Dr. Julie Chen of Wisdom in Wellness: “Stress management is essential in managing weight and lifestyle habits”

Stress management is essential in managing weight and lifestyle habits: Stress triggers the stress hormone cortisol. Cortisol can trigger an increase in appetite and cause cravings for sugars, fats and salts. With high cortisol, it can also disrupt hormonal balances like lowering hormones like testosterone and lead to body composition changes like lower muscle mass. […]

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Stress management is essential in managing weight and lifestyle habits: Stress triggers the stress hormone cortisol. Cortisol can trigger an increase in appetite and cause cravings for sugars, fats and salts. With high cortisol, it can also disrupt hormonal balances like lowering hormones like testosterone and lead to body composition changes like lower muscle mass. Cortisol is also known to contribute to the dreaded belly fat and there are studies indicating belly fat or abdominal circumference is linked to cardiovascular risks. Factors like exercise, mindfulness exercises, meditation, yoga, lifestyle habit management, biofeedback training can help with stress management. I always tell my patients that what happens in your mind doesn’t just stay there, our body is connected to our mind and so our mood and mental state are very important factors that impact our overall health and weight.

So many of us have tried dieting. All too often though, many of us lose 10–20 pounds, but we end up gaining it back. Not only is yo-yo dieting unhealthy, it is also demoralizing and makes us feel like giving up. What exactly do we have to do to achieve a healthy body weight and to stick with it forever?

In this interview series called “5 Things You Need To Do To Achieve A Healthy Body Weight And Keep It Permanently” we are interviewing health and wellness professionals who can share lessons from their research and experience about how to do this.

As a part of this series, I had the pleasure of interviewing Dr. Julie Chen.

Dr. Julie Chen has a BA degree in public health and is a board-certified fellowship-trained integrative medicine doctor who has been featured as a medical expert on shows such as Dr. Oz, The Doctors, to name a few, and has been an advisor/thought leader/executive for numerous companies in Silicon Valley.

Thank you so much for joining us in this interview series! Before we dive into the main focus of our interview, our readers would love to “get to know you” a bit better. Can you tell us a bit about your childhood backstory?

I was born in Taiwan and moved to the US when I was 6 years old. Growing up, my mother always used alternative approaches along with conventional approaches to my overall health. All of my uncles are doctors so she’s not unfamiliar with conventional medicine but I distinctly remember her using ginger for my sprained ankle one time and salt water for dental issues growing up. These are just two examples but it was great growing up with the perspective that there are various ways to approach health to obtain a whole systems approach to health. She was very big on healthy balanced diets and exercise as well. When I started applying to colleges, I knew I wanted to go into medicine because, to me, medicine is a great marriage amongst the sciences and humanities, where the concepts of philosophy, psychology, ethics, biology, physics and chemistry for example can be implemented together to help people attain their health goals in a way that is empowering for a patient and effective in eliminating health issues. I’ve always loved whole systems approaches to things in life and finding solutions in a way that balances many needs, not just physically but mentally and emotionally. I’m extremely passionate about what I do and am very happy that I chose the medical path.

What or who inspired you to pursue your career? We’d love to hear the story.

I was diagnosed with Graves’ disease when I was in 8th grade and the process of dealing with that, with weight fluctuations, impacts on mood and energy to name a few really helped me to see that health is so important to the overall happiness of an individual and I wanted to help others. I also realized when I was going through the process that I would feel my symptoms change even before the labs did and a few weeks later the labs would catch up, so I wanted to go into a field where I could be a patient’s advocate. Even now, if a patient tells me they have a symptom and the lab isn’t fully abnormal yet, I still see the reported symptom as valid and we monitor it and do sequential labs to monitor changes. What a lot of people don’t know is that a lab value has a normal range, it’s a range. Some people feel better on the lower range, some at higher range. None of us are cookie cutter, we are all different individuals, I feel it is important not to forget that and if a patient is reporting a symptom, it’s our job as physicians to take them seriously. We treat the person, not just the lab.

Also, I was diagnosed with rheumatoid arthritis in my early 20s and that event really helped me look into integrative medicine/health since I was able to control a lot of my symptoms simply with healthy diet where I mostly ate whole foods and a lot of vegetables and stopped eating processed starches and sugars and simple sugars. The improvement was dramatic and I’ve been helping other autoimmune patients with lifestyle approaches ever since. Using an integrative medicine approach, the outcomes have been tremendously positive. Many rheumatologists I work with who initially may have been skeptical are now great team players with me and the patient. I really appreciate the team approach to patient care. I would say my own personal health issues really has helped me to become a better doctor and a better patient advocate and has made my career very rewarding.

None of us can achieve success without some help along the way. Was there a particular person who you feel gave you the most help or encouragement to be who you are today? Can you share a story about that?

I wouldn’t say there’s been one particular person. I would say that I’ve been fortunate enough to have had multiple teachers and doctors who I’ve learned from or trained with who have helped shape my vision, passion and goals. I’ve also had great mentors while working at start-up companies in Silicon Valley. What that has taught me is that we should always be open to input and to take things in so that we see it as a point of growth. Ultimately whether it’s a success or a failure, as long as we are learning as we go and we are positive about our growth, I feel that is how we become the best versions of ourselves. I also find that my patients have been great teachers for me along the way. I believe doctors have the special privilege to be in people’s lives at their most vulnerable times. For patients to open up to us, let us help them, and see them vulnerable, I’ve been able to see some amazing examples of true inner strength, true love, true compassion, and true kindness. I feel it’s important to learn from life in whichever avenues we are lucky enough to be a part of.

Can you share the funniest or most interesting mistake that occurred to you in the course of your career? What lesson or take away did you learn from that?

I would have to say that the funniest situation was when I was first learning how to do VC (venture capital) meetings for a start up where I was Chief Clinical Officer. I was training for our VC meetings with the founders of the company because the head of science had to be at these meetings but I had never gone to any of them. He was training me and said “don’t repeat yourself, don’t overshare information, and keep the information succinct.” I was like “But I’m a doctor, I always have to repeat myself, I have an obligation to share all facets of anything I’m dealing with regarding patients, and I have to explain at length for patients to make sure they understand everything about their health state. So you want me to not be myself?” It was funny and honestly very difficult for me but I did ultimately learn those skills and they have helped me tremendously in certain corporate scenarios. I have been extremely fortunate to have been able to learn various differing skillsets from great mentors and teachers in my career from my diverse professional experiences.

Can you share your favorite “Life Lesson Quote”? Why does that resonate with you so much?

One of my favorite quotes I like to use with my patients is that “It doesn’t matter how you fall, it matters how you get up” and that resonates with me because all too often people get hung up on failing a goal, not doing things right, or being hard on themselves, to the point where they just give up. My point is that we all fail and falter. We’re human. What matters is that you acknowledge that you didn’t reach a goal but then get up and try again. It doesn’t matter to me if they keep falling off track, it’s the fact that they keep getting up and trying that is amazing, awe-inspiring and beautiful. I always tell my patients that if they didn’t eat well at one meal, that doesn’t mean the whole day is blown, aim to eat healthy at your next meal. Take one event at a time to build up a sense of success. It’s those little wins that overtime add up to a huge success.

What are some of the most interesting or exciting projects you are working on now? How do you think that might help people?

I am currently working with a company called Human Longevity and I am very excited about this company. They have recruited me for the Chief Clinical Director role for the company as well as the Medical Director role for the San Francisco clinic location and we will be focusing on proactive approach to health using genomic precision medicine. Essentially, a patient gets a full human genome sequence along with bleeding edge technology in imaging and labs and we approach the patient’s health from a 360 approach of clinical, imaging, labs and genomics. We have been able to detect cancers and diseases very early on. I am a huge proponent in proactive medicine instead of waiting for a disease to happen and then doing reactive medicine. Prevention and proactive health approaches to me are what saves lives. I’m very excited about this company, what we are doing for our patients, and our goal to collect data to help further scientific approach to clinical healthcare. The scientist in me is very excited.

I am also currently running a company called Wisdom in Wellness where our focus is on client education about immune health with our blogs and also providing an allergen-free all-in-one immune supplement, ImunOptimyze, that has a blend of herbs, vitamins and minerals that are put together by physicians using ingredients that have scientific studies supporting immune health goals. I am a big proponent in providing tools and knowledge to those seeking it. The goal is to give people an option where doctors have already put it together for you so that all the ingredients are blended clinically with synergistic ingredients at synergistic dosages so it takes the guess work out for people. I’m a big believer in making achieving health goals as easy as possible. The more complicated it gets, the harder it is for people to adhere to it.

For the benefit of our readers, can you briefly let us know why you are an authority in the fitness and wellness field?

My background in public health, years of experience in clinical research, and my formal training in integrative/internal medicine has uniquely positioned me to be able to work as an advisor/thought leader/executive in many health or direct to consumer companies as well as been integral in setting up wellness clinics in corporations. These experiences along with my clinical work with my patients at my clinic have given me years of experience in approaching health from not only the perspective of individual patient care but to the level of global impact on healthcare both in terms of policy, guidelines and commercially at the product level. I have the experience of what works practically at the level of each individual patient with various levels of disease/health complexity to the level of what impacts global commercial market regarding products and also what studies/data is needed to effectively effect change in health guidelines and policies. I believe that healthcare as an industry is multifaceted and complex, in order to effectively try to help change healthcare at the individual level as well as at a global level, being multifaceted in experience is necessary.

OK, thank you for all of that. Let’s now shift to the main focus of our interview about achieving a healthy body weight. Let’s begin with a basic definition of terms so that all of us are on the same page. How do you define a “Healthy Body Weight”?

The National Institutes of Health considers ideal Body Mass Index of 18.5 to 24.9 as “healthy body weight.” For me, that also would include an assessment of patient’s diet and lifestyle habits to make sure it all aligns with a “healthy” body whole systems approach.

How can an individual learn what is a healthy body weight for them? How can we discern what is “too overweight” or what is “too underweight”?

To calculate the Body Mass Index, you would use the formula:

BMI= weight in kg/height in meters squared

Or

BMI = (weight in pounds/height in inches squared) x 703

Overweight is BMI of 25–29.9 and Obesity is 30+

Underweight is below 18.5

This might be intuitive to you, but it will be instructive to expressly articulate this. Can you please share a few reasons why being over your healthy body weight, or under your healthy body weight, can be harmful to your health?

Studies suggest that when we are overweight, our body mechanically has to handle more load/weight which then mechanically wears down body faster. Also, when we have extra fat tissue, there are hormones in there so there are concerns for increased risks of hormone-based cancers. Also the lifestyle habits that lead to being overweight can have negative impact on cardiovascular and diabetic risks. When someone is overweight, the pressure in the chest cavity and tissue in throat and airways can be increased so heart has to pump harder to get blood out and blood pressure can be an issue and obstructive sleep apnea can occur which puts increased pressure in airways, lungs and heart. This is a brief synopsis and only a few examples of why doctors become concerned about a patient who is overweight.

Some of the concerns about being underweight are that a person would be more at risk for osteoporosis, irregular periods, premature births, decreased immune function, malnutrition, nutrient deficiencies, anemia, and fatigue, just to name a few. Our bodies are machines first and foremost, if the storage of nutrients aren’t sufficient, the body’s overall functioning may be more limited and less effective. For example, as we had discussed about adipose tissue having some hormonal impact so when someone is underweight and has less fat than normal, that can impact hormone balance.

In contrast, can you help articulate a few examples of how a person who achieves and maintains a healthy body weight will feel better and perform better in many areas of life?

When we are at our ideal body weight, we are in essence at our optimal nutrient, energetic, and functioning status. Because our bodies are machines first and foremost, having a well-tuned up machine with all parts fully fueled up and efficiently running allows us to feel better and have sufficient reserve to pull upon when we are in stressed states, so that we can perform better in all areas of life at all times.

Ok, fantastic. Here is the main question of our discussion. Can you please share your “5 Things You Need To Do To Achieve a Healthy Body Weight And Keep It Permanently?”. If you can, please share a story or an example for each.

I know these may seem simplistic but they are the true foundational factors that if you commit to them, will help you get to a healthy weight and keep it there. I’ve seen this repeatedly in my clinic.

  1. Eat whole foods, stay away from processed foods and simple sugars: Nowadays, a lot of our foods that seem healthy and clean are in actuality not. The best healthy “clean” foods are the ones that Mother Nature made in real food form. I am a big believer in eating whole foods in their original form so that your body is able to recognize it for what it is and metabolize it as fuel efficiently. When your body sees foods that have been processed, it is less efficient at managing the fuel. For example, some processed foods have xenoestrogens where chemicals act as hormones that imbalance you and your body’s functioning, metabolism, your cravings and moods. Eating REAL foods in their REAL forms are essential at lowering inflammation and helping your body not retain water or swell and to help your body’s metabolism be the most efficient. For example, eating vegetables made up of the colors of the rainbow at every meal ensures that you will get a good balance of nutrients and vitamins which goes a long way with helping your body be more efficient with metabolism because nutrients are what powers cellular functioning.
  2. Exercise daily, your body is a machine that’s meant to move. Efficiency of your body depends on it: Our body is made to move. It is a machine first and foremost. As with any machine, leaving it idle isn’t ideal in keeping its moving parts moving efficiently. I usually recommend patients to get at least 15–20 minutes of movement daily at a minimum, but would prefer 30–60 minutes daily of some form of exercise if they can. Also, if it’s easier, the concept of 10,000 steps per day can be helpful for someone to keep track of movement if needed. For example, try to take stairs at work, walk during lunch time, get in exercise before or after work, put on music at home and just dance around the house, etc. The point is that you should just move every day. Your cells are more efficient at managing insulin sensitivity, glucose management, lipid management if you do. Your mood, sleep, bowel functioning and mental focus, just to name a few, are more optimized as well if you exercise daily. When your mood, sleep, gut, and mentation are all better, you make better choices with food too.
  3. Sleep more than 6 hours a day and less than 9 hours per day: Studies suggest that we are less likely to get dementia if we sleep more than 6 hours per day and less than 9 hours per day. If we lack sleep, our glymphatic system (the network of vessels that clear waste from our central nervous system) isn’t able to be as efficient. Which in the long run impacts our mentation, cognition and mood which ultimately impacts our choices with our diet. Also, when we lack sleep, that triggers increased levels of ghrelin and decreases levels of leptin so we are more hungry and it increases our appetite. Sleep is when our body resets and balances, it’s important not to scrimp on that.
  4. Hydrate frequently every day: Studies suggest that when you drink more water, you crave foods less and it helps you to eat fewer calories. Hydration is also important so that the signals in your body that makes you retain water/salt improve and balance out. Many people feel cravings for foods when in reality they are actually thirsty and need water. So I usually recommend for patients to start the day with a big glass of water and keep pre-measured bottles of water and put them on your desk and make sure you finish them by end of day. All too often, people forget how much water they’ve had so if you lay them out on your desk and make sure you finish them by end of day, you’ll know that you’ve gotten what you need.
  5. Stress management is essential in managing weight and lifestyle habits: Stress triggers the stress hormone cortisol. Cortisol can trigger an increase in appetite and cause cravings for sugars, fats and salts. With high cortisol, it can also disrupt hormonal balances like lowering hormones like testosterone and lead to body composition changes like lower muscle mass. Cortisol is also known to contribute to the dreaded belly fat and there are studies indicating belly fat or abdominal circumference is linked to cardiovascular risks. Factors like exercise, mindfulness exercises, meditation, yoga, lifestyle habit management, biofeedback training can help with stress management. I always tell my patients that what happens in your mind doesn’t just stay there, our body is connected to our mind and so our mood and mental state are very important factors that impact our overall health and weight.

The emphasis of this series is how to maintain an ideal weight for the long term, and how to avoid yo-yo dieting. Specifically, how does a person who loses weight maintain that permanently and sustainably?

I believe that initially people may find lifestyle habit changes daunting. So, giving yourself realistic goals and achieving each step and rewarding yourself with non-food related treats to help you move forward are important. These treats can be time with friends, doing something you enjoy like going to museums or concerts, learning healthy cooking, manicures/pedicures, spending time with loved ones etc. These are all healthy ways to encourage yourself in your healthy lifestyle habit improvements. I think making small changes towards your goal is something that can be very effective in people and I’ve seen that a lot with my patients. I think setting realistic goals and troubleshooting potential obstacles ahead of time is crucial in success. It’s important to enlist the help of your family members and friends to help you reach your goals and keep you accountable with your goals. It is important to create healthy habits and then repeating these habits over and over, until they are second nature to you so that they are as normal to your daily functioning as brushing your teeth. By doing this, you are less likely to deviate and if you do, you are more likely able to resume healthy habits because it’s ingrained into your daily life already.

What are a few of the most common mistakes you have seen people make when they try to lose weight? What errors cause people to just snap back to their old unhealthy selves? What can they do to avoid those mistakes?

I think many people set up unrealistic expectations and then when they can’t reach it, they then say “oh forget it” which is what can lead to recurrent derailment. It’s important to set realistic expectations even if that means you have several levels of goals and you look at each one as “once I’m down 5 pounds then I can decide about the next 5 lbs” so that it’s more manageable. Also, it’s important to prepare for potential setbacks and obstacles so that when they occur, you know what to do and aren’t derailed. I always tell patients to eat before going to an event where they’re not sure if there’s food they can eat. Also, they can clear it by the host/hostess if they can bring food they can eat. This way, they might be helping other people there who also want healthy options. I think having the right mindset is everything. If you are focusing on being perfect, it’s not going to work. If you’re focusing on just getting healthier and making realistic healthy changes and realistic weight loss goals, it’s generally much more successful. If you derail, it’s important to just acknowledge it happened but not focus on that and just say to yourself, I will keep trying to make my next meal be healthy and keep that mindset going. Frequently, it’s not a one big win that gains us success in most things we do, it’s the recurrent little successes and our perseverance in trying to get there that ultimately gains us our greatest successes in life. Weight loss is no different. I’ve seen some patients try for quick fixes but because the foundational habits aren’t there, then once they go back to regular life, the weight comes back. Weight loss, as in general with building health, we need to lay the foundation of healthy habits to have a stability where even when we veer off a bit, we have a strong base to bring us back and get us back on track. Most of my patients who have healthy habits and are now used to it, even if they cheat on diet, they can’t do it for very long, they don’t feel good and will go back to eating and living healthy. That’s in my opinion the best way to achieve a consistently healthy weight.

How do we take all this information and integrate it into our actual lives? The truth is that we all know that it’s important to eat more vegetables, eat less sugar, etc. But while we know it intellectually, it’s difficult to put it into practice and make it a part of our daily habits. In your opinion what are the main blockages that prevent us from taking the information that we all know, and integrating it into our lives?

Life gets busy and hard and there are a lot of temptations for us to eat when we are tired and stressed. So, the main solution is to prep for that and to make sure we have solutions for obstacles that we know may come up. One of my patients bought a trunk/locker that has a timer and it only opens up once per week so she only cheats on sugars once per week. Another patient of mine knows that she’s too lazy at night to go get junk food so she keeps nothing but healthy food at home so that even if she’s hungry or has cravings, she has nothing to eat that’s bad and she’s too lazy to go out to get some. If you have children in the house, another option is to buy snacks that they like but you don’t so you are less tempted or to keep it locked away and only other family members have access to it. I think some of these solutions may sound extreme but it’s important to make a healthy lifestyle transition easier on you and these are meant to get you into a healthier habit and once you are more on track, you can remove these and see if you can keep yourself on track without these. Another main issue is if you don’t have any food in the house and you’re hungry then you are more likely to eat problem foods. Never go grocery shopping hungry and only keep healthy options that are easy to consume at home. If you have to meal prep and it’ll take 30 minutes or 60 minutes and your hungry, it might be easier to pick up pizza and that’s not the goal. Keeping it simple and realistic is huge in making sure you succeed. Ultimately, being honest with ourselves as to what our strengths and weaknesses are in this process is important in setting yourself up for success. Use that knowledge to your benefit when you are creating successful strategies against obstacles that might come up.

On the flip side, how can we prevent these ideas from just being trapped in a rarified, theoretical ideal that never gets put into practice? What specific habits can we develop to take these intellectual ideas and integrate them into our normal routine?

It is a lot easier to integrate these concepts into real practice if we break down our goals into more manageable parts. For example, you can start by just not having any sweets in the house or just not buying anymore processed sugars and starches. Or if removing things are too daunting, start by just adding vegetables to every meal. Once you get that habit down, then add another one and keep the one prior to that. Then over time, these changes add up and your overall healthy habits just seem like a normal part of the day. A lot of my patients will say they don’t have time to change and go to gym or change and go for run. My answer is, don’t change, just go out and walk, put on comfortable shoes and walk. Or just dance at home in your pajamas. Or get a system or bike or something at home where it’s easy for you to work out. If you don’t have time, just make it a habit to dance to music when getting ready in morning or do some push ups or ab exercises during commercials when watching TV. I think when people make these changes into a big deal in their mind, it’s too daunting and they don’t start. But if you say “ok, I’m just going to add broccoli to dinner this week and add brussels sprouts next week” it’s much less daunting. Or simply adjust one meal of the day first like always having a healthy lunch, dinner or breakfast. When we succeed and have these smaller wins, it prompts us to be more confident about our next win and the mindset changes from “it’s too much” to “that wasn’t bad, I can do this.”

Ok, we are nearly done. You are a person of great influence. If you could inspire a movement that would bring the most amount of good for the greatest number of people, what would that be? You never know what your idea can trigger.

My ideal for healthcare has always been about proactive foundational health and empowering patients to be advocates for that for themselves and for physicians to also champion that for them. What I mean about proactive foundational health is that we should dig deeper into patient’s stories and into their current health status wherever they are and not wait for them to get sick and then dig. If and when we find health issues, or even if we don’t, educating patients about what factors impact our foundational health is super important. What we feed our bodies, how we view our bodies, how we view our lives, how we allow our body to rest or stress, how we move our bodies, etc, those are all the mainstays of what determines our health outcomes. All too often, doctors don’t talk about these factors with patients and if they do, they wait until the patient is sick. We should be educating and empowering patients to set up strong healthy foundational health even if they are healthy so we can keep them that way and if they are sick, we need to emphasize the importance of fixing the body from the bottom up foundationally and not just bandaging with medications. I am of course not saying medications are bad, there are definite needs for that but it’s important to focus on diet along with the medications for patients with heart disease and diabetes, for example, and not just give them the medications and that’s it. I always encourage patients to seek answers and seek practitioners where they can have a good therapeutic alliance for a team approach to healthcare. This to me is what leads to optimal healthcare for patients.

We are very blessed that some of the biggest names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world, or in the US, whom you would love to have a private breakfast or lunch with, and why? He or she might just see this, especially if we both tag them 🙂

Throughout the pandemic, Dr. Anthony Fauci has been at the forefront leading our nation in this process that has been at times scary, daunting and confusing. We have all heard about his opinions and views through his public appearances, but I would love to hear about his personal thoughts, behind-the-scenes battles, and experiences throughout this pandemic from a more personal perspective. COVID-19 has been a uniquely confounding and impactful event for us all in the US and globally. With so much that was unknown especially early on and with so many questions aimed at him, I would love to hear his story about his own journey through it all.

How can our readers further follow your work online?

They can find information about me at www.makinghealthyez.com and www.wisdominwellness.com

Thank you for these really excellent insights, and we greatly appreciate the time you spent with this. We wish you continued success.

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