Posts Tagged ‘Exercise’

Ditch fad diets; use common sense instead

Monday, September 16th, 2013

When I returned home on September ninth from a twenty-eight-day trip, I found stacks of mail, magazines and newspapers plus about 650 emails to wade through. Most got short shrift and the old papers were pitched. But then I found four editions of JAMA and started reading selected articles. Over the years I've deplored the menagerie of fad diets that have been described, advertised and exploited for profit.

You don't have to weigh and measure each time you eat a pea

You don't have to weigh and measure each time you eat a pea

So coming upon a Viewpoint piece in the Aug 21, 2013 edition, I read with intense interest  "A Call for an end to the Diet Debates." The pair of PhDs who authored the two-page discussion, Sherry L. Pagoto and Bradley M. Appelhans, are both academics, serving on the faculty of major medical schools. They commented on the host of studies and four recent meta-analyses that have reviewed the results of a variety of diets varying the amount of protein, carbohydrates and fats one is allowed.

Their conclusion is they don't differ in their results in any significant way and that sticking to a diet and adding exercise is what counts.

There's a second comment that was striking: in spite of markedly increased percentages of US adults being overweight or obese, the chances of their getting any counseling on the issue when they see their primary care physician have fallen. Researchers from the Penn State College of Medicine published an article in February of this year titled "A silent response to the obesity epidemic: decline in US physician weight counseling." The National Center for Biotechnology, a National Library of Medicine section, published a short version of this study comparing outpatient visits in 1995-1996 to those in 2007-2008 (the most recent data available from an ongoing national ambulatory medical care survey).

What I think this means is that we still don't pay physicians enough for preventive medicine interventions; we pay much more for procedures, what I think of as "Catch-up Medicine."

Over the past forty-seven years, ever since I graduated from medical school in 1966, I've seen a host of fad diets come and go. The Rice Diet, invented at Duke where I served as an intern and resident, is still around, but was originally utilized as a very-low-protein approach for patents with severe kidney disease. Since then we've seen high protein, low protein, several that focus on carbohydrates, and, this year, in a blog from a Phoenix newspaper, an entertaining look at "5 Fad Diets to Avoid in 2013."

Those include: a gluten-free diet (reasonable only for those who actually have been diagnosed, preferably by an experienced physician, as having gluten intolerance); the Dukan Diet (I'll supply a link to the WebMD review of this French approach), essentially a high-protein and limited calorie approach that may work short-term, but doesn't supply a balanced diet for the years to come; the alkaline diet (here's another review from WebMD) which claims to alter your blood pH, which is nonsense, but basically is a fresh fruit and vegetable plus hydration approach which in itself isn't unreasonable for those who don't have kidney disease or severe diabetes. But the components of this diet can easily be purchased in your supermarket and therefore don't need to be obtained through a website; the HCG diet, dangerously restrictive in calories and supplying a hormone that ought to be used only by a physician's prescription, usually for fertility issues (here's a Mayo Clinic review that says the diet dangerous); and finally, the beef tapeworm diet where some go over our southern border and actually pay to be infected with a parasitic disease. I don't feel the need to even comment on the logic of that approach.

So what does make sense to me is, as always, eating less and doing more.

Of course that's not as easy as it sounds. Some of my previous posts have alluded to the ways I've made this work for me, but you may or may not find them to fit your own lifestyle.

Use a good scale, but it doesn't have to be this fancy.

Use a good scale, but it doesn't have to be this fancy.

So I'd suggest the following: 1). Don't fall for the expensive fad diet ploy; eat in whatever pattern suits you (three meals a day is my habitual approach, but I sometimes eat two with a medium-sized brunch in anticipation of an evening event that includes food in abundance), but avoid snacking and late evening binges; 2) Eat balanced meals with more fruits and vegetables and less (or no) red meat than is typical for many Americans; 3). Find a form of exercise that you're comfortable with and do it almost every day (We walk an hour a day and I spend another hour or often two in the gym six days a week; that may not work for you, especially if you have a full-time job.); 4). Don't beat yourself up when you fall off your eating and exercise (figurative) bike, but get back on it ASAP. 5). Weigh yourself daily on a good scale, at the same time of day, wearing nothing (or as little as possible) and keep a record of your weight. 6). Don't expect to lose twenty-five pounds in a few weeks. If you did that, my bet is you'd gain it all back in a year. Aim for a pound a week.

I took my eating plan, which I first decided on in 1996 or 1997, and really started using in early 2009, and wrote down all of the ideas and some recipes my wife added; I ended up with a 50,000 word book that I may eventually try to polish enough to publish. There are a number of specifics that I've added to the six basics concepts in the paragraph above, but I'll mention those at another time.

I still occasionally struggle with one aspect of my eating plan; late-night reading can be a prelude to minor binging. And events with food are another potential minefield. But I've managed to get back to my diet whenever I'm above what I consider to be my acceptable range.

So I have four by six inch cards that tell me: "Don"t snack at events."

I'll bring one along tonight when I go to a writers' meeting; there will be two speakers, but someone is bound to have lots of snacks for the group.

I don't plan to eat them.

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.


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


They're finally here!

Tuesday, February 1st, 2011

I woke up at 6:30 AM this morning and weighed myself: 149.6 pounds, right in the middle of my goal weight.  I've been working on my life style changes, more exercise and less food, since May 2009 and, although I bounce up and down 2-3 pounds, I'm basically lean.

Breakfast was a quart of "lime water" (I squeeze fresh limes three times a day), a cup of regular coffee for Lynnette and of Cafix for me (a blend of barley, rye, chicory and sugar beets; I avoid caffeine), a banana and a home-made oatmeal dish with millet, brown sugar, sunflower seeds, walnuts, and ground flaxseed to complement the commercial oatmeal. There's no salt in any of the above and we added fat-free milk (Lynnette) or soy milk (Peter) to our oatmeal. We'll eat our big meal of the day at noon and at home.

The Wall Street Journal's Personal Journal section had an article titled "New Dietary Guidelines: Less Food, Less TV." The June 2010 DGAC version from the advisory committee of sceintists and nutrition experts had gone through the expected round of commentary, largely from food indusrty sources and the final products, as always is considerably watered down. You can find it online at if you want to read the entire document, or skim through portions.

So here's a section of what it says:

• Reduce daily sodium intake to less than 2,300 milligrams (mg) and further reduce intake to 1,500 mg among persons who are 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease. The 1,500 mg recommendation applies to about half of the U.S. population, including children, and the majority of adults.

• Consume less than 10 percent of calories from saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids. • Limit the consumption of foods that contain refined grains, especiallyrefined grain foods that contain solid fats, added sugars, and sodium.

How do we translate that into simple English? More than 1/2 your plateful should be vegetables and fruits, buy lower salt products and don't add any when you cook or at the table; eat less red meat. Eat real food, not food products; read labels carefully when you shop. I'd add: eat out less and exercise more.

I read Dr, David Katz's column, "New Dietary Guidelines: A Physician's Perspective" on the website (Katz is the Director of Yale's Prevention Research Center). He agrees that the feedback gave a politicized spin to the final document, but liked the new emphasis on obesity and chronic disease prevention (roughly 1/6 of our kids and 1/3 of our adults are obese). He didn't care as much for the continued emphasis on dairy and meat consumption with less attention paid to plant-based diets.

So this version of the Dietary Guidelines isn't all that much different from prior versions, unless you read carefully and, in some cases, between the lines. I found a section (Chapter one, page 3) on "The Heavy Toll of Diet-related Chronic Diseases that I'll comment on at another time.