Conquer Your Weight

Dr. Sarah Stombaugh: This is Dr. Sarah Stombaugh, and you are listening to the Conquer Your Weight Podcast, episode number 18. Dr. Keegan Stombaugh: Welcome to the Conquer Your Weight podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh. Dr. Sarah Stombaugh: Hi everyone. Welcome to today's episode. This is a very special episode because it is the first time that I am bringing you a guest. And my guest speaker today is none other than my voice actor and my husband, Dr. Keegan Stombaugh. He and Iwe talk a lot about all things related to my podcast, all things related to weight loss and lifestyle. And he has a very unique perspective. And so I'm gonna ask him to share that with you today. So I'm gonna bring him on. And Keegan, go ahead and tell us a little bit about yourself. Dr. Keegan Stombaugh: Well, I like that you said voice actor first. . So I I, I have been told by patients and by people my entire life that I might actually be able to do radio. So this is, this is my official debut. Aside from your introduction. Yeah. Well, we'll, we'll see how it goes. It's always good to have another career in your back pocket, right? Dr. Sarah Stombaugh: Yeah, I, we were talking about sort of joking, this is a low brow podcast, and when I first decided to have a podcast, I wanted to sound legit and I wanted to have a voice actor. And so I had my husband do it. So you'll probably recognize his voice, . Dr. Keegan Stombaugh: Well, and so, you know, for your audience, we are actually sitting right now on one of ourfor lack of better term card tables in our office with Sarah's laptop in the middle here. And we're talking on two microphones. So, you know, sometimes when you wanna start a project the best place to start is at the beginning. And we're developing this, and by we, I mean, her , she's nice enough to have me on. So yeah, I think it's gonna be a good time. I think you did ask me a serious question. Tell me, well... Dr. Sarah Stombaugh: Not serious, but just tell me about yourself. Dr. Keegan Stombaugh: Tell me about yourself. So I was born and raised in Tucson, Arizona. And then I lived in the Midwest for 10 years, and now we're in Virginia. So this is a very different place than the desert. But I grew up running around the desert, had a lot of energy as a kid, loved playing sportsyou know, trying to go play fort and cowboys and, and everything in the desert and avoiding the rattlesnakes and scorpions. And one of the great things about Arizona growing up was that all the pools were outdoors. I gotta say, when I moved to the Midwest for the first time, and I saw an indoor pool for the first time, I was a little taken aback. But with all the pools being outdoors, that was a wonderful oasis and a great place to not only spend time during the summers, but it was a great place to work out and exercise. And so I actually swam competitively, gosh, I don't know if you consider being a five or six year old swimming, competitive swimming . I probably got interested when I was five or six years old. And then I, I really got competitive when I was in middle school and high school. And so that was a big part of my life. I wanted to be in marine force recon for the longest period of time. Unfortunately, when I was 13, I ended up tearing my ACL and, back in the day, they didn't repair that. SoI would've been applying to the Naval Academy with no ACL and with a case of exercise induced asthma probably wouldn't have worked out that well, , Dr. Sarah Stombaugh: Probably not, Dr. Keegan Stombaugh: Probably not. So then I went to University of Arizona. I was not the most disciplined individual as you are probably imagining a University of Arizona student would not be. But that kind of changed over time because I developed a passion for medicine and I went from being, wanting to be a force recon marine to wanting to be a surgeon to what I am nowwhich is so exactly I practice a very specific kind of medicine. So the medical gobbldy gook would be this, I'm a cardiothoracic anesthesiologist who specializes in the perioperative care of patients undergoing heart surgery. And not only in the operating room, but in the ICU and I see my wife looking at me. Yeah. Dr. Sarah Stombaugh: Which I'm thinking maybe I should translate that a little bit. . Yes. So he's an anesthesiologist. Even I, as a family medicine physician didn't realize for many years how many different types of anesthesia there are. And Keegan is specifically a cardiac anesthesiologist, meaning he focuses on heart surgeries and a pulmonary anesthesiologist, meaning he focuses on heart or lung surgeries rather. So when he's in the operating room, he's taking care of patients who are having any type of heart or lung or other vascular surgery, like artery surgeries and that type of thing. But then he spends a huge amount of his time in the intensive care unit, whereas he is the physician taking care of patients who've had those types of surgeries. Dr. Keegan Stombaugh: Yeah, that, that pretty much sums it up very well. If you are seeing my wife for medical treatment, if you're part of her obesity medicine practice, excellent. if you ever see my face and I'm your doctor in a clinical setting it probably means something has maybe not gone great in your life. No. So, so I take care of very sick patients. we, we, it's, it's been fun because we kind of do opposite ends of the spectrum in medicine. Mm-hmm. And we have our own perspective on things. Dr. Sarah Stombaugh: Yeah. It's funny, I think if people imagine, and we've had conversations with friends and family about being married to another physician, and honestly what I do on a day-to-day basis and what does on a day-to-day basis could not be more different. I mean, we are , we are very different. But the reason I wanted to bring him on today is because he is someone whom I really respect when it comes to routine, when it comes to recovery. And we've been having a lot of conversations recently as we do just about my practice and about our lives and our family and our children, and how I help my patients implement these things, how we implement them for ourselves. And Keegan, I'm gonna call you the master of routine and a someone who has honed the skill of learning how to recover over the last many years. But I first wanna start and talk to you about routine, because whether we're talking about day-to-day schedules or sleep or diet, you are someone who is really regimented in that. And so tell us a little bit about that. Dr. Keegan Stombaugh: Well, I think a good place to start is when I was a kid and then at my first few years at University of Arizona where I was not regimented . And that's, that's kind of why I, I spoke about that just a little bit earlier. I was planning on kind of dovetailing that to this. And, and that is to say I realized at University of Arizona that if I did not pull some things together being a pre-business major with a 3.0 GPA just wasn't gonna cut it for getting to medical school. so long and short of it, I would say, gosh, over a period of 12 to 13 years between then and now, I have kind of honed in on certain routines that have made me successful and certain parts of my life that are absolutely essential to have a habit and have a routine in so that I recover and I stay physically and mentally healthy. and I think sleep is a big one of those. Dr. Sarah Stombaugh: Yeah. Because you, excuse me, you have not always been quote the best sleeper. And we've known each other, we were just talking about this for 11 years. Dr. Keegan Stombaugh: Yeah. 11 years dating, 11 years in September. We've Dr. Sarah Stombaugh: Been dating for 11 years, and I've seen over the last 11 years how your, how your sleep habits have evolved. And you were never a terrible sleeper, although maybe at times you were, but you've really gotten yourself into a routine there. So tell us a little bit about your sleep habits before, why you changed that and what your sleep habits look like now. Dr. Keegan Stombaugh: Sure. so when I was a kid, for whatever reason, I was, I had a very active mind and I was very anxious. so I, I've had, I had trouble sleeping since I was a kid. and there are a number of things that go into that. and I, I had a very normal childhood. I had wonderful parents. So it wasn't any of that. I just had a very active mind and I just didn't know how to calm it down. and so I ended up going to college and I, you know, either living in the fraternity house or living in places that had a lot of noise, inactivity, especially when I was a freshman or sophomore. so there were certain things that I, changes I knew I had to make later on in college that would get me on a journey to sleeping better. and you've, you've witnessed some of those changes over the years? I, I can't live in a lot of commotion. I have to have a cool dark quiet room. we've employed the white noise machine ever since we lived in Chicago. Mm-hmm. just because of all the background noise there. And people honking for picking up people for rides at four o'clock in the morning. and so long and short of it, there are a number of strategies I have developed in order to sleep better as part of my routine. you know, but be before maybe I go into too much of that we should probably just talk about the, the importance of sleep mm-hmm. in general. and I know that you've hit on this in your podcast before. Dr. Sarah Stombaugh: Yeah, absolutely. But I would love to hear from your perspective, both as just in general, but especially as a physician and as someone who takes care of patients who are very sick, what role sleep ends up playing for them in their recovery as well. Dr. Keegan Stombaugh: Yeah, absolutely. So and you and I, again, kinda have an opposite perspective in medicine, you were thinking about sleep and how it relates to weight loss. I'm thinking about sleep in my medical career and how it affects patients in the critical care setting. So critically ill patients have a lot going against them. first is there are a lot of alarms. There are a lot of monitors going off in the ICU and they don't sleep well at baseline because of that. Second, because they're critically ill. Their brain has taken a hit from whether or not they have septic shock or, or an infection, I should say, whether or not they have heart disease. and this makes it difficult for them to sleep. This does a few things to them. One, they are not clear, they are not themselves, and very often they're what we would call delirious. In other words, they cannot focus, they cannot pay attention, and sometimes they don't even know where they are. A lot of that has to do with poor sleep hygiene. And then the second thing is, and this is very important is wasting of lean body mass. And what, what do I mean by that? I mean that the body, when it, when it doesn't sleep well and it's critically ill, instead of using fats for energy as it should in, in a state of illness and starvation, it will break down muscle. Mm-hmm. Dr. Sarah Stombaugh: , Dr. Keegan Stombaugh: Lack of sleep. So insomnia and lack of sleep has the same type of physiology as critical illness. Instead of building muscle and losing fat, what can happen is, is you eat away at your body's lean mass. And this is something we see in critical care mm-hmm. Dr. Sarah Stombaugh: . Well, and the reality is we see that in anybody, right? Mm-hmm. , I mean, in my average listener, it may be to a less extreme way, but when we're not getting that rest and recovery, our bodies aren't able to be metabolically healthy and we don't use our fat stores for energy. We may be really struggling to build up lean body mass, which is our muscle mass and, you know, our healthy weight as opposed to then just holding onto our fat mass. Dr. Keegan Stombaugh: Exactly. And so like I said, I was a competitive swimmer. but then I, I have transitioned to weightlifting, which was a part of my life when I was a competitive swimmer, but the catches with weightlifting and kind of power lifting in general, in order to gain strength and size and muscle mass, you have to sleep. Mm-hmm. , it's not an option. Sleep is king when it comes to active recovery. Dr. Sarah Stombaugh: And why is that? Dr. Keegan Stombaugh: The reason being, it goes back to the same thing that we were just saying. If you want to lose fat and build muscle, you need to be sleeping at minimum seven hours a night. some professional power lifters actually probably sleep nine to 10 hours at night. Again, not a professional power lifter here, . I definitely don't sleep nine to 10 hours at night, but power lifting changed my perspective. Mm-hmm. , and I said, if I'm going to be healthy and lose some body fat and keep gaining muscle and lean mass, I need to sleep. And my training and seeing how much critically ill patients suffered mentally and physically without sleep for recovery also really changed my perspective on this. Mm-hmm. . Dr. Sarah Stombaugh: Well, and I think just as an aside, you know, we talked a lot about your history and athletics, and you were a swimmer for a long time, and right now you're really a weightlifter. I mean, you've had different variations of exercise that you've done over the last many years, but over the last couple of years now you've gotten pretty heavy into power lifting, and it's been a evolving process for you to learn about and to learn about that whole rest and recovery and sleep has been really important for you in recovering from that. Dr. Keegan Stombaugh: Absolutely. And I know when I don't sleep, I'm way sore for much longer than I should be. My joints hurt. I do not gain muscle mass in the way that I should. And so I, you know, kind of back to some of the issues that I've had with insomnia in the past that I think were very much anxiety related, and I kind of temporized it with a white noise machine. I temporized it with earplugs. I made sure I was in a cool dark room. And if you go online and you look at a lot of the sleep recommendations from a variety of foundations, and I'm sure many of your listeners have, they're going to say all those things. Mm-hmm. . But what I have found has been the best way to get myself to sleep well is routine. Mm-hmm. . Dr. Sarah Stombaugh: Well, and it's, but going back to all of that stuff, you know, I talk to my patients all of the time, especially back when I was in primary care, and I would talk about sleep hygiene, and I would talk about having a wind down routine before bed and being in a cool and calm and dark environment. And it's funny because a lot of times we hear that stuff and we're just sort of like, oh, yeah, yeah, yeah. Like, of course, but then we don't actually do it. Right. Right, right. Like, it's, it's so important that you actually have those things implemented as a baseline because that's, it's really going to set you up for success. And so for us, that means, I mean, we have blackout curtains, we've had them in every apartment and town home we've lived in depending on shift stuff, you know, sometimes as physicians, especially during training, but even now for Keegan, working overnight stuff might mean that he's sleeping during the day. So it might mean wearing an eye mask to help block out extra light. It means being in an environment that's quiet, which we haven't always been able to control. We lived in a pretty loud neighborhood in Chicago for a while. And so we have a white noise machine that Keegan sometimes sleeps with earplugs, depending on the situation. We always have a fan going. We keep our house cool. And all of that stuff is really a foundation that has to be in place. And it's sort of easy to put it in place, but it's also easy to just sort of blow past that as well. So I don't wanna minimize how important that stuff is. But then you take all of that and you add onto it something like a sleep routine, and that's where , that's where it gets really good. So tell us about your sleep routine. Dr. Keegan Stombaugh: Yeah. So I, I developed this routine and, you know, you listen to a bunch of sleep experts. Matt Walker is one of them. He has a wonderful book out about sleep. I do not recall the title. but he is I think he is at a research institution, maybe Cal. And he talks a lot about sleep. And one of his biggest recommendation, aside from all the things we've already talked about, and, and, and this is the recommendation that's made. The biggest difference for me is routine. Go to bed the same time every night, wake up the same time every day. I would be lying to you if I told you . I did that all the time. But by and large what I have found is waking up the same time, even on weekends, has made an enormous difference. circadian rhythm is a huge part of your sleep drive and sleep signals. And, and as somebody who's had to work nights and night shift in the ICU, I can tell you when you screw that up, I guarantee you, no matter what white noise machine blinds you have quiet, cool room. if you get thrown off that routine, your sleep's gonna get thrown off. So literally telling myself, come hell or high water unless there's absolutely something that needs to get done that I haven't done, I'm going to bed at Time X and I'm waking up at time Y mm-hmm. , that has made the biggest difference all the way from being a child until now in my sleep. Dr. Sarah Stombaugh: Well, and we were talking about this and I think that being parents really just highlighted this for us. Yes. 'cause we have been so regimented with our children in terms of their sleep. I mean, from the time that they were, you know, weeks old or maybe months old, we were starting to get them into certain habits in order to have them be good sleepers. And I look at our four year old son, and he wakes up within 15 minutes of seven o'clock every morning. Like usually it's right about seven, maybe a couple minutes afterwards, but 6:45 to 7:15 every single morning, no matter what. I mean, he has that like, it's so obvious to watch his biological drive for sleep and see how the circadian rhythm is playing out for him. And that's because he goes to bed at the same time every night. And while he's not napping now, there was a period of time that he was, and that was happening at the same time every day. And so as adults, we kind of like, we take sleep for granted, we think we should just be able to lay down, close our eyes, sleep soundly, and then wake up magically rested sometimes like four or five, six hours later. And the reality is, is like, you're not super human. You need sleep and your body wants some routine. Dr. Keegan Stombaugh: Absolutely. and you and I have talked about this, the the mysterious short sleeper. Yeah. Dr. Sarah Stombaugh: , well, I talked about that in my last, I know, Dr. Keegan Stombaugh: Know, Dr. Sarah Stombaugh: 1% of people are less are short sleepers. It's, and you're not one of them . No. Dr. Keegan Stombaugh: and, and look maybe, but odds are you're not . Yeah. Right. Odds are you're not Dr. Sarah Stombaugh: Statistically, you my listener, are not a short sleeper. Dr. Keegan Stombaugh: Yeah. And, and there's a difference between handling sleep deprivation well, and being somebody who can get by and be completely functional with sleep deprivation. Mm-hmm. . will I be on call overnight, go to bed two hours after my bedtime, get woken up in the middle of the night, two hours after that, and go assess a bleeding patient in the operating room or up in the ICU and be able to handle myself well sleep another hour, wake up, deal with more emergencies and, and conduct myself in an appropriate manner to take care of those patients. The answer is yes, but am I gonna be feeling like sunshine and flowers like that? Mm-hmm. , no. Is that a long-term strategy for success in anything you wanna do, whether it's mental or physical whether it's power lifting, weight loss, or just doing your job? The answer is absolutely not. Mm-hmm. sleep is king and you gotta get those. I would say for, for people who are not short sleepers, 99% of you I would say seven is probably what you need to shoot for at minimum. Dr. Sarah Stombaugh: Oh, at least. Yeah. I mean, seven to nine hours is what we recommend. Dr. Keegan Stombaugh: Right. and there are, I think the biggest thing though, that changed my perspective on sleep and helped me get healthy with sleep and avoid insomnia was viewing sleep as active recovery. Mm-hmm. Dr. Sarah Stombaugh: . Yeah. Tell us more about that. Dr. Keegan Stombaugh: So that was the biggest thing. I had probably, like many of you, the idea that I have so much to do, I'm just gonna fit in six hours of sleep, sometimes five and a half. When I was a trainee I felt tired. my emotional quotient or my EQ was low. and I certainly wasn't as adaptable or flexible in my job as I should have been because I viewed sleep as just another necessity, almost a waste of time, if you will. It was time that I wasn't studying. It was time that I wasn't spending with my family. It was time that I wasn't working out. And what I've come to realize is that when you sleep and you sleep well, and it's a part of your life, it's a focus, it is a top priority for you. I take better care of my patients. I gain more lean mass and muscle mass. I have better relationships with the people that I have in my life. So when I sleep, I'm also working out in a way mm-hmm. when I sleep, I'm also studying and improving my knowledge of critical care medicine to better take care of my patients when I sleep. I'm much better emotionally capable of taking care of patients who have dying, family members, working with our excellent surgeons. But of course they have their opinions on things and we work as a team, but that those high level team dynamics can be mentally and emotionally taxing sometimes. So when I sleep, I'm not wasting any of that time. I'm becoming better at all of those things. So I view sleep as active recovery. Dr. Sarah Stombaugh: Well, and it's interesting because this goes back to so much of what we talk about, and in the last episode, we were talking about beliefs around food, but the reality is, is we have beliefs about everything. And sleep is an area of my life. You know, I'm fortunate to never have had any struggles with sleep. And then I have this attitude and this belief about sleep of, I mean, you've heard me say this like, oh, I love sleeping. My favorite place in the world is bed. Yeah. I'm an excellent sleeper. But it's funny how when you have thoughts like that, how that ends up playing out in your life. And I remember going to medical school and people saying like, oh, you know, you're not gonna be able to sleep much and there's so much to do. And I will tell you, I slept a lot in medical school. Yeah. I slept a lot as a resident, and I slept a lot as a parent of a new baby because all of that was my priority, and it was my belief around what sleep meant. And we've even sort of as an aside to that, you know, talk about, like, sometimes you have times where like you wake up at three o'clock in the morning, all of us do this. Right. And maybe to go to the bathroom or something's disturbed or sleep. And when I wake up at three o'clock in the morning, I kind of glance at the clock and I think, oh yes. Like it's three o'clock in the morning, that means I still have three more hours to sleep or whatever. And like, I see it as this bonus of like, yes, I still have three more hours. But for a lot of people, and I know this was you for a long time, you look at the clock and you see three and it turns into like, oh my gosh. Like, why am I awake right now? Yeah. I can't believe I'm Dr. Keegan Stombaugh: Awake a hundred percent. But when I see, when I wake up and I see the alarm clock and I see it's three o'clock, my first thought was not anymore, but it was a four letter word. Yeah. , , you know, I'm just, oh man, I didn't make it. Oh God, I gotta get back to bed. Okay, now I'm thinking about this patient. maybe I'm just better off just getting up and kind of thinking about this patient with liver failure and stuff. And, and again, viewing sleep as active recovery, I, I kind of change my perspective. Mm-hmm. I still try not to look at the clock but if I do and I'm waking up thinking about a patient, I'm like, no, I'm gonna do this patient a favor and I'm gonna go back to bed. Yeah. , , the best thing I can do for this sick patient is go back to bed and have more active recovery. So when it comes morning time and I get sign out from my, my overnight partner, I am ready to rock and roll mm-hmm. and take care of this patient. I'm not bleary-eyed, I'm not worn out. I am ready to do my job because I've actively invested in my recovery by sleeping. Dr. Sarah Stombaugh: Yeah. Well, and it's funny, I remember someone said to me in the context of primary care, like when you're dealing with a patient who has complicated medical issues and you're trying to figure it out, sometimes as a physician, you just don't know. And the best tool that you can have is a consultation for yourself, for or from yourself. And so I can't tell you how many times I'd be thinking about a patient and trying to figure out what was going on. And I'd go to bed and I'd wake up the next morning and I'd be showering or blow drying my hair or something, and it would just click. And I would have this exact, you know, this moment where it all sort of was clear and made sense. And I felt like I had a understanding and a plan for where I needed to go next. And nothing had changed. I had just allowed myself to sleep. And my brain had just integrated that information and had a consultation from myself. . Dr. Keegan Stombaugh: Yes, a hundred percent. And so, you know, I think we've talked about this from a mental realm we've mentioned in the physical realm, but if you talk to powerlifting coaches, good powerlifting coaches and they're getting to know their clients, the first question out of their mouth isn't about their workout. It's not how much they can lift. It's how much do you sleep. The second question out of their mouth is, how do you eat? The third question is, what do you do to actively recover? And then of course, the fourth question, priority four, I want you all to think about that for a power lifter, is what do you do when you work out? Because a lot of life isn't necessarily what you can do, it's what you can recover from. especially if you want long-term goals. Mm-hmm. . And the way you need to think about routine is not necessarily what's gonna get me to my goals at 30 days. How is this gonna benefit my life for the next 30 years? Mm-hmm. . Dr. Sarah Stombaugh: Well, and what is a routine that can really be your routine? Right. I talk to my patients all the time about this. When you take on some complicated and restrictive diet, you may be really successful with losing weight over the course of a few weeks or a few months, but unless that's something you're going to keep up forever, it's not going to stick with you because it's not your routine. And so it's developing, whether it's sleep, whether it's diet, whatever aspect of your life, what are the things that you can do, and then the things that you can stick with because it is a plan that you created that feels good for you and your body and your goals. Dr. Keegan Stombaugh: A hundred percent. So I, I'm thinking about some of my power lifting training. So there, the, the way I train currently is something called the conjugate method. And this has been made famous by West Side barbell long and short of it, west side barbell, I think it probably still has the most world record holders in power lifting in the world. It's a small gym in Ohio. but they developed this workout routine called the Conjugate System. And it is a four day a week workout plan. And it is intense. It involves some heavy lifting and then some fast lifting. Long and short of it I figured out for me, 'cause I wanna do this. I'm not a competitive power lifter, but I want to be strong and enjoy the gym not for the next 30 days, but for the next 30 years. And so what I had to say for myself is I can't recover based on my job, based on my lifestyle. I can't recover from four workouts in a week. I don't eat sleep and live power lifting . My sleep's got a lot better. I sleep more than seven hours a night most of the time, but I don't sleep 10 hours a night. And so what I've said, you know, so that I can do this for the next 30 years, I need to just work out three times a week. Dr. Sarah Stombaugh: Mm-hmm. , and that was a really big shift for you, just really in the last couple of months, have you been playing around with, should I do three, should I do four? And I mean, that's exactly an example of you were listening to your body and you did not feel good. You were, you actually weighed a little bit less. And like for a lot of my patients, that might sound like a good thing, but for Keegan- Dr. Keegan Stombaugh: Right. Dr. Sarah Stombaugh: He's, he's a power lifter. And so he's at a point where his weight has been really stable and there's been times where he's been looking to make gains in muscle mass. And when he was working out more, it was more challenging for you to do that. Dr. Keegan Stombaugh: Yeah. So that stress, I couldn't recover from the four workouts and because I couldn't recover and I didn't have good active recovery with sleep and with other things in my life, paradoxically working out, ate my body away mm-hmm. , which is the exact opposite of what I'm trying to do here. And that, and back to your 30 year, what is your 30 year goal? No way. Yeah. Not even remotely a part of my 30 year goal. Dr. Sarah Stombaugh: Absolutely. And when you say eat your body away, I don't want my patients to listen to that and think like, oh yeah, great. That's exactly what I Dr. Keegan Stombaugh: Should do. Right? No, no, no, no. Dr. Sarah Stombaugh: We'll talk more. Yeah. And I, to be honest, I haven't had an episode on exercise, which I'll do sometime soon, I promise y'all. But eating your body away, you want to be using your fat stores and not eating away at your protein stores, which is comes from your Dr. Keegan Stombaugh: Muscle. Yes. And so I need, I need to clarify my statement. in the context of your podcast, I was eating kinda like what we were talking about earlier with critical illness, eating away your lean mass. I was in such a stressed out state between my job and lifting four times a week I couldn't recover, and I was actually having my lean mass eaten away rather than enhanced by my workout. Dr. Sarah Stombaugh: Right, exactly. Exactly. Speaking of routines though, I want to hear about your eating routines because honestly, probably for as long as I've known you maybe was out of simplicity's sake and survival stake. You were not, and maybe still are not the world's most, you know, fabulous chef . but like all through medical school, you really ate the same thing for dinner. You would cook like once a week and you'd eat the same dinner, which was chicken peas and rice for years. , this man ate chicken peas and rice for dinner every single night for years on end. But you, you have a really specific routine about the foods that you eat. And I would love to hear about, I mean, one, you can tell us what your foods are, just so that we all understand and how that fits into your routine. But why, why do you have that routine? Dr. Keegan Stombaugh: Sure. No, that's a great question. Well, first of all, I think my wife has already hit on, it was out of necessity. I was a bit of a one or two trick pony when it came to cooking . We used to have this little George Foreman grill that I could just plop a chicken breast on and, you know, it would take 10 minutes to cook and then I'd throw some Uncle Ben's, you know, rice and, and peas into the microwave. And that was that. You throw some barbecue sauce on that, you're good to go. Man. , Dr. Sarah Stombaugh: I, he served this meal to me so many times, , I was like, I cannot, and we're talking like a fairly unseasoned chicken breast. It's like some salt and pepper thrown on like two minutes before cooking Dr. Keegan Stombaugh: . You know, this wasn't my- Sarah's a very good cook. And this wasn't really my strategy, but I think my bland cooking occurred so much that it may have actually forced her to start cooking for me. Not an intended side effect, but it was beneficial in some ways. Yeah. Okay. I will say I also make mean scrambled eggs, but that, but that's about it. Dr. Sarah Stombaugh: You do make, he makes really good scramble eggs . Dr. Keegan Stombaugh: But so in terms of moving beyond my inability to cook why have I developed a fairly regimented diet in some ways and, and it has to do with a few things. you know, back to powerlifting and wanting to gain weight there's, it's a little bit bro science, but if you listen to some of the best powerlifters in the world and some of the best bodybuilders in the world, they will by and large tell you that you need one gram of protein per pound of lean body mass in order to even maintain your muscle mass. you're gonna need a little more than that if you're going to gain. And so for me, again, the two most important things for active recovery, for me, it's not going to the gym, it's sleep and eating. If I don't control those things, well, then going to the gym doesn't do as much good as it should. And so I said, I need to be regimented, given my busy schedule given everything that's going on in my life, I'm gonna be regimented about what I eat so that I ensure I get as much protein as I need with carbohydrates also being a part of that. But, but the main focus was protein. And so I just, you know, I did some reading. I listened to some dietary experts in the power lifting world, and I just kind of designed my own food schedule so I could one, meet those protein needs, but two, and we're all susceptible to it. I had reasons not to order out lunch. Maybe that wasn't good for me. Mm-hmm. , I had reasons not to go grab the donut in the break room. And anyone who works in hospitals, if you're listening to this, you know, somewhere in that hospital, there's a break room full of donuts and candy , it's, it's inevitable. People bring in things on night shift. People bring in things on potluck. And so if I packed my own snacks, it allowed me to avoid those things. If I packed my own lunches, it allowed me to avoid some of those things. Dr. Sarah Stombaugh: Well, and I think it's interesting because this is, I mean, this is exactly what I talk to my patients about all the time, right? Is that having a plan and then sticking to that plan allows you actually a lot of freedom because you are the one who gets to make that decision. But it also, you've made that decision in advance, and we were talking about this a little bit earlier, your, it frees up your brain to not have to be thinking about it because whatever your dietary needs are, whether you're making sure to get enough protein or limiting carbs in your diet or whatever the context is, when every day, day in and day out, you're eating something differently. You know, maybe there's some equation that you're trying to do, you're trying to add up, oh, did I get enough protein today? But you don't even have to think about it. No. 'cause you eat the same thing every single day. Dr. Keegan Stombaugh: It's a no brainer. Yeah. And so I prep my food on Sundays for the week and it conserves my willpower mm-hmm. which is really important. Dr. Sarah Stombaugh: Yeah. Well, this idea of like, it's a no brainer. I mean, that's exactly it. Like, it, instead of every day having to use your brain power to think, how much protein am I getting? Is this meeting my nutritional goals? Whatever your nutritional goals are, protein or not, it allows you to use your brain for literally anything else, whether that's saving patients' life or creative energy. You just have already made those food decisions and your life becomes a lot simpler. Dr. Keegan Stombaugh: Yep. It decreases my cognitive load. Yeah, it really does. Even going back to the sleeping thing, I go to bed of course they're extenuating circumstances, but I go to bed at Time X and I wake up at time Y mm-hmm. , and that's just how it goes. Yeah. Barring extenuating circumstances or needing to be on call or ICU night float. Dr. Sarah Stombaugh: . Well, and so I, and I wanna just point that out again because I think we, like, sometimes people get really caught up in this of like, oh, isn't life boring or isn't, you know, like, doesn't that make life boring if you're eating the same thing every day and no. Right. Like, you have so much more opportunity to do anything else because that's not your primary focus. Dr. Keegan Stombaugh: So Jocko Willink, and for those of you who may, may not be familiar with Jocko Willink. Jocko Willink is a retired Navy SEAL that does a lot of seminars on lead. He does a lot of podcasts and seminars on leadership and discipline. And he has a saying that discipline equals freedom. Yeah and that, boy, I'll tell you what, in terms of routine that's true. If I have regimented out many of my meals, not all of them but many of my meals, it frees me cognitively. So like, like Sarah was saying, I can focus on other things. And then, you know, what's nice about that? If I have been so good all week about my meals, I have buddies who want to go out to a pizza place on Friday night. Yeah. I'm gonna go out and I'm gonna enjoy some pizza. And again, , I'm not, I wanna be clear, I am not I'm not recommending this to you. 'Cause this is my life and this is my perspective. My goal is not weight loss. My goal is the opposite, to gain lean body mass. But what happens is that at least for me, I can say, yeah, I'll go and have pizza. Dr. Sarah Stombaugh: Well, and that's, but it's planning ahead of time. Right. It's knowing that like, Hey, on Friday night, I wanna go out with my buddies. And it's not just like, oh, I've been good. I deserve a treat. Right. Right. It's like I, I planned every day this week that I would eat x, y, z foods and then I did that. Yes. And now I'm planning that I'm going to go out and I'm going to enjoy this food. And then you go out and you just really enjoy that food. And if you want to eat pizza and have a few beers, like don't beat yourself up about that experience. No plan in advance to do it. Do it. And then that was your plan. Right? Dr. Keegan Stombaugh: Yeah. Yeah. And I'm not saying, you know, that pizza and beer should be a reward at the end of the week for a diet well followed. I think that that's probably not a great way to think about it, but I think if your buddies are planning on doing that, and I have been disciplined and stuck to my diet, I, I have the ability to say, I've met a lot of my nutritional needs. Can I have pizza and beer with my buddies? Yeah. No sweat. Mm-hmm. , no problem. Dr. Sarah Stombaugh: Well, and you've made all of those decisions ahead of time, Dr. Keegan Stombaugh: A hundred percent Dr. Sarah Stombaugh: Day in and day out. You made the decision of what you were going to eat. And going into a night like that, you make a decision about what that will look like or give yourself some leeway different than what you would typically do. Dr. Keegan Stombaugh: Yeah, absolutely. And, and I think, I think planning that kind of fun in advance is really key. Mm-hmm. and I have noticed, so with myself, where I get into trouble is sometimes if I say spontaneously, ah, you know what? Maybe pizza sounds good. Yeah. We'll do some pizza and that's Friday night, and then Saturday rolls around and I don't really have a plan. I'm like, ah, we'll just do Chick-fil-A with shakes, , you know, and I love Chick-fil-A with shakes, but maybe that wasn't the best plan to do that two nights in a row. But that's usually an act of spontaneity. And that's I can usually avoid that if I have planned in advance mm-hmm. and I'm better off for it. Dr. Sarah Stombaugh: Well, it's using your developed brain, right? It's, we are evolved humans who have developed brains, who are able to make decisions that are in line with our goals for ourselves. And when we actually tap into that developed brain, you know, it can create great things for us that align with whatever the goals that we have are, as opposed to our primitive brain, which is just like our little lizard brain that sees any sort of stimulus and is like, Ooh, this food, ooh, that drink, ooh, this, whatever. And we instead get to use our developed brains. Dr. Keegan Stombaugh: Yes. Routine greatly aids in that. And I think, you know, a, a note on starting new routines Yeah, please. It, it's gonna be tough , it just, it just is. But what, what I've noticed, so, so I've been working out since I've been a kid. For, for me working out, I don't even need to think about it. It just happens. because I've been doing it for so long, it, it just becomes a part of who I am. Meal planning and meal prep, now that I've been doing it for three or four years, it's just, it's not a struggle anymore. It's just a part of who I am. And some of my sleeping habits that we were talking about earlier, how I view sleep, that's really kind of slowly becoming a part of who I am and I'm better off for it. Dr. Sarah Stombaugh: Well, and I think but it's trial and error, right? Yes. Because like we were talking about with your workout routine, you were doing, I mean, there were times in your life where you worked out most of the days of the week Dr. Keegan Stombaugh: Five to six times. Yeah. Dr. Sarah Stombaugh: To three or four times. And then making that switch recently from four times to three times. You know, that might not sound like a big deal to a lot of people, but like, these are very intentional and planned workouts that you're going into when you do this. And when you were making that switch from four to three, it was, it was a big deal, you know, sort of mm-hmm. broadly speaking about it. But this idea of like, we can try things and we're going to fail, we're going to do things that don't work. Dr. Keegan Stombaugh: Yep. Dr. Sarah Stombaugh: And then you gotta get back up and figure out what does work. Dr. Keegan Stombaugh: You know, it's funny you say that, that applies to, to life and it applies to the medical field as well. So very often in the intensive care unit, as I'm sure your listeners can imagine, people have breathing tubes in Yeah. And we wanna get those breathing tubes out, , that that is the goal. That Dr. Sarah Stombaugh: Is your job in a nutshell. That Dr. Keegan Stombaugh: Yes. That is a big part of my job is getting the breathing tube out. but there is a great deal of literature and and culture to say that if you aren't, when you take the breathing tube out, if you're wrong and you have to put it back in about 10% of the time, guess what you're doing? Your job. If you're never wrong about taking a breathing tube out of a patient, that means you're being too conservative. So all this to say, whatever you do in life, whether it's trying to, trying a new habit, trying new, new routine, if you're trying real hard, you're gonna fail. failure is a mark of you trying, this isn't gonna be perfect. And, and these sleep routines and workouts I'm talking about, I mean, these have evolved over a period of 10 years Dr. Sarah Stombaugh: Or more. Dr. Keegan Stombaugh: More, yeah. Mm-hmm. . Yeah, absolutely. but, but they've evolved to where they are because I've been persistent in saying, I, I need to find a way, a workout plan that I enjoy, that I'm gonna be able to do for 30 years. I need to find a diet that I can follow to make me strong and healthy. That's gonna work for the next 30 years. Mm-hmm. yeah, I need to find a way. I don't know if you all can hear our children in the background, . they're exceptionally excited about something. I'm not sure. But I need to follow a sleep plan that is gonna benefit me over the next 30 years. And there have been a lot of failures along the way in terms of developing that routine and that habit, but boy, the more I try, the better my life gets. Dr. Sarah Stombaugh: . Well, and you like, as the plan, like what's working perfectly for you right now is likely not going to be the same thing that's working perfectly for you a year from now, or five years from now, or 10 years from now. Yes. And so being willing to continue to pay attention to what your needs are, how your body's feeling, and then using that in order to create your plan is, I mean that's, that's the crux of all of this. And especially, especially in weight loss. I think with so many diets out there, right. You know, a million people who've lost weight on the keto diet or the Mediterranean diet or Weight Watchers or Atkins or whatever it is, people will swear to you up and down like, this is the right diet. And maybe it was for them, right? Like they finally found the diet that resonated with them and fit their needs. And so good, good for them, but the reality is they are not you. They may have different lifestyle and different food preferences. And so ultimately you have to develop the diet that makes sense for you and then tweak that because it's going to be different. And if it doesn't work, then you just change it. No big deal. Dr. Keegan Stombaugh: Absolutely. I'll tell you now when I'm 65, I'm not gonna be able to deadlift heavy once every three weeks, . There's just no way, man. Yeah. There is just no way. Totally. So I'm gonna, I'm gonna have to change what I do, but, but my goal hopefully is I'll be able to enjoy lifting, have healthy joints, and still be able to deadlift, even if that's less frequently at the age of 65. Dr. Sarah Stombaugh: Yeah, absolutely. Well, y'all, I think it is time we wrap up. I, I've had this before where my kids are making a lot of noise and my listeners always tell me, Hey, we don't hear it. So hopefully y'all don't hear it. But they are thundering around, joyous. I think they're going to a splash pad with our nanny this afternoon. And they are super excited about that. Even if they do that seven days a week, you wanna talk about a routine . So we are going to wrap up here, but Keegan, thank you so much for coming on. I have enjoyed sharing this with you, and I hope my listeners have enjoyed it as well. Dr. Keegan Stombaugh: It's been fun. Thanks for having me. Yeah. Dr. Sarah Stombaugh: All right. Take care everyone. We'll see you next week. Bye-Bye.