Archive for January, 2011

I've got (Circadian) rhythm

Friday, January 28th, 2011

"to sleep, perchance to dream..."

I was thinking about sleep patterns the other day. We're both trying for eight hours of sleep a night and I achieve that goal most nights; about twice a month I'll wake up at 3 or 4 AM and find myself unable to fall back asleep. Lynnette has that happen more frequently than I do.

So are short sleep nights important? I think it depends on how many you have.

The Center for Science in the Public Interest publishes a "Nutrition Action Health letter" that I just started a subscription to. CSPI has been in operation for those forty years and this was an anniversary/retrospective newsletter. In their January/February 2011 edition was an article titled "Unexpected: Surprising Findings From the Last 40 years."

One of those (actually many of those were of interest, but one I followed up on today) was "Too Little Sleep can lead to Too Much Fat." This discussed studies done by Kristen Knutson at the University of Chicago.

When I Googled Knutson and her work I found she's an assistant professor of medicine at the University of Chicago's medical school. She's actually a biomedical anthropologist with a PhD from the State University of New York (SUNY). and did her Master's work at SUNY also.

"Her research focuses on the association between sleep and cardiometabolic health in various populations."

That was cut and pasted from her U of C Department of Medicine (Section of Pulmonary Disease/Critical Care) bio. I also found an article she published in the Achives of Internal Medicine in 2009 where her group found a correlation between reduced sleep and hypertension.

In this current piece, Knutson noted that a a long-term study (16 years) of >68,000 women showed that those who slept less (under five hours a night) were a third more likely to gain significantly (more than 30 pounds) than those who slept seven hours or more a night.

So she recently conducted a much shorter study, getting volunteers and using a sleep laboratory for a month-long period. The research subjects were allowed to sleep four hours a night in one arm of the study and Knutson found they then had higher levels of a hormone that increases appetite and lower levels of another that decreases appetite than when they slept nine hours.

Another part of her study had the subjects, confined to the sleep lab, allowed to snack. When they were allowed to sleep less than six hours they ate more than when they slept over 8 hours.

Hmm, that's intriguing as is her quote from a meta-analysis (a brief definition of that is a statistical combination of a number of studies), that short sleepers are more likely to develop diabetes. That meta-analysis was published in 2009 in the Achives and in 2010 in another medical journal.

When I put those issues together (high BP, obesity, diabetes), I see the Metabolic Syndrome a fairly recently defined entity that goes along with increased cardiovascular risk.

So try to develop better sleeping habits if you're consistently on the short end of the scale (pun unintentional).

They may save your life.

The Gut-brain interface

Tuesday, January 25th, 2011

The human digestive tract

Today I came across an interesting article in the Wall Street Journal. I've spent much of the day trying to track down background information and, thus far, appear to have only scratched the surface.

The initial article was titled "Hungry? Your stomach really does have a mind of its own." It described an research effort by scientists working for the Nestle SA company, a huge firm headquartered in Switzerland, but operating in 86 countries and employing well over a quarter million people.

When I think of Nestle, I think of chocolate, but they started with condensed milk and baby formulas. They've done some praiseworthy things and some that have been severely criticized. Among the former are efforts to halt child labor in cocoa production; the latter includes promotion of the use of infant formula to mothers in developing countries.

The article I was reading talked about satiety factors to stop us from overeating. Nestle has a group of its scientists working on foods that potentially can trick what is termed the gut brain. That's known to physicians as the enteric nervous system, a huge collection of nerve cells involved in actions and reactions in the GI tract: the esophagus, stomach, small intestine and large intestine.

So here's how it works, or at least some of how it functions, in hunger and satiety. Eating stretches the stomach, causing "I'm full" messages to be sent to the real brain, the one in your head. Chemicals called peptides are released when food is present in the intestine; that also signals the brain. Then there's another mechanism I'd never heard of, one called the "Ileal Brake."

The ileum is part of the small intestine and apparently another "I'm full" message can be sent upstairs when there is an excess of fat reaching that part of the gut, in this case excess means more than can be handled (processed) at the moment.

So the Nestle scientists developed a mechanical model of the human GI system, one that cost a million dollars, is the size of a really big refrigerator and is computer-controlled. Using this machine, their lead scientist, Heribert Watzke, and his crew are simulating the progress of a meal through our GI tracts.

I found a video of Dr. Watzke speaking to what appeared to me to be a mostly college-age audience at Oxford, England. He's a very entertaining speaker, obviously partakes a bit too much of his own company's products (or other food) and admits this. He thinks we shouldn't be called omnivores, but rather "Coctivores," creatures that eat cooked food.

His premise is that cooking allowed mankind to develop larger brains and freed them to be able to move around the planet. He wasn't speaking of the food products his company produces, but rather presented a formula: food + cooking = energy.

I need (pun intended) to digest this concept a little more; I'll return to it at a later time.

Meanwhile I suggest you Google Dr. Watzke and observe his show.

What's Good for General Bullmoose...

Thursday, January 20th, 2011

A Bull Moose has some clout

Several major concerns in Americans' diets have apparently taken another step to resolution. I've written how the dietary salt (sodium really) recommendation has recently been lowered so that about 70% of us (all but the young, white and quite healthy) should be ingesting only 1,300 to 1,500 mg. of sodium per day. That's tough enough to do. I saw a recipe yesterday in a "Light Cooking" magazine my wife gets that was interesting: a steak hash. But per portion it had 1,000 mg. of sodium.  That's over two thirds of what I should eat in a whole day. I didn't bookmark that recipe.

Then there's the relatively high cost of fresh fruits and vegetables compared to some other choices, so called "prepared foods" one can buy in the supermarket. Those mixtures are often filled with sodium, fats and sugars, but they're comparatively cheaper in many instances.

We're fortunate enough, as a pair of USAF retirees,  to be able to buy our fruits at the Air Force Base Commissary closest to us as we did when we drove to Cheyenne to see our Dermatologist today. And in the summer, of course, we've again purchased a veggie share and a fruit share from the local CSA, Grant Family Farms. Next summer two sets of friends will join us in that, so the variety will go up and the price per item down as we purchase larger shares. Then we got a quarter of a "hand-raised" cow this year at a wonderful per pound price. That came through friends whose neighbor has a very small herd and sells a few each year.

So what if you're on a tighter budget and don't live where friends and their neighbors have livestock?

Today in The New York Times appeared an article titled "Promote Healthy Foods."  It details how Wal-Mart (since 2008 I think it's actually Walmart), now the biggest retail concern in the country has a new plan, one that over the next five years will cut down on packaged foots content of the sodium, fat and sugars. That gradual approach doesn't ring well with some; I saw some negative quotes, but other countries have followed the same pattern with success. it's hard to go from high-salt to low-salt diets in one urgent push. I know since I tried that when my own blood pressure first went up in the early 1980s.

I tried some "no-salt" foods and hated them. Yet now, some 25+ years later, I'm quite comfortable adding pepper and other spices and using no table salt and no cooking salt.  We cook with a little salt when we have company, using less than the recipe calls for, and I frequently see our guests adding salt at the table. When we eat alone there's no salt shaker there.

Wal-Mart is also planning to offer fruits and vegetables at lower prices. And the article said they plan to build some more stores in rural and "underserved" areas. The company has been discussing healthy eating and our epidemic of childhood obesity with the First Lady and she apparently endorsed their efforts. Why is this significant? Well it's because they can pressure their suppliers to follow along with the concept. They are the Bull Moose herd leader and others tend to tag after them.

We don't do much shopping with them, but in this case I say, "Hooray for Wal-Mart."

Focus on Vitamin B-12 again

Tuesday, January 18th, 2011

high-dose B-12

I've been reading a number of articles about Vitamin B-12 lately. One convinced me we should be taking a higher dose at our age. In young people B-12 deficiency is rare; that's not true for the elderly where some have estimated up to 15% may be lacking in this essential nutrient. What I hadn't fully realized is the omeprazole (Prilosec) I take chronically could potentially also block absorption of B-12.

B-12 deficiency, when severe, causes macrocytic anemia, low red blood cell counts with the cells themselves being larger than normal. That's the flip side of iron-deficiency anemia where the cells are smaller than usual. But there are a host of other issues attributed to B-12 deficiency: depression, dementia, confusion, appetite loss, balance problems. All those have many other causes, of course.

We had been taking a multivitamin for seniors, but added high-dose B-12, (1500 mcg/day. Like the rest of the B vitamins, B-12 is water soluble and if one takes "too much' it can be excreted in urine. That's not true for fat-soluble vitamins like Vitamin D where the potential for overdose is worth thinking about (although there is ongoing debate as to how much Vitamin D we should be getting; see my last post). Our senior vitamin mixture has 25 mcg of B-12 or about 4 times the recommended daily (RDV) value for young healthy adults, but I don't care if I take more than that since I'm about to turn 70 and take that proton pump blocker omeprazole.

beef liver

Today the Wall Street Journal in its Health and Wellness section had an article about B-12 deficiency. It is more likely to be seen in people who don't eat meat or dairy products (beef liver has 48 mcg/slice which is 800% of the RDV). Several chronic bowel diseases  (e.g., celiac disease) can lower its absorption.

The Institute of Medicine recommends that anyone in their 50s or older get most of their intake of this essential vitamin from supplements or, alternatively from so-called "fortified" cereals. When I looked at the NIH's lists of foods that contain larger amounts of B-12, I was somewhat surprised to see at least eight cereals listed.

There is a blood test for B-12 with normal levels of 200-800 picograms per milliliter  cited as the normal range. But my own doc just said my level was superb, ~1,000 pcg/ml in January of 2009. There are now B-12 nasal sprays and some people with severe deficiency have to get B-12 shots, but she talked to a hospital pharmacist who said, just tell me to take my Prilosec at a different time of the day than my B-12.

So if you are 70+ or have a chronic bowel disease or are a vegan, you may want to ask your physician about a B-12 level.

When even the experts disagree

Friday, January 14th, 2011

A good source of calcium

I saw two interesting articles this week that made me pause and chuckle a bit. One came from the American College of Physicians' publication, "ACPInternist:" the other from as A "Best Evidence Review," and compared and contrasted recent US and Canadian authoritative recommendations." The topics were calcium intake/supplements and Vitamin D optimal dosage and the suggestions varied considerably.. I doubt it's because Canada is further north, but that thought crossed my mind.

So let's talk about calcium first.

In July 2010 an article appeared in the British Medical Journal which made many physicians change their recommendations on calcium supplements. There was nearly 1/3 more heart attacks in a group of patients taking calcium pills as opposed to another group who weren't. At a later revelation at an American medical society meeting, the same group of research scientists showed a data from the Woman's Health Initiative (WHI) that also found a heart risk from calcium supplements, this time both in heart attacks and calcification of coronary arteries.

We quit taking our calcium pills, but continued to drink and eat milk and milk products.

Now other medical researchers have cast doubts on the significance of the data saying the overall WHI statistics showed what is a small heart risk at most. There's still a debate as to whether calcium supplements do or do not decrease hip fractures (a major problem, especially in older women).

Then the Institute of Medicine report issued in November as a joint US-Canadian dictum said most Americans, except possibly for teenage girls and some of the elderly, get enough Vitamin D and calcium without using any supplements and that the major risk of too much calcium intake was really kidney stones. There was a specific caveat that postmenopausal women taking supplements may be getting too much calcium.

High-dose Vitamin D

Now the January 5th, 2011 Medscape review looked at Vitamin D recommendations in Canada versus those in the United States. Both came from authoritative sources: The Osteoporosis Canada study concluded that many of us are low in Vitamin D and that more is good, mostly in promoting bone health, but possibly in colon cancer prevention and also in decreasing older adult falls. They suggest taking larger doses than the US Institute of Medicine does. do I parse these varying studies and what do we plan to do. First, we will continue to get our calcium from food sources, mostly milk, soy milk (with its added calcium), cheese and yogurt. Secondly we'll continue to take a larger dose of Vitamin D in pill form, but perhaps slightly less than we are now, and I may get a little more sun exposure.

One comment in the Medscape article was a "young white person needs approximately 4 minutes of direct exposure to sunlight on the arms and legs to generate approximately 1,000 IU of vitamin D3." There's debate as to using sunscreen or not with a small, but randomized Australian study showing a similar increase in blood levels of Vitamin D, measured as 25-hydroxyvitamin D3 (25-OH-D) whether actual sunscreen was used or a placebo sunscreen. Notice, please, that nobody is suggesting prolonged or facial sun exposure.

Sun and Clouds

I may try some arm and leg skin exposure to sunlight; my wife who has had one skin lesion removed won't. We'll continue taking Vitamin D and she needs a follow-up blood level test as her first one was low. We're now on 5,000 IU per day and that may be too much; the Canadian study suggests 800 to 2,000 IU per day; the US recommendations, while lower (800 IU per day for those 71 and older; we're just shy of that), say risks from too much Vitamin D don't increase until doses are over 4,000 IU per day.

Confusing, isn't it; I suggest you ask your own personal physician as to what you should be doing and also ask them if they've seen the most recent recommendations.

When it gets tough

Tuesday, January 11th, 2011

My friend the digital scale

I've struggled to keep my weight where I want it recently. That's right, I'm writing posts on this blog telling others what to do or giving them ideas of what's new in the world of dieting, lifestyle, exercise and the science behind those fields, yet I'll freely admit some days it's been difficult for me also.

We've just finished the extended holiday season from Thanksgiving to New Years and, for some, a few days beyond. That should make the next ten months or so easier.

I weigh 150.4 pounds this morning, less than a pound over my goal of 149-150 and well under my upper limit of 153.

I started this diet in May of 2009 weighing 177 and 153 or under is about what I weighed in eighth grade and under my college wrestling weight of 155. So why aren't I complacent about my diet progress?

I guess the answer is that maintaining a goal weight, for me at least, is never easy, always a challenge. I've got my red 1/3 cup measuring container as a STOP sign on a glass cylinder of microwave popcorn and a 4 by 6 card on the refrigerator door with an acronym for those situations when I'm prone to overeat. I've got a 3 by 5 card that says in bold letters, "DON"T SNACK" leaning against the popcorn container. I even have a card in my automobile that says, "Don't eat/overeat at events."

I have identified my most likely situations for overeating, dinners at friends' homes and staying up later than 11:30 PM to read.

More than anything that simple step has helped. So my advice to myself and to you is twofold: work on those times when you are most prone to slip and be able to climb back on your diet wagon when you fall off. Many years ago I weighed 218 pounds; I firmly intend to never see that territory again.

The most I weighed in 2010 was 157.6 pounds. That was just after returning from a six-day trip to see old friends, all of whom wanted to feed us well, and to help celebrate a milestone (90th) birthday. I got up the morning after we flew back from Texas, weighed myself and went right back on the strict version of my diet plan. I went to the gym the next six days in a row and was down under 153 in two days.

But it took willpower and being able to say to myself, "Well it happened again, but you're not going to continue the upward slide (sic)."

My basic plan when I'm over that self-imposed upper limit (three pounds over my goal) is to go back to basics. Eat more veggies and fruit, less red meat; cut off a portion of each item on your plate and discard it; don't eat anything between meals; don't eat anything after eight PM; exercise every day (in a multitude of ways); let my wife know what's going on; weigh daily.

Maybe someday I'll get to the point where all this is on autopilot, but I doubt it. Maintaining a healthy weight requires thinking and willpower + a little help from your friends/spouse/family.

As they said in that movie many of us remember, "May the Force be with you."

Caveat Emptor

Friday, January 7th, 2011

An article that got me thinking and Googling

Remember when phlogiston was the answer? Well maybe not; that was a long time ago, but ideas in science and medicine come and go.

Two things reminded me of that in the last few days. I usually try to keep up with developments in those areas of medicine that I have a direct or even peripheral interest in. I read the abstracts in the Annals of Internal Medicine and decide which articles make sense to read in full. I look through the bi-monthly Journal Club appended to Annals and do the same.

Then I find suggestions in the two papers and several magazines I read and hunt down the original articles on which they are based.

Some of that is personal; we each take several prescription meds plus a senior vitamin, a large-dose B12 pill, vitamin C, fish oil capsules and vitamin D each day and our supplements have varied over the years as new articles come out.

But even as a medically-trained (now retired for 12+ years) individual, there are times when I find a sudden switch  in the conventional thinking to be jarring.

Two of those happened in the past week.

I was about to write a blog post on Omega-6 to Omega-3 ratios in our diet and give my take on what our optimum ratio should be. American diets have had a ratio well over that in many countries; some advise altering that from the current/recent 15:1 or even 40+:1 to 2:1 or 1:1.

Then my wife, aware of my interest in the area, showed me an article that led me to contacting a senior Harvard professor. Dr. Frank Sacks works in the Department of Nutrition in the Harvard School of Public Health and has chaired, co-chaired or been the principal investigator on a number of well-known, multi-center studies.

He was kind enough to respond to me email and sent me two of his publications, one from the journal "Circulation 2009; 119; 902-907 and the other from The Journal of Clinical Endocrinology and Metabolism 91(2): 309-400.  Bottom line: he feels both Omega-6s and Omega-3s are good polyunsaturated fatty acids (PUFAs) and that ratios make no sense. I'm still digesting his articles and may comment on them later.

Then a friend gave me an article from The Atlantic. It had the intriguing title I pasted in above. I read the lay publication and then Googled the man written about.

Dr. John Ioannidis is a Professor of Medicine at a Greek university, Adjunct Professor at Tufts (where he did his fellowship after graduating from Harvard) and Director of the Preventive Medicine Research Center at Stanford.

Nearly ten years ago he began a project in Greek hospitals that eventually led him to state as much as 90% of the research articles published in medical journals have one or more critical flaws. This isn't limited to medicine, of course. Similar work, termed meat-resaerch, has been done in a variety of scientific fields, with the same conclusions.

Yet a late 2007 blog post by a surgeon/scientist comments 1). to paraphrase Churchill's famous bon mote on democracy, medicine's use of randomized clinical trials and peer-review is the worst way to find the best new treatments, except for all other ways. Whether "evidence-based" reviews have improved the system remains to be seen.

Statistical analysis, as done in a commentary on Ioannnidis's work, can explain why even a quarter of the very best studies can yield incorrect results.

Yet medicine moves on, discarding treatments found to be ineffective or harmful.

In the meantime, I'll not try the latest and "best" least not most of the time.

The American Year of the Vegetable

Monday, January 3rd, 2011

Ever since we met our Chinese graduate student, back in 1999, I've enjoyed figuring out what the current Chinese year is. For instance, 2010 has been the year of the Tiger, while 2011, starting February 3rd will be the Year of the Rabbit.

vegetable medley

But an Opinion piece in the Wall Street Journal today was titled "2011: The Year of the Vegetable." I read that and my copy of the Harvard Heart Letter, which arrived in this afternoon's mail, and found they were both urging us once again to eat  more veggies (and, in the latter case, more fruits).The newspaper article's theme was slanted toward preventing childhood obesity and its many significant consequences, diabetes and joint problems among them.

As the writer of the piece stressed, it's not the kids fault. We as adults and especially as parents and grandparents need to provide healthy choices and strong roles models. Which is to say, we ourselves are responsible for the epidemic of obesity in our youngsters.

How do I mean that? Well to start with our kids should be given healthy food and see that we also eat those foods. Recently, in two iterations, Lynnette and I hosted young adult children of old friends. Their parents are a doc and a nurse who worked for me in the Air Force. One twenty-two year-old  man came with his college roommate for a six-day stay. His older sister, a senior in medical school, visited here for two days while applying for the local Family Practice residency.

Even more veggies

All three young adults ate everything we suggested, including Brussels sprouts (we microwave or steam them and they're a completely different vegetable than the over-cooked ones I had as a child).

I asked the two whose parents I knew, "How come you are so willing to try different foods?

Both responded, "Our mother, when we were kids, said we had two choices. We could eat what the family was having...or we could starve."

I know their folks and I'm sure they would never have allowed the kids to starve, but  they both got the message. "learn to eat everything."

The author of the Opinion article mentioned that only 26% of adults (this came from a recent Center for Disease Control & Prevention survey) eat three or more veggie servings a day. He added that some of those who claim to match that minimum intake would count a hamburger  topped with a tomato or lettuce as a veggie serving.

That means three quarters of us don't meet that standard. Why? Probably because as kids, we didn't acquire a taste for eating them in the presence of adults who did.

So it's up to us to help our youngsters learn what a healthy diet is. And we better start now, or we're, in a sense, dooming our offspring.

I know those are strong words, but think about what's happening with our children; many of them are eating the wrong things and exercising less than we did as kids. Will their lifespan be shorter?

It's time and past time to set examples.