Peeke Performer

Toxic stress and fat are silent but deadly killers. Throwing out the bathroom scales and learning to enjoy some “me time” are both key tools to help us enjoy a better quality of life, fight premature ageing, reverse the menopause and live longer. Dr Pamela Peeke, an expert in nutrition and health, tells Halima Malik how it’s done.

A household name in the States, it surely won’t be long before Dr Pamela Peeke appears on our radar and becomes a familiar figure in the UK. As a scientist with a particular interest in women’s issues and nutrition, she’s devised a programme called Body for Life that offers a common-sense alternative to dieting.

“It’s not a diet – it’s not an extreme exercise programme,” she says. “Instead it’s a blueprint for a lifestyle. People are tired of extreme diets and exercise, all they want is for someone to show them how to live day by day.”

And what goal does the programme have in mind? It’s not just about looking good, but also about taking control of your life and your most precious asset, the body, the vehicle that carries you through life. Dr Peeke describes it as a life-saving skill.

Pamela Peeke’s professional credentials are impeccable. She is a clinical assistant professor of medicine at the University of Maryland School of Medicine and a Pew Foundation Scholar in Nutrition and Metabolism. She is medical director for the National Women’s Resource Centre with a private practice located in Maryland in the USA.

One look at Pamela is enough to know that she’s no dusty academic. She’s energetically engaged with bringing science to life, and making complex medical information accessible and palatable to ordinary people. She’s also physically fit and attractive. As she puts it: “My philosophy is that eating and exercising is not rocket science. You don’t need to have a Nobel prize to measure what you are eating.” She’s a regular in-studio medical commentator for the US national networks and CNN and has appeared on numerous TV shows, as well as contributing to magazines from Newsweek to Glamour.

Her bestselling books Fight Fat over Forty and Body for Life offer a refreshingly contemporary approach to health and wellbeing. And Pamela is clear about her motivation. For her, it was “having the opportunity to present a holistic approach to self-care for women using new science that helps us to understand how women live.” Behind the book lies cutting-edge research and development tailored specifically to women in three key areas: psychology, exercise and what food to eat.

Dr. Peeke calls this “gender-specific medicine”. She developed the 12-week Body for Life system to help women empower themselves. The programme can be used throughout your life and by women of any age. In fact one of her clients is now 95 years old.

The National Institute of Health (NIH) is a prestigious research body in the US, but until the early 1990s the focus of its medical research was male-oriented. Up until as recently as the 1980s only 13% of government-financed research at NIH was spent on women’s health issues. Although cardiovascular illness was the chief cause of death for women, they were excluded from the early phases of drug testing. After huge pressure from women’s health professionals, the Office of Research into Women’s Health (ORWH) was set up. Dr Peeke joined in 1991.

Women’s health issues differ from men’s not only in the type of illnesses that they can develop, but also in their approaches to managing illness. “If I tell a man ‘I want you to take care of yourself: what you need to do is to improve your body composition and reduce that body fat’, they compartmentalise and they do it,” says Dr Peeke. When she gives the same instructions to a woman, she finds they tend to make it more complex because they are more likely to be perfectionists.

What she calls the “power-mind principle” was influential to the way Dr Peeke customised the exercises and concepts in the book specifically for women. Success in any weight management programme starts with a positive attitude. “The hardest part for a woman is her mind,” says Dr Peeke. “Once you are armed with the power mind principles then you are going to find that the eating and exercise is a snap.”

One factor that Dr Peeke is super-aware of is the role of many women as a care-giver. This often means that women will look out for everyone else before themselves and perhaps neglect their own needs. “They fall off their own radar screen,” she says. “It’s like they pencil themselves in. But by the end of the day they have disappeared somewhere.”

To tackle this mentality she tells women to do “a little for yourself” and “a little for me”. This strategy is more effective than telling women make time only for themselves. “Women get that. But if I say you have to make yourself number one, they won’t do that. What they will do is accept the notion of balance. With balance comes no guilt.”

“If care-giving is for you, fine – but be the best care-giver you can be,” she advises. “The only way to achieve this is to follow a healthy lifestyle. All the research shows that care-givers who live in a balanced way are better able to withstand challenges to their immune systems.”

Dr Peeke’s approach to weight management is equally no-nonsense, and is based on the work she did at the National Institute of Health. “We found that the name of the game was never about body weight,” she explains. “In fact I’m telling people across the US and around the world to take their scales and throw them out of the front door. What I want you to do instead is get a body fat analyser.”

Dr Peeke explains that if you have high body fat percentage, your risk for breast cancer is higher, because fat is implicated in the production of oestrogen. “You don’t want to be flooding your oestrogen receptors because you bump up your vulnerability for cancer,” she says.

Of course she recognises that there are other causes of cancer, for example, genes. “You may have a tendency in your family to get breast cancer – as we would say ‘genetics will load the gun and environment pulls the trigger’,” is the way she puts it.

The second issue Dr. Peeke is concerned with is what she calls “toxic fat”. It’s not just the percentage of body fat that you should be concerned with, but also, and more importantly, its location.

“After you reach the age of 35-40 it’s much easier to get fat stored in the belly. The abdominal muscle wall is a dividing line that everyone has. Fat can be lying on top of that muscle wall and underneath it. The bit on top you can grab.” It’s common for men and women over 40 to store a little more fat there. Dr Peeke calls this the “meno-pot”. “Everyone gets it and it has nothing to do with disease and is part of the process of ageing,” she says. “However, if you start to put on fat underneath the abdomen wall, then we have a problem.”`

She explains why. “When there is too much fat under the belly then it overwhelms the liver’s ability to do its work. The first thing the liver likes to do is process cholesterol. And if it can’t process cholesterol you’re at risk of heart disease.”

Other associated risks with this kind of fat are the effect it has on insulin production, putting you at greater risk of type-2 diabetes. If you’ve got some stomach fat, there’s no need to panic – as Dr Peeke points out, even Kate Moss has some fat in her belly – but if you’re starting to look like you’re pregnant (and you’re not) then you’d better shape up, or risk diabetes, heart disease or cancer.

Looking beyond the adult population for a minute, what about children and teenagers growing up in western society? Dr. Peeke says the children of overweight and unhealthy parents are becoming overweight themselves. “They risk becoming the first generation that will not live as long as their parents,” she says . “That’s a scary statistic. A quarter of the children born in the year 2000 have an increased risk of getting type-2 diabetes by the time they are 30.”

Dr. Peeke continues: “The rate of teenage obesity has rocketed in the past five years. If you are an obese teenager then your chance of becoming an obese adult is over 70%.”

These statistics naturally point to quality-of-life issues. Can you have as much fun if you can’t run around with your children or grandchildren, if you get out of breath climbing stairs, or if you’re too large to fit in the seat at a theatre or on a plane?

“We are going to have a population of children who are going to grow up like that, says Dr Peeke. “We’ve already studied what this is doing to them psychologically – kids are unhappy, moody, depressed and not performing well. They can’t do well at sport – they don’t enjoy a high quality of life.”

Dr. Peeke believes that parents have a critical role to play. “If you have children and they can see you live a healthy lifestyle and you can teach them and mentor them, then this is so much easier. But if you yourself are a wreck and you are telling them to eat healthier – that’s hypocrisy. You have to teach by action and example.”

So far, so sensible, but for people trapped in an unhealthy lifestyle it’s difficult to simply turn over a new leaf and overhaul their entire diet, start exercising and so on. Dr Peeke has anticipated this, and the foundation of her Body for Life programme is that it is achievable and realistic, with specific instructions and goals. “Women begin with me, and then six or 10 years down the line they are still doing it; this tells you that whatever they did is meaningful, sustainable and compatible with living,” she says.

One core technique is the MMM formula. This stands for Mouth, Muscles and Mind and these are the three key areas in the programme. “This is the template you work with,” she says. And to achieve the physical and psychological transformation you have to address all three areas. “What happens with many people is they only address nutrition, the mouth – or they only address the exercise – muscles. Some people spend all day long working on psychology and only deal with the mind. But if you want an integrated holistic approach then you need to involve all these aspects.”

Pamela accepts that different aspects are easier for different people – you may be naturally physically active, or already enjoy healthy eating, but she believes that it’s important to tackle the whole package. “You don’t have to fall in love with exercise, but you do have to do it. In the same way that you don’t have to like brushing your teeth but you have to do it – I call it non-negotiable. At some point in your life you accepted that brushing your teeth was part of the action.”

As for the mind aspect, Pamela has that covered too. “I developed a power mind principle in my book – to be able to show women that they have a unique psychology which is all about their hardwiring. I’m not saying that every single woman will ruminate – but a lot of them do. Rumination is part of the action.”

“Women tend to be perfectionists and if they can’t achieve that they often become paralysed. I teach them to regroup around it. The first principle is to embrace adversity. Life is difficult. There’s a wonderful quote from Helen Keller who is blind. She said, ‘Life is either a daring adventure or nothing at all’. I love that. It gives you full permission to just go out and rock and roll, instead of being scared about life. Though you may fall down and you make mistakes – you can learn to get up.”

If this means that women must put themselves forward now and again, and stop feeling guilty for not putting others first all the time, then so be it. “Self is not a swear word: you are here to experience life,” says Pamela. “What’s scary is, when I ask a woman ‘What gives you joy?’, many times women say ‘Taking care of my family. I love it when my kids feel happy’.”

“And I’m thinking, wait a minute – I just asked you ‘what gives you joy?’ There has to be something beyond that. Women will look at me and cannot tell me what specifically gives them joy outside their family.” Dr Peeke’s concern is what will happen to these women when their children grow up and move away. Without hobbies, interests or a job they could be lost.

Other women are unable to answer the question at all. “They can’t tell me what brings them joy – they just can’t do the joy thing. And as part of developing that I ask women to develop target motivation that keeps them on the straight and narrow – they often find it difficult. But to do that, they need to know their joy.” However, once this source of joy has been identified, for instance running a marathon, which is one of Pamela’s personal hobbies, practising yoga or anything else – then you can start taking steps to take care of yourself.

“If I’m going to make a decision when I wake up, for example whether to take that walk or to choose the appropriate food, in the back of my mind I’m saying – if I do that I will be much closer to running the London Marathon,” explains Pamela. “Then I have a focus and anchor. This gives me joy. I can imagine myself running through the street and achieving that goal.” She believes that without joy as a motivating factor it is more difficult to stay anchored and achieve our goals.

In terms of women’s health, Dr. Peeke has identified four cycles unique to women’s lives and the impact of these stages. These include the onset of menstruation and the perimenopause, the changes that take place just before the menopause itself.

“During perimenopause a woman’s body is going through a slow oestrogen withdrawal,” she says.“There is a host of changes that take place, not just physical ones, for example changes in memory – ‘foggy brain’ where it’s difficult to remember things and also mood swings.”

This might sound worrying, but according to Dr Peeke: “If you walk into perimenopause and you’ve been taking care of yourself the symptoms will be minimised. This fact gives people a tremendous amount of hope.” There is even promise of the whole process being reversed, but only if you have been looking after yourself.

As for the physical changes during this period: “All of a sudden your fat distribution changes. Suddenly the fat is settling in the upper part of the body, especially the toxic fat zone, and not only imperilling your existence but also causing problems when it comes to putting on decent clothes.”

No matter what your life stage, Dr Peeke recommends that mind, body, spirit therapies such as yoga or t’ai chi should also form an integral part of your routine. “Think about it,” she says. “The calmer you are the easier it will be to take care of your body. Once you are doing that, then this reflects in your mind. You are happier, content and more centred when you develop a mind body core.”

Yoga also helps maintain and build flexibility and balance, and it can also help reduce stress, while meditation can alter the pattern of the brain waves to help you reach a relaxed state of being.

Stress affects everyone at some stage in their lives. For some it can be an ongoing problem. Dr Peeke identified “toxic stress” while researching her first book. She describes it as “any stress that is associated with feelings of helplessness and hopelessness and defeat.” She gives the example of being stuck in traffic. “If you are pretty centred you wouldn’t let a bunch of traffic get to you. If someone else was in the same traffic and experiencing real rage and saying ‘this only happens to me, I have a bad life’ – that is toxic stress.”

Dr Peeke associates this “toxic” level of stress with excessive, harmful levels of the stress hormone cortisol. This leads to an increased risk of suffering from disorders from heart disease to diabetes to ovaritis, as well as premature ageing. “Cells in the human body are directly affected by the level of cortisol. If you have too much cortisol you age faster and you look older,” she says. “Think about people who are under tremendous stress all the time – look at their faces, the colour of their hair – they go grey faster. If you are a woman out there crying out ‘I don’t want to age,’ get your stress under control.”

But how can we do this? Dr. Peeke says:“You can reverse it as fast as I say take a walk.” This might seem simplistic, but exercise encourages the brain to release chemicals called endorphins, which help to inhibit cortisol secretions, and bring levels down to a point where they are no longer toxic.

Other therapies suggested by Dr. Peeke to tackle toxic stress include massage or any similar body-work. “Anything that helps increase your sense of wellness and pleasure will work like a charm.” This could be something as simple as enjoying a laugh, or consciously creating an environment which is less stressful. Dr Peeke recommends meditation, aromatherapy, taking a relaxing bath or reading a book. “Muted lighting, calming music and flowers also help to create an environment that is less stressful,” she says.

It’s not just the choice of activity that’s important. “A huge part of shedding that crushing load of worry and stress comes from making time – no, assertively taking the time – to eat the way you know you should, and to sweat out stress in a yoga class, on a walk or with weights.”

Keeping in mind her emphasis on the programme being achievable, it’s no surprise that Pamela is realistic in her expectations. “I tell people that if they are not doing something like yoga even if it’s a little here and there then they are fools because yoga by definition allows you to allow mind and body to do things that are doable and reachable and achievable,” she says.

‘‘I use yoga, for instance, when I am working with the national basketball association and have big six-foot 280-pound guys doing dog pose – why? Because it calms them down and allows them to maintain excellent strength and stability. At the same time yoga allows them to develop a centre core piece when they have all hell breaking around them and people pressurising them to do well.”

Dr Peeke is soon to go to Los Angeles where she will be a keynote speaker for the Dance Aerobics Exercise Association which has 7,000 trainers. One of the other speakers will be well known yoga teacher Rodney Yee, with whom she’s looking forward to sharing ideas.

In Dr Peeke yoga has a passionate, high-profile advocate, and one who can back it up with her medical and scientific research. She explains what’s hot on her agenda right now. “We have found that yoga will bring down cortisol levels not only during practise but that this will continue throughout the rest of the day. That is very hot science. If you have what I call sustained endorphin release, that’s awesome – who wouldn’t want to do that? So that’s why I am a firm believer in the entire yoga ethic.”

Body for Life for Women: A Woman’s Plan for Physical and Mental Transformation is published by Rodale International Ltd and priced £12.99.

Fight Fat over Forty is published by Piatkus Books and priced £12.99.

Available from all good bookshops or email sophie@rodale.co.uk

For more information, including details of her retreats, visit Dr Peeke’s website: www.drpeeke.com.

Halima Malik for Yoga Magazine