Archive for April, 2010

How much do I need to exercise?

Friday, April 30th, 2010

I keep running across short articles on exercise and its resultant health improvements; they vary a lot! One, taken from USA Today and published in the Journal of the American medical Society, reported on a long-term study done by researchers at Boston's Brigham and Women's Hospital and Harvard Medical School. This was a huge project, following 34,000 women for thirteen years. The group's average age was 54 when the project began and the women were eating a regular diet and not trying to lose weight. Over the extended period of the study the average weight gain was six pounds. Not very surprisingly, those who exercised more gained less than those who were relatively inactive. But notice they weren't dieting, just exercising.

A second article included multiple takes on excercise. A cardiologist from the Mayo Clinic in Rochester mentioned an overweight patient who started to consume a better diet and got moderate exercise. He lost weight and clearly improved his lipid panel results (the surprise ending to that story was he was his own patient in this instance).

Comments made at the yearly meeting of the American College of Cardiology supported the moderate exercise concept, with a number of studies showing more aggressive approach to preventing heart disease were no more effective than moderate ones. Other studies showed that adding multiple drugs to lower lipids didn't seem to offer additional benefit and a large NIH study concluded that aggressively lowering systolic blood pressure (that's the upper number your doc looks at when you have, for example a blood pressure of 145 over 95) wasn't more effective in preventing strokes or heart attacks in a group of over 4,700 diabetic patients.

What does this all translate into for you. At least my approach is to eat well, keep my weight down and get some exercise as often as possible, sometimes by going to the gym and sometimes by walking up and down the stairs to my second-floor office. I've stayed away from using lots of meds for minimal changes in my lipids and don't have a blood panel done very often (The last time I had one, all my results were okay). Of course I've worked hard at losing the roll around my middle (I've gone from a 37-38 inch waist to 33-34 inches in the past year) and cut my weight 25+ pounds. The dose of my blood pressure medicine was cut in half when I did so.

Listen to what your own doc tells you, but I strongly suggest you take some steps yourself to improve your health. They don't always have to be huge ones, but, in the final essence, you're the person who can do the most to extend your lifespan. Start by doing some walking; think about small things you can do arround the house that burn calories (like my extra stair climbing), ask your doc if you're okay to do more strenuous exercise and if you do so, very gradually increases in your workout pattern make sense to me).

But whatever you do, don't just sit there and let the pounds accumulate, especially pounds around your waist.

So what should I weigh?

Tuesday, April 27th, 2010

I've been reading some of the background material  from one of the articles that appeared in The Wall Street Journal 4-27-2010, in the "Personal Journal" section which today featured Health and Wellness. There were several controversies in other articles: I scanned two: chocolate as a potential antidepressant vs. chocolate being consumed more by those who are depressed; sun-lovers and benefits from sun exposure vs. shade-seekers and harmful effects from excess sun exposure.

The one I was most interested in was titled "A Case for Those Extra 10 Pounds." This one seemed aimed at those who are carrying a little extra in the hips and thighs, rather than the belly. It quoted lots of medical data suggesting there might even be some benefit to a "few extra pounds," an increase in estrogen production  and an accompanying decrease in osteoporosis risk; a Dermatology article was quoted as saying that women who are overweight appear younger than those who are of normal weight or underweight.

So let's go back to basics. One third of all adult Americans are frankly obese, not just a few pounds overweight. They clearly have a higher risk of a number of serious diseases. Many of those in the middle ground between normal weight and obesity, i.e., those who are termed "overweight," carry excess belly fat as well as extra poundage in the thighs and buttocks. I see this all the time in the men's locker room at our gym; my wife says she also notes the same in women. Those folk are also at risk of cardiovascular disease, high blood pressure and, according to some sources, even some types of cancer.

On the other hand, in general, it's not healthy to be underweight People who are underweight may be so because of underlying diseases such as cancer. I should, of course, note that some people who are very slender may be perfectly healthy and are thin because of lifelong exercise (long distance runners come to mind).

We all tend to look for excuses and to rationalize our issues away. So if you're lean around the midsection and carry a little extra elsewhere, perhaps you are okay. But I'd suggest you should take a good hard look at your waistline before concluding that you're one of the folk who can safely carry some excess pounds or not.

Working in the Low-Salt Mines

Wednesday, April 21st, 2010

We're finally catching up with reality, at least in one arena. In the past week I've read two local newspaper articles, one article in the Annals of Internal Medicine and an accompanying editorial in the same monthly journal from the American College of Physicians, all on our need to decrease our salt intake.

Those of us who've spent much of our medical careers dealing with the treatment and the consequences of high blood pressure, medically termed  hypertension, have been on a low-salt kick for years. Both of my parents and, eventually my older brother had hypertension, so I watched my blood pressure for years and, when it went up to high normal, cut way back on my salt intake. I also started to lose weight and to exercise more.

So two days ago I read an article titled "Shaking the Salt Habit." That was written for our Fort Collins paper and was followed by one today, from the Associated Press, titled "Too Much Salt: Report urges FDA to force rollback. Then there were the two medical pieces which came out in the April 20th edition of the  Annals. The editorial encapsulated the concept: "We Can reduce Dietary Sodium, Save Money, and Save Lives.

The bottom line is the American diet contains roughly twice as much salt as is optimal for health, nearly 4,000 milligrams vs. the maximum recommended of 2,300 mg. for young, healthy adults, and the 1,400 to 1,500 mg. that is the suggested maximum for people with high blood pressure, for African-Americans and for anyone older than 40. Much of the excess comes from processed foods.

Other countries have already made progress along the lines of cutting average salt intake (salt, of course, is sodium chloride, but I'm used to using either term). The UK started in 2003, and cut salt intake by an average of 9.5% The Annals article suggests if we were able to do the same, gradually perhaps so people didn't think the taste of food was inferior and started salting things at the table, we'd save lots of lives.

The consequences of hypertension include heart attacks, strokes and kidney failure. That less than ten percent decrease in our dietary salt could prevent over a half million strokes and just under a half million heart attacks in our 40 to 80-year old group. That would save over $32 billion dollars in medical costs.

The UK plans further cuts in salt intake, up to a 40% decrease by 2012. Japan, Finland, Ireland, Australia and Canada plus other countries are also implementing similar programs.

We don't cook with salt for ourselves, decrease the amounts specified in recipes when we cook for others, don't add salt at the table and tend to avoid processed foods. I wondered if we were getting enough iodine, added to most or all salt you purchase, but the salt that goes into processed foods, according to the articles I read, doesn't have idoine anyways. Plus our senior vitamins have the RDA (recommended daily allowance) for iodine anyway. So I quit worrying that we'd develop thyroid problems.

The bottom line is we Americans need to wean ourselves off our excess salt habit and doing so will both improve health and save a healthy chunk of change.

Blog ahead in Spring...

Sunday, April 18th, 2010

We'll be heading down to Colorado Springs on Thursday for the Pikes Peak Writers Conference (and my 69th birthday dinner with cousins). So instead of writing blog posts on Tuesday and Friday, as I normally do, this week I decided to "blog ahead."

Two articles in our local paper got my attention recently. One I'll pair with an article and also with an accompanying editorial comment from the Annals of Internal Medicine, but that can wait till Wednesday as I've not yet fully digested (no pun intended) the dietary advice from the three sources.

Today I wanted to mention a local initiative from the Food Bank for Larimer County, one of our favorite non-profits. I've worked volunteer shifts there when I belonged to a Rotary Club and my wife and I always give the Food Bank one of our larger yearly donations when we start figuring out what we can manage to give to charities.

The organization's director, Amy Pezzani, said in the paper that the Food Bank had 32,000 more visits in 2009 than in 2008. One fifth of our kids in the county are receiving food through schools, food stamps or the Food bank itself.

Yet data collected by other groups says that in that same time period, more than half of our Larimer County residents fall into the overweight and obese groups and one fourth of our students in the K-12 category (I didn't see any statistics for Colorado State University students).

Now the Food Bank has combined their need for more food with our region's excess weight issue. A national TV show gave the local folk the idea of a "Pound for Pound Challenge and Pezzani and her crew have gotten over 700 local residents to pledge to lose nearly 20 pounds each by July. So far, they were up to a 13,000-pound pledge and they're aiming at 50,000 pounds.

Each participant joins the challenge by registering online with a local ZIP code and gives the Food Bank a small donation equivalent to the number of pounds they plan to lose. Pezzani said the 50,000 pound goal would be the the equivalent of two truckloads of food. At the time the article was written, Colorado was ranked 12th in the country in the contest with 135,000 pounds being pledged and Larimer County was third in the state.

Talk about a win-win situation. This idea should be publicized even more widely than it already has. Spread the word.

Pushing the edge: a hodgepodge

Friday, April 16th, 2010

I wrote recently about Springfield's horseshoe sandwiches using them as one example of things in our society's food frenzy that I don't want to join in. Since then I've run into a number of other examples and, fortunately, some opposition to these. I'm going to quickly describe a few of the trends I view as potentially dangerous for those of us who want to stay slim (or become slender) and remain healthy.

One article described how high-end restaurants are experiencing a boom, in some case having up to 30% more business. I read that with perhaps a touch of envy, but decided that the trend for fancy dining came from abundant crops and cheaper prices for strawberries, wild mushrooms,and some varieties of carrots.  Those things I can buy for myself in the farmer's market or the supermarket

My greater concern came from reading two articles on foods being offered for sale that offer much greater risks than fancy restaurant meals. One was on bushmeats, illegally-imported flesh that comes from bats, monkeys and rodents...considered by some to be delicacies and apparently smuggled into the NYC area. Now you may not live near the New York City so this may appear to be of distant interest, but those strange meats have been found to contain a strain of a virus that is distantly related to HIV and many scientists think that consuming such products is how humans first came to be infected with HIV.

Then there's the unpasteurized milk debate. Public health officials (my Dad was one of those), are absolutely against drinking "raw milk," though its advocates claim it has many health benefits lost when the milk is pasteurized, defined as being heated enough to kill harmful bacteria.  In March the FDA reported twelve cases of sickness in the Midwest that apparently were tied to a dairy selling "raw milk." The agency is reviewing its policy on hard cheeses made from raw milk. At present you can purchase those if they are aged sixty days or more. Fresh cheeses made from raw milk have also been linked to disease out breaks.

So you make your choices and decide for yourself. There's a range of food available from the exotic to the expensive to the somewhat mundane. Just remember, to start with, that prior to 1938, when pasteurization became the norm, cow's milk was responsible for a quarter of all water- and food-borne illness. And bushmeat may have led to our current HIV epidemic. As for fancy restaurants, I'll save them for special occasions.

There's fat and then there's fat

Tuesday, April 13th, 2010

For the past few years I've heard passing references to brown fat and white fat, but never understood the difference between them. Today I read The Wall Street Journal's "Personal Journal" section and saw an article that finally clarified the two kinds of fat for me. It also led me to believe there may be developments coming in the field that could potentially (lots of qualifiers there) help our obese and overweight population.

So let's go back to the kinds of fat. Brown fat is different from the kind we tend to accumulate arround our mid-sections as adults if we eat too much and/or exercise too little. It's actually brown in color, found in babies, and contains lots of the heat-producing little cellular "engines" called mitochondria. Little kids are more at risk for hypothermia than adults, so they have more brown fat as a protective mechanism.

Can we use this natural calorie-burning mechanism when we're overweight? In a variety of places researchers are attempting to solve this question. One mechanism for revving up brown fat, at least in mice, appears to be exposure to cold. Some studies have shown that humans may adapt to cooler temperatures by increasing the amount or activity of brown fat, but we're a long ways from anything definitive.

The question isn't as simple as it may seem. Lean men seem to respond better than obese men to exposure to cold, at least in terms of brown fat activation. A map of the United States in another article showed obesity, in general terms, to be more prevalent in the Southeast, but many factors may contribute to that finding.

Harvard and MIT teams are attempting to find a way to produce more brown fat by activating a protein called PRDM16. Their initial work is near completion, but development of an actual marketable drug that works in this fashion is at least five to ten years away.

So in the meantime, should we all turn our thermostats down to say 65 degrees. I think that's a good idea; it would save fuel, decrease our emissions perhaps (thereby helping prevent global warming), and maybe, just maybe help us to lose a few pounds.

Subtle messages

Wednesday, April 7th, 2010

I was leafing through The Wall Street Journal this morning, quickly, as I got up late, will read a book for my men's book club most of the morning and then go to Loveland, eight miles south, to lunch at a restaurant I've never eaten at before. I'm going there to meet a writer friend whose book I've been proofreading.  I saw the headlines in the front section of the paper and will return to them later, but was struck by an article in the last section, the one called "Personal Journal."

The article's title was "What Your TV is Telling You to Do." That caught my attention so I read the whole thing. It's about NBC's use of the technique of "behavior placement." Instead of trying to sell you a specific product by having the star of a show drink, eat or use it, this idea is to show you a kind of behavior you may then decide, consciously or unconsciously, to emulate.

The thing that's different here is that some NBC's shows are now sending you messages, or rather signals, to recycle, exercise and eat right. Presumably they're not just doing this because it's the right thing, but, in part in least, because it will help them sell ads. TV has enormous power to get huge numbers of viewers to do something, because their favorite character does it.

In this case the stars of various shows will be exercising or eating healthy food choices. I'm going to wait and see what the outcome is and maintain a goodly amount of skepticism, but the overall concept is one I love.

For years we've been sold, via ads (which I mute and many who use Tivo skip), products that by no stretch of the imagination could be termed healthy choices. Now, finally, someone is going to try to influence us to make better choices. I'm all for it.

Things I don't want to eat

Monday, April 5th, 2010

I found an article in The Wall Street Journal recently that raised my hackles.  On March 30th, 2010 the paper talked about a food fad in Springfield, IL, quoting the owner of a local eatery there as saying, "We've made something very unhealthy even unhealthier."

Apparently the city has an area favorite, the horseshoe sandwich, which is incredible enough in its original form (large plate sized, open-face with bread, meat, lots of fries absolutely doused with melted cheese, versions ranging from pony shoes at 1,300 calories to regular horseshoes at 1,900 calories each). That many calories is the equivalent of gulping down nine jelly doughnuts according to the article. One place in Springfield briefly tried a relatively healthy version, but found it unpopular.

Now the featured restaurant came up with a  extra-grease-added format with the fries and meat inserted into a tortilla, then deep fried and finally given a river of cheese sauce. It's a 2,700 calorie horseshoe sandwich said to be equivalent to five Big Macs.

This local tradition, that is the horseshoe sandwich itself, has been around since 1928, flourished since the 1970s  and in 2009 the Springfield convention center hosted the initial World Horseshoe Cook-off.

All of which wants me to stay away from Springfield and its restaurants. I had cousins there many years ago, but, even as a once-a-year birthday "treat," the horseshoe is not for me.

For years I've been amazed at some of the food monstrosities our American fast-food places serve. I understand they're trying to get with the trend toward healthier eating and maybe they're succeeding, but here's one town where the opposite has happened. One state worker is quoted as saying, before her monthly indulgence, that she eats salad all week.

None of us is perfect in following a diet; I ate more yesterday at my relatives' home for the holiday dinner than I normally would and even ate some things (chocolate-covered apricots) that I'd never purchase for myself. But falling off the diet wagon..briefly (I'm still within my three-pound-over-target-weight limit), is one thing; eating these culinary death traps regularly is quite another. I just talked to my CPA about picking up our tax forms and, in doing so, mentioned the horseshoe. He called it "a heart attack on a plate."

So that's Springfield and its own tradition; the problem I have is what can I find to eat when I eat out elsewhere? I look carefully at menus, choose Subway if I have to eat at a fast-food restaurant on the road and usually stick to my favorite Thai place for meetings and treats. I think that our love affair with restaurant food has been a major health hazard for many of us. It's time for a change.