Eating Too Much

My research area of interest is obesity and chronic disease.  (I am purposefully leaving physical activity and sedentary behavior to the side - they are also related to chronic disease and all cause mortality.  I exercise more and sit less than most people I know - thus it is a personal passion of mine, just not a professional one.  I continue to review all chronic disease research but my own research will address obesity)
That being said.  Obesity is a state of excess body fat and it can be determined with a BMI but the better measure is waist to hip ratio.  This can be found in multiple past blog posts. (you can find them in the search this blog box)  The state of being overweight or obese is related to over consumption.  Eating too much.  But here is where the simplicity ends and where my area of interests peak (because I have more than one).

Why do people eat more than they need?  I can give you a list of about 30 reasons, my colleagues could add more and still more are as of yet undiscovered. 
It is important to know that the reasons can be biological, individual, societal, environmental, structural, psychological, and educational.
We, as individuals,  do not need the same amount of calories even when holding everything else constant.  We are just different.  So we start at one unique place - and then we go about our lives doing different things in different ways.  We may have a low metabolism, we may be on a medication, we may need less calories because of a genetic imperfection.  
One of the main issues however is that we do not KNOW our conditions- we have a lack of insight into the amount of calories our own body needs. Another central issue is a lack of knowledge or education on calories in general and calories in foods.  Until recently, access to labels that explain nutrient content have been sparse.

Even those that have understanding, knowledge and will may not have the opportunity to use any of it. Some of us do not have choices of what to buy or how to cook it.  For example, people who eat at soup kitchens, work sites and schools - they have to make the best of whatever the option is.

But this last one may be the most frustrating because it is the easiest (relatively speaking) to control. Some of us consistently eat when we are not hungry.  Social pressures to eat exist in many cultures and environments. All of this is said to get to this example.

In one of my classes, which contains only women, the instructor and some of the students bring food to share (every week).  We sit at a long conference table during our lesson.  The food choices are often cookies, fruit, cheese, nuts and candies.  The class meets at 1pm.  I always bring my lunch to this class.  Some of my classmates also bring their lunch.  I remember the first or second day when one of my classmates ate a very nice salad.  A while later, the teacher passed out cookies.  This young lady (overweight) took a few and later a few more.  Because observation IS a research skill - I pay attention to these things.  I thought, dang, she did so well with her salad and now she just added 300 calories to it.

This past week gives another example of why obesity happens.  It was the typical class with foods on the table and some of us eating lunch.  The lady next to me had a sandwich from subway.  After everyone had eaten the snacks and maybe their lunches, another professor stopped in and said she had extra pizza and put two boxes on the table.  The lady who had just finished the sandwich said "oh well, I might be hungry later," and ate some pizza.  So did many others.

So - that's a problem.  Eating when we are not hungry - another reason we take in more calories than our body needs. 

(PS - I know MOM - if you're still reading this - it went a little long - sorry)

Odds and Ends

This week's edition may have a little bit of a travel theme as the day after the "size matters" post, I returned to NC.  I had been on a short visit with family and friends in the most awesome state of Florida.  Since getting back, I have been busy with conferences, meetings and proposal writing and spring break wasn't even over yet!  That explains my recent absence and classes resume tomorrow which will explain this weeks sparsity of blogs.

Foods: Blogging during my travels has often been a pleasure of mine though I did not give a play by play this time I do have something to share regarding meals.  Uncharacteristically, I had only packed a couple of things for my trip home. I then was laid over in Atlanta for hours and hours.  I arrived home (after flying to a different city and renting a car) eight hours later then scheduled.  Interestingly,  earlier in the evening while waiting for my connecting flight I noticed that a lot of foods in the stores and kiosks actually had nutrient labels.  The foods were not always low calorie, but some healthier options were available.  Later,I did cave in and buy a tuna fish sandwich.  It was labeled as having 300 calories.  The turkey and cheese sandwich had twice as many - weird.  The labels allow us to make the better choice even if the choices are the best ones.

Scanners:  You might recall from my last visit to Florida that the airport there has a full body scanner.  It was working this time - the person who checked my license said.  I told her that I did not want to do that and she said that when I got over there, if I was sent to that line, I could simply opt out.  As I approached I asked, "is that the full body scanner "- actually, I might have asked, "is that the X Ray scanner?"  The employee told me that it was fine that it was the wave one and did not have any radiation.  I went in and turned this way and that as the door closed and swirled.  Later I wondered about the veracity of the employee.  Last night I saw that the radiation tests that have been done on the airport scanners are being questioned and all machines will be reevaluated.  If someone such as me, who is concerned about this stuff, was ill equipped to make a decision I imagine that others will be confused as well.  I did review this today and the millimeter wave machine is not supposed to have radiation and the back scatter devices are the ones that are problematic.  In the story I am linking you to here, and in the one I read last night, it is noted that the amount of radiation in a machine is the same that one gets during two minutes of air travel.  This is quite upsetting to me as most flights are hours in length.  If I am concerned about a two minute dose, why in the heck am I flying??  Here is a list of the airports and their scanners.

Image: When I was waiting to board the plane to Atlanta, I was in full people watching mode.  Airports and shopping malls are the best for this.  As I looked at the people in the gate area- OH! side note- at both airports I found it disturbing that people would sit in their seats for hours and then get on the plane to sit a few more.  Sitting is bad people, sigh.-  I noticed that many of the people were overweight, plain, imperfect.  Their hair was not always 'just right" and even the prettiest or handsomest had flaws.  This was an important observation because I am very hard on myself and I suppose I am also vain.  I had talked to my Mom about this during my vacation (dissatisfied with my appearance) and as I looked at these normal every day people - amongst whom I fared pretty well, I realized that I had been doing something Mom had warned about years ago.  Can you guess what it is?  A lot of us do it... Comparing ourselves to the famous people who themselves don't even look like they look!

Genes: I've said it before and will say it again, but because my colleagues at an obesity conference this weekend were discussing the impact of genes on obesity, I will say it today.  If there are genetic implications to a condition or disease that ONLY means that lifestyle factors - or things that we CAN control are that much more important if you have the gene.  As far as I am concerned, we all need to act like we have the obesity gene (we do) and eat less and move more.

Helmets:  I saw two children roller blading in the park today and they had on helmets :)

Odds and Ends

This time, one week from today, I expect to be in a hotel room just north of Savannah GA on my way to a different life in NC. Just so you know!

CDC Vital Signs: This is something new that the CDC has started but it is pretty awesome. Each month they they will target a health issue or disease and give a few succinct statistics on it while suggesting some next steps. The July Vital Signs discusses cancer screening for both colon or colorectal and breast cancers. Though we have certainly made progress in this area, there is much to be done. You can find this Vital Sign here.

Antioxidants: These are wonderful substances that are thought to aid in ridding the body of waste material that can be harmful. Our body is able to make some of them, but we also benefit from consuming foods that are rich in them, like fruits and vegetables. In the grocery line today, I heard the cashier exclaim "Wow, cherry diet seven up!" I looked over at the conveyor belt, as it was not my order. I wasn't sure if I had heard her correctly as that flavor was not new. What WAS new, I noticed, was that the label claimed "antioxidants." Really guys, whether you drink soda or not, it isn't the place to get your free radical consuming antioxidants.

Beach Reports: We have heard a lot about the state of our beaches and ocean water due to oil spills lately, but the NRDC or Natural Resources Defence Council has also released its 2010 report on the safety of US beaches. The report does address the new threats, but for years the NRDC has tracked the amount of bacteria in our waters and sadly, it is rising. You can review popular beaches or all beaches by state if you like. It is a little confusing at first, but when you see the % of times that a state or a beach exceeds standards, the higher the number the worse the beach is. The standards are really limits of pollution and exceeding them is a bad thing. You can learn more here. You may recall that I go to a certain beach in Florida at least once a week and I was very happy to see that it did well.

Eco Salon: Hmm - I wrote my little notes some time ago, but if I remember correctly, there was a bit of investigative journalism in the WSJ where they tested salon services in places that claimed to be eco friendly. None of the places did very well - getting rid of the chemicals was not so easy and when they did the result was not so good. Personally, I only go to the nail/waxing salons on occasion for a BROW wax. Yes there I said it. I do go in and out as fast as I can. If I have to wait I go somewhere else. Those places are absolutely toxic. I know the employees wear masks but so should the customers.

Teen Business: It appears that hotels are trying to cater to the not yet adult but not still a child demographic. Of course, keeping a family happy will increase business and tips so it makes perfect sense. What was dismaying in the article I read was some of the tactics. Video game tournaments (not Wii fit) with prizes. So after being sedentary while playing video games the kids received ice cream sundaes. Now that's the way to fight this obesity epidemic in our youth, eh?

Speaking of: And lastly, I saw a display at the Publix Supermarket today. It was a cardboard school bus and in it were all types of sugary snacks for kids to take to school.

airlines, fats, and tobacco

Not going to be the post you are imagining!


After several unusual and harrowing tarmac flight delays, regulation was proposed and then passed, which limits the amount of time a plane loaded with passengers can sit idle. In other words, people no longer have to worry about being essential prisoners of the airline. As the rules neared enactment, the airline industry warned of dire consequences for THEM and an increase in cancelled flights for us. It turns out, um, that it is not so bad really. The industry has adapted and consumers are relieved.

I mention this in the health blog because the exact same thing could be said with regard to the legislation to rid foods of TFAs, to lower salt in products, to ban smoking in restaurants and so forth. Industry groups panic. Examples I recall for the TFA initiative include frying capacity, shelf life, and taste. As it turned out – the technology was there and NO ONE misses the TFAs. The sodium content in foods has been lowered once already and I doubt a second round is going to devastate the processed food industry. We will adapt. Moreover, those restaurants forced to ban smoking have had a BOOST in sales, not a reduction. We can be a healthier society and companies can maintain financial health. People balk at change, but change is not always bad.

A current instance, for example, is health care reform. The new law includes a provision for free preventative care in all new health insurance plans. The insurance companies might cringe at the new upfront costs, but the benefit is going to be the money they save by reducing the incidence of chronic disease in their plan participants.

Oh and two more I just thought of – oldies but goodies; lead paint and asbestos.

those darn blood fats

From my website:

Triglycerides are another type of blood fat. Having high triglycerides, over 150 mg/dl can increase heart disease risk and also worsen other health conditions. Being overweight and inactive, drinking too much and smoking are all risk factors you CAN control.

I note this because the newest research and development craze for pharmaceutical companies is finding a chemical or biologic compound to lower triglycerides in much the same way that statins can lower low density lipoproteins or LDL.

I ask the same type of question I usually ask – will lowering a persons blood fats reduce the adverse outcome of heart attack and death caused by heart disease? But I have more questions. How low is low enough? Wouldn’t it be more cost effective to educate persons on the dangers of high triglycerides and how to avoid them?

The drug companies and financial analysts are referring to progress in this area as a potential to gain a HUGE market share and to profit substantially from treating this self instigated disease. I want that to bother you. Some of the drugs that are in development have the same properties as Omega 3 fish oil supplements. What is wrong with eating salmon and taking regular fish oil supplements? Well, they are expensive and insurance doesn’t cover supplements so many people do not take them. If they were a medicine and insurance covered them – and doctor’s prescribed them – (because isn’t it easier for the doctor to say and you to hear, “take this pill twice a day” then “exercise five days a week?”) then the companies could make a lot of money.

With regard to increasing your risk for high triglycerides food high in saturated fat is surely an issue but so is just plain eating too much of any kind of food. When we eat more than we need, the body stores it and stores it as fat. Calorie moderation is the only answer – sorry – the truth hurts sometimes. To learn more about this and from a trusted source, please read the information on the AHA page here.

Bullshit Detector

That is me - a true sleuth. You know that I detest diets, in the popular sense. The true definition of diet is what a person consumes on a daily basis. Recall hearing anthropologists say that early humans subsisted on a diet of grains and berries - or some such thing. They do not mean that they were ON A DIET. So on a diet, that is what I am referring to when I say I abhor diets.

I do endorse the concepts of Volumetrics and the Weight Watcher program and I like some of the constructs of what is referred to as South Beach - but only because it seems to encourage lean proteins and quality carbs - but if someone wanted my opinion on a true diet - what one should consume on a daily basis - I would say the prudent or the Mediterranean diet. You can Google them!

What I will NEVER recommend is the Nutrisystem plan. I have already complained about their misleading commercials and alerted you to phrases like "clinically based" or "clinically tested" as that is not the same as "clinically proven." So, just this month a magazine I read had a full page ad for the Nutrisystem Silver plan - sliver- gold- D- for men - whatever the version, they are all misleading.

In this print ad it discusses the 55 pounds that Martha lost and the 93 that Brian lost and the 50 that Annette lost. Then at the bottom it says - of course, in small print- "results not typical." You know what it really should say? Well, I will tell you. It should say , results are atypical." In that they are not at all what you should expect. You should expect what the fine print says - "most people lose one to two pounds a week." And what is the safe way to lose weight? One to two pounds a week through calorie control and exercise. But it gets better. The small print also says that "individuals are remunerated." I read that and said to myself, "does that mean what I think it means?" So I looked it up and indeed so. The people in the ads who have these very atypical results are PAID. And you know what else, it doesn't say anywhere how long it took those people to lose their 55,93 and 50 pounds.

Nutrisystem does offer a money back guarantee - on the food - not the promises. If the food sucks, you can get your money back.

Want to lose weight - check this out. Calorie Balance.

Diabetes Numbers

(thank you to those who have commented on my recent posts, I appreciate your feedback)

Diabetes Numbers

No I am not going to talk to you about incidence (new cases) or prevalence (all current cases) of diabetes. Not going to talk about how the rate of new cases is trending upwards while new cases in the young are threatening the life span of an entire generation. I am not even going to talk about how diabetes is related to blood sugars that run higher than normal for extended periods of time because the body is unable to produce enough insulin or has a resistance to the insulin that it does produce. (Insulin is the trigger that tells the body to move the sugar out of the bloodstream)

No. I am talking about different numbers. I mean the kind that end in lots of zeros and start with this lovely symbol $. Money Money Money.

Now I suppose you are expecting me to tell you how the rising cost of obesity and its subsequent diseases is straining our health care system - nope. If you REALLY want insight into disease - sometimes you have to look at the profit side.

According to an article from the AP and published by Yahoo Finance, global sales of both treatment (medication, insulin pumps) and testing devices (glucometers, strips) is up double digits year after year starting in 2004. The article also specifically notes sales of products from Johnson and Johnson which have topped two billion each of the last four years. It seems to me that some companies would have a lot to lose if we (health promotion folks) could prevent diabetes. Oh by the way, the article notes global sales for diabetes treatment to have been OVER 30 billion dollars in 2009.

See the numbers yourself here as I am not supposed to republish their info. :)

Your Reflection

My personal life experience, my educational background and my career have given me significant insight into the interactions of people. I know that over the years I have worked on my own presentation and how I react in all the spheres that one might have personal exchanges. If you have known me for any length of time, you know that I am most fond of saying that the way people treat you is almost always – 99% of the time, about them and not you. This morning as I was deep in thought (on a run) I realized that our actions can also set the stage for how the other(s) will respond. I think we all know that on a surface level, but I am always interested in the deeper processes.

Let me start from the other side, the messages we project about ourselves, not the behaviors or responses we hope to generate in a deliberate sense but the more subtle nuances of our body language.

I was having dinner with a friend recently and she noted how she first perceived me. Basically she described seeing a person that was very closed off (arms crossed over my chest) and someone nearly tremulous with nervous energy. I seemed bored or anxious to be somewhere else. WOW. That is what my outside was saying and not at all what my insides were feeling. Instead, I was physically uncomfortable – i.e. cold and without a sweater, and I was fearful.
The people around us are not going to respond to what we are thinking or feeling, but what we are showing. It is an important take home message. I take this kind of feedback seriously and try to change myself accordingly. I am going to have similarly challenging new situations in my future and in preparation I am going to practice this little mantra, “check yourself.” Is my body projecting the message I want to convey? I may still be scared or uncertain and that is okay – at the same time it is probably NOT what I want to share, instead I can project confidence. It isn’t that hard really and of course, if I am cold, I can acknowledge that.

On this same subject of people responding to your outsides, it is also true that if you are nice to people, 99% of the time, they will be nice back. I am going to try this the next time I have a big transitional challenge – which you will learn soon is not that far into the future. And at that time, I am going to approach people as if our interactions WILL be positive, balanced, respectful etc. My hypothesis is that I will create a positive environment because the others will be reacting to this energy, much the way people have reacted to my “fear” or “intensity”. There are very few people who just interact due to having agendas and even fewer who put a lot of thought into their projections as I am today, so I can be reasonably comfortable that my expectations will pan out. Which reminds me of another thing I like to say – I own my expectations and no one has to meet them, it is just nice when they do!

Afterthought: I wrote this before I was ready to post and set it aside for awhile. I had forgotten that I had in some aspect already proven my theory. For the last two years, one of my professional responsibilities has been teaching an hour long class that meets for 4 weeks to a group of people who are compelled to take the class for a work place benefit, but who are angry about this requirement. (I have probably completed 50 series of classes) I have turned that class into something that the “students” do not mind attending and even enjoy at times. I framed it – I chose to go in positive and they replied in kind. I highly recommend this approach to life! (Of course, we all get to have our moments of foot stumping and pouting, but seriously – you should do that alone or in the company of those who love love love you dearly!)

I HEART Dad

Eight years ago today (June 18) I woke up to plan a funeral. Well, truthfully, I had not really slept the night before having arrived home from the emergency room near two or three a.m. with my Mother, newly widowed. It was a black day.

It is surreal to imagine that this many years have passed since my father’s death from a heart attack. Seven birthdays, Thanksgivings, Christmases and Easters. A college graduation he did not attend and professional acclaim he has not seen. It does not hurt today, like you might think that it does, because time truly takes that away. Though the time takes away pain, it takes some memories too and it certainly gives nothing back.

I am using my loss as a teaching or motivating point for the men reading my blog today. My father died in 2002; in 2003 the amount of men living with any form of coronary heart disease in the US was over seven million. Over 245 thousand died from the disease with 89 thousand due to heart attacks. In that ONE year. This information is found in an American Heart Association report published in 2006. The CDC tells us that one in five deaths in the USA are related to heart disease and that heart disease is the number one killer of both men and women. It is said that persons with heart disease lose about 14 years of their life. That would have a person dying at 64 instead of 78 – and in my family, we had a couple of those losses as well.

Here is the most important message from the CDC and the American Heart Association. Heart disease is almost always preventable. It is almost always related to things that we do or do not do. My father lived as long as he did not because he was healthy but because he was medicated. Cholesterol, blood pressure and arrhythmia pills – he did exercise and eat right – after his first attack and his lifestyle improved intermittently – but he could not change that his arteries were clogged from many decades of not exercising and not limiting the meats, starches and gravies. OK and YES – he once smoked and he drank too much. He had had an aortic aneurysm at one point, also a cardiovascular disease indication and causally linked to smoking.

In reading about sudden death today, I learned that heart attacks leave scars and that the scars can lead to an electrical instability – in other words the heart doesn’t beat correctly. It can beat very slow or very fast. My father died when his was beating so fast it was fluttering instead of pumping.

My father was funny, smart, entertaining, gregarious, supportive, loving, compassionate and a few less positive things – but he was MY DAD.

Not everyone is a father – I get that, but if you are – as Father’s Day approaches – please, take care of your heart because your little girls and boys, no matter their age, really want to celebrate with you. And so, here goes Father’s Day number seven without my dad, as he died the Monday night after Father’s Day in 2002.

And don’t think you men without kids are off the hook either – eat right, exercise, don’t smoke, watch the salt, and slow down on the booze – 14 years is too many too give up.

http://www.americanheart.org/downloadable/heart/113535864858055-1026_HS_Stats06book.pdf

Insulin and Cancer

I was able to hear some of an interesting discussion on a local radio station (WMNF) this afternoon. The premise related to results released during the just completed American Society of Clinical Oncologist annual meeting. The shows guest was a nutritionist out of Sarasota Florida named Eve or Eva. The show is available in archives on the radio station website, but the guest's name is not spelled out - sorry about that. That particular Monday show (1-2pm) is related to alternative medicine.

I am most often not a fan of pills or alternatives to them if they include herbals and supplements, but that does not mean that I am closed "eared" to other views. A few interesting points were made by Eva and I would like to share them.

• Sometimes the medications that are created to treat cancer can cost up to 80,000 dollars a year to use and cost BILLIONS to create. Often the drug is able to prevent progression of a cancer temporarily or add a few months of life - Eva suggested that the money be used to address ways to prevent disease, perhaps through nutritional programs and also to address the toxicity of our environment - as opposed to adding 16 weeks to a persons life. I tend to agree with her - though she was clear that situations are different. A mother of small children for example, would most benefit from the extra months.
• Insulin in the bloodstream is fuel for many cancers. Though I wasn't able to follow the entire discussion, I understood this to mean that insulin was food for the blood vessels that are created in some cancers - tumors feed on these blood vessels and become larger. For this reason, the nutritionist advised that people, with or without cancer, be mindful of the amount of sugar in their diets AND the amount of sugar consumption at one time. She said that more than 2 teaspoons at once was going to trigger a significant insulin release. She noted the glycemic index and spoke of fruit sugars in the context of fiber. She was not promoting juice and suggested that any "juicing" of fruits be of the organic kind - instead of making a concentrated pesticide brew. Read more about the fructose connection here.
• In regards to treatment of cancer, Eva/Eve did NOT come out against traditional treatments and did say that the first thing to do was shrink that tumor with any means possible (including surgery, radiation, chemotherapy). I believe she said "debulk" the tumor. What she is against is ingesting daily doses of poison which in her opinion(based in research), has NOT been shown to prolong life or cure disease. She did say that there was substantial research to show that the more fruits and vegetables consumed the less cases of cancer incidence and cancer recurrence there is. I did not fact check her statements.

That is all I have for today - I hope this blog made you want to eat an apple :)

Oral Health

I had my regular dental checkup – cleaning – exam this week and the dentist said a few things that I thought, as he was saying them, would be good to share in the blog.

Firstly, the hygienist said that it was time for X-rays to which I said, “no thank you.” Then she cleaned my teeth and all was fine. The dentist poked around, all was still fine. “Everything is looking good. Any sensitivity… here?”, he asked. “OUCH – yes.”

Funny that it wasn’t an issue until he stuck that sharp probe against it. So it turns out that on one or two of my teeth the enamel is worn off near the top. When can you remember ever having a dentist say this, “You just need to back off the brushing a little bit there.” To which I replied, “Okay!”

I then stated with some uncertainty, “Guess I shouldn’t use those whitening strips again.”

His response was the “light bulb” moment for the blog. He said in fact that it was not the bleaches that were harming my teeth, but the toothpaste. He said that these days the whiteners are found in the strips but also in toothpaste. As he said, the strips use bleach but the toothpaste contains abrasives. He used the word, silica something or another and said, “But for you and me, that means sand.”

So I should go a little easy on the spots he noticed – okay. Then another question struck me – so, which is better a manual or electric toothbrush? He said that in “my” situation, the manual. I said that would be fine, I would get rid of my electric if they gave me a free toothbrush J

The dentist also said that I should concentrate on my gums with my toothbrush and maybe use a fluoride rinse as well to protect my teeth and to ease any pain. (Really I have NO pain under normal – not being poked with sharp objects- situations).

So that is a little anecdote about MY mouth – the only real take home message for you is to see your dentist regularly. Do take good care of your teeth and gums as gum disease or periodontitis can have systemic effects. Periodontal disease has been linked to heart disease and pregnancy complications.

Obesity Beat

Our overweight and obesity rates have been steadily rising over the last decades and I have certainly been vocal about this and in offering ideas to address the problem. It appears to me however, that things are gaining momentum and out of the box thinking is now becoming mainstream if not actual law (limits, taxes, etc). The research experts who warned of the high cost both economically and medically, are still sharing their evidence and their ideas for managing the problem, but now they have one very important - no, two -very okay FOUR very important ears....

Mr. and Mrs. Barak Obama. When the first lady of the USA becomes involved in an obesity task force - things are going to get done.

So a few notes from the day:

Kelly Brownell the director of the RUDD Center for Food Policy and Obesity of Yale had some important information to share and did so in a WSJ article that I really hope you can access by clicking here. It is a must read. He reiterates my recent point about genes making one more susceptable to an outcome but environment making it a reality. In fact, he says, "too many calories consumed and too few expended" is the problem.

Yesterday a national plan that has been in development for several years became official. This is a collaborative effort involving many different organizations and persons that are trusted in the field of health promotion. This includes the YMCA, ACSM, ACS, numerious esteemed universities, CDCP, USDA, AARP and more. The name of the initiative is The US National Physical Activity Plan and the goal is to make regular physical activity - a physically active lifestyle- a salient part of the American culture. The end they seek is this " to improve health, prevent disease and disability, and enhance quality of life." Hey that sounds like a mission near and dear to my heart! Read about the Plan here and get involved!

Today I heard a newstory on SODA and sweetened beverages. It really was a priceless piece on NPR - but I don't remember which show it was. My one point to make - truly the best thing I have heard in a while - is something that the VP of the American Beverage Association had to say to the reporter when asked if she felt that the soda and tobacco comparisons were fair. I believe I can quote her, "Absolutely NOT> Cigarettes kill people." THANK YOU - I couldn't have said it better myself. Then she talked about how there was no safe level of tobacco consumption but that soda could be used in a health promoting way. Seriously - she advised giving soda (sugary sweetened soda) to KIDS after they ran or played etc. She said that kids don't generally drink enough water and soda was 90% water and that it might be a good way to get the kids to drink their water. The reporter almost as aghast as I, asked her if she were advising runners to drink soda for replenishment. YES. The lady said YES and though every nutritionist on the planet will tell you that soda is empty calories, the ABA VP said that soda had nutritive value. What is that, the reporter asked and was told, "HFCS - I jest not, she claimed that high fructose corn syrup was a nutrient." So oh boy - this sounds more like Big Tobacco everyday - oh, no nicotine is not addictive...........

Headline Misspeak

I don't know if these articles I read make me smarter or completely boggle my senses. In any case, I saw a news story by a Julie Steenhuysen, a Reuters reporter, with the title, Gene makes people fat, raises Alzheimer's risk. She was reporting on a study that has been published that links a variation in the FTO or fat mass and obesity gene with brain tissue loss. Her article then provides statements attributed to the study author, Paul Thompson who specifically did NOT say that the gene makes anyone fat.

But let us back up a little first. The gene in question is part of all of our make ups and is found on a certain chromosome. Scientists are studying the FTO for all the reasons you might imagine. Obesity is a real and significant health and economic concern for several countries AND anyone that can come up with diagnostic tools and pharmaceutical treatments to address it is going to make billions.

Several variants to the gene have already been identified and associated with certain outcomes. Some information is available at the UC - LA website.

People with variations in this gene - (and ethnicity is a factor) tend to weigh more than people without the variant (all other things controlled). The extra weight on average is LESS than ten pounds. This is not "gene makes you fat."

Scientists like Paul Thompson have been consistent and clear - people who have this particular obesity related allele are NOT advised to throw up their hands and ignore the exercise and weight management recommendations. Other studies have shown that people who moderate their calories and exercise daily, but have this variation, are NOT obese.

The newer research however, is showing that some persons with the FTO variant also have brain tissue loss - or shrinkage. This puts them at risk for a dementia related disease. Whether or not a person has the genetic predisposition, exercise is recommended to prevent loss of cognitive functioning, so again, ALL persons should engage in near daily exercise.

Being at risk for something because of a gene is not the same thing as being destined for that outcome. No matter what metabolic condition occurs, in 99.9% of us - the problem is too much energy in. Additionally, lack of exercise is disease promoting whether one is overweight or not. In fact, Dr. Thompson's study found that very thing. The people with the variant FTO had less brain mass whether fat or not. It has already been found that obese persons have accelerated cognitive losses - so, the answer in this new group is EXERCISE.

On the UC Newsroom website - this quote is attributed to Thompson:
"Half of the world carries this dangerous gene. But a healthy lifestyle will counteract the risk of brain loss, whether you carry the gene or not. So it's vital to boost your brain health by being physically active and eating a balanced diet."

Odds and Ends

Wow that was a fast week!

Kudos! I have noticed an older woman walking in the mornings when I go out to run or ride my bicycle (yes - warm enough to bring out the bike, not yet warm enough for my morning swims). Just the other day, I saw this same woman walking when I got home from work. I said, "Wow - two a day - that is awesome!" I said this because people need to be caught doing RIGHT things. She then explained to me that she had arthritis and she had bad circulation and was stiff. Her doctor told her that she needed to walk often. I was stunned. "Wow! You actually listen - that is very, very smart."

Kudos Number Two: I was at the grocery store today and as I was coming down the condiment aisle, two teen aged girls, appearing to be sisters, were choosing a salad dressing. A woman who appeared to be their Mom was standing by. The girls were looking at Ranch dressings and one was trying to convince the other that they should get the fat free one. One sister was NOT in favor of this, but the other held out the dressings and said 80 calories - 30 calories. She was doing her best to point out that 50 calories was a significant difference. As I walked by, I said, "don't give up!" [personally I buy the Walden Farms near calorie free dressings, but all stores do not carry that brand]

A Billion Dollar Industry: I read a bit of a medical update in regards to diagnostic testing for Alzheimer's disease. More than one company has a test in clinical trials that is meant to give a definitive diagnoses of this brain wasting disease - prior to death and autopsy. The idea is to have a test that can light up a PET scan or functional MRI . The areas in the brain that light up would be those with the plaque that many scientists say are the cause of the brain destruction. In the studies, the tests are done on a person with a tentative or suggested Alzheimer's diagnosis and then when the volunteer dies, the autopsy is compared. Because so many cases of Alzheimer's Disease (AD) are expected in the coming years, the company that has the most sensitive test is going to bring in billions of dollars. There is some evidence to suggest that AD is preventable - I suggest looking into THAT!

And that my friends, is all the odds and ends I have this time!

The Power of Brown

Those crazy scientists - always up to something. Back in 2009 I mentioned a story about the different types of fat that we have in our body. In this wellness weekly, I explained a little of what was being discovered and noted that the issue didn't get as much press as I'd expect. I did think that some company would continue to diligently work to somehow make the finding into an obesity treatment. Really, I said that and you can check by clicking the highlighted link.

The body does have two types of fat cells. They are usually simply referred to as brown and white. They are very different. Without delving into too much biology, our body is made up of cells, tissues and organs. The cells have engines that require energy in order to divide, reproduce, secrete substances, etc. That energy for us is ATP which is created in the cell with oxygen. (Exercise can improve ATP production). The engines are actually mitochondria. Every cell has at least one, and as you might guess, the more mitochondria a cell has, the more energy it will need to keep those engines running or working.

Researchers at Harvard and elsewhere, have found that the brown fat cells have an abundance of mitochondria where as white fat cells do not. Thus, the brown fat burns calories or uses energy and the white fat stores it.

Most of us understand that too much energy in, in the form of food, can lead to an increase in white fat cells. What researchers what to do is figure out a way to get more brown fat cells. So far it seems that babies have the most brown fat but as babies become more able to do things, like move around to create energy and body heat, they have less and less brown fat. If they eat too much, well, then they have too much white fat.

A specific protein in our body is the trigger for brown fat cell production. This protein can also stimulate the transformation of white fat cells TO brown fat cells. Holy Cows, now that would be something. Scientists are exploring ways to make the body create more of the protein (through gene expression), or find a chemical that will mimic the protein, or find a way to make the protein more powerful - all to get more brown fat cells in the body. In a WSJ article on this same topic, a Netherlands researcher cautioned that increasing energy burn in a person might also increase appetite. He was concerned that people who still eat too much.

Another idea on the minds of researchers is exposing people to cold temperatures. Apparently, being in cold air can stimulate brown cell activity. Unfortunately, in the two or three experiments testing this hypothesis, it only worked with the lean people. Obese people have more insulation - as they have more white fat cells, and the job of the white cell is to conserve energy and insulate the person. White fat cells are very good at their job.

My coworkers keep the air condition blowing cold most of the day at work so I have now started to accuse them of making me lose weight.

Recently I wrote a piece about the need to stay dynamic in your weight control - weight maintenance. This was in regards to the research on middle age weight gain and needing to modify exercise AND calorie programs to make up for plateaus. It is clear from this Harvard research that pills do not change any of that. It is always going to be a matter of energy in and energy out. I am beginning to think, however, that some persons who have over consumed and over consumed the worst foods (processed) may really have irreversibly damaged some of the intricate chemical and hormonal workings of their metabolic systems. They may need more than diet and exercise, but that is a very small group of people and always always, pills and surgeries should be the last effort not the first.

Brief O&E Update

Throughout the day I pondered over a topic - I thought, I do not want to think so hard tonight. I have begun reading an article that I think might be good for tomorrow, but tonight I am just going to share a couple of thoughts I have had since Sunday when I posted this entry.

I want to say first that I messed up the info on my generation and obesity. I kind of felt like I had it wrong, but by notes were in the car and oh my gosh, I was too lazy to go down and get them - I know, hard to believe. Funny though that the notes were on this little notepad I keep on the visor. Why do I have a pad stuck in my visor? To take notes when I hear a news story that I want to explore further in order to share on the blog!

So what I meant to say was that people born in the 1960s and 1970s tended to gain weight up until their 20s where the numbers peaked. This generation then tended to lose some of that extra weight. One fifth of the them were said to be obese. Now, I can say that I personally weighed more in my twenties than I do in my forties, so there, research experiment of one! I think I did get the second part of the statement correct last Sunday, which is that later generations are obese at higher rates and they do not peak but appear to continue to gain weight indefinitely. Currently we have an obesity rate of 33% in the USA.

Also in the last O&E I mentioned the concept of behavior placement as an extension of product placement. Since then I saw two blatant examples of both - in fact, they both occurred in TV shows that I was watching simultaneously last night! On Damages, (FX Mondays at 10), a character was at a laptop computer and wanted to look something up. VERY clearly the search engine he used was the lesser known Bing. On the show I was really watching, Saving Grace on TNT , the phenomenal Holly Hunter (whose character smokes all the time :() Stomped out a cigarette in the sand and then picked up the butt and either put it in her pocket or in the trash. Either way, she did not LITTER or cause a fire with her discarded smoke. It is against the law to throw out cigarettes in Florida, where I live - If you have ever seen a wilderness on fire, even on the news, you will understand why.

That's all then - tomorrow I will tell you more about brown fat, as I believe I have mentioned it at least once in the past.

frailty

Frailty is more often found in the over 70 population than the under 40, however, all older persons are not frail and some young persons are. There is no age group for which frailty is a destiny. Frailty is often associated with a chronic disease condition and with lack of physical activity. Or as I used to say to people I worked with who wanted a wheel chair - without being paralyzed or injured - "if you stop walking, you are going to stop walking."

The word frail may elicit an image - it is probably of a thin person, stooped over, perhaps pale and smalled boned. One of the criteria for frailty IS weight loss, unintentional weight loss, but NOT low weight. According to an article published in the JAMA in November 2006, a frail individual is one who has at least three of the following conditions:
- Unintentional weight loss
-Low physical activity
-Muscle weakness (little grip strength)
-Slowed performance (walks very slow)
-Fatigue or poor endurance (feels exhausted)

Chronic disease conditions may limit a person's desire or ability to exercise, but exercise is exactly what is recommended to prevent or treat this condition. According to an article in the Jan-March 2010 ACSM's Certified News, persons who have this medical condition should have a supervised and dynamic exercise prescription. If the person is overweight, as obesity is a condition which leads to limiting chronic diseases (i.e arthritis, diabetes, heart disease, PAD -etc), weight loss is recommended as well.

ACSM recommends a program that first starts where the person is - so their cardiorespiratory function is tested - perhaps by assessing ability to take a six minute walk, their grip strength and flexibility should also be measured prior to beginning. These pre tests not only help to know where to start, but also can show how far a person has come.

The best type of activity for frail persons is weight bearing - such as walking, while swimming or cycling would be second best. Weight training is essential and should be progressive ( this means that over time the weights should be increased) . Static stretching will help with flexibility, where as functional fitness, such as chair sits and balancing can help to prevent falls. Even Yoga and Tai Chi are offered as good movement exercises for the frail individual.

Loss of muscle mass occurs with disuse and a person could very well lose the ability to care for themselves or to live independently if they succomb to the fraility.

It is best to fight the urge to stay in bed and let Medicare buy you a sassy chair. Start with whatever physical activity you are capable of and do a little more everyday. Eat a well balanced, calorie controlled, nutritious diet and find the hale and hearty YOU.

Odds and Ends

Ah now, what have I been holding onto this week?

FAT: I reviewed a study that I did not set aside, so you will have to trust me on this one. I hope my past use of valid resources will persuade you. With regard to heart disease risk and adverse outcomes, persons who eat little to no fat, have more heart related problems than those who consume mono and poly unsaturated fats. These fats are considered the good fats or the heart healthy ones and do include olive and canola oil as well as peanuts and peanut oils and omega three fatty acids like those found in fish, or PUFAs. Saturated fat continues to be a risk factor for atherosclerosis and heart disease. Remember however, that the good fats should be incorporated into your daily diet not just ADDED on top of whatever calories you now consume - unless you want to gain weight.

Physical Activity: A study that made press this week, and involved only women, could be somewhat overwhelming in that it calls for at least 60 minutes of physical activity a day - or 420 minutes a week instead of the 150 minutes previously promulgated. First note this - if you are a sedentary person, becoming active for any minutes on any number of days a week is going to give you a HUGE benefit. If you are however, doing the 5 days of 30 minutes and wondering if you are going to gain weight as you age, the answer is likely to be YES, unless you change things up. According to the research out of Harvard, women who are of normal weight going into middle age can avoid adding pounds with the 30 minutes of activity a day if it is vigorous (see friday's blog!) activity - this is usually described as running, swimming or cycling at a certain pace. If that intensity is too much, than 60 minutes a day is needed. Of course, if weight loss is the goal, calorie reduction AND activity increase is key. Here is the study summary.

Diabetes in China: Much of the time we consider our Western country to be the source of all evil - including, obesity and it's disease outcomes, among other things. When people emigrate to America - they eat our food and live our sedentary lifestyle becoming unhealthy just like us natives. The UK has similar problems, and they too are considered a Western country. Not long ago, I mentioned the very high rate of obesity in Mexico and this week a high rate of diabetes in China was disclosed in a NEJM study. With one out of ten adults in China diabetic, they are knocking at our door. In the USA it is just over that, perhaps 1.1 out of ten. It is all about eating high calorie foods and living low activity lives. Much of diabetes is preventable - by staying a normal weight.

Soda Sales: Yes! Soda sales have declined as have fruit and sports drinks, coffee drinks, bottled water and "supplement" water. Unfortunately energy drinks have gone up, but not by much. According to a WSJ story, the greatest bottled beverage increase ( of which energy drinks was the only other increase) was in ready to drink teas. ( I believe the analyses was only of non alcoholic beverages)

Sin Taxes: I am a supporter of taxes on alcohol, tobacco, junk food and soda. I buy alcohol. I think that these are things that we do not NEED and in some cases, things that are harmful to us. It is argued by some that raising the price of these items will dissuade people from buying them. At the same time, the money generated is used to support state and local economies - so there in lies a dilemma, doesn't it? Well, tobacco has no known identified safe use, so I think it should just be banned - and yes, the tobacco company employs many people, to which I think that they can be tapped for a new industry - perhaps biofuels. But this week I was intrigued by a legal suit in Texas where a hefty tax is levied on strip clubs. Because the politician pushing or supporting the fees stated that the establishments were associated with assaults on females, I considered that a public health issue, and thus blog appropriate. I just wonder why the article I read didn't suggest the validity or lack of - for that claim. I, at first, could care less about the clubs and the taxes, tax 'em! Or if they cause crime, close 'em! Then I have to consider that it is an industry - many people would lose jobs and income and the county - city budgets would lose revenue. It makes the politician look somewhat shallow in my opinion. If she really cared about the status of women, she would work to close the clubs, not to tax them and run a city from the profits - yes? Which does make me realize that if marijuana IS legalized anywhere this year - it is surely because of the state and local economic problems - and if it is legal and more people begin to use it - well I guess we will have to hire more cessation experts (create jobs!) because marijuana also causes lung problems and is apparently addictive. ( I seriously and strongly oppose the legalization for the same reason I oppose tobacco - health consequences. No amount of smoke inhaled into the lungs is considered safe - not from any source)

Peanut Butter:

Lifestyle vs. Genetics vs. Chance vs. Risk

And so forth and so on. The European Breast Cancer Conference is being held in Barcelona Spain this week. News came out yesterday regarding a significant reduction in annual breast cancer incidence if certain lifestyle factors or conditions were modified. So the way the research is presented, and I can link you to the conference abstract, is that a certain amount of risk is related to these factors - through scientific causation - obesity and overweight (though it is a higher risk if the weight gain comes in middle age than if it is constant), use of hormone replacement therapy and drinking more than two drinks a day. There is also evidence to suggest that being physically inactive increases breast cancer risk.

What the researchers did next was to take a population of women, in this case, French women, and consider the percent of those women who were, overweight/obese, who had used HRT, who drank 2+ a day and who were inactive. Each condition raised their risk for breast cancer and the quote that made the papers was that 30% of new cases could be avoided if women were lean and active.
A lot of number crunching is going on not just in the research article but with reporters - but even so....

Women have about a 12% risk of getting breast cancer and the American Cancer Society states that obesity in and of itself increases the risk of getting any cancer by 60% . I believe I have my math right when I say that an obese person would then have about a 20% risk of breast cancer.

I have breast cancer in my family. A grandmother, aunt and sister - one had a terminal or fatal case. Genetics cannot be dismissed on an individual level, but a scientist responding to this research noted that genes are not causing the increase cases, something else is and that has to be environment - or exposure to hormones and possibly toxins as well as what has been mentioned.

At the time of diagnosis, the women in my family would not have been described as lean (though none obese either) and to the best of my knowledge, none of them had a regular exercise routine. I am certainly not overweight and have not taken HRT - so I suppose I have just the 12% risk with a little extra for family history. But I have another sister and she would medically be described as obese. She also smokes. She is inactive. She is at increased risk because of this, but even if it were DOUBLE it would still be less than 25% risk. Hypothetically, she has a 75% chance of not getting breast cancer and she may not. Of course, I pray that she does not - surgery is not so safe for smokers! I use her for an example for another reason however.

There are many people who do not get a disease that they are at high risk for - smokers and lung cancer for example. That NEVER means that the risk does not exist or that the behavior is safe. It has to do with odds.

If the outcome is simply- breast cancer diagnosis - okay, but it isn't. Not having a disease does not make one fit and healthy - it does not make them well.

Regardless of the chances for specific disease outcomes, not exercising and being overweight can significantly reduce the quality of the years that you live.

The abstract of the article noted in the press and presented in Barcelona.

Tanning Tax?

Though I had a topic in mind for tonight, I do not have the time to submit anything substantive so I will simply make an observation.

I was reading over one of a gazillion news stories that are addressing health care reform looking for the pieces that are going to affect prevention - when I saw this... and I am paraphrasing -

Expect new taxes or fees to hit a number of industries - including tanning.

Really? Tanning?? That is AWESOME - maybe the businesses will have to fold up shop and we will save on health care costs related to treating skin cancer caused by the lamps.

Think I am exagerating? Click here to learn more about skin cancer from UV radiation - which comes both from the sun and the lights used in tanning beds.