I’m sure that most, if not all, of you have heard that when dieting to lose weight, it is vital to eat often as it will “stoke the metabolic fire.” This belief goes hand in hand with the idea that if your body is not given food frequently enough that you will go into “starvation mode” where your body’s metabolism decreases and you begin to burn muscle as fuel. When I was younger, I completely bought into this because the argument made sense to me. If I didn’t eat often then my body would begin to break down muscle mass due to muscle being metabolically costly. My body would want to get rid of some of the muscle so that it would take less overall calories to sustain life. This is surely some kind of survival mechanism… Or so I thought.
As I mentioned in my first post on this blog, I become obsessed/enthralled with different topics easily and often. During my first year of physical therapy school I became completely captivated by nutrition and weight loss. I spent countless hours reading research and diet books to try to find the optimal diet and the truth about nutrition. Part of this was for my own benefit to assist in my weight loss journey, but most of the reason was because I was sick of always hearing conflicting information about how to eat to lose weight and for optimal health.
I learned a lot about nutrition during about a year time span and made huge progress with my own physique implementing my new found knowledge and a good strength training program (pics at the end of this post :D). What I found shocked me at the time, but in the years since with my new knowledge base I mistakenly began to assume, since the research is plentiful, that everyone in healthcare probably had a general understanding of the current evidence on nutrition. Since then, what I’ve heard from friends, acquaintances, physicians, and in the clinic regarding diet and nutrition has baffled me. I would expect many lay people and patients to be uneducated regarding current research, but far too often I’ve heard extremely outdated myths being perpetuated by my fellow clinicians. What I find even more intriguing is that these beliefs are so strongly held, yet unsubstantiated, that instead of listening to my explanation of the evidence, people will blindly claim that the information is incorrect. These ideas seem to be ingrained in many people, but their only reasoning is that “I once read it somewhere” or “I’ve always heard…” Although I am a DPT and had limited education in school on diet and nutrition, I believe that it is vital for all healthcare workers to have a basic understanding of diet and nutrition (not based on word of mouth) due to the extremely high incidence of obesity and chronic disease in our society today. Not to mention, patients often seek general diet and nutrition advice when being treated in the outpatient physical therapy setting.
I’m here to tell you that eating often to boost your metabolism is a fallacy. The evidence is overwhelming that eating more frequent meals has minimal or possibly no effect on metabolism, overall body mass, or overall fat mass. Instead, it is overall calorie balance throughout the day that has the biggest effect on weight gain/loss. So where did this “stoking the metabolic fire” argument originate then if it isn’t true? Well it is actually quite simple. When a person ingests food, there is a temporary increase in metabolic rate. This boost in metabolic rate is caused by the thermic effect of food. What this means is that your body has to expend energy to break down the macronutrients (carbohydrates, fats, protein) that you ingest. Each macronutrient has a different thermic effect. This was incorrectly extrapolated to assume that by eating more often, your metabolism will remain elevated. The important thing to understand is that this increase is directly proportional to the amount of calories and the macronutrient composition of the meal eaten. The reason that this is so important is because as long as overall caloric load and macronutrient composition is equated, you could eat all your food in six meals or in one meal and the metabolic effect will be about the same.
A great meta-analysis regarding the effect of meal frequency on body composition was performed by Brad Schoenfeld, Alan Aragon, and James Krieger. Their results show a small improvement in fat loss from more frequent meals, but these findings could be completely negated with the removal of one of the fifteen studies included. Here is a direct excerpt from their conclusion, “The positive relationship between the number of meals consumed and improvements in body composition were largely attributed to the results of a single study, calling into question the veracity of results. Moreover, the small difference in magnitude of effect between frequencies suggests that any potential benefits, if they exist at all, have limited practical significance. Given that adherence is of primary concern with respect to nutritional prescription, the number of daily meals consumed should come down to personal choice if one’s goal is to improve body composition.”
So based on this study there may be a benefit to increased meal frequency, but the effect is likely very small and should not replace an individual’s personal preference on meal frequency.
Now let’s look at another recent study that reviewed the current evidence on intermittent fasting. Valter Longo and Mark Mattson found that the current literature supports intermittent fasting for not only reduction of body fat, blood pressure, and inflammation, but also for reducing the likelihood of developing diabetes and cancer! Add to that the fact that fasting has been shown to extend life expectancy and possibly have a neuroprotective effect on the elderly, and it’s hard to discount it as an effective nutritional strategy. Here is a quote from the conclusion of this study, “Based on the existing evidence from animal and human studies described, we conclude that there is great potential for lifestyles that incorporate periodic fasting during adult life to promote optimal health and reduce the risk of many chronic diseases, particularly for those who are overweight and sedentary. Animal studies have documented robust and replicable effects of fasting on health indicators including greater insulin sensitivity, and reduced levels of blood pressure, body fat, IGF-I, insulin, glucose, atherogenic lipids and inflammation. Fasting regimens can ameliorate disease processes and improve functional outcome in animal models of disorders that include myocardial infarction, diabetes, stroke, AD [Alzheimer’s Disease] and PD [Parkinson’s Disease]… Several variations of potential ‘fasting prescriptions’ that have been adopted for overweight subjects revolve around the common theme of abstaining from food and caloric beverages for at least 12 – 24 hours on one or more days each week or month, depending on the length, combined with regular exercise.”
In a study performed by Bhutani, Klempel, Berger, and Varady results indicated that having participants perform alternate day fasts (24 hour fast every other day) resulted in a reduction of body fat mass as well a several other coronary heart disease risk factors. Another surprising finding in this study is that although fat mass was significantly reduced, lean body mass stayed virtually identical throughout the protocol. Keep in mind that this study involved an entire 24 hours with no food multiple times per week. This certainly seems to destroy the previous theory regarding “starvation mode” with extended periods of not eating. In actuality, these people maintained their lean mass while breaking down adipose tissue for energy while not eating for an entire day.
In this study not only was there not a reduction in metabolism during a period of short term starving (fasting), but there was actually an increase in metabolic rate! The results from these studies may seem shocking for many that have heard and read that they need to eat constant small meals to lose weight, but if you look at things from an evolutionary perspective, it shouldn’t be surprising. It is certainly likely that our ancestors had to sustain periods of fasting, but not by choice. Food was often scarce and they may have had to go for days at a time with little or no food. If the “starvation mode” idea was correct then they would have lost significant amounts of muscle mass during those periods of time. What actually happens with periods of fasting is that sympathetic nervous system hormones are released and excess adipose tissue is broken down for fuel. Of course this is only up to a certain amount of time. At some point (probably in the 48-72 hour range) muscle mass will undoubtedly begin to be broken down at a faster rate, but there is no risk of this when going short periods without food.
Based on the studies above, abstaining from food for between 12-24 hours on one or more days each week or month had a significant impact on multiple conditions, including reducing body fat and improving insulin sensitivity. Reduced insulin sensitivity is what will eventually lead to type 2 diabetes which is now rampant in our population, therefore improving insulin sensitivity will help reduce the risk of developing this disorder. Now you might be realizing that these results fly directly in the face of the outdated theories regarding “starvation mode” happening when eating less often and increased metabolism happening by eating more often. This is important to understand. Recommending that everyone eat more often and to always eat breakfast may not only be incorrect, but could also be detrimental to the individual’s overall health.
Although the meta-analysis on meal frequency and the other studies on fasting are slightly in conflict with each other regarding the best diet for body composition, I believe that it is clear that a potential small improvement in body composition and reduction in fat mass from increased meal frequency is not worth foregoing the many benefits of abstaining from food for a period of time (i.e. fasting), which will undoubtedly mean less overall meals per day. As the authors in the fasting study mention, this is not something that would need to be done every day but “one or more times per week.” Let’s say an individual does undergo a 16 hour fast once or twice per week, what should they do on the other days in regard to number of meals and meal frequency? This should be left to their own discretion based on the number of meals per day that allows them to eat the most quality, nutrient dense food possible while avoiding “snacking” on processed sugary foods. In my opinion this is a big problem with promoting increased meal frequency. Some people may incorrectly assume that eating a sugary, high calorie snack is actually better for them than not eating at all because of their beliefs about starvation mode and a reduction in metabolic rate.
You may be wondering why I chose to discuss studies that involve fasting. The reason for this is not that I believe it is the best for everyone, but instead because it shows that reducing meal frequency and skipping meals does not result in the effects that are mistakenly repeated by many. If foregoing food for 24 hours or more does not result in a reduction of metabolic rate or a reduction of muscle mass, then it is clear that skipping breakfast or another meal during the day will have no detrimental consequences. Repeating the myth “breakfast is the most important meal of the day” may result in a busy individual choosing pop-tarts for a quick breakfast. Based on the research that person would be much better off skipping breakfast and replacing those calories with more nutrient dense options later in the day.
After experimenting with my diet and my body for over a year, I figured out what works best for me. I began intermittent fasting about four years ago and have been practicing different lengths of fasts since then. As I stated above, this is not the answer for everyone. It is important to consider past medical history, especially diabetes, before attempting any sort of fasting. Based on the research, the best recommendation that can be made to an individual is to eat the number of meals that allows them to make the most nutrient dense food choices and that fits their lifestyle. For some this could mean two meals a day and for others it could mean six. Both of these frequencies are perfectly acceptable in the right context.
The physique below (summer 2014) was achieved with fasting periods of between 16-22 hours per day. My “breakfast” was usually around 4-5 PM each day and occasionally I would only eat one large meal per day. While dieting down to this condition, I lost very little lean body mass but a significant amount of body fat. For the sake of full disclosure, I was strength training 5-6 days per week and doing absolutely zero steady state cardio which may be a topic in a future post. I’m including this for further support that constant eating is not necessary and personal preference should be the determining factor for each individual’s meal frequency.
**The image above was taken on Friday at our campground on the NC coast.
One of the most common concerns for those contemplating travel therapy is regarding housing. Most people love the hearing about the higher pay and adventure of traveling around this beautiful country but are nervous about the uncertainty of housing. Unfortunately, there is a lot of uncertainty. I’ll go through some of the various housing options, and explain why we decided before ever graduating PT school and starting our traveling careers that traveling by RV was going to be the best for us.
People often ask us if the travel company sets up the housing for you. Yes, there is the option of having your travel company find housing for you, but if you go this route the company will use your housing stipend to pay for the housing which will likely mean $2,000+ less take home pay per month. Also, I have heard stories of people having to commute an hour each way from their company provided housing to their assignment which would be terrible in my opinion. This may be the easiest and most convenient option in some cases, but you will definitely pay for the convenience.
If company provided housing isn’t ideal, then what other options are there? Well, there are a few. You could always travel to places where you have family or friends to stay with, but this would certainly limit your options for location. You can try to find an apartment complex in the area that would be willing to let you sign a three month lease. However, this is often impossible to find. When we were first starting out, we decided to go the apartment route for the first assignment while we saved to buy our RV. We called about 20 complexes in the area of our first assignment, and six month leases were as short as they would go, and in most cases 12 months. So usually this just won’t work when your contract is for the usual 13 weeks (plus there’s always the uncertainty that they could end your contract early and you’d be stuck in a lease, or you may end up extending your contract and your lease may not be flexible). In addition, if you do find a place that will allow you a three month lease, you have to see if it can be furnished or you have to rent or move furniture and set up your own utilities. If an apartment complex doesn’t work out, you can search Craigslist for housing, but this is hit or miss and can be time consuming. On our first assignment we found housing on Craigslist, but it was a bedroom in a house in which the owner was extremely particular about things. We were very unhappy with the set up, but it was the only convenient option in the area. You can look for housing on AirBnB or VRBO. These places are furnished with utilities included most of the time, but you’re going to be paying a premium for this, and, as with Craiglist, it is hit or miss based on your location. You can choose corporate housing which are furnished (which is usually where the travel company will place you if you go that route), but these places know that you have limited options for short term housing so they are not cheap. We spoke to a complex in our hometown about corporate housing and their rate was $2,200 per month for a one bedroom (furnished with utilities) while a normal yearly lease for a one bedroom would have only been $800 per month. You could stay at an extended stay motel, which is generally quite a bit cheaper than corporate housing ($1,200-$1,500 for the ones we’ve priced). However, these are often not in the best parts of town and the furnishings often leave a lot to be desired. The last option is to buy an RV and stay at a campground near your assignment. I will expand more on the pros and cons of this below. We were already pretty sure this is the route we wanted to go, and after our bad Craigslist experience, it solidified our decision. We never wanted to have to pack and move our stuff again or risk being in another housing situation we hated. A camper was the only option that made sense for us.
Neither Whitney nor I had ever spent even one night in an RV. We were complete beginners, but we knew that it would be the only way that we would continue traveling. We started reading and learning about campers and trucks back when we were still in PT school, and really started narrowing down our search several months before we were planning on buying. We went to an RV show while we were first starting to learn about them in our last year of PT school, and as time grew closer to buying, we scoured every RV sales place near us as well as the internet for sales in Virginia and surrounding states. After looking at hundreds, we determined that it would be better for us to air on the side of buying something too big than risk getting a camper that was too small. We found that a fifth wheel fit our needs better than a regular travel trailer. We set a budget of $40,000 to buy both the camper and the truck which meant that we would be buying both of them used. This price was a big factor in waiting until after our first assignment to buy, because right out of school we didn’t have very much money saved up, and we preferred to buy them outright instead of financing. We ended up waiting for 6 months after starting working to buy. During our search, we made a list of all of the features and amenities that we couldn’t live without. After scouring RV lots, Craigslist, and RVtrader.com for hundreds of hours, we found a fifth wheel with a layout that we loved and for a price that we could afford. Then, we found a truck that had the features needed to tow our camper. In the end we paid about $35,000 for our 2009 fifth wheel and our 2005 diesel F-250. This was a big upfront cost, but more than worth it in our opinion. We have now been living in the fifth wheel for our past four travel assignments and wouldn’t do it any other way. Let’s look at the pros and cons of living in a camper to see why we believe it’s the best option for most travelers.
- Cheaper monthly living costs
- No scouring the internet for short term rentals
- No packing or moving furniture
- No setting up utilities
- Consistency with your surroundings/home
- Quicker turn around from one assignment to the next
- Initial learning curve for camper living, setup, driving, etc
- Upfront costs
- Maintenance on camper
- Less living space
- General “camper life” things such as dealing with water tanks, sewer, setup/breakdown
Although we paid upfront costs of $35,000 for the camper and truck, we estimate that we are able to save about $1,000/month on housing costs staying at a campground vs. finding short term housing. Our average housing at campgrounds has been about $520/month to this point compared to $1,200-$1,700 (sometimes much more) for short term housing options with utilities and furnishing included. Add in the costs of maintenance/repairs, personal property taxes, and extra cost of gas, and we probably come out about $800/month ahead. Since we plan to travel for about five years total, the truck and fifth wheel will more than pay for themselves. In addition, when we finish traveling we estimate we will be able to sell the truck and fifth wheel for somewhere between $20,000-$25,000 which will allow us to recover much of that upfront cost. Based on my estimates, we will save about $33,000 by living in the fifth wheel for five years compared to living in short term housing, and this includes a loss of $15,000 on depreciation of our truck and camper.
Finding somewhere to stay while living in the camper is fairly easy- much easier than the alternative. Once we find two jobs that are near each other, we immediately look for campgrounds that are between the two assignments, find prices on their websites, call to confirm availability at the campsite, and make a decision. Usually this can be done in an hour or less if we are able to call during their business hours. This is so much more convenient than just guessing at whether we will be able to find housing between our two jobs. Even if there is an apartment complex on the map, there are again a lot of stipulations as to whether they will have openings and if they can do a short term lease. If you’re going with other options like corporate housing, extended stay motel, Craigslist, or Airbnb, your search is going to take a lot longer and have a lot more uncertainty, all while your recruiter is waiting to hear whether you’re going to take the job or not. Otherwise, if you accept the job upfront BEFORE finding housing, you’re really going to be at the mercy of whatever you can find, despite the cost, the hassle, or the distance, because you already accepted the job.
We have determined that securing everything inside the camper, unhooking everything from the outside and hooking the camper to the truck takes us about three hours. Getting things back out inside, unhooking the truck, and setting up the outside takes about two hours. Total set up and break down time is five hours, so we can usually complete this and the drive to the new location in one day, or at most over a weekend depending how far we are traveling. Due to this quick turnaround, we have so far always been able to finish an assignment on Friday and start a new assignment on Monday, including our biggest move so far from VA to 13 hours away in MA. Since daily and weekly pay is so high as a traveler, missing one day or one week of work due to moving can be very costly, especially since there is no such thing as paid time off between assignments. Also not having to pack boxes and load cars is invaluable to us.
Utilities provided at campgrounds vary, but they all include water and sewer. Electricity is either included or metered (paid for separately in addition to the monthly rate), but is always provided one way or the other with no additional setup by you required. Most, but not all, campgrounds have wifi included and some have cable included as well. Not having to set up your own utilities saves time and frustration.
Constantly moving to new locations is very exciting, but we find that we really enjoy having the consistency with our living situation. We always know that no matter where we go we will have the same bed, same couch, same chairs, same shower, etc. In addition, our clothes, dishes and other belonging are always in the same place as they were at the last location. This might sound insignificant, but it can mean a lot in some situations.
Having a smaller living space may be a problem for some, but this has not been an issue at all for us. Our fifth wheel is about 230 square feet inside with the slides out. This may sound small to some, but it’s bigger than it sounds. For some pictures, check out this post written by Whitney.
Camper maintenance is a given and needs to be factored into costs. For the most part it is usually very minor if you stay on top of things, but, of course, there could be occasional big costs if something malfunctions and has to be repaired in the camper.
Learning about the camper including hooking up, unhooking, pulling/backing, emptying tanks, etc. can seem daunting, but with Youtube and forums, is really not that bad. As I mentioned earlier, we started learning a few months in advance, so we took our time reading and learning which made it easier. We had some problems when we started, but thanks to helpful fellow campers and the internet, we figured everything out.
Overall we have been very happy with our decision and enjoy the adventure of living in the fifth wheel. It allows us to save money and travel with much less hassle. If it wasn’t an option we probably would have taken permanent jobs long ago because packing and moving is very draining for us.
I hope this post is helpful. I’m always open to questions about anything in the comments section below!
This is one of the most common questions I get asked by PT’s or students that are considering travel PT. Everyone knows that generally you make more, but these people want to know if the extra pay is enough to outweigh the hassles of traveling. In previous posts I have written that $1,500/week take home pay is a pretty decent starting point for a new grad travel assignment, but many people don’t understand exactly what “take home pay” means compared to their current pay check. Let’s start with some definitions before getting into an example:
Gross pay: this is your total pay before taxes. This is the number that people talk about when they say things like, “My salary is $70,000 per year.” If you’re hourly you can get this number by taking your hourly rate, multiplying by the hours you work per week, and then multiplying by 52 weeks in a years. (i.e. $33.50/hr x 40 x 52 = ~$70,000/year)
Net pay: This is your “take home pay” after all deductions and taxes. These might include: federal taxes, state taxes, Medicare taxes, insurance, etc. Finding what this number would be for you can be a little more difficult unless you are currently working. This is the amount that is directly deposited into your bank account on pay day.
Per diem/stipends: This is money that you get as a traveler that is tax free to reimburse you for things such as housing, meals, and incidentals while on a travel assignment. You only get this money tax free if you make sure you meet the requirements in the tax laws for travelers. I will write a future post of these requirements.
In the past I have had people comment on the $1,500/week take home pay for travelers and say, “I can make more than that at a full time job! Why would I travel and make less?” I guess that it is possible you could make more than that as a perm employee, but it is very unlikely, especially as a new grad. Most likely these people are confusing gross pay with net pay. $1,500/week gross pay is definitely possible as a perm PT, but getting that same amount after taxes is much more difficult.
Also, this is probably obvious but, it’s important not to confuse just the amount per paycheck for travelers with the amount per paycheck for perm PT’s: as I have mentioned, travelers get paid weekly, while most perm employees get paid bi-weekly. But for the sake of comparison I’ll be using the weekly pay numbers.
Let’s breakdown $1,500/week gross pay into hourly and salary numbers and then compare that to $1,500/week net pay to see the true difference.
Gross pay: $1,500/40(hours per week) = $37.50/hour. $1,500 x 52 (weeks per year) = $78,000/year. Depending on setting and location, these numbers may or may not be attainable as a new grad PT. People starting out in a SNF or working in home health will likely make this much or more, while for those starting in outpatient or acute care it may be a little less likely. Ben Fung has some great resources on average salary for full time PT jobs across the country, and this would be a good comparison to look at for new grads deciding between travel and full time jobs.
Net pay: This will be different for everyone depending on the state you live in and your number of federal allowances (dependents). Fortunately there is a great site called Paycheckcity where you can easily calculate this number for yourself. The results I will show here are for my situation (living in Virginia with only one allowance). To get a net pay (take home pay) of $1,500/week, my hourly pay would have to be $57/hour, and my gross pay would have to be $2,280/week. $2,280 x 52 = $118,500/year. As you can see the difference between gross pay and take home pay is huge ($78,000/year compared to $118,500/year) and this is due to the factoring in of taxes which are usually much higher than people new to the working world expect.
Now you may be thinking, “Almost $120,000/year as a new grad sounds great, but how likely is it to actually make $1,500/week take home pay as a traveler?” The short answer is, very likely. Whitney and I have been traveling for a year and a half now and $1,500/week is the lowest we have ever been paid on a contract so far. Some contracts have paid quite a bit more than this.
Example: Fortunately at one of my first travel assignments, I was offered a full time position after finishing my travel assignment with them, so I can directly compare my travel pay to the perm PT wage offered. For reference, this was an outpatient ortho clinic. My travel take home pay was $1,530/week and I was offered $35/hour to stay and work there as a perm PT. Let’s break these numbers down and see what the difference would be in my pay if I had stayed as a perm employee. $35/hour x 40 hours a week x 52 weeks per year = $72,800/year gross pay. Now I can use Paycheckcity to see what my net pay per week would be on this amount. Filling single in VA with one allowance, $35/hour would equal $983/week net pay (take home pay). That is quite a big difference. I would make $550 less per week after taxes by taking this job as a permanent employee instead of as a traveler. We can also go the other way with the numbers and determine what my hourly pay was at this job and then compare that to the $35/hour offered for permanent employment. Filling single in VA with one allowance, my $1,530/week take home pay would be the equivalent of $58/hour! I would make $23/hour less by taking this job as a full time employee instead of as a traveler.
These are obviously very big differences, and it illustrates the very high pay rates that can be achieved with travel assignments compared to full time employment, but I would be lying if I said that this is all you need to consider. If I had taken a full time job at this clinic, I would have gotten paid vacation of three weeks per year, whereas with a travel assignment, paid vacation doesn’t exist. This can be a huge benefit of being a permanent PT. Paid holidays as a perm employee can also be a consideration, although we have always made sure that we get paid when the clinic is closed on a Holiday and we have to miss work when agreeing to our travel contracts. Also, depending on how you choose to travel, working all 52 weeks in a year as a traveler may or may not be feasible. When we first started traveling, Whitney and I worked 16 months straight with no unpaid days, but doing that is not for everyone. Many people want to take time off between assignments, and this will obviously cause you to earn less for the year.
In my opinion, traveling as a new grad is a great way to be exposed to a lot of different treatment styles while also making extra money to pay off loans or contribute to personal investments, but you do miss out on some of the perks of being a permanent employee. Hopefully these pay breakdowns help in understanding what the actual difference in pay would be. If you have any questions about travel or pay, don’t hesitate to ask!
I’m late on posting this but it’s been a busy month. We were out of town almost every weekend in December. We visited Asheboro, Raleigh, Chapel Hill, Savannah, and went home for Christmas. We had the day after Christmas off of work so we got to spend a long weekend at home which was very nice. We spent another three day weekend for New Year’s Eve in Savannah, and stayed at the awesome Hyatt Regency Savannah for free using credit card points. This was a beautiful hotel in a prime location in historic downtown Savannah right on River Street which was definitely worth the points.
Despite the trips, personal property taxes, and car repairs, I was still able to surpass my savings goal for this month. This is mostly due to there being five paychecks in the month of December. My net worth was boosted by another month of high market returns despite overvalued equities.
At this point I am on track to reach financial independence in July, 2020 which is only three and a half years away! Whitney and I are still on the fence about what exactly we will do or where we will settle down once I reach FI and we finish our travel PT journey. Since we are so used to changing locations every few months, we have discussed “slow traveling” Go Curry Cracker style and spending at least a few months living in southeast Asia. Speaking of changing locations, we finished up our contracts in Fayetteville, NC yesterday and will be moving to Morehead City, NC tomorrow to begin our new jobs Monday morning! We’re very excited about this move and can’t wait to spend a few months at the beach… even if it is during winter. Another advantage of the new contracts is a higher pay rate which will help me with my savings goal each month.