SUGAR vs. FAT

As many of you know by now, fat has been given a bad rap. People worry about high blood fat levels, about being fat, having a fatty liver, or plaque in their arteries…

But what really causes all of the above? Is it fat?
NO – it’s SUGAR!

One might be asking then: so what about all those recommendations for a low-fat diet? Here’s a clue: a recent New York Times article revealed how 50 years ago three Harvard scientists were paid off by Big Sugar, including Coca-Cola, to say that sugar was fine, and fat was the culprit regarding cardiovascular disease!

What Really Happens…

When we eat, our bodies break down the macromolecules of protein, fats and carbohydrates into micronutrients, amino acids, fatty acids, and ultimately glucose. The pancreas then secretes the hormone insulin to carry the glucose to our cells. Inside the cells are insulin receptors. These receptors travel to the cell membrane to meet the insulin/glucose molecule and transport the glucose inside the cell for energy production.

OK- so that sounds like glucose is necessary for energy production, and it is, but not from table sugar (sucrose), or refined carbs like breads and pasta. Overconsumption of those kinds of sugar causes the pancreas to secrete too much insulin.

When there’s too much insulin binding with the glucose, the insulin receptors become resistant to responding. This is known as insulin resistance. Think of what it’s like when your inbox is constantly being flooded with emails asking for money; even though the causes are all great, you just start pressing the delete key without even reading the emails.

So what happens to the excess glucose attached to the insulin? It gets stored as FAT, or as PLAQUE in one’s arteries. Not only that—insulin resistance foreshadows diabetes.

This is because the pancreas, with so much sugar/carb intake, after overproducing insulin for a while begins to weary of producing it. Eventually it either stops, or does not produce an adequate amount to transport the glucose to the cells. THIS is diabetes. As a result, in order to utilize the natural glucose produced from the breakdown of even healthy food, one needs to take medications such as Metformin. This medication, and others like it, are not without sometimes serious side effects.

Another thing that happens when one eats sugar is that the liver takes the sugar and then creates fat (lipogenesis). In other words, excess sugar causes fatty liver, as well as excess body fat!

EATING FAT, on the other hand is essential for brain health, neurologic health, metabolism, mood, energy, hormone production, and the health of the cell membranes which regulate the transport of nutrients and other biochemicals into and out of the cell.

Of course, this all depends on the kind of fats we consume. Primarily, we want the health-supporting Omega 3 fats. Omega 3s improve insulin sensitivity and help to lower inflammation in the body. Omega 3s also mobilize fat from the fat cells to be burned by the mitochondria (the cell’s powerhouse), and this leads to weight loss.

Other good fats are medium chain triglycerides (MCTs) such as those found in coconuts and macadamias. These are rapidly burned in the mitochondria as well, and are considered super fuels. They also help one lose weight!

Processed fats, on the other hand, disturb our metabolism. Interestingly, and very importantly, the fat in beef changes depending on what the cattle are fed. Pasture raised, grass-fed cows produce the healthy Omega 3s. Those feeding on antibiotics, grains, and hormones do not. The fats from these animals are rendered fats. They produce free radicals, which are damaging to our cells. Another type of highly processed fat is TRANS fat. Trans fats poison the mitochondria, inhibit energy production, and cause weight gain.

Making it Simple…

Fats that are damaging and inflammatory:

• Sweet, salty fats – like French fries! 
• Meats from hormone and antibiotic injected animals
• Trans fats: margarine, shortenings, deep fried foods, store bought cakes and cookies, crackers with long shelf-life (think saltines and Ritz), pancake and waffle mixes, and many more store-bought processed foods.

In fact the FDA is working to remove artificial trans fat from the food supply  by 2018.

Healthy Fats:

• Cold water fish such as salmon, sardines, herring, mackerel, black cod, bluefish
• Avocados
• Olives
• Nuts, seeds (pumpkin, flax, chia)
• Olive oil, coconut oil, grass-fed butter, ghee, algae oil
• Dark chocolate (in small amounts ).

Now I’m getting hungry! 

The Bottom Line…

STOP or greatly minimize sugar consumption; that includes white bread and white flour products. These are absorbed too rapidly, causing spikes in blood sugar levels. As we now know, this leads to insulin resistance, puts stress on the pancreas, and can result in diabetes.

As an aside, if you’re thinking “well I’ll just use artificial sweeteners like Sweet n’ Low,” think again; those kinds of sugar substitutes are endocrine disruptors. These too have been shown to cause metabolic syndrome which leads to diabetes.

STOP eating trans fats. Here’s a good rule of thumb: “The longer the shelf life of a product, the shorter your shelf life.”

EAT HEALTHY FATS, as listed above.

And if you need a little more help with what (and what not) to eat, here are some healthy diets you can follow:

• Paleo
• GAPS
• FODMAPS
• Anti-inflammatory

Most of these are low (or no) starchy/refined carbs, and high in protein and good fats.

For more on this, see my earlier blog  I LOVE FAT.

I LOVE FAT!!!!

(Not on my body, of course…)

But in my food! Yes! That’s where I want it. I adore avocados, go wild over walnuts, applaud almonds, am so pleased with pecans, go crazy for coconuts, over the top for olive oil, mad for macadamias, so silly for sesame seeds, would swim the deep blue sea for salmon, yell hurrah for herring, smile at the smell of sardines, feel fueled by flax, and it’s not cheating eating chia either.

Why, you may ask? Many, many reasons, but for this post I will talk primarily about maintaining healthy weight, and diabetes / cardiovascular disease prevention.

To begin with, for years I have told my patients that they need to eat fat to burn fat. What?! What about that whole low-fat thing that started in the 70’s? Well we now see clearly what THAT lead to: OBESITY, DIABETES AND HEART DISEASE! How so? Because fat tastes so good, and when it was removed from foods, in order to compensate for the loss of flavor, the fake food giants added sugar! Too much sugar leads to insulin resistance, which in turn leads to diabetes, and then to heart disease. Plus, when one is insulin resistant, glucose cannot be utilized properly for energy, and then it gets stored as fat: a.k.a. obesity! You can read more about this in my Healthy Weight Loss Blog.

So how does eating fat contribute to weight loss? Here are a few mechanisms:

1) We have receptors on our intestinal lining that bind with omega-3 fatty acids (that come from fats). These turn on the gene that enhances insulin sensitivity, thereby allowing the glucose (which all foods break down into, and is not to be confused with sugar that we eat) to be used for energy, rather than being stored as fat. This process also lowers inflammation in the body.

2) Fat is the preferred fuel for the mitochondria (the powerhouse of the cell), and thus increases mitochondrial function. The main function of the mitochondria is to turn food into energy; i.e. burn more calories, thereby increasing weight loss! BAD fats, such as trans fats, do the opposite. They inhibit energy production from the mitochondria, and cause weight gain.

3) Another benefit to eating fats in terms of weight loss is that fat increases satiety. We feel more satisfied and full when we eat good fats, and therefore do not feel compelled to eat more or overeat. It’s the opposite of what happens with sugar. Sugar and refined carbohydrates are addictive. They actually turn on a part of your brain called the nucleus accumbens, which drives addiction. And remember, it’s the overconsumption of sugar and refined carbohydrates that leads to insulin resistance, obesity, and diabetes.

Fat Sources are Important

To elucidate: Cows that are grass-fed do not manufacture the same kind of fat that cows injected with antibiotics and bovine growth hormone do. Grass-fed cows take the unsaturated fat from the grass they eat and convert it to a healthy omega-3 saturated fat, while cows treated with bovine growth hormone (BGH) and antibiotics are not able to manufacture that healthy omega-3 saturated fat. The fat in beef from that cow is inflammatory, as are butter and dairy products from such animals! You will not only fail to lose weight by eating BGH/antibiotic meat, you will also be likely to disrupt your endocrine system; i.e. hormones, insulin, estrogen, testosterone, etc. But that’s a whole other can of worms, best saved for a future blog post. Suffice to say, just don’t eat it!

Another matter to consider is food treated with pesticides. Pesticides kill bugs. We have trillions of health-modulating bugs in our intestines. Pesticides wreak havoc with them and, consequently, our intestines and our immune system. Remember, the omega-3’s bond with receptor sites on the intestinal lining to fuel the mitochondria to burn fat. Well that’s not going to function so well with the pesticides killing off our good bugs. So actually, plants that have been sprayed with pesticides not only have the potential to prevent us from losing weight, they may actually contribute to weight gain!

Here’s my advice, and this has been said by many renowned physicians before me: a healthy diet should be approximately 70% plant-based, mostly organic, and 30% lean organic or wild protein, along with healthy fats. You don’t have to go seeking the fats so much either. For the most part these are incorporated in protein-rich foods: wild fish, nuts, grass-fed animal products. And when you cook, cook with olive oil, coconut oil, ghee, or butter from grass-fed cows. You don’t need to count calories, you just need to look at your plate and make sure 70% of it is a colorful array of vegetables, mostly greens!

All this to say, if you only fall in love once, let it be a true infatuation with healthy fat!

Healthy Weight Loss and Improving Body Composition (Part I)

What does Body Composition Mean? Most times when patients go to a doctor, the doctor measures their height and weight. But height and weight alone provide limited information about a person’s health and what they’re made of. For example, a pound of cheese is not the same as a pound of fish. The fats in fish, the Omega 3s we all know and love, are very healthy fats. They’re anti-inflammatory in nature and help support brain function, nerve function, cardiovascular health AND weight loss! The fat in cheese, however, as with other animal fats, is primarily saturated fat. Here’s the breakdown of cheese vs. fish:

4 oz. of cheddar cheese has 457 calories, of which 58% is fat, 23.91% saturated fat. It also has 28.24 grams of protein, and 704 mgs. of sodium. That’s a LOT of sodium.

4 oz. of salmon, on the other hand, has only 133 calories, of which 6% is fat, and only 0.64% saturated fat. It has 22.93 grams of protein, and only 6 mgs. of sodium.

Although a certain amount of saturated fats are necessary, the wrong kinds – like those found in fatty meats and fried foods – can clog arteries and contribute to cardiovascular disease. Still, they are NOT the main culprits! In fact, low fat diets can be detrimental to your health, as well as your weight loss goals. There are several health benefits with certain saturated fats: bone health, brain health, immune support, for example. And because saturated fats are more slowly absorbed, they increase satiety. One feels more satisfied, therefore, and consequently will eat less. Regarding diet, the biggest obstacle to weight loss is excessive carbohydrate consumption. This will be discussed in Parts 2 and 3 of this series.

So how do I know if a person’s weight is healthy or unhealthy? I measure his or her body composition with a device called a bioimpedance analysis machine (BIA). When hooked up to the BIA, a small electrical current is sent through the body. Different tissues – muscle, bone, fat – and water have varying resistance to the current; the resistance can be measured, and that is how we can know one’s body composition more precisely. The BIA measures Percent Fat, Percent Muscle, Intracellular Water and Extracellular Water. One should have more water inside the cells than outside the cells. Too much extracellular water puts pressure on one’s blood vessels, and is an indicator of inflammation.

The BIA also measures Body Mass Index (BMI), but BMI only takes into account weight and height. This doesn’t provide enough information because, as you may already know, muscle weighs more than fat. Consequently, a high BMI can be the result of high muscle percentage, which is healthy metabolic tissue that enhances cell function – vs. excess fat, which is unhealthy. Among other things, fat cells store toxins and are inflammatory.

Another measurement we get from the BIA is the Basal Metabolic Rate (BMR). The BMR is particularly useful because it lets me know how efficiently one’s body is burning energy, i.e. calories daily, and thus helps me personalize healthy weight loss programs. That means making the right food choices and serving sizes. These measurements are also instrumental in helping me track one’s weight loss, making sure it is indeed healthy weight loss, i.e. losing more fat than muscle, rather than the other way around. It also allows me to make sure one is not sacrificing one’s health in other ways, such as bone loss and dehydration.

So you see, there really is a lot more to a body beyond simple height and weight. Regarding overall health, as well as weight loss, it’s very important and useful to know the composition of the body.

Stay tuned for Parts 2 and 3, where we cover: What Causes us to Gain Weight; What Happens When We Eat the Wrong Kinds of Foods; How Hormone Imbalance Contributes to Weight Gain; Food Addiction; What Gets in the Way; What to Do.

Healthy Weight Loss and Improving Body Composition (Part II)

What Causes Us to Gain Weight?

 Most people would say “eating too much,” and/or “not exercising,” and although those reasons are contributory to weight gain, they are not the whole story. There are many people who exercise and do not overeat, yet their weight keeps increasing – or they are not losing the way they expect to. So why is this?

1) EATING THE WRONG KINDS OF FOODS, rather than eating too much, is frequently the cause of weight gain. For example, no matter how much celery a person eats, he or she will not gain weight from overeating celery.  The wrong kinds of foods are the foods that lead to fat storage, rather than energy utilization: foods that are addictive such as fast foods, for example, or processed foods containing additives and preservatives that can cause hormonal disruption and weight gain. Other foods leading to fat storage and excessive weight gain are dietary sugars and grains, consumed in excess.

2) INSULIN RESISTANCE is a major contributor to weight gain and a pre-diabetic state. Ultimately, while all food breaks down into glucose, carbohydrates, such as bread, pasta and sugar do so at a much faster rate. When our food is broken down our pancreas secretes insulin. Insulin is a hormone that binds with the glucose in the bloodstream to carry it to our cells for energy production. Inside the cell are insulin receptors. They meet the insulin-glucose compound at the cell wall and transport it into the cell for energy. BUT, if there is too much sugar/carb consumption, the pancreas pumps out more and more insulin, and then the receptors inside the cell become overwhelmed – i.e. resistant. It’s like a telemarketer calling all the time; after awhile, you just stop answering the phone. Consequently, the glucose does not get into the cell for energy, but rather gets stored as fat, or increases in the blood stream resulting in high blood sugar, weight gain, and diabetes. Diabetes often leads to cardiovascular disease, brain degeneration and neuropathies. Most experts in the field now agree that the main cause of weight gain and diabetes is excessive carbohydrate consumption – not fat.

Incidentally, many people think it’s OK, or even healthier to use artificial sweeteners, like the ones in the little pink and blue packets, instead of sugar. In fact these artificial sweeteners can lead to weight gain as much as, if not more than sugar! There have been several studies revealing that artificial sweeteners such as these are endocrine (hormone) disruptors. They alter the hormone insulin’s ability to transport glucose into the cell for energy usage; that is to say, they can cause Insulin Resistance.

3) LEPTIN RESISTANCE – Leptin is a hormone made by our fat cells. When we have eaten enough it signals our brain to let us know that we are satiated.  However, if a person has too many fat cells, and therefore too much leptin, the brain becomes leptin resistant, meaning it no longer receives the information that we are full, and so we keep eating! This is a very challenging problem, but treatable.

3) GUT MICROBIOTA  imbalances – We have more microbes in our digestive system than cells in our bodies, and more genetic material in all those bugs than in the entire human genome. A study regarding obese and overweight people revealed that individuals who had more of the Firmicutes type bacteria had a greater tendency to gain weight and be heavier, while those having more of the Bacteriodetes bacteria were slimmer and did not gain weight as easily. I always ask my patients about their gut function. This is important because, as a doctor, I need to explore as many reasons for weight gain and difficulty losing weight as possible, in addition to other health issues. Symptoms like constipation, diarrhea, bloating, belching, heartburn, acid reflux, fatigue, depression and brain fog are signs of an unhealthy gut. This means that attention must be paid to restoring gut health in order for a person to utilize nutrients, eliminate toxins, and have an overall healthier metabolism – in addition to losing weight!

4) HORMONE IMBALANCE can be another cause of weight gain. Cortisol is a hormone produced by one’s adrenal glands as a natural response to stress. Among its many functions, cortisol helps regulate blood sugar. Too much or too little cortisol will cause a dysregulation in blood sugar balance. This can lead to increased fat storage, especially around the abdomen. Abdominal fat is called angry fat. It is inflammatory and can lead to diabetes, as well as other inflammatory diseases. Since cortisol imbalance happens when there is excessive stress, one way to combat that – and weight gain – is by a variety of stress reduction methods: meditation, exercise, sleeping enough, and being with loved ones.

Another hormonal imbalance involved with weight gain is Estrogen Dominance. Estrogen is produced in both men and women, so it’s important for everyone to have normal, healthy levels of estrogen. The problem with high estrogen levels comes primarily from our environment; human made estrogens called xenoestrogens, or foreign estrogens, are in pesticides and plastics predominantly, as well as birth control pills, IUDs, and even paper store receipts! Estrogen imbalance, too much or too little, can also lead to weight gain, and again, more specifically around our abdomens.

TO RECAP: Causes of weight gain and/or difficulty losing weight can be the result of too much carbohydrate and sugar consumption leading to insulin resistance, other hormone imbalances such as leptin, cortisol, or estrogen, gut bacterial imbalance, and overall eating too much of the wrong kinds of food: fast food, fried food, gluten, processed foods, and food laden with pesticides.

Stay Tuned for Part III – THE FIX!

Healthy Weight Loss and Improving Body Composition (Part III) – The Fix

What helps us have a healthy body composition, overcome our food addictions, and subsequently lose weight?

1) To begin with, we need will power; that’s for sure. There is no magic pill, no easy fix. We need to realize that food addiction is like any other kind of addiction: tobacco, alcohol, narcotics, etc. We need to be conscious in every decision we make about what we put into our bodies, every time, realizing it is our choice. Also, and perhaps MOST importantly, we need to be patient and loving with ourselves. We must understand and accept that change happens gradually. After a long time in meditation, Buddha realized that he didn’t need to transform himself, he just needed to be kind to himself. I believe that the greatest transformation happens when we learn to be kind to ourselves.

2) We need to increase our metabolism, our basal metabolic rate. This means increasing metabolic tissue, i.e. muscle! How do we build muscle? We exercise! There are so many kinds of safe exercise, and all are good. The main thing is to find one that you will do consistently! Here are some examples:

Resistance Training – working with weights or bands to increase muscle strength and size.

Aerobic Exercise – bicycling, running, dancing, aerobic movement classes.

Interval Training – a mixture of short bursts of intensive exercise to rapidly increase heart rate, combined with interim slower aerobic movement. This form of exercise increases insulin growth factor (IGF) production by the liver. The more IGF, the more efficiently we burn fat, and build muscle:

On a stationary bike or treadmill, for example, after a 2-3 minute warm-up at a steady – but not strenuous – pace, you walk, run, or pedal as hard and fast as you can for 30 seconds, followed by a normal, steady pace for 90 seconds. After 8 rounds of 30/90 second intervals, you finish with another 3-5 minute warm-down.

In order for the IGF to stay circulating, it’s important that you do not eat any grains or sugars within the first hour after your training. Interval training not only increases your metabolism while you’re doing it, but if done regularly will increase your daily metabolism.

Yoga – is another wonderful form of exercise that incorporates strength training, flexibility and meditation. It is not only good for the body, but also good for the brain. Yoga exercises incorporate many balance postures that enhance cerebellar function and neuronal plasticity. This keeps us well coordinated and steady on our feet. It has also been well documented that meditation helps enhance mood and reduce stress, thereby helping keep our stress hormones in balance, further helping us to lose extra pounds and maintain healthy weight.

These are just a few examples of the wide variety of exercise activities from which you can choose. As I mentioned earlier, the point is to find what works for YOU – and stay with it. It could be swimming, dancing, running or speed walking; just make sure your exercise challenges you! When I see people at the gym on a bicycle, chewing gum and reading while pedaling at an easy pace, not a drop of perspiration on their bodies, I can’t help but think, “what’s the point?” One is much better off committing to an intensive 20-30 minute exercise routine 3-4 days per week, than a daily hour-long bicycling, gum-chewing routine. The only thing that’s being exercised there is the jaw, and that will definitely not help with weight loss, unless, of course, one’s jaw is too tired to actually eat afterwards.

AND REMEMBER: Whenever you embark on a new exercise regime, it’s a good idea to go slow, and an even better one to check with your health care professional to make sure the fitness regime you choose is the correct and safe one for you.

3) We need to eat the right kinds of food; that means real food:

Proteins – we need protein to build muscle, but it should come from lean sources: fish, nuts, legumes, lean, grass-fed, organic beef, or free-range, hormone-free and antibiotic-free chicken.

Foods that burn fat – we need good fats to burn fat: coconut oil, macadamia nuts, Brazil nuts, avocados. These actually increase your metabolism and help you burn fat faster, but you only need them in small amounts: ¼ cup or a handful of nuts for example, not a cup or several handfuls. Also green tea, hot peppers, and celery help to increase metabolism and burn fat. You can easily find lists of fat-burning foods on the Internet.

Vegetables – lots of them! Vegetables provide us with phytonutrients: plant nutrients that are important for cell protection. They are rich in antioxidants and are anti-inflammatory. They help support liver detoxification, and decrease cancer risk. They give us energy!

Specific Nutrients – There are several nutrients that help with increased insulin sensitivity and better glucose utilization for energy. Here are just a few: Alpha lipoic acid, Cinnamon, Gymnema Sylvestre, Fennugreek, Chromium Nicotinate, Biotin, Acetyl-l-Carnitine, CoQ10, Irvingia Gabonensis, Garlic, Green Tea, Vitamin D, Gingko. One doesn’t have to take all of them, and I strongly recommend working with an experienced health care professional to determine which ones can best meet your specific needs.

Gastrointestinal Health – A healthy gut relies on having a good balance of pro and pre- biotics in ones diet. Probiotics such as acidophilus and bifidobacteria and others are found in fermented foods such as sauerkraut, pickles, and coconut kefir. Prebiotics are found in foods like garlic, leeks, onions, dandelion greens, radicchio, and endive. They feed the healthy probiotics. Polyphenols in red and purple foods such as berries, grapes, red cabbage and beets help encourage the bacteriodetes microbes in the gut. This increases the ratio of good to bad bacteria, making it easier to lose weight.

Hormone Balance – To improve hormone balance we need, as much as possible, to avoid endocrine disruptors, the xenoestrogens found in our environment: plastic food containers and water bottles, pesticides, coated sales receipts, birth control pills, IUDs with progestins, and conventionally raised animals such as beef and chicken that have been injected with synthetic hormones. We need to eat organic, as much as is feasible and affordable. There are sites on the Internet listing which non-organic foods are the most and least toxic. Generally, if a fruit or vegetable has a thick skin or rind, like bananas, melons and avocados, one doesn’t need to worry as much about pesticides getting into the fruit. But foods like berries, tomatoes and lettuces are much more vulnerable and should only be eaten if organic. Other ways to keep hormones in balance are exercise, meditation, and avoiding excessive carb consumption.

What gets in the way?

Habits/addiction – We are creatures of habit. It’s always very difficult to break or change an undesirable habit in the beginning. So what do we do? We create a NEW habit. Instead of having a bagel and cream cheese for breakfast, have organic yogurt, fruit and nuts every morning, or eggs and steamed spinach, or a rice cake with nut butter and fruit. Little by little you will develop healthier habits. Also, when changing habits it’s a good idea to plan ahead so there’s less likelihood of falling back into the old, unwanted habit. Regarding addiction, as I said before, one really has to go cold turkey. We DO have to eat, but we DON’T have to eat sugar or bread.

Peer pressure and family – Much of the time people get used to you the way you are and don’t want you to change, often because they feel THEY have to change as well. So one must be careful not to act holier-than-thou while opting for the healthier life style. You can say: “my doctor told me to…” or “ it just makes me feel happier.”

Knowing what to do, what to buy, how to cook – That’s where having a knowledgeable health care professional comes in; especially in the beginning, when you’re likely to need some help figuring out what to eat, when, how much, which nutrients, which gut support, etc. Then, once you’re on the right track and you’ve changed your lifestyle, you can be on your own!

How to change and implement…

“Add a little to a little and you get a great big heap.”

I recommend taking things one-step-at-a-time, starting with reduced grain consumption. Depending on how severe the extra weight, blood lipids and blood sugar are, I usually recommend only 1 serving of grain/day; i.e. 1 piece of whole grain bread, ½ cup of rice, 1 rice cake, 1 tortilla. And if one needs to satisfy the starchy desire one can also have ½ sweet or Yukon gold potato, beets, carrots or squash. Also, if you can do it at the same time, avoid all sugar.

Eat LOTS more vegetables. One can find fabulous recipes online by simply typing in a few vegetables. One site I especially like is YUMMLY.

Next you might want to reduce your dairy and/or animal consumption (meaning the ones with the hormones and antibiotics in them).

After few weeks, try adding a little exercise. Perhaps yoga once a week, walking, or bicycling.

After another month you can start to exercise twice a week. The more you do it, the better you’ll feel, and the more you’ll want to do it.

Feeling and being healthy can be addictive as well; endorphins are released that make us feel good. But keep in mind that it’s a healthy addiction, and that’s OK! And remember, one-step-at-a-time is still moving you closer to your goal.

I hope this blog series has been helpful to you, and that you feel inspired to make some BIG changes, little-by-little; and to, above all, be kind to yourself!