THE FACTS ABOUT WEIGHT LOSS AND FITNESS

A man goes to see his doctor. He says that he feels like crap. The doctor examines him and find that he has a carrot in his left ear, a stick of celery in his right, and french fries up each of his nostrils.

The doctor says "Your problem is obvious. You're not eating right."

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Why focus on obesity? Quite honestly, some of us (physicians) get tired of treating chronic diseases that are preventable. It's so much more satisfying to focus on health and help our patients to achieve optimal wellness. After all, maintenance of a healthy/appropriate weight is one of the most important things that one can do to stay on this planet longer. Just look at the documented benefits of weight loss on common chronic conditions (taken from the bariatric surgery literature):

As many of these conditions improve (or even resolve) with weight loss, the need for prescription medications can be reduced (or even eliminated). I've had patients that have been able to stop their blood pressure medications, Type II diabetics get off of insulin (and sometimes their oral medications), GERD (heartburn) patients bid "Farewell" to their little purple pills, etc.

No one wants to live like this:

To learn how to live a healthier life and achieve optimum wellness, read on.

NOTE: This first sections contain current/"enlightened" scientific teaching about how to lose weight and keep it off. You can read what we used to teach in the sections that follow.

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Good Calories, Bad Calories Let's begin with my original brief review of the excellent SCIENCE book,by physicist-turned-science-journalist Gary Taubes (2008). Within the substance of my review are some excellent links that you should also check out. My review (in pdf format) can be found here. Read more about Gary Taubes (including an interview link) here.

[Most computers have Adobe Reader installed. If you cannot open this file, you can download the free reader program from the Adobe site here.]

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How To Lose Weight (and keep it off): I originally created this as a powerpoint presentation, but as not every computer can open that type of file, hence I've converted it into .pdf format that also includes my notes for some of the slides. Click here to open the .pdf format.

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You can find the BMI chart described above here. Find your height along the vertical axis, then scan to the right until you find your where your current weight lies. Then, look to the top of the column to see your approximate BMI. For example, a 5'10" individual weighing 240 lbs has a BMI of 34. A healthy goal is to be below the weight listed for the BMI 25 for your height. In this example, goal is 174 lbs or below.

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So, two of the keys to successful weight loss are 1) eating all of the time (e.g. every 2 1/2 hours) and 2) trying to keep your total effective (or net) carb count (sugars/starches) to under 100 grams per day in order to maintain ketosis/fat burning state. It's totally possible to accomplish this on one's own by learning how to read nutrition labels and doing the math. For example, here are some examples of low sugar foods (along with their nutritional information chart) from a recent Costco run:

			How to calculate carbs? Read a food label? Read here What about sugar alcohols? What are they? Not much to worry about for most. Read about them here.
Want to know the nutrutional scoop on your favorite foods or snacks? I found this great web site: http://nutritiondata.self.com/. Enter the food name in the search box near the upper right part of the page.

To sum up: you must eat at least 6 times/day to keep your metabolism up (e.g. 5 small meals and 1 larger one). The body is a machine that runs on energy i.e. it requires fuel. Rather than think of those smaller meals as food, instead consider them as fuelings between 100-200 calories each, and keep them low in sugars/starches (protein is fine). Your one larger meal should consist of a protein source and low sugar/starchy vegetables. Drink when you're thirsty and avoid sugary fluids (beware fruit juices as much as soda!).

This change in lifestyle is very important for us in order to maintain our ideal body weight for the rest of our lives. The people who tend to regain their weight tend to do so when they increase their sugar/starch intake without a concomittant increase in their activity levels. [As discussed in the lecture above, while exercise hinders rapid weight loss, once you're at your goal, exercise is very important for maintenance of optimum health. Recall that exercise demands sugar for fuel and the average male runner burns up approximately 125 Calories per mile. Hence, it takes about 2 miles of running to burn off one large (20 oz) non-diet soda that contains 65 grams of sugar/240 Calories! I don't see many of the kids today doing this which goes along way towards explaining the dramatic increase in childhood obesity.]

Exercise feels good. Make it fun. Make it interesting. It doesn't have to kill you and can help to handle life's stresses, as well. Consider early morning or evening walks - so very refreshing! On the other hand, if - for whatever reason - you're either unable or unwilling to exercise, it's important to keep your total daily sugars/starches low to maintain your healthy weight.

OPTAvia [formerly known as Take Shape For Life (TSFL)]

Admittedly, counting carbs on one's own can be daunting, if not cumbersome to many. That's why I personally used the Take Shape For Life (TSFL) program using Medifast products and recommend it to my patients (since re-branded as OPTAvia). Here's why:

In January 2012, I decided to become a coach for the Take Shape for Life (TSFL) program because I found that some of my heaviest patients did so well on it. I had been referring my morbidly obese patients to another physician in the county [Ellyn Levine, M.D.] who had an excellent reputation for achieving weight loss in her patients without the need for gastric bypass surgery or lapbanding. However, her office was too far for many of my patients to travel and so she convinced me to learn the program in order to provide local help for my obese patients. I personally followed it, as well, dropping 45 pounds over a period of 3 months [Note: this is the equivalent of me carrying a 5 gallon water jug every day.] My GERD went away, as did much of my snoring, and I now have lots more energy. All told, I dropped from 240 pounds down to 174 pounds over course of 4 months without significant exercising. After attaining my goal, I began exercising again (weight training at home, cycling).

	Me before (LEFT) and after (RIGHT) weight loss.
	LEFT: January 31, 2012 RIGHT: December 23, 2012
	LEFT: January 31, 2012 RIGHT: December 23, 2012

OPTAvia is a simple/easy-to-follow program designed to help change lifestyles in the long run. It's a great tool available to help our patients achieve optimum health. In the short run, it is a very effective weight loss regimen that follows the science. It is NOT an extreme diet program.With this program, participants eat 5 pre-packaged meals/day plus one "lean & green" meal that they prepare themselves (or eat at a restaurant). For people who require structure in their lives, this is an excellent approach.

The advantage of using pre-packaged meals is that they are already pre-measured meals (usually around 90-110 calories each and low sugar; they're also fortified with vitamins) so there really is no fretting about what to prepare. One consumes real foods, not a liquid diet - breakfast options include dry cereal, oatmeals, scrambled eggs and pancakes; lunch options include various soups, chili, sloppy joes and mac 'n cheese. The "in-between" meals can consist of various nutrition bars, brownies, shakes, and other items. Participants learn healthy eating habits. The plan makes it very easy to get used to eating every 2 1/2 hours.

OPTAvia is a very cost effective affordable program for most. To start with, there are no monthly coaching costs (found with so many popular programs; instead, health coaches get compensated directly from OPTAvia/Medifast). All you pay for is your food/"fuelings", which are ordered on a monthly basis. For approximately $13/day, you get five "fuelings" - it's hard to eat cheaper than that - plus the cost of making your lean & green meal. Average OPTAvia food cost is around $380/month per individual ($18.95 for box of 7 fuelings; 20 boxes will be needed per month. This means that each of the "fuelings" come out to about $2.50). [When I figured out my monthly food costs at supermarkets and restaurants, this turned out to be a real bargain for me. Do the math for yourself. Figure out what you spend on all food for a week (this includes everything - Ralphs/Vons supermarkets, restaurants, etc) and make your own comparision. Food is generally ordered on a monthly basis for convenience and to gain you free shipping of your orders. You might also take into consideration the costs of remaining obese (costs associated with several chronic diseases and possibly medications). For most of us, it's a no-brainer.]

For a comprehensive overview, I had annotated the old TSFL Quick Start guide to include my coaching pearls to explain the program more fully. This advice remains unchanged for the OPTAvia re-branding. Click here to really understand ALL of the specifics of the plan.

To learn all about the OPTAvia program or get started, head over to https://725704080.optavia.com/725704080.

As mentioned, losing weight is not the only goal, but it is the first one upon which we focus. To help keep it off, it's important that one develops what TSFL co-founder Dr. Wayne Scott Andersen calls "Habits of Health." Learn what motivates our day-to-day behaviors and it's possible to make intelligent decisions throughout life. This is essential to keeping the obesity hounds at bay and living life to its fullest. Dr. Andersen has written a book and an accompanying workbook on this subject. Studies show that people who develop these habits of health find it easier to maintain their weight loss. To help individuals get started on the road to optimum health, Dr. Andersen initiated a 30 day challenge that incorporates lessons from his books. Learn more about it here.

Striving to achieve optimum health is far better than dealing with the costs and complications of disease states, most of which are preventable through the maintenance of healthy habits. I want to help keep my patients healthy and disease free. Feel free to contact me if you or a friend is interested in the Take Shape for Life program.It's scientifically valid, easy to follow, inexpensive and - most important - it works. I personally coach all of my clients to help get them started on the right foot. Because I spend a good hour to an hour and a half usually, I do not perform these consultations during my regular office hours. Rather, I schedule them after hours or on weekends, either in person or via Skype.

Note that I strongly advise interested individuals to go through the OPTAvia program, rather than the other Medifast options. Medifast is the much larger parent company with 3 divisions:

- Medifast Direct: individuals purchase Medifast products on-line and follow a self-guided program with online support/tools. There is no personalized coaching.

- Medifast Weight Control Centers: These provide in-store counseling, but it is very expensive. One of my new patients informed me that she went through our local Medifast Clinic in order to lose 45 lbs. She was charged $900 and this did not include her food!

-OPTAvia (formerly Take Shape for Life or TSFL): provides a free health care coach and mentoring to guide you to optimum health. [ as noted above, OPTAvia reimburses coaches for their time so clients do not pay additional monthly coaching fees found so often with other programs.]

I'm happy to address any questions/concerns at any time. Please feel free to contact me by e-mail (jocdoc@medicine-in-motion.com), skype (drjpearson1), or leave a message for me at the office (760-688-0411).

Are you a health care provider or someone with an intense interest in helping others to lose weight and live healthier through Take Shape For Life? Look at this to learn the basics, then contact me to learn how to implement the program for your practice.

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Start ignoring here (This is what we used to teach):

There is no question that how we feel about ourselves influences our behavior in everyday life and no one is more pleased to remind us of this fact than the companies who promote all sorts of weight loss programs on the air waves or in the print media (But looks aren't everything - maintaining one's appropriate weight is necessary for the maintenance of good health. Obesity is steadily making it's move to overtake tobacco as the #1 cause of medical problems in the U.S.). To the tune of about $40 billion a year, weight loss is a national obsession and has become a field of rapid growth within the health industry.

But who should one believe? Given the multitude of choices that include everything from "heart healthy" diets to "A Twinkie a day keeps the doctor away," is it any wonder that the American public remains confused?

Let's begin with some simple facts: After heredity (genes), an individual's weight is largely determined by their balance of energy (calories). In other words, weight gain or loss depends upon the quantity of calories consumed, in comparison to the number of calories used ("burned up"). Specifically, an individual can gain weight by eating more or exercising less (the "couch potato" syndrome). Sound simple enough? [Actually, it can get a bit more complicated - we’re skipping all of the stuff about hormones (insulin) and chemicals in the brain (serotonin) for now.]

One pound of fat is equal to approximately 3500 calories. In order to lose this amount over the course of a week, one would have to create a negative balance of 500 calories per day. Rather than starve ourselves, the healthier way to achieve this goal is to increase the level of your activity through that "dirty" word called exercise.

Why? Because our bodies are finely-tuned machines with the ability to monitor and regulate our metabolism (use of energy). Here's an oversimplification: Imagine a sensor in our brains, much like a thermostat. Our bodies are constantly burning up calories for things that we don't even think about - our heart beating, lungs breathing, occasional walking, etc.. Let's say that a body uses up to 1500 calories/day essentially doing nothing more than basic life functions. If this individual takes in only 1000 calories/day, he or she would lose 500 calories/day because of this "negative" energy balance.

Unfortunately, this lasts only for the first two or three weeks because the "sensor" realizes "Hey, this jerk is trying to starve me - I'd better conserve energy!" The thermostat-like mechanism then resets itself to a lower number (for example 1000 calories expended per day for those same basic functions). The 1000 calories/day coming in now balances the 1000 calories/day being burned up, therefore, the weight loss slows down or stops. Therefore, you have a better chance of losing weight if you eat throughout the day, rather than dieting, if you eat correctly.

Also, exercise works by helping to reset that thermostat - usually to even higher than the 1500 calories/day at baseline, let's say to 2000 calories/day. It is through this mechanism that weight loss can then be achieved.

Incidentally, the Wall Street Journal recently published an excellent article, "The Diet that Works - what science tells us about successful weight loss" by Tara Parker-Pope (April 22, 2003). I recommend that everybody read this piece. (If the link doesn't work, I've scanned the article here.)

If you do nothing else, simply reducing your daily fat intake will result in weight loss. Learn how to read food packaging labels. Try substituting lower fat foods for those that you normally consume. For example, drink 2% milk instead of whole milk; frozen yogurt instead of ice cream; eat leaner meats; use low-calorie mayonnaise and salad dressings. These relatively easy substitutions alone can result in a 7-15 pound weight loss over the course of a year.

Suggestion: try to think of food only in terms as a source of fuel for your body, rather than as a source of recreation. Eat only when you sense your body is hungry in response to low energy stores and not just because you’re going to a movie or to "kill time."

[Stephen Furst is an actor best known for his obese roles in Animal House, St. Elsewhere, and Babylon 5. He went from 320 lbs down to 170 lbs and now looks great - I listened to him speak at the 2001 AOA (American Osteopathic Association) meeting.  Steve participated in a discussion for the American Diabetes Association which can be found at http://www.diabetesforecastlive.com/edition1/index.html.  If you have a weight problem and about an hour of free time, I recommend listening to this often humorous discussion on losing weight.]

A Crash Course in Nutrition

[FYI: For an excellent and very readable book on nutrition, I recommend checking out Nancy Clark's Sports Nutrition Guidebook.] I also highly recommend 30 Secrets of the World's Healthiest Cuisines by Steven Jonas M.D. and Sandra Gordon.

Carbohydrates (carbs) represent an immediate source of energy for your body; they provide the fuel for your muscles and other organs such as your brain. Deprivation of carbohydrates, such as seen in persons who fast, results in easy fatigue, possibly interfering with activities of daily living. Carbs are your body's first choice for fuel i.e. if given a choice of several types of foods simultaneously, your body will use the energy from carbohydrates first.

Protein is necessary for building new tissues such as muscle fibers, after they are damaged from routine everyday use. [note: get your protein from natural sources such as fish and poultry, rather than those very expensive supplements sold in the health food store; the quality of protein is usually much better and at a significantly cheaper price!] 

Fat is not used immediately by your body , but rather is stored for future energy reserves. In other words, fat goes right to fat. (Actually, some is used to create needed hormones such as estrogen and testosterone. Also, endurance athletes do use fat as fuel.)

Not all nutrients are created equal in terms of energy value. One gram (approximately 28 grams = one ounce) of carbohydrates is equal to 4 calories. Protein has the same 4 calories of energy value. Fats, on the other hand, have 9 calories for every gram - more than twice the amount of either carbohydrates or protein.

What this means is that if you eat equal amounts of carbohydrates and fats, for example 20 grams of each, you will gain substantially more calories from the fat (180) than from the carbohydrates (80). [Remember this at snack time when you're trying to decide between potato chips (high fat) and pretzels or Graham crackers (high carbs).]

Incidentally, each gram of alcohol yields 7 calories that your body is unable to use directly and is thus stored as fat (hence the origin of the "beer belly").

Opinions vary. For example, the American Heart Association (AHA) recommends that no more than 30% of our total daily calories be derived from fat. Even this is probably too high for most people. The Pritikin diet, on the other hand, recommends a 10% limit. This is difficult for many to achieve (as fat is what makes food taste so gosh darn good!).

They work - plain and simple, although not everyone agrees as to the reason why. They gained much recognition in the press following the introduction of Dr. Atkin's Diet Revolution and Sugar Busters! books. Insulin, a hormone secreted by the pancreas, is the touted culprit behind weight gain from carbohydrates.

In addition to it’s role in reducing blood sugar after a meal, insulin helps to deposit fat! Simple carbohydrates (e.g. sugars) stimulate the quickest/greatest insulin release, whereas complex carbohydrates (e.g. grain breads, yams, etc.) induce a slower, more measured insulin response. The rating of a carbohydrate's ability to stimulate insulin production has been termed the glycemic index. Foods with a high glycemic index release more insulin than those with a lower index.  For example, according to Sugar Busters!, baked potatoes have a very high glycemic index (yet many people consume these as part of their diets), whereas sweet potatoes (yams) have a very low glycemic index. Hence, for weight loss purposes, it makes more sense to consume yams over regular plain potatoes. (By the way, the healthiest part of a baked potato is the skin which contains the most important nutrients.)

Personally, my beliefs are along the lines as touted by the Lean For Life program, which was developed by doctors at UCLA more than 30 years ago and is the mainstay of the Lindora Weight Loss Clinics.  As noted earlier, our body's preference for fuel is carbs, which is fine when I was a toothpick in high school. However, when I wanted to lose weight, I had to find a way to force my body to utilize my stored fat as fuel, instead. Therefore, by reducing my dietary intake of carbohydrates, I was hoping to  do this.  This is termed "ketosis." Incidentally, one of the side benefits of maintaining your body in slight ketosis is that appetite is dampened, making it less likely that we'll overeat.

In this program, individuals are encouraged to eat throughout the day, generally three main meals consisting mainly of protein with some carbs, and supplementing with protein-based snacks whenever one is hungry. My personal favorite are the Premier Protein 8 Bars which contain 30 grams of protein and anywhere from 1-6 grams of sugar, depending upon the flavor. I've tried a lot of different products and, in my opinion, these taste the best. [They can be found at many stores, but the best value is to find them at Costco during a road show; note that Costco normally carries the regular Premier meal supplement bars with higher amounts of sugar, not the Protein 8 Bars.)] Beef/turkey jerky, sunflower seeds, etc also work for snacks. Also, be sure to drink lots of water throughout the day to keep your kidneys well-hydrated. Protein contains nitrogen, like fertilizer for your lawn. If you fail to water your lawn adequately following application of fertilizer, you may "burn" it!

Be aware that fruits and vegetables contain many necessary vitamins and minerals. If an individual cuts down too much on their carb selections, they will be at risk nutritionally. While multivitamins can provide these lost vitamins, they do not furnish fiber and other phytonutrients (derived from plants) that are also necessary for our health. Getting back to the subject of glycemic indices, complex carbohydrate containing foods tend to help out with this regard. This is the logic behind selecting 100% whole grain bread and cereal products over plain ol' white bread, or wild rice over white rice. So be sure to incorporate these into your meal plan. (Click the following link to read the Patient Care magazine education handout "Advice from your Doctor": A Healthy Low Carbohydrate Diet.")

The jury is still out on why people lose weight on these plans. Is there something really special about the carb/insulin relationship? Is it ketosis? Or do these patients simply end up eating consuming less calories overall? I suspect the latter, but patients often require specific instructions for whatever ailment they are treating and weight loss is no different. Asking patients to reduce the serving sizes of the white breads, white rice, etc. seems to make it much easier for them to make decisions about what goes into their mouth. [My own personal addiction is sushi. We have an all-you-can eat sushi restaurant near our office, that I hit several times a week for lunch. I pick the fish off off the rice, allowing me to boost the percentage of protein in my diet. When I'm finished, my plate is covered with mounds of rice that I would have otherwise consumed. Forget the fact that there might be something special about carbs, I take in a lot less calories at each visit by not eating the rice.] While I'm on the subject of excess calories, don't ever supersize anything - Lots of calories in those sodas and French fries! [If you haven't already seen it, rent the highly entertaining and informative DVD of the documentary "SuperSize Me." Then, pick up a copy of Eric Schlosser's excellent book, Fast Food Nation, and learn what really makes those  fries and burgers taste so great...]

Is Santa obese or merely overweight? (and what’s the difference?)

Obese = plain and simply means too much fat! (e.g. 20% above ideal body weight)

Overweight = weighs more than would be expected for height. Fails to consider muscle mass. e.g. Arnold Schwarzeneggar weighs more than the typical male, but mostly due to muscle!

 Fat content of common foods and snacks

How to read a food label

The Mediterranean Food Pyramid [http://www.oldwayspt.org/html/p_med.htm]

Burning up the fat!

Exercise, for our purposes, refers to anything that you enjoy doing, that makes your heart go fast (i.e. aerobics). These activities can include running, swimming, cycling, racquet sports, etc. for those so inclined, or fast (race) walking for persons concerned about trauma to their joints. If running/jogging, be sure to wear good shock absorbing shoes!

The good news is that it doesn’t require much intensity for your body to burn fat as fuel. While sprinting (and other activities that encourage short bursts of energy) use stored glycogen/sugar for fuel, slower endurance activities, such as jogging, burn free fatty acids as fuel. Therefore, you don't have to "kill yourself" in order to lose or maintain a healthy weight.

Low to moderate intensity exercise is all that's required. The simplified formula for calculating your target heart rate is as follows:

HRmax = 220 - age                  [HRmax refers to your maximum heart rate.]

HRmax × 0.60 = target heart rate for low intensity exercise

HRmax × 0.80 = target heart rate for moderate intensity exercise

e.g. 50 year old starting a low intensity program would aim to maintain a target heart rate (pulse) of 102 beats per minute.

That being said, I dislike formulas. Instead, aim to exercise with enough intensity so that you can talk, but not sing.

The American College of Sports Medicine guidelines state that the minimum amount of time required to achieve fitness benefits per week is about 90 minutes. For most people, 30 minutes 3 times a week or 20 minutes daily should be relatively easy to accommodate. Start out easy and, ideally, try to work up to 30 - 45 minutes of low-moderate intensity exercise, 5 times a week. Varying the types of exercise activity can help maintain interest, as can setting up your exercycle/stairmaster/treadmill in front of your TV during the evening news broadcast, Wheel of Fortune, or other favorite show. 

Exercise has other benefits, as well. Primary among them is a positive effect on mood. Studies show that individuals who engage in low to moderate intensity aerobic activity for 35-45 minutes/ 5 times per week improve their mood/attitude. Besides generating those endorphins (runners high), the improved endurance that develops from training probably makes it less likely for someone to become fatigued towards the end of the day and improves one's tolerance for things that would otherwise "tick" us off! Endurance  activity is also excellent for improving one's lipid (cholesterol) profile.

A modest loss of only 1-2 pounds per week at the most should be expected on average; any more is usually a result of water loss and not fat. This may not seem like a lot, but remember that this can represent 8-16 pounds over a 2 month period (and even more if the program is continued!). Be aware that it may take up to two years for your brain’s "thermostat" to finally reset itself to a leaner weight, so don’t give up the effort - it’s worth it.

In short, the secrets of a healthy weight loss program should not be a mystery to anyone. As The Nike advertisement so eloquently states: "JUST DO IT!"

Frequency: 5 times/week or more

Intensity: low-moderate

Timing (duration): 30 - 45 minutes/day

Fat is comprised of small units called fatty acids. Each fatty acid molecule consists of carbon (C), hydrogen (H⁺), and oxygen (O), arranged in a special pattern. When there is a H⁺ at every available spot in the molecule, the fat is saturated. When one H⁺ is missing, the fat is mono-unsaturated. if more than one H⁺ is missing, it is considered poly-unsaturated.

Coconut oil

Palm oil

Butter, shortening

Beef

Chicken

[Saturated fats are used by the liver to make cholesterol, hence this is considered to be the most dangerous type of fat. Both total and LDL ("Bad" cholesterol) are raised. These should not exceed greater than 10% of your daily caloric intake.]

Olive

Canola

Peanut

[Mono-unsaturated fats do not appear to have any effect on cholesterol levels. The problem with these oils is that they do not have a long shelf life. ]

Safflower

Sunflower

Corn

Cottonseed

[Polynsaturated fats do not appear to raise blood cholesterol levels, either.]

A word about Trans fats

Trans fats were developed in order to increase the shelf life of certain food products. These fats are the by-product of hydrogenation - the chemical process used to change liquid unsaturated fat to a more solid fat. As a result, these are structurally similar to saturated fat and they can elevate both total and LDL cholesterol levels,  too. They have been linked to a greater risk of heart disease. Stay away from these!

Trans fats may be found in stick margarine as well as most commercially prepared cookies/cakes and snack foods.

You can learn more about trans fats at: http://fpc.unl.edu/ProductCategories/TransFat.htm

For those of you who watch what you eat, here's the final word on nutrition and health. It's a relief to know the truth after all those conflicting medical studies.

1. Japanese eat very little fat and suffer fewer heart attacks than Americans.

2. Mexicans eat a lot of fat and suffer fewer heart attacks than Americans.

3. Africans drink very little red wine and suffer fewer heart attacks than Americans.

4. Italians drink excessive amounts of red wine and suffer fewer heart attacks than Americans.

5. Germans drink a lot of beer and eat lots of sausages and fats and suffer fewer heart attacks than the Americans.

CONCLUSION: Eat and drink what you like. Speaking English is apparently what kills you!