Saturday, July 12, 2008

25 Summer Fitness Tips

Vacationing this summer is a time for you to relax, but it also can be a time for us maintain good fitness. There are so many wonderful ways to enjoy vacations without feeling like you’re destined to gain weight.

Having a commitment to physical activity as a daily part of your life allows you to find creative ways to fit it in. And summer vacation is a perfect time for that creativity!

In fact, when you incorporate a variety of fun physical activities into your vacation, you’ll return home feeling both fit and energized.

Even better, fun exercises like these also help you sleep well, so you wake up each day feeling refreshed and ready to explore some more.

Here are some fun suggestions to get you started when you’re enjoying family and friends on your vacation:

  1. Explore your national or state parks. To find a national park close to your location visit www.nps.gov. To find your local state parks, visit their individual web pages.
  2. Don’t just visit your parks, experience them. For example, if you’re in the Grand Canyon, go hiking or canoeing down the rapids. Try rock climbing, caving, or trail running — there are so many options!
  3. Book hotel rooms that have a swimming pool or tennis and basketball courts.
  4. Take walking tours. Most major cities offer guided walking tours. It is a great way to learn a new city while getting exercise.
  5. Eat at one restaurant, but plan on walking to different place for your dessert.
  6. If driving for a long period of time, take breaks at rest stops for a brisk walk or stretch. This also helps increase your alertness at the wheel.
  7. Rent bikes and choose to see the area you are visiting by peddling around.
  8. Participate in water activities such as swimming, kayaking, canoeing, paddle boats, or rafting.
  9. Pack a picnic, find a location with an inspiring or pleasant view, and then enjoy your picnic lunch.
  10. While you’re sitting on the ground, do some simple stretching exercises.
  11. Many hotels offer yoga or water aerobics classes. Kick-start your morning with an activity like these to rev up your metabolism for the day.
  12. Other hotels have simple weight rooms. Just be sure to stretch well before starting so you don’t pull any muscles!
  13. Go dancing. Ask the concierge for places that offer lessons, then dance the night away with the new steps you’ve learned.
  14. Take morning walks on the beach or through nature trails before everyone gets up.
  15. If you have to wait in long lines, do calf raises.
  16. Many locations have attractions where you can swim with the fish or snorkel nearby coral reefs.
  17. If visiting family or friends, a walk after dinner provides a perfect chance for catching up.
  18. Take the kids (and yourself!) to the water parks.
  19. Bring activities you can do with the people you’re traveling with (Frisbee, badminton, soccer ball, beach ball, etc).
  20. If you have an infant, invest in or borrow a child- carrying back pack. Lots of babies like the gentle rhythm of walking. And you will get a cardiovascular and strength training activity all at once.
  21. When you find yourself in an airport, browse the airport shops between flights, rather than sitting in the lobby.
  22. Pack light and check as many bags as possible so you won’t be burdened down by your carry-on luggage.
  23. Always avoid the airport escalators and moving sidewalks, unless you’re in a desperate hurry or are disabled in some way.
  24. To prevent the stress fatigue that can inhibit your daily activities, practicing your breathing exercises whenever you have a few minutes.
  25. Finally, don’t overdo it, or think you have to try all of these ideas. Just pick the ones that make the most sense to you and have a great summer.


Friday, July 11, 2008

Say Cheese!

This is a new angle for the dairy industry. It used to be "Milk, it does the body good." But now recent research showing the link between dairy and weight loss, and even the prevention of weight re-gain after you've had a backslide into weight problems.

These new findings remind me of the habits of the healthy Mediterranean people who finish their meals with cheese for lunch and cheese for dinner. By the way, yogurt is a very common breakfast item for them, as well. This "dairy connection" fills in another piece of the French paradox!

Supplements

And it's not about the calcium - the health benefits of foods are not found when the active ingredient is abstracted into a pill (Zemel 2002). In 17 studies that compared the effect of weight with use of calcium supplements, only one showed any effect at all. As stated by Dr. Zemel, the lead author of many of these studies:"These findings are further supported by … data demonstrating a profound reduction in the odds of being obese associated with increasing dietary calcium intake."

Volume

The key is quality over quantity. Eat small when you're having sumptuous, energy dense foods like cheese. As a ballpark measurement, keep the size of your portion to about the size of 4 dice put together.

How to add dairy

When you have your cheese at lunch, do it like these thin healthy French people do and use it as your "ender" to the meal - the punctuation of pleasure, after you've eaten, that tells your body and mind that the meal is over. The protein and oils send messages of satisfaction to your brain so that you just don't want to eat between meals. You cut your cravings, increase your weight loss, add in Calcium, Magnesium, and Vitamin A, and all you've done is increase the pleasure of your meal. Let me tell you, it's all good.

My favorites

Parano is a wonderful variety that reminds me of Parmesan, except it's a little less sharp, a little more accessible to eat. Even though Morbier is a firmer cheese, it has a lovely creamy texture to it. If you like stronger cheeses, Reblochon and Taleggio are wonderful at the end of the meal with cold grapes from the refrigerator.

Supplemental material

Kidney stones. I was floored. Dr. Walter Willett and colleagues at Harvard analyzed the data from the massive Nurses' Health Study to see the effect of calcium supplements on bone health. But do you know what they found? Calcium consumed as food was not only better for preventing kidney stones, but taking supplements actually increased the risk! I never saw that published study on the supplement commercials, but here's what the doctors at Harvard conclude. "High intake of dietary calcium appears to decrease risk for symptomatic kidney stones, whereas intake of supplemental calcium may increase risk".

Brain Freeze!

And speaking of dairy, summer's coming on and it will soon be time to indulge in everyone's favorite hot-weather dessert, ice cream. But the problem is the dreaded ice cream headache, also known as "brain freeze."

Brain freeze, known to all true ice cream aficionados, stabs the forehead like a migraine. In fact, one scientific group recently proposed that it could be a model for studying this class of headaches.

What causes it?

Like migraines, brain freeze headaches are thought to be caused by changes in the blood stream. This is all in theory, because no proper explanation of this dreadful medical malady has been formulated. But the idea is that a big mouthful of ice cold ice cream rapidly cools the soft palate in the roof of the mouth, chilling the nearby arteries that run into the brain. The rapid cooling makes them contract - because they're cold - which increases the blood pressure produces the brain pain. In fact, any icy substance held to the soft palate with the tongue, should yield the same painful result. But, while we're doing science here, we might as well be testing it out with ice cream.

Cures

If you achieve a good solid case of Brain Freeze, what then? Some have proscribed putting the tongue on the upper part of the back of the palate to warm it up. But in reality, the pain only lasts a few minutes as the palate warms back up on its own, so most of us just wait it out.

Prevention

Although there are no known cures for the worst of life's ills - the common cold, old age, and Brain Freeze - but certain preventative measures can be taken to keep them from happening in the first place. Be warned, however, because this requires some training.

The key is to eat your ice cream at a lusciously slow pace. This gives your palate a chance to warm back up before more of the frozen yumminess can cool things off again. Because this can be difficult in our rapidly moving lives - and when we don't stop to smell the roses - when we don't stop to really taste the ice cream. In times like these, brain freeze strikes and science reminds us that we need to go slow and enjoy. It may be hard at first, but practice, practice, practice.

KCRW Transcript April 19, 2005

Thursday, July 10, 2008

Careful With Correlations

Every day, Haley's comet careens further from the earth. Every day, my cat gets more ornery.

These two things are perfectly correlated, and yet have absolutely nothing to do with each other. Science 101 teaches you that two things moving together, no matter how tightly in lock step, are not necessarily tethered. They may be, but correlation only implies cause, it doesn't prove it.

It's surprising then, to hear scientists routinely confuse cause and effect like this. Just this week, we read that "If salt intake was reduced by half in all children … there would be an average reduction … in the consumption of sugar-sweetened soft drinks … of 2.3 soft drinks per week." This is according to Dr. Feng J. He, M.D, at St. George's University of London, England.

What Dr. Feng's study showed was not that reducing salt intake reduced soda consumption. What he actually found was that the kids who ate more salty snacks also drank more soda. The authors of the study only guessed that the two are linked.

Incidentally, they also found that kids ate more snack foods as they got older: increasing age is correlated with increasing salt intake. But no one is stating that "If salt intake was reduced by half in all children … there would be an average reduction … in the aging of our children … of 2.3 years per child."

But, so what? Why niggle like some picky scientific method wonk?

No one is suggesting that sodas are good for you, nor that salty junk food snacks are in any way healthy. Further, we all agree that we should reduce the consumption of both, if our goal is optimal health. That said, this research report states quite flatly that you can reduce your child's consumption of soda by reducing the salty snack foods.

So the reason to give this study a Yellow Card is simply because it is misleading. The authors are telling you that Haley's Comet is causing my cat to be grumpy, and if we could somehow reverse its meteoric ellipse, I would get a pliant lap cat who is 99% hiss-free. In other words, cut out salty snacks and your kids will give up sodas on their own, because these two are causally linked.

But this is an error we have seen before. Do you remember when we were told that coffee was bad for us? One of the reasons for that conclusion came from the very same Science 101 snafu. In the 1950s, researchers identified a correlation between coffee consumption and cancer.

Therefore, they surmised, coffee causes cancer. However, later, they figured out that the folks who were drinking their morning joe were also smoking cigarettes. Cancer and coffee were perfectly correlated; perfectly unrelated.

To reduce the consumption of foods that fuel our childhood obesity epidemic (and the adult version as well), a great first solution would be to do your own correlation analysis research.

Measure the consumption of salty snacks and sodas when you have them around the house, compared to when you just don't buy them. I hypothesize that you will see statistically significant decreases in consumption, when they are not in your home. You might even write a research paper on it!

The study they quoted was very well done, showing that kids who consumed low levels of salty snacks also drank fewer sodas. In fact, each reduction of 1 gram/day of salt was correlated with 27 g/day less of sugar-sweetened soft drinks.

The researchers suggested that reducing children's salt intake would cause them to consume fewer calories in soft drinks, therefore helping to reduce childhood obesity. It might also improve their cardiovascular health directly, since salt intake is correlated with blood pressure.

Dr. He and colleagues determined that mean salt intake rose with age, from 4.6 g/day (SD 1.5) among 4-year-olds to 6.8 g/day (SD 2.1) for 18-year-olds. The researchers did not count salt added during cooking or at the table. "The majority of salt intake is from salt already hidden in food, i.e., added by the food industry," they wrote.

The researchers found that soft drinks accounted for more than half of fluid consumption among most age groups for girls and boys, except for 17-year-olds. Taking all of the participants together, 56% of total fluid intake was in the form of soft drinks, of which 55% were sugar-sweetened and 45% were low-calorie.

Consumption of low-calorie soft drinks fell by about half as children grew older and consumption of soft drinks containing sugar increased slightly.

The researchers also found a highly significant association between salt intake and total fluid consumption. They calculated a partial correlation coefficient of 0.33 and a beta value of 100 g/day (SD 7) of fluid consumption per gram per day of salt intake (P<0.001), after adjusting for age, sex, and body weight.

When the researchers compared salt intake with sugar-sweetened soft drink consumption, they also found a significant correlation, with a coefficient of 0.12 and beta value of 27 (SD 5) (P<0.001), after adjusting for age, sex, and body weight. In turn, they added, the reduced soft-drink intake would translate to 61 fewer grams of sugar and 244 fewer kilocalories each week.

Per-capita consumption of soft drinks is similar in Britain and the United States, the researchers said.

Dr. He and colleagues said reductions of 10% to 20% in the salt content of processed foods "cannot be detected by the human salt taste receptors and do not cause any technological or safety problems either."

They said prospective studies and other research have demonstrated that changes in salt intake lead to altered beverage consumption, including sugary drinks.

There are direct cardiovascular benefits to reduced salt intake as well, the researchers said.
They noted that, in Finland, systolic and diastolic blood pressure has declined by 10 mm Hg since the country began a national effort to reduce salt intake by its citizens in the 1970s.

Moreover, they said, stroke and coronary heart disease mortality have fallen by 75% to 80%, even though average body mass index and alcohol consumption have risen.

Great Britain now has a policy to reduce salt content of processed foods. However, Dr. He and colleagues said "some members of the food industry outside the U.K." have resisted compliance, in part to protect soft drink sales.

"Some soft drink companies own large snack companies that specialize in highly salted snacks," they said.

"However, they should not be allowed to stand in the way of a reduction in salt intake, because this reduction would have major benefits to the health of the whole population and, particularly, to children in potentially preventing the development of high blood pressure and obesity, thereby reducing the appalling burden of cardiovascular disease later in life," the researchers concluded.

In an accompanying commentary, Myron H. Weinberger, M.D., of Indiana University Medical Center in Indianapolis, echoed the sentiment. He wrote that "prevention of obesity, rises in blood pressure, and the other precursors of cardiovascular disease must begin in childhood."

He also agreed that reductions in salt and soft drink consumption among children could help avert health problems in adulthood.

But diet is not solely responsible for the rising prevalence of cardiovascular problems and obesity in children and adolescents, Dr. Weinberger said. Lack of physical activity and exercise play an important role as well.

He also noted that, in the U.S. at least, making foods healthier is a major challenge. "Motivating food preparers and commercial sources of food and drink to reduce salt and calorie content of their foods has been very challenging and relatively ineffective," he said.

He called the conclusions of Dr. He and colleagues "provocative but largely speculative based on currently available evidence."

Wednesday, July 09, 2008

BMI Blues

The Death Knell of a Diet Diagnostic

We get all excited when we hit on something that (we think, we hope, we pray) will give us an objective measure we can point to on a chart and say, "You see here, this says you're going to have x, y, or z." In fact, making our decisions objective and quantifiable is one of the goals of the scientific process.

But in diet and nutrition, this is very difficult. We tried calorie counting, carb counting, fat gram counting and every other variant to plug into an equation that equals low weight and healthy lives. The obesity diabetes heart disease metabolic-syndrome mess we're in right now doesn't speak well for these strategies.

Another testament to their failure is the repeat business that new objective measures get. After all, if our current strategies were working, why would we glom onto the latest greatest new tool in the toolbox, which hopes to finally make a dent in the obesity epidemic.

We saw the "glycemic index" arrive in the intoxicating flurry of the Atkins Revolution. The GI is the number that should tell you how much your foods will spike blood sugar and stimulate an insulin response.

You know what they say, "When you have a hammer, everything looks like a nail." Ture to form, the GI spawned scads of diet approaches along with actuarial tables of foods paired with numbers representing their GI values. This worked very well for diet books, and very poorly as a diet because it actually can help in the short term but typically fails in the long term.

The bloom faded from the GI rose and, although you still see the cling-ons hangers on, this tool is not the end-all it was touted to be. The reason is that the GI of your food (remember all those tables you had to consult?) varied depending on what you ate it with. A banana with peanut butter was not the same as a banana eaten alone, for example.

In any case, with obesity roiling, and clinicians a bit queasy about telling overweight people that they're overweight without the protective shield of an objective number to hide behind, they turned to another shiny tool: Body Mass Index.

And, as it stands now, BMI is really the only objective "number" we have to measure overweight/obesity, and has been latched onto so strongly that several tipsy individuals have even proposed to apply this measure (a ratio of height to weight) to every school child.

The BMI value, however, is totally flawed. Because it only measures weight (and muscle weighs more per volume than fat), a muscular person who is completely fit will be called overweight or even obese. This makes BMI a ballpark rough estimate guestimation of something you can already see with your own eyes - this person is either overweight or not.

In fact, researchers at the Mayo Clinic just published a paper showing that the BMI tool should be shelved completely. Their results, which just appeared in the journal Lancet, showed that patients with a low BMI had a one-third higher risk of dying and dying of cardiovascular disease. Overweight patients had the lowest risk of dying in general and from cardiovascular causes as well. Obese patients had no increased risk at all.

It's time to go shopping for another tool.

Alternatively, we could just default our humanity, our instincts, our gut. Crazy idea, I know. But what would it be like if you went into a doctor (this is a science fiction scenario a al George Lucas, so hang on to your light sabers) and you were a person rather than a chart of BMI values? What if you went in and the physician was charged with looking at you to see how you were, not how your data point filled out the pie chart?

In the second scenario, an overweight person and an athlete with the very same BMI value, who both saw the doctor, would both get meaningful responses. The doc would look at each and immediately know that one was obese and the other was not. It's not objective, but who cares? It is more accurate.

So maybe the solution is less number crunching and more humanity in diagnosis; less glycemic index and more common wisdom; less BMI charts and more straight talking advice. After all, which of these would you rather hear (and which would be more effective for you)?

1. "Your BMI places you in the 73rd percentile of caucasians of your age range within your demographic, indicating that you might possibly need to alter the glycemic index range of your diet, depending on your particular build and muscular profile."

versus

2. "Looks like you're getting a little heavy in the middle. Pull back on your portions at the plate. Instead of snacking on Ho Hos and Jolly Ranchers between meals, have some water or some unsalted nuts once in a while. Try that and let me know how you're doing next time."

When we go shopping for that new diagnostic tool we desperately need, let's start with the instincts and humanity of the physicians themselves. That is a tool we can all use in the long term.

Tuesday, July 08, 2008

Ban the Fat!

Step up to the Plate. Ban the Fat.

This weekend on my radio program, a diverse group of individuals weighed in on the proposition that we follow New York City, and very soon Chicago as well, to ban the use of trans fats in restaurants throughout the municipality of Pittsburgh.

The voices represented through interviews, oral and written, as well as direct call-ins spanned everyone from a US Congressman, former city executive, Director of Food Service, corporate Chef for Big Burrito Restaurants, and the Allegheny county moms and dads who made their voices heard on the air.

From every level, the only surprise was their uniformity. Despite our typical Pittsburgh turf-bound regional wrangling, I heard none of the messy mix of special interests, hemming, hawing, and hand-wringing over what to do. Rather, it was a chorus of concern with a tight focus around the harmful nature of these fats in our foods and the recognition that their elimination is positive for us as individuals, as families, and as a city.

Pittsburgh should the step up to the plate. Ban the fat.

We know the data. Trans fats kill an estimated 30,000 per year in heart related deaths, and are even worse than saturated fats for your heart and health. Given this clear and present public health hazard that looms within the enlarging shadow of our obesity epidemic, why not just replace those oils with healthier ones? What could be more obvious and important than providing sustenance that doesn't also happen to contribute to your death?

The loudest antagonist of this no-duh solution is the restaurant industry, which moans that it's too hard, no one will like the food, and it's too expensive. But KFC and Wendy's are going trans fat free already, Oreo has already made its signature cookie trans fat free without incident, and the Big Burrito restaurant group is proactively ridding their foods of trans fats with no sacrifice of flavor.

In fact, the problem is not the price of your food, the bother of the change-over to healthier products, and certainly not the flavor of the trans fat foods with the shelf life of plastic. The real problem with ridding foods of heart-harming oils is more fundamental. It comes from that kernel, lodged deep within each of our foot-stomping, you're-not-the-boss-of-me Libertarian hearts, that screams that no one can tell us what to do.

That same rhetorical antic made people rebel against the seat belt law that has saved thousands of lives, the sale of cigarettes to children, and most recently the helmet law.

But when the public health cost - our costs - reaches into the billions of dollars in preventable health expenses every year, the issue goes beyond the individual, if that weren't enough. The bill for these expenses is reflected back onto us all in increased insurance premiums, making it a problem for our person, our family, AND our pocketbooks.

It's time to step up to the plate. Ban the fat.

If we can do this, we will save lives and Pittsburgh will show ourselves to be proactive, rather than reactive; guided by principle, rather than dragged along by necessity; and a far-sighted city that can make forward thinking health decisions for our people.

Will Clower

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