In continuation of our series, The Six Pillars of Lifestyle Medicine, we are going to delve into exercise as well as touch on the relationship between sleep and appetite, which affects energy levels and our aptitude for physical activity. For this article, we connected with Dr. Tro Kalayjian of Dr. Tro’s Medical Weight Loss and Direct Primary Care headquartered in Tappan, NY.


Our bodies are made for movement, but our modern lifestyle has the ability to essentially satisfy most of our needs at our fingertips, thanks to technology. Not to mention that many work environments consist of stationary settings that don’t require much physical activity. The diminished physical activity coupled with poor nutrition of American society is a detrimental public health crisis.


When it comes to exercise, there are guidelines that are suitable for every body. The American College of Sports Medicine and CDC recommend 150 minutes of moderate intensity exercise or 60 minutes of high intensity exercise per week and two or more days of strength training to “work all major muscle groups.” The science behind exercise is to activate the heart (cardiovascular), activate the muscles (strength training) and participate in activities to improve flexibility and balance.


“A good exercise prescription will cover a person at the mitochondrial level, the cardiovascular level, [and] the muscular level with progressive overload.” - Dr. Tro Kalayjian


Dr. Tro explains that “when you’re more active, you create more muscle tissue and that is like a sponge for sugar and free fatty acids.” By moving our bodies, it decreases inflammation, cortisol, visceral fat and triglycerides as well as reduces the risk of diabetes. Resistance training builds muscle and strengthens bones, which prevents osteoporosis. This is why it’s important to take steps to challenge your body, such as increasing the weight when lifting until you cannot lift anymore. There are many health benefits that result from adequate exercise and physical activity each week.


We asked Dr. Tro, to break down scientifically why and how physical inactivity is a social determinant for cancer. He explained that while he is not a cancer specialist, he can attest that “higher blood sugar is associated with cancer,” so if you have diabetes, you are more likely to get cancer. Many things contribute to high blood sugar including consuming junk food, a sedentary lifestyle, and having less lean muscle mass. Although, having higher blood sugar or diabetes does not cause cancer, it is a risk factor for developing cancer. Having excessive fat tissue around the organs (visceral fat), “releases inflammatory compounds,” which are associated with disease including cancer.


Sleep and Appetite

Dr. Tro cites a sleep intervention study that was conducted over a period of 2 weeks that monitored how sleep affects appetite and the study found that people who slept 2 hours more per day ate 300 less calories each day. By sleeping more, one can decrease their food consumption and cravings. A similar study was done to measure the effects of sleep deprivation, where participants only slept 4.5 hours per day. These sleep deprived individuals consumed more food, were more hungry and had increased cravings.


Sleep is very much intertwined with our appetite and drive to eat. Ninety-percent of binge-eating happens in the late evening or night. Sleep deprivation causes increased hunger, which makes you more likely to binge-eat. Eating late and close to the time you go to bed will also lead to a lower quality of sleep because your body is still digesting the food you consumed and you’re more likely to have reflux. By the time you wake up, you would have had several disruptions in your sleep and therefore will not feel rested. Your impulse will be to consume food to acquire energy, but what is actually needed is more sleep.


In our culture, sleep is most certainly devalued and this comes at a major cost to health. In the past 50 years, Americans have lost an hour and a half of sleep each day. In the same time period, diabetes and obesity have skyrocketed. According to the CDC, American adults on average sleep 6.5 hours per day. Dr. Tro recommends that adults get anywhere from 7 to 9 hours per sleep each day.


Quality of sleep also matters and when you eat does have an effect on this. It is best to give your body the time that it needs to digest food before going to sleep, which is generally 3-5 hours. Otherwise, your quality of sleep will be much lower and it will have an effect on your cravings and energy level the next day.


Exercise as a Lifestyle for Mental Health

We wanted to understand how we can make exercise and physical activity more of a lifestyle choice and not just something to focus on when trying to lose weight or achieve a certain milestone, such as compete in a race, so we asked Dr. Tro how he encourages his patients to make this shift.

Woman stretching arms outdoors


“I tell all my patients that exercise is a mental health tool [and] a body composition tool - meaning muscles, bones, fat; it is not a weight loss tool.” - Dr. Tro Kalayjian


Through exercise, endorphins get released, a “feel good” hormone, which lifts mood and combats feelings of sadness and helplessness. Dr. Tro claims that exercise “has about the same potency as an SSRI for anxiety and depression.” He mentions this not to discourage the use of SSRIs but to consider other ways to address long standing mental health issues as many people don’t find SSRI medications to be effective.


Nutrition, Sleep and Physical Activity

Nutrition is paramount for positive health outcomes and exercise is secondary because you can easily negate calories burned with exercise by having an unhealthy diet. Dr. Tro gives the example of burning 300-400 calories in an hour at the gym and consuming those calories in a minute by eating a donut. Ninety percent of weight loss happens via diet and just 10% via exercise. However, people who successfully maintain their weight after losing it, do exercise daily. Additionally, ninety-percent of people who maintain weight loss do their exercises in the morning. Exercising is effective against cravings and binge-eating, but “not incredibly effective as a weight-loss strategy.”


Dr. Tro stresses that American society needs reform and education around nutrition and physical activity in order to be healthy. He shares his personal story of how he was obese at 350 pounds and the prevalence of obesity in his family of origin. His parents immigrated to the U.S. from Syria, but are of Armenian origin and each had to work 2 jobs in order to survive. Food in the household consisted of inexpensive, convenience items including fast food, pre-packaged, processed foods, cereal, bread, etc.

Dr. Tro weight loss

“We need to help people realize that their diets are going to significantly impact their overall health and how they feel. The importance of nutrition, the importance of moving your body in space, the importance of great sleep…all of these things transcend the work, life balance.” - Dr. Tro Kalayjian


Sleep is so easily sacrificed in the quest to be more productive, but in this feat it more often than not tends to be counterproductive. Because in the seeming short-term productive gains, there are unavoidable long-term losses that have a cumulative effect, which result in negative health outcomes. The bottom-line is that the body only needs so much food and can only take so much physical activity and exercise, ultimately replenishment and restful sleep cannot be substituted.


“I wouldn’t lose sleep for anybody, I would prize your sleep first and foremost.” - Dr. Tro Kalayjian


A rhythm of quality nutrition, regular exercise and sufficient, uninterrupted, restorative sleep promotes positive health outcomes and longevity. These three pillars are all linked and we will go deeper into the science of sleep in another article. For more information on Dr. Tro, whose practice is licensed in all 50 states and offers virtual and metabolic primary care, visit We encourage you to also check out The Low Carb MD podcast, which features conversations with patients on weight loss, wellness and disease reversal with co-hosts, Dr. Tro and Dr. Brian Lenzkes on Spotify or Apple Podcasts.