Friday, July 31, 2009

Extreme Measures

A study was completed from 2005 to 2007 that has been analyzed and reported in the New England Journal of Medicine this week. It pertained to bariatric or weight loss surgery. Long time readers will know that I have written about this in the past and that I am 100 percent against the surgery. My main reasons for opposing it have been the high percentage of complications, the need for repeat surgeries and the terribly invasive nature of the surgery itself. In my mind, rearranging the internal workings of our bodies instead of losing weight with calorie control and exercise is far too extreme to be considered healthy or sane.

I have been overweight..I have not been obese. My empathy then is very limited and I must be fair. I am especially reconsidering my position because someone I care very much about has recently had the surgery. I have always been worried about her weight and of course, encouraged her to eat fewer calories and to exercise.. but often she could not exercise because she was so heavy. Today when reading the article I was surprised to learn that some people could lose 20 years of life due to their obesity and just as with smoking, the quality of life they have before their early death is not going to be very high due to chronic disease conditions.

There has been concern about adverse outcomes with both the Roux-en-Y and the gastric banding surgeries and though this study attempts to ease our minds, I do have a concern. The study, abbreviated as LABS, included a good number of persons (almost 5000) and they noted several different adverse outcomes as endpoints. These were death, VTE, having to have any additional operations or reinterventions, and not being discharged from the hospital. You do remember VTE yes? That is venous thromboemolism, or more simply a blood clot. As stated in the Medscape report, the 30 day mortality rate was .03% and the 30 day rate for one or more of the other listed adverse outcomes was over 4%. The mortality rate is low compared to other surgeries.. I looked it up. However, the 30 day endpoint is not long enough in my mind. That really doesn't tell us anything about effectiveness and serious complications.

I know that we have to look at the risks of death, disease and disability from being obese as compared to the risks from the surgery, but in my heart I just cannot believe that this is better than a lifestyle approach. I will concede that the lifestyle change would likely involve a host of specialists to promote, support, encourage and monitor the patient and that the cost may be off putting to insurance companies, but until I get real long term data on outcomes, I am not convinced that this is a best practice option.

The researchers did note that certain things will increase the risk of death or adverse outcome and they are an extremely high BMI, though a BMI over 40 is usually needed to be considered for surgery so I cannot imagine what extremely high would be, as well as, history of clots, chronic obstructive sleep apnea and impaired functional status.. I assume this would mean immobility.

My friend, who is eating pureed food for now is keeping notes and will be one of two guest bloggers that I have on tap for you guys.. but we are going to wait a while for that one.

Thursday, July 30, 2009

Move for Health

Today's post regards physical activity. In order to achieve maximum health and reduce the chance of being diagnosed with a chronic disease, there are three very important measures of which you have control.
Physical Activity

This week we have heard a lot about the annual cost of treating the consequences of obesity in the USA. In 2004 the World Health Organization presented and disseminated a Global Strategy on Diet, Physical Activity and Health. From their website I report some facts.
  • nearly 2 million people a year die because they are not active enough
  • doing regular, moderate physical activity for at least 30 minutes 5 days a week, will reduce the risk of many chronic diseases... more minutes more days is better still
  • just being inactive can cause a disease, such as heart disease and diabetes.. all by itself, inactivity is a risk factor
  • being physically active five days a week can reduce the risk of the illnesses below:

cardiovascular disease
type II diabetes
colon cancer and
breast cancer

  • regular physical activity will have a positive effect on the conditions below by reducing them, eliminating them, or improving treatment of them:

osteoporosis and falls risk
body weight and composition
musculoskeletal conditions such as osteoarthritis and low back pain
mental and psychological health by reducing depression, anxiety and stress
control over risky behaviours particularly among children and young people (e.g. tobacco use, alcohol / substance use, unhealthy diet and violence)

I recall from my time at the Cooper Institute that there is a level of physical activity that reduces disease risk and then there is the level that promotes cardiorespiratory or cardiovascular fitness. So it would behoove you to do any amount of physical activity that you can while it would elevate you to do vigorous activity many days of the week.

I chose today to talk about physical activity because yesterday I passed an exam for an American College of Sports Medicine certification. I am now able to call myself a Physical Activity in Public Health Specialist. I have personal training certifications (not currently active) that came with good training programs, but I do think that the ACSM is a gold standard and I am pleased to have this new credential.

I also made a new youtube video today that is NOT a PSA or a cooking video but a demo tape of two exercises. Check it out here:

Now the WHO said that its member states would sponsor a Move for Health day every year but I have not heard of one yet. I say that every day should be a move for health day. Also, I learned yesterday that there are 4 domains of physical activity and thus four areas of your life to which you can add movement, they are:
At work (whether or not the work involves manual labour)
For transport (walking or cycling to work, to shop etc)
During domestic duties (housework, gathering fuel etc)
In leisure time (sports and recreational activities)

And with that, I better get moving :)

Wednesday, July 29, 2009

Swimming with the Pathogens

Let us take a break from food and exercise, obesity, over medication and sun damage... let's go to the BEACH. I love the ocean. It is calming and peaceful. The ocean is vast, at times still and others turbulent. I go there alone. I go with family. I revigorate with friends.
I am even overcoming my fear of swimming with the fishies(sic)... because the water is often warm and good for my running muscles.

But according to the National Resource Defense Council.. I should be worried about a lot more than the fish. Indeed, we are swimming with much smaller vectors. Microorganisms that carry disease or pathogens, have been a growing problem in our oceans and bays for years with no improvement in the last four years. The disease causing bacteria are mostly accumulated from storm water run off and from sewer system leaks or overflows. In other words, we are getting sick from human and animal waste.. not marine waste.. but waste from our pets and livestock.

Measures to curtail the storm water run off can be put in place with policy and monetary support. Some bills in congress now would enable states and localities to do so.

Other causes of ocean related illness are chemicals, from spills, dumping, and run off as well as harmful algal blooms or HAB. It is not true for example, that red tide is harmless.

The illnesses associated with beach pollution include, but are not limited to, respiratory infections, rashes, hepatitis, dysentery (bloody, mucus filled diarrhea - aren't you glad I said dysentery), stomach flu, and neurological disorders... which include problems with the central, peripheral and or vascular nervous systems. The illnesses can be especially harmful if not fatal to the elderly, children and those with impaired immune systems.

It is best to avoid swimming in the ocean for 24 hours after a significant rainfall.

If you have the opportunity, let your legislators know that you support policy that would address beach pollution.

resource used:

Tuesday, July 28, 2009

Let the Comparison Begin

I am actually torn about tonight's post. Yesterday I received an article in the mail from a dear friend in Maine. I did not read it closely until just now.
Last night the first news stories were published about the cost of treating obesity (147 billion a year) and out of curiosity I looked up the cost per year that Tobacco Free Kids estimates is spent on tobacco related illnesses (96 billion a year). Obesity has indeed passed tobacco, I expected it would.
And this morning, I read an article about reducing hospital re admissions and got rather frustrated at a lack of personal responsibility in the patients. So all that is on my mind!

The article, ironically, compares Big Tobacco with Big Food and was written by Ellen Goodman. She notes a new film and a new book regarding the food industry's tactics to get us to eat more cheap, fast and harmful food and wonders if the mood of America isn't about to change and say, "Enough." She does note a concern that always frustrates me and that is the controversy over accepting ones weight or size and rallying against obesity. Well, the fact that it is considered a controversy is the problem. I actually had the thought today that maybe our Armageddon is going to be related to our total lack of responsibility in taking care of the body that the creator(s) gave us. Many times it seems a total disregard for health and wellness. An abuse of our very essence... we wouldn't treat our cars or motorcycles this way and expect them to keep running, would we?

I am not without empathy and I do feel that addictions exist and are not something that can be willed away.. however, one has the personal responsibility to adopt a treatment or follow a plan to change what is wrong. In the article I read this morning, a woman with chronic heart failure was dismissed from the hospital after an exacerbation of her illness. She was advised not to eat hot dogs, as the July 4th Holiday was approaching. The patient is quoted as saying that she went to the picnic and said, I am not supposed to have a hot dog, but give me one anyway. She further commented that if she was dead in the morning she would never know. Well, ha ha, isn't that funny. Instead, she was back in the ER and admitted to the hospital because she did NOT do what the doctor's said. Perhaps people need to understand that not taking care of themselves has a ripple effect. Her family would have been worried and strained by this readmission, doctors and nurses would have to care for her and somebody did not get a bed at that hospital because she was in it. Oh, and she is a Medicare patient so premiums for everyone can be effected.

I suppose everyone has a right to go to hell in a hand basket at their whim.. as my friend Tom Brown used to say.. but only if they can do so without wasting the rest of our valuable resources to get there.

So yes, I feel incensed by some of the recent news...

Monday, July 27, 2009

Quitting Smoking and Weight Gain

Today's post isn't only about quitting smoking and weight gain, but also about how people (and doctors are people too) think to manage weight gain. The post is inspired by a statement made in one of my quit smoking classes. Many people are concerned that when they quit smoking they will gain weight and for both medical and aesthetic reasons, that is often a deal breaker. Unfortunately, literature does support that people who quit smoking will gain ten or so pounds, some will gain much more and some will not gain at all. What the literature doesn't get into, is WHY the person gains weight.. I mean the REAL why.

My "student" is very motivated to quit and has the support of her primary care physician. In fact, he told her that if she gained weight to come back to him and he would assist her. She joked and asked if he was going to send her to a psychiatrist.. I offered my guess, a nutritionist? thinking this doctor was really on top of his ballgame when the "student" said, "No, he said he'd give me something for it." Ah... a pill. I told her not to worry because my health education would cover the weight gain issue and hence, this blog post was born.

[All readers know that I consider medication to be a last resort treatment or certainly a second or third approach , but never a first response to a non emergent situation.]

With regard to tobacco... Some will say that nicotine effects metabolism.. well, it may, but not by much. Seriously, if it increased metabolism enough to affect weight we would bottle it up and use it to treat obesity. More say that nicotine is an appetite suppressant. I agree, it is similar to coffee in that regard.

A person who quits tobacco has to get reacquainted with their appetite. There is also the psychological piece of being bored and eating when one would have smoked, being nervous and eating, being angry and eating.. etc. the classic emotional eating pattern that people who have disordered eating experience everyday.

I smoked myself for about 17 years and through it all I have pictures of life events. Sometimes I am thin and sometimes I am quite overweight (ranging 100 to 149 lbs). Many times, I have a cigarette in my hand or a pack of Winstons on the table near to me. I am fat or thin NOT because of cigarettes but because of FOOD. If you eat too much you will gain weight.. it is energy in and energy out, truly that simple for 95% of the population.

So a former smoker or an emotional eater has to learn two or three things. First, when am I hungry and when am I emotional.. Two, how to cope with emotions in health promoting ways.. journaling, exercising, talking, music, aromatherapy, massage, eating nutritious food! and Third, how does weight control work i.e, what food is healthy, how many calories do I need , how many am I currently eating, how do I keep a healthy low calorie food healthy and low calorie when I prepare it and so on.

When I work with people I encourage the Volumetrics concept. It is important because it is NOT a diet, it is NOT temporary and it IS safe, effective and health promoting.

I really frown on my quitters getting all those toxins out of their system just to put more chemicals in. Lifestyle change first and risky drug therapy and surgery as last resorts.. got that?

Sunday, July 26, 2009

Odds and Ends

Odds and Ends for the week's end:

Seen and heard: At the store today, a couple was reading out loud the ingredients of a dog chew. You know, the rawhide chews people give their pets. I heard the woman reading from the label that one should be careful to wash their hands after handling the product. She turned to the man with her and noted that this didn't really sound like something she wanted her dog to chew on. "How safe can this be?" she asked. Indeed. I wonder if they read their own food labels with the same discerning eye!

I was looking for chrome polish during the same shopping trip and saw a can of Acetone.. to remove rust...Acetone, I recalled is one of the chemicals found in tobacco smoke.

From the doctor: Okay.. so today is a week since my last great act of stupidity.. running when I felt a new pain in my foot. In fact, a week since I have run. When meeting with a doctor who knows me well (on Friday), I was admonished to start low and go slow. Ah, that is what we always said on the psych unit regarding medicine. It makes sense in fitness too. Goodness, isn't it advice I myself give in these pages. I was out of running because of an abdominal strain so I did some aerobics (step and floor). I took three classes, increasing in intensity in one week. Doc asked, "When was the last time you did that type of activity"..." um" I replied, "... six years." He shook his finger at me in the mock Italian way, "take it easy!! start low go slow." He then caught me in the hall about to take the stairs and personally escorted me to the elevator, pushing the button himself. Stubborn me.

Newton's Fruit Crisps: They really are that good. I have been waiting for the sugar free PopTart, and well, I still am, but this new product, in two flavors comes darn close. I wasn't buying them however because of cost. I checked the UPC on the shelf today however, and they are cheaper than most of the 100 calorie snacks.. they come eight to a box. So I bought some! Another reason I like them is because they come two to a pack but each piece is 50 calories, so it isn't one of those tricks.

Other Eating Disorders: A friend and blog reader asked me about discussing eating disorders such as Anorexia and Bulimia in this blog. I defer, and you all should know, not because I think that they are not serious but because as sensational as they are, they are rare. The most generous numbers put them at 10% where as overweight and obesity are over 60%. To be clear, of psychiatric illnesses, Anorexia Nervosa has the highest death rate. Overweight and Obesity at this time have been accepted as medical diseases, but not a mental illness.

Letter to the Editor: Today I read a letter in the Wall St Journal that I wish I had written, but alas, my letters don't get printed so I guess it is better that I did not write it. The letter from a physician in CA proposes that healthiness be rewarded while people who maintain excess weight and who smoke be required to pay higher insurance premiums. His letter is a little harsh, but when he implies that people will change when their bottom dollar is affected I can hardly argue. After discussing this with a Facebook friend, however, I had this thought. As higher cigarette prices DO lower rates of tobacco use, perhaps lower prices on health foods would increase their consumption.

Preventing Colds: Lastly. I overheard some coworkers talking this week as they felt they were coming down with various ailments. Someone mentioned the herbal supplement Emergen C as a way to thwart the malaise. I decided to look that up after having read disappointing results on some other herbals and supplements recently. I found two very good pieces of information to share. Both are from Web MD. The first link will be12 things that you can do to be healthy and maintain a strong immune system. The second is information on the herbal supplement itself. This is an awesome link. Web MD has medical oversight and therefore I trust its content. On this page, the evidenced based effectiveness of this supplement for several conditions is listed. For the common cold the evidence is not concrete but more supportive than I expected. Please note, the page has several tabs and includes info on ingredients and interactions. Be cautious too because supplements are not regulated by the FDA and unfortunately, many a time the product you actually buy does not have the same ingredients or same amount or same combination of what was found effective.

this link is natural ways to prevent a cold

this link shows Emergen C as maybe effective for common cold prevention

Saturday, July 25, 2009

Do You Have Cankles?

Well, I cannot believe that I am doing this post, but alas I am. Cankles are ankles that lack definition. They are firstly caused by obesity, but other causes can include a genetic inclination to store fat in the lower leg, chronic achilles tendinitis and other less common situations. According to an article I read in the WSJ, the average circumference of an ankle is 11 inches. Women have become increasingly concerned about the look of their legs as clothing styles can accent the calf and ankle. (you can Google the word in case you don't know the look)

In fact, there are exercise programs designed to target that area so that the ankles can be slimmed. And you know, I am not sure that I have mentioned this in the last year or two, but you cannot control where exactly you will gain or lose your weight. It just doesn't work that way. I would suggest that one way, perhaps the best way, to prevent fat ankles is to not be fat. Albeit, there are exceptions as there always are...sometimes things just happen.

Funny thing, I HAVE tendinitis right now. When the doctor was looking at my achilles and ankle area yesterday and recommending ultrasound for healing, he actually said that he thought the treatment would work well as I did not have much adipose tissue there. I measured just now, having read the article, and my ankle is 8 inches around.

I also read in the same article, by Amy Chozick , that some counselors were worried that focusing on "cankles" would lead more girls to develop eating disorders. Really.. are you kidding me? Here is an issue to worry about...

childhood obesity

Indeed, I saw a boy at the Farmer's Market today with his Mum... he was very overweight, drinking a soda. Sweating in the sun. He was swollen everywhere, no doubt his ankles too but I didn't look.. instead I was looking at this 8 to 10 year old boy with BOOBS and thinking that really ought to count as child neglect.

Friday, July 24, 2009

What Works Best?

I have already blogged a time or two about the concept of Comparative Effectiveness Research, which is abbreviated in the press as CER. This is research that compares medical treatments in an effort to determine which one works best and causes the least problems. I support this and am pleased that over a billion dollars has been included in the US stimulus package that was signed this passed February for these studies. I understand that what hasn't been addressed is how to deal with any issues related to cost of treatment by comparison. People fear that less effective treatments will be chosen because they are cheaper. I do not have this fear myself.

I am mentioning CER again today because there was a nice article in the New England Journal of Medicine on Wednesday related to it. It was written by K. Volpp and A. Das. It was a brief piece but the content was important and I dare say, I wish I had been the one to bring it up.

The authors note that over thirty percent of deaths in the country that are premature, are related to the behaviors that we adopt or choose. Our causes of death are related to things that we do or do not do, not something that happens TO US. Because that statement is true, I changed my career from social work to public health. I want us to get in front of the adverse outcomes because conditions like diabetes and heart disease are far easier, safer and cheaper to prevent then they are to treat.

Volpp and Das support CER and note that almost everyone does agree that the information will help the patient and the physician make better treatment decisions. What they add is that the research should not only compare medicines but also behavioral interventions. If, they say for example, an intervention leads to long lasting weight loss it can save a significant amount of money. I agree. Weight loss could prevent the need for medications, surgery, and assisted living and preserve disability dollars and the work force.

So the authors suggest that these types of interventions be included in the research. They gave an example of smoking cessation where the quitters were given incentives to quit, money. They compared those outcomes to outcomes from cessation medication. The range of success had the intervention at its lowest equal to stop smoking medicine Zyban and at its highest it was almost doubly effective. They point out also that the people given meds, whether NRT or non NRT, often relapse where the ones given the money at the end of the program did not. In other words, the expensive medications did not produce the outcome desired and the monetary payment wasn't given until after the outcome was achieved.

I agree that people's behaviors are key causes and key cures.. now.. where is the money for the education and systems change that will allow us to address it?

Thursday, July 23, 2009

Teaching Moments

We have a new employee where I work and she is only now getting to know me. I say this because what she said was so funny being said to ME. Her story was priceless and a wonderful teaching moment, then and now.

And do let me say.. I am NOT making fun of my coworker, nor judging her nor overtly trying to change her. I am subtle but open while at work. I eat the way I eat and when people ask me about my food or lifestyle I share information, ideas, recipes, and products. I LOVE doing that. I recall saying this before but it is worth repeating. People won't eat junk food if it isn't around, and people WILL eat good food if it is.

So not really knowing me that well, Sally (not her real name :)) began her story this way,
"This morning when I stopped at McDonald's..." Before she could finish her sentence, I said, "McDonald's???!!" and she continued, "Yeah, I always get a steak bagel (500+ cals)." To which I think I said, "Oh my." I believed she acquiesced that it wasn't so healthy and then added, "But today I decided to get the combo (with hash browns and coffee) because it is cheaper." I was very animated and dramatic while she talked, telling her she was killing me.. that my arteries were clogging as she spoke.... I was joking and educating at the same time. She did ask me when I last went to McDonald's and it was in the early 2000s when they released the Go Active meal with the water and pedometer. Anyway, the point Sally was trying to make, though I hardly let her finish, was that the coffee spilt in the bag and when she got out of the car the bag broke and her food fell on the ground... see, she was not meant to eat all that fat!

Seriously though, we have real life example of two things I have said recently. One is that it is significantly easier and cheaper to eat too much than to eat the right amount.
And the other, an example of someone who doesn't know which foods are health promoting and which are not. She often brings a microwave meal for lunch and eats all of what is meant to be three servings, but she may not even know that. I believe that her eating and her health will improve because her coworkers are great role models.... I being just one.

Wednesday, July 22, 2009

The Three Faces of Prevention

With regard to health promotion and prevention of disease there are basically three tiers. Health care debate often develops around these three tiers.

The three levels of prevention are usually referred to as primary, secondary and tertiary and can be explained this way.

Primary is meant to stop disease or injury from occurring. This includes using seat belts, helmets, sunscreen, adopting a healthy diet, engaging in regular exercise and receiving vaccines.

Secondary is to cure the problem, fix the injury and prevent any chronicity or long term disease and disability. Here a person may lose weight to avoid having to go on prescription medication or wear a cast to heal a fracture. In some cases this stage does involve long term use of medication but the goal is to cure the disease if at all possible. Both this level and the one above can include health promotion and health educators as sources of expertise.

Tertiary really isn’t prevention in my mind except that it strives to prevent pain and despair. This is treatment of disease to prolong life and add quality years if possible while providing comfort. There is effort to prevent further decline or spread of disease, though it is not as effective in this stage as it would be in stage two when caught early. Many times this will include high cost cancer treatments, surgery interventions, even loss of limbs and or organs to prevent disease progression or death. For example, a person with uncontrolled diabetes may require an amputation. A person who had a heart attack and did not follow treatment recommendations in stage two may now need a pace maker or stent placement. In this stage there is also effort to preserve independence and functioning. This level is very clinical and health educators may be replaced with nurse case managers to ensure treatment compliance or Hospice initiation.

As you can see, the numbers of person targeted in each stage is going to be different and the cost of the intervention will be different. Thus, the ROI or return on investment varies and is the interest of many a health economist and congress person.

An example for each level:

1-A simple PSA broadcast nationally, for example “Lose the Juice” or “1% or Less is Best” does not cost very much and can reach millions of people. However, it may not change as many people as a more intense or tailored message would or it may not reach the people who most need to change.

2-A health screening may identify pre hypertension or untreated hypertension which could get those persons into care to stop a problem from developing. This is more costly up front, but could save billions in the end. Questions about general screenings include how to handle false positives and referrals for care, especially in the uninsured. Cholesterol checks at health fairs would also fall into this category as would a general class on nutrition.

3-A chemotherapy drug or surgical procedure to treat smoking related lung cancer is extremely costly, may not prolong life and is invasive to the individual. This is expected to cost the most money for the fewest amount of people. Unfortunately, things are changing somewhat and more and more people do end up at this level because of the devastating and mounting consequences of obesity in our youth.
Still, all things considered… what if the cost of primary prevention equaled the cost of tertiary prevention… we could skip the first level yes? Actually, no. The use of resources and the high emotional and physical cost to the patient is NOT ACCEPTABLE. Of course, level three clearly does cost more and will only grow in the near future. We do have the ability to prevent disease and thus prevent suffering. We have the ability to add quality life years and it would be unethical to shirk that responsibility.

Just as the public health arena or the government has the responsibility to provide preventative measures to the citizens of this country... so do the individual citizens have the responsibility to heed recommendations. We are all in this together and if we want to keep costs AND disability down, we must take care of ourselves. So yes, regulation does come into play. seat belt laws, tobacco use laws, taxes on junk food, mandated health insurance… it all promotes health, physical and financial.

as I finish this post... our President speaks......

Tuesday, July 21, 2009

All Sun is Harmful?

This is an important post. My title is a little play on words associated with tobacco smoke. We, as health care professionals, are very clear in saying that there is no safe level of tobacco smoke... period. It appears that there is no safe level of unprotected sun exposure either. This is a new message. It is important because as harmful as the sun may be, its creation of Vitamin D is health promoting.

In the past week a statement regarding sun exposure and vitamin D was released by both the American Academy of Dermatology and The National Council on Skin Care Prevention. Both challenge an idea from only three or four years ago that I myself promoted. The old message was that 10 to 15 minutes of sun exposure would provide adequate D without putting the person at risk for skin cancer. That is no longer the last word.

I was also under the impression that sunscreen did not prevent the natural absorption and synthesis of ultraviolet light to vitamin D. I was wrong on that all along. As it is not considered safe to be exposed to any amount of sunlight without protective lotions (spf 15 and up) clothing and sun glasses, other sources of Vitamin D are to be utilized.

There are other risk factors for vitamin D deficiency which include older age, obesity and having dark skin. All of us are encouraged to talk to our physicians about how to get enough vitamin D and physicians are encouraged to study the issue so they can make the recommendations.

It is hard to get Vitamin D solely from your plate unless you are eating foods that have it added to them. Milk is of course the most popular source for the vitamin, as it is fortified. (fat content of milk does NOT effect calcium or D). The USDA nutrient data base does not yet list foods in order of Vitamin D content as it does with other nutrients, however, a project is under way to find those foods and supplements because " Vitamin D is among the highest ranked nutrients of public health significance and is, in part, the subject of recent publications published by the Institute of Medicine, National Academy of Science. " The data gathering is supposed to end this fall. I am very much looking forward to that.

Eggs and fish are other sources of vitamin D.

No matter how the vitamin D arrives, sun, food or supplement it still goes through two changes in the body before becoming usable. In case you are wondering, the process is called hydroxylation and one occurs in the kidney and the other in the liver.

Please note that there is an upper limit on vitamin d intake, meaning there is a level of which toxicity occurs. At this time, some experts, including the ones I respect, do advise at least 1000 IU of Vitamin D-3 for adults with up to 2000 IU as safe. Children under 18 and infants also need vitamin D though the recommendation is 400 IU. It is said that they too can have up to 1000 IU a day. Absolutely discuss any supplementation with your child's pediatrician.

The take home message is this. We must avoid unprotected sun exposure and we must get adequate vitamin D intake. I think that many of us do not take the risk of skin cancer seriously. I DO not and I know better. I think I am a bit like a smoker who rationalizes not quitting by saying, "well I used to smoke 2 packs a day". My rationalization for not always wearing sunscreen or hats or glasses, has been, "Yes, but I used to lay out with motor oil." In both cases, better isn't best. All smoke and all unprotected sun exposure are to be avoided.

Again, the vitamin D supplement that is recommended is called D-3 or cholecalciferol.

Monday, July 20, 2009

all produce is not equal

For this post I want to share with you the calorie count of some fruits and vegetables. The information was obtained from the USDA nutrient data base.
Each item is of the same weight, 100 grams, which is below the usual serving size for most of these items and far below the size many people actually consume. So this is not a list of calories for a piece of fruit or a serving of broccoli but a comparison of energy density. You can determine the amount of calories in a serving of food by using the above link.
This is also NOT a tool to denote a food as good or bad. This is an exercise in awareness. Be aware that not all fruits and vegetables are equal. Remember too, that Dr. Walter Willett encourages more vegetables per day than fruits. A variety of foods is best, and yes, it would be wise to not always choose the highest calorie ones.

All of these foods are fresh and do not have anything added to them. The amount is 100 grams. All foods are uncooked except the black beans and lentils.
Remember this is the amount of calories for that food at the 100 g serving size. Most of these items are eaten at 150 to 200 gram sizes. I did list them from least to most calorie dense. Do remember though, this is by weight and some things are heavy, i.e. watermelon and some are very light, i.e. mushrooms.
The veggie list should give you good ideas for volumetric meals. Also, today I uploaded a full day food diary on You Tube... which shows you all the food I ate on a recent Saturday.

Watermelon 30
Strawberry 32
Cantaloupe 34
Honey dew 36
Peach 40
Orange 46
Plum 46
Apricot 48
Pineapple 50
Apple 52
Raspberry 52
Blueberry 57
Pear 58
Kiwi 61
Sweet cherry 63
Mango 65
Grapes 69
Banana 89

Summer squash 16
Tomato 18
Bell Peppers 20-30
Mushroom 22
Eggplant 24
Greens 26
Broccoli 30
Spaghetti squash 31
Green beans 31
Carrots 41
Butternut squash 45
Onion 40
Potato 69
Peas 81
Corn 86
Sweet potato 86
Lentils (cooked) 116
Black beans (cooked) 132

Sunday, July 19, 2009

A New Flu Vaccine

There has been news recently regarding the 2009 swine flu (oops, that is Influenza A H1N1) and how we can best prepare for the second wave of this now declared pandemic. Pandemic meaning that the infection is active world wide and affects a great number of persons.
There is some concern that the flu is going to hit us harder this fall and that makes sense knowing that colder temperatures (inside and out) are more appealing to the virus.
What is concerning to me is that several governments, including that of the USA, are seeking vaccines for this strain of the flu by telling drug makers to rush and I have seen at least a suggestion that the makers will not be held accountable for adverse outcomes. My concern over the push for vaccines is on several levels.
1) the vaccine may not work
2) the cost of making and distributing the drug
3) the availability of the vaccine
4) adverse events associated with it
and 5) haven't we done this before?

We had a scare of flu in 1976 referred to as the Asian or Hong Kong flu. The then president rushed the vaccine and gave the drug makers immunity. The pandemic did not come and some cases of Guillain-Barre Syndrome, ( an auto immune disorder) were blamed on the drug.
I understand that vaccines are important and have eradicated many life threatening diseases. I am grateful that my parents had me vaccinated against many diseases when I was young because as an adult I am scared of the drugs. I do get my tetanus and that is about it. I do not get sick very often. I do my best to keep my body healthy so that it can resist viruses.. however, I am also protected to some degree because other people DO get vaccinated. That is referred to as herd immunity.
I don't know what to say about the new flu and the campaign to fight it.. I only know that we should consider the past.

I feel that the CDC is a credible (and up to date) source for information if you would like to read more:

Saturday, July 18, 2009

Lose the Juice

Today's post is a video PSA, if you receive the daily blog in your email, you will need to click on the yourhealtheducator link at the bottom of that message and it will take you to the webpage where you can view this PSA.

Friday, July 17, 2009


I am working on a new public service announcement regarding fruit juice which I hope to have ready tomorrow evening. I did get some interesting feedback from yesterday's post regarding the amount of sugar ( by weight and teaspoons) in many of our popular beverages. Readers were especially surprised to find that what they thought was a health promoting beverage at best and an healthy alternative to soda at the least, was neither.

I am a label reader. I generally won't consume a product if I can't figure out what is in it, and that makes me unique. That is unfortunate.

I bring this up today as I was just reading more about Wal-Marts new initiative to have eco or green labels on all store products so that the consumer can tell if sustainable practices were used in the manufacturing of said product. In the Wall St Journal article that I was reading, there was concern noted by some that the concept was complex and scientific which would make the task of creating a consumer friendly label rather daunting. Another person said that they envisioned the labels to be much like the nutrition labels that were commissioned by the FDA in 1990. Not such a good comparison.

I think that the labels are a fantastic idea and the more information that becomes required the better. The problem is, there hasn't been adequate education on how to read and use the labels. The info is available on line and in handouts, but seriously, have YOU ever seen it? One of the reasons many people drink fruit juice is because they think it is healthy, but a label check would quickly prove otherwise. We have got to learn how to determine a food's content, what is good and bad in that content, and then make healthy choices so that we can avoid illness. This is why nutrition info on menus are also needed.

Here is a link to some of the educational material available for reading food labels. Remember, the serving size is very important. Many times you are reading about a third or half of the package but eating all of it.

Thursday, July 16, 2009

Sugary Drinks

The chart to the right can be seen much better at it's source, the Harvard School of Public Health's Nutrition Source website. It is worth a close look as it shows the grams of sugar and amount of teaspoons of sugar in some of our most popular drinks. I have always spoke against orange juice and in case you can't see, it is the third red column from the left. I.e. red is bad.

In the last day or two, I heard a commercial that I expect was commissioned from a beverage industry trade group. The ad was an attempt to get people like you and me to contact our legislators to let them know that "now is not the time to add a tax to soda and juices." Well, boy buddy, they don't know me because I say NOW is exactly the time for the sugary drink or junk food tax. This may increase the price of the products that have been most directly linked to the increase in our countries rate of overweight and obesity. And with stressful economic times, people are more likely to grab said foods due to lack of coping skills and because of cheap availability.

The expert researchers, scientists and nutritionists at Harvard School of Public Health have proposed several strategies for addressing the issue. One is a call for a class of beverages with no more than 1 g of sugar per serving. Another is a call for labeling changes so that the drink label gives info for the bottle, not an 8 oz serving from a 20 oz bottle. They have also a website available to help people make healthy beverage choices.

Before I send you there... water is calorie free as are teas and least until we start adding stuff! I choose to drink diet, calorie free soda, in moderation, but cannot tell you that soda in any form is healthy. Stevia sweetened drinks could be an alternative, though I am not weighing in on that right now. Juice is really NOT a healthy option. Let me say that again, even 100% juice drinks are not the best option. Fruit is better than fruit juice. Fruit juice is not a low energy density item.. fruit is.

The link below has specific valuable information that you can apply to your life today. As always, I endorse all information associated with the esteemed Dr. Walter Willett.

Wednesday, July 15, 2009

Heart Disease odds and ends

I may have said this before, but I get weekly updates from Web MD's Medscape. I will just quote their own description to explain. "Medscape offers specialists, primary care physicians, and other health professionals the Web's most robust and integrated medical information and educational tools."

Many topics are in each alert that I receive and today I chose to read one on chest pain. The article was actually meant to help physicians determine when to refer a person to a specialist or an emergency room based on symptoms, history and clinical exam. While reading the article I came across many terms or conditions that were new or somewhat new to me. So the article had me searching the web for MORE info, I do enjoy doing that.

Here are some neat things that I learned.

Well, firstly, this as an article for physicians and I was very happy to see a section on lifestyle factors that said every patient should be advised to not smoke. It was said there that the number one most important and preventable risk factor for both heart attack and stroke is SMOKING.

The clinicians are encouraged to measure height and weight, waist circumference, blood pressure, pulse, check heart sounds and extremity pulses.. all this should be done before any blood work is ordered. One condition that came up here that was 100% new to me -

xanthelasma or tendon xanthomata : they are actually similar in meaning and I will tell you what they are, but I am going to post a link to some pictures as well and I would be surprised if that doesn't get your attention. These conditions are what doctors are told to look for on the body to indicate if the person has hyperlipidemia or high blood fats, including cholesterol. The xanthelamsa are puffy, oval like, yellow pockets of fat, just under the skin. They can be on the face or on tendons and ligaments. See below:
p.s. I did not vet this website, so any health info should be validated by you!

Other terms that I learned more about today:

Angina is pain in the chest due to a lack of blood supply, but not considered fatal.

Aortic stenosis involves a valve that releases blood from the left ventricle of the heart into the aorta where it can then go to nourish the cells, tissues and organs of the body. In aortic stenosis the valve does not open all the way and blood can back up into the ventricle and lungs. It is not related to lifestyle.
HCOM or hypertrophic obstructive cardiomyopathy is a combination of things really. Myopathy is any number of muscle diseases that affect proper functioning. Cardiomyopathy refers to a diseased heart muscle. You may have heard about atrophy.. meaning the wasting away of something, of muscles, like when you cannot use them. Hypertrophy is the opposite and in this case is an enlarged heart muscle. This is a dangerous condition and is said to be the main cause of instant cardiac death, often in athletes.
Substernal refers to behind the sternum. Doctors check for substernal pain when assessing angina.
Coronary Heart Disease is the same as coronary artery disease. The disease is marked by a lack of blood flow or decreased blood flow because the arteries are clogged and narrow and brittle. It is in large part due to lifestyle. CHD is the number one killer of both men and women in the USA.

And there was one thing that did not sit well with me. In addressing the issue of chest pain in a person with a risk of heart disease greater than 20 percent, an aspirin a day is recommended. (75mg) This is true and well researched, but these authors suggested that a PPI med be used if there was a high risk of stomach or gastric upset. OH NO... that was yesterday's post....

Is the treatment the problem?

In March I wrote about gastroesophageal reflux disease because someone I care about has it. Since then I am more likely to take note of articles, ads, and research studies regarding this condition and the prevention or treatment of it. Today I am following up with a summary of a newly published study and a editorial response to it. For history of the disease, please see the original blog entry which also has a link to a very good patient information website.

Very simply speaking, one medicine that is used to treat the symptoms of GERD appears to cause some of the very same symptoms it alleviates once the medicine is discontinued. The technical term for this is RAHS or Rebound Acid Hypersecretion. The biggest problem being, this type of medicine is not meant for long term use. Another problem, besides the need to extend use because of use, is that it is prescribed for mild symptoms or symptoms that have not been evaluated for actual GERD.

The medicine is in a class of drugs called Proton Pump Inhibitors, or PPI. These drugs reduce acid production and are also used in peptic ulcer disease and to neutralize a bacteria known as Heliobacter pylori.

A study that was published in a recent issue of the peer reviewed journal Gastroenterology notes that people without these diseases who were given the drug for two months, developed the acid reflux symptoms at discontinuation of the medicine. They were compared to a group that received a placebo. The participants were randomly assigned to either group. The medicine is called esomeprazole, or the little purple pill, Nexium. This is not the first study to raise these concerns.

Briefly, the gastric juices that we secrete are meant to aid in digestion. GERD is not a condition of too much acid, but that of the gastric fluids gaining access to the esophagus because the lower sphincter is not working correctly.

In an editorial response to the research study, Kenneth McColl and Derek Gillen both physicians with the University of Glasgow call for a limit to the use of these meds and a renewed effort to modify lifestyle factors that may lead to GERD as well as more research into how to correct the LES [lower esophageal sphincter]. There are options for surgery at this time but they do not reverse the situation completely. GERD is the leading cause of esophageal cancer.

The study and response can be found in Gastroenterology 2009; 137:20-39.

I consider this to be another example of over medicating a public that is demanding to be over medicated because the drug industry has led them to believe drugs are the answer to every possible discomfort they may experience, regardless of the often more serious outcomes related to the taking of said medicines!

My friend, by the way, no longer uses PPIs. Yea her!

Tuesday, July 14, 2009

Alzheimer's Disease Risk

I am going to posit that the two most dreaded diseases are any type of cancer and dementia, esp. Alzheimer's type.

Most of the news that I see regarding Alzheimer's Disease (AD) these days comes from updates on pharmaceutical company research and forward looking statements. In other words, the stock price of companies who are completing drug trials or laboratory studies on either preventing plaque build up, breaking plaque up, slowing or stopping progression of disease and plaque buildup and creating a vaccine. When I refer to plaque I mean the amyloid plaques which are indicative of the disease. The outcome of using these drugs would be a slowing or stopping of memory loss and cognitive functioning.

I can tell you from personal professional experience that the disease is devastating. It challenges the nerves, hearts, minds and physical capacity of the victims, the medical care providers, the professional caregivers, the loved ones, family caregivers, society and the health care system. So seeing the financial pages discuss the AD market as a billion dollar cash cow is rather off putting, wouldn't you agree? Seriously, a financial analyst was quoted in a WSJ article saying that the annual world wide sales of a plaque affecting drug would be 25 billion dollars.
Today then, let us look at some AD facts.

Every disease or condition has risk factors and protective factors. Some are modifiable, (like wearing a seat belt) some are not, like being a man (prostate cancer).

There is also a standard risk for a particular disease or situation. You know, there is a certain chance that anyone will get in a plane crash, for example. I do not know the general risk of Alzheimer's but have called an organization to see if I could get this baseline number, so to speak. I will let you know if and when I get that.
The reason I seek that number is that the first risk factor that you generally have no control over is your age. I do not know what the risk factor for AD at age 65 is for relatively healthy people without genetic risk. Let us hypothetically say that it is 2 percent.

For every five years after age 65, the risk for AD doubles. That being said, our 2 percent baseline would increase thusly:

age 65 2% risk, age 70 4% risk, age 75 8% risk, age 80 16% risk, age 85 32% risk and age 90 64% risk.

Because the population is aging at a bit of a glut, there is much concern about the over 85 population and how many of them might have this disease. There is no cure and there is no vaccine at this time. IF anything, it is comfort or palliative care that exists.

The second non modifiable risk factor is genetics. Scientists have found some links to the more common late onset AD in a gene (apolipoprotein E) and its sub types. Some APOE is protective other increases the risk, but none of the three identified guarantees you will get it or not get it. Early onset ED is related to a gene mutation.

Like any disease, having a non modifiable or non changeable risk factor does not mean that a person would not benefit from addressing the risk factors that are controllable or modifiable, if anything, that would be a more compelling reason to focus on lifestyle.

It is important to know that we do not have a causal link to life style and AD at this time. What we do have are some suggestive studies of populations and animals. The NIH (National Institutes of Health) as well as other agencies, are currently funding studies that can help to prove or disprove these associations. So what I am presenting below is suggestive but worth considering for yourself.

Simply Put:

Exercise is shown to improve brain health. Scientists can view the brain with special imaging techniques and have learned that exercise nourishes the brain through blood flow and that it can also increase brain mass and stimulate activity in certain areas of the brain. Having your brain changed this way would appear to be protective against insult and disease.

What you eat can improve brain health especially in regards to inflammation. We all have free radical damage throughout the body, it is what happens on a cellular level just from living, but it is worsened in some conditions and with some disease. Eating foods with antioxidant properties, sometimes referred to as phytochemicals can clear up some of this damage and again, protect the brain. Brain activity, thinking and memory, appear better in animals that eat things like berries. There are studies about the anti inflammatory properties of omega 3s in fish and fish oil supplements. Actual vitamin supplement studies have not shown the same positive results. Eating patterns, such as that in the Mediterranean Diet are also health promoting. It is thought that eating and exercising in ways that prevent chronic disease and some cancers, will also protect against AD. It is not clear if having diabetes and or high blood pressure increase dementia risk, but controlling them is thought to be beneficial.

Another important factor is life long learning and engagement. Again, in studies of populations there are less cases of AD or of mild cognitive impairment becoming AD in people who have higher educations and who stay engaged in life. It makes good sense. When you learn new things or how to do old things in a new way you stimulate different parts of your brain. If you then have an insult to one area, the other is more able to adapt, to compensate, even to take over so that functioning is preserved.

Lastly, there is research ongoing for a vaccine. In fact, one company has a drug that worked in preventing plaque from forming in AD patients, but the side effect was severe brain inflammation and the study had to be halted.

So what you can control is your eating, your physical activity and your participation in a broad range of activity, including social, recreational, religious, academic, etc.

The information in today's post was obtained through my professional experience, trainings and course work as well as the following website:

Interested in a calming evening snack? Take a look at this video. It provides additional weight management information as well.

Monday, July 13, 2009

the high cost of eating well

Every blog post does not have to be a research paper and so tonight I will just express opinion and grave concern about the state of disease prevention.
Health care reform is happening and within the congressional debates and presidential meetings are many nods to the importantance of prevention. Specifically, prevention of disease can be tied to three things of which we have control, and a fourth of which we don't, genetics. We do have control over our weight for the most part, for what we eat, again for the most part and for the amount of exercise we do.
With regard to what we eat, when legislating change, I implore the powers that be to confront the issue of how our food has changed and how readily available and cheap the worst types of food have become.
I say this as in the last day or two I have seen the 1 dollar double cheeseburger promotion, the 25 cent hot dog and the 1.50 dollar discrepency between a snack that is full of sugar and one that is sugar free. What IS THAT>?!
We have a crisis and it is because people cannot afford to eat nutritious low calorie food. Furthermore, they don't know exactly which food is healthy and low calorie nor how to prepare that food so it remains so.
I feel frustrated because I could absolutely educate society with a public health grant.. I could take the information that I have on my blog and You Tube to people who do not access the web. I cannot however, change the price of food.
Even today at the beach, I saw a family where the mother and perhaps her sister were substantially overweight.. they came from the snack bar with french fries, which they shared with the children who were not YET overweight. Was there another option at the snack bar? I do not know. Was it as cheap as the french fries? Likely not.
It is so hard for me to know the right thing and witness the wrong thing. Many people, regardless of circumstance, are naive when it comes to how food and exercise affect their health but pointing it out individually is not the right technique. It will backfire. Community education and policy change is less threatening and more cost effective and physically effective than pointing out individual misgivings and mistakes.
There are people who are in my inner circle who do not do the right things even though they are pretty well informed. I get that. I DO get that. It is like smoking. Smokers know that it is killing them, but not smoking is a completely different lifestyle for them. Same with ME and running. Running all the time is not the best thing to do, I often have over use injury, I KNOW that but I love running.
So my job, my quest.. it is two fold. Food has to be affordable and people have to know how to prepare it and eat it. We joke about backing away from the table, but seriously, we HAVE to back away from the table.
An example, I found these awesome 100 calorie snacks today... on my Mom's counter!! They are Newton's Fruit Crisps, pretty expensive so I probably won't buy them.. but there are two "crisps" in the package and the package has 100 calories. When I tried them it was like I finally found my low calorie Pop Tart.... very very yummy. I ate a pack today and thought, I can see that people would eat several packs at once, exactly how NOT to moderate calories. If people would retrain themselves to eat every few hours and to have a general idea of what those foods are going to be, they will STOP eating (when the meal is over) as they remind themselves that they will eat again very soon.
So today I just wanted to express my frustration I suppose. I am frustrated that healthy food is not affordable. I am frustrated that many people do not know which foods are healthy and how to keep them that way when preparing them. And I am frustrated that people do not do what works even when they know what it is. Many of these things are not the fault of the individual, except in the end, you decide whether or not you will do the "treatment".

Sunday, July 12, 2009

Keeping Your Fruit Safe

A recent discussion with a friend prompted a bit of investigation and this blog post. We were talking about food safety and picnicking, when I said that fruits and vegetables could not be left out all the day. Most of us are aware of why we don’t leave meat and salads out, but expect that uncooked things are immune to bacteria. This is not so, and we really knew that, i.e. the lettuce and spinach contaminations of the last few years. My friend and I weren’t exactly sure why it was wrong and we pondered the habits of our older relatives who often left food out on the counter for days with seemingly no adverse outcomes.

It is likely that the behavior of bacteria and the environments for which it can spread have changed. All we can really say now is that it isn’t going to hurt to follow the safety recommendations and could very well help. The symptoms of food poisoning can be mild diarrhea to severe cramping, vomiting, fever and even death in some sensitive populations.

With regard to our question, it is uncut food that can be uncooled for days, but cut fruit is as perishable as other picnic dishes. (by the way, it is good to rinse the fruit to get any germs off the rind or peel before you cut into it, as not doing so may contaminate the inside) From the CDC, USDA, FDA and other food safety sites, we learn that the temperature that is most conducive for bacteria growth is anywhere between 40 and 140 degrees. It is recommended that cut fruit not be out on the table for more than two hours, that NO food is on the table for more than two hours and that when it is over 90* outside, then the limit should be one hour. [by the way, freezing will stop or slow growth but does NOT destroy bacteria]

At our gatherings, the heat and the people are the main instigators. Be careful how you set your food out so that a person can get the serving they want without touching the rest of the food. Certainly have hand sanitizer available and don’t be afraid to point it OUT. A hurt feeling beats the hell out of a hurt gut.

On an interesting additional note, if the serving utensils were out for the two hour limit you need fresh ones or to clean them before reuse as bacteria can thrive there as well.

Basic picnic rules apply. Keep colds cold until serving and hots hot. Do not store these together. Do not pack raw meat in the same container as cooked meat. Do not keep produce and meat together. Items that do not require heating or cooling should not take up space in the containers of things that do.

Most often the best information on food safety comes from our agricultural extension centers or university departments. This is true here. This website and the table you will find there may be of use to you.

Thursday, July 9, 2009

Per Chance To Dream

With great interest, pride (I was born not far from Troy) and excitement I learned of a research study being conducted out of Rensselaer PolyTechnic Institute in upstate New York. The study involves using different types of light, through light bulbs, glasses and other gadgets to try and reset the body's natural sleep wake cycle. The lead researcher is Mariana Figueiro and her study was discussed in a recent Wall St Journal article. The few experiments she and her team have done involve only a handful of older persons, so no conclusions can be made. However, she is building a case for a full fledged clinical trial and I think this a noble project for funding.

Her theory and intervention revolve around the likelihood that as people age they spend more time indoors and in so doing they do not have the benefit of the "blue" light. She believes, but not all researchers concur, that the light our eyes see as blue is what helps us keep our rhythm and that inside light is mostly the "red" kind. She also noted that the aging eye does not perceive light in the same way. Those two things may be making it difficult for a significant number of older persons to get restorative sleep. Persons may have trouble falling asleep, sleep initiation, or staying asleep, sleep termination.

The most truly inspiring thing about her work and why I feel that it deserves funding is that the scientists are trying to find a solution that does not involve taking PILLS. Older persons, much like their younger counterparts, are over medicated. Medication can affect balance, appetite and constitution... not problems we need as we age.

Separately, another sleep study with the cute acronym, SHUTi has completed, at least one phase. This study is from the University of Virginia. It too involves using sleep hygiene, or cognitive behavioral therapy and certain routines, to improve sleep patterns. It will not reach everyone because it is Internet based, but the reason it is Internet based is pretty ingenious to me. When you cannot sleep, you go to the website and follow the online program. I am not sure how long the program lasts, (days or weeks) but the first research report is pretty promising. Again, this is an intervention that does NOT involve medication. The letters stand for Sleep Healthy Using the Internet. They may create software that insomniacs will be able to use.

At this time, both studies involve volunteers who get to use the special lights or programs for free and that is another good thing about research. Both schools have gotten at least some of their funding from the National Institutes of Health.

I guess we will have to stay tuned for this one..

Wednesday, July 8, 2009

The Great Calorie Debate

oops I forgot to post this last night... sorry....
As I reported when I returned from my Cooper Institute training, the most effective means to lose pounds is to cut calories. This was emphasized in a lecture I attended which was conducted by Sue Beckham , Ph.D, but many others and research support her statement.

[I always like to iterate when I talk about calorie cutting that I am NOT saying exercise is
unimportant.. it is VITAL to good health,
mood regulation and weight maintenance.]

Now, if weight loss requires calorie adjustment and a person does not know how much they are currently consuming how can they change it? This is why I fully support calorie"disclosure". This issue was the subject of a Wall St Journal article today. Let me summarize.There is concern over inaccuracy of the nutrition content information, concern that individuals will not change behavior because of the regulations and that consumers will eat unhealthy at their other meals.

This is a very important article and what it should impress upon legislators is that a rule or mandate is NOT enough to affect change. We have had good nutrient info on our food labels for some time, but many people do not know how to apply that to their particular situation. We need PSAs, label guides and education in our classrooms to make a real difference. I created two proposals for just such a campaign in 2007 and MAYBE the time is right to present them again.

The bottom line is that the calorie information is needed and it MUST be accurate because 100 calories will absolutely make a difference. And again, a person needs to know how many calories he or she requires to maintain a healthy weight, but also what the benefit of doing so would be. So maybe we have to start with the "Are YOU at risk for an obesity related disease?" campaign and then educate on how weight is gained or lost, "Energy In - Energy Out", give general guidelines on caloric needs and then the "Read your Labels - Check that Menu" can be promoted.

Are YOU at risk for VTE?

True to the nature of this blog, I am reporting beyond the headlines. Only yesterday a study on Venous Thromboembolism was reported in the peer reviewed journal, The Annals of Internal Medicine. After seeing the Reuters story I sought the actual research article and a few other sources in order to address the issue of travel related blood clots. A venous thromboembolism is a clot in the vein. The fear with VTE is that it can lead to a clot moving through the vein to the lung. This is often referred to as PE, which is pulmonary embolism and it can cause death. It is a very serious condition. (clots can interrupt blood flow or cause an artery or vessel or vein to burst)

You may have heard at least one story about flying and the risk of getting blood clots in the last few years. What the scientists from Harvard sought to find was evidence for or against the increased risk and explanation for why some studies show an increased risk and others do not.

Much is explained in the actual research article that leads me to believe that their conclusion that traveling, by plane or car, (in other words, being immobilized) does increase the risk of VTE as compared to not being stationary for those two plus hours. They found a 3 fold increase.

There was a lot for me to sort through and a few good points to make to you. First of all, what is a 3fold risk. To the best of my understanding it is 3 times the risk. That being said, 3 times WHAT? If the risk for getting a clot or VTE is 1 percent in general and now it is 3 percent, well there is a 97% chance I won't get one, so not so bad. The best I could come up with was in reading another article about deep vein thrombosis where people were put into categories of low/no risk and moderate and high etc. It said that the low/no group had a rate of 4 per 10(4) which I interpreted to mean 4 per 100,000 people. So that many people might randomly be expected to get a blood clot. This new study would then be saying that 12 people out of 100,000 would get one from traveling. Not to0 high, but I don't like that number so much.

I learned a lot in my research today. Firstly, there is a triad of things that could lead to a blood clot, this triad is named after the clinician who described them. It is the Virchow triad. The scientists found that travel can lead to 2 of the 3 conditions of Virchow's Triad. The conditions pertain to:

the vessel wall, blood flow and blood composition

The vessel wall is lined with special flat blood cells called endothelial cells and they exists to keep blood from clotting inside the blood vessel. (coagulation is a good thing when you have a cut, but it is called thrombosis when it occurs inside the blood vessel, and a thrombosis is bad)

Endothelial cells can be damaged from smoking.
The vessel wall changes do not occur because one is traveling or immobilized. The other two conditions can. They are stasis, or sluggish blood flow and a change in blood composition. The change in blood composition means that the blood platelets are more likely to come together and form a mass or clot. Some reasons this may occur are dehydration, being on birth control pills and having a history of blood clots, as they can scar the vessel walls. Further, being obese and having high blood fats will increase thrombosis risk. Another risk factor is varicose veins. They interrupt blood flow because they are often kinked, crooked and bulging. Normal blood vessels are straight and narrow.
So what can you change and not change and what is specific to traveling. You know that you can work on weight and hyperlipidemia and stop smoking. That is a given for any disease risk.
For flying, at this time there is concern about hydration and ambulation. After two hours the risk of VTE is up 18% and so rises every two hours. Right now you can choose to stop often and walk if you are traveling by car and do drink adequate amounts of water. When I travel by plane, I sit in the aisle seat and always go to the bathroom (to stretch my legs).
The studies that were reviewed by these scientists were not experiments, so the results are not the strongest. They do call for more research and I think they make a good argument. They call the issue a public health one, as world travel has increased. They pondered measures such as having people wear TED hose to having people take medication before travel, blood thinners. They did NOT disclose any pharmaceutical ties or funding!
They noted that older persons, pregnant women and women on birth control or HRT might be in the high risk category.

My ending though is this. If this issue gains weight through additional replicable research and dehydration is a big risk factor.. will airlines, for fear of lawsuit, limit or ban caffeinated and or alcoholic beverages in flight?

Here is the published study:

Tuesday, July 7, 2009

How to Stop Eating Too Much

We made a joke at work today. It had to do with something I learned along the way in my quest for a healthy ME weight. I want to share what I think are the most important things that I have learned. These tidbits come from research, from the classroom, from seminars and web searches. My lessons were both formal and informal - professor directed and self directed. They were learned through my MPH program and through my LIFE program.
In the end, I am an experiment of one and I know what worked for me.
The last time I lost weight was in 1999 and I lost it in an unhealthy way. It took a while after that to get it together, wrap my mind around science and maintain my weight in a way that was both mentally and physically health promoting.
I have been in a good place since probably 2004.
I was an active small child. I struggled with self esteem and then weight probably from 1983 to that last great "diet" in 1999. I cannot find words to tell you how self confident, productive, energetic, creative and determined I am though you might discern it from my posts. I CAN tell you with conviction that those things about me are due to my treating my body with respect and fueling it in a way that will increase my ability to successfully handle stress, illness, disease, accident and genetics.
Until 1999, I lost weight by stopping eating. Sometimes I exercised and sometimes I didn't. I liked very much to eat until my belly was swelled and full to bursting. I am agog at the amount of bread and pasta I used to consume... butter, oils, fats and sauces. Craziness. When I began to maintain the 1999 weight loss I was exercising three days a week. I have NOT stopped - I have never stopped this time and I won't. Over time, I increased intensity and days of exercise and I also INCREASED the amount of food I eat. Now I exercise most days of the week, but the activity level is varied.
There are just three things that I think you need to know and or do:
Change WHAT you eat
Change HOW you eat

WHAT: Choose foods that are low in energy density and high in nutrient density.... you know this.. it is volumetrics... and I even made videos for you.. no excuses!

HOW:Eat these smaller meals much more often. I no longer eat until my belly is so full that I am useless. (by the way, more heart attacks occur on Thanksgiving Day in America than any other day). Eat breakfast, and pre lunch and lunch and pre dinner, and dinner and then some. Seriously.. take your 1500-2500 calories and divide them UP.
This may have been the hardest change for me those many years ago. I didn't want to stop eating. I would go ALL day with just coffee and cigarettes so I could fill my belly from six until eight and then SLEEP. This is where the work story comes in. I have learned that I have to get up from the table. I plan a meal, eat it, and am done. How can I do this? I know that I am going to eat again in two or three hours... all the day long, until I go to bed. Eating every few hours throughout the day is probably the most important change you can make for your metabolism and endocrine systems.
Plan your meals! There is no office, family or social pressure that will get me to eat crap. I will not join in to feel good for a few minutes only to feel bad for the other 23 hours of the day. Now what I do not encourage for you is my rigidness. You would do well to do this 5 out of 7 days a week. I do it every day because that is what works for ME. I very much fear the unhappy girl of the past.
Here is the National Weight Loss Registry Link: This will give you evidenced based messages on how people lost weight and kept it off. Review your own history.. there is a lot there to learn as well.

And the joke was:

"Back away from the table and no one will get fat"

[there are some, albeit a select few, that have not struggled with food issues such as if that is you and your weight AND your blood work are health promoting.. then, do carry on!]