Tuesday, January 31, 2012

Treating Depression

*** Please discuss the use or discontinuation of any medication with a physician.

I actually spent a few minutes in my car today as I traveled  to a community meeting (still working on those school vending machines!). I heard a bit of a news story discussion a new medication that is meant to treat severe depression (suicidal thoughts/harm to self or others/hospitalization).  What is unique about this particular drug, because there are PLENTY, is that it is supposed to work fast.  That matters because psychotropic medications generally take at least two weeks to take effect and old or new, most psychiatric meds are associated with significant side effects and minimal treatment benefit.
Experts on the show today, made note that in many situations, exercise with or without talk therapy can be as effective if not more so, than standard medications.  It was also said that the positive outcomes from exercise last longer.  Sadly, it was further noted that though these things were true; exercise works, is not harmful and has better results, many people are not willing to commit to an active recovery/treatment regime and would rather just take a pill.  And that to me is "stinking thinking."

*** Please discuss the use or discontinuation of any medication with a physician.

Monday, January 30, 2012

Caring About Our Young Parents

I was working out in the gym (the student rec center) this morning while two young men (age 19-21) were talking.  Actually, one was just listening as the other went on for quite a while.  I believe that he was talking about his aunt, who he said was not even 50 yet (gasp).  Whoever she was, the young man was concerned about her weight - what she was eating and her lack of physical activity.
It was not his Mom because later I heard him say that his mother had four or five siblings and she was the small one.  I think he said that she weighed about 110 pounds and he could toss her "over his shoulder."  
He was about 6 foot or taller and muscular.  He also spoke with an accent, possibly eastern European.  I have worked out at the same time as he several times.
The young man was concerned that this person ate the wrong things or too many calories because I heard him say something about her eating a lot of bread and that if she just changed that it would make a big difference.  I also heard him tell his friend that he encourages this person to do more physical activity.  When there is some place to go, he tries to get her to walk.  Since she isn't exercising at all, he suggested she try swimming.  
The woman he was referring to is not much older than me but appears to be my polar opposite.  I know that as children we sometimes worry about our parents when they get into their 70s and 80s, but this young man is much more intuitive and on target.  If his aunt is not taking care of herself in her forties, her likelihood of a long, healthy, active life is significantly compromised.

I also wanted to take a moment to remind you that everyone, (exercisers and non-exercisers)  is at risk of metabolic changes (problems) when they spend uninterrupted hours sitting.  It is worse for non exercisers but bad for all persons.

By exercise I mean - activity that is intended to increase the heart rate or respiration during the activity's duration.
Exercise as defined in the Physical Activity Guidelines for Americans document:. A subcategory of physical activity that is planned, structured, repetitive, and purposive in the sense that the improvement or maintenance of one or more components of physical fitness is the objective. "Exercise" and "exercise training" frequently are used interchangeably and generally refer to physical activity performed during leisure time with the primary purpose of improving or maintaining physical fitness, physical performance, or health.

Sunday, January 29, 2012

Odds and Ends

Oral Cancer - To continue on an issue of concern... HPV is the virus associated with cervical cancer, but it is also linked to oral cancer (more so than smoking or smokeless tobacco).  This week researchers who published in the Journal of the American Medical Association or JAMA, found that 7% of us (US Adults and Teens) carried the HPV in our oral tissue (mouth).  Transmission of HPV is through sexual contact, i.e. the genital area including the anus . It is believed that the virus is transmitted through all types of sex; oral, anal and vaginal - but not through kissing.  Still, the finding of the virus in the mouth can help to explain the increase in oral cancer cases that we are seeing.  Once the virus enters the body, the cells that it tends to attack are of the cervix and oral cavity - with regard to cancer.
Grief - There is an effort underway to have grief added to the diagnostic manual that psychiatrists use.  If this were included in the manual,  one can be said to be suffering from grief in the manner of a psychiatric disorder.  Everyone will, at one time or another, lose a loved one (human or pet) and experience grief. Who would benefit from identifying this normal and inevitable part of life as a disease?  Well, as I have said, name it - treat it - medicate it.  I am 100% against this initiative.  You can hear a podcast about the debate at this link from Australia's national radio.
Tablets - I am passing on some advice I heard somewhere this week - probably the NBC nightly news.  People who have tablets, notepads - basically your IPAD, who read from them in laps or on the table - without using the little legs that let you tilt the screen, are having painful cases of neck strain.  The advice is - don't do that.
Heart Disease - The biggest for last today.  In a study that is being published in the NEJM, scientists looked at certain risk factors for heart disease in persons at various ages and tracked the outcomes up to age 80.  In other words, they looked at people who had or did not have the risks at age 45, 55, 65 and 75. The risks that they considered were related to blood pressure, cholesterol, diabetes and smoking. The ideal profile is to be normal for all levels and to not smoke.  The researchers compared the normal profile to persons who had two or more of the risk factors.  The results were staggering.  A 55 year old person with two or more factors was much more likely to have a heart attack and die, have a heart attack and not die, have a stroke and have fatal heart disease - any and all of those things before age 80.  The difference between people with no risk factors compared to those with two or more - in regards to percent of adverse outcomes was approx. 6% and 30% . In other words, I might have a 6% of having a heart attack and a person with high blood pressure who smokes might have a 30% chance of having one.  A further point of the research is that it didn't matter at what age the risk factors were present, the risk of death or other bad consequence was much higher among the group that had only two of the factors (i.e. high cholesterol and high blood pressure) than those with none.The full article was not available this week but I expect that there are increased risk differences based on age of onset of the 'factor.'  I hope to review the full article soon.


I hope that I can do this story justice, as it must be told.  No one was really there to see it – what a waste.  It is a funny story.  It isn’t about disease prevention directly, but I suppose it qualifies indirectly.  It is a story about what happened when I went running yesterday morning – and running is exercise and exercise is medicine and the fountain of youth so let’s dig in:

On Friday, I needed to get up and complete my run before a meeting on campus at 11am.  I wanted to run about six miles and was considering trying an amended route.  I had explored this on USATF running routes to make sure it would be about right and I would not get lost.  I was looking forward to the run because we have been having some unusual weather here in Greensboro NC.  It has been very cold (for me, for NC), and I have run in hats, gloves and tights in 25* weather but it has also been in the 40*s and even higher.  It also has rained often, but I have managed to work my run days around that.  I keep a steady eye on the weather, as I had Thursday evening.  And the expectation was a near 60 degree morning for Friday!  Crazy, I know.  I had put out running shorts and a tee shirt the night before as I had not run in shorts since my December visit to Florida. 
I was ALL set.

The first thing that went wrong was my GPS watch – but I didn’t know that until later.  Instead, as I awakened with my coffee and the news, I was confused because the rain showers from the night before had not exactly ended.  It was not raining, but storms or showers were still possible for the next hour or so.  Of course, I could not wait – I had a meeting.  I vacillated, but I could not stay undecided for long.  The weatherman was saying that the temperature would be moderate all day, but would be dropping, not rising.  I finally decided to go out.  Thinking, I can always turn around if it does start to storm ( I say, and never do).

As I started running, in my shorts(!), my watch failed.  “Oh, bother.”  I did not want to run the new route without my tracking device, but I was fine.  I chose another way.  About ¼ of a mile into my run, it began to rain.  Not heavy and it was not cold.  About one mile out, well, it was raining pretty hard.  At about two miles, it stopped and the sun came out.  It rained again later, but at about mile five, when I was almost done, it seemed that the rain was all past.  I smiled.  I was proud of myself for sticking with it.  The day would be even better because I had gone on this run.  I had even run a little faster than usual (it was raining and a bit chilly after all).

So here I came into the home stretch.  Of course, this was not the first time I ran in the rain, heaven’s no.  And certainly it was not the worst rain I have run in.  Not on purpose, but I have gotten caught in storms so bad I was certain to meet ‘my maker’ with a lightning bolt. I have run into and through puddles that came half way up my shins.  And I have chosen to start a 13 mile run in a very heavy downpour in Florida (no thunder and lightning then - though).  I have run when it was cold enough to freeze my face and another time, when ice cycles formed on my gloves (I knew because I heard a funny sound and it was the rubbing of the ice on my stomach as my arms and hands moved back and forth).  I have run in wind gusts that pushed me backwards.  Oh YES – ' - insert chest thumping ' – I AM a RUNNER.

But I had NEVER experienced what was about to happen at mile 5 of my Friday 6 mile run…

I came around the corner which had me back on same traveled ground – if that makes sense.  Can’t show you the map because the watch wasn’t working. But here is a similar map.

I had run up one road, crossed over so I ran back on a parallel road and then came back across at an under pass.  So that the first and last mile were on the same roads – get it?
I crossed the street at the light, and in the glory I described above, went back under the bridge (see where the lines reconnect) and as I did so….. cars were in both lanes going West past me (I was on the sidewalk).  The car in the nearest lane to me hit a puddle that literally gushed over me from Feet to Face – drenched as though a tidal wave had hit me.  I was totally engulfed in the water, and I squealed out loud. I don’t think the driver caught it, but the lady in the outer lane sure did.  It was PRICELESS.  My shirt and shorts, everything was plastered to my body, to the left side of my body - because of torquing water flow.  The splash went directly into my face as well.  

Of course I kept running!!  About a ¼ mile after that, because I had no running buddy to say it for me, out loud I exclaimed, “THAT was Awesome!!”

Friday, January 27, 2012

NSLP debut

Today is the day.  The National School Lunch Program has its first thorough revision in 15 years and now more closely aligns to the USDA's  Dietary Guidelines for Americans 2010.

In the past few months, I talked (blogged) a lot about the new rules based on the recommendation from the Institute of Medicine and the challenges they faced in Congress.  The potato lobbyists won their fight and the limits to potatoes were directly changed (omitted), but my indirectly be implemented.  I found it very important and telling that the DGAs and the school rec's recognized that starchy foods and vegetables needed to be limited in the diets of the American adult and child.  These types of foods are more calorically dense.  It is a good idea to limit them in schools because this could lead children to limit them as adults.  We eat what we're fed.

The school lunches still have to limit calories, salt, saturated and trans fat.  Servings of leafy vegetables and fruits must increase. No whole milk will be available.  All milk will be 1% or less fat. (that is another thing for adults to consider - whole milk and even 2% milk is too high in saturated fat to be considered healthy). I think that these conditions will lead to less potatoes, peas and corn served, even if the actual mandate to limit them was thrown out.  I believe this because the schools still have to keep the calories low and trust me, potatoes and marcaroni are not low on calories.

If you are interested in more information on how the NSLP played out - my previous posts on this issue are available here.
For news on the implementation that started this week, this article from the NY Times may interest you.

Thursday, January 26, 2012

Social Norms

People whose work involves behavior change, often use theories that incorporate the concept of social norms. 

However, because a person believes something to be normal (common or routine) doesn't mean that it is.

We often base our ideas about behavior outcomes and behavior frequency on what is happening in our personal  world (our view or frame).

Consider the 16 year old smoker.  He may have started smoking because his friends smoke or chose his friends because they smoke.  Either way, he is surrounded by 16 year olds who smoke.

Now I ask him, "What percent of 16 year olds smoke cigarettes?"  and his answer is, "60 to 70%"
The true number is closer to 20%.  The teenager is basing his truth about the world based on what he sees in his circle of friends. He thinks almost ALL teenagers smoke.   He is mistaken.

So when you hear about heart attacks, dementia cases and other diseases that are related to poor diets and being overweight and say, "well -  my grandmother ate fried foods every day and lived to be a 100."  or "I know people who are overweight and eat whatever they want and they are just fine."  You should recall the mistaken perceptions of the teenage smoker.  Just because the three or four people you know did the wrong things and didn't get sick, doesn't mean those things don't make people sick.

Wednesday, January 25, 2012

Calorie Burning (dancing) Bats

Today's post is going to be a lot more fun than yesterdays... even if it does involve statistics.
Well - not much statistics, but that is where we have to start.

In my class today, we were discussing a research study involving the energy expenditure (i.e. calorie burn) of bats who use echolocation verses non echolocating birds and non echolocating bats.  Ebat and Ne bats.  The researcher wondered if the ebats, would burn more calories because they are doing more (flying and sending out sound waves), or if they somehow compensate for it by conserving energy elsewhere.

The scientists used a procedure called regression so that they could control for body size (weight).  As you know, the bigger a person or BAT is, the more calories they burn.  This type of statistical procedure can make it so that all the birds and bats weigh the same (hypothetically speaking) and then the only difference should be - echolocating.

So  - do you know what echolocation is???  I think you will enjoy watching this video (for children) which may lead you to burn some extra calories from laughing!


PPACA - Your Health Benefits

I was inspired to write today’s blog post after receiving an email from my health insurance company this morning. More on that email in a bit.

I have very basic health insurance through a company that is affiliated with my university – because of the PPACA  (Patient Protection and Affordable Care Act)– they have to provide for (no charge to me) screenings that are recommended for my age and gender – mammograms and pap smears and if I wanted it, birth control.   This was not true before the law. (BTW – all companies have to pay for screening mammograms, not diagnostic ones, so beware)

There are many parts of the new law that benefit people and I am concerned that the law could be appealed.  I believe that some of the problem is the stigma associated with this law because it is attributed to a democratic president.  In other words, it has a party affiliation – the kiss of death.

I sincerely, and most fervently wish that we would stop dismissing things out of hand because whatever it is (policy, law or issue) is accompanied by a party label-

These labels are doing us no good at all and I, for one, would like to see an end to them.

I am registered to vote in my state – of course, but I am registered as unaffiliated and I AM – unaffiliated.  I do not have a loyalty.

I choose sides and evaluate issues or programs based on their substance, not on what president or congressperson is associated with them

I have great fear that many people discount things out of hand based on a misguided affiliation with or aversion to, a certain party (and much of the time people do not even know why they are a republican or democrat, much less what that party might have, at one time, stood for in general principal)

The very basic dichotomy is that democrats want more government and republicans less –
However, in reality, it seems to depend on the type of government or government program one is referring to –

Regardless, that is not the point I meant for today.  
I just want to encourage people to know what they are aligning themselves with or against before being so adamantly for or against something –

The PPACA does good things for a great many people (and some not good things) – but if the whole thing is appealed – a helluva lot of folks are going to miss the benefits they do not even know they are receiving.

If you clink on this link you will see some of the services that are provided to persons age 65 and older who have Medicare.  You can also search for preventative care for women or men, special services for children etc.

The email I got today was a notice that my plan would only cover elective abortions if I opted in for this coverage.  Interesting.  If I had more time I would look into that – I think it has something to do with an abortion law that passed in my state senate this year.  I am not a candidate for pregnancy, planned or other wise, so the issue doesn’t matter to me personally.  I won’t opt in for that coverage.  I can see where some women might.

Here is what the email actually says:

Effective January 1, 2012, if elected, your coverage under the System-Wide Student Health Insurance Plan will not include an Elective Abortion benefit unless you "opt-in" to include this benefit. This benefit option, if selected, applies to the 2012 Spring/Summer Semester. The inclusion of this benefit in the Plan does not change the premium amount.

I think it unfortunate that I felt inspired to write this blog when the President was about to do his state of the union address because most people will be pissed off when they read this – but remember, the law –PPACA- is (or can be) a good one.  If you are going to complain about it – complain because you do not like what is in it, not because you don’t like who voted for it.

Tuesday, January 24, 2012


In keeping with the goal of this blog - let's break down a headline from today...

Women experience more pain than men.
Women report more pain than men.
Leading to these questions - you should be asking

Is it that women are asked more often whether or not they are in pain, by physicians or researchers?
How was this information collected?  Did researchers ask physicians about pain reporting in their patients (i.e. a second hand report)? 
Do physicians ask the same questions to men and women?

Was the man or woman asked about pain in a written self completed survey?  
Were they asked in an interview?  Did a man ask a man and a woman ask a woman - or opposite sex pairs or was there any "set" way?
 Would a woman say something to a doctor, a researcher, on paper or in person that she wouldn't say the other way?  Would a man?
Does it matter who is asking?
Do men and women always tell the truth about their pain levels or frequency?  Does that answer change based on who or how the question is asked?

Isn't it more socially acceptable for a man to hide his pain from others?

Does the pain level or frequency reported equal that experienced?
I.e. if I say I have x amount of pain x days a week - do I have that exact amount or more or less?
 Do women really have more pain than men, or do they report more pain than men - could be yes' and no's.

My personal experience - (not an experiment or a survey)- Men may not tell their friends, doctors or coworkers that they are in pain, but boy do they tell their partners... and the tolerance for pain in the men I know has been rather low!!

Sunday, January 22, 2012

Odds and Ends

Heart Attacks and Sex: This week many news anchors and print reporters noted that the AHA  released guidelines on when persons who had had a heart attack could resume sexual relations.  The part that got the most attention was in evaluating your sex readiness based on your ability to walk up two flights of stairs without complications (shortness of breath, chest pain).  If you are having trouble with this now, and you have NOT had a heart attack - I suggest you think about that. My first thought when the guidelines made headlines was that it was man centered.  But what I found in the AHA's own publication was more important.  1) they want physicians to talk to their patients about sex and 2) having sex is a "miniscule" risk factor for heart attacks, as said here.
Environment and Paper: My natural gas bill came this week and as usual it had a note that thanked me for doing something good for the environment, i.e using natural gas.  Ironically, the company does not offer paperless billing.  I am sure that countless trees are killed every year in order for customers to get a 2-3 page bill, and a return envelope (not used because I pay online), delivered in another envelope.  I suppose the post office is thankful for their business.
Grading Obesity: I had time to read the full report from the NCHS obesity trends brief that I referenced on Friday.  A few interesting extras there.  Did you know that there is a grade 2 and 3 of obesity based on BMI?  Obesity has been defined as a Body Mass Index (BMI) greater than or equal to 30 for as long as I can remember.  But these grades.... I wonder when it became necessary to add  categories of 35 or greater (grade 2) and 40 or greater (grade 3).  Actually, I do recall references to morbid obesity.  This must me a different way of expressing that.  In regards to these grades, for women specifically, in nearly all adult age groups, there are twice as many black women in  grade two and in some age categories, there are three times as many black women in grade 3.  However, here is a caveat that deserves some thought.  Man or Woman - whites have higher body fat percents at any given BMI than blacks.  (Flegal, K., Carroll, M., Kit, B., Ogden, C. 2012 JAMA)
It is called TESTOSTERONE: Okay well - I, for one am tired of hearing the commercial for a drug that is supposed to increase testosterone levels.  First - I hate direct to consumer advertising for drugs and Second - hello - it is called testosterone - not T.  "you may have low T."  Seriously, can't men say or hear the word testosterone?  It is their primary hormone for goodness sakes.
Mexico:  Kudos to President Calderon for taking steps to address fraudulent advertising and for pointing out that his people have very high obesity rates and the health conditions that are associated with being overweight.  He contends that the issue is too serious to let people be misguided by false claims on weight loss.  Read more from ABC news 
Eye Trick:. It is possible that my mother told me one or both of the following statements, but I also heard it from friends  while growing up - especially as a teenager and young adult.  
1) Don't go out with out make up on (what a drag), and
2) your make up is not complete without lipstick. 
Well- when I was between 15 and 30 years old, that was pretty much the way of things.  However,  I realize now that make up is not a necessary part of being a woman nor is it exclusively for women.  Funny how we change with age, education and experiences.  What has not changed however, is that I have a certain amount of vanity and I don't want to look unattractive and I cringe at the thought of looking old.  This has led me to be hyper critical of my face, and especially my eyes.  Mediterranean skin, eye swelling and living in a colder climate has not really helped.  However, I have found something that absolutely improves the appearance of my eyes - Lipstick.  No - not on my eyelids - But only Lipstick.  Lipstick and NOTHING else... funny that - but it works :) It takes everyone's direct attention away from my eyes, including mine - but also softens the look of my eyes - hard to explain - but try it!

Saturday, January 21, 2012

It's the Flour and Sugar

This is the word.  As you know from many past posts, my favorite nutrition scientist (and professor) is Walter Willett from Harvard University School of Public Health.  The HSPH had a press release on January 12 in which Dr. Willett says this:
 “Unfortunately, many well-motivated people have been led to believe that all fats are bad and that foods loaded with white flour and sugar are healthy choices. This has clearly contributed to the epidemic of diabetes we are experiencing and premature death for many."
 The press release highlights the need for whole grains and good fats as part of a health promoting diet.  Recipes are offered as are comparisons to other muffins.  
The recipes are worth a look as are the ones that I have posted on You Tube, however, mine do not contain any heart healthy fats - mine are 100% fat free.

Friday, January 20, 2012

Disturbing Numbers - Our Obesity Epidemic

I will tell you the numbers first but I hope you stick around for a little more (I moved the technical stuff to the end).

78 Million (plus) American adults are obese, or were obese when the numbers were gathered in 2009-2010.  That is 35% of our population and that should give you pause because the 78 million does not include the additional 78 million who are overweight -  when you combine overweight with obese the number is just over 69 percent.
12 Million (plus) American children and adolescents are obese (2009-2010 data).  The definition of obesity is different in children than adults so we have different percentage points here.  By most accounts it is 12 percent, if the cut off is a little lower it is 16 percent and if we include overweight it is about 30% of children ages 2-19 .  For children we look at percentile rankings (we compare their BMIs to all children that age and if 85, 95 or 97 percent of children are lower, the child is considered overweight or obese, accordingly.  Don't let this confuse you - the words obese and child should not occur in the same sentence.  
There is separate information for infants and toddlers and sadly, about 10 percent of them are also 'obese.'

I am going to share the NCHS data brief with you.  It is not long and contains graphs that show the differences in obesity prevalence (the number of person's who are currently obese) by age group and gender.  Interestingly, the most obese age group for women is age 60 and older and the lowest is the 20-39 age group.  You can read the report for details on differences between men and women, boys and girls and who is catching up to the other.
When you hear the news reports this week - because you will if you haven't already, the main message is that we seem to be stabilizing. 
***My  point for the post today is to clarify what that means.
We are not getting fatter at the same rate as we were ten years ago - we have slowed down, we have not stopped.
Here is an example using small numbers...

At some point,  10 people per year were NEW to the obese category (they joined the already obese people)
then it changed to 15 people per year, and then 20 people per year and it kept going up - every year MORE people joined the group than the year before- but (mostly) no one LEFT the group....
We have now stopped increasing the amount per year that we add, but we still add people every year.... GOT THAT?

technical stuff:
The National Health and Nutrition Examination Survey or NHANES is a nationally representative survey that has been conducted through the National Center for Health Statistics since the 1970s and which is now a continuous survey which collects information in two year cycles.
It has 3 components and complex sampling procedures that allow the type of  extrapolation that I speak of today and that informs the CDC report that I linked.
NHANES is not an experiment.  It is a voluntary study, but people are invited to participate through random selection - in other words, people don't so much volunteer to be in the study as they consent to be in it, once the researchers contact them.
A household interview takes place, some persons also visit a Medical Examination Center (MEC) where lab work is completed, including height and weight, cholesterol readings, etc.  A group of individuals who attend the MEC are also interviewed with a very sophisticated food frequency recall program.  They report 24 hours of food intake and within a week, they get a phone call and complete a second 24 hour recall.  [this information will be invaluable for me and my research, but it really doesn't have anything to do with this particular obesity report - sorry]

Thursday, January 19, 2012

BK Fights Back

Truthfully, I couldn't think of an appropriate title for the post today - but it seems that Burger King is my arch enemy.

It is bad enough that fast food joints increase in density the poorer  an area becomes - making high calorie food the easier choice both for price and location for people living there - and to that-
BK is now (in select places) making deliveries.

All I can say - is ... You MUST be kidding me....Actually PLEASE be kidding me -

Those of us working to fight obesity have to beg, borrow and steal every dime we can in order to promote and support funding for mobile Farmer's Markets and now Burger King decides to bring 'junk' straight to peoples' doors.  

I could give up - but I am too darn stubborn.  Still - GEEEZ

Wednesday, January 18, 2012


My studies and this blog are specifically related to chronic disease that is attributed to dietary factors and exposure to tobacco or other carcinogens.  Generally however, I am interested in anything related to health and so from time to time the blog post may wander in another direction - like financial health for instance.

Today I mention something associated with  relationships because I have been reading an article that mentions theories that lead to successful ones. 
One of the theories is exchange theory and according to Buhrmester, Furman, Wittenberg and Reis (1988), an important component of exchange theory is this:

-"appropriately asserting displeasure with others"-

I think you should read that line again.  It is really saying TWO things.  The first is that when you are in a relationship (romantic, friendship, or familial), it is important that you DO share your feelings when you are displeased (unhappy, etc). The second part is that you do so appropriately.  
Sulking and withholding affection or attention, for example, are NOT assertions.  Yelling that your spouse is a jerk IS communicating, but not appropriately.

I think what I want most to impress upon you, the reader, is this:  It is not healthy to keep things inside.  It does not help you or the relationship.  Suffering in silence - being a dutiful (yet,conflicted) person  - or being unhappy, gracefully - these are not strategies to improve the health of a relationship.  It does not help you, the relationship, or the other person(s).

Tuesday, January 17, 2012

Promoting Moderation

As many of you may have heard by now, the celebrity chef Paula Deen appeared on the NBC Today show today and announced that she has type two diabetes.
If you will recall from this post, diabetes onset is triggered by a high fat diet and one of the the body's responses is the inability to manage blood sugars.  Diabetics have circulatory problems which lead to heart disease.
Paula Deen is famous for her high fat recipes and today when asked about changing the way she eats, she indicated that she always tells her audience that moderation is key.  (It is also being said that she has been sick for some time while continuing to 'peddle' her less healthy creations.
I wonder if people realize that when you moderate something you LESSEN it.
It was also disclosed, and I heard this from 1) my nephew on FAcebook and 2) Brian Williams the news anchor, that Paula Deen is a paid spokesperson for a diabetes drug maker.

I will leave you with the great words of wisdom that my young adult nephew had for Ms. Deen-
"Join Weight Watchers!!!"

Monday, January 16, 2012

Switching Bad Habits for 'Good' Ones

There is a difference between nasty or bad habits and good ones.  We are often enticed to learn about the 7 Habits of Highly Successful People, for example.  So we agree - a habit, routine, regimen, something you ALWAYS do, can be a positive thing.

This is the case with health.  Adopting practices that will reduce your risk of disease and improve your chance for healthy active aging is smart.  

Sometimes your routine may include a habit that is good practice but for some reason needs to be revised.  It is good to brush your teeth every day (at least twice) and you should do this for the rest of your life!  Of course, if you are brushing them wrong or with the wrong type of brush or paste, then you should switch - even though you have always done it the other way... Now you will always do it 'this' way.

Many people enjoy a drink of alcohol after a days work.  In regards to health, there is some evidence that one drink (and the definition for what a drink is -  4 ounces of wine, 12 ounces of beer or 1.5 ounces of liquor) can have a positive impact on health (not for all people however).
I have family and friends who enjoy too much alcohol.  I myself have had periods in my life where I also drank too much.  I am very careful not to do that now.  Remember, it is not just the impact on your system and organs but also your waistline that is of concern.
I have a drink on the weekend (sat and sun).  If I go out to dinner during the week, I may also have A drink (but this is rare).  I have my drink at 630ish because dinner is 730ish.  These times change with my life phases, it is just the routine I am in these days.
On weekday evenings, I have a cup of hot tea and a little snack (the same 100 calories that would be in my alcohol {because I have one light beer or one fresca whisky sour whenI drink}) at this 630 time, while thinking of what to prepare for dinner.  
I tend to look forward to 630 on all seven days of the week because whatever the 'treat,' it is calming to me and isn't that why many people drink?  To unwind or relax?

Just letting you know, substitutes can help.

Sunday, January 15, 2012

Odds and Ends

Weight Watcher's Meals - In the convenience section of my local grocer, i.e. the deli, I noticed  Weight Watchers (TM)  single serving microwavable meals.  Costly, but calorically sensible.  Choose these over sandwiches and you're likely to make the better choice.

Listen - Unlike many people, perhaps some of you included, I am much more likely to follow my health promoting routine or lifestyle as it is encrypted in my head than to make day to day decisions based on how my body feels.  This week, I had two occasions which challenged my rigidity and I listened.  One of them involved feeling that a running related muscle pain (old injury) was speaking a little louder than usual.  I believe that was Wednesday.  It was also forecast to be a cold and rainy day. I listened to my body.  I did not run on Wednesday but chose an alternative cardio activity that would not work my muscles in the same way and which took place inside.  On Thursday, the day I ran in place of Wednesday, I noticed that my DOMS (delayed onset muscle soreness) from Monday's weight training session had not truly abated.  If my muscles were still that sore, they needed more rest (so that I could work them hard again, as that is how muscles strengthen and grow).  I did my weight routine on Friday instead.  SO- if I can be more attentive and smart, so can you. You may have the opposite problem however - not feeling like sticking to any sort of routine whatsoever, esp. if your body is telling you it is tired.  Sometimes the weary feeling comes from lack of activity - so GET GOING.

Hostess - Ah - the bakery company is filing bankruptcy or bankruptcy protection.  I heard a joke on the radio in regards to the absurdity of a snack food company going bankrupt in AMERICA, but my thoughts on hearing the news were different.  I thought, "Hmm > that is because they charge too darn much for the 100 calorie cupcakes and I cannot afford to but them!"

Vegetables Ahead - Yesterday I roasted (baked in the oven) two bags of frozen cut green beans (with onion powder and thyme), a bag of frozen Brussels sprouts (first time I bought frozen - better price, better quality) with red pepper flakes and curry powder (because I was out of ginger), I cut a yam into three pieces and boiled it, and I cut, cleaned and baked a spaghetti squash (to add garlic powder and Parmesan cheese with I reheat it later) and I think that is about it!  I am ready for the week ahead.  I portioned the veggies out and froze them.

Give the Man... (NO)  Today was a great day in that my favorite football team, the NY Giants won their division and are on their way to the NFC championship.  When the game is on any channel other than NBC (which airs it live online!), I can only listen on the radio. I have a favorite radio station out of NY and I like the announcers.  However, when a NY Giant has a great play, one of the show's sponsors gives them an award - I can't remember the name of the business, but the announcer says that so and so gets the (business name)"Give the Man a Cigar" award.  Boo - cigars are full of toxins and I don't want my awesome men of Big Blue to get a lung disease !!

Saturday, January 14, 2012

What You Don't Know

In another reading today, I came across a quote attributed to a congressman as he was speaking to his colleagues... He was talking to them about a policy decision or a program that they were considering and he said, "Don't pretend that you know what you don't know..."  This is attributed to Senator Moynihan and he was urging congress not to pass something with no knowledge of the theory that drove the idea or testing the theory itself.  
(I read this in a book chapter written by Eleanor Chelimsky.)

I want to think about that statement because it is very important.  I will think about it(out loud to you) in regards to the theory/idea that I support - that 1)providing access to information about food (calories for example) and 2)access to healthier foods (perhaps with lower pricing) will lead to informed eating and possibly a lessening of the obesity crisis that America and many countries now face.

Do I KNOW that the policies that make these strategies a reality will work?  NO.  Are the ideas based on a theory - YES.  Can this be tested?  Yes.  Has it been?  Yes - on a small scale.  Should we continue to test it when we implement it?  Yes.  Does the theory include more than just providing the information?  YES.  What else is needed?  Education and Promotion.  Should the evaluation of the policy also consider the amount of education and promotion that was delivered?  Absolutely.
What are we waiting for?  I have no idea!

Friday, January 13, 2012

FOP Labeling Goes On

Busy day for my assistantship work so this will be a brief post.

I stopped at a higher end grocer yesterday to grab a few things on my way home from class.  They had some frozen vegetables on sale and I wanted a bag of cauliflower so I grabbed one.  Tonight as I was opening the bag, I noticed these strange pictures and letters, like EV and LS.  Looking more closely, I realized that it was some type of front of pack labeling system.  Of course , it was not the standardized and simple format that is recommended by the IOM.
It looked like this:

I noticed that the heart healthy part was explained on the back of the pack, seen here.

But the clincher, which has nothing to do with FOP systems, were these words...
'product of Mexico'

Hence - I can get the same product for a lot less money if I shop at Wal-Mart - which I usually do.

Thursday, January 12, 2012

A Telling Definition

The terms health education and health promotion have several definitions,no agreed upon definition and are sometimes used interchangeably.  
Though I use this blog and other venues to educate people on health related issues - I still consider myself someone who primarily promotes health and wellness.

In a reading for one of my classes, I came across this definition of health education and thought, "Well - that is it then isn't it?"  And I wanted to share:

Attributed to Griffiths(1972) from the text listed below:

" health education attempts to close the gap between what is known about optimum health practice and that which is actually practiced."

In other words - the difference between what we know will keep us healthy and what we actually do.

From : Glanz, K., Rimer, B.K., & Viswanath, K. (eds). (2008). Health behavior and health education: 
Theory,  research and practice (4th Edition). San Francisco: Jossey-Bass.  [page 10]

Wednesday, January 11, 2012

FEVone and FVC for Pot Smokers

Ah ha - got your attention on that last part didn't I?

You may recall from past posts, several of them, that I am a advocate for spirometry testing in smokers - in fact, I find it much more important and necessary than CT scans.  A spirometer is the device used in a lung function test.  It is relatively simple and straight forward.  The patient takes a deep breath and then blows into a tube which measures the volume you expire (blow out) in one second (FEVone) and your full expiration or FVC.  Read more here.
Certain values are indicative of lung problems and the diagnosis of Chronic Obstructive Pulmonary Disease.  Pulmonary means lungs.  COPD is very common in cigarette smokers and involves lung enlargement, air sac destruction and loss of elasticity.  It can feel like one is drowning and unable to breathe.  Emphysema is a type of COPD.
When I was doing presentations on the medical complications of tobacco use, the audience would sometimes ask about marijuana use.  I would say, "Anything that you light on fire and breathe into your lungs will cause them harm."  I still stand by that statement, however, research reported in the Journal of the American Medical Association this month, shows that marijuana smokers do NOT have the same decline in lung function, based on FEVone and FVC as cigarette smokers do.
This was not a lung cancer study, but it was a study that followed many people over 20 years.  The people in the study were classified as either 1) non users of both cigarettes and marijuana, 2) cigarettes users only, 3) marijuana users only and 4)users of both.  
The marijuana only group did not fair as well as the nonusers of both but certainly better than the smokers or both group.
Some thoughts put forward by the researchers include 
  •  Cigarette smokers consume several cigarettes every day whereas marijuana users might have a whole marijuana cigarette or two only once per week.  Most marijuana users do not use every day or even every week.  
  • Marijuana smokers breathe in very deep and hold their breath before exhaling - similar to what one does with spirometry (so they practice what the test requires and they may strengthen their lungs in the process) 
  • THC, which is found in marijuana may actually soothe or heal lung tissue.
Interesting study - it does not imply that marijuana use is safe nor that we should add THC to our cigarettes, but it is evidence that marijuana smoking does not damage lungs to the same extent as cigarettes do.  This study does confirm the severe, adverse effect that cigarette smoking has on lung function.

Association Between Marijuana Exposure and Pulmonary Function Over 20 Years
 Mark J. Pletcher, Eric Vittinghoff, Ravi Kalhan, Joshua Richman, Monika Safford, Stephen Sidney, Feng Lin, Stefan Kertesz JAMA. 2012;307(2):173-181.

Tuesday, January 10, 2012

FOP Delay Breeds Confusion

When the Institute of Medicine was conducting its review of front of pack labeling systems prior to making its final recommendation to the FDA at the end of 2011, it addressed several existing systems that were currently in use.  
Included in their analysis were NuVal and Guiding Stars.  Both of these systems were deemed inadequate and misleading and the IOM ended with a recommendation that would be used across all products and would include a point earned for meeting certain criteria, only after an overall benchmark of "goodness" was achieved. My past posts in regard to this issue can be found here.
Unfortunately, the FDA is not ready to make the new national labeling system happen and I am most certain politics abound and work to delay the efforts.  
You are probably seeing front of pack systems on the products you buy now, but education on their use has not begun and they are not the symbols created by health experts. 
Some big grocers are themselves adopting the systems that the IOM discredited - which is really the fault of the FDA not the grocers.  In the article I read today, a couple of the health experts are consulted and stand by the IOM report.  You can read it here.

Monday, January 9, 2012

Comparative Fatness

My title is a word play on a concept that was addressed in a recent news paper article or series of articles.  A journalist, Marni Jameson, interviewed several health experts for her four part series "Why We're Fat." 
I was most interested in the last piece and you can read it in its entirety here.  Part 4 focuses on the environment and governmental policies, which are also my areas of research and career interest.  I particularly would suggest that you look at numbers, 1,2, 4 and 8-10 if you are curious about my leanings. 

Item 8 is the one that inspired my title, but in Jameson's article, Steve Smith, PhD is credited with saying "Fat is the new normal" and Ms. Jameson's header is "Fat is Relative."  Sadly, both have a legitimate point.  If everyone around you is overweight, then your obesity does not stand out with  the importance that it should.  Not only is fat prevelant, so is chronic disease - i.e. diabetes and hypertension.  These conditions might then be normal, if you take normal to mean "majority," but they are not 'healthy' states of being.  Also, in this particular section of the article - vanity sizing is noted.  In other words, the clothing industry has responded to our vanity - not wanting to wear a size 12 or 14 because those are fat sizes - and takes those SAME patterns and calls them a 10.  This is a grand form of denial - not of attractiveness or unattractiveness - that is size neutral and really IS a matter of opinion - but of disease.  Disease states are measureable and objectively defined - overweight> diabetic>hypertensive.... >disability>unsuccessful aging> premature death or disability adjusted life years (living as long but in poor health).

Read the entire article and see if you can guess why I do NOT like the way it ends - (hint (ok answer) - the article explores reasons why people are fat as related to government subsidies, marketing ploys, food availability, food content, etc... and then tells the individual to do something different)

Sunday, January 8, 2012

Odds and Ends

 My first few points for the O&Es today can be traced back to my recent Florida visit and time spent in close proximity to my mother - i.e. we cooked and ate together :)

Twist Ties:  A trick I learned from my Mom - but only recently, (which makes me wonder why we didn't do this when I was little and who she might of picked it up from ) is: if you have a bag of something like lettuce or frozen vegetables,  cut the bag open with a long, straight, 1/4 inch strip, and use that strip as a twist tie to reclose the bag.  I do it all the time now!

Water Conservation:  Happy to see my Mom doing something I do and have mentioned in the blog.  When you wash your produce, e.g. grapes that you have to swish around and strain several times, you can use the used water for your plants.  If you do not have plants, you can pour it on the grass instead of down the drain.

Batteries:  Recall that I was very excited to report that my university offers recycling stations that include a place for batteries.  This is important because they can be harmful if placed in the trash and eventually, our landfills.  Making the recycling of toxic materials convenient is something that all states and cities should work on and few have.  I went through quite a few batteries taking pictures over the holiday but there was nowhere to put them.  So I flew home with them in my bookbag and promptly placed them in the school recycling cube.  Which, by the way, had plenty of batteries in it :) It is meeting a real need.
Oranges:  My sister has an orange tree as is common in Florida.  She brought me some fruit when she came to see me.  She made a point to note that she picked the smaller ones because she knows that I prefer them.  YES!!!  Jumbo fruit has less taste and more calories... we really only need what we need.  And, I love my sister.....

Toilet Bowl:  I asked Mom where her toilet bowl cleaner was and she replied, "I don't have any, I just use the brush."  Well - that is actually super cool - the chemicals would just find their way into the ground water.

*******************   In thinking of the above posts,
I am reminded that because many of us in many countries do not
continue to live in close networks or villages,
the things we would learn from each other are lost*************

Ford - I am watching:  Ford motor company is requiring that its materials suppliers use a certain percent of recycled material.  They are also using recycled plastic bottles to make seats in some of their vehicles. This is very cool.  Read about it here.

Weight Loss Goal Setting:  I have mentioned my dear friend who has had WLS - weight loss surgery - the major one, gastric bypass.  This is the woman with whom I take an hour walk on most Saturdays (yes, we're still at it).  I love her very much and so this past week I asked her about losing more weight this year - I suggested 10 pounds.  She thought that was not a big enough goal but I pointed out that it doesn't appear that she lost much last year, so we should start small.  To help her, (and playing it forward, my readers...) we went through her day to find any repetition that we could attack.  It is easier to identify a pattern and go for it then to just say "oh, I will eat 50 calories less."  So we found her iced coffee.  She is going to replace her whole milk (sometimes 2%) with skim milk, BUT she is going to froth it up first so it will be thick!  [I gasped when she said she was using whole milk!!]  Remember, WLS shrinks the stomach and the patient has to eat smaller amounts of food but that does NOT equal lower calories... that is a conscious choice.  I am not a fan of WLS - I am a fan of my friend.

And lastly - the semester starts tomorrow.  My classes included Advances Theoretical Basis for Community Health Education, Advanced Statistics for Behavioral and Social Sciences, Advanced Program Evaluation in Health Education and Public Health Practicum... so... not sure how much time that will leave for blogging - recall I also have an assistantship (which involved data analysis related to college athletes and alcohol, tobacco, OTC and RX drugs - not obesity, but quite interesting)

Saturday, January 7, 2012

McDonald's Resource

Though it does pain me to do so, I am alerting you to a pretty cool feature on the McDonald's website.  First I will tell you what led me to explore their website today.  I had mentioned that I received a coupon book from them in my mailbox (the post office appreciates their business).  On one of the pages there was mention of wholesome choices and on this page were pictures of a few items with the caption, "300 calories or less."  I took that to mean that they had a line of entrees that were called Wholesome Choices and I wanted to check them out to see if they really were on the lower end of the calorie spectrum.  My plan was to make a note of these special items for readers of my blog.
In fact, they do not have that category, but they do have a search feature that lets you see all items that they sell, presented in order of calories (or fat, or sodium, or sugar-you pick the sort feature).  After you select the nutrient of interest,  a list of the items in order from lowest to highest will appear.  They display as icons, pictures, and if you let you mouse hover on the picture, it tells you the nutrient info for the item.  Pretty darn neat.
This will not get me into McDonalds and there are three points that should be made - beyond the fact that currently, the people who would be most likely to make use of this resource (like me) don't eat at fast food joints and do not have a weight problem.

That last point is the basis for these important steps:
1) first we have to make the resource relevant - i.e. educate people on the impact of calories and why they should limit them
2) drive people to the resource - and that includes providing access because not everyone has a computer or an internet connection 
3) get people to use the resource once one and two are in place (promotion)

The webpage and search feature that McDonald's provides is a tool that allows for informed eating and for that I must give... Kudos! It is called the Full Menu Explorer and can be seen/used by clicking here.

Friday, January 6, 2012

Beware the Food Bargains

(First - I did not blog yesterday because after I wrote my last post and viewed it in my email - I saw how very long it was. I heard my Mother's voice "Sometimes they are too long and people get tired of reading."  Hence, I gave you an extra day to absorb it.  I really loved that post myself!)

As you prepare to live a healthier 2012, the purveyors (suppliers) of calorie dense (high fat high sugar), nutrient poor foods are looking for ways to increase their sales.  In other words, they are out to sabotage your efforts and their strategies will be especially directed at persons with limited incomes.

I came across an article on a financial webpage which describes some of the tactics, such as the dollar menu (and more meat(i.e. even bigger portions)) as well as ten dollar pizza's, coupon books, cheaper buckets of chicken and promises not to raise prices.  You can see the story here.

I hope that you will not succumb to their tricks, gimmicks, ploys or strategies because what the special ads do not tell you is how many grams of fat and sugar the items contain, nor what large amounts of calories and sodium(salt) they have.  I believe it was the same news story that offered this link, but here you can see a picture of some of the highest calorie items along with the numbers.

So I offer you another thing to add to your list of 2012 commitments - packing your own meals. 
I hope that in the future, a future I plan to impact, foods that are nutrient dense and lower in calories will be offered as two for one deals and found on dollar menus.  I hope that  coupon books - like the two I received this week (BK and McDs) will include salads and healthier items for cheap prices, too.

Wednesday, January 4, 2012

Protein - Calories - Weight - (from headlines to clinical studies)

Last night I came across a news story comparing calories vs protein intake in regards to weight gain.  I went to the news story only to find out who the authors were and where the study was published.  I found it today and it is available free for anyone to read by clicking on this link.

I did not keep the link to the news paper story but you could probably find it easily through a web search.  It is a little complicated - three groups of people ate an additional 900 or so calories from their stable baseline, but different amounts of fat and protein within that same calorie amount.  
One of the groups gained less weight (pounds), but the other two gained leaned body mass.  The extra calories seemed to turn into fat and were provided as fat.  The amount of protein did not impact weight gain, but it does appear that one of the groups increased what is called metabolic efficiency.  This is a number - a ratio - determined by the increase in calories divided by the number of pounds gained.  Thus having a low denomenator (fewer pounds gained) creates a higher 'score' indicating efficiency.  The weird thing is that the group which gained the least and had the greatest score, lost lean mass whereas the less efficient groups gained lean mass!

But what I really wanted to tell you about was the intricate details of the study because the news paper article doesn't give the low down.  Trust me that what they did in the lab - well - it won't be happening at your house!

First there were only 25 people in the whole study and these people were put into one of three conditions so that each group had less than 10 people in it. (in research the best studies are said to be controlled - but they are expensive and use fewer people - another marker of good research is having a large amount of subjects!  It is hard to get both of these things)  
There were men and women in the experiment and they were between the ages of 18 and 35.  More participants were black than white and all lived in Louisiana. They all had normal BMIs at the start of the study.

The participants stayed in the center for the duration of the project.  The scientists used fancy, expensive and ultra sensitive equipment to determine each persons total energy intake, as well as resting, non resting and total energy expenditure.  The scientists then fed each person the amount of calories necessary to make sure their baseline weight remained stable (the test lasted four days).  Stable meant that the weight could not fluctuate more than 2 pounds.  They tried this up to three times and if the weight wasn't stable when everything else was being held constant - the people were sent home (:(.

(During the study, the meals were prepared by the 'metabolic kitchen' staff and sent to a lab for analysis - later in the study, when the people were put into separate groups, the people and the scientists who measured their body changes did NOT know who was getting which protein amount- in other words, it was "blind.")

During the stabilization phase, the caloric amounts were the same and the breakdown of macro nutrients was protein 15%, fat 25% and carbs 60%. The people were then randomized into the three groups - low, normal and high protein intake.
The carbohydrate amount was not manipulated and stayed around 40% of total calories for all three groups.  The low protein group had 47g protein per day (6% of total cals) with 52% calories from fat, the normal protein had 15% and 44% fat while the high protein (228g) or 26% of total cals and 33% from fat.  They all started off at about 2400 calories a day and added 900 cals a day in the 8 weeks of overfeeding.

If you look at the information above carefully, you can see what the problem may be. The groups did not only change protein - they changed fat percent as well and the low protein group ate the most fat.  They also gained on average 6 pounds compared to 12+ pounds for the other two groups.  They ate more calories from fat but gained the least pounds.  The other groups gained more pounds, but also gained lean tissue mass.

The conclusion offered by the researchers - calories impact fat storage while protein impacts energy expenditure (burn) and lean body mass - do not carry over to practical application, that I can see. I.e the group with a higher energy expenditure at rest still gained more weight.
We know from this study that if you eat more calories than you need you will gain weight (which is old news).  It also looks like the amount of calories that you consume in fat grams will have a negative impact on body composition and metabolism (this is related to how nutrients in fat are metabolized and is beyond the scope of this blog). 
The problem with the outcome is that the low protein group did not increase their total expenditure (where as the other two did [no group changed activity level - this is all related to the intake]) and still the low protein group gained the least amount of weight. 
Other studies have noted that over time, if people continue to overconsume, the increase energy burn from the protein increase will abate and they too would stop gaining lean tissue.  
PS - the participants stayed in the lab an extra day or two after the overfeeding to get their cals back to normal.  
PSS - this was a very well controlled laboratory experiment!  and super fun to read and there are lots of charts you can see in the actual study if you go to the journal article.