Cheers!

This is high on health. Your weekly nudge to explore new things in health, take action, and do more while finding balance.

Welcome back! As you may remember, my wife and I recently took a long weekend trip to our former home, New York. We had a fantastic time, and I'd like to share some of our experiences with you if you ever find yourself in the city.

• Breakfast at Clinton St. Baking Company. I highly recommend the pancakes, and the Huevos Rancheros were also fantastic. The Bloody Mary was a hit, too. If you're an early bird, you may be able to get a seat on a weekday without a reservation, but otherwise, I suggest making one.

• Steak at Peter Luger Steak House. While this is a well-known spot, it's still one of our favorites. We tried something new this time and went for lunch at 1 pm. We got a spot at the bar and had the best service and experience.

• Lobster rolls at Red Hook Lobster Pound. This place is special in our hearts, as it's next to our old neighborhood of Carroll Gardens, Brooklyn¹ . We had a great time chilling in the sun while enjoying the best lobster rolls in town and taking in the beautiful view of the Statue of Liberty.

• Thai food at Untable. This is a new Thai restaurant in Carroll Gardens, Brooklyn. The food was seriously some of the best and most authentic Thai cuisine ever. I couldn’t help myself and ordered the hottest dish on the menu (🌶️🌶️🌶️🌶️🌶️🌶️🌶️🌶️🌶️🌶️🌶️🌶️ - no idea if that’s an official rating but they put 12 chilis next to it..) and suffered but enjoyed it nonetheless. Although they don't take reservations, the restaurant is run by a well-known chef and was named one of the best newcomer restaurants at the end of last year (here and here). Be prepared for long lines, but it's worth it.

• Digital art at the Mercer Labs Museum of Art and Technology. The large installations, the total immersion of visual art on all walls, floors, and ceilings, and the 4D sound creations blew us away. It was a wild trip, and we truly appreciated the possibilities of digital art.

• Practice at Kundalini Yoga East. Although this yoga style may not be for everyone, we enjoyed the session and the opportunity to try something new. We realized that it's essential to occasionally step out of our comfort zone and try new things. Also, my wife is a certified yoga teacher who loves exploring new styles.

We have had more fantastic food and drink experiences, neighborhood strolls, and shopping sprees. The above were the highlights of my trip.

I highly recommend taking some time off from your busy lives, grabbing your partner, and going on a trip like this. It might require you to find a babysitter for a few days, but spending some alone time as a couple, talking for hours, and enjoying simple things like lying in the sun and not following a tight schedule can be healing.

This made me reflect on how I usually go through my days, balancing my family, job, side gigs, and hobbies and trying to live a healthy life. Some of you have asked me how I stay sane, and I share my approach in this edition.

Take care!

¹ It is located in Red Hook, Brooklyn. It’s Brooklyn’s harbor area and still maintains some of its roughness and raw beauty. We have always loved to go there and experience the charm and unique vibe.

A typical day in my life (and its variations)

I firmly believe that structure and planning are effective in achieving our goals. Although I don't always stick to a strict routine, I intentionally approach aspects of my life unstructured to experience surprises and go with the flow. However, I've realized that implementing routines is crucial for forming habits, as it increases the likelihood of adherence and compliance.

Around a decade ago, I read Charles Duhigg's The Power of Habit: Why We Do What We Do in Life and Business. The book's key messages left a lasting impression on me.

To refresh your memory, the book explains the science behind habits - why they form and how we can improve them. Here are the crucial takeaways:

1. Habit Loops: The book breaks down habits into three parts: the cue that triggers a behavior, the routine (or behavior itself), and the following reward. Understanding this loop is the first step in changing our habits.

2. Cravings and Habits: The book shows how anticipating rewards can lead to automatic behaviors, making new habits stick when driven by solid cravings.

3. Changing Bad Habits: Bad habits can't be erased but can be changed. The trick is to keep the old cue and reward but switch up the routine. It's a simple formula with the power to transform.

4. The Role of Belief: Change is tough, but belief is a powerful ally. Believing in the process is crucial, whether personal change or organizational transformation.

Here is a classic example of the habit loop in action. It's the process of forming a habit of drinking coffee early in the morning. Later on, we will discuss why you might want to change that habit. Let's break it down:

• Cue: Your alarm goes off in the morning, signaling the start of your day.

• Routine: You brew and drink a cup of coffee.

• Reward: You feel more awake and energized, ready to tackle the day's tasks.

In this scenario, the alarm is a cue that triggers the craving for the energy boost coffee provides. The routine is the act of brewing and drinking the coffee, and the reward is the feeling of alertness and readiness for the day. Over time, this loop becomes automatic. The sound of the alarm alone might start to make you crave the feeling coffee provides, reinforcing the habit loop.

You must follow the Golden Rule of Habit Change based on the book to change a habit: keep the same cue and reward, but change the routine. Let's apply this to the coffee-drinking example:

• Cue: The alarm goes off in the morning, signaling the start of your day.

• New Routine: Instead of brewing coffee, drink a glass of water with lemon and do a quick 5-minute stretching or yoga session.

• Reward: You still feel awake and energized, ready to tackle the day’s tasks.

In this modified habit loop, the cue (alarm) remains the same, and the reward (feeling energized and ready for the day) is also preserved. However, the routine has changed from drinking coffee to a healthier habit that still satisfies the craving for an energy boost in the morning. This approach leverages the existing habit structure (cue and reward) while substituting a new routine that aligns with your goals (such as reducing caffeine intake or incorporating more physical activity into your day).

Experimenting with different routines is essential to find the one that delivers your desired reward. Sometimes, finding the perfect fit that makes the new habit stick might take a few tries. Belief in the possibility of change and persistence through experimentation are crucial factors for success.

OK, let’s go.

The AM

I have always been a morning person. Since childhood, I would wake up at around 6:00 am and feel bored of sleeping. Even when I tried to sleep in until noon, sometimes, I couldn't. So, I took advantage of my natural sleep-wake cycle and energy pattern and got up early. I usually set my alarm between 4:45 and 5:15 am, but most days, I wake up around 5:00 am without an alarm.

Why is it an advantage? Well, my wife and I have three kids. If I want quality time alone and to get things done, I need to wake up before them. After waking up, I drink a glass of water instead of coffee¹ and do some breathing exercises. It's a new habit I've developed, and I'm excited about it. I ignored breathing as a tool for health and longevity until someone recommended "The Oxygen Advantage" by Patrick McKeown, which describes the Buteyko Breathing Method² .

Around 5:30 am, I start my exercise routine. I try to balance running, weight training, yoga/stretching, and movement/animal flow/bodyweight exercises—a hybrid athlete approach. I rarely take a day off and still do light things like stretching, foam rolling, and mobility work on my rest days. I'm lucky and privileged to have my home gym. I converted an extra room next to our apartment into a home gym with almost everything I needed to work out.

Around 6:30 am, I have a protein shake and do 30 minutes of body rehab. I have a bad back (have I mentioned that ever?), so I use a red light heat lamp, an acupressure mat, a massage gun, or cupping. The weapon of choice depends on how I feel. My wife and I also finalize the day's logistics during this time.

From 7:00 to 7:45 am, I get ready for the day, including having my first shot of coffee. I love coffee, so I buy whole beans, freshly grind them when I prepare a brew, and either hand-brew filter coffee or get a shot of espresso from my beloved espresso machine³ .

Then, I get the kids to school on our cargo bike. I have a Bluetooth speaker and audiobooks to keep them calm during the ride (#protip). Harry Potter is a safe bet for keeping them quiet. After dropping off my kids, I head to the office, take my first call on the way, and start working around 8:30 - 8:45 am. The hours before noon are my most creative and productive, so I try to accomplish the heavy lifting during that time. Besides the protein shake after my workout, I don't eat breakfast. This helps me stay clear in the morning. It’s my way of modifying a restricted eating schedule.

The midday

Between 12:00 - 1:00 pm, I always feel hungry and crave protein. I have always been this way, and everyone who knows me can confirm it. Whenever I have a choice, I always opt for protein over carbs. However, there are times when I need to consume carbs before longer workouts or endurance sessions, and I have to force myself to eat rice, for example.

Also, rice or other carbs act as sleeping pills for me. A carb meal immediately puts me to sleep, and I can barely stay awake in meetings. Sometimes, it's a struggle, and I must stand up, walk around, or drink another shot of espresso. Speaking of which, you will rarely see me drinking specialty coffee drinks; I almost exclusively drink double espressos, Americanos, or filter coffee. I don't like the added taste enough to justify the additional calories.

One of my weaknesses is not drinking enough water throughout the day. Hydration is super important for all sorts of things, but it doesn't come naturally to me, and I still have to form this habit. I'm working on it.

I want to share three things I do during the day that should be more common. I highly recommend incorporating these practices into your routine:

1. Walking: Research has shown that our modern generation spends too much time sitting in a bad position, which can lead to a "C-shaped" posture. This posture involves rounded shoulders, a forward head, and a curved spine, which is bad for our health. Walking helps counteract sitting in a slumped position, and it is also proven to improve thinking. Whenever possible, I try to have walking meetings.

2. Napping: I take afternoon naps whenever my schedule allows. I set a 20-minute timer (or less), find a quiet place in the office, and snooze off. As a young surgeon, I learned to fall asleep quickly when needed, and I believe it's a competitive advantage. I'm not ashamed to admit it!

3. Hanging: This is a less common practice but has many benefits. Regular hanging from a bar in a dead-hang position can help with spinal decompression, grip strength enhancement, shoulder health improvement, and core activation. I have installed a free-standing pull-up bar in my office (I know.. no judging, though) and use it thrice between meetings for about one minute daily.

Overall, I try to avoid spending the whole day staring at screens, and I make it a point to have lunch with someone in person.

The PM

I am describing a typical day in the office, which requires adjustments and compromises. The key is to have a routine to refer to and know when you are deviating. Maybe in another edition, I will describe my days on the road.

When I look at my office day, I always aim to achieve three things by the evening:

1. 10,000 steps: My watch tracks achieving 9,200 steps. Anything between 9,000 and 10,000 is my goal. I will walk home when I am short when I leave the office. Sometimes, I even detour and call someone, for example, my parents, while walking. It is surprising how little we walk on some days despite its vast benefits.

2. See my kids: Leaving the office before 7:00 pm ensures I see them before bedtime. Sometimes, I can even join the family dinner. Being around and giving them the feeling that I am there in case they need me is crucial. Very often, they proudly tell me about something they have done that day, get approval and recognition, and can close the day positively. We have a dinner tradition where everyone shares what made them happy, what they did not like, and what they look forward to the next day.

3. Going to bed early: Given my early rising, I tend to be pretty useless after 10 pm. I can do it if necessary and push through the week with only 5 hours of sleep per night, but it is not cool. Instead, I close out the final tasks for the day, including responding to critical requests or providing feedback after dinner. Then, I wind down between 9-10 pm. My bedtime routine almost always includes reading and no screens. We do not own a TV, and we do not watch linear television.

I'm currently experimenting with different sleeping arrangements. Recently, I replaced my standard mattress with a Japanese futon and a tatami mat. I find it more natural, and I appreciate the minimalist style. It also aligns with my preference for firm bedding and lying on the ground.

In addition to this, I've been practicing breathwork (see above). One new technique I've tried is mouth taping. Although it may seem strange, I enjoyed it. Taping my mouth shut forced me to breathe through my nose during the night. This practice is claimed to have benefits, and I plan to continue experimenting and reporting back.

The weekend

On weekends, I allow myself to sleep until 6:00 am. However, I often wake up earlier than that (see above). Then, I follow my usual routine for getting ready and working out (often for a more extended session on Saturday).

I also prepare breakfast on weekends. On Saturdays, I make eggs, and on Sundays, I prepare pancakes. The kids enjoy these meals.

The rest of my weekend is mainly spent running errands, attending the kids’ activities, and pursuing my projects, like writing this newsletter.

I’m not a machine

As mentioned, I try to adhere to my routines at least 85% of the time. However, due to my responsibilities and schedule, I may not always be able to follow it perfectly.

In the past, I used to get frustrated when this happened and would end the day feeling unhappy. But I've realized that nobody cares about my imperfections, and feeling unhappy is ultimately my decision. It's not easy to unlearn this, and I'm still learning, but I remind myself that our lives are busy and complicated. Every day that I manage to achieve something is a good day.

Having a North Star or goal to strive for helps me to stay focused and form good habits. I don't have to think too much about what I need to do; I need to do it whenever circumstances allow.

What about you? What are your northstars and habits? I would love to hear about it!

¹ I have started implementing a new routine after learning about the cortisol circadian rhythm and the overall effectiveness of caffeine intake. I learned about this from Andrew Huberman. Some days, when I plan for a more intense workout session but don't feel fresh enough, I may still have an earlier coffee.

² Konstantin Buteyko, a Ukrainian doctor (1923 - 2003), developed the Buteyko Breathing Method after he faced personal health challenges. His exploration of breathing patterns' impact on overall health led him to create a method that emphasizes nasal breathing, reduced breathing volume, and breath-holding exercises to improve health. Buteyko's approach gained popularity and showed potential benefits, but it faced skepticism within the medical community.

³ Italian is the preferred choice. I have a Rocket at our vacation home and a LaMarzocco in Berlin. It's one of those things you can't go back once you've tried it.

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Friedrich Nietzsche's insight highlights the strong connection between movement and mental creativity. Walking goes beyond physical exercise and becomes a meditative journey that creates a space for thoughts to flow freely and interconnect. This rhythmic meditation aligns our physical steps with the pace of our thoughts, allowing them to expand in new and unexpected ways.

Nietzsche's link between mind and body suggests that movement benefits physical health and stimulates mental capabilities. Walking, particularly in new or natural environments, exposes us to fresh stimuli and perspectives, sparking creativity and insight. It serves as a dynamic backdrop for introspection and the exploration of one's mind away from the distractions of daily life.

In essence, Nietzsche's observation underscores the importance of solitude and the physical act of walking in cultivating deep thought. In an era dominated by sedentary lifestyles, his words remind us of the simple yet deep power of walking to unlock our intellectual and creative potential.

Friedrich Wilhelm Nietzsche was a German philosopher of the late 19th century who challenged the foundations of Christianity and traditional morality. He believed in enhancing individual and cultural health and emphasized life, creativity, power, and the realities of the world rather than those situated in a world beyond. His philosophy centered around "life-affirmation," which involved questioning all doctrines that drain life's expansive energies, regardless of their social prevalence. Nietzsche is often considered one of the first existentialist philosophers.

DISCLAIMER: None of this (such as text, graphics, images, and other materials) is medical or health advice. This newsletter is strictly for informational, educational, and entertaining purposes only. While I’m a medical doctor and a dentist by training, I’m not your doctor. The content is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on high on health! Please be careful and do your research.