Friday, December 26, 2008

wellness weekly

Treating Pain: The article I read for the blog is about rebound headaches and the like from over reliance or over use of pain medications in regards to treating migraines. It can be said of pain medications in general however. Many people rely on pills instead of ice, heat or physical therapy to treat pain and for some issues that can prolong the pain instead of ameliorating it. With regard to migraines there is not a lot of literature on prevention but of avoiding triggers. These can include certain foods and stress. There are medications that work to halt the migraine and though they have side effects, they are right for some people. The caution on rebound headaches, whether from over the counter or prescription meds is highest with narcotics and barbiturates. For muscle and joint pain, there is treatment outside of medications and that might be a wiser first action.
Drug Combo Dangers: Never one to overlook news on medications because I DO feel they are over used and misused, I read this week about a concern of poly pharmacotherapy with the 57-85 year old age group. (isn’t that an odd age range?) Anyway, it was found by the University of Chicago, that 50 % of that age group takes at least five medications on a daily basis. There are some medicines, especially noted in this research, that increase the risk of bleeding. Excess bleeding or thin blood can interfere with clotting. The problem is exacerbated by over the counter medications and supplements. Only 4 % of the study group did take drugs in combinations that were alarming, but if your one of them or love someone who is, the percent doesn’t matter. It is the doctors, pharmacists and patients responsibility to share information on ALL meds taken. Interestingly, one of the supplements that was taken by a large number of persons was Ginkgo biloba which we know was recently found ineffective in preventing memory loss. Taking an aspirin a day which is often recommended to persons over 50 becomes an issue when persons take supplements that also thin blood. Keep the lines of communication open, but also, try to get nutrients in your food where it is most generally considered safe. (ironically though, people on coumadin for example also have to watch what they eat).
Mega Nutrition: At the local farmer’s market last weekend I purchased a bunch of swiss chard. I also bought canned pumpkin last week and have made many dishes with both since then. I like to use the USDA nutrient website to see what is in my foods and WOW, both of these are jam packed with vitamins that can help our immune systems and our antioxidant activity. A tasty pumpkin spread I make includes plain canned pumpkin, fat free cream cheese, splenda, cinnamon and ground cloves. A delicious swiss chard side dish can be made by simply roasting the chard (stem first, leaves later) with garlic and parmesan cheese. (no cream, no oil needed). Calcium, iron, vitamin C, A, K and more can be found in abundance in the chard. (vitamin K can affect the INR of someone on coumadin). Pumpkin is great for potassium and beta carotene and vitamin A. Both of these are very low in calories, so if you remember the Volumetrics lessons, these are low density foods.
Lung Protection: I read this report of a research study with some ambivalence. The study found that a certain gene, when expressed, was protective for COPD. Chronic Obstructive Pulmonary Disease includes chronic bronchitis and emphysema. COPD is a killer and the majority who die from it are smokers. COPD can also be triggered by air pollution. The gene in question, which may also protect against lung cancer, is called Nrf2. It actually turns on other genes which do the work. The work is cleaning up the damage. This is where antioxidants can clear free radical residue and reduce inflammation and disease or as the makers of CDDO-lm hope, detoxify the harmful particulates. My concern is that people might think that this drug, once developed, could be something to take in order to keep smoking. Also, it could be used as a way to limit clear air measures by alleging to obviate them. Pollution and cigarette smoke do more than damage the lungs and I hope people do not consider this potential drug to be a panacea.
Diet Danger: Probably the things I speak out against the most are tobacco, pills and diets. An FDA alert gives me the opportunity to speak against two at once. The FDA recently reviewed some weight loss products that are for sale on the internet. These substances do not have to be approved by the FDA because they are not medications, but they have to answer to the FDA if they are caught doing inappropriate things, such as having medications in them and or causing adverse health events. The companies have restrictions on what they can advertise as well. Some products reviewed are contaminated, some have cancer causing agents in them and some have medications that have been found to cause adverse health outcomes. My thought though is that people want so badly to take a pill and lose weight that they will take these unproven and often dangerous concoctions at their own peril. These same desperate persons will not eat well and move more and I do not understand why this is so.
CHF: Chronic Heart Failure kills 300,000 persons a year according to an article I read this week. I am used to telling people that smoking kills 438,000 a year and I think that is a staggering number, so too, I was shocked by the CHF number. In that article the lifestyle factors associated with CHF were noted to include being overweight and not exercising enough. It is the end of the year and many people may start 2009 with a desire to improve their health and their active longevity. To do so, again I say, eat well, move more.

Happy Weekend.

Ps. My sister made an awesome Christmas meal for us and our dessert was fruit kabobs, with a yogurt based sauce. REALLY fresh fruit on a stick, strawberry, grapes and apples. Is that creative or what?!?

Saturday, December 20, 2008

Wellness Weekly

Time for another entry and I feel like I have not read as much about health and wellness this week or at least I have not read anything thoroughly. A few highlights or thoughts then.

Caffeine and Alcohol: Not a good idea really especially as drinks that combine them are often marketed to young adults who mistakenly think that they can consume more alcohol without having their wits affected because the caffeine makes them feel alert. And so this week MillersCoors has agreed to stop selling the drinks, called SPARKS though they deny any intent to encourage under age drinking. Or they may still sell SPARKS but change the ingredients.
Exercise and Energy: It has been said by experts and repeated by me, that exercising will actually increase your energy level. It is a hard concept to sell to people who feel tired most of the time, but lack of cardiovascular exercise could be the very cause of their lethargy. And this week we can add my anecdotal contribution to the research. I, when the gods are for me and the stars align perfectly, exercise nearly seven days a week and accumulate 40 miles of running along with a few other activities. Neither has been the case since October and besides feeling quite out of sorts (emotionally, mentally, physically and socially) I am TIRED! It especially hit me yesterday when I started out on a four mile run, my second run of the week. (the old me would have been on my third or fourth six mile run) and I felt sluggish, tired, weak. Geez I thought, you’d think I’d be refreshed but instead I was beat. I felt much better at the end of course and then got up early and rode my bike this morning as not exercising is clearly not the answer to my woes.
Smokeless Tobacco: My knowledge is growing in this area but no where near complete. Still, it helps to repeat what I read or hear so that it gets into my long term memory. And for that, I thank you faithful blog reader! So, recently it came to my attention that most oral cancer is NOT caused by smokeless tobacco products but by cigarettes. The carcinogens are in the smoke and of course the smoke does pass through the mouth on its way to the lungs where it does the most of its damage. That being said, though smoking causes oral cancer, smokeless tobacco does not cause lung cancer. There are carcinogens in chew, spit, snuff and snus but at varying levels by product. In fact, most of the tobacco available today is lower in carcinogens than the tobacco used in research which connected the product to oral cancer. Of course, there is still plenty of nicotine which may increase heart disease risk and either nicotine and or tobacco specific nitrosamines are correlated to pancreatic cancer as well. I learned at a workshop yesterday that smokeless tobacco products are not made the same way. A product called snus and originally from Sweden is a fine ground oral tobacco as is our Skoal and Copenhagen snuff . Both are called moist but made so differently. Snus are made through a pasteurization process but our products are fermented. The tobacco has to be processed this way to kill microbes. Any ways, the traditional American made product actually has more carcinogens to begin with and while the cans sit on shelves for sale more are created. I know a tobacco treatment expert who supports or at least doesn’t object to the sale and use of Snus as an alternative to smoking. He said that the absolutely worst thing a person can do is light anything and inhale it. However, smokeless tobacco products do contribute significantly to oral disease. And though tooth loss does not equate to lung cancer, it is still something that can be avoided. Also from smokeless tobacco comes gingival recession, bad breath, lesions that can become cancerous and poor oral treatment outcomes.
Sweetener Goes Mainstream: A sweetener that has been available for sale at Whole Foods for some years now and which is said to be calorie free and containing fiber, (it is made from an herb or plant), is now approved to be used as an additive. What does that mean for you? That soon sodas and perhaps foods will have this as the sugar free, calorie free sweetener instead of aspartame, saccharin or splenda. I wonder how long until someone sends an email about how Stevia will kill us. The only reason I kept using other sugar free products when I first heard about Stevia is because sold as a “sugar” it is very expensive. I wonder if this price difference will be reflected in our sodas and such. Be ready though, Pepsi and Coke have products ready and the first you may see is a new Sobe Lite.
Oatmeal: Just briefly, I see that some of our dining chains, like smoothie shops and maybe Starbucks are going to be offering oatmeal. The reason is because it is warm, filling, cheap and shouts, heart healthy. That being said, if nutrition info is available where ever you are inclined to buy this oatmeal do yourself a favor and check it out. It is very possible that your oatmeal could contain the same fat and calories as a donut by the time Starbucks gets through with it.

Okay I got a load of vegetables at the farmer’s market this morning and think I will go slice, dice and bake….

PS I asked Santa for a little camcorder and even if I happen to be the after Christmas Santa, I do think I will get one so that I can upload videos of some of my cooking techniques in the New Year.

PSS We do not gain so much wait on Thanksgiving and Christmas indulgence as we do by eating our way FROM Thanksgiving to Christmas… so slow down already.

Saturday, December 13, 2008

Wellness Weekly

Healthier Life Steps: Part of my job as a tobacco educator is to present information on treating tobacco dependence to health care providers. For many years, ten or more, there has been in place a clinical, best practice guideline for doing so. It is unfortunate that many providers are still unawares of what is referred to as the 5 As. I bring this up today because the AMA has come out with a similar strategy for identifying and addressing, let me repeat that, addressing, risk factors for disease in the patient. The four targeted behaviors are healthy eating, physical activity, reduced drinking and smoking cessation. The AMA has a survey that the patient would complete in the waiting room which the doctor and nurse could refer to during the visit. The clinical guidelines include handouts and a website. In case you are thinking that your weight or inactivity is not a problem because your doctor hasn’t mentioned it recently (or ever), this should disavow you of that notion. Instead, your health care provider may be uncomfortable addressing the issue.
Family yes, but genes or tradition? We tend to carry weights similar to that of our families, especially if we are isolated. People often assume that it is predestined, a matter of genes if you will. I wholeheartedly agree with Dr. Oz and his ilk. Genes are only about 25% of the issue. What you DO with those genes is really the determinate of weight and health in the long run. This week a research study supports that family lifestyle has at least the same impact on obesity as genes do. Individual behavior would of course have the greatest impact. In the Journal of Sociology, lead author Molly Martin stresses the importance of regular meals and physical activity as protective. A lot of times people, for fear of failure or fear of effort, accept an unhealthy weight as genetic or familial. This is a deadly acquiescence. When people point out my low weight and believe me THEY DO, I take the opportunity to promote the concept by saying, “It is NOT genetic.” It isn’t, there are some heavy people in my family.
Fish Mercury in Doubt? Long time readers are aware of my passion on this issue and my effort to stay on top of the good fish bad fish dilemma. Thus, I am perplexed about a recent headline, recent as in yesterday, regarding the FDAs stand on fish consumption. The official recommendations have not changed; the current issue is rather a political controversy with the EPA and FDA at odds with each other. Most of the mercury in fish is a consequence of coal fired power plant emissions so that makes me suspect the FDAs wavering as well. With the change in administrations approaching and clean coal and cap and trade back on the table, wouldn’t it be nice if methyl mercury didn’t hurt us after all? Fish is a good food for brain and hearts, but please do educate yourself on which fish have the highest levels of mercury and avoid them. (ps, the article I read didn’t mention coal at all, that is info I absorbed in graduate study)
Breast Cancer Test: Yesterday in Texas, a researcher reported that a gene test was more accurate in identifying women at high risk for breast cancer than the model that physicians have been using for some years. The problem is that it is one of five gene tests on the market that have not been approved by the FDA.(there is no current rule that the FDA has to vet them for efficacy) Most oncologists feel that genetic testing, especially direct to consumer, is more likely to cause fear than save lives. There is significant concern that tests like these will lead people into unnecessary surgeries and amputations. There is also concern that people will rely on tests and not take the advice that is offered for prevention of disease, including many cancers. That advice should be common knowledge to you now, but I will happily reiterate. To protect yourself, to control what you can, it is recommended by the ACS, the ALA, the AHA, the ADA, the AMA, and the DHHS, for starters, that people not use tobacco, refrain from excess alcohol use, move(their bodies) EVERY day, maintain a healthy weight and eat a low fat diet high in fiber, fruits and veggies.
Colonoscopy Alert: As I continue to dread turning fifty (ahem.. many years from now) and having to have one of these, more scary news is released. Apparently the two common bowel clearing medications prescribed to patients prior to the exam may damage the kidneys. There is a black box warning on the two sodium phosphate products and certain groups should use them with caution. One of which is people over 55, you know, the ones getting the colonoscopies. From an article regarding this, I want to point out that over the counter bowel cleansing products, (not regular laxatives) may also cause harm and may be under investigation. PLEASE do not consider bowel cleansing a safe activity. Eat more fiber and drink water. Anyways, colonoscopies can be life saving and colon cancer is a serious threat in this country. I do hope though, that this news might encourage insurance companies to promote the non invasive colon cancer screen that is available. Also note that there are other bowel cleansing products that can be prescribed or given for the colonoscopy that do not come with a black box warning.
MEDS: Ugh. I am already anti pill, and a WSJ article worth reading yourselves, only enforces my belief that we do NOT know nearly enough about the pills we take to trust them as we do. Unfortunately, those that prescribe the medications do not know the full story on whether they are effective and whether or not they are harmful either. That is not usually their fault, but the fault of drug companies who do not release ALL of their clinical data. New rules have been established and websites are in place to have all research reported but even then who is going to cull those reports and assuage our fears. I think it may be agencies like Public Citizen and Center for Science in the Public Interest. The article by Robert Lee Hotz is in yesterday’s journal. BTW, I was reading an article on a medication or treatment the other day at work and recall being really stymied by this research conclusion “it is more effective than placebo.” What does that mean, this worked better than not doing anything? Well, how MUCH better and at what cost? Saying something is better than nothing, oh and hey, could damage the kidneys, well that my friends, is a problem.
PRICES: Last note because it really pissed me off. At the store I noticed that regular highly processed snack cakes cost 1$ and the equally processed but 100 calorie kind, cost 2.50$ or 3$ for the same amount depending on brand. Food in boxes is generally not healthy, but sometimes we do want that processed sweet and right or wrong, many parents buy these snacks for their kids. Which one, especially in this economy, are they going to buy? The price difference is such bullshit.

Speaking of snacks……. I am due for one……… later…

Happy Weekend
Don’t smoke!
Eat Well
Move more

Saturday, December 6, 2008

Wellness Weekly

The Brain: I took note of a researcher’s recommendation while reading an article about the aging brain. The study was in regards to loss of attention, distraction and remembering. The science community is a bit concerned about the depth of this problem when baby boomers, as they are now, start turning 65 and older. It is expected that in the year 2050 the largest age group will be those over 65. Interesting. If they age well this could be good, though it is not expected that the majority will. My notes were that the brain can be protected if its host stimulates it with mental challenges, like learning new things or doing cross word puzzles and by exercising and eating food that is nutrient but not calorie dense. Sounds like a hell of a motivator to me.
Alcohol: Quick regurgitation here. Research states that women who have more than two drinks a day significantly increase their chance of having the type of irregular heart beat that can lead to stroke. It did not say that drinking was bad, it said that too many drinks is bad. Please recall serving sizes for alcohol. Wine is 4 ounces, beer is 12 and liquor is 1.5. Measure your drinks if you have to. Your life may depend on it. (by the way, saving your one to two drinks a day for one or two weekend days, NOT RECOMMENDED)
Tobacco and Pregnancy: I read a few things on this topic in the past week, some new, some older. First, it is a fact according to our US Surgeon General’s reports, that maternal smoking and exposure to second hand smoke can lead to low birth weight babies. It is also true by research, that low birth weight babies are 20 to 25% more likely to die in the first years of life than normal weight babies. In regards to poor birth outcomes it is also said that the mother’s weight is a factor. An overweight or obese mother has twice the chance of an adverse pregnancy outcome than an underweight mother. In regards to tobacco use again, very new research which should be tested through repetition, has shown that the adult children of mothers who smoked or who were exposed to significant amounts of second hand smoke, have artery changes indicative of heart disease. When you add that to the fact that many of those children were sedentary and overweight as well, the assertion that the generation will not live longer than the one before seems to gain credence.
Assistive Devices: The WSJ had a feature this week on devices that may make it easier for those baby boomers to age in place, in their homes, even though they may have some physical limitations as they get older. There were some interesting items and appliances in the works, however, the note I wrote regarded Moen’s special grab bars that will hold the weight of a 350 pound person. Now they would not be spending the money to make these special grab bars if they did not think there was a market for them. Pretty much I don’t know of many people who could be considered at a healthy weight if they were more than 200 pounds at any height, so that pretty much sums up a lot of our problems doesn’t it.
5210: This was explained to me in passing (ok, it wasn’t really in passing, it was while I was having my two beers and I wasn’t taking notes) so I may not get it just right. There is a right way as it is a campaign by one of our respected health and wellness agencies. The gist is that we should strive, on a daily basis, to have 5 fruits and vegetables, no more than 2 hours of screen time, at least 1 hour of physical activity and 0 sugary drinks. Pretty neat.

Happy Weekend
Don’t smoke!
Eat Well
Move more

Saturday, November 29, 2008

Wellness Weekly

General Motors: As Americans we are reluctant to make changes that will improve our health. I do not know why this is so, and yet it is. Americans do not like hard. Americans like to have their cake and pie and chips and dip and eat and eat and eat them too. Respected scientists and physicians like Dr. Willett, as well as popular ones, like Dr. Oz, will tell us that it is about eating well and moving more, but even our heros we do not believe or if we believe, we do not follow. We root for the drug companies and the scientists who study obesity in search of the “I can eat what ever I want and do nothing pill.” Instead, we adopt healthy behaviors sometimes because we have no choice and I admit that the more I study this issue the more I believe that is necessary. You know, you can’t eat trans fats if they stop putting them in your food and you are more likely to quit tobacco if it is illegal to purchase. Along these lines, you are more likely to take the stairs at General Motors if they turn OFF the escalator. Seriously. During certain shifts they are turning it off to save money. Lord how I love it. Obviously we have handicap issues, and it is not my intent to overlook that, just to make a point that the company will do something to save money that might coincidently save a life. See below for more.
McDonalds: The economic crisis is also affecting portion sizes when we eat out. I have already mentioned this irony. Last week though, McDonald’s made another move. They have taken there regular double cheeseburger off the value menu and replaced it with a burger that only has one piece of cheese. That cost saving trick will shave off more than 100 calories.
CEOS: The Wall St Journal recently facilitated a meeting of top CEOs regarding the problems that face our country. With regard to health care, this panel was united in claiming that our number one problem was obesity. Not lack of health care or health insurance, though they were on the list, but of utmost concern was this apparent epidemic of a controllable risk factor that leads to preventable but dire outcomes. How is it controllable? Again, due to what one eats and what one does. You can blame you genes if you want to, but not matter what your genes are programmed to do, you have a brain and you have choices. If you are prone to put on weight just by looking at certain foods, well, that SUCKS, and you have to work harder than those who do not have that genetic make up. If you want to be healthy then you will choose that option. The CEO panel stated that in America we spend more than any other country and have worse outcomes. They also stated that the three best strategies for increasing our longevity and active aging are to ban tobacco, list nutrition info and educate on weight and health. AMEN. I am trying in my small way to do just that.
Melamine: We have found traces of melamine in our infant formula. Some people are outraged and demanding that the formula be removed from shelves. Some are telling us that the amount found is so minute as not to be harmful. The FDA in fact is not making a recall. I just find it enlightening that we would become incensed over one chemical and immune to the fact that cigarettes, when lit, contain about 4000 chemicals including green house gases, toxic metals and carcinogens. What is UP with THAT?
Tar etc: Speaking of tobacco. The claim that a cigarette is low in tar and or nicotine is no longer an option according to the FTC. The machines that test these levels are not accurate, which has been true and known for sometime. People and robots do not hold the cigarette nor inhale it in the same manner. And though the FDA may tell you there is a safe level of melamine, they are NOT telling you that there is a safe level of tar. There is not. Tar coats lungs and causes emphysema and chronic bronchitis. It is found in second hand smoke as well and can affect the lung development of children… there is no safe cigarette nor is there ANY safe level of cigarette smoke and it does NOT matter who is holding the cigarette.

Happy Weekend
Don’t smoke!
Eat Well
Move more

Saturday, November 22, 2008

Wellness Weekly

What Drug Companies Do: Well, they aim to make money and never have I seen this clearer than while reading an article in the WSJ this week. The article, by Jonathon Rockoff, discusses plans by Cephalon as it braces for a generic version of its narcolepsy drug Provigil. Narcolepsy is a sleep disorder. Provigil is sometimes misused by people who need an artificial means to feel rested and alert. Cephalon is only able to market it for narcolepsy, sleep apnea and shift-work sleep disorder. Anyway, the patent is about to expire and people who use Provigil would likely switch to the less expensive drug. I am not someone who thinks that generics are second class drugs, I think that they can be a bargain and if no contraindication exists, a better option for the over prescribed public. Anyhoo, if a company changes something in their drug to make it, longer lasting for instance (that happens A LOT) then they can get a new patent. Cephalon is indeed making a longer lasting version which they call Nuvigil. Patients are being switched to it now and it costs less than Provigil. When the generic comes out people will likely stay on Nuvigil. So instead of losing all the revenue they are losing a smaller percentage.
Tri’s: No not triathlons, triglycerides. A cardiologist/researcher speaking at an American Heart Association meeting this week reported on a review of the literature from several decades of NHANES statistics. What is noted is a drop in the numbers of persons who have high bad cholesterol, probably due to more low fat eating and definitely more medication. What was not so good is that the numbers of persons who have high triglyceride levels has really gone up. It is important that people lower the amount of fat or triglycerides in their blood. Dr. Cohen is concerned about the staggering rates of overweight and obesity in this country and was quoted in this article, saying, “….it’s weight loss, weight loss, weight loss.” He said exactly what I say every week, move more, eat better, and eat less. He also noted that our pill popping had reached its limits.
Memory: Results from a multi state multi year research project on Ginkgo Biloba has ended. The supplement was not found to enhance memory or prevent memory loss. The scientists involved advise that taking it for such an effect would be a waste of money. I just wanted to mention this study because my dad was part of it. Sometimes when you read the actual journal articles on these studies you can see how they break people into study and control groups. Also the authors will explain how many people got the pills versus placebo, what the drop out rate was and about adverse events. Sometimes it will say that a person died of a heart attack and that it was not considered to be from the study medication. I just wanted to note that because my Dad was such a person. He was very excited about being in the study though. I was his proxy or something. They asked him memory questions and separately asked me the same ones so they would be able to ask again later and see if he retained true memories, etc. I also remember that I had to turn in all the study medicine when he died. I do not know if he had the supplement or placebo. I do know this, he was pretty damn sharp for an eighty year old and now, my mom is too.
Cholesterol: Some members of my family have high bad cholesterol. Most of them are like me and do not want to take medications, especially not as a first line response. Well truthfully, one is like me, one is stubborn and won’t go to the doctor and the other takes the pills. One member has lost weight and exercises regularly but her LDL did not come down. That sent me looking for research on diet and cholesterol as compared to statins. Her doctor mentioned fish oil supplements and I thought that though fish oil helps with inflammation it is not usually recommended for cholesterol lowering. I also think that for some people the statin may be necessary, I mean, it beats a heart attack. Good news from a 2003 study may help my medicine adverse family member. Eating a low fat diet with certain specific cholesterol lowering foods did match the effect of a statin drug in the study group. Foods include fiber, plant sterols, soy and phytochemicals. Oh yes, the diet included almonds. Also, in the study everyone ate six times a day……… Yes SIR.

It is cold here in the South, but the sun is bright and it is the Weekend

Be Well

Saturday, November 15, 2008

Wellness Weekly

CRP: Yes this is still in the news and I am continuing to try to wrap my mind around it all. To help, there was an NPR show this week that had the lead researcher from the JUPITER study as well as a physician who was not involved in the study. I also read a WSJ on the article and the actual journal with the research results. To review. Two indicators for heart disease risk and risk of heart attack or stroke are cholesterol levels and levels of inflammation. One inflammation marker is known as C Reactive Protein. Lowering total and LDL cholesterol levels is protective in persons who have high levels. Some individuals do not have high LDL but do have high CRP. If I remember correctly, it is best to have CRP less than 1. When mine was checked it was .5. That number is mg per deciliter. There has been a lot of success in reducing cholesterol levels with statin drugs. Now the question has become, what if any benefit would statins provide to people who have normal cholesterol but high CRP. Could taking a statin reduce the number of adverse health outcomes like heart disease and stroke? According to the JUPITER study, yes. I still believe that diet and exercise are the first defense AND offense for people and that is exactly what the physician on NPR said. It is important to know that all medications have side effects and putting everyone on a drug is costly both physically and financially. The JUPITER study was paid for by the maker of Crestor, however, it was a double blind placebo controlled study, which should mean that no one knew who was getting the statin and who was getting a sugar pill, so to speak. Also, the makers of Crestor were not privy to the results of the study until the manuscript had been written by the independent researchers. There are some interesting points in the study. First, it involved a lot of people and there were things that would allow someone into the study and things to keep them out. They did have to have elevated CRP and the average was 4mg. I notice too that they asked about smoking status and the majority of people in this study were not smokers nor did they have a family history of heart disease. So two groups of relatively healthy people, matched for similarities and given a drug randomly, had two significantly different outcomes. There were lower adverse events in the Crestor group AND their CRP levels came down where as the study groups did not. What we don’t know is if we had two groups of 8 thousand each and one group ate a Mediterranean diet for example and exercised five days a week if they TOO would have the same positive outcomes. Because as was said by both physicians on the NPR show, the problem is the increase in obesity and diabetes which contributes significantly to heart disease.

How old are your arteries? Just as scientists have discovered a way to determine a lungs age, so have they figured out how to assess the age of one’s arteries. I imagine that as we age, even under the best of circumstances, our arteries will have some hardening. So the doctors can determine the level of hardening or thickening that most 30 year olds or 40 year olds have for example and then test people to see if their arteries are aging appropriately. This is important because with the aforementioned obesity epidemic children’s arteries are ageing at an accelerated rate so much so that some ten year olds are said to have the arteries of 45 year olds. OF course, I would like to think that if they were THIS 43 year old writer’s arteries they would not be so bad off!

HPV: In this past year I have mentioned the Merck vaccine named Gardasil and have offered my two cents worth on its value. Of course I am concerned about giving this to everyone because we do not know what long term consequences there may be. I am also concerned that it is marketed by Merck as a cervical cancer vaccine and that is not what it is. Pap smears and the removal of precancerous lesions or cells is what prevents cervical cancer. I am concerned that Merck wants ALL women to take the vaccine when ½ of all adults have been exposed to the human papillomavirus virus already. The vaccine is best for girls who have not yet had sexual activity and that is the group that may be most at risk for any long term consequence. ACK! But here is the real kicker. Now a study has found a protective effect of this vaccine for men. Well…….. You can’t call it a cervical cancer vaccine if you want men to get it can you. So NOW, Merck is calling it a genital warts vaccine, which it is, to an extent. Bottom line… use caution, use a condom and don’t have sex with everybody!

What I am 100 percent in favor of is calorie and nutrition content available for any food that I might eat at a restaurant. The state of NY began this requirement and the news this week is that it may become a national trend. This is good. We should all be aware of what we are eating. You can choose to eat 3000 cals a day instead of 2000 but you need to know that you are.

Ok, last weekend I made spaghetti sauce, today I made sugar and nearly fat free biscotti. I hope they came out okay! (the fat would be from the eggs, 15 grams)

Happy Day

Saturday, November 8, 2008

wellness weekly

METS: Okay, I said that I would tell you about METS this week and so now I have to do it. This means I have to finish reading the section on them. Geez. What I am about to share with you is my interpretation from the Physical Activity Guidelines. A MET is the metabolic equivalent of energy expenditure used to describe exercise. If you are not doing any activity then your MET is one and anything above one can be catalogued and counted towards your better health. Scientists determine the MET of each exercise, though one activity will have different METS based on how you do it. For example a slow pace in walking might have 2 MET while a brisk walk could have 4. Running will obviously be higher in METS. However long you do that activity, for example 30 minutes, times the MET level will equal your MET minutes. A thirty minute activity that equals 4 MET will be worth 120 MET minutes. The people who worked on the guidelines offer us a number of MET minutes for which we will improve health. And it comes with a range. There is no upper limit. They do suggest at least 500 MET a week to improve health, but more than that is necessary to lower disease risk for breast cancer. Remember too, that you can do an 8 MET activity for half the time you do a 4 MET activity and still have the same MET total. Some examples offered in the guidelines include a ten minute mile pace for runners being equal to 10 MET and a twenty minute walking mile (three miles per hour) as being a 3.3 MET. IF you do fifteen minute walking miles your MET would be higher. A cyclist would need to be able to do a 6 minute mile to be considered vigorous. These are all the low end of vigorous BTW. It seems that 1000 MET is a good goal. (PS your exertion and your fitness levels change, for instance my running is more often moderate than vigorous)

Forty is NOT the end: I found it surprising that an article would say that it is difficult to find world class athletes over the age of 40. Surely the author is aware of the 2008 Summer Olympics. The article regarding some research about the body and brain’s decline in motor control that begins, perhaps, at the age of forty, explains. A healthy brain or central nervous system is one that sends and receives messages very quickly. One way to test this is to count how many times an average person can tap their finger in ten seconds. I ALWAYS wondered why doctors tell people to tap their finger really fast! Anyway, the brain circuitry (nerve fibers) works best when in is coated in myelin. The researchers in this study found that the slower tappers had broken down or frayed myelin in the finger tapping area of their brain. We do have a system that can repair myelin and the more physically and mentally active we are and remain, the healthier our brains will be. This is assisted also by preventing disease processes associated with sedentary lifestyles and malnutrition.

C Reactive Protein: When an article came out in the WSJ this week on the same topic we discussed last week, it had exactly the opposite conclusion. CRP is a very important heart disease indicator and should be addressed with medicine. I am sticking with the news from the week before however, that the inflammation level is a marker and the problem is a disease process that yes may be medically treated but more importantly lifestyle prevented.

President’s Cancer Panel: I don’t know about you, but I was not aware that we had such a council. We do and they came out with a report recently that urges government to get on board with more funding and diligence. The council is afraid that the message is getting damped down when “every day 4000 people in the US are diagnosed with some form of cancer.” WOW. I read about this in a Washington Post article where I was also surprised to learn that 40 % of us will develop some form of cancer in our lifetimes. That is a very high number. In the article, which calls for direct White House action, Dr. M Kripke of the Anderson Cancer Center in Texas reminds us that many types of cancer can be prevented and she states that tobacco causes at least 15 types, accounts for at least 30% of all cancer death and 87% of lung cancer deaths.

Migraines: Ever have a migraine? I have had two for certain and I think a few sub migraines.. I say sub because now that I know what they feel like I would never minimize that suffering. I cannot imagine what life would be life to have one every day. In fact, I believe that true chronic pain can destroy a person’s soul. I was interested then in reading an article whose headline promised to ease migraines. This is what I learned. (nothing. I haven’t read it yet! I actually read this stuff while writing the blog more often than not as life has gotten busy!) There is a medication that helps with migraines now but it has to be used with caution in persons with high blood pressure, high cholesterol and blood flow diseases. A new medication, made by Merck, may be able to treat migraines without constricting blood vessels. I hate that it is medicine again and I hate that it is from the makers of Vioxx because I still have fears about having used that medicine. Still, I was happy to see at the end of the USA Today story that a neurologist recommended that one pay attention to lifestyle factors, including sleep, nutrition and exercise. AMEN. I do myself have more headaches when I am unable to run.

Vytorin: Another drug associated with Merck. As you may recall, I have been against this cholesterol lowering medication combo from the very beginning. The latest news comes rather full circle and addresses my initial point to a degree. The Vytorin had the commercials about having Aunt Martha’s genes and eating Aunt Sally’s pie or some such nonsense. The commercial could easily mislead a person into thinking that taking the medication would obviate the need for healthy eating. This in my most professional opinion is bullshit. Merck and Schering-Plough also claimed that this medication worked better than older generics, which research has proved untrue. There are investigations and inquiries in place on both issues currently.

Make them achievable and it will build self efficacy and self esteem. I have really been struggling with my running and was feeling pretty down on myself because I couldn’t meet the mileage goals in the training plan I had devised. I revised it and you know what, it feels better to come in and check off the four or six mile run than having to put an X on the ten mile one…………

Happy weekend. I think I will get up and make some spaghetti sauce now. I love to smell it simmering on the stove. I use diced up onions (and maybe green pepper and mushroom) and garlic, simmered/sautéed in a splash of wine, then I add chopped tomatoes and basil, oregano and a bay leaf. I let it cook for a half hour or so. When it is all done I remove the bay leaf and stir in one packet of sweetener.


Saturday, November 1, 2008

wellness weekly

Volumetrics: When I refer people to Barbara Rolls books regarding Volumetrics I am encouraging people to learn about a concept and to apply that concept to the way that they eat. I wanted to take a moment now to clarify. Volumetrics is NOT a diet or a meal plan. It is not at all like Atkins or Weight Watchers. Volumetrics is a concept. I only hope that you will buy or borrow the book and see what Dr. Rolls is referring to. I am not an expert on her program though I explain it this way. It is about eating foods that are high in nutrients and low in calories. It is a way to eat more without eating more. It is healthful and satisfying.

Supplements in Disguise: It is no secret that I do not endorse pills. I have long spoken out against taking most supplements when the research on the particular vitamin or nutrient is based on EATING the food that contains it. Some medications have substantial research behind them and FDA regulation. There are some medications that are truly necessary for health. Aspirin is one of those. It helps with pain and fever and even helps to prevent heart disease or heart attack. The problem for Bayer, the number one aspirin producer, is that it couldn’t just leave well enough alone. Bayer has received a warning letter from the FDA in regards to claiming that two of its products can offer health benefits beyond that scientifically proven and beyond which Bayer has received FDA approval to market. These products are for heart health and for bone health. They each add something to aspirin. Calcium for the bone health and phytosterols for the heart. The phytosterols are what in foods have been found to lower cholesterol levels. The bottom line here is that aspirin is for a specific medical indication and the rest of this is bunk and it is illegal for Bayer to claim or market otherwise.

C Reactive Protein: I have to come back to this issue because I was quick to talk about it when research first began appearing four or more years ago that said increased levels of inflammation were associated with heart attack and stroke risk. Blood protein levels were and probably still are additional indicators of cerebral or cardiovascular disease risk like high cholesterol and high blood pressure. I remember learning the level of CRP which indicated an increased risk and even having my doctor check my CRP though I had no other risk factors. It was of course at the ideal level. Except maybe the level itself is not the issue as a recent report might imply. This study of 50,000 persons which was led by Dr. Borge Nordestgaard in Denmark does not claim that high levels of CRP are not indicative of a problem only that it is not THE problem. The problem is atherosclerosis or plaque buildup which does lead to heart attack and stroke. The concern is that some drug companies latched on to the first studies and planned products that would reduce the levels of CRP, but CRP is an indicator that needs to be taken seriously and suppressing IT would lower your risk of heart attack if you still have a raging case of plaque buildup. The best thing for us is to eat well and exercise so that we do not develop atherosclerosis in the first place.

Colon Cancer: Did you know that the second leading cause of cancer death is colon cancer? The leading cause of cancer death for women is breast cancer and the cancer that may cause the most deaths (but not the highest cancer incidence) is lung cancer. I do not at this moment know the leading cause of cancer death for men (bet it is lung or colon). Anyway, colon cancer can be associated with what one eats or doesn’t eat, weight and smoking. One way to detect it is the ever dreaded colonoscopy. I have been following the press on the virtual colonoscopy or CT colonography because I very much do not want to have the old fashioned tube down into your intestine test! It is all a matter of time for me, seven years left! The problem these days is not so much with accuracy and even the insurance issue may soon resolve itself, the problem will be what to do if the CT scan does find a polyp. If a polyp is found under the standard test it can be removed immediately, not so for the other. There is not a consensus on how to handle this as of yet, especially if it is a small polyp that doesn’t necessarily warrant removal. At this point though, the recommendation on frequency is beginning at age 50, the CT every five years and if normal the colonoscopy would be repeated in ten.

Exercise: I am near completion in my reading of the Activity Guidelines for Americans and just read about the impact that regular, moderate activity can have on cancer recurrence and even the course of cancer. It is positive of course. Specifically noted in this report were breast and colon cancer. Exercising can reduce the chance for disease, disease recurrence and treatment complications. It can also help prevent the survivor of cancer from getting another chronic disease or cancer. Exercise is hands down the best tool you have for preventing disease, increasing longevity and improving the quality of all of your life years. Not to mention what it can do for your mood. (next week I will talk about MET)

Breast Cancer: I also read this week that persons who are thin and who exercise vigorously may have lower levels of estrogen which at least in the case of breast cancer, can be protective. A study found significantly less cases of breast cancer in that particular population.

Diabetes: News you may have seen this week. The rates of diabetes are staggering, especially so in Florida. The increase in new cases of type 2 is related to the increase in weight that this country has seen. The medications to treat diabetes are innumerable (well almost) and costly. Actually, the newer medications are the problem with regard to cost. Older meds are especially helpful when a person is mindful of what they eat and engages in regular and moderate to vigorous physical activity. Avandia is a newer drug which costs as much as 200 dollars MORE than the standard first line drug. Along with the extra cost of Avandia, are side effects so significant that some are calling for its removal from the market. Best thing to do here is prevent the disease, which means addressing the causes of obesity. Second best thing is to try to catch the disease before it progresses and treat it with diet and exercise. Thirdly, use medications that do not cost a fortune and do not cause more problems!

Headline Reaction: I saw the headline regarding the results of a study that I did not read. I have no idea about the validity or the methodology, but I shuddered none the less. The headline suggests that children who receive Zoloft and counseling have less anxiety and or depression. AACK>< Sorry, but again these medications may be necessary but they come with such a real cost and to begin using them on a young and developing body is in my opinion, the wrong thing to do, or at least it should be the last thing we do.

Fish Farms
: Jeez, I have to take my mother’s sentiments into consideration at this point. Maybe you read too much and maybe you tell us too much. My Mom thinks I scare people sometimes. Well, I just read an article I knew better than to read. It is an article about cod farming that was in the WSJ this week. IA guy my very age, an entrepreneur, is hoping to create a vast cod farm that can produce millions of this fish a year. He wants cod to be the new salmon. Farmed Cod, they say, will fetch a higher price than wild cod. The opposite is true of Salmon. This has to do with time to market. Anyways, there are many issues with fish of both environments. Pollutants are a significant issue that is not erased on farms, remember, ground water! In reading the article though, I learned details of catching, slaughtering, other uses, and preparing for market that make me wonder why I eat fish. I would like to do more research on farmed versus wild cod though because if memory serves me right, cod is a low mercury fish that does have a decent ratio of omega 3 and 6.

Happy weekend and for goodness sakes, stop eating that left over candy!

Saturday, October 25, 2008

Wellness Weekly

A Good Change: I am a big supporter of expanding food labels or at least making them clear and mandatory. As much as I like and use them, many people are not comfortable with them. Many folks do not read them nor understand what they are reading. Even if what the person reads makes sense, they may not know how to apply it in his or her choice of foods. There is a place on the sidelines of this blog to learn more about label reading. For instance, it is important to know the calorie, sodium, sugar and fiber content of the food you are eating in the amount that you are eating. This week there is news that a few large food manufacturers are making this information available to you in a much easier to read format. What I think is especially neat about this new voluntary act is that the same Smart Choices symbol will be used across different companies and even retailer Wal-Mart. The symbol means that the foods have already met the criteria for a healthy product in regards to low cals, fat, sodium and TFAs while also being higher in fiber. The label will include calorie per serving info and number of servings in the package. Begin looking for this new symbol next year and then USE it.

Junk Food and Heart Attacks: So the foods that have the Smart Symbol should not be in the same category as these foods. An article this week reports that eating certain foods can increase a persons overall risk of having a heart attack. Another study has been completed that compares the types of foods a person eats on a regular basis and the risk of heart attack in that population. For instance a diet heavy in tofu and soy and sauces that are of high sodium content was not protective probably because of the salt. It was rather a neutral or average heart attack diet. The Western diet or one similar to the old USA plan of high meat, high fat and junk food had the highest link to heart disease and heart attack while the lowest is in what is considered a Prudent diet, or the way I eat. High fruits, veggies, fiber etc. Where as the Western diet increased risk by 35% the Prudent one REDUCED it by 30%. Here is the thing though – we already know this.

Healthier Life Steps: In large part due to the study referenced above which included 52 countries, the AMA is increasing its efforts to assist people in attaining and maintaining a health promoting and or disease preventing weight. Their intention is noble and their materials are helpful but they may not be accessible to the people who need them the most. The steps are spelled out on a website and website tools are used to motivate persons to NOT smoke, drink appropriately, exercise daily and eat a diet that is Prudent. There is a growing voice amongst health professionals that there needs to be more effort on preventing obesity than just trying to treat it. Obesity can lead to life changing, debilitating disease and almost every related disease is treated with medications, chemicals. Medications have side effects; they come with a financial and physical cost. Please, take control, insulate yourself from disease. It seems hard at first sure, but YOU CAN quit tobacco if you use it, eat smart if you don’t and move more.

Physical Activity Guidelines: The USDA has written several versions of a food guide pyramid and recommendations on how much of what foods to eat based on certain individual characteristics. (personal nutrition information should be provided by a registered dietician) The latest guide even recommends physical activity. Now the Department of Health and Human Services has written the first physical activity guideline. I mentioned this not long ago. The recommendation is about 76 pages long and I have read most of it. There are one page handouts as well. The main point is this; the new “enough” is “MORE”. The guidelines do not ever support inactivity. They note a low threshold for when health benefits, including disease prevention, can occur but they say they have not found an upper limit. In other words, more is better. A minimum is about 2 and a half hours a week, five hours is better, seven hours even more so. The guidelines are almost the same across age groups. Children should do an hour a day, adults and those over age 65 should do the minimum of three days. Activities promoted include, walking, swimming, biking, running, jogging and aerobic dance. Weight or resistance training is also recommended. Everyone should do some thing. Anyone who does not have a chronic disease should begin immediately and those with illnesses should touch base with their docs and then GET MOVING. Interesting that they noted that there is a risk of injury with some exercise and there is even a risk of heart attack for some people but any and all risks they said are far less than the benefit that one gains from regular daily activity. To note, the activity should be at least ten minutes long but can be accrued over the day. In fact, the guidelines discuss how long, how intense and how often. The single most important factor was how long and again, longer is better. They separate moderate and vigorous activity and say that if you do something moderate, like walk, you can do something vigorous like running, for half the time and have equal benefit. Note: cycling and running are only vigorous at certain paces. Most of my activity is at the moderate pace as I can easily carry on a conversation even when running. When I do intervals of course, I have moved into vigorous territory. I also found it interesting that the DHHS said that they see one injury in every 1000 hours of walking and four injuries in every 1000 hours of running. But you would have to walk twice as long as run to get same benefits so the risk is really only half of running not ¾. It is an interesting read actually, REALLY.

TOY ALERT: Please note a serious issue that may affect your children this year. There is a class of chemical in some plastics called Phthalates which has been found harmful in some research studies. (We actually had a class assignment on this when I was getting my MPH so I know it is a real deal). I recall that there were actual cases of reproductive problems in animals exposed to this chemical and apparently the science supports that these reproductive and hormonal side effects could be found in children exposed to the chemical that is often used to make plastics harden. There are at least six types of phthalates and three are banned altogether and three are to be temporarily banned while additional research is gathered. Most importantly we do not want this chemical in products that children will put in their mouths. Here is the important alert. The law removing these phthalate containing products from the market doesn’t take place immediately. So not only are things like rubber ducks which contain the chemical still on the shelves, they are being discounted so that store owners can get rid of them and still make some money. I do not think there is anyway for you to know which products have them either.

Have a great weekend and don’t buy any rubber duckies!

Friday, October 17, 2008

wellness weekly

Vitamin D: Two things about this amazing vitamin. One is that pediatricians have come out with a statement on increasing the recommended daily intake of Vitamin D, not only because more seems to be better, but because what we have been consuming may not be adequate. The recommendation was 200 IU a day beginning at two months of age, but now it is 400 IU a day at an even younger age. If you are a parent, please discuss this with your child’s pediatrician or physician before making any changes. For adults, Walter Willett has been recommending, as have others, up to 1000 or more IUs a day. I was going to mention something about Vitamin D this week before the AAP recommendation was released, so that was a nice segue. I had begun consuming additional vitamin D over a year ago. I added one 400 IU and had 400 in both my calcium and multivitamin. I just bought another bottle of each and was dosing them out when I checked the labels, just to be sure and good thing I did, the multivitamin now has MORE vitamin D (800 iu), more than I feel comfortable consuming. So I have a bottle of Vitamin D if anyone needs it J.

Cancer Prevention (for women): When reading an article regarding a health awareness survey, I took note of the study author’s suggestion that people in public health should help to get this message out. So here it is. Endometrial cancer is also associated with lifestyle factors and is significantly correlated to weight. Endometrial cancer is the most common gynecologic cancer and few women understand that excess weight can increase the risk for it. Additionally, obese persons with endometrial cancer have a higher risk of death from the cancer. The good news is that there is a cure for this cancer, through surgery, as long as it is caught in time. (prevention would be the best case scenario of course). Two signs for the disease were noted in the article by A. Harding and they are bleeding after menopause or and possibly between menstrual cycles. The study was a survey of professional women and asked if they thought obesity increased the risk of breast, colon and or endometrial cancer and the lowest response was the endometrial. The sample isn’t representative of the general public because the respondents had at least a 4 year degree. This means that it is likely that less people know of the risks than more.

Selective Fear: I was in the office complex gym one evening this week. (weight training !) Two guys were also there and one of them I had seen before and had spoken to several times in the gym. I had also seen this man smoking around our complex. It is odd that I see him working out and taking his walks as he obviously wants to maintain his health, but that is the way it is. Anyway, we were all working out and one guy was sweaty and was cleaning off the equipment with a bottle of stuff that looked like Windex. My smoker friend said he wasn’t so sure about using that stuff as it might cause CANCER! Well, of course I said something……….. And isn’t it just the way we are! We worry about things that have yet to be proven to be harmful when continuing to do all the things that science has pretty much confirmed will kill or debilitate us.

Vigilance: There is a place for my kind of rigidity after all. A study released this week builds on some other studies regarding people who have lost an important amount of weight and maintained that loss. It is vigilance. The successful persons exercise almost an hour a day and do not overeat. They are conscious of calories in and out and they have fewer TVs then heavy people. Well. Oh and their exercise is of the high intensity variety which in the USA Today article was described as jogging, aerobics, and cycling. More proof that it is a lifestyle not a DIET. And yes I am talking to you, person who will not be named here…

STENTS; Stents are the little, ok teeny tiny tubes, if you will, that are used to prop open arteries that have become clogged. We have talked about this a few times, recalling, they have drug eluting stents and plain metal stents and studies compete to prove one safer than the other as it is a multi million or billion dollar industry…….. OK good. Now there is another study about the number of stents. Apparently, not all surgeons or cardiologists complete the gold standard stress tests or artery volume scans (?) before placing stents. A company that sells a technology that can determine if an artery is actually clogged supported a study regarding the use of less stents. The persons with fewer stents had better outcomes over time than those with multiple ones. I>E they were still alive. So , are the results valid even though the study was funded by the medical device company? I don’t know, but it seems to me less would be better than more.

MCR and Home IV Infusion: I got a new perspective when I read an article in the WSJ this morning about the fact that Medicare does not cover the full cost of home IV infusion, for example, for antibiotics. I know this from my days as a hospital social worker. I also know, as the article states, that hospitals often have indigent funds that they use to pay for the home therapy. The therapy can be very expensive but not as expensive as a hospital bed. Hospitals can save money if a person is discharged on home IV meds and it used to be my job to try to make that happen. The WSJ article didn’t say that Medicare usually pays a prearranged fee for a condition and if the person needs more service than the money covers, too bad. Hospitals are also in a bind to free up beds, in certain departments anyway. AND, some diseases are worth more money than others. SORRY< but this is true. What I didn’t wrap my mind around before are two things that I should have. One is that it is a good idea to get the hell out of the hospital as fast as you can because of those ever increasing and now talked about GER MS. But most importantly, don’t most people WANT to go home?! (ok, in my case, a lot of the people did NOT want to leave the hospital, but they had oh so many other issues as to not make them the average person.) Ok, so now I know, pushing to get patients out of the hospital isn’t poor patient care after all.

OK, remember vigilance and diligence. You are worth the effort, EVERY day.

Friday, October 10, 2008

wellness weekly

The Changing Brain: In my recent studies of addiction I learned exactly how drugs affect the brain and that nicotine for instance specifically causes neurotransmitter release and a host of “feelings” in response. Now that I am “off running” do to an injury, I know too that running causes certain “feelings” that I have come to crave. Drugs and running aren’t the only things that can cause the central nervous system to change. Overeating does as well. When one consumes an abundance of calories, as many a person does, and that person’ becomes obese, a certain chemical that is not usually active becomes so. It is like the appendix. We have one, but we do not need it. We also have a compound in the hypothalamus that when activated, causes an immune response and inflammation. As you may recall, inflammation is often an indication of heart disease and is associated with obesity. This news is from a study recently completed in mice and it is just one of many that are being conducted in order to better understand and treat obesity. The study author is Dongsheng Cai and she is with the University of Wisconsin-Madison. While waiting for the magic pill it would be a good idea to stay active and maintain a health promoting weight.

Advair: I heard a commercial for this medication where the announcer suggested that YOU ask your doctor if Advair would improve your lung function. And the commercial states that Advair is used to treat COPD. Now COPD includes emphysema and chronic bronchitis and is often associated with smoking. In fact, 90 percent of emphysema is caused by smoking. So in my mind, the person with COPD would be better off asking their doctor how quitting smoking could improve their lung function.

Move More: The Department of Health and Human Services made a statement this week that is intended to reduce the confusion surrounding how much physical activity, how many minutes a day, a person needs to maintain health. As soon as I saw the words, reduce confusion I prepared myself for the opposite. So, I hope that I can give you the recommendations with less if, ands or buts. Sigh. First, it depends on if you are already active, sort of active or just plain sluggish and then if you are young or old and then….. See what I mean! The government put a panel of experts together and they support the research that physical activity may be the most important thing you can do to prevent many diseases, and this includes, heart disease, colon and breast cancer, hypertension and diabetes. Regular physical activity, the kind that increases your heart rate, can lower you heart attack and stroke risk by 20% and can also help to prevent fractures and depression. This is NOT NEW NEWS; it is just getting the official seal. The recommendations don’t seem any different to me either, but here they are. First and foremost, ANY amount is better than NONE and MORE is better. The amount of time you need to spend depends on the intensity of the exercise. You can walk an hour or run for 30 minutes, for example. Children should exercise an hour a day and adults about 2 and a half hours a week, minimum. If you are doing nothing, then you start with ten to twenty a day or every other day and build on to that. Like I said, the recommendation is dependent on where YOU are now, at baseline. Feel free to post comments if you want more personal direction.

Do You Really Need that Drug? Okay, a study in the journal Neuron tells of mice who were trained to equate a sound that they hear with positive sense of self, safety, will to live. And I totally understand the conditioning piece of this experiment because it is like Pavlov and the dog. It is about strong, powerful, primitive associations. The horror of this is how the study was done and that this is HOW studies are done. For many scientists, and apparently many pharmaceutical company researchers, the way to see if a drug can improve mood is to first cause an animal to feel really hopeless. They use learned helplessness in that they have mice swim until they are exhausted and then they give up as if to drown. They just turn over and float and then the researcher might give them the drug in question, it acts on the brain, stimulates a will to live and the mouse begins to swim again. So in this new experiment, the mice were taught first to fear a sound and then to welcome the sound. I guess the first way was a test. They shocked the mice at the exact time the sound rang, then another conditioning experiment was for the mouse to be in pain except when they played the sound. OMG, it seems so very cruel to me. In this experiment the researchers used just the tone and also used a drug. They both caused a neurotransmitter response, but not the same one. Interesting! The conditioned sound response was dopamine and the pill was serotonin. (these are the two of the chemicals released by nicotine, BTW) So maybe we can condition people to meditate or associate some calming thing, music for example, with happiness and obviate at least some antidepressant meds as they are crazy full of side effects. Dr. Eric Kandel led this research.

That’s all for now, happy weekend.

Saturday, October 4, 2008

wellness weekly

Mexico: Many local, state and federal governments are concerned about the obesity rates in their populations. In fact, a number of them, including my city, Sarasota; state, Florida; and my country, USA encourage mindful eating and exercise. We have a goal to reduce our rates of overweight and obesity by 2010, but almost across the board and certainly in the Southeast, the rates are up, not down. I often thought that people who moved to my country from Mexico for example, gained weight because of us, but I learned that it is not necessarily so. In Mexico, they have a problem of their own making. The new national campaign in Mexico is called Vamos Por Un Million Kilos – Let’s lose a million kilos. They have the same issues as the USA. That is, less activity and more processed and fat laden foods. About 50 percent of their population is overweight or obese whereas, about 66 percent of the US is. In reading about the start of this campaign, it was noted that the health experts in Mexico are fearful of their people becoming as fat as those in the US. This would be because of the health care costs associated with treating obesity related illnesses.

Spit Tobacco: Smokeless tobacco causes cancer and may be associated with heart disease. It is not a safe alternative to smoking as long as it contains nicotine and carcinogens. Nicotine is what addicts a person to tobacco (it is found naturally in the tobacco plant). Nicotine also increases heart rate, blood pressure and pulse. Spit tobacco has more milligrams of nicotine per “dip” than a cigarette – much more. This is concerning and it is concerning that people are not aware of the adverse effects of this product. It is true that there are no second hand spit diseases, but that is no reason to use it. There are changes in consumption and that is why I bring it up. Cigarette use is down about 3- 4% in the past year, while spit tobacco use is up 6 - 7%. This is likely to continue as Phillip Morris parent, Altria has just bought UST which owns the SKOAL brand. PM is the largest US cigarette maker and Skoal had a revenue of almost 2 billion last year. (according to a September WSJ article)

Supplements: I continue not to endorse them because few have the research to support efficacy and none have regulation to enforce purity. Here is another popular duo that may not be worth the money. Glucosamine and Chondroiton. Many people take the supplements to treat pain associated with osteoarthritis and to slow the loss of cartilage in knee joints. In fact, I considered using them before but I realized that the cost of them (if by a reputable company) would be over 30 dollars a month and the presumed benefit only comes after continuous monthly use. I realized that the only thing guaranteed by using them would be expensive pee. Research recently analyzed supports my hypothesis. The supplements did not increase cartilage or conserve it and it did not reduce pain. The information is in the journal Arthritis and Rheumatism. Also note that OA is most often associated with age, gender, genetics, weight and previous injury. (in other words, not exercising is much more likely to lead to bad knees and joints then exercising!)

No Smoking Here: Another country, yes, there are whole countries with public smoking bans, has opted to ban smoking. In the US, we with have several local bans and two states have banned it. India, where approximately 19% of persons over age 15 smoke, enacted such a law yesterday, 10/3/08. Persons who do smoke in public will be fined. No business, restaurant, pub, school, hotel or hospital will allow smoking in or just outside their buildings. I learned this from a WSJ article which included some additional stats from the WHO 2005. What startled me the most, and this is my professional field, is that the country of Greece has a 52% over age 15 smoking rate. Russia is just a few points below this and the USA is between 19 and 24, depending on the source year. (later this week an article came out regarding the expecting explosion of lung cancer disease in China within the next 25 years, mostly due to smoking). But back to India. Because a good portion of the country is illiterate the government is using pictures on the cigarette pack to educate about the dangers. For example, they are using a picture of a skull and crossbones. Well, if they are POISON, why are they for sale? The only entity with the kind of moxie needed in regards to cigarette bans appears to be the Himalayan kingdom of Bhutan which has indeed banned the SALE of cigarettes.

Pharmacy and Tobacco: I, more often that not, have ill will towards both industries. There is a place for at least one of them, I must admit. Medicine can save lives and / or increase the quality of life by ameliorating disease symptoms or slowing progression. My issue is our dependence on meds to solve non medical problems. Like the bad knees we sometimes get because we ate too much and did too little. That dependency on meds is in large part due to the direct to consumer marketing by the pharmaceutical companies. Add to that, the direct to clinician marketing and I’d say, lobbying (wining dining and greens fees). This week I have more direct angst towards Pfizer and Merck. Pfizer for saying that they were going to significantly reduce the amount of time and money they put towards medications for the treatment of heart disease in order to spend more of both on the “much more profitable” oncology or cancer market. (not notable or desperate, but profitable) And with Merck. My issue with Merck, besides trying to kill me with Vioxx, is the Gardasil vaccine. Again, the vaccine may stop some HPV cases that would lead to cervical cancer, but only in a certain at-risk population. NOT The entire male and female population of the United States, but much younger women. Also, it does not obviate pap smears or condoms. So the fact that the US has added the Gardasil vaccine to the REQUIRED immunizations for permanent LEGAL entry into the US (i.e. citizenship) just burns my butt. This is the real mind blower though, because I was talking about big Pharma AND big Tobacco…
One group, Pharmaceuticals, gets people to take medications that may or may not improve their health but costs the user and the insurer a LOT of money while exposing the drug taker to side effect risks – and for cervical cancer anyway, could only save 4000 lives a year….while the other, Tobacco is scientifically proven (US Surgeon General, CDC and the WHO) to kill 438,000 persons a year and is sold legally every where except perhaps the Bhutan kingdom!

Eat Smart Move More
Use condoms :)

Friday, September 26, 2008

wellness weekly

Busy Parents: Here is a great way to stay fit, model fitness and spend quality time with your children. In the morning ride your bike to school with your child and then ride home. In the pm, ride back to escort him or her home. I saw a mom doing this today and both she and her son looked happy to be greeting the day in this way.

Medical Devices: Off label use means prescribing medication for an indication outside of the FDA approved use. It is legal and relatively common. However, drug companies are not allowed to market the medicine for other use nor suggest to providers that they use the medicine to treat an “off label” condition. I did not know the same rules and practices apply to medical devices. If drug or medical device companies advertise or in any way try to influence such off label use they can be sanctioned or sued. Currently, Medtronic is being sued for encouraging surgeons to use its spine product for conditions outside of the FDA approved indications.

Knees!: Speaking of unnecessary, a study out recently suggests that too many people are having arthroscopic knee surgery. A couple of research studies that included a large number of subjects, and control and experimental groups who were followed over time , indicate that in many of the cases where it has been used, this surgery, which is done through a very small incision, is NOT more effective than physical therapy and medication. The surgery has risks, surgery always has risks, and it is expensive. This type can cost around 7000$ for an outpatient procedure. The article I read doesn’t say this, but I am pretty sure there would be some medication and rehabilitation post surgery. Meaning that the surgery doesn’t take the place of physical therapy but is don’t in addition. The best results of arthroscopy are for injury (meniscus tears) or mild to moderate arthritis. Advanced osteoarthritis where one may eventually need total knee replacement is not ameliorated by this less invasive procedure.

Bring It On: A small but interesting study offers a new concept with regard to overcoming the temptation to eat unhealthy foods. In this study, Kelly Geyskens Ph.D, had women participate in a fake marketing exercise which also had them exposed to sweets which they did not have the ok to eat. Compared to women who did the same exercise without any do not eat candy in the room, the first group was more likely to resist the temptation to eat sweets when they were available without restrictions. Dr. Geyskins suggests then that will power can be learned through exposure and building on success. This questions the theory of our Mom’s who say, “Don’t keep that stuff in the house!” Because the author of the study says, without practicing how to handle temptation, tempting situations are not handled well. Hmm. Not sure I would try this with people trying to quit smoking, or maybe we should. Oh that would be a cool study!

Plastics: Again there ARE chemicals in them which may or may not cause harm if you heat them, may or may not cause harm if you drink from them, and almost certainly cause problems when they are put in the ground and when companies who make them allow chemical waste to leach into our ground water. Now a study does link one of the plastic chemicals, Bisphenol A or BPA to both cardiovascular disease and diabetes. This chemical is found in many household products including plastic bottles, but also CDs and helmets. Many companies have reformulated their products so as not to use BPA. Past FDA / EPA reports did not find a high enough level of BPA in persons to warrant concern. They are now reviewing this additional data.

Which leads me to this weeks closing thought, how can a product with a multitude of toxic chemicals and cancer causing agents still be legally sold anywhere in this world?

Don’t smoke! Do exercise, do eat right, do rest, do find peace, do get moving……….

Wednesday, September 24, 2008

wellness weekly

OK, I have completed my presentation so expect a real health update soon

Saturday, September 13, 2008

Wellness Weekly NOTE


I am currently preparing a piece on the effects of nicotine in tobacco users and will post it for your review and or comment soon. It is my homework really, for a presentation but it has kept my brain quite full and I haven't been able to explore any other health and wellness issues this week or weekend.

Be active and well as you stay tuned for more...........

Saturday, September 6, 2008

wellness weekly

Heart Attack: A study from Norway looked into age differences between men and women with regard to heart attacks and smoking. What struck me most was that there is an average age for heart attacks for both genders. That implies that most people will have a heart attack if they reach that age and I for one do not want that to be true. I imagine that genetics and lifestyle can increase and decrease the odds of any one person reaching that typical heart attack age and then having one. As it is, the age for men is 72 and women 81. However the age of first heart attack is much earlier for smokers and drastically earlier for female smokers. The study results found women smokers to have their first heart attack some fifteen years earlier at 66. Men also have them earlier if they smoke, making things more even, at 64. This does explain why more smokers die from heart attacks than lung cancer.

Parental Oblivion: A study from the UK addressed the consequences if any, of measuring young children’s weights and notifying their parents of the result. There is concern among health professionals that if we note a child as being over weight or obese that it will traumatize the child. Of course, I think that the trauma associated with being obese and having to take medications for disease management when one is 12, is pretty damn consequential. Either way, harm was not found because of this project. What did catch my attention was that some of the parents opted out of the study saying that they did not want to know their children’s weights. Disturbing.

Vytorin: Some time ago I shared that several studies have not found combination cholesterol lowering drug Vytorin to be any more effective if at all effective, than the generic cholesterol lowering medications that are now available. I have always disliked the drug, because the marketing of it implies that one can blame their genetics for the fact that their high fat diet is causing them harm and that is not how it is. Even Dr. Oz will tell you that genetics are only a small part of the equation and what you eat and what you do is the bigger piece. Anyway, now reports are surfacing to show that this medication is also increasing the risk for some cancers in people who take it. This is good news for pharmacy benefit programs as they can keep their enrollees on the cheaper medications.

Lipitor: Speaking of cholesterol lowering medications, Pfizer has the best selling one, if not the best selling drug, period. They took some flack for having a spokes man in their ads who implied he was a practicing physician. This same ad had a body double for the physical activity piece. The ads are being replaced with the real person story. So I guess Pfizer has done its homework on effective marketing campaigns. The same is true for anti smoking messages. A real person discussing a serious health issue followed by a means to address the issue. Well done guys.

Physical Activity: Two late stories which I wasn’t able to vet applaud exercise as being health promoting in cutting risks of many cancers and heart disease. So why are you sitting here reading this? Get Moving!

Thursday, August 28, 2008

wellness weekly

Hot Dogs: A commercial is running in some areas that cautions on the risk for colon cancer associated with eating processed meats. The commercial is only concerned about hot dogs. It is causing some angst especially with the Hot Dog Council (there is a hot dog council?). This council fears that people will come to believe that occasional hot dog consumption will lead to cancer. Research does support an increase risk of colon or colorectal cancer in persons who eat red meat and or processed meats every day. There is a 50% increase of cancer for eating a two ounce hot dog every day, over time.
Here is one link for more info, I also studied this topic in grad school. I did have to vet the research so I feel comfortable telling you that there is an increase in cancer risk if you eat a lot of red and processed meat and it is reduced if you limit these foods. Some of this relates to chemicals from cooking and nitrates from processing. The risk can also be attributed to high saturated fat content. Some people who eat a lot of red meat also eat little fruits and vegetables. Fiber rich foods are protective. Now I have totally digressed from the ad issue. The ad shows a young boy lamenting that he is going to have or has colon cancer as he and his friends eat hot dogs. Hot dogs are high in fat, sodium and nitrates. Nitrates have been shown to cause cancer in animals. Hot dogs are not health food. If people eat less, if schools serve them less, that is not a bad thing. Will an occasional hot dog hurt you? Probably not. Should you enter the next all you can eat hot dog contest? Most definitely not. Oh and after reading L. Tanner’s article I doubt you would want to. She notes that hot dogs may legally contain pig snouts and lips, livers of cows, lamb spleens and goat gullets. You could eat meatless ones, but they may have nitrates, I am not sure.

Ritalin: This medication is used in the treatment or management of ADHD. In reading about childhood nutrition this week, I learned that children on this medicine may have weight and growth reduction. It is important to know that the drug can suppress appetite. Parents can time meals around the suppressant effect of the medicine. For example, the dosing is every six hours in many cases. The child can be given meals at the fifth or sixth hour and then be given the next pill. Not that I am advocating pills, I nearly never do that. It is also suggested that children not be on the medication during growth spurts, like adolescence and some parents even choose to forgo the medicine during school breaks.

Milk: Though I drink (skim) milk everyday and consume cheese, yogurt and ice cream, I do appreciate Walter Willett’s comments regarding the irony of our 1) continuing to drink milk after weaning as no other mammal does, and 2) our drinking milk from an animal not our mother or species, which rarely happens with other animals. So though he didn’t note this when I heard him speak, a book by Registered Dietician, Susan Magrann, which covers food allergies, almost always suggests cow’s milk as a first possible allergen. In fact, she recommends that children not be given cow or soy milk if at all possible until after age one. (remember too that after age two they should no longer be on whole milk – in most instances). Calcium in milk products is very important to our system, however.

Cancer Causing Lifestyle: An organization called the International Union Against cancer has completed a survey involving 29 countries of high, middle and low income. The higher income countries, USA included, were less likely to know or believe or admit that high or even moderate alcohol intake increases the risk for many cancers. It actually increases the risk by 42%. Our country has more understanding of the protective effect of fruit and vegetable intake, unfortunately, that doesn’t protect at near the level that alcohol harms. Other countries seemed to understand this better. It was also found that people were far more aware of the risks of cancer from cigarette smoking than from obesity and inactivity. FYI< obesity is responsible for the same or more deaths per year as cigarette smoking.

Water: I read an article this week that was inspired by a new book called Bottlemania… etc. The story and book refer to the incredible increase in revenue for the bottled water industry. Author Elizabeth Royle refers to the way that these companies have made bottled water seem a commodity. It isn’t of course and water is a natural resource that may be threatened by this method of production and consumption. One interesting unforeseen consequence could be the lack of attention to tap water infrastructure and thus its decline in purity and safety. There is a huge problem with recycling of the plastic bottles and the environmental impact from the factory production and the transportation of the bottles and jugs. It is better to save the bottle water for natural disaster and drink your water from a glass, from the tap, with perhaps a filter. I will try to do better with this myself.

Fat Tax: Not really, but certainly a type of user fee. Alabama intends to charge significantly obese persons 25$ more a month for their health insurance if they do not make progress in weight loss after a health risk assessment identifies their 35+ BMI and they are enrolled in a health promotions program. Alabama state employees can refuse the HRA but there is a fine for that. Currently, smokers who work for the state must pay a fee each month. In Sarasota County Florida where I live, the county will not hire smokers anymore. I understand these two strategies for trying to deal with apparent lifestyle choices that impair a person’s health, reduce their quality life years, if not their total life years, and adversely affects the bottom line of the company that employs them. It also can affect the rest of us in regards to taxes and entitlement programs for disability income, Medicare, Medicaid and social security. Seriously.

Some state programs or ADA programs offer these aphorisms:

Eat Smart Move More
Less Fork More Foot
Eat Smart Play Hard
Mine of course
It’s ALL About energy in and energy out

Wishing you wellness!

Friday, August 22, 2008

wellness weekly

Thank You BK: So the economy may do for us what our nutritionists have been unable to do. Normalize our portion sizes! That is right, we can finally address the whole supersize me issue without engaging the wrath of the food and restaurant industry. WHY? Because they need to cut costs and one way to do that is to give us less food. Burger King recently noted that they would be making their hamburger patties smaller. A little less bun might also be a good idea. This is really an interesting turn of events. For years I have been crafting an Obesity Prevention Project. My friends all know this as my OPP. I will need a million dollar grant to implement this school based community program and one of the key constructs of OPP is reciprocal determinism. Let me explain. My plan is to educate children about nutrition, give them new skills (such as label reading) and allow them to put this knowledge and skill to practice, i.e. ordering out. This will produce young adults who demand healthy options and the restaurant and food industry will in turn offer lower calorie and fat meals which more people will then eat. When more people eat them, more places will offer them. Reciprocal Determinism, paradigm shift. The results of my plan may not effect the obesity epidemic for a generation, but the high cost of food has at least made my quest a little more politically correct and timely.

Gardasil: This is the vaccine by Merck which claims to prevent cervical cancer. It doesn’t of course. It may prevent some of the 100 strains of HPV which can lead to cervical cancer. I have been opposed to the mass inoculation recommended by Merck and many medical associations, from the beginning. I especially abhor the ads that recommend it and say that it prevents the cancer. What prevents the cancer is gynecological exams and pap smears. If abnormal cells are detected they can be removed. Cervical Cancer cases are on the decline in the US because of preventative care. News out this week, in several sources, brings to light other concerns about the vaccine and the way that Merck has pursued both doctors and legislators to get this vaccine mandated. It is too new, in my opinion to be given so freely to all of these young girls. And as I indicated in another blog, the makers of Gardasil, Merck, are now targeting not just men, but boys as well. More information on the effects, benefits and risks, are needed on this medication.

Athletes: I just wanted to note, laud and applaud the many athletes in this year’s summer Olympics who are over age 30. Many near forty are themselves medal winners. This includes a gymnast, runner and swimmer. A diver who did not win a medal was also an older athlete. Older only in terms of what was once expected. People can and DO live better longer, but not by accident. Times have indeed changed and many of us non athletes are finding our fitness groves in our 40s and even 50s. It is certainly true here in Florida. To stay active one must be active and many people live that belief here. I myself like to say that I do all the things I do- eat well, run, swim, bike a bit and weight train so that when I have one foot in the grave, I’ll still be standing.

Okay, not much this week, sometimes life happens and I don’t get to read as much!
Wishing you wellness and longevity

Friday, August 15, 2008

wellness weekly

Thin or Heavy, Health Risks Exist: A study published in the Archives of Internal Medicine is being touted as a study that implies weight is not a major factor for illness. This research and the headlines it will inspire should not be used to assuage fears associated with our obesity epidemic because the fears are real. More important in the study is that weight alone is not an accurate measure of health. Food eaten and activity level are at least as important as scale number, BMI or WHR. Though the study found overweight adults with normal blood pressures other research shows overweight children on chronic disease meds. Something is wrong. It is just more than the weight.

Mercury Sources: I am very concerned about mercury in fish as most readers know. I wish it were entirely for the sake of the fish, but I am also concerned for the persons who eat the fish and the promotion of fish as heart healthy when in fact they may be neurologically toxic. So I pay attention to mercury stories. This week I read an article about a lake in Utah which has incredibly high levels of mercury. Well, not just any like. The Great Salt Lake. And I should clarify it is the form of mercury known as methyl mercury to which I am referring. The Great Salt Lake is more salty then the ocean. So much so that much does not survive there. It is famous for some very small species of shrimp but is otherwise its only real life forms are algae and bugs. It is also a place that attracts ducks as they travel from north to south. There is concern about mercury buildup in the ducks. What it will do to them is a concern as is what eating them could do to humans. There is a warning out about that. Something like, Do Not Eat These Ducks. There is also a study under way to determine why this lake has more mercury than any other body of water in the US. One hypothesis, and one that concerns me for all bodies of water and soil, is the transportation and deposition of mercury from industry and especially coal fired power plants. I will be interested to know what the scientists learn and if their research will have an impact on the Clean Air Clear Sky Acts that are supposed to address issues with coal for starters. In fact, there is a way to burn coal without mercury escaping, it is just costly. There are ways to do many things without emitting pollutants, we just don’t do it.

Environment and People: The other evening I saw a show on PBS where a photographer was returning to see some marine life that he had photographed many years ago. He learned that many of the great whales he had tracked had died because they were full of toxins. The whales’ carcasses were considered hazardous waste material. Remember the whales are at the top of the food chain and eat all the fish that we are told to avoid! The artist was visibly shaken by these events, as was I. My thoughts were concerning what we have done to our world and extended to this: we have obese pigeons, diabetic ducks and toxic whales. Along with fish and fowl who are poisoned by mercury. What have we done and what will we do to stop the bleeding and heal the wounds?

Fast Food – Fast Fat: Why we need research on this baffles me a bit, but if you were in denial, more science may sway you. Meals for kids are loaded in fat and have far more calories than the children need. {I.e. the obesity epidemic}. This is not any different than the restaurant meals intended for adults. The Center for Science in the Public Interest did a study on nutrient content, at least where information was available. Most, well, nearly all meals that are intended for children had enough calories for half the day. Subway which was the best only had appropriate caloric content in two thirds of its choices.

LA: Another city may make this type of information (calorie content) easier to come by. Of course, posting nutrition information on a menu or menu board doesn’t mean that it will be used or even understood. So I guess I agree with the California Restaurant Association when they say that people need to be educated about nutrition. This is the cornerstone of my school based Obesity Prevention Project. We must educate people on what they need and why and then let them make the choices. If people know what to put in their bodies and in what quantities, they will demand that the restaurant associations comply. I am 100 percent behind full disclosure!

Activity Level and Obesity: The Wall St Journal ran a story regarding the reason 16% of American children are obese. [Note that an equal if not higher percent are overweight]. The reason noted is risk of harm. Children stay inside to avoid kidnapping, molestation and drive by shootings. But more than that, some school systems have become so worried about lawsuits that they restrict the physical activity of kids during recess. As usual, we are overcompensating for this fear of injury and causing another adverse outcome. I have to say, bruises and even breaks will heal where as high cholesterol, abnormal blood sugar and hypertension will kill. And for the record, you will never hear ME say, “Stop running!”

Sweet Endearments: In our country and many others it is common to show our love by way of food. Not just any food, but comfort food that is either high in sugar or fat or carbs or all of the above. Some people consider my eschewing this tradition to be anathema. Well, I have found a way to shower people with this love without also causing them to be unhealthy. Cupcake, sugar, honey bun, Twinkie, muffin….. No, not on the table, as a term of endearment. So enjoy your weekend, cookie! Bye for now cheesecake! Ta ta mac n cheese!

Live well