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Dr. Darrell White's Personal Blog

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Posts Tagged ‘sunday’

Optimization vs. Diminishing Returns

Some time ago I wrote about the Minimum Effective Dose (MED), the concept in which we seek to optimize our results with the smallest amount of whatever it is that we are using to achieve that outcome. The quest to find the MED is one that crosses quite easily between my day job (medical) and my own quest for health (CrossFit). A quick mention of Eva T in Outside magazine and the program she uses with her clients made me think a bit more on the MED. The Everyday Math column in the WSJ provided an enhanced vocabulary for the journey.

Sometimes the MED really is a “something” you take. Here one thinks of medicine or food, for example. More often is the case that we are looking at a dose of time or effort. Or perhaps both. In this case we are seeking to optimize the effort as it relates to the outcome, to make the value of outcome divided by effort as large as possible. The rate limiting factor here is the Law of Diminishing Returns, of course: at some point additional effort produces such a small incremental increase in the outcome that it becomes not worth making. This applies to everything from WODs/week (or day) to decorating a birthday cake. At a certain point you just have to feel you’ve succeeded.

How, then, to know when you have reached this optimal level? Eugenia Cheng, the mathematician who wrote the WSJ piece, offers the concept of the “minimal acceptable standard”. Once she has reached this outcome the additional effects garnered from more effort have moved beyond the point where Diminishing Returns kicks in and she simply accepts the outcome. We would call these “minimal standards” goals, but the concept is essentially the same. We want an outcome; setting a target or a goal is step one in optimization.

Cheng then goes on to refine optimization with a discussion about boundaries. One is your goal, of course. In real life others also exist, things like a 24 hour day and a 7 day week and the need to make a living. The dose you choose, both qualitatively (what it is) and quantitatively (how much you get) is unavoidably affected by boundary conditions over which you have less control.In the end no outcome worth getting happens without effort. Health, friendship, or the unraveling of a gnarly math problem–you’re going to put effort in to get your results out.

Maximizing your outcome-to-effort ratio is just another way to say you are seeking your Minimum Effective Dose, in CrossFit and elsewhere.

Evaluating and Treating Stress

Let’s talk about stress, shall we? It’s the Holiday Season in North America after all. Frankly, it’s been on my mind pretty much all day, every day, for a couple of years now. Probably because it appears to have taken up permanent residence in my body and soul for that same couple of years. Lots and lots of talk about stress around me, too. Everybody is talking about “having stress” in their lives, especially as the holidays roll around, so let’s talk.

First of all, as in all things it’s important that we lay some ground rules, establish some definitions so that we are sure to be talking about the same thing. Stress is what appears in your body in response to stressors; stressors are what you have in your life that produce stress, like serving dinner to family on Christmas Eve. I know, I know, it’s a pretty fine point, but bear with me because I think it will make a bit more sense in a moment.

In my day job I am constantly asked if various and sundry ailments are caused by stress. The most accurate and honest answer, from a strictly medical/scientific standpoint, is “yes”. What people are actually asking me, though, is: are the ailments that they have a direct result of the stressors in their lives? Again, perhaps a bit of a fine point, but it will matter. Everyone routinely conflates “stress” with “stressors”.

You can reduce the stress in your body; you may or may not be able to effectively reduce the stressors that cause it.

Think about that for a moment. You can do quite a few things that will reduce the ailments you may have because stress has been induced in your body. The simple science is that chronic stress throws your neuro-endocrine “fight or flight” response out of whack. Our bodies secrete cortisol when faced with acute stress. This is in turn associated with a release of adrenaline. Your pupils dilate, your BP and heart rate go up, and you shunt blood to skeletal muscle in preparation to do battle or to flee.

Chronic stress, on the other hand, causes an increase in both the basal cortisol secretion and a blunting of the normal daily secretion pattern of more in the AM and less in the PM. You have a flatter curve over the day, and the whole curve is elevated. In time you have a chronically elevated BP, and your state of chronic “readiness” begins to affect all manner of the rest of your systems. Stress then becomes a stressor itself, a repeating negative feedback loop. For example, your sleep pattern gets fried. Heck you may not sleep very much at all. That makes stress worse. That “lump in your throat” feeling when you are just pre-panic”? Yeah, that can be there all the time. It even has a name: globus.

Rather ominous word, that. Globus. Stresses me out just typing it.

Here’s the rub: if you could avoid stress—the adverse affect on your body—who wouldn’t do so? When people talk about trying to have less stress in their lives what they are actually saying is that they wish they had fewer and less powerful stressors causing that stress. Work issues, illness, family strife, money issues…life would just be better if we didn’t have them. Pretty simple. Get rid of stressors, get rid of stress. Sadly, our ability to excise stressors from our lives, or even insulate ourselves from them, is somewhere beyond inadequate and approaches impossible.

What to do then? If we cannot avoid the root causes of our stress, how can we relieve it? It turns out that both the magnitude and particular variety of stress can often be measured. Specific symptoms (sleep abnormalities, globus) will point toward equally specific interventions. There are laboratory tests that can be ordered given your particular stress (e.g. midline fat deposition); nutrition adjustments can be made in response (elevated cortisol reduces insulin sensitivity->consume carbohydrates during periods of lower daily cortisol levels).

For me the bottom line is this: we likely have little to no ability to control stressors, those exogenous factors that incite stress. Further, left to its own devices, our body will respond with stress. We can manage that stress by acknowledging it, evaluating it, and then proactively going about counteracting it. You are a Black Box experiment with an n=1.

Attack stress in exactly the way you attack fitness or nutrition. Weigh it, measure it, analyze it, and then attack it.

Sunday musings 12/17/17

Sunday mornings are quiet mornings at Casa Blanco. Re-rack after feeding the dogs, catch up with newspapers that have piled up in addition to the Sunday papers, a third cup of coffee just for the linger. Over the course of a week I collect thoughts and ideas for either musings or an eventual longer piece here, but as often as not it’s something that I read over coffee that turns up in my little Sunday piece. One fertile hunting ground is The Ethicist in the Sunday NYT Magazine, and it is here that I found my muse this week.

I have offered, here and elsewhere, that it is perfectly proper to make an enemy as long as you do it with forethought, and do it on purpose. In my long-held opinion to make an enemy by accident is the second greatest insult one can extend to another human being; it suggests that the newly formed enemy was not even significant enough to consider that they existed prior to your actions (or inactions). This leads, of course, to the single greatest insult that you could ever foment: to actively and purposely choose indifference to the existence of another.

This is a part of a topic addressed by The Ethicist on Sunday. He defines a “decent person” in part by whether or not they have what philosophers call appropriate “reactive attitudes”. In short how we react to others, and by extension how we react to what others in turn display toward us. The philosopher Peter F. Strawson mentions resentment, gratitude, and anger that we may have in response to how we perceive that others have treated us, or treated someone who we care about. Simply feeling these emotional reactions acknowledges that we feel the others are a part of our lives. They exist. They matter.

This time of year is fraught with the entire spectrum of emotions as we come into close contact with family and others with whom we have history. The simple fact that we come together means that we are not, cannot be, indifferent to either them or their feelings about us. Now to be sure there are some among us who have family members who are truly disturbed and either cannot or will not extend any type of goodwill or positive emotion whatsoever. Those, I believe, are rare exceptions, and to you who may be in this position you have my deepest, heartfelt sympathy. For the rest of us, though, in North America the Holiday season presents us an opportunity to re-boot our “reactive attitudes” toward family and friends.

Do you remember what it felt like to go home those first couple of years after you got out of high school? Remember how excited you were to see your folks, your grandparents, and your siblings? There was a buzz in your circle of friends as you conspired to sneak away and re-convene right where you left off the last time you were together. Remember? Trust me, the feeling was at least mutual (if not even stronger) on the part of your parents (and grandparents).

Families are complex and messy, but for all of that no matter what your particular story may be families are never indifferent. You could certainly take the position that we should always be connecting with family, and that the pressure of the Holidays would be lessened if we made more of an effort to be with those who trigger our “reactive attitudes” throughout the year. I’m OK with that. Actually, as a son, brother, in-law, father and grandfather I’d be thrilled with that. But here we are during Hanukkah, with Christmas a week away, so how much we see folks over the year is a topic for another Sunday.

Today, it’s time to go home.

 

Actions Speak Louder Than Words: Wisdom From Dad

When it came time to pick a location for their CrossFit Affiliate my sons were adamant that there be no question that they were opening their Box in a truly new, unserved area. They disqualified several fertile locations, only doing market research in areas well outside of the catchment zone of the Boxes then open. Their intent was righteous and above reproach.

Interestingly, although the boys were quite vocal about why they opened where they did, only one of the established Affiliate owners ever acknowledged this. “The Heir” and Lil’bingo walked away from their home town and all of their parents’ contacts, a simply terrible business decision. They felt it was somehow wrong, unseemly even, to move into the close proximity of gyms they felt were doing CrossFit the right way.

We’ve been parsing the lessons taught by my Dad over the years. On his 75th birthday we gathered 75 of them, and the list has been making the rounds among people he’d touched in life. One of them was an admonition to judge a man based on what he did, not what he said he’d do. The lesson was deep, deeper than any of us knew at the time. Folks make all kinds of promises and give all kinds of assurances, but in the end you only know who they really are by what they actually do. One can divine intent only when one can examine action.

In the end the lesson is that we will learn who you are not by what you say you will do, but by what you actually do. You may make the wrong decision for the right reason, but experience teaches that this is quite rare on a micro, personal level. No amount of explanation or rationalization will hide intent forever. That was the follow-up lesson from my Dad. Eventually, what you’ve done tells the rest of us who you are. “The Heir” and Lil’bingo told the world who they are by what they did. Few people listened, and fewer still understood. They paid a dear price, but they upheld their honor and did the right and righteous thing.

It’s not what you say you will do or why, it’s what you choose to do that tells us who you really are.

When We Will Exclaim a Person of Substance

My life is centered around, and centered by, the myriad women with whom I share airspace. There are certainly men there, too, and I am certainly fortunate in that my immediate world does not include anything like what other folks would consider a boss. While most of the women in my daily professional life are either employed by me directly, or employed by someone who has in some way contracted to assist me, the reality of my daily existence is that I have a symbiotic relationship with teammates who happen to be women, and we depend on one another every waking moment.

Because of this I have become alert to all kinds of slights leveled at women in general, and women who work in healthcare in particular. Frankly my worldview is really pretty restricted when it comes to the workplace, especially since the family Box closed a couple of years ago. In healthcare the hierarchy/patriarchy has historical sheltered bad behavior directed at women from both view and recourse. Is it changing in this volatile world that has emerged these last few weeks? That’s not really for me to say, of course; all I can do is whatever is in my means to provide an environment that respects a gender-neutral environment and chain of command whenever I have the privilege of setting the tone.

What is very interesting to me, and what I find to be a very positive (if tardy) side effect of the recent “outing” of men in power who have abused that power, is the celebration of thoughtful women whose thoughtfulness might not have been quite as well-known before. Again, it goes without saying that this should not be something that is remarkable in the least, but for the sake of this particular musing perhaps we can simply acknowledge and agree upon that, and spend our time thinking about what it is that these women are saying.

Reese Witherspoon comes instantly to mind, of course. Ms. Witherspoon has forcefully said that SOP in Hollywood is no longer even a little bit OK when it comes to opportunity to control the spoils of the industry. Not content to simply raise the issue she has literally put her money on the line along with that of like-minded individuals and begun to create those opportunities. Ms. Witherspoon has much to say that is worth hearing. One could do worse than the recent WSJ Magazine cover article as a jumping off point to begin your listen.

It’s highly unlikely that there is any woman in the world about whom more electrons have been circulating of late than the actress Meghan Markle. There’s not a rock big enough for you to have crawled under in the developed world for you to be unaware that she has recently been betrothed to an heir to the British throne. While Ms. Markle and her beau are, indeed, impossibly cute together, it’s more than a bit of a shame that it has taken her very public romance for the non-People reading public to discover her, her story, and her intellect. This is a person of substance.

Hopefully Ms. Markle will forgive me for I will certainly get some of details wrong (as usual I am writing without notes). She is the daughter of a caucasian father and an African-American mother, and she has been on the receiving end of various forms of discrimination from a very young age because of that. She tells a story of being forced to declare in school that she is one or the other, Black or White. To check a box because, well, that’s what is done. She declined. Maybe she was 12. She opted not to opt. I don’t know how long it’s been since you’ve been in school, or had a child in school, but that’s a rather gutsy move.

She went home and asked her Dad why. Why should she have to choose? His response informs her message today: draw your own box. Man or woman, if the choices that are presented to you do not include the right choice, draw your own box to check. Ms. Markle tells the story so much better than I, but I am happy to pass it on with a further encouragement that you should go look for her telling this story, and while you are at it there is a wonderful clip of her accepting an award for her advocacy on behalf of empowering women. She is universally described by anyone who has listened to her as a woman of substance.

My hope, and my goal in writing this today, is that the term “woman of substance” will one day be replaced (as I did above) for both men and women with “person of substance”. Substantive ideas matter, and they ought to matter irrespective of whatever labeling might be applied to the holder of those ideas. While they may not have the name recognition of Ms. Witherspoon or Ms. Markle, I am surrounded by women of substance whose ideas bear our listening. My wife and my daughter, my sisters and my mother, my daughters- and sisters-in-law, as well as the extraordinary women with whom I’ve worked in healthcare and met through CrossFit, give me confidence that this can be.

Not today, not yet, not soon enough but soon, for the benefit and betterment of all.

 

Sunday musings 11/26/17, Rigged in Your Favor

Sunday musings…

1) Capulet. Juliet’s last name. No reason; just seems like a cool thing to know.

2) Apokalypsis. Ancient Greek for uncovering or unveiling. I’m not exactly sure why, but this particular derivation of “apocalypse” seems all too appropriate for the last couple of months, eh?

3) Lifetime. After a bit of time I recently tried to access an online place to which I’d once been given a lifetime subscription. It’s one that I used to look at very frequently;my user name and password never changed. I discovered a different sign-in format, one that did not even accept the form of sign-in I’d been accustomed to. “Lifetime” in this case had nothing to do with my longevity, but rather the employment lifetime of the gifter, or the lifetime of institutional awareness of my being.

It leaves one to ponder: how many lifetimes do we have, and what is it that brings any particular lifetime to an end?

4) Babar. I have a thing for watching the end of a series. TV, movies, a particular character in an author’s books. I seem drawn to them even if I had little to no engagement with them over the course of their long or short lifetimes. Just the tiniest bit of introspection leads me to M*A*S*H, a beloved television series that I actually did watch quite religiously. I’m pretty sure that the final episode of M*A*S*H was the first finale I consciously watched as such (thanks again for hosting us all Evan Tabor!).

What’s funny is that I have gone out of my way to put the series finale of shows that I pretty much never watched on my calendar with the same amount of “gotta see it” as those few that I never missed. “St. Elsewhere” was just as much of a must-see as “Hill Street Blues”, for example. Even more interesting–maybe sillier is a better word–I find myself with the same type of nostalgic yearning at the loss for both. Weird.

So it is as I discover that the beloved children’s character “Babar” has made his swan song. With the publication of “Babar’s Guide to Paris” author and artist Laurent de Brunhoff signs off and Babar takes a final bow. There is no heir, and the character is not meant to have any further adventures. After finishing the WSJ interview I know that I will read this book despite the fact that I have read (or been read to) only the original story (written by Laurent’s father Jean) and not a single intervening edition. As avid collectors of children’s books and enthusiastic readers to our children and now grandchildren, this is even more striking.

Why this book, and why now? Well, I have to admit that I’m a sucker for sentiment, and this quote makes it a slam dunk: “I never really think of children when I do my books. Babar was my friend and I invented stories with him, but not with kids in the corner of my mind. I write for myself.”

Who wouldn’t want to spend a few pages with a 92 year old and his friend of some 70 years as they explore the City of Lights together one last time.

5) Rigged. “Live life as if everything is rigged in your favor.” –The Persian poet Rumi (as told by Neda Shamie)

Have you ever heard a more lovely description of optimism? What a smashing way to approach life! In the past I’ve written that one should assume that each endeavor will be a success, that this simple assumption does, indeed, increase the odds that it will happen. So often we hear from people that the game is rigged. Heck, I’m gonna go out on a limb and say that every single one of us has felt this at least once in our lifetimes. We all know people who have simply given up on all but sustenance, so completely do they believe that any effort at advancement will be thwarted in a game that is rigged.

But it isn’t.

At least it isn’t if what we aspire to is simply taking that next step up. Sure, if your only definition of “winning the game” is to have Gates/Soros/Koch kind of money, the game is surely not set up for you to succeed. In reality, success (see “Gratitude = Success”) and happiness do not require such an outsized outcome. Therein lies the brilliance of Rumi’s insight. If everything is “rigged in your favor”, if all of your “ducks are in a line” and the deck is stacked for you, why NOT take that opportunity and turn it into your next success? You could certainly accuse me of being a pollyanna here, but heck, doesn’t it feel better to look forward with hope than otherwise?

The game of life is here, today, just waiting for you and me to play a winning hand.

I’ll see you next week…

–bingo

Drama at the Speed of Light

Teen drama. Very little of it at Casa Blanco right now (knock on wood), likely because everyone is now in their twenties, but I had an interesting conversation about this in the office with some grandparents talking about watching their teen grandkids being raised. We all had it, the drama. It seems to be a universal observation that it’s of a greater magnitude now. Why is that?

If you are of a certain age (like me) you communicated with your friends by telephone. You know, the one on the wall in the kitchen, typically the only one in the house, the one that you shared with everyone else in your family. I know, I know…those of you NOT of a certain age have only seen this on “Leave it to Beaver” re-runs on Family TV, but it was really like that.

Your teen drama took place primarily face-to-face in school, or transpired one-on-one on the phone at night. You had a limit to how long you could talk (your stinky brother wanted the phone), and the “phone game” of a story growing and evolving with each transmittal was the real deal because, well, there was only one call at a time.

Fast forward to 2017. Verrry fast forward. Teen drama, whether it’s a bunch of teenagers or a bunch of folks involved on Twitter, is indeed a much more intense phenomenon. It hits harder and faster, and it spreads at the speed of light because it TRAVELS at the speed of light. Cell phones, Twitter, Facebook, Text…drama transmittal is now exponentially faster so drama growth is no longer linear but exponential as well.

Actionable point? Eh, I dunno. I guess if you are a parent or grandparent it helps to understand why it is that your teen and young adult kids seem to be hit so much harder and so much faster when the same stuff you experienced hits them. As an adult exposed to your OWN drama, though, I do think this knowledge should give you pause, encourage you to actually pause when in the midst of this kind of thing.

Because you can’t un-ring a bell, and when you ring that bell in 2017 the sound travels at the speed of light, and whatever tune your tone rings forever in the vast electronic symphony hall. Teach your teens, but don’t forget yourself.

You’re a big kid now; slow it down.

Textpectation

I am the world’s second worst texter. I’m not sure who is the worst texter, but I’m pretty sure that there can’t be more than one person who is worse than I am. I’m not too concerned about that, though, nor am I all that interested in making much improvement. I just can’t stand the pressure.

Haven’t you noticed? Unlike a phone call where it’s totally OK to let it go to voicemail, there’s an expectation that a text is going to elicit an immediate response. Actually not so much of an expectation as a demand. Call it “textpectation”.

How do I handle the pressure of “textpectation”? Easy. I simply continue to aggressively suck at texting. I have effectively lowered expectations so far that any response at any time is considered something just short of a “visitation”.

YMMV, but if you’ve sent me a text, don’t take it personally.

The Enemy is the Couch

One of the repeating themes in all of my writings on fitness is that it is exponentially more important that one gets off the couch than it is what one does after getting up. To be sure, we in the CrossFit community have been reasonably and accurately accused of being zealous in our support of our chosen post-couch activity. Unlike “Fight Club” it has been observed that the first rule of Crossfit must be that you ALWAYS talk about CrossFit. Fair dinkum. Still, while we may be proven more right than not in the end, there exist other effective fitness options.

My nephew, a retired hockey and lacrosse player, has found his post-collegiate sweet spot in one of the cycling/spinning communities. His preferred version is “Soul Cycle”, but that’s probably more like saying Ben & Jerry’s when you really mean ice cream. You and I know all kinds of folks who swear by Pilates, Barre, various and sundry types of Yoga, and the legions of people who lace ‘em up and run at all kinds of levels at all kinds of times in all kinds of places. In the end even the most zealous among us has to admit that each and every one of these non-CF activities are substantially better than continuing in an unhealthy relationship with your couch.

Fitness, and by extension health, are profoundly complex entities. Hence my own personal difficulty in arriving at a single integer that can be used to measure relative health. It also explains the abject failure of the collective whole of the health wearables industry to come up with a single meaningful, actionable measurement. Still, we ought not dismiss the wearables industry entirely if for no other reason that putting on that Fitbit, or launching Health on your Apple Watch more often than not is like magic; it levitates your ass off that couch.

Simplifying our discussion about fitness and health along the straight line between relatively high intensity exercise versus what could be called long-slow aerobic exercise blinds us to both the essential value of forsaking the couch, while at the same time limiting our ability to explore why it is that there doesn’t seem to be that one, single best approach. Part of the genius of CrossFit is that it starts with a definition and then demands measurement. CrossFit proper has enjoyed explosive growth, growth which is now also occurring in a parallel universe of derivative programming offered by trainers who got their start owning a Box. Is it, are they, better than everything else out there?

Does it matter?

Zero sum games require that someone lose in order that another wins. Likewise, a zero sum grading of ideas means that one eventually must become axiomatic at the expense of the demise of another. Zone/macro quantitative strategies of nutrition vs. Paleo and similar qualitative strategies, for example. A complex system demands that we constantly assess not only the “games” themselves, but also the relationships between the various “games”. Perhaps the greatest gift that I have received from my discovery of CrossFit and the CrossFit community is my ongoing curiosity about all things fitness, and by extension my willingness and desire to pursue the inquiry. By extension I have learned that what works for me may not necessarily work for you.

Is it better to do my CrossFit Rx or my nephew’s Soul Cycle? The answer of course is ‘yes’. Should one do the “Taking Back Eating” macro program or find health in “The Paleo Solution”? Likewise: ‘yes’. Broad acclimations await better measurement followed by the evaluation of those measurements across very large groups of people. However, you and I need not await those conclusions because we can embark on a highly actionable study of our own, n=1.

All it takes is getting off the couch.

 

Someone Is Keeping Your Receipts

Once upon a time records were kept prospectively in order to support some sort of existence. Transactions of some sort or another would be the most common example. Of course, if one wished to avoid or deny the existence of some sort of transaction, or indeed to deny the existence of some event, one simply had to avoid the creation of a “paper trail” which documented some part of that event. Receipts involved commerce, and if you spent just the tiniest bit of time thinking about it you could limit the number of receipts that were out there.

Now? Not so much. A “receipt” is now any type of irrefutable documentation of some event. Sure, that credit card receipt puts you in that Uber at 0200 in SoHo, but so does the Tweet that mentioned you in passing. Or the pic your companion SnapChatted and was saved as a screenshot. The ultimate, all-time greatest receipt was a certain dress that never made it to the dry cleaners, but nowadays scandals as great or orders of magnitude tinier are rendered factual by the seemingly banal.

Thinking back it’s funny, how I got to be “bingo” here and elsewhere. In those early days of online communication one gave reasonable thought as to whether it was prudent to use your own name online. Heck, my prenup consists of a single line: “Darrell will not run for elected office” so that the family would be spared the scrutiny of an election. To be anonymous in today’s world it takes either herculean effort (try to find something about the family that owns Perdue Pharma, for example), or a complete indifference to that which seems to drive western societies (think bridge troll). What was once the “paper trail” became the “digital footprint” and is now a ubiquitous “universal map” of your life. Does it even matter? One wonders in this day of Alexa and Siri and paying for the privilege of placing the equivalent of Big Brother v1.0 in your own home.

I have endeavored, here and elsewhere, to make kindness the currency of my transactions. Indeed, CrossFit.com (and my blog) have been little “behavioral gyms”, if you will, where I have practiced making kindness the irreducible movement in my interactions. The on-line world in its earlier days was kind of a mulligan for folks of my generation. Not a day goes by that one or another of us sighs in relief that cellphone cameras and social media had yet to be invented when we were young. Now? Now it’s a running tab, a veritable windfall for the social accountants who tally up the score. They are everywhere, and it matters not how many degrees of separation they are from you and Kevin Bacon.

Someone always keeps the receipts.