I don’t recall a time in my life when I wasn’t doing at least some planning for “worst case” situations.  That may have come from growing up in an earthquake prone part of the country, and during the cold war when we drilled for nuclear attacks during the school day.  My mother, who was a single parent through much of my life, also modeled planning for “hard times” by storing food, following world and local trends closely, and being careful with money.  I became serious and more intentional in prepping following Katrina, when it confirmed my suspicion that we had better be prepared to take care of ourselves in a disaster, and after reading James Howard Kunstler’s The Long Emergency,  and watching his predictions come true.  My spouse and children have endured my lectures, emails, nagging and copies of relevant articles with patience, and are also on board with their own preparations.

By training and background I am a clinical psychologist, with specialty training in health psychology, helping people manage the emotional impact associated with illness, injury and death.  In addition, I am active in disaster preparedness and disaster mental health, serving locally and internationally as a disaster responder.   I have truly seen situations in which it is TEOTWAWKI for those involved, where home, family, job, government services have all been lost.  And through my years in practice, as well as my work in disaster planning, it is clear that the most important preparation is not “beans, band-aids, and bullets” (although those are important) but mental preparedness and psychological flexibility.   I want to share some of the factors which come into play in big abnormal events such as natural disasters or terrorist events, because I believe we can take lessons learned from these into situations where it all comes apart, and we are left to stand and survive if we can.  In this essay, I’d also like to help you develop some simple skills to manage your own emotional responses and to help your family and friends.

It may surprise some to know that research shows that the most common long-term response to the trauma of a major disaster is not Post Traumatic Stress Disorder (PTSD), but resiliency and growth.  People are pretty good at overcoming bad things without any help from professional counselors or other mental health types.  That’s not to say that people aren’t affected by losing their homes, family members and security.  They are.  Most people show a range of symptoms in the immediate aftermath of a disaster, but tend to recover in about three months.   Some of the responses we should be prepared for are discussed in the next section. Some people will have some significant longer terms psychological issues following a disaster, but hopefully, those people will be in the minority. 

Common Short Terms Responses to Disaster and Loss:

Big events have an impact on body, mind, and spirit.  Once the initial phase of a disaster has passed, doctors begin to see many more patients showing up with MUPS (medically unexplained physical symptoms).  When we human beings experience a traumatic event, it releases a cascade of stress hormones and other chemicals in our bodies.  Sometimes, the body reacts as though the threat is ongoing and the condition can become chronic.  When the body is out of balance, we often begin to experience stomach aches, headaches, fatigue, dizziness, trouble sleeping, pain, and changes in appetite.  The distress experienced by someone who has those symptoms is real.  The pain is real.  It’s a real response to a real physiological change in the body.  But…it is not related to a disease, infection, or injury, but to the body’s chronic stress response.

We also commonly experience cognitive or thinking changes such as trouble making decisions, difficulty with remembering things, trouble concentrating, and re-occurring thoughts about what has happened and what we’ve witnessed.  And, our behaviors and emotions can change due to the stress we’ve undergone, making us more likely to be irritable or aggressive, cry more often, withdraw from our loved ones, feel terribly guilty or depressed, feel panic, engage in more risky behaviors, or “self medicate” with drugs or alcohol. 

We may experience a change in our relationship with God, becoming angry over what has happened, losing interest in prayer or avoiding worship settings and rituals, which formerly were very important to our spiritual lives.  The opposite may also happen, where there may be a renewal in faith life following a terrible loss.

Children and teens are vulnerable to all of the above as well.  In addition, children may regress in their development, acting much younger than their age.  They may begin to wet the bed or play like a younger child, and have trouble being able to separate from their parents or loved ones.  Nightmares are common.  In young children, you may see repetitive and obsessive play, which re-enacts the event(s) they have experienced.  This is the way a young child attempts to make sense of the event and regain some sense of control. 

Interestingly, the elderly can often do better under such duress than others, possibly due to their life experiences which have provided some “stress inoculation”.  Seniors can provide wisdom from their perspectives as well as information from their life experiences.  On the other hand, seniors who have some dementia may become very agitated and confused due to being away from familiar settings and routines.

Individuals with pre-existing mental health issues such as anxiety, depression or psychosis may, in the short term, temporarily get better.  It was reported that, following September 11th, many patients in psychiatric wards temporarily “cleared” their psychosis and the rates of suicide declined.  However, without the access to appropriate medication, patients with significant psychological disorders will need care and support.   Individuals with mental disabilities such as developmental delays or head injuries may experience confusion, fear, and disorientation. 

Many people following a major disaster will have lost loved ones, but be unable to access the services and rituals which would typically help them through the grieving process.  For example, mortuary services and funerals may not be possible in the events of mass casualties, civil breakdown, or pandemic diseases.  Community support may be limited because so many have experienced deaths in their own families and are unable to reach out and help others.  This may lead to complicated bereavement and depression.

When TSHTF How Can You Help Yourself?:

We cannot avoid bad things happening, but we can prepare ourselves psychologically so that we can more effectively use the tools, food, skills and other resources we’ve gathered.  People who do best when their worlds fall apart tend to have some specific factors helpful to their ability to survive and thrive:

They have a support system of family and friends, who can share in the struggle

Human beings are innately social creatures.  We are designed to live in community with others.  The myth of the lone wolf, living off the land all by himself, is just that…a myth.  Following disastrous events, people who have community support are more likely to survive.   Groups are more effective than individuals in identifying resources, sharing work, and in defense against outside forces.

They have spiritual practices which help them to find meaning and comfort even in dark times.

The old saying goes that “there are no atheists in foxholes”.  It may be true that you can suddenly discover your Maker in tough times.  However, preparing for tough times is enhanced when your prayer, study, worship, and charitable practices are a core part of who you already are. 

They have an innate style, or learned a psychological style of thinking which helps them remain more calm, more optimistic about their future, and more realistic about the threats to themselves and their loved ones, neither living in fear nor in denial. They tend to have a mind-set of assuming they have control over their lives and decisions vs being at the mercy of others’ control.

We’ve all known people who were quick to panic, tended to see the worst possible outcomes, magnify the impact, fail to see the good portions of any event.  Those folks generally suck all the energy out of their companions, and are not useful when the SHTF.  I’m assuming all those on forums such as this want to be useful and helpful and not a drain on resources during emergencies.  This involves practicing mental exercises in much the same way you practice marksmanship, canning, or gardening.

Here are some tools which may help you become more flexible and resilient in your approach if life takes a terrible turn:

Learn to recognize when you are making “thinking errors” such as magnifying, assuming, having a negative bias, or worrying unnecessarily.

1. Magnifying turns a problem into a disaster.  For example, you may drop a case of canning jars and break them.  This is a problem.  It may create a resource limit.  Canning jars may be hard or impossible to get.  HOWEVER, it does not qualify as an End Of The World event.  Your family will not starve because of this one thing.  One way to counter Magnifying is to ask yourself “what is truly the worst case scenario with this event?” and then counter that thought with “and what can I do if that happens?”  In nearly every event, there will be some way to mitigate.
   
   
2. Assuming creates catastrophes when there may not be one in the immediate future.  For example, I might assume that because Mrs. Smith doesn’t say “hello” to me she doesn’t like me.  I may further decide that if she doesn’t like me, she might wish me harm.  Because I assume she wishes me harm, I avoid her…and so on.  If I ask myself whether my assumption might be in error, and whether there might be another reason for Mrs. Smith’s behavior, I can flex my thinking to include the possibility that 1) Mrs. Smith didn’t hear me say “hello”, 2)that she might be distressed about something completely unrelated to me, 3) that she didn’t see me etc.  Those possibilities allow me to more realistically assess the whole situation and also provide me with a chance to practice more flexible thinking.
   
   
3. A negative bias causes us to fail to see the possible positive outcome to a situation or decision, thereby narrowing options.  Listing pros and cons and forcing the numbers to be equal can be a good exercise in learning how to counter your bias.  The worst case of “negative bias” often happens in suicide.  It is tragic to see someone commit suicide because they truly thought there was no possible way they could manage something like losing a job, or breaking up with a girlfriend.  Suicides like that tend to happen because the person is in so much distress they are unable to imagine any outcome except the worst.  They cannot see anything but the negative and this leads to a deadly despair, due primarily to them not being able to identify any positive outcomes.
   
   
4. There are plenty of reasons to worry in our world.  That’s why we try to prepare ourselves for some bad eventualities.  Preparing is different from worrying.  I tell my patients to watch out for “what if…” thoughts.  Sometimes “what if” thoughts can be helpful, such as when we try to plan for the “what if” the JIT delivery system doesn’t work.  But, if you find yourself feeling in a tizzy and uptight all the time, “what if” may be a marker for an anxious thought…e.g. “what if we can’t get food because the trucks are not running, and then what if the garden fails and then what if there’s a big EMP, and what if the nuclear material from Fukushima washes up the river from here and creates mutant zombies and we don’t have enough ammo….” and…well you get the picture.  Sometimes we need to set limits on those “what if” thoughts, so that we can be calm and emotionally more healthy when some of the “what if” stuff happens.  A great tool is “thought stopping”.  If you find you have the same negative or scary thought over and over, it helps to literally say “stop!”, find something to distract, or even snap a rubber band on your wrist.

Cultivate an “outside of the box” thinking style by asking “and what else could we do?” over and over, and using brainstorming techniques.  In brainstorming, nothing is off the table initially.  There are no stupid ideas.  This allows interesting and creative solutions to pop up.

Learn some ways to self-calm so that the thinking part of your brain is able to work. When we become too scared, the lower sections of our brains take over.  Those are the ones useful for “flight or fight”. However, when those parts of our brain are too activated, the thinking/planning/judgment part of our brain isn’t able to work.

1. Learning simple breathing techniques allows us to be more centered so that we can figure things out better.  An example is “bubble breathing”.  In this technique, you pretend that you are blowing the biggest bubble you can with soapy water and a wand.  In order not to break the bubble, you breathe in softly through your nose, and breathe out very softly through your mouth.  This induces a relaxation response.
2. Finding a calming thought and repeating it in our heads, or out loud, can help.
3. Calming spiritual rituals such as reciting Bible verses or the Psalms uses our brains and our bodies and both distracts and calms.  For Catholics, meditating on the prayers of the rosary occupies mind, body and spirit in ways that allow for relaxation.
4. Physical activity works for many, as does yoga

When TSHTF  How Can You Help Others?

What makes a good helper?

1. Open communication, trust, empathy, honesty
2. Recognizing that not all problems can be solved and not all people want to be helped
3. Recognizing that the helper must set limits of time and energy, and values.  Helping does not mean that you destroy yourself trying to help another

In The First 24-72 Hours
In the first two to three days following a disaster or other large negative event, the focus needs to be on basic needs.  You can help by:

1. Doing a self “check in” to make sure you have the ability to help someone else.
2. Listening without trying to “fix “ the problem
3. Making sure the person has access to food, water, shelter and some measure of safety.
4. Helping the person locate other family members.
5. Helping the person identify resources.
6. Letting them know they are not alone in their reactions
7. Answer questions honestly and simply

In An Ongoing Disaster, In addition to the foregoing

1. Try to help them establish a return to some sort of routine, even if it is simply trying to eat at the same time each day
2. Provide a quiet place, if possible, to reduce noise and other stimulation
3. Help the person establish small and manageable goals
4. Help the person to focus on “here and now”, and shorter term future vs long term future issues
5. Request information about positive things in the person’s life: (“What do you do, on a day-to-day or weekly basis that you enjoy and which helps you feel less distressed?”)
6. Teach them some ways to manage their bodies and their thoughts: A.) Deep breathing for relaxation and calming. B.) Thought stopping and thought replacement

If you feel that a person you are trying to help is dangerous to themselves e.g. suicidal, dangerous to others e.g. homicidal, or is suffering from a major mental illness e.g. bipolar disorder or schizophrenia DO NOT ATTEMPT TO HANDLE THIS ON YOUR OWN.  THIS NEEDS HELP FROM OTHERS.  IF THERE IS NOT A MENTAL HEALTH PROVIDER AVAILABLE, GET HELP FROM FAMILY, FRIENDS AND COMMUNITY TO ASSIST THIS PERSON SAFELY.

Bottom line…human beings are remarkably resilient survivors.  You can do some mental prepping so that your chances of remaining emotionally healthy, and being a helping resource are increased. 

First off: English is not my native language. I apologize if this article is not easy to read. I hope that its usefulness will outweigh the inconvenience.

I am 40 years old, overweight by about 50 pounds, and I regretfully admit that in the past 15 or so years I became a “couch potato”. In other words, my physical fitness is not up to the challenges of any survival situation.

When I was a lot younger, I practiced karate, boxing, and weight lifting. I was pretty tough, and even back in high school there was no bully who would risk messing with me.
Apart from being a martial arts practitioner, I had (and still have) a huge library of very good books on various martial arts, with an emphasis on “street fighting” applications.
I dare think my opinions are based on a thorough analysis of various available options combined with my own experience and learning from mistakes, rather than mindless following someone else’s rigid views or advertisement.

As I got a family and a job about 18 years ago, hard work with lots of overtime did not help my plans of “getting back to the gym”, but quite frankly - I just got lazy.
I trained less hard and less frequently, until one day last year I realized that I had completely lost whatever skills and physical fitness level I used to have, and I can hardly run half a mile, let alone being able to defend my family in a SHTF situation.
I walk my dog, with an occasional sprint-run up the hill to the house where we live in Western Washington, and I try to keep my flexibility at a semi-decent level... but, other than that, I am completely “out of shape”, - both figuratively and literally.
My results in push-ups and pull-ups exercises are ridiculously low, and my punches are too far from being nearly as powerful as I want them to be.

I’ve been pondering an idea to start regular training, but without a well thought out system, I have more chances of hurting myself in the process than getting any results back. [Been there, done that...]

This article is my first attempt in many years to create an actionable fitness and hand-to-hand combat plan, and I hope that it will be useful not only to myself, but also to someone who can honestly identify himself (or herself) as a “couch potato” and wants to start preparing physically for the SHTF situation.

I will spare you my efforts to provide mental preparedness and/or motivation.
If you have a family, you have all the motivation you need. Just imagine what might happen to your loved ones if a gang of armed, ruthless, blood-thirsty looters attacks your neighborhood... and you’ve got all the motivation you need.
The only trick is to learn how to turn your fear and anger into a burning desire to train harder than before. But please remember that the older you are, the more careful you need to be when performing physical exercises.

Let’s start with the goals: what are we trying to achieve?
Your goals will define your list of exercises, training sessions frequency, etc.
In time, your goals will mostly stay the same, but the list of exercises will have to change.
Here’s my list, which might be very different from yours:
Minimal physical fitness to help me and my family survive the coming collapse. I must be able to:
- walk long distances with at least 50 pounds of weight (basic bug-out bag, weapons, ammo);
- run fast;
- run long distances;
- carry bigger weights for a short period of time (e.g., if an injured family member or neighbor must be evacuated from a burning building);
- climb and jump;
- fight (unarmed) against one or two enemies who are not armed and do not have special training.
Long-term goals:
- continue getting stronger and faster;
- more physical endurance;
- fight using a stick, a knife, and anything that can be used as a weapon, against armed and well-trained enemies.

This last one most likely made you laugh...
I know all too well that real-life fights are nothing like movie tricks.
It is almost impossible to win a fight if you are unarmed, and you fight against a group of special forces soldiers armed with guns.
But seriously: who do you think will be your real enemy?.. Most likely, one or two (worst case scenario, - three) gang members, armed with sticks or knives. Maybe, one of them will have a gun which he will be pointing at you at a short distance.
It is realistically possible to win this fight.
Of course, you need to be really well-prepared, and you need a good portion of sheer dumb luck... but there is a chance. And I say, it’s better that just giving up and letting my family be raped and killed. I’d rather die fighting, but I want to take as many bastards with as possible. Perhaps, as luck would have it, even win…
I can’t rely on always having a gun available, because we all know what happened after Katrina.
How such a situation would develop depends on a lot of factors, such as their original intentions (grab-and-go vs. rob-rape-and-kill), how many members their gang consists of, what the surrounding circumstances are (are you on the second floor of your house with a gun in your hand, with your family behind you, or are you unarmed in a street, with a bandit holding a knife at your teenage daughter’s throat?..), what weapons their have and - more importantly - how ready they are to murder someone. Needless to say, a hungry unarmed neighbor who came to steal your can of beans is not exactly as dangerous as a gang of prison escapees armed with guns.

Sorry, I digress... That was more of a motivation than a plan...

Anyway, let’s get back to the goals.

If you’re like me, and you need to start your physical fitness almost “from scratch”, you need to start slow.
I can run up my hill twice, but then I’ll probably have a heart attack. At the very least, my knees will hurt for several days.
Punching a heavy bag too hard is another good example of my stupidity.
I learned from my own mistakes that I need to know my current limitations, or I won’t be able to exercise for quite some time just because of traumas. If you are half as pissed off as I am, and about as willing to defend your family as I am, it is far too easy to overestimate yourself and have one training session after which you will be able to barely move for a couple of weeks, if not worse. Be realistic. Do not expect great results in a day.

What I am going to do (and you probably need to do that, too) is make a list of some basic exercises that I am going to perform in the nearest future (that is, within the next couple of months, until I feel I am ready for a more serious training) and write down the results I can currently get without negative consequences.
For example, how long can I run at a relatively slow speed before I feel I’ve had enough for today? How many push-ups, and in how many sets, can I do, without having debilitating pain for the next few days? And so on, and so forth.
If you don’t know what exercises to perform, don’t worry, I’ll get to them shortly.

The idea is to figure out how much you are capable of under normal circumstances, and start – slowly but steadily – building up the foundation for future exercises that will help you prepare for a survival situation.
When analyzing your abilities, try to figure out what you already have and what you need to focus on.
For example, if you are strong, but you can’t run a mile, it is obvious what you need to do: more walking and running.

An important thing to keep in mind is that there are different kinds of pain, and it is extremely important to be able to distinguish between them.
If you practiced any kind of sports ages ago, you know what I am talking about.
There’s good pain which you feel (normally, for a day or two) after a good workout. It shows that, once your body has had enough rest and food, your physical results will grow a little bit, thus adding up to an overall progress of your training program.
And then there are all kinds of bad pain, which indicates that something is wrong.
This might be from some illnesses, but it can also be caused by over-exercising or traumas.
I can’t describe in a short article how to be sure that the pain you are feeling is good. If you are sure, fine. Otherwise, talk to a doctor.
Bottom line is: “no pain, no gain”, but not all pain is good.
And you need to be certain that you get exactly the right amount of exercise for your current level of fitness and for your current condition. Too little, and you won’t get any results. Too much, and you’ll be sick. The same goes for frequency and intensity of your training sessions.
Besides, you might feel great today and be able to exercise a lot, but tomorrow you’ll get tired at work and be unable to exercise at all.
There are far too many variables which make it absolutely impossible to make an optimal training plan for everyone. Experiment with your training routine, and change it often to continue “surprising” your body to give it a stimulus to develop.
Worse yet, for each “couch potato”, it is often very difficult to distinguish between tiredness and laziness. Deal with it. Motivate yourself. Just imagine what would happen if your family is attacked, or starving, or needs to be evacuated from a burning building, or something like that...

Now, a few words about self-defense.
I could write a book about all kinds of Bravo Sierra surrounding martial arts, but this is just an article.
The more you research this topic, and the more you practice some kind of fighting skills, the more “deep understanding” of it you get. Sometimes, it’s just a feeling that something is right or wrong, and it is difficult to put it into words.
So, I’ll be very brief.

1. Practice often.
2. To start with, use only a few primitive techniques (punches, kicks, blocks, movements) and combinations of them. A simple well-practiced technique is far better than several of those which you won’t be able to do in the critical situation. A simple and reliable technique is far more valuable than a complex one.
3. Each technique must be practiced in all kinds of scenarios hundreds of thousands of times before you can be sure it will work for you when you are scared to death, in an disadvantageous position, tired and injured, and so on, and so forth.
4. Practice while wearing the same type of clothes you wear every day. If you train for a survival situation, a uniform with a colored belt is not for you.
5. If you never practiced martial arts before, too bad. Learn. Read books. Do not learn from movies. Nearly all martial arts schools suck: it is rarely their goal to teach you how to fight for your life. If you can, find a private instructor who has experience teaching in the military or law enforcement: most of the time, they know how to fight for real. The best possible option is a Krav Maga instructor with military background.
6. There is no substitute for a very heavy and very hard (as opposed to “soft”) punching bag. Period. Buy it, use it, learn to love it. Remember to start slow, even if you were very good at it years ago.
7. If you can’t do at least 50 push-ups in a single set, your punch will never be any good.
8. Practice kicks from a sitting position on the floor with your hands tied behind your back. If you know what I mean, good. If not... just do it. Thank me later.
9. Practice as if one of your arms is injured. If you are any good with kicks, practice with tied hands (there are a lot of blocks which use feet or shins). Practice hand techniques while hopping on one leg.
10. Learn to sweep an enemy’s weapon away from you (and away other people around you) in one swift move. Practice those moves with a heavy club or a dumbbell, then repeat without a weight, but with a maximum speed. If you see techniques which show a couple of steps combined with a complex wrestling-style throw or arm lock, know that this is BS. Remember that your enemy is neither super-dumb nor super-slow, and there will probably be at least two of them. You can only hope to distract his/their attention and then use at most half a second before he pulls the trigger. As a general rule, learn to tell movie tricks from real practical techniques.
11. Practice at home, in the backyard, on the staircase, in a car, in a room full of furniture... in other words, practice your skills everywhere where you expect to fight in real life. A gym is hardly the right place. Fight on the ice, under rain, under blindingly bright sun, in complete darkness, when it’s cold and when it’s hot. Wear shoes or be barefooted.
12. When you get better at fighting skills, add exercises with weapons, especially a knife and a club. Do not use nunchaku or sai or kama or any other samurai/ninja/peasant garbage: it’s just stupid; we are not in a medieval Japan. Learn to use almost anything as a weapon that you can find in the street (a stone, a piece of wood) or in your living room. But again: be realistic; you can’t use a match box as a weapon, regardless of what some idiots claim. A weapon must enhance a human’s ability to self-defense. A table lamp, a pen, or almost any potentially dangerous object probably can be used as a weapon, but a coin with a sharp edge cannot. Just imagine defending yourself with a sharp coin or a match box against an attacker armed with an AR-15, laugh, and move on to practicing serious stuff.
13. Learn how to fall down. While you’re at it, learn how to fight when you are on the ground. No, I am not talking about wrestling; I mean blocks and kicks and jumping back up to your feet. If you have any doubts about efficiency of wrestling techniques for a real survival fight and if you enjoy watching MMA fights, imagine that the referee is another one of your enemies, and he is armed with a knife while you are wrestling with another guy.
14. Practice blocks. It takes time and lots of practice to set up your defense, but you won’t survive without it.
15. There are hundreds of martial arts styles, dozens (if not hundreds) of thousands of individual techniques. Let this sink in: YOU DO NOT NEED THEM. All you need is (at most!..) a dozen punches and kicks, plus a dozen of blocks, all of them combined into 2-, 3-, or (at most) 4-elements combination techniques, which you have practiced countless thousands of times each, and which you can deliver under any conditions with lightning-fast speed and steel-crushing power. Leave jumping-spinning-back-hook-kicks to movie actors, professional sportsmen, and chronic idiots.

Of all the styles, I recommend Krav Maga and Shorinji Kempo.

I can spend days discussing pro’s and con’s of various techniques for self-defense.
But the point is, you either start practicing now, or you spend years talking about it while scratching your belly.
What works for me, might not work for you, and vice versa.
To start with, for a complete newbie, I recommend:

1. Forward elbow strike.
2. Palm-heel straight punch.
3. Forward knee kick.
4. Forward kick to the groin.

Once you’ve got some experience (assuming you don’t have any yet), you will add more techniques (but not too many!..).
These 4 will get you started. Imagine a very fast and very powerful kick to the groin, followed by an elbow strike, and you’ll feel much better about your ability to defend you loved ones and yourself. Another good thing is, - these simple techniques let you not worry too much about your enemy wearing a bulletproof vest: it is very unlikely that his groin will be protected.

One of the most difficult things to do for someone like me is holding myself back when performing some formerly-familiar exercises.
When I was 17, my friends and I used to break bricks just to show off. My mind still remembers all the stuff, but my body doesn’t. If you practiced, for example, boxing 20 years ago, but have not hit a punching bag in years, be extra careful on the punching bag: you can think you can punch a hole in it, but your fist is not nearly as strong as it used to be, and your wrist will hurt terribly if it can’t hold the punch and bends. Hence, my advice to strike with a palm heel.
The older you are, and the less fit you are, the more careful you must be when you try to become fit.

And I want to emphasize it one more time: talk to a doctor before you start any kind of serious training.

In my opinion, the most important fitness-related abilities for SHTF situation are endurance, some basic strength, and self-defense.

If you’ve been running/jogging for some time now, you are in a better shape than most of us.
But if running is the only exercise you’ve been doing, then you are still not prepared physically for survival.

For a complete couch potato, I recommend the following exercises:

1. Walk as much as you can every day. If you have a dog, just walk him around your neighborhood or in the park, until you feel really tired. (again: do not confuse it with just being lazy).
2. Run as much as you can at least 3 times a week. It may be for just a few seconds to start with, but do it. You’ll get better very soon. Watch your pulse and breathing. Talk to your doctor first, especially if you have any medical problems.
3. Do squats without any weight. Just stand up (try it now! I’ll wait...), then bend your knees completely, so that your butt almost touches the floor, then stand up again. Do it slowly, as many times as you can. If you can do it close to 100 times, you are not a couch potato. Sorry for wasting your time. Keep doing whatever it is you do to be in good shape. Otherwise, do one set of this exercise twice a week (say, for example, right now, and then in 3 days, and then in 4 days, and then again in 3 days, and so on). When you feel it is easy, start doing 2 sets, with 2 minutes rest after the first set. Perform this exercise right after you’ve come back from a jog. Then do the stretching exercises, and then practice kicks: this “pre-tiredness” will help a lot if you have the same problem with my knees as I do (they hurt from kicks unless my muscles are already not only warmed up, but really tired when I start kicking practice).
4. Pushups. A must-do for everyone. One of the best exercises for your upper body, and you can do it anywhere, anytime. If you can’t do it properly, put your hands on the side of your bed (instead of the floor), and you’ll feel how much easier it is. If you are able to do at least a couple dozen pushups in a set, start varying the technique: put your hands shoulder-width, or wider, or narrower. Keep your feet on the ground or put them on the chair. Push up on open hands or on fists or (if you can) on fingers. Do slow pushups or very slow or normal speed or very fast or “explosive” style. There’s a big difference - and you’ll feel it - between hands-together-feet-on-the-floor-very-slow-pushup and fists-very-far-apart-with-feet-2-feet-above-floor-fast-pushups.
5. This one is very hard for a real couch potato... but also extremely important. Pull-ups. Basically, the idea is to grab something above your head and pull yourself up by bending your arms. Before I got my own training equipment (and while having no money for a gym...), I used to do pull-ups in a children’s playground. There’s always something close to your home where you can do pull-ups. Worse-case scenario, just hang a rope between two trees. Or, buy a pull-up bar from a sports store: it goes in a doorway, it is easy to set up and to remove (it takes seconds, without any tools), and it costs around $30. Look up “pull up bar” in Amazon.com to see what I mean. The problem with pull ups is that not every middle-aged man or woman can do them. Don’t trick yourself by thinking that you can replace this exercise with dumbbells or barbells “curls”: no, you can’t. If you can’t do a proper pull-up now, not even once, do not despair: you can put something under your feet to step on, so that you can grab a pull-up bar while your arms are already half-bent, and then perform partial pull ups. When your arms get stronger, eventually you’ll be able to get rid of that chair or whatever, and perform regular pull-ups. There might also be another problem: if you are overweight, and/or your grip is weak, you might have difficulty just hanging in there... literally. There’s no better solution for this than regularly hang on the pull-up bar as long as you can, and for as many sets as you can before it really hurts, as many days a week as possible.
6. Abs workout. There are so many exercises... If you are overweight like me, I am sure you know them all. Do whatever works for you. My favorite: lie down on the floor, then simultaneously raise your hands and legs while exhaling, so that only your butt touches the floor; slowly lie down again; repeat until it hurts.
7. Punching bag. If you’ve ever worked out on a punching bag for more than a minute, you must know that it’s also a great workout, - both for your muscles and for your cardio-vascular system. The only problem is to be careful with every single move; otherwise, the traumas take very long to heal. The most common injures happen when you punch too hard and/or almost miss the right spot (in which case your wrist can bend and hurt terribly for several weeks), and when you punch the bag without any protective gloves, and your hand slips (this is where you lose a good chunk of your knuckles’ skin, and you can’t punch a bag for about a week). Just be careful, use gloves or hand wraps, and land you punches with precision.
8. Jumping rope. If this exercise sounds silly and childish to you, try to do it 200+ times without stopping, and you’ll feel how useful it is. You don’t need an expensive jumping rope from The Sports Authority. A piece of regular rope which is long enough and heavy enough will be just as good.
9. Developing a strong grip. Useful for all kinds of survival situation: from lifting and carrying heavy objects to evacuating from a tall building using a rope, to climbing, to self-defense, and so on, and so forth. There are good grip strengtheners; be sure to get those which are hard to squeeze. Pull-ups, hanging on a rope or a pull-up bar also helps. Besides, performs pushups on your fingers at least once in a while.
10. Last, but not least: practice blocks and punches with weapons. I don’t mean guns, but heavy objects. I perform several sets of blocks with police-style clubs which have a short handle sticking out (these clubs are also known as “tonfa”), and this helps not only techniques, but also muscles and tendons, while developing speed.

I’d like to say a few words about diet, but I do not think I have a moral right to talk about it until I lose a few more pounds.
Anyway, the only thing really worth mentioning is fasting: regular fasting is good for your health if you do it right, and it is certainly useful to be able to function a day or two while being hungry in case you just don’t have any food at all in a survival situation or you have to give it all to your kids if there’s too little available.

It turned out to be nearly impossible to cram a lot of information in a short article.
I hope it will be useful for someone who wants to get started on TEOTWAWKI/survival self-defense and fitness training, but does not know how.

Yes, I am a grumpy, middle-aged, fat man. But I am determined to maximize my family’s chances of survival in the coming imminent collapse of life as we know it. I’ll do whatever it takes to defend them, and hopefully help my neighbors and friends in the process.
I am preparing, and I suggest you do the same.

I first began prepping about two years ago so I am fairly new to this.  In those two years I have been fairly aggressive with my education and training on the topic with much of my real world education coming from reading blogs.  I have found an area where there is a great deal of misinformation and limited preparedness so it has prompted me to address this topic since it is the one area where I possess a skill set that I can share.  The topic is healthcare after the SHTF.  I think it is difficult for any of us, especially in America, to understand how so many aspects of our health we may be taking for granted.  I can honestly say that I was in the same boat which is a sad statement considering the fact that I am a physician.

To give a little background as a lead in; I worked as a general and vascular surgeon for about 10 years after I finished residency.  A little over two years ago I walked away from that to focus on nutrition, fitness, and wellness counseling.  There were many reasons for this change, lifestyle being a big one but more importantly I came to understand that we were no longer practicing medicine but rather pharmacology and surgery.  I found that training people to modify lifestyle was the best defense and prevention strategy and this certainly applies to prepping.

I will be focusing on four topics:

• Optimizing your health
• Nutrition
• Fitness
• Healthcare skill sets
• Water and hygiene
• Healthcare supplies

Optimizing your Health

Health should be viewed as a spectrum with chronic disease at one end, disease-free in the middle, and optimized health at the other end.  Think about where you would want to be and whom you would want in your survival group should the SHTF.

In reading through the various prepper and survival blogs, I see so many people that are unhealthy and they do not hesitate to talk about it.  I would be worried if I were in this situation or if I had to rely on this person as an essential link in my support group.  Stocking up on medications may help but what happens when they run out or expire?   Will you live to take advantage of all your amazing preparations or will they be taken from you?  The solution is to get out of the chronic disease end of the spectrum and get as close to optimal health as possible.  I treat and resolve chronic disease every day by basically changing one thing: lifestyle.  This means nutrition and fitness.  You just have to understand that chronic diseases such as Type II diabetes, high blood pressure, and most high cholesterol are actually just symptoms of a poor lifestyle, you fix that, and you fix the problem without medication.

Nutrition is the key to good health; the problem is there is way too much misinformation out there as to what constitutes good nutrition.  What I am about to say will make most prepper gasp, but let me explain.  Get rid of all grains from the diet!  Now, that said, I do store grains but I do not currently eat them, they are reserved as emergency foods only.  You may now be asking, “where does this insanity come from?”  Well the answer is biochemistry and anthropology.  We are and always have been physiologically hunter/gatherers and grains were not a part of our natural diet.  Our bodies function best and experience the most positive effects from a hunter/gatherer style diet.  I am not asking you to immediately take my word for it just because I have a few initials at the end of my name, but I do ask that you try this challenge – give up all grain, bread, pasta, rice, crackers, chips, pretzels, popcorn, sweets, etc., for one month and see how you feel.  You will eat only meats, eggs, vegetables, fruits, and nuts during this time and eat all you want.  You will experience amazing results.  Since I do have limited space here to go into all the details, I have provided a link to a video on Vimeo to help explain my approach to this diet: Functional Nutrition.

Other good sources of information are the books The Paleo Solution: The Original Human Diet by Robb Wolf and The Primal Blueprint by Mark Sisson.  Sisson also has a great web site at MarksDailyApple.com.  Good nutrition is 80% of a healthy lifestyle, it is the base of the pyramid of health and without it you cannot develop optimal health.  I am not promoting some agenda here or trying to sell some magic snake oil, all I can tell you is that I have been utilizing this diet in my clinical practice for years and the health transformations and the disease resolutions I have witnessed are amazing.

Another aspect of optimal health is fitness.  It is a necessity in survival and should be an integral part of any preparation regimen.  Everyone seems to prep for food, medical and self defense but another aspect of preparation is your body.  I would like to see the 3 Bs change to the 4 Bs: Beans, Bullets, Band-Aids, and Body.  Your level of fitness will be directly proportional to your chances of survival so you need to train the right way.  Bottom line – lift heavy stuff and run fast.  What I recommend is functional fitness and you do not need a gym for this.  Functional fitness means training the body to be able to do the necessary things in life well and remember, life will be substantially different if society fails.  If you have weights available, then lift heavy – squats, cleans, military press, rows.  Add push-ups and pull-ups.  Chop and carry wood, dig ditches, and run sprints. The book The Primal Blueprint that I mentioned has some good functional training advice and workouts.

Healthcare Skillsets

The practice of medical care could change dramatically in this scenario.  Physicians and nurses currently practice with the aid of technology, sterile environments, a slew of available instruments and specialist referrals.  EMTs and paramedics are trained in stabilization and transport.  Despite my surgical training and experience, my experience in a level 4 trauma center and having been an Advanced Trauma Life Support instructor, I would have little skills to care for people in a post-apocalyptic scenario.  That was until I began studying wilderness medicine.  Wilderness medicine training is available for health care providers (EMTs, paramedics, nurses, and physicians) and what makes this different is that you have to diagnose and more importantly TREAT in the field without the benefit of technology and transport.  In TEOTWAWKI scenario things like minor wounds, burns, blisters, and fractures become potentially life-threatening emergencies. I never realized all this until I took a Wilderness First Responder course offered by NOLS (National Outdoor Leadership School) and I feel that this is an absolute necessity for someone in your group.  We should all know how to properly clean and care for wounds, close lacerations, treat a burn, splint and reduce fractures and dislocations in situations where we do not have the luxury of modern technology.  Now this course will not make you the Dr. House of the TEOTWAWKI but it will give you the basis to build from and a level of comfort in dealing with many of the issues you may encounter.  You should still have access to someone with advanced medical training.

Water and Hygiene

Wilderness medicine gets you thinking about things we take for granted like water or hygiene.  In the wilderness, clean water is your best friend.  Even sparkling clear mountain spring water can be full of protozoa and bacteria so boiling or filtration is essential.  What kills more people worldwide?  Infectious diarrhea.  This is also one of the number one debilitations in the wilderness along with food poisoning related to poor food prep hygiene.  It is also important to remember that filtration will not get rid of viruses, so in the face of a viral outbreak if the water supply gets contaminated, you will need a chemical disinfectant as well.  Iodine and/or chlorine will work well for this added safety.  We need to look at the health care issues faced in the third world countries in order to fully understand what we need to prepare for should the worst case scenario occur.

Healthcare Supplies

First thing to remember here is that it will do you no good to stock up on supplies that you have no skill or knowledge to use.  When I design and stock kits for people, I always find out what abilities they possess first.  You also have to determine what size group you want to prepare for and the environment where the kit will be needed.  I typically see a need for three types of kits and a stock of supplies on top.

Kit #1: Basic field kit.  This kit needs to be compact and lightweight but still be supplied to cover you for a 1-5 day trip away from your Bugout Location (BOL) for 3-4 people.  This should cover everything for stabilizing illness or injury long enough to get you back to your BOL.  This is the kit that I keep in my Bugout Bag (BoB) and I take hiking or camping.
Basic contents:

• Sterile and non-sterile gloves
• Facemasks with eye protecting, also antiviral mask
• Thermometer
• Ace bandage and scissors
• Various quantities of different size sterile gauze and gauze rolls
• Field surgical kit and sutures
• Variety of medical and athletic tape
• Moleskin for blisters and second skin for burns
• Opsite or other occlusive dressing
• Steristrips and benzoin for wound closure
• Small vial of povidone iodine or betadine
• Bacitracin and Cortisone
• Thermal reflective blanket
• SAM splint
• Eye pad
• Large irrigation syringe
• Several cravats
• Quikclot or Celox trauma bandage
• Pen light
• Emergency resuscitator pocket facemask
• Ibuprofen, aspirin, Benadryl, and various antibiotics

Kit #2: Advanced Home Kit. This is an advanced medical kit for the home or BOL.  It contains all the above items from Kit #1 just larger quantities, plus:

• Stethoscope and BP cuff
• Fiberglass casting wrap
• Greater variety of surgical items
• Lidocaine, needles, and syringes
• Battery operated cautery device
• Skin stapler
• Greater variety of antibiotics and other prescription meds
• Emergency cricothyrotomy kit

Kit #3: Advanced Trauma Kit.  Now this kit would be mainly for people with advanced medical training or military field medics.  I keep this is a STOMP bag and it weighs about 40 pounds.  It is basically a portable trauma bay with advanced surgical instrumentation, major wound treatments, airway control, etc.

My recommendation is to train each person in your group in the basic medical skills and have each carry a basic kit.  Many prep groups run drills for defense and bug-out but few run through medical scenarios and these are the most likely issues that they would encounter.  Each group or family should have someone in charge of medical and it should be their responsibility to train the others.

So our best course of action is prepare and prevent.  Prepare by optimizing each individuals health, have the training necessary for your environment, and have the appropriate tools and knowledge in order to act.  Prevent by obtaining/maintaining optimal health, recognizing and understanding the risks of your environment, practice good hygiene, and utilize adequately filtered water.

Bring to mind one of the post-TEOTWAWKI scenarios you most frequently imagine, be it the after-effects of a worldwide flu pandemic, series of natural disasters, economic collapse, or nuclear war.  Is this a world into which you’d want to bring children?  At least for the short-term aftermath, I bet you wouldn’t.  Not while you may be on the move or actively defending your retreat or community from danger.  However…”birds do it, bees do it, even educated fleas do it”…c’mon, sing along with me and Cole Porter…”let’s do it, let’s fall in love!”  As the song says, love is natural and often accompanied by relations that can result in babies being born.  What if the methods of contraception you had long taken for granted were not readily available?  If your bunker isn’t well-stocked with condoms, you’re probably out of luck.  Prescription contraception?  Won’t be available.  Medical or surgical interventions (think IUD or vasectomy) won’t be worth the risk, in the absence of ongoing qualified medical care, even if they are available. 

Of course, the best way to prevent unwanted pregnancy is abstinence.  But assuming that abstinence is not the preferred option, how can heterosexual couples engage in sexual intimacy including intercourse and prevent ill-timed pregnancy without contraception?  By observing the woman’s body’s natural function over time and planning intercourse during the days when she is not ovulating, that’s how.  Conveniently, this method also helps couples plan the optimum times to conceive a child as well.  Also known as Natural Family Planning (NFP) or the Rhythm Method, the essence of this approach is that women and their loving menfolk track the ovulation cycle and avoid intercourse or make sure to use a barrier method of contraception (diaphragm, vaginal sponge, condoms, all of which should be used with spermicide to be most effective) when the woman is ovulating.  How does one do that?

The first requirement for an ovulating woman is to understand your monthly fertility pattern or menstrual cycle.  (Men are fertile from birth, but women only become fertile after achieving sexual maturity, usually around age 12-13 and lasting until menopause, which may start between the ages of 40 and 60.)  Days of the cycle may be divided as follows:

• days when you are fertile (able to get pregnant)
• days when you are infertile
• days when fertility is unlikely, but possible

Day 1 of the cycle is the first day of a woman’s menses, or period; the average cycle lasts 28 days, but a healthy cycle might last from 12 to 35 days and vary throughout a year or over a number of years.  The amount of time in the cycle before ovulation--crucial information for pregnancy planning,--aries from woman to woman and sometimes monthly for the same woman.  The period always starts (unless a woman is pregnant) in 14 to 16 days.  The period is the shedding of the blood and uterine lining that will not be needed, as there is no fertilized egg present.

Women with a regular menstrual cycle, which means they menstruate for the same duration each month with about the same number of days between the first day of once cycle and the next, have about nine or more fertile days each month. Should you not want to get pregnant, do not have intercourse on the days you are fertile or use a barrier method (condoms, diaphragm with spermicide, etc) of birth control (this could be a way of conserving your limited supply of barrier contraception, if you have any.)

The knowledge of when you are definitely or likely to be fertile is essential both for pregnancy planning and natural avoidance.   There are three ways to track fertility; they involve monitoring:

• basal body temperature
• the monthly calendar
• cervical mucus

The most accurate method is to combine all three approaches.

Basal body temperature

The average human body temperature is 98.6 degrees, and most people have a consistent body temperature that is close to 98.6 degrees. Basal body temperature is your temperature when you first wake in the morning, before you start moving around a lot.  During ovulation, a woman’s body temperature rises, though usually by less than a degree.  By monitoring body temperature over time, a woman can learn what her basal body temperature is and be able to note when it rises.  This method requires a special thermometer, available at most drug and grocery stores; if you aren’t currently using one, you may consider adding it to your preparedness supplies.  Remember, " two is one and one is none", so think about purchasing a few.  Illness, alcohol consumption, or getting out of bed and moving around can all raise basal body temperature.

Most women have ovulated within 3 days of the temperature spike; you’re most likely to get pregnant 2-3 days before the temperature spike and 12-24 hours after ovulation.  This gives an average 6-day window of likely fertile days.  Sperm can live inside a woman for up to three days, which extends the window to 9 days.

Calendar Method

This method involves recording your menstrual cycle over a period of time, at least 6 months, to determine the pattern.  Projecting into the future, you may calculate the days you’ll be most fertile by subtracting 18 from the total number of days in your shortest cycle (for example, 26 days.) Take this number (in our example, it would be 8) and count ahead that many days from the first day of your next period, once you get it. Mark that date on your calendar; it is the first day you're likely to be fertile.  Then subtract 11 from the total number of days in your longest cycle (for example, 32 days.) Count ahead that many days (in our example, it would be 21) from the first day of your next period. Mark this date on your calendar. The time between the two dates is your most fertile window and the time when you would want to abstain from intercourse or use a barrier method of contraception.  In our example, the window is 13 days, which is long but possible.

This method is the least reliable, so you should always use it in combination with the basal body temperature or cervical mucus method.

Cervical Mucus

A woman’s cervix, which is the portion of the uterus where is joins with the vagina, produces mucus; the presence or quality of this mucus is an indicator of ovulation. The menstrual cycle is driven by hormones, and the same hormones change the quality and quantity of this mucus.   For a few days after a woman’s period, there is no cervical mucus present.  As the egg starts to mature in the ovaries (this happens monthly for a fertile woman), cervical mucus increases and appears at the vaginal opening, cloudy and sticky.  Just before ovulation, the mucus become more copious, clear, and slippery (think egg whites.)  This is when you are most fertile.  About four days later, it should change again.  This method (really all three methods) requires the use of a calendar to record your observations.  Label each day “sticky”, “dry”, or “wet.”  You are most fertile at the first signs of wetness after your period ends.

Many couples who are trying to conceive purchase ovulation kits or fertility monitors from drugstores. These kits detect surges in luteinizing hormone, which triggers ovulation.  You could store some of these kits in your cache, but they are more for people who are trying to conceive than for people who are trying to prevent pregnancy.

Of course, times of significant stress (i.e. TEOTWAWKI) may disrupt a woman’s regular menstrual and ovulation cycle, so this method may not be 100% reliable.  The Center for Disease Control describes it as being 75 – 99% effective at preventing pregnancy (compare with condom use, generally accepted as being 85 – 98% effective); of course, natural family planning will not prevent sexually transmitted infections.  It is also worth noting that chances of conceiving or of  carrying a pregnancy to term diminish after age 35.  According to the National Institute of Health, “For women aged 35-39 years the chance of conceiving spontaneously is about half that of women aged 19-26 years.” (“ABC of Subfertility”, 2003.) Postmenopausal women are not able to become pregnant.

If the anticipated circumstances of your survival situation make it absolutely undesirable to encourage pregnancy (hopefully for a limited time), you will want to include a great number of condoms in your cache.  They take up little space but should be rotated like other perishable items; over time, latex breaks down and loses its strength and flexibility.  Condoms have expiration dates on the packaging.

Besides pregnancy planning and/or prevention, there are a number of other sexual health topics commonly covered in advanced first aid training that are beyond the scope of this article.  A crucial part of preparedness is training and practice; consider taking an advanced first aid or first responder course.  If your natural family planning doesn’t work, then you may need to know how to safely deliver a baby!

IBS and TEOTWAWKI

Irritable Bowel Syndrome (IBS), is a difficult and tricky topic to cover.  First, let’s get some of the politics out of the way and then some pretty interesting facts about IBS to start with, then we will move on to some helpful management tips.  The actual definition of Irritable Bowel Syndrome is this:  a gastrointestinal syndrome characterized by chronic abdominal pain and altered bowel habits in the absence of any organic cause.  Obviously, if there is no way to actually test for a disease, then there is a wide interpretation of who has it and why they do; therefore, the politics.  There are some folks that believe that IBS should be labeled as a psychiatric disorder.  Often IBS is treated (sometimes successfully) with anti-depressant medications or even psychiatric medications.  Therefore, there are many out there that just toss IBS on the pile of “made up” diseases and close their minds to other options.  There are others that think IBS will be discovered to be a specific autoimmune disorder as time and research progresses.  Again, some medications that help problems like RA (rheumatoid arthritis) help some of the patients that suffer from IBS symptoms.  Others feel that IBS is a mechanical problem and if treated with the right diet and bowel regularity can be cured.  Still others feel that most IBS is misdiagnosed and if the proper workup were completed, these patient would find many alternate diagnoses instead of IBS.
 
The facts are interesting though about IBS:
• Prevalence varies widely among countries and is usually higher in developed countries
• Younger patients and women are more likely to be diagnosed with IBS
• Females to males with IBS is 2:1
• Costs estimate to be up to $30,000,000,000 dollars for IBS health care impact [, including missed days of work]
• 2nd most common cause of work absenteeism after the common cold!
• 25 to 50% of all GI (gastroenterologist) referrals
• Emotional stress often worsens the pain
 
The great thing about IBS is that almost all of us could really be diagnosed with it based on the criteria.  You can have diarrhea, or you can have constipation.  Usually, the pain is accompanied by a change in your bowel habits, but not always.  It can be relieved by a bowel movement, but not necessarily.  The official criteria, call Rome III Criteria, are as follows:
• recurrent abdominal pain or discomfort
• at least 3 days per month for at least 3 months
• associated with 2 of the 3
? improves after defecation
? start of symptoms is with change in bowel frequency (increase or decrease)
? start of symptoms is with change in stool appearance
 
Now, not to get too personal here, but if we eat enough Thai food or Mexican in my family it’s IBS for everyone!  This is what makes IBS tough for people to live with when they have a bad clinical case of it.  Most of the people around them think:  “big deal, you have stomach cramps and bowel problems, who doesn’t get that?”  The problem, from this Family Practitioner docs view, is how much do the symptoms have a life impact.  Lots of people meet the criteria for IBS and it doesn’t really affect their day to day living.  In fact, estimates are that only 15% of people with IBS criteria actually go to the doctor to do something about it.  There are others though that are basically disabled by IBS.  They have severe pain with bad diarrhea and are suffering every day.  This is why lots of different medications end up being “tried out” on IBS patients with severe disease.  Doctors just want to find something that helps the patient.
 
All patients will IBS should have already tried to eliminate all lactose from their diets to see if their symptoms improve.  That should be the case now rather than later.  Some patients will notice specific foods that worsen their IBS symptoms, and all IBS patients should keep a food diary for 2-3 months and note all foods and all symptoms in that diary.  The trends can be reviewed and those foods that worsen symptoms be avoided.  Again, this should be done now rather than when there is limited choice in foods.  Food allergies can often be a cause of or exacerbate IBS symptoms, and if you have IBS get your lab panel done now to see if food allergies are one of the causes of your symptoms.  Be sure the panel includes gluten, which is another source of IBS symptoms for some patients.  Some other foods that are thought to worsen some IBS patients include:  fructans, galactans, fructose, sobitol, xylitol, mannitol, and even fiber.  The diary should help to clue a patient in if these worsen or cause their symptoms.

Physical activity does help many, but not all patients with IBS.  Moderate physical activity is recommended for patients with IBS symptoms, and in a study those that did exercise improved and worsened less than the patients that were inactive.  Psychosocial therapies can help some patients, but the politics really kick in when you recommend hypnosis, biofeedback, and psychotherapy to a patient with stomach problems.  These treatments will obviously not be available WTSHTF.
 
Medications really are a last resort for the management of IBS, and any medicine is only to be used with the lifestyle and diet recommendations already reviewed above.  Any medication would have to be life-long and there is a lack of any convincing evidence of therapeutic benefit.  That being said, there are many IBS patients out there that take medications that truly improve their quality of life.  Again, any management of IBS should be done now as trials of medications and adjustment of doses will not be possible at TEOTWAWKI.
 
So, what can a person do to plan for the future without a grid if they have moderate to severe IBS.  The plain answer is:  make sure you have completed all the steps to modify and control your IBS symptoms, then continue more of the same.  If you have IBS now and manage it with diet, stress reduction, and fluids; you will need to continue those things WTSHTF.  If you take a medication, either over the counter or prescription, and it helps manage your IBS. You should probably have stockpile quantities of those meds for when the grid is no more.  The message is pretty clear:  get moving on management of your IBS when the grid is up and you will be a lot better off if it does go down.  Like most prepping issues, planning ahead pays off ten-fold compared to the “what do we do now” approach.  Stay strong, - Dr. Bob

JWR Adds: A family member with chronic IBS reported that Peppermint, Anise, and Fennel teas allproved to be a tremendous relief. The great news is that you can grow your own peppermint, anise, and fennel in many climate zones. I recommend that you start growing a patch of each now, so you can help any IBS sufferers in your community. Just be careful not to let the anise spread--it can become a pernicious weed.

--

Dr. Bob is is one of the few consulting physicians in the U.S. who prescribes antibiotics for disaster preparedness as part of his normal scope of practice. His web site is: SurvivingHealthy.com.

Hello James:

I stumbled across some excellent advice for foot care.  The advice targeted diabetics.  Diabetics need to be especially mindful of their feet are more susceptible to circulation difficulties.  Foot problems can rapidly escalate. 

This advice is also very sound advice for after the Schumer hits the fan.  It is likely that we will all be putting more miles of pounding on our feet. - Joe H.

JWR-
Dr. Ted is incorrect. "Dropping below 15% protein risks Kwashiorkor – it’s the reason why those starving kids in the television commercials have fat bellies – lack of protein actually causes more fat to be deposited!"

More fat is not deposited. [A swollen belly in these cases is a symptom of] edema (fluid) that collects in the abdomen or feet. It comes from the capillaries when there is a lack of protein in the diet and the liver cannot produce enough albumin. Thus the blood is hypo-osmotic and fluid is lost into the peritoneum, also called third-spacing. - J.W.M.

JWR,
 
I found this article interesting: Protesters Coming Down With the "Zuccotti Lung". Park conditions put demonstrators at risk for variety of sicknesses, officials say.

The weather and conditions at the "Occupy" protests are likely a microcosm of a post-Crunch refugee camp, along with the attendant diseases and problems associated with lots of people living close together in raw weather.
 
I think this should give pause to those who believe they can simply pack up and head out into the local woodlot and survive a Crunch-type event. You may leave home healthy, but inevitable contact with other folks will introduce the bugs that can end up killing you. A clean, warm, dry shelter at a fixed retreat goes a long way toward preventing or limiting communicable disease.
 
Blessings, - G.R. in Texas

Sir:
I would like to follow up on my recent article, Some Thoughts of How to Live in Times of Hunger, with a few actionable implications that might make a difference to my fellow preppers. As always, I eagerly look forward to the contributions of the worldwide prepper community to add to or correct my conclusions.
           
If I ever have to bug-out on foot it will be under dangerous circumstances, and I will need to move quickly and cover at least several miles. This on-foot bugout is my truly worst-case scenario: minimum supplies, emergency escape. If I can plan for this scenario then all other scenarios should be simpler. It is my fail-safe.

However, right now I’m having a terrible time keeping my Bug Out Bag weight low. I can carry it out to my truck. I might even be able to wear my pack and hike a mile. But I sure won’t be moving fast and I won’t get much beyond a mile, if that, in rough terrain. I’m not particularly young, I’m not athletic, I have a sedentary job – I might even represent the “average” American prepper.

Some of the weight in my pack is food, several pounds worth. I’ve researched ideal foods that combine calories, nutrients, and protein in a robust ready-to-eat package for meals on the move. But I’ve been thinking about the whole hunger thing in a different light.

If I escape by the “skin of my teeth” into the wilderness and have enough food to sustain me for two or three days it will only prolong my death if I do not also have the equipment to obtain food once I am in the field. Just as I cannot carry enough water to last me through even two days, I may not be able to both carry enough food and have the equipment to obtain enough food long term by hunting, trapping, or fishing

Based on my hunger research, I know I can perform at near-peak levels for a couple of days with a minimum of food, after which point my performance will begin to taper off as hunger sets in. I won’t be happy about it, but I will survive the experience of “going hungry.”

If I’m not mistaken, the name of the food game, at least for the first several days of a bugout, is sheer calories. But what if I only carry (1) quick-energy carbohydrates to fire my muscles during hunts and escape, and (2) slow-energy calorie-dense foods like fat (or mostly-fat foods) for the sheer caloric-content of it?

Here’s my logic:

Glucose is my body’s primary energy source that it stores in my liver for emergency energy. Sports gels contain mostly glucose/dextrose (or maltodextrose) because it hits the bloodstream quickly and doesn’t require much digestion. These might very well be the best quick-energy option because some gels also contain electrolytes (mentioned in the Hunger article) and caffeine. What’s not to like?

The caloric content of gels is around three calories per gram, while solid glucose/dextrose candy should come in closer to four. Candy made from sucrose (table sugar) has the same caloric content. Werther's Original Creamy Caramel Filled hard candies candy (which I happen to have on hand), for example, is mostly glucose (and you really have to love that caramel filling!). If you can’t afford the more than $1 per pack for the energy gels you could still do pretty well with hard candy for a shot of energy once it dissolved in your mouth.

Yes, there is an energy crash following the “sugar high” (less with sports gels) but the important thing to note is that the sugar (or sugar and caffeine) does indeed provide the energy burst to hunt or escape, and do it with an effectiveness and with a speed unmatched by any other food source. That’s important.

High-sugar foods like hard candies and energy gels aren't the highest calorie content foods, though. The highest concentrated calories come from fat. Pure, solid glucose is something like four calories per gram (the same as protein). Fat contains around nine calories [per gram], that’s 225% more energy per gram! However, fat takes longer to metabolize. For a quick burst of energy during a hunt or escape you certainly would not eat fats. It’s no substitute for sugar.

Imagine that you can barely carry your BOB even with NO food in it. You have the equipment you must have to hunt/fish/trap, but NO food. Zero food.

You work out at the gym and finally have the additional strength to add a bit of food to your pack. What do you add? Sugar. Why? Because it will at least give you the short-term bursts of energy to do the two most essential things you must do: hunt/fish/trap and escape should that be an issue. It won't fill you up, it won't stop you from feeling hunger, but it will work for what you need it for.
 
Back at the gym you’ve been hard at work and you finally can add a little more weight to your BOB, in addition to the sugars you figure you’ll need.

You know your body isn't going to need a lot of vitamin and protein replacement right away (electrolytes maybe, yes). You know you won't starve for nearly a month. You know that you can function on “empty,” if you have to. You know if you leave on foot you could end up in an unfamiliar location and it could take you days, or even weeks, to begin hunting/fishing/trapping well enough to begin meeting your daily caloric needs [and then transition to gardening and raising livestock once your reach your retreat, where you presumably will have a deep larder]. You may not be able to carry all of the calories you would like, but you would like to minimize the depletion of your body’s energy reserves (fat, sugar, muscles).

If you packed sesame snaps (one of my personal favorites with sugar, fat, protein, and fiber, 186 calories/35 gr package) you’d need 21.5 packages (1.7 pounds) of snaps per day for 4,000 calories. In two week’s time you would need nearly 24 pounds of snaps!

But what food has more caloric energy than any other food on earth? Fat. What food, coincidentally, burns reasonably slowly? Pure fat. Nine calories per gram. It doesn't get any better than that. You need calories, it has calories. (Hey, it's good enough for the Inuit! Can you say muktuk!)

If you packed fat instead of sesame snacks you would only need to carry 14 pounds, SEVEN fewer pounds than sesame snaps. Or, to look at it another way, if you were able to add an extra 24 pounds of weight, the snaps would last two weeks (@4K cal/day), but the fat (453.6gr/lb x 9 cal/gr x 24 / 4000) would last ten more days. (Turkey chili, one of my favorite all-around-nutritional foods, contains 460 calories in a 15 ounce (420 gram) can, works out to 1.1 calories per gram - 800% fewer calories-per-gram than fat. Bad choice as your second tier food!)
           
Your stomach does flips at the thought of just eating Crisco plain but you realize that coconut oil has a lot of other benefits besides its incredible caloric density. It’s solid at room temperature (liquid in desert temps!), doesn’t burn at high temperatures (like cooking over a campfire), and is very easily digested by the body. And if you get the really good virgin coconut oil from a health food/supplements store it will even smell great!

Coconut oil has antimicrobial, antioxidant, antifungal, antiviral and antibacterial properties – all things we’d like to have in an emergency situation. And its medium-chain triglycerides require less work from your liver to convert it into usable energy (which is why it’s used in sports nutrition, hospital feeding formulas, and foods for people with digestive disorders). Have a look at the amazing properties of coconut oil and its digestibility.

With the weight savings of not having to carry as much food weight (only energy gel for quick bursts) and carrying food with the maximum energy density (fat), I can afford to carry more of what I will need in the long run: equipment to help me hunt, fish, and trap. (Equipment first!)

It does me no good to have a lot of food if my BOB is too heavy to make a quick getaway – the getaway is the thing. And it also does me no good to have a lot of food in my pack if I can't subsequently secure an adequate supply once in the field. The most important reason for carrying the BOB is to get out with the tools and supplies I need to survive long-term.

Eating just sugar and fat while you orient yourself to your surroundings and start to put wild foods on the table is not the final word! There are a lot of variables. You will be able to add the occasional fish, handful of berries, bird, or edible tuber and give yourself some variety while extending your food reserves. You may want to add to your BOB a little of the tastier foods (MREs, freeze-dried meal, canned turkey chili, or sesame snaps) just to keep your sanity...

But do it with the realization that any food that is not pure fat is trading off taste for calories (i.e., raw “body fuel”). You can stretch your body’s energy reserves further with foods that have a high caloric density, and the very highest of these is fat.  Then make an educated choice about the foods you pack!

And if you can’t carry as much food as you’d like, at least be sure you have the equipment you need to obtain food once you’re in the wild! You don't need to be full of food each and every day – you know that can safely survive on “empty” for quite a while!

I’m going to continue to work on my walking and climbing fitness so that I can carry the maximum amount of gear during a critical escape situation. But in the mean time, this weight tradeoff based on an understanding of how hunger actually works might help make my long-term survival a more sure thing. And that’s what it’s all about.

Be Prepared. Trust God. We can do both. - ShepherdFarmerGeek, in Spokane

JWR Replies: My general advice for anyone that cannot live at their intended retreat year-round is to cache nutritious food at several places along your intended route, in buried plastic cache containers. (Like the four liter containers made by Nalgene, triple-bagged in heavy plastic bags.) It is best to cache in rocky soil, to reduce the chance of burrowing rodents finding it. Check your caches annually.

Hiking long distances at a deep caloric deficit is dangerous. If nothing else, hunger is distracting, so your personal security awareness and sleep will both suffer. Hunger can also encourage you to make bad decisions. Longer-term hunger can also degrade your night vision. (See Nick Rowe's POW narrative, Five Years to Freedom.) Further, dependence on refined sugars for your primary source of energy is inadvisable. First, it causes sugar rush-then-crash cycles that are debilitating. Second, depending on your particular physiology, sugar crashes might even cause fainting. Lastly, overloading on sweets can even trigger a diabetic reaction. (Wouldn't that be ironic, to survive on mostly sugar for a week and make it to your retreat, only discover that you've become an insulin-dependent diabetic?)

For ultra-compact food for a lightweight bugout bag, I would advise making powdered blue-green algae (also known as Spirulina) your core food. Ounce-for-ounce it is the ultimate trekking food for humans. The freeze-dried algae powder could be supplemented by whey-based protein powder (like those used by bodybuilders), powdered milk, jerky, peanut butter, ghee (storable clarified butter), coconut oil and perhaps a few sweets like Clif bars and Larabars. This approach has been discussed at length in backpacking magazines, backpacking discussion forums, and blogs. By the way, I've read that you can even make your own energy bars with blue-green algae. (Although I haven't tried this myself, so no guarantees.)

Be advised that for anything more than a four day trek, constipation might become an issue with a protein dense diet like I've described. The importance of storing gentle bulk laxatives (such as Metamucil) has been discussed previously in the blog. Even after you have arrived at your retreat, keeping regular will become very important if you have a diet with a preponderance of meat from wild game. So don't overlook getting a supply of bulk laxatives. Even if you don't end up needing them personally, they will be useful for barter or charity.

Lastly, be cautious about packing too much caffeine (as found in coffee, tea, and sports gels) or other stimulants like chocolate in your bugout bag. Odds are that you will already be feeling very tense in a true Get Out of Dodge situation, so don't add the risk of a panic attack.

Dear JWR:
Well, hallelujah for Dr. Bob's practical attitude toward fitness! 

I've been working our homestead for almost 20 years, now, and I've been amazed at what the workout crowd can't do, hurting because they had to shovel manure and those particular muscles weren't on the look lovely list.  I've worked many a man into exhaustion, although I do pay when it's time to try to buy a dress that fits - women aren't supposed to have biceps.  For years I've wondered about spending big bucks to go to the gym when the push lawnmower and a few other practical things would probably do it, but people want the glitz. 

Recently my husband has been able to spend more time on the homestead.  Until then his main exercise was running or training his lower body and he hated tilling and shovel work and had trouble doing it.  By switching to a rowing machine he's been able to do far more - now he tells me to get out of the way so he can move the pens or other work I would have been doing myself.  Can I get an Amen?

One last idea:  if you know the water is going to be a distance away, Dr. Bob, why not plan now to bring it a little closer?  Our water went out a few years back because of a failure in the water tank.  We have a well but we couldn't access it, so until the plumber could get out we dragged water for flushing from the irrigation wells.  It was late winter/early spring, so it could have been worse, but I got to thinking what it would be like to haul all the water in bad weather in a grid down event.  Decided to get a Bison pump.  It does everything they say it does, and it's in the back yard, not in the woods.  Nice during Hurricane Irene.  So if Dr. Bob can find a way to get that water to move even half the distance to his house now (ram pump?  gravity feed?) he'd be doing himself a favor, because if you are living that old-fashioned lifestyle, you have a zillion other things to do beside the water chore.

And when I'm doing that kind of work, I don't worry about my weight, either, and I don't fuss over the eggs or other supposed bad foods because I'm burning them off.  An old pamphlet I found in my grandmother's kitchen actually extolled a national brand of fat for its high caloric content.  Bit different lifestyle then, wouldn't you say? - Linda S.