tell you what his answer is. I’m only going to tell you that it was practical. I don’t think that doctor is his doctor anymore. Let’s put it that way. It’s called Paul Stanley on Growing Old on YouTube. It’s only two minutes. I recommend it for anyone who wants to understand the concept of Reality Meets Science and discipline without extremism or what I call the flexitarian philosophy of life.

That’s important because when we’re talking about food, we hear so many things. We read things on the internet, books and whatnot. We have all this information. There is so much noise out there. We have to understand how to filter through the noise and find what works for the individual. I’ve found many people go through these cycles throughout their life. It takes them so long to find that one thing. I hate to say it’s unfortunate that it happens. I keep seeing the same trend over and over again. It’s up to that individual to make that decision for themselves to take whatever guidance they receive and take that guidance and do something with it. That’s where Reality Meets Science comes into play.

The individualization of the approach, which you’ve done through your center and we do through our program is key. You can only be a navigator and not a pilot. The different types of ways of eating can be differentiated from what you eat. Somebody can do intermittent fasting with the Standard American Diet or what we call the SAD. You can do it based on plant-predominant fruits, vegetables, etc. You have to find out what works for you. All I can say is that for myself, in the midst of this what we call the cacophony of confusion, there are many messages whether it’s the rhythm and the way you eat or what type of food to eat, low fat, low carb, no gluten, no oil. At the end of the day, there is no single food choice at any single point in time that’s in and of itself a mistake.

As I like to joke often, it’s not the cake on your birthday, it’s the cake on everyone’s birthday. That may be an issue. By all means, when you have an indulgence, as rare as it may be relative to the average American, please enjoy it. Let’s not get caught up in words like guilt and cheat. Those don’t end up with a healthy relationship with food. There is the concept that you are what you eat. I would say that’s something that pretty much stands true but you also eat what surrounds you. You are what you eat and you eat what surrounds you. You want to get something down to what we call the 5% fun zone, while 45% of the time, you spend your day in the house around a box of Oreo cookies, which I’ve eaten way too many in my life.

Reality Meets Science: The individualization of the approach is key. You really have to find out what works for you.

That’s me. I go to my parents and my mom always texted me and says, “I found this cool new flavor of Oreo. Do you want to try them?”

“Please leave them at your house, mom. I don’t want to bring them into my house,” because that’s like bringing a wolf into the house pretending it’s a dog, and then blaming the wolf when the wolf bites you. There’s a difference between not in life, which is a diet versus not in house, which is a lifestyle change. If you want it that bad, go to mom’s or go out and enjoy it but maybe you want to rethink whether you’re surrounding yourself with temptation constantly. Willpower is a bit overrated. By itself alone, it’s a tactic. Maybe you can grow your willpower a little bit but it’s more about how to manage the willpower you’re born with.

In our house, if you look at our refrigerator, there is zero processed food. Not even in the freezer. My wife has been good about that. She’s vegan, gluten-free, dairy-free and all that stuff. She’d be limited in what she can have because she has Hashimoto’s. Through the years, she learned what works and what doesn’t work. The better part of that is I’ve learned how to eat better myself. I’m appreciative of that. A lot of times, I feel like it’s all about your surroundings. I found that a lot of people who have families, especially with kids, have that struggle. You have that one person who wants to make that change but they’re struggling because they have to take care of their kids or their husbands. My question with you is, how do you balance that when you’re working with clients?

I’m sitting here and thinking about how I balance that working out with my own family. One thing I love that you mentioned is that you and your wife are on the same page. There is a study called the English Longitudinal Study of Aging. It was quite clear that when life partners, spouses or otherwise make a lifestyle change together, whether it’s physical activity, smoking cessation or weight loss, the odds of success is always better. I didn’t think we needed a study for that. It’s pretty self-evident when you have a saboteur versus a supporter. Nevertheless, the evidence is clear.

It’s the same with myself before I was married. I gave my wife a chance to run mad. I admitted to her first that I was a binge eater before I went public. I said, “I can have anything in my life but my face is a different story. If you want to run, I hope you don’t run, you can go now but I want to be honest with you.” We have a good relationship like that in the house as well. I have two kids and we have a dedicated part of the cupboard for their food. I can’t fully restrict them. That wouldn’t be fair. They are metabolic machines. They’re different from us.

All the family knows that I can’t have that food interspersed everywhere. We said, “This is the dedicated cupboard.” Otherwise, if you don’t have a supportive environment like that, which is a real challenge that I’ve had with several clients, you end up with some difficult situations. You must guide the client in terms of assertiveness and not aggressive discussions because that will blow up if you tell someone, “You’re trying to kill me with all that junk food, bringing up the ice cream to the bedroom at night.” You’re unlikely to get a good result. At the same time, if you’re passive and you just allow it to happen, and you don’t set your boundaries, that’s not good as well.

It’s coming up with a line that expresses not a want but a need in a respectful way and practices it. I’d like you to spend several times in the mirror. It’s that Hollywood line, “Fake it until you make it.” Practice the line and get comfortable with it. Frank Sinatra used to say when he was asked why he doesn’t get nervous singing in front of 50,000 people, “Of course, I get nervous. I just know my lines.” Practice it and then engage in, “This is my idea. What do you suggest?” Engage the partner in a way that they feel respected and that they have buy-in. That doesn’t always work but it works a lot.

I’ll be honest with you, Coach Jordan. I’ve even seen it sometimes where the health challenge and the lack of willingness to go forward are so high that sometimes it ends up in people having to split. That’s not common but I want to emphasize that health is that serious to some people that they have had that happen. We see that after bariatric surgery when people’s lives dramatically change. You see it when people are recovering from drugs and then they have to make a decision, “I can’t hang out with the same heroin circle.” If someone’s challenged with alcoholism, maybe it’s not a great idea to meet your friends at the bar. Those are self-evident.

What we don’t seem to be willing to accept is that some “foods,” which we might put in quotes because I’m not so sure after seven PhDs designed it, which I’m pretty darn sure was the case with KitKats. I have a PhD in the anatomy of a KitKat, which I earned from Mom University. When we grew up, we had pound boxes of KitKats everywhere. I know the entire anatomy of a KitKat. Nevertheless, those types of foods trigger such a hyper-palatable dopamine reaction in the brain that we have to sometimes think of them as drugs. I’m careful not to say zero tolerance because there is a difference between a KitKat and heroin. It may not be dramatically different but we are inundated with what we sometimes call calorie-rich, refined and highly processed foods. If you make it into an acronym, it’s CRRAHP. It’s everywhere. I don’t even want to mention a specific business because it’s everywhere. It doesn’t matter.

There is so much stuff out there. They advertise within the newspapers and everything. When I think about my grandparents, they would tell me, “Hey, eat.” There were big potatoes, carrots and everything was all cooked. There weren’t a lot of processed foods. My parents, the new generation have processed foods and microwave foods that are coming into play. The obesity rate skyrocketed. I saw that the obesity rate back in 1995 is still high but not as nearly as high as it is now. It’s around 35% or 36% in the United States or something. Don’t quote me on that. It’s somewhere around there. It’s interesting to me because I’m not blaming the media, but there are many easy temptations, not to mention KitKat and Oreos. Don’t get me wrong, I eat healthily but I love my chocolate.

It’s better to take the opportunity you’re ready to make now for prevention. 

I’m with you. To be realistic, everyone needs what I call a 5% fun zone. That’s not a 5% guilt zone. It’s not a 5% cheat zone. We want you to have a high level of mindfulness and enjoy your non-negotiables. We discussed that probably the best way to keep it down is not to have it constantly around you. At the same time, when you have it, why spend your time being guilty about it? Enjoy that moment. You’ll find that the memory lasts longer. You can say, “No, thank you,” several times in between the next one because you say, “I enjoyed it recently enough. Thank you. No, thanks.” Know that you can always have it again. It’s not going to be verboten or never have.

Reality Meets Science: You must guide your client in terms of assertiveness, not aggressive discussion because that will just blow up.

That being said though, the approach of balance is yet to be realized. This concept called flexitarianism is gaining so much popularity among the scientific community, which is the word vegetarian mixed with flexible. Flexitarian is not a complicated word. It sounds nicer than semi-vegetarian. When you ask most people if they’re willing to move towards more plants and they’re given an option of zero animal, plant pure, which is fine if somebody is willing to go there, versus how about becoming plant-rich? Over 70% of Americans surveyed said, “Yes, I would go with that type of flexitarian approach.” That approach is now up in the US News and World Report every year as best diets. Let’s replace the word with lifestyle.

The Mediterranean is still number one. I would say it’s more because it’s sexy than necessarily anything else. Flexitarians are now tied with the so-called DASH diet, Dietary Approaches to Stop Hypertension. It’s tied for number one for weight loss. The only real reason is that it’s practical. It moves people towards less processed, more plant predominant foods but says, “No, you can have a released valve on your pressure cooker.” You don’t have to live your life in a pressure cooker without a release valve because that’ll blow up in your face. Flexitarian is the type of approach that disciplines without extremism. That tends to work for most people that I’ve seen as patients or now as coaching clients.

I appreciate that approach. When you talk about flexitarian, it’s a way to help people focus more on trying to eat more real foods and adding more color to their diet and still be able to have a few of the others like meat and whatnot. It’s flexible enough. My problem is that everybody says, “I’m going to go cold turkey on X, Y, and Z.” As you know, that’s a direct way to fall out and being back.

It’s a blessing as it’s a curse. It’s very simple. For the short-term, it’s like coming out of the gate at the Boston Marathon sprinting, “You won the first 100 yards of the Boston Marathon. Good for you.” Does anybody care who won the first 100 yards of the Boston Marathon? Does anyone even know who won the first 100 yards? Nobody cares because it’s a long-term race. As far as a kickstart goes, I have no problem with temporary detoxing and going absolute for a short period. You have to have a plan that’s going to accommodate real-world or find where reality meets science. That’s where that concept of a 5% fun zone works.

I’ll give you an example. I had a patient who brought back successful long-term lifestyle changes and weight maintainers. He happened to be maintaining a 100-pound weight loss. I say that as it was a side effect. When we asked, of the five keys, mind matters or psychology, nutrition activity, environments, including food and social environment, and accountability, which one is the most impactful? More than half said mind matters. Many said, including him, that it was the concept of the 5% fun zone are non-negotiable.

I said, “What are you talking about? He said, “When I met you, you asked me what my non-negotiables were. I told you it was a Coney dog.” I said, “Okay. That’s interesting.” He goes, “You didn’t beat me over the head with a stick about it.” I said, “No, I just asked you what your non-negotiables are. Why would I start negotiating your non-negotiables?” He said, “I haven’t had one in four years because of that.” I said, “How did that work?” He was, “You told me I could have one. I kept saying, ‘Maybe next week.’ The next thing I knew it was four years.” He’s pointing at me the whole time and he said, “I tell you, Doc. If you told me I couldn’t have one, I would have had ten the first week. My blood pressure would have been up. My weight wouldn’t have fallen. I would have lied to you about it and told you your diet sucks.”

Nobody wants to be told that they can’t do something. Whenever I meet with someone, as far as that key of nutrition and it’s blended with mind matters. I asked them, “What are your non-negotiables? Put them right on the line.” If you want to ask me what the definition of the 5% fun zone or moderation is, it’s whatever amount you need of whatever to not want to kill me until the next time I see you. I can’t tell you how much that is. You have to tell me.

There’s no explanation for that. The fact that you have that rapport with that patient is phenomenal. It’s great.

The coolest thing in nutrition is the concept that you can feel full on fewer calories. 

I appreciate it. It gives them agency. It’s realistic. You can’t take over someone’s journey. At best, you can be an invited navigator. They’re still the pilot. If you try to take over that steering wheel, you’re going to get some elbows. It usually doesn’t work well. Rarely will people come in and say, “Tell me what to do.” For that once-in-a-while person that wants a drill sergeant, I’ll accommodate it but it has to be an open invitation for anything like that. I’ll be skeptical, “How long do I have to hold on to the wheel?” I don’t want to have to hold on to the wheel very long.

That’s the thing. You’ve studied and researched so much information to be able to put up the five keys. What’s been the most successful for yourself over time? I’d love to get that one example but I want to take it a little bit further to understand. Everybody is raised in different ways. There are probably different ways that everybody was raised. It seems like it takes so much time for someone to realize that they’re ready. My question is, are people coming to you when they’re at their breaking point or are people coming to you from a preventive measure standpoint?

I hate to say it, sometimes it’s the latter but usually, it’s the former. When people have that learning moment, when they’ve just had a heart attack or they’ve seen that their A1C, their blood sugar numbers were in high levels of pre-diabetes or they’re diagnosed with Type 2 diabetes. Their weight is so high that they’re facing a potential knee replacement. Those are moments that reality comes to face them. The science is no longer bubbling underneath. It’s right there and it’s in their face. I have seen people who have had histories of being adopted and not knowing and therefore they want to do everything they can to prevent. They’re just wise because they’ve seen their parents having dementia, cancer or something that instills a direct fear in a way because they’re caretakers and they don’t want to have anything to do with that unless necessary. People do have to be ready.

In 2017, the US Preventive Services Task Force came out with a guideline that essentially emphasizes the criteria for someone to be referred for intensive lifestyle modification is based on their readiness for change. They were employing doctors. Even if they have no metabolic problems now and they want to prevent them, please refer them. The odds of becoming a metabolic case in the United States is so high that it’s better to take the opportunity that they’re ready now to push to prevention. I know you recall that the American Heart Association has simple seven criteria for metabolic health. It’s having to do with what we eat, physical activity, smoking, weight, our cholesterol, our blood sugar and our blood pressure. It’s slightly less than 1% of Americans meet the ideal for all seven categories. This means everybody, no matter what their weight is, only 70% of us are overweight or obese. That means that everyone who’s normal weight probably has something they could do.

That’s one of the reasons why I try to be careful about discussing weight in terms of couples. It’s often, “I don’t have a weight problem. He does,” or “She does.” You end up finding out that the other person has high blood pressure. I hate to say it but the person you’re seeing has a problem with their weight has normal blood pressure. Blood pressure is the biggest metabolic issue that you could have. Weight might make it worse but it’s driven by low potassium, low magnesium, high sodium. We don’t see that in people. We don’t have people walking outside with their blood pressure stamped on their foreheads. We see a person’s weight.

I get a little bit wary about making weight too important. The way I view weight is it’s an important part of the solar system. It’s like Mars. It’s not the Sun. It’s not the Earth. It’s an important planet and we can’t disregard it. It’s got to be put in context if that makes sense. What are some of the highlights of the five keys that supersede a culture, age or ethnicity? If I were to give you some highlights, although we talked about some of the items like the non-negotiable and 5% fun zone. In mind matters, other than asking someone what their non-negotiables are, the real first question I ask is, “Why are you here?” I appreciate that you might want to get off medications or the scale. Those aren’t wise. I’m going to keep peeling back, “You want to get lighter. Why?”

Until I hear things like, “Doc, let me be honest with you. I want to be able to sit next to my granddaughter at Cedar Point next year on the roller coaster.” This is the truth. I didn’t make this one up. Let’s say it’s an erectile dysfunction issue, “Doc, I want my parts to work until I’m 90.” It sounds good to me. “Doc, I need to go backpacking and kayaking and go to Denali twice a year without those one week where I’m by myself or with my brother, my whole family relationship, my work relationship. My knees are about to go out. I can’t lose those trips.” I keep peeling back. What is your why? Mine is simple. It’s not rocket science for me. Two of my biggest whys are my children.

Whatever that person’s why is, it needs to be identified. It might not be your first meeting. That one about the erectile dysfunction, it took him a couple of months to figure it out. He came back and he said “Doc, I’m thinking about it. I love my kids. I just got divorced.” I’ll let you fill in the rest of the blanks. This is what I find that motivates me. I can’t determine your why. That’s personal to you but you want to find that. It’s like a lighthouse in the fog. At times you’re challenged, you’ll remember what your why is. You probably won’t stay off the center of gravity as long because that why will pull you like a magnetic force better.

The coolest thing in nutrition science that is not nearly discussed enough is this concept of having people know that you can feel full on fewer calories. There’s this science of water-rich foods that the weight of foods seems to be much more correlated with fullness and satiety than other things. There’s chewing and mouthfeel and taste. I’m not denying any of that. One of the biggest things is that we typically need somewhere around at least 2.5 to 3 pounds. Some of the larger eaters may need more than three pounds of food per day. It’s a lot easier to change what you eat than how much you eat. Foods range from about 100, sometimes less than 100 calories per pound up to 4,000 calories per pound. It’s getting more water from fruits, vegetables, beans, lentils, peas, cooked 100% whole grains.

Reality Meets Science: Nobody wants to be told that they can’t do something. So, whenever you meet with someone, ask them what their non-negotiables are.

I’m not saying to never eat something dry and crunchy. We’ve been talking about this the whole time that it’s just a ratio. You eat 1,000 to 1,500 times a year. We’re not talking about making those choices every single time you eat. If you can shift that ratio up, you can find that people don’t have to be particularly hungry any more than normal. You can eat when you’re hungry. Please don’t wait until you’re starving. We can talk about how that isn’t changing. Eat when you’re mild to moderate hungry. Stop when you’re comfortably full as often as you can.

Shift your calorie density so that you’re eating more water-rich foods that have foods full of water from roots in the ground, fruits and vegetables or cooking beans, lentils, peas and 100% whole grains. There are some high water-rich foods in the animal world, yogurts, egg whites, fish and chicken breast, things that haven’t been deep-fried. You mix and match these things. It isn’t complicated at all. It’s simple, which is to be distinguished from easy because simple isn’t necessarily easy. If we were with our friend, for some reason stuck under a car, it wouldn’t be complicated. We got to find 7 or 8 other strong guys and lift the car. I don’t need a physics formula or PhD for that. Is it easy? No. Is it complicated? It’s not complicated. You better lift the car.

That being said, in the physical activity world, you and I both love to exercise. I’ll be honest with you, I’m going to use the term addicted. I’m pretty much addicted to exercise. My mind matters can’t live without some exercise. One of the biggest areas in much of the United States that isn’t yet exercising is to talk about non-exercise activity time because we have less than a quarter of people even coming close to the American Heart Association recommendations. The data is starting to build that all movement counts and you should probably seal the deal with exercise.

If you’re not moving at all, I’ll make a deal with you about just walking into the 2nd or 3rd water fountain or parking further at a grocery store or taking the stairs. If you’re on the 8th floor, it’s okay. Take the elevator to the 6th or 7th floor. You can start there. You don’t have to go up through eight floors. Everyone wants to find a reason not to do something. Every little bit counts. Even the American Diabetes Association is now recommending in their physical activity guidelines that for every 30 minutes, at least five minutes of anything. They said even kicking your legs. The muscle seems to be a “what have you done for me lately” tissue.

When it comes to blood sugar, your exercise might help your blood pressure, your bones, your muscle and your mood. If you exercise and sit for eight hours straight, you may not be getting maximum benefit for movement. You become what I call a NEAT freak or Non-Exercise Activity Time. You and I know that the technical last letter represents the word thermogenesis. When I say Non-Exercise Activity Thermogenesis to people, they go, “What are you talking about?” I replaced the word with time because it’s where reality meets science. Environment, we already talked about. You are what you eat but you eat what’s around you.

For accountability, this is where programs like CrossFit and communities and a coach, even tracking your steps or your blood pressure or your weight, anything. You don’t have to overdo it. Pick something. Accountability is that deal-sealer for people who are starting to change their lifestyle. Let me give you an example of why accountability is important. The National Weight Control Registry, which is a group of thousands of Americans who have maintained a weight loss for long periods, which is not too common but it’s common enough that they’ve got thousands of people. They found that it takes at least two years of maintenance before the odds of long-term success start to increase. In those two years is where that accountability can be helpful. Eventually, you can rely more on internal accountability than external. For a while, it helps.

It’s like a young tree. You put those sandbags at the bottom of the young tree so that it doesn’t get blown by the wind until it grows into the oak tree and then it can stand by itself. That’s the analogy for accountability. You want to have that support. What you bring is what I call compassionate accountability. You bring that. I bring that. Accountability that’s rough, we use the term drill sergeant, might work for some people. Most people want support that’s compassionate and non-judgmental. Those are some tips in the five from mind matters, nutrition activity, environments and accountability.

I appreciate the accountability. I want to bring up why I want to do this. The more you do things together, the easier it becomes. I agree with the two-year mark where we are pushing that and had the accountability and see the results. They’re comfortable with the results. They’re comfortable with the decision that will be made. They’re able to understand it and be able to do it. I’ve been in the fitness industry for a long time. I agree with that statement.

You’re not alone. You’ve got great compassionate places to come to for help. 

In the beginning, where they find their food is a challenge and eventually it becomes easy, “I know where this, that and the other thing is.” I sometimes have to do it. I’ll be honest, I have to sometimes do a tour of 2 to 3 different grocery stores to get everything I want but I don’t mind. Once a week, I go out and it’s worth it to me. What fitness wear they like? What shoes they’re comfortable in? All those things that are a challenge in the beginning as they stack on become easier and easier. It becomes more autopilot.

There’s the fact that we have these landmark moments once a year. Let’s go back to Halloween. Sometimes I call it Halloweek because it’s supposed to be a day but it starts a week before. Halloween or Halloweek into Thanksgiving into Hanukkah and Christmas. That whole season is a challenge by itself. It’s almost a stress test. Once they make it through, there are a lot of things where we have to go through what we call the SLIP technique, Stop, Look, Investigate, Plan. You don’t have to wait a year before it comes around again to try that new plan out.

Maybe there’s a little bit around other holidays that you could potentially utilize those skills. At that end of the year, that Halloween and then Thanksgiving and then Hanukkah and Christmas is a stress test challenge. Since we do have a 365-day rotation around the sun, it’s also not surprising that it sometimes takes two years as well. Sometimes people have very challenging emotional anniversaries. I remember a patient came in to see me. We first met when I was working with Trinity. She stayed for six months for phase one. We asked her to do another six months because it’s a good idea. Little did we know that in the holiday season, it was the anniversary of her husband’s loss.

She went into this holiday season and then came back around March of the next year. She had regained everything and everything was back to where it was. I said, “I’m sorry that happened but I’m glad you’re back.” She expressed to us, “ Dr. Tom, I didn’t tell you I lost my husband on Christmas. I wasn’t ready for it.” If we were there with her through that, we might not have been able to completely mitigate but we probably could have helped quite a bit. I urge people to stick with their program and coaching. Two years is typically the amount of time it takes to maintain a real lifestyle change before it becomes autopilot.

I understand that point because I see it all the time in the fitness industry. People are consistent with it and then life happens and they fall off. We try to encourage everybody, even if you could make it to the gym once a week or something but at least get in there. Get those endorphins going. Get yourself feeling good again. Speaking of routines and whatnot in terms of how things happen, how do you think the pandemic has impacted the world positively? Do you think of positive or negative with the pandemic?

Let me try to stay with a positive thought first because it’s so easy to go down the negative route. Admittedly, the reason I went full time with Reality Meets Science is that I saw that the future in health has to leverage, if not completely used because we always are going to need to be around real people. I hope we don’t forget that. Technology is going to help people reach expert types of programs that brick and mortar only may not be able to by itself.

When I was working in metabolic health, I could maybe see 150 new patients a year. I saw them multiple times, every two weeks for the first three months and then monthly for the remaining months. Potentially, even up to two years. We had plenty of office visits. They were centered on a certain number of patients and that’s what defines intensive lifestyle intervention. It means a lot of time is spent. As I started to think, the five keys work great clinically but can they work digitally so that we can reach more people? Maybe we won’t be as impactful for any single person as much as a hand-built car. If we can reach more people, there could have a wider social impact.

I built a prototype product. You’re aware of the Diabetes Prevention Masterclass. I put all five keys together on a fourteen-hour offering and product that people can watch at their convenience. They join a private Facebook community where we spend weekly time doing Q&A. It took a prototype of the model that was learned in clinical medicine and put it into the so-called commercial world for highly motivated people. One of the things from the pandemic is that people have become much more comfortable with tech. I hope not too comfortable. I don’t want to live in The Matrix, “Blue pill or red pill,” if you remember the movie that I’m talking about. I do think that’s a plus.

On the other end of the spectrum, we have pretty good evidence that about 40% of people gain significant weight during stay-at-home orders. The amount is staggering. I’ve seen it. I’ve thought to myself, “Is it possible? I am seeing the exception to the rule?” It’s about a 29-pound weight gain on average for that 40% who gained a lot. Speaking of tech of movement, we saw from digital tracking that physical activities dropped to about 5%. Talking about a country that’s already pretty sedentary. Some people got more active. That’s true but on average, we dropped.

I can’t lie, I wouldn’t want to. I gained 17 pounds. I’m down about 12 pounds of it. Between quarantine 15 and the COVID-19, I gained exactly right in between, 17 pounds. That’s me. I could have easily blown up 50 pounds. I used to weigh over 200 pounds. I’m only 5’7″. Thank God for the five keys that helped me. Below average, the amount that’s been gained by some is a challenge. I can say there’s a positive in terms of accommodating more to digital technology that can help people. Looking at the data, there are a lot of challenges and I hope that we’ve learned from it. If we go through a pandemic like this again, we can thread the needle and find where Reality Meets Science so that we can gain protection for those that are vulnerable but not necessarily make so many in society less healthy in the process.

Reality Meets Science: The data is starting to really build that all movement counts, and you should probably seal the deal with exercise.

My point is I struggled and we all struggled through the pandemic. There were some of the unknowns. The first thing when people are unsure of what’s going on in the external environment, everybody is going to gravitate towards food. Nobody was going anywhere in the first couple of months in the pandemic. Unfortunately, people are getting in this habit of, “I’ll do something about it.” They realized that it takes a bit harder to get back into their routine. That’s what I’m trying to focus on with our client, trying to make sure that everybody stays consistent with what they’re doing. That’s a challenging thing. As a coach, you’ve adapted to stress that our clients and patients understand what that means. We can tell everybody all the information but it’s up to them how they interpret it. We can show them empathy and help them understand what needs to get done, “Here are the tools and the course in the private Facebook group.” That sounds wonderful.

What we both do is to remind them, “You’re not alone.” We’re even saying it, “Coach Jordan and Coach Tom, we’re telling you, you’re not alone.” That’s one thing we can put to rest. You’re not alone and you’ve got great compassionate places to come to for help. The expansion of the already gold standard brick and mortar go to someplace complemented by technology makes it so that people will have a choice and that can be helpful. I hope I can try to balance what I’m about to say here well because I’ve been dealing with it myself. It is much easier to gain weight than to lose weight. The human body is designed to get it and capture it. It’s waiting for the next famine. If we do have any type of famine, we’ve got bigger problems to worry about.

I want to make it clear. I said that I’m down 12 of the 17 pounds. These last 5 are going to be more challenging than the first 12 pounds. They are like comparing rooks to pawns in chess. Though you can’t compare the piece to piece. Pawns are easy to kill off. Try killing off a rook, a bishop, a knight or a queen. It gets harder as the chess game goes on. I don’t want to claim that, “He has no problem. He’s going to lose the other 5.” It’s challenging me. You’re not alone. The type of support that you can get and the accountability whether it’s on-site in what you’re doing with CrossFit or it’s a masterclass and it’s online or it’s both. They’re both perfectly compatible.

We encourage people to find a site that would be similar to yours that they feel comfortable with and provides a warm welcoming atmosphere to accentuate that accountability and physical activity key at the same time. When you’re doing well in one or other keys, it has spin-off effects. Their mind matters will feel better. They typically then start to make better food choices because they’re like, “If I went and I moved that much into exercise, maybe I don’t want to necessarily have my 5% fun zone.” They can be like that guy, Larry, and say, “Maybe next week.”

That’s the thing and I’ve said this to you. When you said to yourself, “I’m going to wait until next week.” As you said before, “That was great,” but the reality is if you’re going to do something, you should do it now. Don’t wait for, “I’m going to do it next week after the big birthday party.” As you know, it keeps adding on. Take good advantage of these resources that you have, the accountability and the people that you know. Don’t try to do it yourself because it’s hard to do it yourself.

It helps to have that accountability. I was talking about it in terms of indulgence. When it comes to health, don’t wait. Whether you want to come out of the gate flying or you want to come out of the gate and be more of the tortoise than the hare, the best time was yesterday. The second best time is right now. Since you can’t go back to yesterday, right now is the best time. Every little bit counts. One of the myths is that you have to have this all or nothing. For some people, they do. They want to come and kickstart with something intensive, dedication to all five keys, hitting the gas at once. That’s not necessarily what will work for everyone.

Knowing that there are five keys is enough. Picking one thing could be physical activity because then a lot of things can spin-off from there. It could be like, “I want to get into meditation and get into an app for meditation because I need to get stress management or my sleep under control.” I have been sleeping for four hours. I’ve got undiagnosed sleep apnea. We haven’t talked about that a lot but stress management and sleep health are a big part of mind matter. Wherever you start, it’ll start growing from there. As you said, Coach, just start.

That goes along with two more of my questions. What did you do to recalibrate on that subject?

I have to be honest with you. For me, as a binger, a lot of what helps me recalibrate is momentum with food. When I start to break out of my healthy center of gravity, even my taste buds change. There’s something called taste bud rehab. You’re probably aware.

I cut out all processed sugar. For over sixteen days, no processed sugar. I went back and I hate it. The first thing I had was a KitKat after a sixteen-day no sugar. It was too sweet.

It’s overwhelming. I’ve had that happen with hot dogs or pizza. They thought it was going to be a certain experience. All of a sudden, they felt like they were eating a salt stick. It can go the opposite direction. You have to dull your taste buds again. It takes a while to go back. I had to go through the house and say, “We’re resetting the house.” I’ve got to reset back to the cupboard for where the kid’s stuff is, back to the fruit on the kitchen counter. I had to reset my tastebuds. I didn’t need to have all that temptation sitting in front of me. To me, that was a helpful kickstart. For anyone else, it can start about anywhere. It can be making a date to say, “I’m going to go on a walk with a friend that I like.” Admittedly, my wife is like that. She can walk for 4, 5 miles by herself. I find her coming back to the house within ten minutes. It has to be individualized.

I agree with that. For me, I have a hard time with meditation. I realized that working out, playing hockey, being in the boat or mountain biking, that’s my meditation because I’m not thinking about anything else. I’m focusing on what I’m doing. As busy as I am with all the things I have going on, that’s the one thing I know that can calm me down and recalibrate myself.

I call it moving meditation.

My wife is a yoga instructor. Interestingly, she will walk. It’s like walking meditation and she’s paying attention to the actual steps and thinking about each step. It is not easy to think about it and to do that as an actual meditation.

Ironically, I’m not sure if this is necessarily a way to support what you’re talking about and what your wife is doing but I do notice that when my posture is better when I walk, my feet hurt less. There’s something that’s connecting the top of my body to my feet. She could probably explain it.

You think about the proper position. You got your shoulders back. You’re resetting the body. The last question is, what brings you joy?

There’s no question that my children bring me the most joy. If you’re going to ask me prior to my kids, I could say music. Music still brings me joy. I love playing my guitar. I used to have more time and I used to have a band. It used to be a type of meditation for me. Although I lost some hearing from it. The bottom line is that music and travel too but that’s intermittent, brings me joy. My children, without a doubt. Nothing comes close.

My joy is doing the podcasting. I’m having a great time with it because I’m learning a lot from all the individuals that I’ve been talking with. We’ve known each other for over ten years. I’ve enjoyed following your journey and I look forward to following your next journey over the next ten years.

Likewise, Coach. Thank you so much. This is fun.

IMPORTANT LINKS:

• Reality Meets Science
• Paul Stanley on Growing Old – YouTube video
• English Longitudinal Study of Aging
• http://DPM.drtomrifai.com/
• Facebook.com/DrTomMD
• @DrTomRifai – Instagram
• @DrTomRifai – Twitter
• http://LinkedIn.com/in/drtomrifai

ABOUT TOM RIFAI

Dr. Tom Rifai is certified by the American Boards of Internal Medicine and Lifestyle Medicine. He is a past president of the National Board of Physician Nutrition Specialists is Harvard’s online Lifestyle Medicine course director for Nutrition and Metabolic Syndrome. Before obtaining his medical degree from Wayne State University he earned a Bachelor of Science in Psychology with Highest Honor from Michigan State University. Dr. Rifai has spent over 20,000 hours in direct patient care and coaching leading lifestyle and metabolic health programs including for the Beaumont and Henry Ford Health System as well as the Pritikin Longevity Center. In 2018 Dr. Rifai shifted 100% of his time and effort towards being the CEO for Reality Meets Science, a tech-driven health transformation company, now featuring his online Diabetes Prevention Masterclass.flexitarian approachlifestyle changenutritionphysiologicalplant-basedpsychologicalBob Waun – Principal At DIRT Realty & DIRT IntelBrian Kruger, Producer And Director At Stunt3 Multimedia & Buddy Moorehouse, Senior Creative Director At Stunt3 Multimedia