Archive for the ‘Healthly lifestyle’ Category

The "tippling" point

Tuesday, February 8th, 2011

one too many

My wife clipped an article from The Wall Street Journal last week and stuck in my "read this, Peter" stack she keeps. I got around to it yesterday and was impressed enough to do the background research. The writer had looked at the 2010 Dietary Guidelines for Americans and focused on the beneficial effects of moderate alcohol consumption.

Well that caught my attention; I drink a glass of wine two or three nights a week, rarely drink two and never more than that

The author of the short article, Stanton Peele, is a psychologist, attorney and writer on addiction recovery. He is a PhD, JD who has written nine books on addiction and has a different view than the "Disease Model" that many of us were taught in our medical training. His take is  the "Life Process Model"in which addicts use their drug of choice to cope wih life. I did note that eleven years back some of his research was sponsored by the Distilled Spirits Council and the Wine Institute  (their support of his work ended in 2000).

Okay that made me a sceptic, but I decided to read the section on alcohol in the recently released 2010 DGAC. It begins by emphasizing the hazards of heavy EtOH intake, quoting a 2009 study attributing 90,000 deaths a years to alcohol "misuse" in the United States. It also estimates that 26,000 deaths were averted (I like that term better than prevented since eventually we all die) by moderate EtOH consumption.

The traditional definition of moderate is one or two drinks per day for males and one per day for females. A lot of people exceed those levels with 2009 and 2010 studies showing estimates of 9% of men and 4% of women drinking heavily.

So what's the good stuff assuming you're an adult, not pregnant, don't have a drinking problem and don't have disease that are exacerbated by alcohol? it appears from extensive reviews of the medical literature that moderate drinking isn't associated with weight gain (remembering that EtOH is "empty calories and you still have to eat a balanced diet). Also moderate evidence supports less cognitive decline with age in moderate drinkers and strong evidence "consistently demonstrates" a lower risk of coronary heart disease in moderate drinkers. Bone health as shown by the incidence of hip fractures appears to be improved by moderate drinking.

MVAs and drowning as well as falls are more likley with heavy drinking, but the risk for these is less well estbalished with moderate drinking.

There's even a section on lactation and breastfeeding; Alcohol reduces milk production and decreases infant milk consumption for three to four hours after alcohol is consumed, but the DGAC concluded that after age two to three months, an infant's exposure would be negligable if the mother waited three to hour hours after consuming a single drink before breastfeeding.

And of course nobody is urging you to start drinking if you don't already.

So I'm going out to dinner with my wife and a friend tonight and will order a glass of wine.

But she's going to drive home.

They're finally here!

Tuesday, February 1st, 2011

I woke up at 6:30 AM this morning and weighed myself: 149.6 pounds, right in the middle of my goal weight.  I've been working on my life style changes, more exercise and less food, since May 2009 and, although I bounce up and down 2-3 pounds, I'm basically lean.

Breakfast was a quart of "lime water" (I squeeze fresh limes three times a day), a cup of regular coffee for Lynnette and of Cafix for me (a blend of barley, rye, chicory and sugar beets; I avoid caffeine), a banana and a home-made oatmeal dish with millet, brown sugar, sunflower seeds, walnuts, and ground flaxseed to complement the commercial oatmeal. There's no salt in any of the above and we added fat-free milk (Lynnette) or soy milk (Peter) to our oatmeal. We'll eat our big meal of the day at noon and at home.

The Wall Street Journal's Personal Journal section had an article titled "New Dietary Guidelines: Less Food, Less TV." The June 2010 DGAC version from the advisory committee of sceintists and nutrition experts had gone through the expected round of commentary, largely from food indusrty sources and the final products, as always is considerably watered down. You can find it online at www.dietaryguidelines.gov if you want to read the entire document, or skim through portions.

So here's a section of what it says:

• Reduce daily sodium intake to less than 2,300 milligrams (mg) and further reduce intake to 1,500 mg among persons who are 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease. The 1,500 mg recommendation applies to about half of the U.S. population, including children, and the majority of adults.

• Consume less than 10 percent of calories from saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids. • Limit the consumption of foods that contain refined grains, especiallyrefined grain foods that contain solid fats, added sugars, and sodium.

How do we translate that into simple English? More than 1/2 your plateful should be vegetables and fruits, buy lower salt products and don't add any when you cook or at the table; eat less red meat. Eat real food, not food products; read labels carefully when you shop. I'd add: eat out less and exercise more.

I read Dr, David Katz's column, "New Dietary Guidelines: A Physician's Perspective" on the Huffingtonpst.com website (Katz is the Director of Yale's Prevention Research Center). He agrees that the feedback gave a politicized spin to the final document, but liked the new emphasis on obesity and chronic disease prevention (roughly 1/6 of our kids and 1/3 of our adults are obese). He didn't care as much for the continued emphasis on dairy and meat consumption with less attention paid to plant-based diets.

So this version of the Dietary Guidelines isn't all that much different from prior versions, unless you read carefully and, in some cases, between the lines. I found a section (Chapter one, page 3) on "The Heavy Toll of Diet-related Chronic Diseases that I'll comment on at another time.

I've got (Circadian) rhythm

Friday, January 28th, 2011

"to sleep, perchance to dream..."

I was thinking about sleep patterns the other day. We're both trying for eight hours of sleep a night and I achieve that goal most nights; about twice a month I'll wake up at 3 or 4 AM and find myself unable to fall back asleep. Lynnette has that happen more frequently than I do.

So are short sleep nights important? I think it depends on how many you have.

The Center for Science in the Public Interest publishes a "Nutrition Action Health letter" that I just started a subscription to. CSPI has been in operation for those forty years and this was an anniversary/retrospective newsletter. In their January/February 2011 edition was an article titled "Unexpected: Surprising Findings From the Last 40 years."

One of those (actually many of those were of interest, but one I followed up on today) was "Too Little Sleep can lead to Too Much Fat." This discussed studies done by Kristen Knutson at the University of Chicago.

When I Googled Knutson and her work I found she's an assistant professor of medicine at the University of Chicago's medical school. She's actually a biomedical anthropologist with a PhD from the State University of New York (SUNY). and did her Master's work at SUNY also.

"Her research focuses on the association between sleep and cardiometabolic health in various populations."

That was cut and pasted from her U of C Department of Medicine (Section of Pulmonary Disease/Critical Care) bio. I also found an article she published in the Achives of Internal Medicine in 2009 where her group found a correlation between reduced sleep and hypertension.

In this current piece, Knutson noted that a a long-term study (16 years) of >68,000 women showed that those who slept less (under five hours a night) were a third more likely to gain significantly (more than 30 pounds) than those who slept seven hours or more a night.

So she recently conducted a much shorter study, getting volunteers and using a sleep laboratory for a month-long period. The research subjects were allowed to sleep four hours a night in one arm of the study and Knutson found they then had higher levels of a hormone that increases appetite and lower levels of another that decreases appetite than when they slept nine hours.

Another part of her study had the subjects, confined to the sleep lab, allowed to snack. When they were allowed to sleep less than six hours they ate more than when they slept over 8 hours.

Hmm, that's intriguing as is her quote from a meta-analysis (a brief definition of that is a statistical combination of a number of studies), that short sleepers are more likely to develop diabetes. That meta-analysis was published in 2009 in the Achives and in 2010 in another medical journal.

When I put those issues together (high BP, obesity, diabetes), I see the Metabolic Syndrome a fairly recently defined entity that goes along with increased cardiovascular risk.

So try to develop better sleeping habits if you're consistently on the short end of the scale (pun unintentional).

They may save your life.

I'm over 100

Friday, December 17th, 2010

Well I don't mean I'm that old (actually I'm 69), but I looked at my old posts in the process of extracting tidbits to go into the book I'm working on, Eat like the Doc Does, and realized this would be my 103rd post. On the over hand, if my brain and body hold out, especially the former, living past 100 might be okay.

This man is over 100

There's a Chicken Soup book coming out on December 28th with one of my stories included. The book has the subtitle "Shaping the New You," and is centered on diet and exercise and lifestyle topics. My story is titled "Life Changes." I got ten pre-print copies, kept two for myself and sent eight out to friends, writing mentors, relatives and former graduate students.

When I reflect on the changes I've made in my lifestyle and diet over the past year and a half, I come up with a few simple concepts. I eat less overall and lots more veggies and fruit. I exercise more, usually iding a recumbent bike for an hour and five minutes a day and sometimes hiking or snowshoeing. I fall off the diet wagon from time to time, but always get back on (I weigh twenty-five pounds less today than I did in May of 2009). And finally, I usually think before I eat...not always, but usually.

I came up with an acronym for my weak spots; I've mentioned it before, but will reiterate. it's TABLE, meaning my triggers for overeating and mindless eating come when I'm "ticked off," on "autopilot," "bored," at a "low energy/late night state" or at an "event," loosely defined.

I'm by no means perfect, but my progress keeps evolving. This week my wife identified an area where  I could short-circuit one problem area. I got a new Clancy book and instead of reading until eleven, which is my usual pattern, I stayed up until 12:30 devouring not only the book but also five different snacks.

The next day, after our discussing the issue, I read while I was on the bike and again from ten until eleven PM, then quit. My weight, which had ballooned up two plus pounds, was down three pounds today, back in my acceptable range.

I don't expct this to ever be easy, but I don't intend to be one of the 90% who regain their weight after losing it.

Find your own path and join me. It's time and past time.

Two thirds of us can benefit

Saturday, December 11th, 2010

I just read an article in the Annals of Internal Medicine, the journal published by the American College of Physicians. Although I've been retired since 1998, I still am a Fellow of the ACP and their publication is the only medical journal I subscribe to and read (at least scan) regularly.

Counseling session in progress

This months Annals had a meta-analysis, a review of multiple papers, on the subject of behavioral counselling and its effects on cardiovascular disease. I scanned it and wasn't overwhelmed; then I read it in detail and was highly impressed.

The authors, two physicians, one PhD and a person with a Masters degree in science, reviewed 13,562 abstracts and 481 articles, looking at the effects of low-level, intermediate-intensity and high-intensity counseling that was intended to promote either an increase in physical activity or a healthy diet or both.

They were looking at the effects counseling produced in patients who did not have cardiovascular disease, hypertension, diabetes or abnormal blood lipids. Some did have borderline high blood pressure or other risk factors, most did not.

At first I thought the relatively small results meant that the time wasn't well spent. Blood pressure was reduced in most studies, but not by much; the same was true for lipids.

But there were almost no ill effects (they estimated one heart attack would occur per 1.42 million person-hours of exercise, usually in people who started as couch potatoes.

But the unimpressive decrements in blood pressure, especially in those with borderline BPs to start and the relatively small changes in cholesterol and LDLs, when translated to large population groups, were stunning.

A decreased incidence of coronary heart disease (CHD) of 6 to 16%, 30% in those more at risk, from what seemed a tiny change in BP, was impressive. A 25% decrease in CHD from a 10% decrease in total serum cholesterol was also striking.

Most of these counseling session, of course, especially the more intensive and repetitive ones, would be done by someone other than the physician involved.

But I finished reading the article and said, "Counsel on, nurses and therapists." it certainly seems worth it in both normal-weight and overweight, but not obese people. I'm less sure of the results in that group and they didn't appear to be involved in these research projects.

I had thought that most of us blow off the words directed to us in these kinds of medical encounters. Maybe that's changing and it's about time.

Drinking your calories

Friday, September 10th, 2010

We have a close friend who always says, "No dessert for me; I'd rather drink my calories." Now she's fairly slender and doesn't drink to excess, but today I heard a story from another writer about a visiting relative and her drinking and eating patterns that made me look up data on calories in alcoholic beverages.

I do drink, almost always wine and very rarely more than two to three standard-sized glasses a week. I've had reaction to Cabernet in the past and don't like dry white wines, so these days I usually prefer sweet Riesling or, if I'm elsewhere and the only white wine offered is Chardonnay, I'll have a glass of Merlot or Shiraz.

There are some medical data I've read in the past few years that talk of health benefits from wine, especially red wine. The term "in moderation" is always attached; there are obviously lots of medical concerns with excess alcohol consumption.

The story I heard today is of a woman who typically has at least two or three drinks, gets a little tipsy and then starts munching on snacks. She's not going to be driving, so that at least is something positive, but I wondered about her calorie intake.

Let's start with wine. Five ounces of Chablis is 120 calories, according to several references I found. A dessert wine, sweeter by a considerable measure, may weigh in at 165 calories. Twelve ounces of a light beer gives you 100 calories; a regular beer 150 calories.

Then there are rum, vodka, tequila and gin, all offering at 80 proof (40% alcohol), 100 calories per ounce and a half shot. Mixed drinks up the ante. A frozen margarita is 246 calories and a Daiquiri 314 calories.

In one of my posts I talked about cutting your calorie intake by 50 calories per day. That adds up, over the course of a year, to losing five pounds. If you add 50 calories of exercise (and don't eat extra) you can lose ten pounds in a year. Those numbers are approximates, as 3,500 calories is the equivalent of a pound. So 100/day x 365 days equals 36,500 calories or somewhat over ten pounds.

Now go the other direction. If you eat the same amount as usual, but add a glass of wine a day, you can gain ten pounds or more in a year. If  you typically have a mixed drink or two, we're talking weight gains of twenty pounds or more. And that's before the snacks. No wonder some people who think they eat a fairly healthy diet and complain they can't lose weight, turn out to be "drinking their calories" and still eating dessert as well.

Now many Army recruits are overweight and out of shape

Tuesday, August 31st, 2010

I was setting up Lynnette's new Kindle (we are now a two-Kindle family) and in doing so looked at the one newspaper I subscribe to on what is now our old Kindle. I get the "New York Times" breaking news, updated three or four times a day. I scanned through the article list quickly, then I stopped and read one article carefully.

In the last few years the military has come to grips with our obesity epidemic. In 2010 the

optimal Army recruit

Optimal Army Recruit

Army has had to change its recruit physical training program. They aren't having the newbies do situps anymore; now they do yoga and Pilates. The underly rationale is partially to cut down on injuries and get soldiers ready for challenging terrain, actually it's because so many more of the youngsters who enter the service are overweight and out of shape.

I guess with all I've studied and read on the area that shouldn't have been surprising, but it still was. An Army report, "Too Fat to Fight" said the proportion of possible new recruits who couldn't pass the application physical went up by 70% between 1995 and 2008. Many of those who passed that exam still can't "cut the mustard" in physical activity like their predecessors. All this is being attributed to junk food, video games replacing outdoors sports and less time spent in physical education classes in schools.

Kids are drinking sugar-filled sodas and more sports drinks and not getting enough calcium and iron according to the three-star general who is in charge of Army recruit training. That plus the lack of serious exercise in their teens leads to a markedly increased percentage failing fitness testing and suffering injuries along the way.

I remember when one of my Air Force dieticians came up with a heart-healthy recruit diet trial; that was about 1995 or 1996. The youngsters actually liked the fruit "pizza" and other food items she substituted for what one senior officer on our base termed "the same old slop." We didn't totally change the worldwide menu for what we termed "chow halls," but we did add 300 heart-healthy items to the list of choices.

Now, roughly fifteen years later, the Army recruit diet is changing with milk vs. sodas, more green vegetables and lots less fried foods. It's about time, was my first thought. My second was, we've got to start earlier than the 18 to 24 year-old group.

It's time to set an example for your kids and grandkids and to pay attention to what they get to eat when they're first starting out. I suspect too many parents are letting very young children make bad choices in their diets and not setting limits on their sedentary activities. We need to steer our next generations for healthy eating habits and more physical activity.

Kids don't always listen to what you say, but they will notice what you do.

Before it's too late.

Living to 100; I tried some of Harvard Medical School's ideas

Monday, August 30th, 2010

We've purchased a number of Harvard Medical School's short publications; as expected they're excellent. I just was re-reading on on "living to 100." Most of the concepts, e.g., don't smoke, exercise regularly and eat a healthy diet, are well known to almost all of us but less commonly followed than I'd like to see. Some of the others, like take care of your teeth, establish a social network that lasts and kept your brain working hard, are also fairly obvious, but less well-publicized.
But then there was an idea that I really liked: keep an optimistic viewpoint on life. I tend to be cheerful, like puns (that's a "two-fer," optimism and brain play) and view the cup as mostly full, rather than partially empty.

My wife isn't hiking this summer as one knee has been bothering her; she goes to the gym for Pilates and/or yoga two or three times a week and is still in her "Strong Women, Strong Bones" class twice a week. She has a group of friends who attend one class and sit and converse afterwards; she has a close friend in the Strong,Stong class and has a snack with her afterwards.

I've noticed her social network and thought I needed one myself. So this past weekend I went for a hike in the mountains with a close friend of ours. I'm ten weeks out from back surgery and have been walking, but not going to the gym. In the week before the hike I walked further, three and a half hours without pause one day (actually I stopped to pet a dog for a moment) and two hours up and down hills another day.

My legs weren't as strong as usual going up the mountain to 11,440 feet and I had to stop twice, but made it to the summit. Then, on the way down, something extraordinary happened. We had seen a couple hiking up and later heard the man had stopped with Acute Mountain Sickness. Someone called 911 when they got to a point where they had cellphone reception and ten of us gathered around the couple and, in one way or another, contributed to getting the man down the slope.

The National Park medics arrived with oxygen and another group brought a stretcher with a single huge wheel. When my friend and I got to the trail-head I thought, "What a great day; exercise, a superb group effort and lots of positive approaches to solving a problem."

Then to top thing off, our friend came back with me, and joined my wife and I in celebrating our anniversary. With days like that I may live to 100.

To Overeat or not to Overeat, now that is THE question

Monday, August 23rd, 2010

I read an article in "The Wall Street Journal" recently (WSJ July 13, 2001) that gave me clues for my own eating "Hot Spots," those times when I tend to go on eating autopilot, switching from being a fairly lean, healthy eater to my late 1960s pattern of consuming anything in sight. As usual, I also looked for source material, and found an article in "Applied Psychology" that was published two years ago and another in the June 21010 issue of the "American Journal of Clinical Nutrition."

Swiss researchers used the "Power of Food Scale" to measure three groups' vulnerability to so-called hedonic/hedonistic eating. Obese patients tended to react much more to the sight, smell and, in other studies, even the names of "attractive" foods. Several recent studies have shown brain activity in the amygdala, a primitive area of our brains thought to be connected to emotion, to differ in lean vs. obese subject, in response to the smell and taste of milkshakes. Scientists are exploring, via functional MRIs and measurements of hormone levels, how and when we decide to quit eating.

So what does that mean for you and me? Many of us tend to eat on impulse, reacting to sight, smell, sound, and taste of foods we really like. People who are obese seem to have less/little control over this reaction. Successful dieters have the ability to pause, to have second thoughts before launching into an eating frenzy.

When I look back at how I once ate, it's clear to me that I was, at times, a hedonistic eater. Now I'm almost always a homeostatic eater, eating to satisfy hunger, rather than eating impulsively.

Yet there are still times when I can switch patterns. That's when I need to adopt the "one bite only" method, eat prior to parties, try my own method of cutting off a portion of each food item, avoid even the sight of high-calorie foods or just pause for a moment.

We ate a wonderful Australian dinner with our small gourmet group last night. There were lots of unusual food items, some of which were potentially high in calories. I ate very well, but only gained two tenths of a pound. This morning I walked for three and a half hours, doing some hill work in preparation for a mountain hike this coming weekend. Today is a mostly vegetable day. I think I understand the hedonistic eating pattern better and, in doing so, find myself much better able to withstand tempting foods.

Think about your own eating patterns, especially those times when you tend to overeat without thinking. How can you avoid or minimize this happening?. How can you spend as much of your life as possible as homeostatic eater?

Slow Food, farmer's markets and more

Wednesday, August 18th, 2010

I had heard of the "Slow Food" movement, begun in the late 60s after McDonald's got to Rome. I didn't know much about it until I read Michael Pollan's June 10, 2010 online article in "The New York Review of Books." His six-page piece is exceptionally well worth reading; I just got back to it via Google without any difficulty. Now I'll attempt to articulate some of its points and add a few of my own views.

Pollan covers some far-flung aspects of the recent history and current trends of "food in America" (and elsewhere). Early on he mentions that our citizens now spend less of their money and time preparing and cleaning up from meals than any other group in history. There has, however, been a secondary, but crucial cost, the decline of meals eaten together as a family. The impact of this is visible: our kids are growing up with meals eaten in front of the TV with an absence of family conversations; our food industry has had an enormous sway in what we eat and where, e.g., "Fast Food;" our diet with all its emphasis on ease and speed of preparation has led to the epidemic of obesity and its related diseases.

Pollan notes the variegated segments of the food movement, distinct as they have been over the past thirty years or so, have now appeared to have a common focus on high-level problems: we cannot sustain our present food/farming patterns longterm without major environmental and economic consequences. Climate change issues are at the heart of this shift, as is the realization that cheap fossil fuel enabled the huge post WW II increases in farm/food system productivity via the pesticides and fertilizers they spawned. In order to solve our global warming and water issues, we will almost certainly have to alter our farming/food patterns.

Our current diet, centered for many on meat-eating, consumes huge amounts of our increasingly valuable water supply. Our habits of wanting produce grown around the globe to be available on our tables year-round consumes fuel in enormous quantities.

The new health care reform legislation, Pollan feels, may lead to health insurance firms having a keen interest in the prevention of chronic diseases. We appear to be at a cusp where food-related businesses, locovores, food movement organizations, health insurers and even our government may agree on the need for change.

I'm tentatively hopeful that the next twenty years will see progressive shifts in our dietary patterns, our food sources, our use of fossil fuels and the longterm health of our kids and grandkids. Maybe that's asking for a lot, but the alternative is truly frightening. It's time and past time for a whole series of interlocking changes.