An Apple A Day

 

I hope that, respecting tradition, you have dedicated yourselves to creating some better health habits in this New Year.  I also hope that you are going about that in a joyful way, understanding that doing the right things will help you enjoy your life more.  Also, pursuing good health habits should be fun, not tedious and just “good for you”.  Sure, sometimes it takes a little while before you start noticing the benefits, so a little discipline is needed to establish your new habits.  Other times, you feel better right away.  Instantaneously or gradually, disease-reducing, longevity-promoting or not, do it because you will feel better. This newsletter is a map, guiding you along the most direct path towards a better life. Change is not just a matter of will-power. Going about it the right way makes it much easier, and markedly increases your chances of success.

I am in an exercise focus right now.  Admittedly, some of that is because of the time I spent during the last month working at the Olympic Marathon Trials and attending a sports nutrition conference, but more importantly, a lot of new data is coming out that is very interesting and will be useful to you. In this blog I will soon post some thoughts about some physical training specifics.  The purpose will be to make your exercise more efficient and more effective.

Making changes

The idea of making changes in the New Year is easy fodder for comedians.  Everyone talks about it, but no one really accomplishes anything.  That’s right and it’s also very wrong.

In the Northern Hemisphere, where most of us live, the New Year roughly marks the return of the sun.  The days start to become longer and warming weather will follow.  Greeting the New Year with hope and new ideas has been the tradition as far back as we can trace human cultural history.  I think this tradition would have died out long ago if every attempt were met by failure.  On the contrary, every day I see patients successfully change their lives for the better, not just at the New Year.  You should be optimistic about making changes.

Change doesn’t happen simply by rolling out of bed on New Year’s Day, although that IS a necessary first step.  To ensure success, you need to develop a plan.

Self-Assessment

The dark, cold months of the year are traditionally a time of reflection, a time of the inner life.  Figuring out where you are is essential to creating a map to get you where you want to be.

I cannot overemphasize how important an honest and thorough self-assessment is when you are trying to make changes.  Your self-assessment must be as objective as you can make it.  An inaccurate assessment inevitably carries the seeds of failure.  If you think you are in better shape than you really are, the training for that April marathon WILL injure you.  You might think you aren’t eating well enough when your lack of exercise or poor stress-management is the bigger issue.

We usually perceive some problems clearly, but others we think are bigger than they really are, while still others are invisible to our own eyes. Trying to sort things out by yourself can be a lot like painting a self portrait without a mirror, or maybe having only a distorted, funhouse mirror to look at.  This is the reason so many people find the help of a professional useful.  A professional can identify problems and solutions you might not recognize or know about.  A professional should have learned from the experience of many patients and can use that accumulated wisdom to guide you.  Seeking the advice of family and friends can also be helpful at times.

Reflection is an inward, ideally a meditative, process.  In keeping with that inwardness we should start from the inside, meditating on who we are and who we want to become.  Following is a list of some areas to consider:

Essential health habits

Drink Enough Water

Exercise Almost Every Day

Eat Well

Take Your Supplements

Avoid The Things That Make You Sick

Get Enough Sleep

Be Involved in Your Community

Have A Healthy Sex Life

Remember That Attitude Is Important

Spirituality/Life purpose

Goal Setting

After you sort out where you are, you can create an image of where you want to be and construct a map to get you there. Deciding that you want to be younger is not going to work anymore than deciding you want to be taller or win the lottery.  Make your goals achievable!  That is the first step in goal setting.

In a more subtle way, deciding that you want to be stronger or thinner or calmer won’t work either.  There is an art to creating goals that will help you achieve success.

Second Step – Goals Must Be Specific

If you set a goal but don’t have a path to follow towards the goal, or you don’t know when you are there, you won’t ever get there.  For example, you decide that you want to lose weight. You then must sort out how you are going to do that and how you are going to measure it.  Let’s say you determined that, for you, the keys to improved health are to increase your activity and change your diet by eating more vegetables and cutting out soda and alcohol.

You could begin by tracking your activity level for a week, either by timing yourself, or better still, wearing a pedometer.  Then, as you set about implementing the changes, you have clear evidence and incentive by simply reading the numbers.

The same applies to your diet.  You could decide that you will eat some vegetables at every meal, including two servings at lunch and dinner with a leafy green salad every night.  You also determine to limit yourself to no more than one alcoholic drink and one soda a week.  All you have to do is look at your plate and into your drinking glass to learn whether you are reaching your goals.

I have a couple of comments about weight loss as a goal.  First, it is not a particularly health oriented goal, so I don’t like it much.  As long as you are sort of close to “normal”, other factors (especially physical fitness) are much more important than the reading on the scale.  There is some evidence that, as long as you are physically fit (i.e., good aerobic capacity and strength), obesity might not be a risk factor for death, disease or feeling poorly.  The scale does not tell you what you are made of, your body composition.  Most people who do a lot of strength training are overweight on the charts, but have low body fat.  Increased levels of body fat are more risky than similar increases in body weight. Many people find that improving their diet and exercise pattern does not change their weight as much as it changes how they feel, their physical capacity and how their clothes fit.  Muscle is denser than fat, so patients usually tell me their clothes are fitting looser even when their weight has not changed significantly.

Third Step – Early Success

To maintain and build on a change we need positive feedback.  If you try to do too much, feel horrible while doing it and feel worse the next day, how likely are you to try it again?

Creating those specific, achievable goals helps you set in motion a positive feedback cycle.  You met your goal.  What you did made you feel better.  You felt good because you met your goal.  You then want to keep it going.  It is vital to let yourself feel good about your accomplishment.  CELEBRATE YOUR SUCCESSES!

Short-term vs Long-term Goals

Tied closely to the concept of early success is the distinction between short and long-term goals.  If you are only going to be satisfied when you have gone all the way from couch potato to triathlete, you are going to be unhappy for a long time and probably never going to become a triathlete.

Short-term goals are the steps on your path.  Long-term goals are the destinations to where the path leads you.  If you think only about the beach, you are going to get lost on the path through the jungle.

Taking Action

Implementing your strategy requires determination, but it also demands gentleness.  Living with a drill sergeant is not going to work, especially if YOU are the drill sergeant. For some patients I need to be a cheerleader, doing everything I can to convince them of the need for change and applauding their positive steps.  For many others, particularly those who are less healthy than they used to be because of age, illness or they just let themselves go, I have to work hard to reign in their over-enthusiasm.

Particularly with exercise, it is very easy to do too much too fast.  The consequence is often an injury, and the time then needed for recovery often sets the patient further back than she/he was to begin with.  You will make the fastest progress by going slow.  When increasing physical activity, I tell all but the youngest, strongest patients to increase EITHER intensity or duration by 10% a week.

The other side of it is that changing several problem areas in your life at the same time can be very good and a highly successful approach.  Diet changes in particular are often most successful when they are dramatic.  You feel better quickly and that experience helps you do more.  As you feel the benefit, your commitment will be stronger and you will have more energy to do more to feel better still.

The greatest wisdom is in simply paying attention to how you feel and adjusting accordingly.

Failure

The road of excess leads to the palace of wisdom – William Blake

Failure is good.  It is good because we have to make mistakes to learn.  When I see a patient who has not implemented my recommendations I always want to know why.  Actually I have to understand why they failed, in order to help them go further.  Problem-solving is an inevitable part of doing anything new.  If I recommend swimming for a patient with back trouble as the best exercise for her condition, but she can’t swim, what is the point?  If a patient has not been using the breathing exercise I recommended because he did not understand it, I need to make it clearer.

The only real mistakes are those that we do not learn from.  Mistakes teach us how to correct our course before we get way off track.  If you haven’t made mistakes, you haven’t been trying.

Water For Weight Loss

An interesting weight loss study found that people who drank 2 cups of water before each of their three daily meals lost five pounds more than the unwatered folk in the trial. This was a small study, with only 48 people, all of whom were between 55 and 75 years of age. All the subjects were on a diet restricting their calories. Over a 12 week period those in the water group averaged about 15.5 lb weight loss, while the other subjects lost 11 lbs.

Now, someone can slap a fancy label on bottles of water, rename it and roll out a scientifically-substantiated advertising campaign. Just kidding, aren’t I?

Doctors and Diet
I became interested in the health effects of diet long before I thought seriously about going to medical school. As my interest grew, I found a physician who became my mentor and encouraged my nutritional studies. He also inspired me by demonstrating the effects of nutritional interventions with his patients. (See his books DIET AND NUTRITION and RADICAL HEALING, both impressively still in print after decades).

In medical school a few of us created a student group that brought in outside experts on healing alternatives to broaden our education. Although I am proud of that effort and the fact that the group is still functioning over 30 years later, I am dismayed that it is still necessary. A new study makes it very clear just how necessary. Even considering uncontroversial, basic nutrition training, medical education is woefully anemic.

That student group (we called it the Humanistic Medicine Committee), sponsored one lunchtime lecture every week. During the time I was there we also organized two weekend seminars. One of those was on birthing alternatives. Because we felt it was so urgently important, the first of these seminars was on nutrition. Just over 80 out of 460 first and second year medical students attended. Pathetically, those students DOUBLED the number of hours of nutritional instruction they received during medical school. For the others, the extent of their nutritional training was a one hour lecture each day for two weeks in our first year biochemistry class. The lecturer’s lack of enthusiasm for healthy nutrition was revealed during one of those lectures when he sniveled about “the odor of the rancid fatty acids from those organic muffins you in the back row are eating”. Guess where I sat. I was forced to do my own studies. Bizarrely, my medical school was renowned for much of the most important research on human nutrition ever since Ancel Key’s landmark studies of the effects of starvation on World War II conscientious objectors.

In the mid 1980′s the National Academy of Sciences recommended that US medical students receive a minimum of 25 hours of nutritional instruction. A new study shows that only a small minority of medical schools require that of their students.

I fully accept that my interests and perspective were and are unusual. That was evident even as a college undergraduate. When I went for the mandatory career planning interview required by my university, the counsellor unsuccessfully attempted to convince me that, because of my interest in nutrition I should become a dietician instead of going to medical school. However, I am confident that my decision was correct. Instead I wonder if, reflecting their disinterest in nutrition, many doctors should have been routed towards some other career.

The best solution would be for medical education to teach more nutrition, but the most important goal might be to educate docs about how important nutrition really is. If the medical community truly recognized the importance of a healthy diet, this ridiculous educational vacuum would be filled quite quickly. Just think of how much better hospital food might also become.

The recent, very brief hot spell here was good for the souls of Northern California residents who were feeling guilty about how beautiful and temperate our summer has been compared to everyone else’s. I especially loved it as the mild weather helped me train for and achieve a goal I set for myself a couple of months back. Spurred by my daughters’ decision to come home and run the Santa Rosa Half Marathon, I decided to finally settle whether my many joint surgeries had put such running activities beyond my reach. Surprisingly, my strength training, minimalist shoes, and familial inspiration allowed me to complete the race, even bettering my hoped-for pace. Sure, my pace was 50% slower than my last marathon, but I have accepted that 30+ years does change people. (Photo from Santa Rosa Press Democrat)

Far more remarkable is the success of one of you. This patient is a young man with a number of significant health problems. His severe obesity made these problems much worse, and his life was difficult. He recognized the price he was paying and committed himself to doing all he could to make his life better. He began exercising daily. He focused his diet on healthy food, including lots and lots of vegetables. Today he weighs 200 lbs less than he did when he made his decision a year ago. He tells me that the change in how he feels is even more dramatic than the change in his appearance. He inspired his girlfriend to lose 85 pounds. They have married and are now seeking to adopt a little boy whose single mother is homeless and drug-addicted.

While we cannot achieve such dramatic successes every day, each of us has the power to make fundamental changes to better ourselves. I have learned that it all comes down to making the effort, focusing on the process. It is also important to remember that big successes are the inevitable result of comparatively minor daily successes. One day choosing to make one better dietary choice, getting some exercise, keeping yourself from overreacting as you normally would, making time to relax for a few minutes all seem insignificant and trivial. However, doing the right thing today inevitably leads to a better tomorrow. There is much that is out of our control, but taking care of what is in our power can make a very big difference for ourselves and for those around us.

Egg Recall

The salmonella-contaminated egg recall is an opportunity to think about numbers. Nearly 1/2 billion eggs have been recalled. That is 1-2 contaminated eggs for every American. 500 million is a staggeringly huge number of eggs. However, the most important questions, “why” and “how”, come down to a very small number. That number is 2. All of those eggs came from just 2 farms. That number “2″, almost-the-smallest-possible-number is the most startling fact of this case. The idea of 2 farms producing half a billion eggs is shocking. The number 2 also accounts for the problem. Mega-industrial farming inevitably leads to cross contamination of waste with food. Such a concentration of animals makes them extremely vulnerable to the spread of disease amongst the animals and those who would use them as a food source. Sure these farms were already notorious for their long track record of health violations, so no one should be too surprised. But how could such bizarre living circumstances ever be healthy? Absolutely the companies are at fault as is the lack of governmental regulation. But we are seriously deluding ourselves to think this sort of problem, as well as rising antibacterial resistance with new “superbugs”, are not dead certain consequences of consuming the products of such a dysfunctional approach to agriculture. Support your local farmer!

Ginseng
Ginseng has long been one of the most popular herbs. As a young man in Minnesota, I knew of people wild crafting ginseng in the local woodlands. A recent quality investigation found that nearly half of the ginseng products tested either did not meet the standards claimed on the product label or were contaminated by lead.

Chromium
Weight loss products are probably the most likely product to be either adulterated or contaminated, right next to herbal preparations imported from Asia. One of the most popular weight loss supplements is chromium. Although the form I recommend (polynicotinate) is safe, I do not like the more common “picolinate” form. Much worse, hexavalent chromium, the kind made notorious by Erin Brocovich, was found in 3 of 8 chromium supplements when tested by an independent laboratory.

Muscle Supplements
Most people think of body builders when they think of muscle-building supplements. They also suffer from the very wrong impression that the products used to this end are the sort of thing that gets your name in the paper for the wrong reason or are at least damaging to your health. Not so. Just like eating well and taking care of yourself in many ways can also help you build muscle, there are a number of supplements which build muscle mass and make you healthier, when used correctly. In recent years we have been learning a great deal about utilizing these approaches to help people who need to build muscle, not to win some contest, but to lose weight or simply move around better. For example, there is quite a bit of scientific evidence supporting the use of creatine in the treatment of Parkinson’s disease.

Most players on a high school football team ended up in the hospital several days ago. Confused families and media ignored the unsafely designed practices (intense muscle work, twice a day, in extreme heat) of an inexperienced first year coach and instead blamed the problem on creatine.

Creatine is an amino acid abundant in meat and a useful training supplement for those seeking to increase their skeletal muscle mass (that includes us aging old folks as well as young football players). Despite widespread use accepted by the NCAA and high school authorities, as well as hundreds of studies demonstrating the safety of creatine, myths persist that it can cause everything from kidney damage to muscle cramps.

As I have lectured on creatine since 1998 and the evidence even then strongly refuted these misconceptions, I find such lasting ignorance disturbing. While it is kind of these families to think well of their new coach, the harm suffered by much of this high school football team is certainly due to his careless and over-aggressive training, not creatine. It is unfortunate that such unscientific “knowledge” is perpetuated. As some of you know, I am a member of the editorial board of the Journal of the International Society of Sports Nutrition. The ISSN issued this commentary -

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