Archive for the ‘Exercise possibilities’ Category

Which came first: the diabetic chicken, the obese egg or the depressed farmer?

Saturday, February 26th, 2011

The chicken and the egg

My wife is a Mental Health therapist, attended a conference recently & then got an email from the presenter which referred to a study linking diabetes and depression. I got the synopsis from the Web and then went to our local hospital library where I could get a copy of the article. I'll come back to it later, since it was a new twist on the familiar entity .

the depressed farmer

Firstly, in spite of my post's title, this is no joking matter. I found a World Health Organization (WHO) fact sheet dated January 2011 on diabetes: It's a worldwide epidemic with more than 220 million suffering from the disorder and its consequences including an estimated 3.4 million deaths a year. If you're diabetic your chance of dying at a given age is twice that of your peers. If you are diabetic for fifteen years, you have a 2% chance of being blind and a 10% possibility of having severe visual impairment. Ten to twenty percent of diabetics die of kidney failure and then, of course, there's heart disease and stroke and amputations from diabetic vascular disease.

Next I found a medical article with stark  statistics: in 2007 about 2.6% of the US population aged 20-39 had diabetes, 10.8% of those aged 40 to 59 and 23.1% of those over 60. Diabetes and its complications consume 14% of the US health dollar and we're fairly high up there in the list of countries having a significant prevalence of the disease. Lowest on the WHO list was Iceland at 2% and highest was Saudi Arabia with 13+% of those who are 20 to 79 years old being diabetic.

There is a strong correlation between diabetes type 2 & excess weight, especially among women. That association is 80% or higher in Europe, Latin America and North America according to still another article.

And, as you might expect, eating a healthy diet, getting regular physical activity, maintaining a normal body weight and not smoking are the basic of diabetes prevention. By the way, 90% of diabetics around the world have type 2 disease, resulting from the body's ineffective use of insulin.

So what's the new angle? I already knew that half of all diabetics die from cardiovascular diseases, incluing heart attacks and stroke. I didn't know the odds were considerably worse for women with both diabetes and depression. The article I had printed off followed over 55,000 women for ten years (1996-2006) as part of the Nurses' Health Study. There were strong correlations between diabetes and depression in this study performed by researchers from Harvard, the University of Singapore and two English medical schools. Another professor, this one from Indiana, stated that over the past twenty years they'd learned that people with diabetes are twice as likely to suffer from depression as those who don't have the disease.

The Harvard group, in another article, state that death risk is three times as great if a person has both diabetes and depression. The two diseases appear to be linked; the question of antidepressant drugs being associated with an increased risk of diabetes was raised, but causation is unclear at present.

So once more, eat well, stay slim, exercise and be happy; it's good for your health.

You and your not-so-little dog too

Tuesday, February 22nd, 2011

the way for both man & dog to lose weight

The Wall Street Journal has an interesting article about obesity in pets this morning. That made me recall Blue, the fifty pound beagle I once had and, more recently Suzie, a cocker-springer mix who, as she got old clearly needed to diet, and her pack mate Dewawho was jealous of the special foods Suzie got to eat.

I'll come back to them in a bit, but let me return to the article first and the lessons it presents for us both as pet owners and, in some cases, as participants in the epidemic of obesity. Many pets eat "people food" which in itself is a bad idea. The example I read about was a dog that got steak and chicken and ice cream; not surprisingly that dog also became obese.

For pets, as well as for humans, obesity leads to multiple medical problems. One pet insurance company (yes some people do get health insurance on their dogs and cats) paid $25,000,000 in 2010 in claims for pet health problems related to obesity. Another said five of its most expensive insurance claims relate to weight issues.

Okay, lots of us don't own pets (we no longer do), so why does this relate to us?

The problem here is too much of the wrong food and too little exercise. Does that sound familiar?

So now companies are rolling out new low-calorie pet foods and even exercise equipment. The article showed a pet treadmill and a "tread wheel" with prices ranging from $375 to $999.

How about a nice walk instead? And while you're walking your dog, guess what? You too will be burning calories.

One pet resort is offering a contest for owners and their pets to simultaneously lose weight. Another had a "Fit and Spaw" retreat last month. None of these places, I'd bet, are inexpensive.

Somehow the wheels have come off, to use a phrase that comes from a totally different arena.

As a civilization we're eating too much, too frequently, too many of the wrong foods and getting far too little exercise. And guess what, now it's showing in our furry companions.

I seldom walked Blue, didn't do enough physical exercise myself in the days when he was part of the family, and both let him eat, and not infrequently ate myself, too much of the wrong things. With later pets I talked to our veterinarian and started a low-calorie diet that made sense for Suzie, an elderly dog with heart failure. That included carrots instead of dog treats. Her pack mate Dewa, younger and slimmer, wanted some of the carrots too and continued walking with me on a regular basis, including several mountain trails.

While this was happening I got back on the more veggies and fruits trend and pushed my exercise. Now dog-less, but slender, I'm continuing to eat more sensibly and exercise regularly.

So maybe this is a lesson for all of us; some have traditional pets, some have critters that don't fit the paradigm (chubby goldfish?), some of us currently have no pets.

All of us can look at our life patterns; eat less, eat the right things, do more.

I'm over 100

Friday, December 17th, 2010

Well I don't mean I'm that old (actually I'm 69), but I looked at my old posts in the process of extracting tidbits to go into the book I'm working on, Eat like the Doc Does, and realized this would be my 103rd post. On the over hand, if my brain and body hold out, especially the former, living past 100 might be okay.

This man is over 100

There's a Chicken Soup book coming out on December 28th with one of my stories included. The book has the subtitle "Shaping the New You," and is centered on diet and exercise and lifestyle topics. My story is titled "Life Changes." I got ten pre-print copies, kept two for myself and sent eight out to friends, writing mentors, relatives and former graduate students.

When I reflect on the changes I've made in my lifestyle and diet over the past year and a half, I come up with a few simple concepts. I eat less overall and lots more veggies and fruit. I exercise more, usually iding a recumbent bike for an hour and five minutes a day and sometimes hiking or snowshoeing. I fall off the diet wagon from time to time, but always get back on (I weigh twenty-five pounds less today than I did in May of 2009). And finally, I usually think before I eat...not always, but usually.

I came up with an acronym for my weak spots; I've mentioned it before, but will reiterate. it's TABLE, meaning my triggers for overeating and mindless eating come when I'm "ticked off," on "autopilot," "bored," at a "low energy/late night state" or at an "event," loosely defined.

I'm by no means perfect, but my progress keeps evolving. This week my wife identified an area where  I could short-circuit one problem area. I got a new Clancy book and instead of reading until eleven, which is my usual pattern, I stayed up until 12:30 devouring not only the book but also five different snacks.

The next day, after our discussing the issue, I read while I was on the bike and again from ten until eleven PM, then quit. My weight, which had ballooned up two plus pounds, was down three pounds today, back in my acceptable range.

I don't expct this to ever be easy, but I don't intend to be one of the 90% who regain their weight after losing it.

Find your own path and join me. It's time and past time.

Two thirds of us can benefit

Saturday, December 11th, 2010

I just read an article in the Annals of Internal Medicine, the journal published by the American College of Physicians. Although I've been retired since 1998, I still am a Fellow of the ACP and their publication is the only medical journal I subscribe to and read (at least scan) regularly.

Counseling session in progress

This months Annals had a meta-analysis, a review of multiple papers, on the subject of behavioral counselling and its effects on cardiovascular disease. I scanned it and wasn't overwhelmed; then I read it in detail and was highly impressed.

The authors, two physicians, one PhD and a person with a Masters degree in science, reviewed 13,562 abstracts and 481 articles, looking at the effects of low-level, intermediate-intensity and high-intensity counseling that was intended to promote either an increase in physical activity or a healthy diet or both.

They were looking at the effects counseling produced in patients who did not have cardiovascular disease, hypertension, diabetes or abnormal blood lipids. Some did have borderline high blood pressure or other risk factors, most did not.

At first I thought the relatively small results meant that the time wasn't well spent. Blood pressure was reduced in most studies, but not by much; the same was true for lipids.

But there were almost no ill effects (they estimated one heart attack would occur per 1.42 million person-hours of exercise, usually in people who started as couch potatoes.

But the unimpressive decrements in blood pressure, especially in those with borderline BPs to start and the relatively small changes in cholesterol and LDLs, when translated to large population groups, were stunning.

A decreased incidence of coronary heart disease (CHD) of 6 to 16%, 30% in those more at risk, from what seemed a tiny change in BP, was impressive. A 25% decrease in CHD from a 10% decrease in total serum cholesterol was also striking.

Most of these counseling session, of course, especially the more intensive and repetitive ones, would be done by someone other than the physician involved.

But I finished reading the article and said, "Counsel on, nurses and therapists." it certainly seems worth it in both normal-weight and overweight, but not obese people. I'm less sure of the results in that group and they didn't appear to be involved in these research projects.

I had thought that most of us blow off the words directed to us in these kinds of medical encounters. Maybe that's changing and it's about time.

Help your baby; gain less during pregnancy

Friday, August 13th, 2010

A health-conscious blogger friend from Australia, Liana Werner-Gray, was gracious enough to feature this post recently on her own blog, The Earth Diet. Liana's blog was suggested to me by my local friend, Pat Stoltey, an author of two wonderful mystery novels.

Original post Aug 13,2010:
I read an article in "The Wall Street Journal" on August 6th that was a long ways away from my usual areas of interest. But in this case, it caught my attention enough to track back to an article published in "The Lancet" the day befores week and another one an Epidemiology journal from nine years ago.The synopsis of the two articles is that women who gain large amounts of weight during pregnancy have large babies. No surprise there. But large babies often end up as large teenagers.

Why did I do that legwork? Well I'm really concerned about our upcoming generation's weight. Lots of youngsters are overweight; too many are obese and heading for trouble, medical-problem-type trouble, down the line. We can blame TV, lack of exercise, fast foods, fat and sugar-laden processed foods, families that let kids decide what they'll eat from early on...all the usual suspects. But here was an idea I hadn't paid much attention to, do some kids start life with an obesity strike or two against them.

My caveat is this really isn't my turf; I'm an Internal Medicine subspecialist. I've delivered fifty babies, but that's old history. Nonetheless, I wanted to see the data and decide if it stood the test of time.

The 2001 piece was a Finnish study that looked at nearly 4,400 sixteen-year-old twins and tracked their progress from birth. Not surprisingly, adolescents who were tall at birth and had tall parents, were often tall at age sixteen. The group I focused on were those who were of normal birth length, but high birth weight.

That group was much more likely to be overweight at age 16. That fits with a number of other studies that didn't focus on twins.

So there's been some good data indicating high birth weight increases chances of high adolescent weight; the same is true for high adolescent weight foreshadowing high adult weight.

Now how much is nature and how much is nurture isn't clear to me. What makes sense if to re-emphasize to young women that gaining average amounts of weight during pregnancy is important. Too much gained increases the chance of heavy babies, heavy teenagers and, eventually heavy adults.

Our youngsters have enough factors that can contribute to their becoming obese adults; why add one more?

If you're a young person planning to have a baby, discuss this one with your own doctor. The life you improve may be your child's.

More on "What to Eat"

Friday, July 23rd, 2010

I finished Dr. Marion Nestle's book, "What to Eat" some time ago, but got distracted by several other books and articles in various publications I read. Now I'd like to return to her superb volume and make a blanket statement to begin with. I've been concentrating on books, articles and online sources, in the wide field of food, nutrition and dieting for well over a year now and have found and read a number of excellent publications . If you were limited to reading only one book in the area, I'd strongly suggest this one.

That being said, I'd like to devote a few posts to the book and my reactions to it.

Nestle expanded my concept of who benefits from our having an overabundance of food available, and eating much more of it then we should (remember two thirds of Americans are overweight. and half of that group, one third of our total population is obese). So of course the food industry, in all its manifestations, food production, sit-down restaurants and the plethora of fast-food outlets, benefits directly from our overeating.

What I hadn't thought of as collateral beneficiaries were the whole diet industry, our expanding number of health clubs, our pharmaceutical firms and even my colleagues in medicine.

Then there's the stock market angle. A number of those entities I've listed (a list I've obtained from reading Nestle's book) are actually publicly owned and have shares traded on the stock market. As such, my take is they need to demonstrate constant growth, or at least a pattern of growth, to maintain share value.

Nestle also emphasizes changes, over the last thirty years or so, in our eating patterns. We are encouraged to snack from an early age and most of those snacks, unlike my occasional piece of fruit, are empty calories. More calories ingested equals more weight, unless you're also burning more calories.

I'm now six and a half weeks out from back surgery and won't be able to return to our own health club for another ten days. So for now I'm walking, and going a little further each day. Today I walked for seventy-five minutes. I wasn't moving very rapidly and I didn't calculate how many calories I burned. I didn't care really; it was a beautiful morning (I started at 7:45 AM) and I enjoyed the walk. I chose a different route than I've taken in past days and saw some different scenery.

A major part of losing weight is to think about what you're doing when you shop, when you eat and when you chose how to spend your time. I may watch a TV show from time to time, but I'd rather spend the same amount of time exercising.

How about you? What choices do you make in these areas?

Protecting your arteries

Saturday, June 5th, 2010

I read an article in the "Wall Street Journal" dated June 1, 2010. The subtitle was "How to Turn Back
the Clock when your blood vessels grow old before you do" and that really caught my eye. Most of the article wasn't anything new; you can prevent or lessen damage to your arteries by some combination of eating a healthy diet, controlling your weight, sticking the meds your physician gives you for heart or blood pressure and not smoking.

Okay, so I already knew all that and so should you, whether you actually "walk the walk" or just talk about doing so as so many of us do. Over the years I've quit smoking (when I was a third year medical student and saw a cancer patient smoking through his tracheoestomy), decided, progressively,to lose weight (I'm now under 150 pounds consistently, allowing myself to bounce up and down a few pounds; my max weight, many years ago was 218), eaten a more healthy diet (just got a notice from our local CSA that our weekly "couples veggie share" and "fruit share" will start on the 14th and made sure my blood pressure was controlled

The striking data here appeared in the journal "Circulation" last August, co-authored by a professor of preventive cardiology at Northwestern. Men and women, in his study, who followed the precepts I've mentioned above, could have arteries that were equivalent to those of people 14 to 21 years younger. The flip side was certainly true also. A 35-year-old man who does the exact opposite (smokes, doesn't exercise, has diabetes (probably Type 2 and obesity related) and abnormal cholesterol levels), may have arteries equivalent to those of a 76-year-old.

Your heart, if your resting heart rate is ~70, beats about 100,000 times a day; every time it does so it exposes your arteries to wear and tear. So I had an EKG done last week. My resting heart rate is 53, down from higher levels before I started to exercise regularly. There were no signs of heart damage on the cardiogram and my own personal physician said a while back, "Peter, you've gradually increased your exercise level over the years; now you're doing the equivalent of a stress test every day."

I think I'm on the right track, but I spent time yesterday with a friend whose belly overflowed his belt buckle. I mentioned that I thought he might want to read my blog and he said, "I weighed 174 in high school and I'm only at 185 now."

The problem is where the weight is distributed. Many of us had more muscle mass and less belly fat in high school. We may weigh the same, or nearly so, but still be at considerable risk for heart disease and other blood vessel problems.

I've taken four and a half inches off my waist measurement; is it time for you to do the same?

Paying more for your soft drinks?

Friday, May 28th, 2010

I read two articles on the topic of new taxes recently, in this case taxes on soft drinks, teas and sports drinks.  The lawmakers are, of course, not just interested in our health; they need to "plug budget gaps," as one of the newspapers commented, or pay for new programs, including health initiatives. About thirty states are taxing sodas already, including my home state (for the past eleven years as of the 31st) of Colorado.

As expected the makers and sellers of these beverages don't think it's a good idea at all and the sum the American beverage Association spent on lobbying went from $668,000 in 2008 to $18.9 million in 2009 to $5.4 million in the first quarter of 2010. A large part of that went toward fighting off the new taxes.

I drink one diet soda a day and don't mind paying the extra two cents on twelve ounces that has been proposed. I see youngsters in our health club chugging down large amounts of sports drinks every day (I'm there six or seven days a week) and frequently mixing in "muscle-building" powders.

I've looked back over some of the medical literature on my diet soda and there's a controversy as to adverse effects even there. But the question is clearly unresolved, so for now I'll stick to my one-a-day routine.

Otherwise I have a great idea for you: drink water, preferably not from small plastic bottles, maybe filtered if your local water is of concern. I just bought a half-dozen limes (oh my, the price has gone up!) and used my lime squeezer to make a one-quart glass of lime water. It was sitting on a coaster beside my mouse pad as I wrote this. I use the past tense because I just finished the glassful.

I don't think the sports drinks, the muscle-building powders, the sugary sodas make much sense, especially when they come in potentially (and I say that without a great deal of data to support the statement) hazardous little plastic bottles that won't compost or disintegrate for many centuries. I'd prefer to hydrate the old fashioned way, with water.

Now for a period of five years when I headed a section of our largest Air Force hospital, the section that interfaced with the base itself and, among other things, had a troop clinic for basic trainees and others to get their first-line medical care, I really liked a particular sports drink. When kids from the north came to Texas in the summer for Air Force Basic training, the frequently got dehydated, lost not only water in their swaet, but electrolytes as well. Those young folk did very well with a sports drink as a first step in rehydration. But even they acclimated after a short time (three to four weeks) and water sufficed thereafter.

So my bottom line is here's one tax I'm in favor of.  If you're working hard in hot weather you may need some electrolyte-containing fluid, for a while. Otherwise, drink more water.

Getting help in remembering to exercise

Tuesday, May 18th, 2010

I read an interesting article this morning. A study conducted by researchers at Stanford using subjects averaging in their mid 50s and previously inactive showed the importance of social support in helping people develop and maintain an exercise regime. The project followed adults, with an average age in their mid 50s, for a year and showed that people who got phone calls, even monthly ones,  from a health educator markedly increased their time spent exercising. That's compared to a group who only got initial health education classes. Even automated phone calls work, but a human touch was best. Those new and improved health habits held at the 18-month followup.

There were other bits of information I gl.eaned: the majority of people, like me, prefer to exercise alone. My wife participates in four exercise classes a week; I don't join her in any of those. I often think my way through issues as I exercise (especially during the 65 minutes I spend almost every dayon a recumbent bike), zoning out and working through issues or just allowing thoughts to come up as they will.

The Stanford lead investigator, Dr. Abby King is a PhD professor of Epidemiology and Medicine at Stanford's Prevention School of Medicine Research whose major research study relates to the role of physical activity as it links to other healthy behaviors and promotes improvements in life-coping mechanisms. She herself usually is a loner when it comes to exercise, but sometimes drips out for a period of weeks and then tends to join a small class to get back into her usual pattern.

What I take from this is if you don't find it easy to get into a pattern of regular exercise, find a buddy who will call you from time to time. Most of us will never end up in a formal research project like Dr. King's; almost all of us could help a friend and be helped in return.

Lynnette was just on the phone calling her another woman who is in the twice-weekly "Strong Women, Strong Bones" class she takes. She's developed a brand new, close friendship through this class, frequently has a cup of coffee afterward with her exercise buddy and the two of us, from time to time, go to dinner with her friend and that woman's husband.

As we age, I think social support is crucial and, if friends can help us stay in shape, maybe lose a few pounds or keep those off we've lost already, they have even more value in our lives.

So find an exercise buddy or even someone who'll help you keep working out, whether you walk together, go to a gym together or just make phone calls to support each other's good habits.

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.