Archive for the ‘Exercise possibilities’ Category

The very high-priced spread

Saturday, February 4th, 2012

This obese teenager could be headed for trouble

I've been concerned about our burgeoning problem of excessive weight, so when the Journal of the American Medical Association for February 1, 2012 arrived, I was intrigued by the variety of articles touching on the subject. Let me start with a disclaimer: I have no clear-cut special competence, no magic bullet for preventing or treating obesity in our children. I do think it's a major threat to the upcoming generations here and elsewhere in the world. I am also very aware that its opposite numbers, hunger and even starvation, threaten whole populations around the globe.

But my own background, both as a physician and as someone who has successfully fought weight issues (I weighed 218 in 1969 and 148 this morning), has made me concentrate on the American epidemic of eating to excess as a major area of my interest.

The first article dealt with kids and adolescents. A group of CDC researchers reported an update on obesity in American kids, giving data from 199 to 2010. The newest statistics show nearly ten percent of our infants and toddlers are obese and close to 17% of our kids ages two to nineteen. As the kids got older, more boys than girls were obese in this survey with over 4,000 participants.

Then there was an article titled "Weight Loss Stratagies for Adolescents," based on a Boston Children's Hospital Conference roughly a year ago. The MD, PhD Harvard Professor of pediatrics who discussed the issue began with the case history of a particular obese girl, a fourteen-year-old who was five foot six and weighed nearly 250 pounds (giving her a body mass index,BMI, of 40). Her adoptive parents were overweight themselves, but had to learn to "back off" in their attempts to control her diet. There is some early data that suggests that parents can help by providing health food choices in the home and facilitating enjoyable physical activity throughout the day (versus a fixed "exercise time).

I had seen an example of that with some former neighbors whose boys, in order to have their one hour of "screen time," had to be outside playing for several hours at a time. Both youngsters were lean.

One critical point to be made is avoiding focusing on obese kids only. A large Danish study, published in the New England Journal of Medicine in December, 2007,  followed over a quarter million children born in the 1930 to 1976 time period. Denmark established a national civil register of "vital statistics" in 1968 and enrolled everyone in the country, giving them a unique number, ironically termed their CPR number. Although that had nothing to do, I gather, with cardiopulmonary resuscitation, which is what I think CPR means, the study did look at risk factors for coronary heart disease.

When your heart's on fire, it may not be from love

The results are impressive and threatening: every one point increase in BMI across the spectrum was associated with an increased risk of coronary artery disease. A child didn't have to be fat to be at risk later on. One calculation estimated that a 13-year-old boy weighing 25 pounds more than the average had a one-third increase in the likelihood of having a heart attack before the age of sixty.

It's time to start helping our kids live leaner and longer, healthier lives.


Vindication? Part 1

Thursday, January 5th, 2012

One way to get lots of protein

Since the late 1990s when I invented a diet, or perhaps I should say an eating pattern, I've relied on one principal concept: Eat Less; Do More. I came upon this simple idea after listening to a group of medical professionals who were discussing which diet they should go on while they were simultaneously consuming huge portions at our hospital cafeteria.

One of them, I recalled, had tried a high-carb, low-protein diet the past year; losing nearly twenty pounds, then regained it all and more in a few months. Now she was going to attempt  to lose twenty-five pounds with a different approach, this one with an emphasis on protein. I had seen weight-loss plans come and go and didn't believe any of them were the answer, at least not for everyone. I remember coming home and saying to my wife, "Lynn, I've invented a new diet"

I explained it was simply, "Never finish anything; No snacks between (meals); Nothing after eight." I added, "Get lots of exercise."

I lost the seven pounds I had gained on a two-week vacation and didn't need my strategy again until early in 2009. Then I weighed 177 one morning, up three pounds from my normal weight since 1991. I attributed that to eating out four times in the prior week. But when I tried on a pair of good suit slacks, I realized the weight hadn't changed much, but the distribution sure had.

I went back to my eating plan, lost five pounds easily, then coasted a while before resuming the diet. Lynn bought me a digital scale and I weighed myself daily. I also started going to our gym six days a week. Eventually I shed thirty pounds and five inches off my waistline. At 147 pounds I was twenty-five under my usual high school weight. This morning, nearly two years later, I weighed 148.

I allow myself a three-pound zone of weight fluctuation, thinking that would account for fluid shifts and the occasional big splurge. Whenever I exceed 150 pounds I go back on my plan.

Then I read a Wall Street Journal article titled "New Ways Calories Can Add Up to Weight Gain: Study Challenges Idea That Varying Amounts Of Fat, Protein and Carbohydrates Are Key to Weight Loss." It quoted the Journal of the American Medical Association, AKA: JAMA. I went online and found the JAMA article and an accompanying editorial.

I read both pieces in detail, even finding a wild typo, "...their diets were returned to baseline energy levels and diet compositions (15% from protein, 35% from fat and 60% from carbohydrate)." I called the AMA and suggested they correct the numbers since they added to 110%.

Is a high-carb, low-protein diet safer?

But the basic premise of the study's data intrigued me. It's something I've believed for years, calories count, as opposed to what form those calories come in. But there's one extra facet: low-protein diets can be dangerous.

I'll analyze that in detail in my next post.



What's worse than TBI?

Friday, December 9th, 2011

play today, pay tomorrow?

In my last post I wrote about the immediate risk to our youngsters, that of traumatic brain injury (TBI). Now I'd like to move on to an even grimmer issue, much more severe and long-lasting brain damage that's also trauma-associated. We've heard of professional football players developing personality changes, then more severe neurological problems; most recently I read of a professional hockey player who had similar issues.

So I found the Boston Center for the Study of Traumatic Encephalopathy (that term translates as "disease, damage or malfunction of the brain."), and read one of their major publications on what is called Chronic Traumatic Encephalopathy   (CTE). Trust me, most of the medical jargon it uses is tough even for a Internal Medicine subspecialist. It was published in a journal I've never heard of, J Neuropathol Exp Neurol, but is very well written and, in addition to detailing the brain changes in 48 cases of CTE, provides an excellent background discussion of the entity. Ninety percent of the neuropathological confirmed cases of CTE were in athletes.

I remembered a story in 2009 of a 26 year old Cincinnati Bengals receiver who had died after falling out of a pickup truck during a domestic quarrel, reviewed the recent New York Times piece on a 260+ pound NHL "enforcer" who died of a combined alcohol and painkiller overdose and found another Times article, this one from May of 2011, about a former Chicago Bears defensive back who had committed suicide and donated his brain to the Boston research center. All three had CTE.

That article said about two dozen retired NFL players were eventually found to have this disease; the research article mentions that over one-sixth of those having repetitive brain injuries called concussion or mild TBI eventually will go on to have CTE .

But we're not just speaking of football players or hockey players. Professional wrestlers, soccer players, domestic abuse victims, military veterans, horseback riders, seizure victims, head bangers as well as boxers and hard-form martial arts participants may well have similar recurring brain trauma and potentially could go on to CTE.

It's time to study their brains, hopefully before it's too late.

The NFL donated $1 million in 2010 to CSTE, the Boston University research group; researchers at the center have lined up 100 former players  to try to find ways to diagnose the condition during life and more than 250 active and retired NFL players have agreed to donate their brains and spinal cords to the CSTE.

Nearly 100 are suing the league over the issue of player safety, saying the NFL has down-played the concussion problem to give fans more action. A knowledgeable friend told me the NHL allows bare-fisted fights between its enforcers and others to go on for roughly fifteen seconds; he said the audience loves the brutality.

Bread and circuses were a way to keep the Roman populace from revolting. Why are we emulating them?



It goes far beyond football, boxing and hockey

Wednesday, December 7th, 2011

The brain is vulnerable to trauma

I feel like I've opened the proverbial can of worms, finding, in this case, a topic that keeps expanding. I started with reading an article in The New York Times about the death of a professional hockey player, but I quickly delved into the medical literature.

I've spent much of the day reading article after article on traumatic brain injury  (TBI), which can be mild or severe, and another entity called chronic traumatic encephalopathy or CTE, one that's frequently been in the news over the last two years. Let's start with TBI. I'll be writing about teens and younger kids. I'll deal with CTE in another post focused on adults.

A Center for Disease Control and Prevention (CDC)  report in the most recent edition of the Journal of the American Medical Association reviewed nonfatal TBI related to either sports or recreational activities in kids age 19  or younger. The numbers involved were staggering, nearly 175,000 per year being seen in Emergency Departments (EDs).

A large majority of those sports and recreation-related TBI ED visits were by boys and the annual total of those ED trips increased markedly during that nine-year time frame. They were injured biking, playing football, soccer, basketball or while engaging in miscellaneous playground activities. They went to the ED in smaller numbers for injuries suffered in many other activities, including horseback riding, ice skating, ATV riding, tobogganing and even golfing (here the injuries included those related to golf carts). Surprisingly, skateboarding accounted for only a fourth of the ED visits for biking and football accidents and TBI was less frequently seen.

A helmet is a good start

As my wife and I drive around town, we often see college students riding their bikes at night while helmet-less and light-less. I fear for their brains.

There's another, less well-accepted entity, so-called "Second Impact Syndrome." I read an article about this in a February 2009 article by two authors on the faculty of the University of California, Irvine School of Medicine. In this scenario athletes who've had a TBI then have a second brain injury when they go back to playing their sport far too quickly. The initial injury may have been relatively mild; the recurrent trauma may kill them in a matter of minutes.

Another review of this  syndrome said 94 catastrophic head injuries had been reported in American high school and college football players in a 13-year time frame, 92 in high schoolers.  Seven of ten had a prior concussion in the same football season; over a third played with continuing symptoms.

This speaks to the crucial question of when an athlete (or a bike or horseback rider) who has suffered TBI should return to their sport/activity. Last night I called a younger friend who had been bucked off his spooked mare and suffered a concussion eight days ago. He was still having headaches and agreed with me that it was far too soon to get back on his horse.

A new CDC program called Heads Up offers TBI guidelines for coaches, parents and physicians.




Slim down those truckers

Wednesday, November 23rd, 2011

some truckers are relatively slender

I have two series of posts going, but couldn't resist the article I found in the New York Times while riding a recumbent bike in the gym. The title alone, "A Hard Turn: Better Health on the Highway," was enough to grab my attention.

The first story was typical, a trucker driving long hours every day, eating all the wrong foods, getting no exercise, gaining huge amounts of weight. I found the online abstract of a 2007 Journal of the American Dietetic Association article cited: long-haul truckers of necessity eat at truck stops and of 92 such truckers stopping at a Mid-eastern US truck stop nearly 86% were overweight and 56.5% were obese.

One of our family members used to be a truck driver and I've heard his stories of long days spent behind the wheel, eating greasy foods when he stopped. He's slimmer now and in better shape as his current employment allows him more exercise time and a choice of where and what to eat.

Now that insurance costs are rising sharply, the trucking firms are getting involved and the truckers themselves, there's over three million of them in the US, are coming to grips with the issue out of necessity. One group ran a blood-pressure screening clinic for 2,000 truckers at a truck show. Twenty-one were immediately sent to a nearby emergency room; one had a heart attack before reaching the hospital.

drive carefully around trucks like this

Trucks are involved in 400,000 accidents a year and 5,000 fatalities. I just watched a nearly eighteen minute video on how we, as drivers of passenger vehicles, contribute to those accidents; 70% are caused by the drivers of other vehicles (see link below). Yet many of the ones caused by trucker driver error occur because the trucker has a health problem or falls asleep.

Some truckers are taking steps to decrease their weight and its accompanying risks for themselves and those who share the roads with them. A number of companies are helping (and perhaps finding a lucrative new client group). I just looked at a website for "Rolling Strong," and found a gym in my area that offers fitness programs for truckers. Others are joining Weight Watchers, a solid organization that my slender wife has belonged to for many years (she says she was "chunky" in high school) or creating their own programs for fitness: one carries a fold-up bike in his 18-wheeler and uses it whenever he stops for a break. Many are cooking in their trucks or even hiring a trainer.

Others joined the Healthy Truckers Association of America, paying $7.50 a month to belong to an organization that is rapidly growing (see link below to Chicago tribune article). That group now offers truckers a prescription drug card enabling its members to save ~60% on meds.

I applaud all these moves; if I'm on the road with a large truck or a series of them, I'd like their drivers to be in shape and wide awake.

Do our kids have a bleak future?

Saturday, November 19th, 2011

As close to a salad as he'll get

I'm taking a break today from my series of posts on greenhouse gases, alternative energy source, volcanoes and global warming. All of those will affect the generations to come and those now growing up, but I want to re-examine another side of their issues. This morning I read two articles and one newspaper report on the heart health prospects for our American kids (and, by extension, kids elsewhere in the developed/rapidly developing world). The initial article came from a section of the Wall Street Journal I hadn't gotten around to reading yesterday and was about to recycle. Then I saw a title that caught my eye, "Kids' Hearth Health Is Faulted."

I found a CDC website with an explanation of the National Health and Nutrition Examination Survey, NHANES. This is a continuation of a US Public Health Service effort started 40 years ago and is updated annually. Medically-trained interviewers may well come to your town and even to your front door someday. The data they obtain is used in many ways (I'll paste in a website that leads you to some comments on NHANES as well as to a link to a video).

Now a portion of the survey/study looked at 5,450 kids between 12 and 19, finding they were a long ways from matching the American Heart Association's (AHA) seven criteria for idea cardiovascular health (see 2nd link below to Harvard's Beth Israel Deaconess Medical Center's article on the subject). The adult health measures, known as Life's Simple 7, are: 1). Never smoked or quit more than a year ago; 2). Body Mass Index (a measure of height versus weight) <25; 3). Physical activity on a weekly basis for 75 minutes (vigorously) or 150 minutes (moderate intensity).; 4). a healthy diet (four or more components meeting AHA guidelines); 5). total cholesterol <200 mg/dL; 6). blood pressure (BP) <120/80; and fasting blood glucose (AKA blood sugar) <100 mg/dL. The original article was published in the journal Circulation January 20, 2010 and is available free online. The metrics are slightly different for kids.

So where do our kids stack up? If you exclude eating a healthy diet, only 16.4% of boys and 11.3% of girls meet the standards for the other six criteria; if you include diet, none of them do. They don't eat four to five servings of fruits and vegetables a day; they also don't get enough whole-grains or fish and they consume far to much salt and sugar-sweetened drinks. Only one fifth of them even eat "fairly well."

drop that hamburger and run for an hour

Many of then also don't exercise on a daily basis for at least sixty minutes (50% of the boys do and 40% of the girls). More than a third are overweight or obese.

There's some hope: a just-published article in the New England Journal of Medicine, examining the data from four studies following 6328 kids, found that those who do manage to lose weight had lower risk for type 2 diabetes, hypertension, abnormal lipids and carotid artery disease.

So I'm heading to the health club and will read the 2010 Circulation tome on an exercise bike.

Thus far my one biologic grandson, about to be 12,  is physically active and slender. I'll encourage him to stay that way and the non-biologic grandkids to follow his example.

More on this subject to come.

Check out these articles:

Survey Results and Products from the National Health and Nutrition Examination Survey

AHA Defines "Ideal" Cardiovascular Health


Beating the heat by using the new data:

Tuesday, August 23rd, 2011

Ready, set, eat well

A recent article in The Wall Street Journal described how the Houston Texans professional football team is using data I read in the Archieves of Internal Medicine online to improve player safety. The Texans are facing some of our worst summer heat and are going to extraordinary lengths to prevent heat-related injury.

I'm not at all sure I agree with their stategem, practicing in triple-digit weather outdoors in the full sun. Their theory is that doing so helps their players remain fresh in the heat of early-season games. Other teams have opted for temperature-controlled practice arenas or night-time workouts or cooler climes.

We'll wait and see the results, but at least they're using the latest medical research and some practical concepts.

Players are weighed pre-practice and afterwards (the team, collectively, lost an incredible average of 450 pounds per two-hour session one week). That's in spite of replacement fluids and ice to the tune of 100 gallons of water, 50 cases of Gatorade and three quarters of a ton of ice for ninety men. One three-hundred-plus tackle lost seven pounds and had to receive IV fluids.

The Archives  article and a subsequent Harvard Heart Letter detailed research and historical perspective. Our intake of sodium, in table salt and foods, is important, but the ratio of how much sodium to potassium in our diets may be even more crucial.

An older edition of the Harvard Heart Letter compared our modern diet to that of our primitive ancestors. Paleolithic man consumed sixteen times as much potassium (in milligrams) as sodium; today our typical diet has nearly five times as much sodium and less than a quarter of the potassium as the hunter-gatherers ate, so the ratio has marked changed.

lots of potassium in this bunch

So how do you return to a healthier diet, in those terms. Well, a banana, for instance has over 400 milligrams of potassium and almost no sodium (1 milligram). An orange has over 230 times as much potassium as sodium, steamed Brussels sprouts 35 times as much (I mean in milligrams in all cases, so scientifically my comparisons are ratios).

The Texan's head dietician and senior trainer are altering the team's diet, using lots (and I mean lots) of electrolyte-containing vegetables and fluids. They even formed a players' food committee to make sure the team members would have choices that they would like. Southerners want okra and potatoes, so that's what they get. The team members were concerned about blood pressure effects from all the salt they're getting; then they heard how the new research showed foods high in potassium and other electrolytes can balance out the effects of sodium.

The proof is in the pudding is the old saying; we'll see how the Houston team does when the season starts.

But I can certainly see the sense behind their approach.


Beating the Heat

Friday, August 12th, 2011

Cooling down

We've been away for a short vacation with our eleven-year-old grandson at Harry Potter Wizarding World in Orlando. It was hot and humid much of the time, although the frequent rain storms helped cool things off.  One of the reasons we moved from the San Antonio area to Colorado after retiring from the Air Force was the heat. My comment in the late 1990s was, "Texas has Summer and the other three days."

I grew up in Wisconsin, my wife in Montana, and although we lived in a number of locales during each of our 20+ years as USAF officers, most of them were in warmer climates. We wanted four seasons in our retirement location and we certainly have them now.

Florida brought back memories of my years in Texas; sixteen of my twenty-three active duty years were spent there. So the article in the August 2, 2011 edition of The Wall Street Journal titled "Spotting and Taming Signs of Heatstroke" caught my attention.

I've had very little experience with heatstroke, but considerable dealings with heat exhaustion, a milder manifestation of heat-related illness. A lot of that was with basic military recruits, many of whom moved to their initial Air Force training from cooler places. Most of my own exercise these days during the summer months is in an indoor setting, so I'm at somewhat lesser risk in spite of being seventy.

Heatstroke killed over 3,000 Americans from 1997 to 2007 and the National Weather Service statistics said 138 in 2010 and at least 64 in thus far in 2011 died from heat-related illnesses. In some years heat causes more deaths than hurricanes or floods, the other major weather-linked agents of fatalities.

Games offer less risk than practice

Hydration, hydration, hydration is a major, but not infallible preventive step with water being ranked as good as sports drinks according to a co-author of the American College of Sports Medicine' guidelines. High-school and college football players, who suffer the majority of heat-related sports deaths, need rest breaks, shade, and water, especially during practice, according to that expert who had his own brush with heatstroke in 1985 during a 10K race. During the games themselves, he says, rest breaks are built in.

Along with athletes (and infants left in a hot car), older adults are at high risk, especially those with underlying diseases treated with medications that can worsen the severity of the reaction to heat.

Treatment of heatstroke is a medical emergency, so early diagnosis is critical. Look for confusion, irrational speech, skin that is red, hot and dry, rapid pulse, throbbing headache, dizziness  and nausea; some of those casualties become unconscious. Call 911 and get the victim into the shade.

Beyond that lies controversy with some professional groups recommending cooling the afflicted person as rapidly as possible in a cold or ice-water bath, others such as the American Heart Association suggesting fanning and sponge-bathing the person or misting them with cool water, rather than ice water.

Looking at online news articles, I think we may break records this year for heat-associated illness and deaths.


Post-exercise protein choices, part 1

Friday, June 17th, 2011

Maybe a few more pounds than this

I received a comment recently on one of my April 2011 posts asking if I still had the April edition of the Nutrition Action Health Letter (NAHL) published by the Center for Science in the Public Interest. My reader had lost her copy and wanted to know what protein supplement CSPI thought was reasonable. I found the info (it was creatine monohydrate with background research done by an associate professor at the University of Regina in Saskatchewan), emailed it to her and decided to review the whole topic in more depth.

I'm in the gym six or seven days a week for ~two hours or a tad more. I'm not trying to bulk up and never attempt the weights I see some of the really husky guys lifting.

As I walk in, I pass a lineup off supplements and see men especially, mixing up powders from large containers. I've never even considered the idea. I told my reader that the professor's credentials seemed reasonable, but she should ask her own physician before starting any supplements from a bottle. I also mentioned that I hard boil eggs, compost the yolks and eat the whites at meals that are otherwise low in protein.

But I reread the article in the April NAHL "Staying Strong: How exercise & diet can help preserve your muscles." The opening quote caught my eye. Miriam Nelson, the director of Tuft's Center on Physical Activity, Nutrition and Obesity Prevention said, "Muscle is the absolute centerpiece for being healthy, vital and independent as we grow older."

I turned seventy in April, so it made sense to pay attention to her. I'm already active and doing some "resistance training" as was recommended later in the article. I saw also quotes from Ben Hurley, a professor of kinesiology at the University of Maryland (and husband to Jane Hurley, an RD on the NAHL staff).

Hurley has been a longtime student of strength training AKA resitance or weight training and feels it is the mode of choice for preventing muscle loss.

Notice I said preventing loss of muscles, not muscle building. I see men in our gym who are only a few years younger than me and are still bulking up deliberately. The sixteen to twenty-year-old youngsters are presumably doing so to impress the young women or because their friends do so, but why do that at age sixty plus?

I actually bought Stonyfield Organic Oikos yogurt

But back to protein intake; experts like the woman who holds the Distinguished Chair in Geriatric Medicine at the University of Texas Medical Branch, Galveston, say we should consume 30 grams of protein soon after exercising and that smaller amounts won't work in older adults.

So that's four ounces of skinned chicken breast (170 calories) or my egg white plus some Greek yogurt (with twice the protein of regular yogurt). I'll try that a while and then comment on the idea.

Obese kids, a growing problem

Tuesday, April 26th, 2011

eating too much of the wrong things

There is a very interesting article in the Wall Street Journal today about how Portland, Maine, concerning about the growing number of obese kids in the community, developed a city-wide plan to combat the issue. Their concept has now spread elsewhere in the state.

Well that caught my attention and I started looking for background medical and non-medical data. Many of the websites I visited initially were poorly written, causing me to move on, but I found one for the 6th Biennial Childhood Obesity Conference to be held in San Diego starting 0n June 27th ( The underlying dire fact is the percentage of kids in the US who are overweight or frankly obese has nearly tripled in the last thirty years.

The conference offers youth scholarships for travel, hotel accommodations, meals (presumably healthy ones) and registration/materials fees. This way kids ages 14 to 18 can meet with medical experts, teachers, policy makers and other kids to hear the evidence-based best approaches to combating obesity.

some start off the wrong way

Former President Bill Clinton's foundation's web page said we've got ~25 million kids in the overweight and obese danger zones and the medical therapy for obese kids costs us three times that of normal weight kids. Twenty-five percent of our children don't engage in any kind of free-time physical activity.

So is it genetics or food or activity that's causing the problem. I think the answer is "yes," but I'd certainly put more emphasis on the latter two factors. Less than 25% of our high school kids take PE on a daily basis; instead they spend an average of four to five hours a day doing non-exertional "techy" activities including video games, computer use and even plain old television watching.

So back to Portland's plan. They developed a 5-2-1-0 concept: five servings of fruits and veggies, 2 hours or less of "screen time," at least one hour of exercise a day and zero sugar-filled drinks. They've already reversed the upward trend in obesity, but at considerable cost ($3.7 million) and with some difficulty in measuring the results. Now the CDC has recently given over a quarter of a billion dollars to 39 US communities in an effort to both start programs and follow their outcome.

I Googled the name of Dr. Victoria Rogers, a pediatrician mentioned in the article. She works as Director of the Kids Co-op at the Barbara Bush Children's Hospital at Maine Medical Center and is involved in the 5-2-1-0 Goes to School program, another  Portland-based program called "Let's Go!," and the state-wide Maine Youth Overweight Collaborative.

In Maine alone, Let's GO is now active in nearly 350 schools and the local business men and women who funded the original project are able to see some preliminary results already. One phone survey found increasing (but still relatively low) percentages of kids adopting healthier eating and exercise habits. Dr. Rogers and her cohorts want to follow 1,500 kids who are in the Let's Go! study long term to see if they change their eating and exercise habits for a lifetime.

So what's happening in your town or city and your state. It's our kids; we have to make a difference in their lives and this is a great way to do so.