Denying Truth

As happens from time to time, an unexpected exchange becomes fodder for my blog.

This one occurred at the pool and regards the pool but so much more than the pool. 
I have been counting down the days until I will have met my goal of continuing to swim throughout the fall semester (ending in the first weeks of December).  
To be honest, I have become accustomed to my swimming routine.  I will blog about my progress when December comes.  The obstacle I face at this time is the water temperature.  It is not warm.  I have been telling myself as the air outside gets colder that the inside pool is going to be the same as it always was.  My mind might think it is getting colder but in reality the inside environment would be unchanged.
Still the last couple weeks - well - it has always been this way - the getting in is hard.  I probably have something like negative 5% body fat (kidding) so I am not really exaggerating my cold sensitivity.  Each time I say to myself, "It only feels bad for a minute.  Before you complete half a lap it will be okay."  This turns out to be true, every time.  

The air turned cold in NC this weekend.  This morning it was in the 30s and I did not ride my bicycle to school.  I envisioned the swimming that would come at 12 (even as I was lifting weights at 10 and having breakfast at 11).  In other words, I was  preparing myself for the initial "getting in".  When I got to the pool, it was only just opening but there was a MAN in nearly every lane already.  As I walked by one of them, he said to another, "This water seems to be getting colder.  It's probably just in my head though.  ha ha"  My internal response, "Damn - I really did not need to hear that, ever."
After changing into my suit, I stood at the top of one of the lanes and waited for the man in it to arrive so I could ask to share space. [In the time it took me to change ALL of the lanes had filled with swimmers] He said sure and swam away and back again only to find me still standing there and not in the pool.  I then went in by way of the ladder, but lingered and shivered.  I also must confess, I wavered. My negative voice saying something like, "why are you doing this to yourself - it is too cold".  The pushy voice saying, "you didn't ride your bike today, you need to exercise,"  and  "you can't quit" - "you said you'd do it until December." 
My lane mate said, "You are doing it the hard way.  Just jump in."   I laughed and said, "I know."  "I know it'll be fine in just a half a lap, but it's cold now."  And he said, "You don't trust your own experience."

As I began my laps then, he words lingered.  He was an older man, older than me but not as much older as I'd like to believe (smile).  He reminded me of my father for two reasons.  One is that we had a little above ground swimming pool when I was a child and my dad always jumped in and told anyone who crept in that they were doing it wrong. We were torturing ourselves. 
The second reminder was from his words. My father tried to educate me and protect me from mistakes that he had made by sharing his "experiences" with me.  I could not learn from his experience. We all seem to have the need to make our own mistakes.  Today's pool comments  made me think of this again and the words still rang true.  
We do NOT trust our past experience. 
We don't believe that exercise will leave us feeling good and sometimes even feel good in the moment, even when we experienced that very thing in the past. 
And, we cling to the belief that diets will work when every time they do not.

Odds and Ends

From the last week's news headlines, I could almost do an entire Odds and Ends on the HPV virus and its vaccine - neither of which give me great joy.  But here are three things to start us off.

HPV and Heart Disease - A link between this virus and heart disease in women was introduced in the press this week.  Heart disease, not cervical cancer, is the number one killer of women and it is not something that can be prevented with a pap smear.  This has my attention and I would like to have time to review the research on this disease link.


HPV and Cancer - Not sure why I made myself a note about this.  We have known the association between cervical and oral cancer. The CDC states penile and anal cancer can also be a result of HPV but I thought I heard another one added to the mix this week.  Anyone know?


HPV and Boys - We have also known that males can carry the HPV virus but a CDC recommendation for vaccination against it was not made for boys until two things happened.  Men actually started getting cancer related to the virus, such as oral cancer, and girls did not get vaccinated at as high a rate as was expected.  In other words, if the boys are vaccinated too, the spread of the disease might be curtailed.  (of course, the benefit to Merck increases if both genders are recommended for the vaccine and eventually required to receive it - I did not see that the other company's vaccine was recommended - there are two)


Cereal Feedback - I have eaten my sample boxes of Fiber One Honey Squares.  They are okay but the brown squares really do taste gritty.  They remind me of what people think fiber is going to taste like and that is not a good thing.


Cholesterol Testing - I do not find the evidence in support of adding another test to standard cholesterol screening to be compelling.  The new test is one that is meant to measure certain particles that are associated with or components of low density lipoprotein (LDL).  Several scientists/cardiologists that were interviewed for a CBS news story are worth quoting directly - or cutting and pasting - from the story by David Freeman:

Many of those high-risk patients could be caught by a closer look at standard tests "for no additional charge," says Dr. Roger Blumenthal of Johns Hopkins University and the American College of Cardiology.
Triglycerides, another harmful fat, are a good indicator, Blumenthal said. You're at risk despite a low LDL if your triglycerides are over 130, not to mention a low HDL, he said. People who are obese, diabetic of borderline diabetic also are at greater risk, because they often have higher LDL particle counts.
Another way to measure without an added test: Just subtract HDL from your total cholesterol number. The resulting bad-fat total should be no higher than 30 points above your recommended LDL level - and if they are, it's time for serious diet and exercise, adds Dr. Allen Taylor of Washington Hospital Center.

 That's all for me tonight. Hope your week starts well. 

Fish Fraud

Searching my own blog for "fish" posts returns 8 mini pages of results.  Most of those pertain to the benefits of fish consumption in regards to the Omega 3 (good fat) content and the generally low calorie nature of fish or the risks associated with some species (i.e. preditory fish like shark and big fish like swordfish) due to high mercury content.  I am certain that buried in one of those posts is a discussion on sustainability and over fishing, as occurs with grouper and lastly or most recently, my post about the inaccurate nutrient facts labeling of my Walmart purchased salmon and tilapia. This last post noted my complaint to the government's Center for Food Safety and Nutrition (who were of no help).


Imagine my intrigue then when I saw a USA Today headline regarding mislabled fish.  Consumer Reports, which is a subscription only publication, did an independent study where they purchased fish and conducted laboratory analysis.  Though they did not discuss nutrient information, at least in the news story, they did point out that the fish people buy is not the fish they think they are buying.  Of course this will directly impact the nature of calories, sustainability and mercury levels.
I can link you to the same USA Today story that I read and if you subscribe to Consumer Reports you'll have access to the full analysis.

Thus fish fraud continues... BTW - the blog post I did about grouper related to a scientist who said he never ordered it because 1) it was over fished and 2) it often was NOT grouper.  The news from today only supports his assertions.

Why the NSLP Matters to Everyone

NSLP is the National School Lunch Program.  Earlier this year I blogged about the 2010 Dietary Guidelines for Americans and the alignment mandate that has long existed between the two.  I mean that the meals that are fed to the children are supposed to meet these guidelines.  If you recall, the DGAs call for the increase of fruits and vegetables, whole grains, good fats(oils) and the limit of calories, salt, saturated fat and added sugar.  For the first time, the DGAs discuss the difference in quality amongst vegetables.  This is something that was evident in the food pyramid from Walter Willett and Harvard that I posted many years ago and several times.  The problem is potatoes and starchy vegetables such as corn and peas.  Because of their lesser status, the school lunch program has to limit them.

There is a great post about this on the Harvard School of Public Health's website.  I receive their newsletter and became aware of this post today.  It makes far more sense for me to share the page with you then to try and restate it here.  

The point of my title today is that what is being done with the school lunch program is something we should all be doing -limiting foods that are higher in calories and which have a composition that is not the best for our metabolic system (insulin and such)

PLEASE read more here.

HIV KNOWLEDGE QUESTIONNAIRE

*******HIV KNOWLEDGE QUESTIONNAIRE (HIV-KQ-18************

* Reference: Carey, M. & Schroder, K. (2002) 

This is was created by the researchers sited above.  

The answers are at the bottom.

For each of sentences below, decide if it is True or False.

Coughing and sneezing DO NOT spread HIV

A person can get HIV by sharing a glass of water with someone who has HIV

Pulling out the penis before a man cums keeps a woman from getting HIV during sex

A woman can get HIV if she has anal sex with a man  

Showering, or washing one's genitals/private parts after sex keeps a person from getting HIV  

All pregnant women infected with HIV will have babies born with AIDS  

People who have been infected with HIV quickly show serious signs of being infected  

There is a vaccine that can stop adults from getting HIV  

People are likely to get HIV by deep kissing, putting their tongue in their partner’s mouth, if their partner has HIV  

A woman cannot get HIV if she has sex during her period because her menstrual fluid protects her  

There is a female condom that can help decrease a woman’s chance of getting HIV  

A natural skin condom works better against HIV than does a latex condom  

A person will NOT get HIV if she or he is taking antibiotics  

Having sex with more than one partner can increase a person’s chance of being infected with HIV  

Taking a test for HIV one week after having sex will tell a person if she or he has HIV  

A person can get HIV by sitting in a hot tub or a swimming pool with a person who has HIV  

A person can get HIV from oral sex  

Using Vaseline or baby oil with condoms lowers the chance of getting HIV  

Answers: T,F,F,T,F,F,F,F,F,F,T,F,F,T,F,F,T,F

HIV Myths

In tonight's class I had the students take a True False HIV quiz which contains 18 statements.  They did very well.  Some of the students shared their experiences of HIV/STI testing.  I am continually impressed by the openness of my students.

I do not have the Quiz with me at the moment so I am going to share a CDC website link with you instead. However, I will try to get the quiz up here tomorrow.
On the CDC website, you can click on different tabs that might be of interest or curiosity.  For example, can you get HIV from oral sex ?(yes) and can you get HIV while you are menstruating? (yes) and more.  Click here.

Segway - NO WAY

Yesterday I attended my first meeting with the Sustainable Transportation Committee on campus.  We are interested in things like car pooling, electric vehicles, walking and bicycling, for example, as ways to conserve energy and reduce carbon emissions.   I represent the Graduate Student Association on this committee and various other departments and groups are represented.  One of the members is from law enforcement.

At one point during our meeting, someone asked the law enforcement officer about the "segways".  In case you do not know, these are motorized stand up, um....- hell I don't know how to describe them, I only know I abhor them.  I do not like them because I believe that people who can walk, should WALK not stand still and let this thing which looks like a dolly sort of, cart them around town.  

Apparently the police department bought some Segways to use for security patrols and my colleague was asking if they still had them, etc.  The officer said that no one wanted to use/ride them (No kidding!). He then told stories about officer's running into things with them, crashing into bushes for instance and just generally falling off because they could not keep their balance.  I actually stopped the officer who was speaking to be certain that he was talking about police officers using the Segways  - yes, I was told, in much the same way they might use bicycles or horses.  Well, that is just crazy - in my opinion.  I could envision out of shape officers cruising parking lots on the Segways - what a laughing stock they would be.  Not only do people walk faster than the Segways roll but people NEED to walk.
He said that the Segways were more novelty items than anything else - (again,as no one would ride them).   I was relieved to hear that they were not being used.  But again, I was stunned that they were even ever considered for use.

Oh and here I found a picture on the Internet of this very idea (now I  have trouble respecting this version of authority).

NCD Alliance

To the best of my understanding, the NCD Alliance met during the UN General Assembly Meeting that was recently held in NYC.  It was during this meeting, that Tea Collins, the Executive Director of the Alliance, was interviewed by a fellow physician and Professor, Eli Adashi, for Medscape News.

I read this interview and wanted to share a few things with you.  The first is the definition of NCD -
NCD stands for Non Communicable Diseases.  The 4 types of diseases that are in this group of diseases were at one time referred to as chronic diseases.  The reason for the name change has to do with some communicable diseases(namely HIV/AIDS) becoming chronic diseases.  So to differentiate between disease we can pass from one to another and diseases that are in large part related to lifestyle factors, the category name has changed.

Dr. Collins does not particularly like the the NCD phrase because the word NON makes the illnesses sound benign or harmless.  They are not.  The four conditions, heart disease, diabetes, cancer and some lung conditions (i.e. COPD) are  serious and epidemic.  These are the top four killers for the entire WORLD.  Sixty percent of all deaths are attributed to these 4 NCDs.  

Though I agree with Dr. Collins point on lifestyle factors being the main cause - I do have to take issue with his qualifying them as "easily modifiable."  The modifications she advises, and you have heard them before, are tobacco control (i.e. don't use it), alcohol moderation, improved diet (i.e. weight loss or maintenance) and increases in physical activity (exercise).  They may all be "easy" in theory but when it gets down to individuals, a whole host of problems seems to occur.

Speaking of individuals, the interview did note that there are two main strategies or interventions for dealing with the chronic diseases.  They are population level (i.e. public health and policy) and individual level (treatments and programming - i.e. physicians, nutritionists, health educators).  I have been and still am, interested in the population level approaches such as banning smoking in public, outlawing tanning beds, reducing prices for healthy foods, promoting active living by design, etc.

Lastly, another good point that Dr. Collins made regards the mistaken perception that these NCDs are natural parts of aging and that it is the equivalent of "everybody has to die of something."  She specifically said that to consider these diseases of aging is incorrect.  She noted also and correctly that many of our children and young adults are being diagnosed with NCDs.  I would say this is especially concerning considering how few years they have been engaging in that unhealthy lifestyle.  It comes upon us quick and the longer one has diabetes or heart disease, the worse the outcome and the greater the disability (and quite frankly, the cost to society).

You can learn more about the NCD Alliance and view the worldwide list of members and supporters, including the USA by clicking here.
 
 Oh and not only is Dr. Collins and MD, she is also an MPH, MPA and a DrPH (like she must have been in school his entire adult life!)  - I think that the MPA is a Masters in Public Health Administration but I am not sure.

Odds and Ends

CHEESE!: I was in one of the higher end grocery stores yesterday to pick up a few items that I cannot get at Walmart.  One of those items is Smartbeat Cheese slices.  As I came into the aisle, a youngish woman was holding two packages of Sargento Cheese - a provolone and a muenster.  She stopped me and asked about the two cheeses.  (funny thing I actually once worked in a deli and could offer some input)  As I was explaining what I knew, inside my head I was trying to find a way to gracefully encourage her to choose the 2% reduced fat Sargento, instead.  I did, I said, "well I always buy the 2% and I saw over there (pointing), they are on sale this week".  She actually did change and get a 2% pepperjack variety - which I could then say was a favorite of my Mothers.  Bottom line: YAY!

Print, Copy and Lunge:  I thought of you Friday or maybe it was Thursday.  YOU - my blog readers.  I was waiting for a document to print and later for a document to copy.  In both instances, I stood there for a second and thought - "why am I standing here, I have been sitting at my desk for like an hour".  The first time I waited, I did those real slow marches which work the abdominal muscles and the second time, I did some walking lunges.  Bottom line:  Yay again :)

Nicotine and Muscle Power: I ran across a flyer in the Rec Center on campus yesterday.  It was a recruitment flyer for a research study.  The grad student and his faculty supervisor are going to study the effects of oral nicotine (i.e. NOT smoking) on muscle strength or power.  I wish I could remember exactly what the flyer said. I do recall that the people had to already be users of nicotine in order to participate. And why would that be???  I hope that you answered because it is addictive.  Anyways, I did email the professor, as I had just been introduced to him about a week ago.  I told him I would be around this summer if they needed any help with the data analysis etc.  He told me that they were having some trouble finding people to participate.  I suppose that is a good thing really (yay again).  You may also recall from my posts a few years ago that I DO believe that nicotine has some positive attributes, it is smoking and tobacco in general that I dislike (abhor).

Free Sample: It was just my lucky day at the Rec Center yesterday.  (I was there because my walking buddy had to cancel our walk and I thought if I used the treadmill I could also read the articles I had to read for my classes - multitasking YAY).  Near the group fitness studio I spotted some samples.  We get freebies from time to time, deodorant, perfume, Avery products, etc.  Yesterday there were samples of Fiber One Honey Squares cereal.  Interesting thing is that the little box had a NFP (nutrition panel) for the serving size of 3/4 cup but it said that there was less than that in the sample.  It has 10 grams of fiber, and promotes itself as healthy.  The ingredients are corn based however and sugar is near the top of the list, as is sucralose.  I am very curious to see if that cereal would get FOP points under the proposed criteria, which I am still reviewing.

Putting it All Together:  Yesterday I spotted a woman and immediately thought 'smoker'.  I wondered about my gut categorization and thought that it had to do with many things.  We make our decisions based on a convergence of things.  For example, I was a smoker once (past experience).  I have read about smoking and the effects it has on the skin and the hair (research and book knowledge).  I noticed that her skin and hair looked very dry, she was wrinkly but looked like she was too young to be so wrinkly (generalization of aging), also as all this was being processed in my head, I walked by her and the third hand smoke smell lingered on her clothes (using my "senses").  Bottom line:  No YAY about smoking.

Workout:  I finished my 4 of 4 workouts on Thursday so I need a new routine starting tomorrow.  I think that I will visualize it all in my head tomorrow while I am drinking my coffee.  I'll let you know what I come up with - I anticipate more challenging leg work and maybe chest flies with dumbbells for starters... WAIT - I said I would figure it out tomorrow..... sigh -

Highlights from the Proposed Vending Rule - document

Here is the information on the document from which I am pulling out a few interesting points:

Food Labeling:

Calorie Labeling of Articles of Food in Vending Machines NPRM

Preliminary Regulatory Impact Analysis 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration

Docket No. FDA-2011-F 0171

Office of Regulations Policy and Social Sciences

Center for Food Safety and Applied Nutrition

March 2011 

And my little points of interest are:

• There is one vending machine for every 40 people in the USA
• 10% of the items in the machines do not have nutrient data available and would require laboratory analysis to be in compliance with the law
• Foods eaten away from home are often associated with over consumption of calories because of their extreme caloric density.  Vending machine "meals/snacks" make up 5% of away from home eating.
• "present-bias" is a term that refers to thinking about what we want right here and now and not the consequence it may have on our weight or health in the future.  Having caloric information "in our faces" at the time of purchase may have an impact on this phenomena.
• 79 Million adults are considered to be obese (USA)
• A lot of convoluted math was thrown out in this document and by convoluted I mean complicated and over my head.  The authors of the report suggest that informing consumers about the calories in foods may lead to a reduction in caloric intake.  In order for this policy to be beneficial, we should decrease caloric intake from vending foods or drinks by 140 cals per day*.  If this is done, they extrapolate (with caution), we could see a decrease in the obesity rate in adults by 4.3%.  This regards only this intervention, not other strategies. 
• Vending machine food is associated with higher calories, thus weight gain and obesity.  Obesity is itself related to adverse health outcomes, disability, decreased productivity and abbreviated life expectancy.  However, people tend to live just as long when they are obese, just not terribly well it seems.
• I am really concerned about the sentence below regarding the nutrient analysis and disclosure piece - as stated on page 16 (the underlined part esp.).  In other words, the proof of accuracy should not be a choice but a given.

Although the proposed rule does not mandate recordkeeping, vending machine operators will likely need to be able to ensure that calorie disclosures for covered vending machine foods are accurate and consistent without needing to re-analyze these foods. 

• The exception to the rule (p. 18)! Here is the kicker. It says in this document that if total calorie content is included on the label and that label is viewable through the case (i.e a glass case) then the machine would be exempt from the new rules.  If we could walk up and see that the fritos have 300 calories for the bag we are thinking of buying - before we buy it, then the machine is already doing what the law intends.  Thus, I have two things to say.  One - years ago I said, turn the packages around - and I still think that is a fine start.  Two, - front of pack labels :)

The document is available on the Internet here.
**correction - that should read 140 calories a week.

Proposed Vending Rule

Right before the IOM released the Phase II report that I mentioned yesterday (and printed in full today), I had gotten my hands on the text for the proposed vending machine labeling rule - mentioned previously.
I had been in recent meetings with some colleagues on campus in regards to a vending machine initiative. We knew that the FDA was supposed to give its final rule on both menu and vending labeling by the end of this year.
As I said, I have mentioned the calorie disclosure rules here and am following the progress, but basically it has to do with a mandate in the ACA. (if you click the link above you will get the better overview) This regards disclosing calorie content information at point of purchase, before purchase, so that customers make more informed choices.  Well at least they will have the information they need to make the informed choice  - there is no guarantee that they will use it and of course, education and promotion are key to all the initiatives (vending, menu and front of pack).
I found the full text by accident - I was just looking for an update.  There is not much more to share about the propsed rule, but the full document talks about the cost to vending companies and the projected benefits to consumers and  the country with regard to productivity, saved lives and reduced medical costs.  

All this preamble was necessary for me to tell you some things that  I found interesting or newsworthy in the document.   So my friends, that is exactly what I will do - tomorrow :)


 

FOP - Final Recommendations

I am excited to say that the Institute of Medicine has released Phase II of its commissioned study on Front of Pack labeling systems.  In Phase II, it recommends how a standardized program should look and be implemented.
[I do not have time to read all of the 224 pages (now), and you know that I really do want to.]
There was a live report on the release this morning.  I caught just a bit before I had to run to class, notably, someone asked about short fall nutrients.  If you remember from my previous FOP posts, the Phase 1 report had made recommendations on what items to include on the label - just not how to do so.  The person asking that question was referred to the first report (where it is decided to only address the items that we are encouraged to limit).  The speakers did reiterate their desire to align the system with the DGA 2010 and with the NFP. 
If this is the first you've read about this - I suggest you click on the hyperlink above as I have detailed this initiative in several past posts.
Ok - here is the bottom line as I understand it from first and brief glance.
The recommendation that the IOM is giving to the FDA for final rule is this:
* Items to highlight

• Saturated and Trans fat
• Calories (per household serving size - i.e. 1/2 cup)
• Sodium
• Added Sugars  <<>>

* Foods to include

• pretty much everything (snacks, cereals, dairy, breads. packaged foods, meats - everything)
• bulk foods and produce will have shelf tags (instead of a FOP label)

* Point system

• They did not choose the multiple traffic light,however the proposed label has three circles and each circle may receive a check (see below)
• Each item (combined trans/sat fat, sodium, sugar) has a set criteria of the maximum amount a serving can have and be considered healthy (I haven't read the qualifiers yet).  For trans fat it is usually zero.  Anyways, if it meets the BEST category it gets a point or check - if it does not, it gets a zero.  In the food category of cereal for example, the choices with 3 checks or 3 points will be healthier than a cereal with 2, 1, or zero.  

 There is so much more to read and consider but it may have to wait for me.  I have given you a pretty decent over view. The FDA is likely to take the info and make a proposed rule.  If it is like the menu and vending label "proposed rules", there will be time for more comment before a mandate is given.  [I noticed that some of the popular press outlets are running a story on these recommendations as well  - so you may also see this in your morning papers]
I am very excited that we are making progress - as you know, I get very frustrated at the lack of consistent and  complete, nutrient transparency when I am shopping.

Farm Bill 2012

The US Farm Bills are often discussed in regards to the subsidies they offer to certain industries or for certain crops.  There is an indirect association between the farm bill subsidies and obesity.  For example, corn is subsidized and used for corn syrups.  High fructose corn syrup sweetens snack products.  We can over consume calories when we eat snacks that are high in sugar.  We eat more of these foods because the foods are cheap and mass produced.
The 2012 version of the Farm Bill is being discussed in a Webinar tomorrow.  I cannot attend as I will be in class.  I understand that the Webinar will be taped and made available via the Harvard School of Public Health's website.  They are the sponsors of the seminar and the paragraph below is taken from their website:

In election year 2012, the U.S. Congress will be considering a new Farm Bill, the government's primary means of setting food and agriculture policy. The current Farm Bill has been criticized by public health experts for subsidizing crops used in ingredients—such as high-fructose corn syrup—in unhealthy foods. At the same time, the bill helps fund food assistance programs in the U.S., making food—healthy or otherwise—more affordable for many Americans. Amid calls for federal budget cuts, this Forum webcast will focus on the implications for feeding the nation when politics, economics and nutrition collide.

 You can visit the website yourself for the live or recorded seminar and also to learn more about the issue.

The work that has kept me busy today is not something that lends itself well to blogging - so instead I will talk about weight training, sometimes called strength training or even personal training.  I refer to my own routine in this post.
As previously mentioned, I prefer to do a full body workout (meaning all muscle groups in one session) twice a week.  Research that I have read from the American College of Sports Medicine supports this method as one of several that is effective for increasing muscle strength and size.  Also supported by the ACSM, is my penchant for fewer reps and higher weights.  Lastly, one should rest between muscle training days and recent studies suggest that 48 hours between workouts (of the same muscles) is ideal.
The information that I have just referred to can be read in this edition of the ACSMs Certified News from 2010.
I had been doing the same routine on both days - Monday and Thursday (which are also the days that I swim).  Recently I began doing the same routine 4 times in a row.  I was using too many creative thinking cells and I think 4x in a row is not too many at all.  That means I am switching the routine every two weeks and my muscles will not become immune to the workout (you have GOT to switch it up).  I have also been increasing the load on my biceps and am pretty pleased with that.
Today was the third time I did this routine:
Bicep pyramid hammer curls (weights go up, reps go down - 10 lbs 12x, 12 lbs 10x, 15 lbs 8x and back down)
Squats with a lunge (you can see this move and me here)
Triceps push down traditional and bent over extension 
(both with a rope attachment)
Squats with the Smith Machine (2 sets)
Seated chest flies with a cable machine
Abdominal crunches (with a machine)
Lateral pull down and low row (for the back)
[but I was sitting on the floor and using a different type of cable machine for the low row]
Another set of the squat lunges
Shoulder rows and overhead presses (with 8 lb dumbbells)
That's all - plus the swimming and riding my bicycle to school :) 

It was very cool to be able to use the ExRX website to give you an idea of what my exercises looked like.  I think it is the best place to go for information, education and visual descriptions.  But do be careful not to click on any of the ads that come on the free website.

Contraception Use in the USA

In case you are wondering, this week's lesson in the class that I teach  regards  contraception.  I have been trying to prepare the material.  I came across this website that has a lot of information - though it appears that it is 2010 data.

According to the website, among women of child bearing age - over 80% use contraception and the most common method is the pill.  The website gives information on frequency of use by method type also.

Teenagers, Sex and Protection

I won't have much blog time this weekend but below is a link to a report from the CDC.  The results from a national survey of teens in the USA gives some idea of the percent who are having sex, when they first had sex, how often they are and the times they are used protection.  These are general numbers because some youth will say more than they do and others will say less - you know - same as adults.  HIghlights and the full report can be accessed at this link. 

Make the Time

I absolutely did not have time to go for my swim today - but I did it anyway.  The whole while I was walking up the stairs, into the locker room, changing my clothes - I thought - "I do not have time for this".  I was a nervous wreck and I reflected on my feelings as I felt them - thinking, also, of all the people who really don't want to exercise and have to talk themselves into it every single time.  My friends think I do not have those moments but I do.  I am convinced (by what I have seen with others and my past) that if you miss once, you will miss twice.  If you miss twice - it's over and that is just not an option.  So now I have to stay up later to get my work done - my health (physical and mental) is worth it.

I did not have time to go the bicycling advocacy group open board meeting tonight - but I didn't know when there would be another.  I know that I cannot simply complain about bike lanes and not participate in solution making.  I went (my first meeting) - did not stay the whole time, but learned some things.  I learned that cyclists police themselves a bit and get frustrated with aggressive riders who break rode rules.  I learned that car drivers really do not know what the laws are for bicyclists and that a lot of confusion leads to a lot of danger.  I spoke up about educating people on bike lanes.  When the discussion centered on drivers and educating both the riders and the drivers - I thought of cyclists using hand signals that drivers do not understand.  One person recalled a meeting he went to where the people in the audience were asked if they had ridden their bikes to school as children.  The younger the adults in the audience - the fewer the hands (i.e generation effect).

I do not have time to do my blog tonight.  My mom is coming for her very first visit to my little graduate student apartment- in the morning, and my house is not clean enough for her.  But blogging is what I do - so there it is....

Now, that floor needs a mopping :)

When Supplements are Harmful

This is a subject that is very dear to my heart and one that gets my dander up every time.  I believe one of my blog side panels gives my viewpoint on supplementation and I have openly stated it here, repeatedly, over then past ten years.
What I consistently say is that the vitamins and minerals that we need, including antioxidants that may be helpful in reducing chronic disease, inflammation and damage from aging, are best obtained in their NATURAL forms - in foods, in plant based foods.  These awesome vitamins, minerals and antioxidants should be transported via a fork or spoon - not taken from a pill bottle.
The only convincing evidence I have ever seen for taking supplements involves calcium and Vitamin D.  Calcium is also associated with negative outcomes so even it cannot be considered an absolute.  All research findings are open to falsification - there can be no "truth" just the truth we know today.
And today we know that there is a lot of harm to be found in these pills, shakes and powders. 
I am going to quote a couple of scientists who are responding to this new research and link you to an abstract on the actual published study,
But before I do - let me remind you of something very important - all those vitamins and supplements you see lined up for purchase are NOT FDA regulated.  The people who make them are the ones claiming how great they are - they are not claims from health experts or nutritionists they are claims from companies with a billion dollar industry -  they want  your MONEY.

You do not have to read the article or its abstract but please know that there IS real harm in taking some of these pills and that harm seems to be especially true for older women.  If it were me - or someone I care about - which really is all of you - I would not recommend anything except calcium and D and only if that person's doctor agreed.

Here is an article (or blog post)regarding the just released study - I am linking it because I am pulling a direct quote from the article which I most want to share, it is attributed to Drs. Goran Bjelakovic, M.D., D.M.Sc., of the University of Nis in Nis, Serbia, and Christian Gluud, M.D., D.M.Sc., of Copenhagen University Hospital in Copenhagen, Denmark

. . . . add to the growing evidence demonstrating that certain antioxidant supplements, such as vitamin E, vitamin A, and beta-carotene, can be harmful.

 This link will take you to the abstract - or summary- of the actual research which discusses the risks of some supplements to older women.

Self-Monitoring and Weight Loss

I have reviewed the following three research articles, one of which I have read several times because I am critiquing the study for a class assignment.  One of the articles refers to a main clinical weight loss trial that is called PREFER, another refers to a specific study on self monitoring as part of that trial and a third used interviews with select participants after the first two parts were complete.  It is the last one that I am reviewing for class.  Both ancillary studies are of interest to many of you, I would suspect.  They are also entwined.

The rationale for self monitoring of meals,(calories and fat content) and of exercise is provided in the studies. The major study used education, monitoring and group support as the factors involved in weight loss.  The smaller study involved reflections of keeping a food diary.
The main points to share, with the limited time that I have, follow:
There are certain characteristics that people who adhere to self monitoring share.  
When self-monitoring is consistent, complete and timely it usually correlates to weight loss.  This reminds me of my sister's friend who I mentioned before - every bite, lick and taste.  It is important to get everything but also to record the meals in real time.  Successful losers record on the same day that the intake occurs and within minutes of consumption.  It makes sense.  If you wait until the end of the day, the ability to see and attend to over consumption will be lost. 
Persons who keep their record and make the connections between too many calories and weight gain are also more likely to be successful weight losers. In the article, there were quotations of persons who were astonished about the amount of calories they had been consuming.  I think that this is very important and is related to the passive over consumption that I have mentioned lately.
Persons who self monitor, make connections and lose weight are rewarded with increased self-efficacy.  This self-efficacy is empowering and leads to long term monitoring adherence. 
Successful loser/maintainers may not continue to keep food diaries into perpetuity, though some do, but, they employ the strategy at times, or as needed.  
Successful self-monitors also use the information to plan ahead.  They aim to eat a certain amount of calories a day and if they are like me, they like to eat many times a day.   It is this planning that leads the weight loser to decline more caloric foods that they might be offered throughout the day (you know from the food pushers :)).  
Other identified components of success included group support, support from spouses (which was hard to come by) and not having been in numerous weight loss programs prior to the study.

Burke, L. E., Choo, J., Music, E., Warziski, M., Styn, M. A., Kim, Y., & Sevick, M. A. (2006). PREFER study: a randomized clinical trial testing treatment preference and two dietary options in behavioral weight management--rationale, design and baseline characteristics Contemp Clin Trials (Vol. 27, pp. 34-48). United States.

Burke, L. E., Sereika, S. M., Music, E., Warziski, M., Styn, M. A., & Stone, A. (2008). Using instrumented paper diaries to document self-monitoring patterns in weight loss. Contemporary Clinical Trials, 29(2), 182-193. doi: 10.1016/j.cct.2007.07.004

Burke, L. E., Swigart, V., Warziski Turk, M., Derro, N., & Ewing, L. J. (2009). Experiences of Self-Monitoring: Successes and Struggles During Treatment for Weight Loss. Qualitative Health Research, 19(6), 815-828. doi: 10.1177/1049732309335395

The Rest of the SNP Story

In an Odds and Ends post dated July 31, 2011, I wrote this:

SNPs - Guess what a SNP is?  It is pronounced SNIP and has to do with DNA and genetic codes?  OK - Single Nucleotide Polymorphism.  It means that a mistake is made when a cell is reproducing.  The body can sometimes catch and repair these mistakes and at other times, changes occur which could make one susceptible to a disease or condition or vice versa.  I read an article about SNPs and muscle strength and endurance this week.  There is some interesting research about predispositions - but GREAT  caution was made against using gene testing to determine athletic prowess or prescription.  I want you to hear that - if you read advertisements about a test that can determine if you or your child could be a sprinter, jumper or Olympic marathoner - do NOT buy into that hype.  I am looking forward to the next article in the series, because it promises to tell us how to change the things that we CAN change.  Brace yourself, I expect it will take some effort.   (article by Dr. Maria Urso in the ACSM Certified News Vol. 21[2])

 The last article in the series has been published (same reference as above except it is Vol. 21 [3].  I have read it and it was pretty technical. The conclusion is the important part though it is ironic that I am posting it at the same time that a new study is questioning (once again) the need and the safety related to supplementation.  Maybe we will get to that later but it is what I have been saying for years - get your nutrients from your food!


With regard to building endurance and strength within the constraints of our own genetics, the upshot is this:
We cannot change the genes that we are born with but through our actions, efforts and exposures we can turn them on and off and otherwise "micromanage" them.  The author of the three SNP articles, Dr. Urso,  made several good points in the last piece.  The first is her reference to "beneath the skin" and "above the skin" factors.  The above the skin things, exposures (smoke, sun) and behaviors (sedentary, active) can have an impact on beneath the skin mechanics. So what are the things that we can do with the genes we have that will improve our muscular strength and ability?  And  which are effective AND safe?  For now, Dr. Urso offers the following points to ponder.

• antioxidant supplementation may be counterproductive
• the most important strategy is using a  weight"load" that is strenuous enough to tax the muscle and lead to protein synthesis
• the best nutritional approach is a protein carbohydrate combination (which would include the one I always recommend to my friends, peanut butter on whole wheat bread)
• the protein source should contain the amino acid leucine, and yes, I checked - peanut butter does
• with regard to  increasing skeletal muscle growth through the targeting of cellular level processes/signaling  the only safe and effective way to do that today is "proper exercise and nutrition."

Odds and Ends

No Helmets No Manners? :  As I was running along the greenway this morning, I was quite startled and nearly run over by a man and child on a tandem bike and another child riding on his own.  As I watched them ride off in front of me - taking the full width of the greenway path - I noticed that not one of the three were wearing helmets.  So I thought of the results of the research study I have been working on.  We are predicting helmet use by a condition. For example, does gender or travel path impact helmet use?  So I thought, hmm, "is rudeness predicted by lack of helmet use?"

Combo Pills: One of the big drug companies is celebrating this weekend.  The FDA approved a new drug that is basically a twofer.  It treats high blood sugar (diabetes) and high cholesterol.  From this we might draw a conclusion.  Diets that are high in saturated fat can lead to both conditions.  Whether you take one or two medications - the side effects of those drugs should give you pause.  Also the medications treat the symptoms of the diseases, but do not cure them.  The outcomes for diabetes and heart disease include loss of functioning and early mortality.

Breasts and Penises: In my sexual health class last week, one of the my students presented on a research study that compared women's feelings about their breasts (too big, small or droopy) and their partner's perceptions - with things like whether or not the woman will undress in front of the man or if she feels comfortable in a swim suit. It was called the Barbie Mystique if you want to look it up. This coming week, we might discuss the dilemma that Cuba is having.  Men who feel that their penises are too small can have a surgery to enlarge (lengthen) them.  The surgery will be paid for by the health care system if it is physician recommended.  There seems to be a surge in requests for the surgery.  The increase in the surgeries cases has led the government to put out an official statement in this regard.  It speaks to the importance of not letting the inches of your penis determine your self worth.

Off label ads (it'll cost ya) -A drug company I have never heard of and one of its corollaries (Fremont's Scios Inc.) is in trouble for encouraging the use of its medicine for treating chronic conditions when the FDA only approved the medicine for acute conditions.  Specifically it is for acute flare ups or exacerbation of congestive heart failure or CHF.  You see, when the person who has heart failure comes out of the acute phase of their condition, they would no longer take the medicine.  The drug company was encouraging physicians to use it to treat the heart failure patient on a long term basis.  Of course, they would want to do so - it increases revenue.  The company has been fined by the US govt. and will pay 85 Million.

Kids and Dogs (pulling 'em along)-  More observations from my walk this morning.  A dog being drug along by its owner and a child running along beside her "dad" as he pushed the tricycle she had been riding (helmeted).  The "sister" was some feet ahead of them.  The dad was walking, holding the little girls hand and her arm was stretched to its limit - because she was so much smaller than him.  She could not keep up with him - she was running, stumbling and being sort of jerked off her feet.  I, in fact, said, out loud as I ran by, (because the girl about fell and started to cry), "What the hell is that?"  And as I came back around the circle, he had picked her up.  
When I was studying child development a hundred years ago (okay 1986), the teacher had each of us pair off and practice being the toddler.  We had to "walk" along holding the  "parent's" hand while on our knees.  I have never forgotten what that felt like. 

Physical Activity after and during Cancer Treatment

In my last post, I referred to the American College of Sports Medicine's exercises recommendations for persons who are in cancer treatment or who are post cancer treatment.  The goal of the exercise programs is to improve cardiorespiratory fitness or CR.  CR is a measure of the body's ability to transport oxygen.  When we breathe oxygen in, it is sent to our cells, tissues, organs etc. Oxygen is basically a fuel and nutrient for our cells.  Enhanced transport is essential.
With regard to the exercise recommendations, what struck me as most important was not that the goal should be 30 minutes of cardiovascular activity a day- such as walking - five days a week, but the sentence that followed.  

This should be considered the minimum level you need to set as a goal for your post-cancer treatment rehabilitation exercise program.

There were a couple of other statements in the article that are worth repeating here.

Being physically active may prevent the risk of cancer recurrence for cancer survivors. 

And

...one of the primary objectives is to return CR fitness to pre-cancer levels post therapy and in many cases, increase it beyond pre-cancer diagnosis. (in other words, get the person at a level of fitness that is greater than the level they had prior to becoming ill)

A list of benefits that can be achieved is listed in the article.  It is not yet available on line, but includes increased muscle strength, muscle mass, quality of life, sleep, decreased anxiety and depression, decreased symptoms from treatment, increased energy and vigor, decreased physiological markers of disease, like insulin resistance and inflammation and the best one - as stated in the opening of this post - decreased risk of cancer recurrence.

As I said, the article is not yet available for on line viewing, but you can click on this link to see the ACSM's press release on the guidelines, which was released about a year ago.

We have come such a long way from the frail cancer patient who was encouraged to eat, and who often died during the course of treatment.  Now we have the one who is encouraged to eat well, monitor their weight and  keep moving.

 

Preventing Breast Cancer

I receive newsletters from the American Institute for Cancer Research or AICR.  The most recent one refers to the incidence of breast cancer (new cases per year), and research into the prevention of cases.

The AICR offers several strategies, including weight control, physical activity and limiting alcohol  to prevent this disease or perhaps more accurately, to reduce risk.

They have also created a brochure that highlights some of their research based suggestions.

Additionally, I am in the process of reading an article in the current edition of the ACSM's Certified News that offers exercise recommendations for cancer survivors.  I will get to that in a future post, perhaps tomorrow.

For now I would like to take you directly to the AICR materials.  The Enews article can be found here and the colorful PDF brochure should open here.  

IF you have trouble with the brochure, go back to the first link and at the very bottom you can access the brochure.  (you do not have to sign up to get it, you can skip that part)

The Denmark Tax

At the end of September, Denmark became the first country to levy a tax on fat.  Saturated fat that is - in foods.  I mentioned it here at the time, but was just able to explore it  today.
The tax is a "certain amount of money on a certain measure of weight".  In Denmark this means that they are adding 16 kroner per kilo.  If this were in American money and weight, it would be about a dollar a pound.  OF course, most products don't have a pound of saturated fat (except maybe Blooming Onions and butter), so the tax is really ten or twenty cents more for whatever the product is.   

It might have seemed a good idea at the time - imposed by the exiting government (imagine that) - but it is VERY complicated.  It applies to local and imported foods and requires importers to declare the amount of Sat Fat in their foods (which I thought ALL labels had to declare in the first place).  I suppose if someone is bringing in a truck of goods it could be tricky.
Worse - unless they have a provision in the law that I am unaware of - healthy, heart protective, foods and oils like olive oil and (Smucker's all natural) peanut butter will ALSO go up in price.  For those two specific products the amount of monounsaturated or GOOD fat is six or seven times higher than the 2 gs of sat fat they contain, but they would cost more (now) in Denmark.  That would go directly against one of the goals of the DGAs (Dietary Guidelines for Americans). 


I think that price differentials are very important but this wouldn't be the way I would go about it.  If I were to raise taxes - I would do it by class of food.  Really, I would prefer that we suspend or lower taxes on fresh fruits and vegetables as well as whole grain products - for a start.

The Potato Wars

 Please review this past post on changes that are proposed for our National School Lunch Program.  The statement below comes from that post.

The lunch will have more whole fruit and vegetables, with LIMITS on starchy vegetables and specific amounts of green, orange and legumes is mandatory.

One of the starchy vegetables that is to be limited is the potato.  Several studies, including one released this summer and discussed in this blog, have noted that in any form, but especially as fries and chips, the potato is associated with weight gain.  Even the baked potato with or without its accompaniments (butter and sour cream) continues to be a problem.

Today the potato farmers, lobbyists and their congresspersons are fighting to have this part of the NSLP revisions (in line with the DGA 2010) eliminated.  One of the arguments being made is that by replacing the starchy peas, corn and potatoes with higher quality vegetables the cost of meeting the school lunch standard will increase.  The increase in price was considered unacceptable.

This dialogue and the very real chance that the politicians will win the fight is incredibly disheartening to me.  It is as though the idea of obese children turning into obese adults who have long term, debilitating, chronic diseases and lowered life expectancy means NOTHING and food politics means everything. 
Lastly, the recommendation is not to remove potatoes and starchy foods but to limit them.  Why is it so hard for people to accept limits??? 

Settle Up Reebok

This snippet is from a blog post written on August 27, 2010 -  more than one year ago-

Oh, and I saw a lady walking wearing those shoes that are advertised (falsely according to a ACSM report) to tone you up or burn more calories etc. Though it is a silly waste of money on the surface, if it means that person is going to walk, which WILL help them, then let 'em wear the shoes, right!

 I am not sure how the lawsuit was started, but apparently someone read that ACSM article (American College of Sports Medicine) and sued Reebok. Or it may be that the Federal Trade Commission took action on their own.  You can read more about the charge of false advertising in this FTC press release which announces a 25 million dollar settlement that Reebok has agreed to pay.  The claim that the shoes tone the legs and butt muscles more so than walking in "other"  shoes is made without proof.  As we noted over a year ago.

The shoes that I talked about this year (last month) are from Sketchers and I am not sure how they advertise.  Those shoes, which have lots of cushion and bounce, actually lead me to over pronate. 
Pronation : When we walk we naturally have a bit of an ankle turn in.  It is ever so slight with each step.  IF someone over pronates their ankles dip in by inches and if they under pronate, they tend to walk on the outside of their foot.  (It is entirely possible that I have this backward, but I do not think so).  Anyway, over or under pronating is a sign of an imbalance that needs to be corrected - usually with a shoe insert.  Since my spongey, cushiony, 50+dollar shoes cause me to over pronate - I think I too have wasted my money, but for an entirely different reason (I never intended to get a work out from my shoes).  I probably can't sue Sketchers either :)

Another Step in Reducing Smoking?

It has been several years since the Cleveland Clinic and the Weyco Company  banned smoking  on their campuses and for anyone who wanted to work for them.  When each rolled out these directives - pre 2007, they provided smoking cessation support, counseling and medications.  They also test to confirm that the persons are not using tobacco (this gets tricky if a person is using Nicotine Replacement Therapy and I do not know they particular policies for those circumstances but I have ideas on how they might manage).

Over the weekend, banning smoking in workers was again in the headlines.  It seems more companies are joining in on the fun.  I wonder what people who are hard core individual rights activists and/or those who are anti GOVERNMENT regulation (often free market and corporation friendly)- what do they think about companies deciding that a behavior is NOT okay.

To be clear, as I mentioned in this old post (under the Weight Watchers heading) I am completely for banning smoking - in fact - making it illegal would tickle me (a former smoker).

When the CEO of the Cleveland Clinic was interviewed for NBC Nightly News recently he noted that YES, they were concerned about the health aspect of it and the health insurance aspect of it but even more so now, the financial risk to of having smokers as employees is too great a risk to take.  These "smoker" employees (in general - maybe not YOU an employee that smokes) are more likely to miss work, be present but less productive,  become diseased and disabled,  or to retire early and possibly on company disability insurance and so on.  

As I said, several companies are now participating.  Baylor Health and Georgia Power were specifically mentioned in the news cast.  In fact, there are 21 states who have  companies who ban smoking in employees. I know it is banned for new hires for at least one of the county health departments in Florida.  (24 states do have smoker's rights laws, again, according to the news story I heard on NBC - so companies might have trouble in those states).  BTW - several industries have high smoking prevalence in their employees - construction is one, but I believe the USPS is another.  


Jobs are  hard to come by these days and as someone interviewed on the news said ,"If I can work for some place as esteemed as the Cleveland Clinic and they want me to quit smoking, Sign ME UP."   I say -Here - Here - or is it hear, hear - because that is a message we need to hear.

Not hiring people who smoke or use tobacco may be just as effective a strategy as raising taxes, using warning labels and promoting NRT for improving quit rates and reducing the numbers of persons who die from smoking related lung and heart disease.

I believe that you can get to the news story by clicking on this link - it is pretty interesting.