Odds and Ends

My favorite posting day - little bits and pieces that have nothing much to do with each other and may or may not be related to news and research.

Hostess:  I am not going to let you forget my new tag line -  "obesity prevention through informed eating".  I am most interested in point of purchase food content information and it's proliferation (grocery, restaurant and school).  Some of the manufacturers of the foods I purchase have been putting information on the front of the label for some time - i.e. Morning Star Farms vegetarian products. 

note calorie info on front of package

Most companies highlight their labels if they are selling 100 calorie packs.  Some cereal boxes have fiber and sugar content on the front.  We do not as of yet have a uniform system.  This week I noticed that Hostess is putting some information on the front of  dessert cake packages that are not 100 calorie packs.  They are 150 calorie cakes and I can see this without picking up the box.  Pretty exciting.

Abilify:   I was surprised to hear a commercial for this medication on my computer.  I must have been watching a TV show on line for free (w/ads).  Abilify is a psychotropic.  It is a medicine that can alter ones mood by effecting neurotransmitters and or the secondary chemicals they trigger.  It was originally approved for use in people with schizophrenia (as an antipsychotic), and then for people having manic episodes who are diagnosed with bipolar disorder, and THEN for treatment of depression that isn't responding to other medicines and most recently for use in children with autism related problems. It is also approved for use in children with the above other conditions.   You can confirm this by visiting the FDA website here.  Abilify is not approved for treatment of agitation in elderly patients with dementia.  Every time the drug receives approval for another indication, the company that makes it can advertise it as such.  But we know which one gets the most air play - depression. I haven't looked this up, but I imagine that more people are diagnosed with depression than schizoprenia and/or are more likely to tell their doctor they are depressed and want this drug.  (schizophrenics are often out of touch with reality and do not seek treatment themselves).  The drug company that makes Abilify stands to make a lot of money from all these approved uses (YES?).  When I listened to the commercial earlier this week, the side effects associated with the medicine clearly freaked me out.  What we don't hear on the TV is results of research studies that often show the same benefits without the risks that exercise can provide in the treatment of depression specifically.

Natural Fries:  Speaking of marketing, what do you suppose is the goal behind Wendy's new commercial for natural cut french fries.  Are we to assume that this french fry would be better for us than one that was an artificially cut french fry?  Either way, it IS fried. 

Soft:  I feel ambiguous about this observation. It was unusual enough to consider mentioning here, though I wondered if I were hyper critical (NO - really, me?).  I mentioned it to a friend and she confirmed that she had noticed the same thing when she attended a dance performance at this venue, so I will say it.  I went to a student/faculty winter dance concert and the dancers seemed soft.  Not heavy and soft, though some were heavier than is common and very few were that too thin waif size, but soft - undefined.  I am used to athletic dancers with toned even sculpted muscles.  Rather odd that they were soft.

BMI in the News:  Most people add books to their must read lists and I add research articles/studies.  My next must read is  the NCI's BMI and All-Cause Mortality Pooling Project.  Very briefly, and without review of validity (i.e. this is not a controlled lab experiment), persons with BMIs that are over 25 are more likely to die (in a given time period) then persons similar to them with BMIs from 18 to 24.  The information is specific to NON SMOKERS only.  Smoking ups the risk of death from all causes at any given time, period. In quick review, this looks like a good study so I am going to punt it for a full blog post next week.  Stay tuned :)

Social Norming and the Environment:  I tend to listen to World Have Your Say or On Point when I am falling asleep.  A recent discussion topic for World... was climate change and social norming.  Social norming is a strategy for health educators/promoters to use when seeking behavior change.  For example, if most people do not smoke and I make it a point to tell people not the percent of tobacco users, but number of people who do not use - I am using social norming to make 'not using tobacco' the thing to do - "Your peers are not smoking.  Smoking is not cool.  Don't Smoke."  Social norming is often effective.  On this recent show, researchers used social norming to increase the percent of hotel guests who reuse their towels.  (you do, don't you?)  If you have been to a hotel in the last year or so, you might have seen a little table tent in the bathroom that encourages you to save water by reusing your towel.  The researchers in this study simply added to that card.  I WAS falling asleep so I didn't catch any numbers, so I am making this one up.  The card might have said, "75% of people reuse their towels".  The scientists compared towel reuse between guests whose room cards did and did not have that extra sentence.  When we think everyone is doing something - well, we want to do it too! 

Obesigenic

This is a term that I came across in my studies today. It is not in the dictionary just yet and there are at least two spellings.

The way it is most often used is to describe environments - such as one's family or one's community or even country. Let's see if you can figure it out from this sentence.

The United States is obesigenic. In other words, the country is functioning in such a way as to promote obesity. Obesity is promoted by the following:

• the availability of high fat foods
• inappropriate portion sizes
• sugary drinks
• social customs that promote high fat eating (church suppers, work parties - Thanksgiving - just kidding :))
• lack of access to low calorie foods
• unsafe neighborhoods that prohibit physical activity
• jobs that require sitting
• family habits, etc
• genes

In some of the articles I previewed today there seemed a bit of blaming - but you have heard it before - heavy women tend to have certain behaviors that their children model and thus they too are heavy. Not just Mom's or even families for that matter. We tend to do what our friends and coworkers do as well. Researchers are increasingly saying it has to be both genes AND environment and that it is almost never just the genes.

Do you live, work, play in an obesity causing environment? Are you the model of health and fitness instead - what would be the word for health promoting environments? Salubrious I think...

Clinical Trials

This post isn't really about clinical trials in general, but about the latest one for the H1N1 virus. This is of course, the strain of flu that was formerly known as swine flu.



Previously I blogged about the data that had been gathered from the first wave of this virus and how it seemed to effect pregnant women most significantly. One reason for that is the suppression of the woman's immune system during her pregnancy, but another is the decrease in lung capacity and oxygen flow during the final month or two as the fetus' size impinges on the lungs. For these two reasons at least, the CDC and others are putting pregnant women at the top of the vaccine list. Problem is, we do not yet have that approved vaccine.



The makers of the seasonal flu vaccine have created an H1N1 version that is showing efficacy and safety in animals and people, during the clinical trials. The NIH is now supporting a trial of the vaccine on pregnant women. They are testing dose strength and dose frequency. Women have enrolled in the trial.



Yesterday there was some discussion of this on NPR and someone asked why a woman would volunteer for the trial. The scientist being interviewed explained why pregnant women would benefit from the vaccine, but not why they would risk themselves and their unborn child in a clinical trial whose aim it is to prove safety and efficacy.



I continue to scratch my head over the same question. I realize that someone has to do it, but there is no way it would be me. Would you participate in clinical trials? A vaccine one? One during pregnancy?



Most drugs are not tested in pregnant women and instead are reviewed when we find pregnant women who have taken them. I imagine the need for a vaccine in this target group is great, and I still do not know why I would participate in the trial.

Bone Health Across the Lifespan

I read an interesting article in the American College of Sports Medicine (ACSM) Certified News today. The article was about bone health and how to protect it at different times in a persons development.

Succinctly:
Children or Youth would be building their bone density and it is crucial that they do this in their early years so that they can withstand the amount they will lose as they get older, even in the best of situations. We expect that kids are healthy and trim and if so, then high impact activities are recommended. Sports like tennis, gymnastics, basketball, soccer and also running are to be encouraged. Be careful with this however as it is also true that injuries in joints at early ages can lead to osteoarthritis later. (this is also true if joints lack of osteogenic stress.) Plyometrics are also good for building bone. This includes jumping, hopping, big jumping jacks, even skipping. Resistance training is also recommended though one is to be mindful that the only bones that benefit are the ones that are worked. Not a lot of bone stress occurs with weight training, but the hips can be targeted with leg presses, for example. So at this stage we are concerned with building bone mass.

In middle age we are concerned with preserving the bone mass we have attained at earlier ages. People who have been doing high impact exercise should continue to do so. Walking, swimming and bicycling are not considered high impact activity. Otherwise, moderate impact activity as well as resistance training can be used here. Moderate impact activity does include walking and jogging. People here can continue with sports such as tennis and can use stair climbing and elliptical machines in the gym. Here were want to maintain bone mass.

In some middle aged people and more older persons, bone mass decline can be enough to be considered either osteopenic or osteoporotic. Osteopenia is bone loss that is more than would be expected for age and more than is normal for the general population at that age. It is imperative that bone loss be stopped and bone mass preserved to avoid the very painful and debilitating osteoporosis. Weight bearing activities are still recommended but high impact sports are not. Resistance training is always recommended. People with osteopenia may be prescribed bone loss medicines, though they are not themselves without risk. There is not strong evidence that pills alone make a difference, but pills plus resistance training have been effective in restoring some bone mineral density. Calcium and Vitamin D supplementation is also used. I lean more towards calcium in foods and Vitamin D supplements myself. Again, this is preventing further bone density loss.

People with osteoporosis have to be careful.. Falls can break bones and broken bones can lead to further disability and decline in functioning. This is also a very painful condition. It is crucial then, that persons here reduce their fall risk and that can be done by exercises that improve balance and agility. Walking and stationary biking can be used in this group. Osteoporosis is an irreversible condition that affects both men and women. Smoking and lack of physical activity are risk factors, as are being thin and white. In this stage, usually in late late life, the focus is on preventing bone breakage.

okay, then.. get up and build those bones!

Odds and Ends

Protect Your Feet: Ever notice people’s feet when they are wearing sandals? Well, you will now. Some people have very smooth looking feet while others have white looking dry skin, especially at their heels, layers of it really. I first began to notice this some years back and quickly changed my routine to prevent such an outcome for me. My Mom had always told me to apply lotion after a shower and I have done so, for years and years. I used to not apply it to the bottom of my feet, but as I said, once I noticed how bad feet could look, I made sure to go from face to feet with my lotion, EVERY day. Here is a tip for you. Have a bottle of lotion by your bed and apply to feet at night. Make this a routine, like brushing your teeth. Trust me on this one. Actually, you should trust me on all of this!

What People Will Say: I was out and about doing my paid job this week when an older person, a hospital volunteer actually, said quite loudly to me, “You are so little. What are you a zero?” I replied that I was, but only because they make clothes bigger than they used to so that heavy people don’t feel so bad. But her question, which didn’t really offend me, begs this question, “Why is that okay to ask?” Had she seen an overly large person would she have said, “You are SO big, what are you a 24?” Likely not.

Pfizer’s Trickle Down Effect: I didn’t think of this until my Mom mentioned it to me as we strolled along the beautiful Florida gulf beach this weekend. When Pfizer was at its most aggressive marketing and drug promoting, it often brought health care professionals to restaurants or brought food from restaurants to the hospitals and clinics. My mother said that some waitresses or cooks really began to rely on the 25 dollar tips and that since then some have actually had trouble paying their bills. I absolutely think Pfizer should pay up the 2.3 billion in settlement fees, but this shows how much of a ripple effect the behavior of one company can have.

Joints and Exercise: I heard a report on NPR this past Friday that supports previous research that the use of our bodies is a protective factor against arthritis. And again, injury of knees or ankles and such are the biggest cause of later life arthritis. IN other words, highly active people, even life long runners, do not develop arthritis from activity unless they have had injuries in certain joints. You can read about it here:
http://www.npr.org/templates/story/story.php?storyId=112556135

My last odds and ends have to do with some foods I recently saw advertised. The first I have noted before, OJ. I cannot find the ad online but suffice it to say, OJ is not the best way to get the nutrients that an orange offers because the juice is concentrated and thus high in sugar or fructose and low in fiber.

Things get worse from there. The other two food items that I became aware of this week are from IHOP and Bob Evans. I saw a mention of the IHOP NFL promotion of AFC and NFC stuffed French toast in the WSJ. The bit in the paper just noted that there was a 50 cent price difference between the two. IHOP’s website notes that it is their classic stuffed French toast but shaped like a foot ball and served either over some strawberry or blueberry concoction, not fresh fruit. IHOP doesn’t say, but other websites state that the meal has about 1500 calories, not counting orange juice (kidding). That is just about my entire calorie need for the day! http://www.eatmedaily.com/2009/09/football-shaped-stuffed-french-toast-at-ihop/

And lastly, I saw a commercial for a Bob Evans dish. I knew it was bad before I even looked it up. It is called a knife and fork sandwich. There are several varieties but I saw the ad for the meatloaf one. This is what I saw; meatloaf with a slice of cheese, on top of mashed potatoes, on top of a thick slice of bread, covered in gravy. That comes in at 820 calories and 37 grams of fat. http://www2.bobevans.com/WebSite/Nutritionals.nsf/$$TemplateforNutritionals?OpenForm&category=SANDWICHES

Oh and I should add this last thing that I heard. Frito Lay has decided to put MORE chips in its bags.

All this being said; who is it that thinks that the food and restaurant industries are going to voluntarily make their items healthier? And who doesn’t think having calorie info on the menu when you order is a good idea?

I believe this post might last two days with tomorrow being Labor Day so enjoy your picnic and remember those not cheeseburger salads on You Tube.

A Rose by Any Other Name

If Roses were called broccoli, would they still make us smile and blush when we were presented with them? I do not know the answer to that, but I can tell you that broccoli and other cruciferous and green leafy vegetables are the roses for our hearts and arteries.

It has been long recommended that we eat our vegetables. In doing so, we will have less chance of heart disease and cancer. A new study from London attempts to explain why.

Now this is a real deviation from my usual reports on epidemiological studies on nutrition. (studies regarding what populations do and the effects those behaviors have on their health)
This study involves mice taking a chemical basically. It was a lab experiment.

Some scientists believe that a chemical in broccoli called sulforaphane turns on a protective protein in our bodies that can reduce fatty plaque build up in our arteries (atherosclerosis).

The study that comes out of the Imperial College of London did the exact opposite of what I say people should do. Instead of the mice eating "broccoli" they were fed a purified form of sulforaphane that must have been synthesized some how. In the animal studies the protective protein, called Nrf2 was indeed activated. The scientists will now try giving the mice with hardened and clogged arteries the same chemical as it appears in broccoli.

It is said that if this does not have the same positive effect, the recommendation will be that people take sulforaphane in pills. OMG.. did I just say that on my blog?

Actually, the news article I read did not mention anything about drugs that reduce plaque buildup but other websites and articles note that the broccoli chemical worked as well as prescription statins, now that IS newsworthy!

http://www.bhf.org.uk/default.aspx?page=10400&utm_source=Front%2BPage&utm_medium=Promo%2BBox%204&utm_campaign=Brocolli040909

BTW, this is a good reason that restaurants should offer sides of broccoli to our children instead of cucumbers and celery... which are really low in nutrients. Oh, but parents, be careful, just because they steam it doesn't mean they don't add butter. Ask and Decline!

Support from the NFL

Today I want to give a shout out to an NFLer who really doesn't get a lot of good press. The reason he gets kudos from me and on my health promotion site is because he is a big man who eats a whole lot of calories and does a lot of physical activity, including a very serious weight training routine, but still chooses to eat healthy to get his calories. In fact, he orders his food in much the same manner as I, and that, from a 6 foot 3 inch 223 pound man, is something to share with the world!

Terrel Owens, a wide receiver for the Buffalo Bills was featured in a WSJ article on "What's Your Workout" this week. In discussing his diet, or what he eats on a regular basis, he spoke of lean proteins such as chicken, grilled fish, low fat yogurt and egg whites. He is quoted as saying that he eats five to six small meals a day, hello, just like ME! He also eats whole wheat pasta and steamed or raw vegetables. When he gets a salad at a restaurant he tells them to hold the bacon and cheese, JUST LIKE ME!

If he is going to be on the road a lot, though, he brings a chef along who can prepare him healthy meals. I am my own chef, but he could hire me. He also avoids sweets. Oh and one of the best things he said is that he no longer drinks protein shakes or really any kind of liquid calories, preferring to eat real food to get the protein that he needs. Man oh Man.. he just validated years of what I have been saying.. Cool Beans.

If I ever get to do a community based obesity intervention and he stops pissing every body off, he can be my celebrity spokesperson!

Pfizer Pays

In my paid work, I address (educate) health care professionals, students and groups of persons interested in the field of tobacco treatment. Because of this, I learned about FDA approval processes and guides for using medications. In my presentations, on some level or another, I explain that a medicine becomes available for use through a process that involves applications to the FDA, lab tests on animals and experiments on humans, phase I, II and III clinical trials, panel recommendations and final FDA approval. The FDA approval will be for a certain indication and whatever that indication is, is what the drug company can market and promote the medicine to treat. You have heard me say this here, but again, this is FDA approved use or first line use.

(As an aside, drug companies do have to create a drug to treat a condition that no other drug treats, or treat a condition more effectively than an existing drug, or do the same as an existing drug, but with less side effects, etc)

Once a drug is approved for a condition, the drug company can do its promotion, its commercials and such, for that FDA approved purpose. IF it turns out that the drug also treats another condition or one of its side effects is something beneficial to people without the disease condition, a physician can CHOOSE to prescribe that drug for an off label use. Legally.

A company cannot blatantly market the drug nor offhandedly promote it for any other use. This includes spending money on doctors and nurses with gifts and meals, handing out samples and mentioning that Geodon(antipsychotic) might also work on children, or Bextra ( NSAID like Vioxx)is good for a sprained ankle, or Lyrica (for epilepsy) helps with pain. Pfizer has just pleaded guilty to illegally marketing Bextra for acute pain and for promoting at least Geodon and Lyrica for off label uses. They have to pay 2.3 billion in settlement costs.

I was witness to these events. Drug reps from Pfizer came to the hospital with gifts and suggestions, they hosted dinners for interns and certain Attendings appeared to be educating others on these off label uses. I know that we prescribed Lyrica to treat pain, which was legit, but I don’t know how we figured out to try it. I myself was given samples of Bextra to take for an acute running injury, which was an off label use.

Pfizer is being watched more closely as this is the third time it has had to settle in court for such behavior. It is on a 5 year special scrutiny list and a reporting system is being set up so that clinicians can report when they feel a Pfizer rep was inappropriate. There were 13 drugs involved in this particular case.

Lessons from Bears

Bears are getting ready for winter. Some bears are showing up in people's houses, breaking into their cars and rummaging through their trash. Bears are getting aggressive in their pre hibernation efforts, especially in Colorado. People have been told for years, not to feed the bears, but have not listened. Now people in some Colorado towns are being beseeched to scare the bears away.. yell, throw rocks, call the police, but do NOT encourage the foraging beasts.

Here are some things to be learned from the experience of Coloradans :

1) Processed foods that people eat are high in fat and calories
2) Berries, nuts and plants are low in both
3) To gain weight for the winter's rest, bears consume about 20,000 calories a day
4) It is easier and more efficient to eat the foods found in cars, trash and kitchens, then to eat hours and hours and hours of plant based foods
5) If you do not want to gain layers upon layers of fat like bears do, then eat the plant based diet!

Again with the Water

Seriously, I will be brief.


In a recent blog post I shared my story about addressing the fact that my tap water did not taste okay. http://yourhealtheducator.blogspot.com/2009/08/water.html

I ended up buying a pitcher that has a water filter in it and several people commented that they had done the same thing and were very happy with their choice.


I want to suggest that you do it too or something similar and refrain from buying actual single serving bottles of water. The main reason is the effect that plastic has on our environment, other reasons include the cost, the fact that it is, at times, just tap or public water that someone else put in a bottle and lastly, because they are heavy and you could hurt yourselves and your backs lifting those cases of water!

I do not feel as strongly about water bottles in vending machines, because I think we should have a healthy alternative to soda, and I am not 100% against the companies that sell bottled water. Many have reduced the amount of plastic in them.

I will say that US sales of bottled water, not counting Walmart, was over 7 billion last year. And that is down several percent.

I bring this all up today because there is a bit of a price war going and the cost of the 24 packs has come down from six bucks to three bucks and the companies are trying to get you to buy, buy, buy... I hope that you won't. The companies have also said that they are just cutting the prices because of the recession and because people are drinking their own tap water. Some of the reduced sales are due to people like you, I hope, who have taken the concern about our environment seriously. According to a WSJ article I read today, the Coca Cola, Pepsi, and Nestle cos, etc all plan to pump those prices right back up as soon as we start making more money again.

Odds and Ends

Another week has ended..for me time flies, for others it drags... I understand this.

I have a few scraps of paper here with jotted down notes. The first few regard calories, specifically our discretionary ones.

One of my dear friends sent me part of the package from some disposable plastic containers she recently purchased. Why? Because the label says that they are perfect for 100 calorie snacks. My friend wondered if people might think that the container could be filled with anything and have 100 calories.. Good call. And wow, that would be very cool!

My mom mentioned that her yogurt had 11g of sugar and asked me if that was a lot because it sure seemed like a lot but it only had 80 calories. First, YEAH Mom for reading your labels! Second, well, I told her that I try to have no more than 8g of sugar per serving in any product when I can, but that it didn't seem awfully bad. I looked at my yogurt just now and I have two. One is a Dannon brand and the other, Walmart, both are the low calorie kind. And well, I know at least one of my friends will think I make this stuff up, but seriously, the Walmart value brand only has 8g of sugar per serving and the national Dannon one has 11g. The one my Mom was talking about was the Publix Supermarket brand. Oh and I would add that we are allowed about 24gs a day for the 6 teaspoon of sugar recomendation, so Mom has three left after her yogurt!

Another friend, they all send me bits of info so I have something to do in the evenings, told me about this new cream she bought for her face. It has shiitake mushrooms in it. I thought you were supposed to eat them, but of course, there is soap with yogurt in it so what do I know. My friend bought the facial cream because it was recommended by two older women who looked phenomenal and swore by it. Just a quick search and I can see that there are properties in the mushrooms that may be beneficial but I did not uncover any good research studies to prove the hypothesis.

Now, here is a real humdinger.
Be fit or be a frog.. a real issue to ponder. Let me tell you what happened...It involved two completely different events.

Earlier in the week, during one of my tobacco education classes, a student challenged the notion that quitting tobacco and possibly warding off deadly diseases was a smart thing to do. At best, he implied it was unneccesary and at worst, futile... because you cannot change your destiny. The student noted God in the conversation so I refrained from much of a challenge. I thought about it though, for days. I meant to say back to him, but did not, sure, but what if we are destined for some great physical challenge.. shouldn't we live our life so that we could meet it, just in case.

I firmly believe that we should take care of ourselves in case we don't get hit by that car or shot by the jealous lover at age 40 or 50 but instead live until we are 90, because living that long without physical and mental faculties intact is just NOT pretty.

Then the second thing happened.
Last night I caught my cat apparently in the act of getting a frog into the house. The time before I just found the dead frog. So in through the cat "window" came the cat and frog. The frog hopped across my bed and my cat chased after with intent to kill. I scolded the cat and wondered how in the world to catch a frog. Ah plastic ware.. I got a container and returned to the bedroom. Cat and frog were in the closet at this point, I trapped the frog, yelled at the cat again and then went back to the kitchen. How to pick it up??? I returned with a plate. Cat still guarding trapped frog. It was actually easy. I scooted the plate under and lifted all taking the frog out my front door. And away he hopped, headed towards the stairs and a nice tropical courtyard.

This morning I walked to my car, and there on the pavement was a sprawled flat dead frog. Surely it was NOT the same frog. But if it was, well, you can't change destiny and that just stinks.

Samples that Shouldn't Be

My post for this Saturday evening or Sunday morning will be brief. I am disillusioned once again, though I should not be because I KNOW, that is why I write the blog, so that I can let YOU know…

I am signed up for regular prescription, medical device and other such warnings from the FDA. Most of the medicines or equipment that I receive alerts on do not effect a significant part of the population and rarely do they directly effect me (not since Vioxx!).

I receive notices in my email when an existing medicine receives a black box warning or a label change and when a medicine is contaminated. Recently I have received some alerts about IV tubes and diabetic strips that were irregular. And most recently I received a notice about several products that were being marketed and sold illegally. I read the alert and therefore my brain stored it somewhere, but I did not expect it to matter to me and I did not say anything to you guys.

The alert was regarding various companies that are selling topical ointments, sprays or creams that have ibuprofen in them. They may also have other ingredients, like herbal or supplement products. The companies are getting letters from the FDA because ibuprofen is a medicine. One cannot just add it to things and sell it and not have FDA approval for safety and efficacy.

I read it and moved on. Then on Wednesday of this week, my physical therapist suggested that I take some of this sample medicine home, Ibunex was the name. She gave me two samples and a brochure. I read the brochure and I said to her, this is ringing some kind of bell in my head. I thought at first that it was undeclared ingredients or something. I came home and re read the alert and this was exactly one of the products that was being recalled. The physical therapy office had a sign up offering two free samples if you bought a bottle of the spray.

So just like drug companies, these lesser companies sway health care professionals including mine, and my health care professionals were likely selling the medicine/supplement to make a profit. I emailed the alert to them the next day. If the product is still on the counter Monday, we will have an issue.

BTW, the PT office also had a sassy chair or whatever you call those godforsaken motorized scooters in the lobby with a big sign on it regarding how they could help you buy one.. just so disillusioned am I.

the Benefits of Blood Flow

This week my research took place in doctor's and physical therapist's offices. I spoke with an orthopedic specialist and separately with a physical therapist. Though they practice in different offices and do not know each other and indeed have different specialties, they said the same thing. (that never happens :))

Their opinions or medical advice were supportive of what I have been told by others in sports medicine over the years, but as with research, anecdotal evidence that repeats itself gains more sway.

The issue addressed was cardiovascular exercise when injured. Indeed, this applies to acute and chronic injury, but also to chronic disease conditions such as arthritis and back pain. Gone is the recommendation for bed rest or even relative rest and in is the need for doing some form of physical activity. This increases mobility, decreases atrophy and in regards to injury, can speed healing by carrying oxygenated blood to the injury site and carrying inflammation or free radical damage away. The heart pumps this blood through our system and exercise can enhance that pumping.

To be fair, the doctors and I had a deeper conversation in regards to athletes and people who engage in routine vigorous physical activity. This class of person is getting a lot more from their “exercise” than a strong heart and increased blood flow. Usually, the exercise is used as a coping skill, mood stabilizer, competency booster and to challenge ones limits. People in this category tend to push through pain when they are injured, and according to Jason Koczman, PA at the Advanced Sports Medicine Center in Sarasota Florida, it doesn’t always lead to worse injury. Jason said that sometimes pushing through can work and the problem ceases. That is not usually what happens, but since many of us know that it could happen, it is our first response and desperate hope. Other times, an injury, a pain, is a message to stop doing whatever it was that caused the injury or exacerbates it. Both Jason and PT Judith Chmiel agree that maintaining conditioning and blood flow will improve healing. The point is to do something that does not hurt but to do something. Both were clear that complete rest was not recommended. Active recovery appears to be the newest mantra in sports medicine and I for one am glad of it. Oh and pain meds are pretty much old school as well. Most docs will now recommend ice and limited use of ibuprofen.

Unnecessary Radiation

Just quickly browsing the paper this morning, I noted three persons of some notoriety that had died of cancer. The World Health Organization or WHO recently stated that over 7 million people died of cancer in 2005 and that by 2015 84 million people would die from the disease (of which there are many types).

The leading causes of cancer are not genetic, but environmentally related. Cancer, the uncontrolled growth of abnormal cells, is often triggered by an exposure (external, internal, involuntary and voluntary). The biggest risk is, of course, tobacco use or second hand smoke inhalation (1.5 million of the above total was attributed to tobacco use). Probably the second biggest is inactivity and diet. Other exposures can include chemicals in the air or in our homes, the sun and tanning beds. But one that we may not think about and should is our exposure to radiation in routine X-rays and CT scans.

Not all illnesses or injuries present symptoms at the time of onset. You may feel the effects of food poisoning within hours of eating the bad food, or a burn from the stove within seconds, but not realize that the time you just spent in the sun has caused DNA damage to your skin. This delayed response is a big concern for smoking related cancers and today’s topic – cancer related to radiation through medical tests.

People are exposed to more radiation from CTs then from X-Rays. Either way, these are not meant to be used as every day diagnostic tools. In some instances, for example heart disease risk and lung cancer screens, the CTs may be more risky than they are effective in ruling out a problem. I tell you this because these scans may be marketed as preventative but could actually put you at risk for the condition you are trying to avoid. It is far better to avoid tobacco, inactivity, unprotected sun exposure, radon, asbestos, and saturated fats, to name a few, then to rely on a test to tell you that you ALREADY have the disease.
And because the damage from any of the above is cumulative, beginning exposure in childhood significantly increases the chance of cancer. Because CTs are now common place, this could especially increase cancer cases from radiation in our children, when they are older.

http://www.who.int/mediacentre/news/releases/2006/pr06/en/

Diet Drugs

How well do you know your blog writer? Here is a test question. Does Deirdre believe in diet drugs? Answer. NO



It has been a little while since our grocery stores held prominent displays of the latest OTC weight loss drug, Alli. Long too, since Wynona Judd did her print and TV ads endorsing the product. I of course, had my say in these pages
http://yourhealtheducator.blogspot.com/2009/03/wellness-weekly-with-video.html

This drug was intended to enhance weight loss by blocking some fat absorption, probably because eating less fat would be too inconvenient for some people. I railed against it, I still rail against it and now the FDA has made a cautionary statement in its regard.

FDA notified healthcare professionals and patients that it is reviewing new safety information regarding reports of liver-related adverse events in patients taking orlistat. Orlistat is marketed in the United States as a prescription product, Xenical, and as an over-the-counter (OTC) product, Alli. Between 1999 and October 2008, 32 reports of serious liver injury, including 6 cases of liver failure, in patients using orlistat were submitted to FDA’s Adverse Event Reporting System. The most commonly reported adverse events described in the 32 reports of serious liver injury were jaundice, weakness, and abdominal pain. FDA is reviewing other data on suspected cases of liver injury submitted by the manufacturers of orlistat, analysis of these data is ongoing and no definite association between liver injury and orlistat has been established at this time. FDA is not advising healthcare professionals to change their prescribing practices with orlistat. Consumers currently taking Xenical should continue to take it as prescribed and those using over-the-counter Alli should continue to use the product as directed.

Scientifically speaking the safest and most effective way to lose weight is to take in less calories that you burn.

Sweetness

First, thanks for the comments on yesterday's post! I love to know you're out there...

Today 's story first showed up on my yahoo home page last night from several news sources then again this morning in my print news copy ( wall st journal). So do let us talk about SUGAR, added sugar that is, white granulated or sticky syrup SUGAR.

The American Heart Association has made a formal recommendation on the amount of added sugar or non nutritive sugar we should consume, if any, on a daily basis. The goal is to reduce overweight and obesity and the diseases so associated.

Whether or not added sugar directly causes obesity is not yet proven. What can be said is this: You have a certain amount of calories that you need per day. This amount will keep your weight steady. Which type of foods you use to fulfil that requirement determines what your body will then do for you. So weight aside, nutrients can heal you, fuel activity, accentuate brain power, help you perform physically and keep you free of chronic disease.

You can spend all your calories on junk or pleasure-only foods, but you will get a compromised system in return. Your vehicle will be a lemon. The more calories you spend on sugar, the less you spend on lean proteins, good mono and poly unsaturated fats, and the complex carbs that are our fruits, vegetables and whole grains.

The American Heart Association recommends that women consume a limited 100 added sugar calories a day, or 6 tsp which should be about 25 grams and men, (of course it is unfair) men get 150 added sugar calories, or 9 tsp at ~ 37 grams. Most of the time the food packages list sugar in grams not teaspoons. This is an approximate conversion as sugar has 4 cals per gram and Rachel Johnson from the University of Vermont who authored the recommendation gave the calorie requirements. I just did the math. Recall that I have suggested that you do not buy any processed food that lists the sugar as more than 8g per serving. Also, determine what exactly that serving size is and act accordingly.

Added sugar refers to table sugar and syrup, sugar in processed foods and some dairy foods like ice cream and sweetened yogurt. The biggest source for us is soda and juice. Most women would use all their discretionary sugar and then some in one regular soda. And as you have heard me say, "Lose the Juice." Sugar in juice is discretionary sugar in fruit it is not!

Now the American Beverage Association and the Sugar Association are not happy about this AHA statement and want to remind you that there is not a direct link from sugar to obesity, but as you can see, that is not the only reason to avoid sugar.

Oh and a last note on a comparison made in the WSJ article that got my dander up.. I KNOW that rarely happens, any ways..
A moderately active middle aged woman might consume 1800 cals
while a
Sedentary middle aged man would consume 2200
Okay, first HE does nothing and gets to eat more, second, why don't we change just the one variable, ie sex......... and compare the same activity level...

Water

I want to write about water today. Water in the sense of environmental health more so than physical health, but do let me start there.

We all need fluids to maintain well, our life. We get the fluids we need both in the things that we drink and the foods that we eat. There was a time when many health care professionals from docs to exercise physiologists were telling us that we need 8x8 glasses of water a day, or 64 ounces. That was never a scientific finding or official recommendation, and most people know that now.

We still need water however and where we get it has also been a matter of controversy. I.E “everyone and their water bottles”… plastic and waste, chemicals and landfills, cost and fraud, tap water vs spring..(in bottled water) etc.

I live in an apartment and have for the last two years. The water from my tap has an awful taste. I have struggled with this dilemma, as I do drink 60 or so ounces of water a day. Buying packages of bottled water every week is too costly for my wallet and our environment. I tried filling bottles with water and leaving them uncapped in the fridge for say 24 hours, as my niece suggested, but it only took the edge off. I filled my bottles at work from the portable water cooler as often as possible, but it wasn’t enough.

I went away for about a week and when I came home, I was unaccustomed to the taste of my tap water again. It was gross. I kept thinking it could not be good for me.

Now I have gone back and forth with what to do for almost the whole two years. I looked at filters you add to your faucet and filtered pitchers. I evaluated a home water delivery system, or buying a cooler and refilling it at the supermarket weekly. For a while I bought two gallons of water on the weekend to drink during the week, but even recycling those two jugs was an issue for me. Plastic recycling is not necessarily a safe, economic or even actual thing. I worry about that.

So I finally bought a water pitcher which came with one filter and an additional box of three filters, on sale at Walmart I think. Fifteen dollars each. The filters last 2-3 months. It was the best thing I ever did. The water tastes fine. I do not have to carry any cases of water or gallon jugs and I do not have to discard any waste. Also, if it is true that plastic bottles can leak chemicals into our water, I am mostly avoiding that as well.

So if you also struggle with this, I recommend the pitchers!

My schedule is getting the best of me and I am not sure that I will be able to blog tomorrow. If not, please accept my advance apologies… Deirdre

Odds and Ends

My final thoughts for the week:

Fiber: Interestingly, I learned one thing new about the positive effects of fiber in the diet. I have long suggested my cereal bars as a great source of tasty fiber with the message that fiber can remove bad cholesterol, keep blood sugar level, help you to feel full and keep your elimination system working well. It can also help to keep the good bacteria working in your gut. The last one is what I learned today. I read an article about food companies adding fiber to everything, which you know I abhor and in that article it was said that the companies are adding fiber because consumers do not like it when things such as sugar and salt are taken OUT of their foods. It was also said that the price will be steep and the outcome will be poor. Many of the new products will have more sugar and fat than is healthy, to go with the fiber. For goodness sakes. Natural sources are best and lowest in calories, remember that. And here again is the cereal bar recipe.

http://www.youtube.com/watch?v=qEZkK_Z3deQ&feature=channel_page

Diet: Just a note. My friend and I were talking about my passion on wellness and diet earlier this week. In that conversation we talked about the misconception that some people have on the word diet. You see “diet” is a noun not a verb. It is NOT something that you do and if it is, you are bound to be disappointed, but the overall picture of what you consume. For example, my diet consists of lean non meat proteins, many vegetables, fiber and fruit with some monounsaturated fats. That is what I eat on a regular basis. Your diet is the food that you eat not that you don’t eat!

Exercise: On my mind this week because I seem to be in a bad place in that regard. My preferred form of exercise is mostly inaccessible and my second and third choices are themselves causing me some difficulty or pain. Even so I have to remember what I have said in one of my side bars, which is, “I will not wallow, I will not whine and I will not succumb.” So each day I find a way to exercise and I keep my chin up and I know that I will find a good place again.

Tobacco: Early this week I mentioned that I was seeking the source of the nicotine found in medications that people use to quit smoking, or nicotine replacement therapy. I received an answer from GSK, but now I realize that I didn’t ask the necessary follow up question. Does the nicotine comes from tobacco that cured or uncured? Curing is what creates tobacco specific nitrosamines which are linked to cancer. It is an important question. The same question about nicotine sourcing needs to be asked of the electronic cigarette makers.

Sunscreen: This time at the beach I heard a parent say the right thing so that is worth noting as well. A dad came to the beach with his two children, an umbrella, a chair or two, some sand tools and buckets and began to unload. He said to his children, approximately aged 5 and 2, “Ok, the very first thing we have to do is put on your sunscreen.” And he proceeded to slather them up!

Me and Julia: And lastly, I saw the movie Julie & Julia this weekend and really enjoyed it. I will say this about me and Julia Child. We both love food, love to eat and love to cook. We both love a place. She loved Paris and I love Sarasota. So she thinks butter is divine and I eschew it in all recipes. She was tall and big boned while I am short and a bit dainty. Otherwise, really, we could be twins!

But is it a BETTER longer life

We have gained two tenths of a point in our life expectancy rate. That is supposed to be very significant. Our main causes of death are heart disease and cancer. They account for almost 50% of the two million plus deaths per year. And while the incidence of some causes of death have come down emphysema death rates have actually risen.

I want you to take pause when you read the head lines. Remember, we are living longer not because we are healthier, but because our diseases are not killing us as quickly. This is where the concept of compressed morbidity comes in, again. We don’t have compressed morbidity. We should strive to increase healthy life years and squeeze all this disease and disability into the very last years of that long life. For now, for many, it is a longer life but not a disease free longer life.

[my mom reads my blog so let me point out that she is 81 and is very active and healthy.. a role model to my 30 year old friends!]

Obesity has become such a serious threat to our health and our economy that the Cleveland Clinic CEO was on CNN last night discussing how to reward employees for not being obese. They already do not hire smokers and most laudably use the Go Slow Whoa eating concept in their cafeteria. There was discussion about not hiring the obese if that person would be too impaired to do the required work.

It is of great concern that today’s children will have the onset of chronic disease before the age of forty. For that generation, living 37 years with diabetes, heart disease and other disabling conditions does not shout PROGRESS to me.

Something must be done.

the Tobacco Plant as Hero

Before the market collapsed and the economy sank state and local budgets, I was in support of increasing tobacco taxes and imposing public smoking bans. At least three years ago, I wrote a handful of letters to the editor regarding tobacco. Some were published in the Winston Salem Journal. I was aware then as I am now, that beyond tobacco companies, for whom I have no sympathy, there are tobacco farmers and cigarette factory workers whose income and skill is intricately tied to this deadly industry.

I once proposed that the tobacco companies find a way to make tobacco an alternative fuel. I see now that it would be harmful to have many of the same chemicals in cigarettes emitted through exhaust. I had also proposed that the tobacco farmers’ change crops altogether and use those as an alternative fuel. That idea remains a valid one in my opinion.

Today we have yet another use for tobacco, one that can save lives and prevent illness instead of taking lives and causing morbidity. The tobacco plant can be a creator of vaccines.

The most recent and perhaps only successful example of this process thus far, is a vaccine created for the norovirus. It is very cool in that the tobacco plant is stimulated to create a protein that it forms into a little ball. When this protein ball is placed in an animal the immune system recognizes it as a virus and attacks it, which creates the antibodies, but the ball has NO virus in it, it’s a dummy virus! How cool.

Norovirus does not generally kill people, but it does quarantine whole cruise ships of people. A vaccine would likely be voluntary, and not make a company too much money. I understand that plant based vaccine development is a new and growing field. Creating vaccines in plants is faster than the way most are done now, in eggs.

While reviewing and writing about this, I came up with a question that I am surprised I never had before, which is, where does the nicotine used in nicotine replacement therapy come from? If it is taken from the plant itself, then the tobacco farmers would still have a use for their crop if cigarettes and other tobacco products were banned. I have emailed a tobacco expert to find out, and will let you know as I know.

Post script: Well, my tobacco expert, and I mean national expert, did not know the answer and suggested that I contact GlaxoSmtihKline which produces many of the products. It actually took four people at the pharmaceutical company before I got my answer. They do sell a patch, gum and lozenge all of which are created by using nicotine from the tobacco plant itself. I think that this is great. I am not anti plant or anti tobacco farmer, just anti tobacco products that kill.