Coffee Break

We are surrounded by coffee! In our commutes to work (many of us are drinking it), post lunch in the work place, in our lectures, etc. I mean there is literally a Starbucks on every corner. The majority of us are reliant on this caffeinated brew but are the physiologic effects beneficial, negative or does it remain unclear? Well, as is true of much scientific research, it is controversial but it seems that the upside may win out.

Multiple organ systems are effected by caffeine; no wonder it successfully helps us function in the face of fatigue, boredom, after a large meal...The second we start sipping a Cup of Joe the widespread response is initiated. The major systems triggered are cardiovascular, neurological, and metabolic (pretty much the most important systems). Think about the sensations that arise over the course of a cup of coffee-maybe a little hot, jittery, energetic and focused just to name a few.

Since society these days is focused on weight loss (primarily since we dug ourselves a hole in the last few decades) one of the main questions surrounding coffee is does it help us lose weight? In addition, will it help us prevent diabetes? The answer is possibly. Evidence from studies (there have been almost 20,000 in the last few decades) indicate that caffeine induces thermogenesis, basically induces more energy expenditure. However, in these studies patients drank up to 6 cups/day for only 100 kcal burned that day. I don't know about you all but 6 cups sounds like a tremendous amount. The possible etiology of this increase in energy expenditure via thermogenesis may be via an induction of lipolysis (increased fat metabolism). Part of this increased metabolic rate is likely secondary to increased peripheral resistance which leads to increased cardiovascular work and higher blood pressure. This is the reason that those with high blood pressure should only consume coffee moderately if at all. People with diabetes should also be cognizant that the beverage most of us rely on may actually impair sugar metabolism.

I have alluded to stress hormones in previous posts, specifically epinephrine. It turns out that epinephrine (one of the fight or flight hormones) is increased in the circulation with coffee consumption. As we discussed previously, when we are stressed our body wants to keep a lot of sugar in the blood stream so we have a readily accessible source of energy. Well, this surge in epinephrine causes a temporary, or possibly long-term, insulin resistance which can be detrimental to diabetics. For non-diabetics it may make sense to hold off on that afternoon coffee until we have a chance to digest in order for the blood sugar to return to its baseline level. However, I understand the clock is ticking once lunch is over till the afternoon fatigue and loss of focus hits (a low carb. meal is one of the best preventions). I am with you all!

How exactly does coffee fight off that fatigue? Basically it works to overcome the activity of adenosine (a major compound involved in energy) which when bound to specific receptors slows the body down. The amount of adenosine increases throughout the day in order to prepare us for bedtime. When caffeine is consumed it competes with adenosine and usually wins by binding to its specific receptors and the result is an increase in energy. If we are going to have an increase in energy we certainly want to be able to maximize it for its full potential.

We have all heard an extensive amount about Alzheimer's disease and Parkinson's disease in the media the last few years. Studies have indicated that inhibiting adenosine (the bodies chill pill) may actually slow the build up of amyloid plaque which is associated with Alzheimer's disease. Additionally, dopamine levels may also be preserved with caffeine and thereby delaying or preventing the onset of Parkinson's disease. All good news but yet to be concluded and it seems like we need a high amount of coffee daily to reach these benefits. Who knows maybe caffeine pills will become the new Omega 3 fatty acids craze.

For awhile I was on a big green tea kick (see previous post, "It's Good to be Green") but now I am just confused. Maybe I will alternate days or weeks between green tea and coffee.

Good news (or maybe not) I am now on twitter. You can follow my daily health related tips at www.twitter.com/dodellmd (or just click on the upper right corner of this page to be linked). I was resistant to get involved in this whole other world (thought Facebook was enough) but it is a great way to get all your news and other daily information in one place.

Hope you learned something from this post!

FATigue

It's all right I went yesterday, maybe I will sleep in today, I went to bed late last night, I have a full day of work so I should get some extra sleep...Are these thoughts unique to me when the alarm goes off to go to the gym prior to work? Human beings are incredibly adroit at rationalizing (although I don't have other species to compare). Of all the things that we humans rationalize on a daily basis, food and exercise are probably the most common. Our amazing talent to convince ourselves to procrastinate health or take a day off is probably one of the reasons that weight regain is the norm.

I was going strong for the first 6 months or so of my new lifestyle change (a doctor attempting to live by his own advice) but I have sensed some return to old habits (not so fast as Lee Corso says). The summertime (the best) has been celebrated with late dinners and social events, and therefore, more difficulty waking up early in the morning to hit the gym. Based on my scientific mind (not really) I have determined that the days that I don't exercise in the morning (hence sleeping an extra hour till 5:45 A.M.-I know, poor me) I actually feel more tired. Why is this?

A paradox indeed, but when met with fatigue the best treatment is actually exercise. The thought of exercising versus taking a nap in the mid afternoon or after work seems like a no brainer when we are fatigued. However, to get the best result (rectifying our fatigue) we should choose exercise. A study from the University of Georgia by Tim Peutz, Ph.D demonstrated that individuals who engaged in low-moderate intensity exercise 3x/week for 6 weeks reported a 20% increase in energy levels and a 49-65% reduction in fatigue compared to a control group. What is the etiology of this response?

Exercise improves our cardiovascular fitness, thereby making our body more efficient. A fit cardiovascular system will deliver 25% more oxygen at rest and 50% more oxygen during exercise than an unfit one. Our tissues (muscles, brain, etc.) all rely on a constant flux of oxygen to run efficiently. Essentially, a deconditioned individual will feel tired both physically and mentally since their bodies are not "running" at full speed. This effect has been replicated even when I miss 48 hours of exercise these days.

Feeling sluggish physically usually corresponds with also feeling "off" psychologically. Stress, irritability, anger...all seem more present when inactivity prevails. There is some truth to the runners/exercise high. Endorphins are the hormones that are responsible for the euphoria, stress release and decreased pain that can occur with exercise at 75% of your maximum heart rate (220-age). This is based on the binding of the endorphin chemicals to receptors to block pain signals. Maybe no pain, no gain is a myth since if you are working out hard enough pain should be absent? Actually, those who exercise in the afternoon are less likely to be injured since we are most alert by then (I am half asleep in the morning) and our muscles are warmed up throughout the day.

Research has been completed to determine if morning or afternoon exercise is best and there is no clear answer (just another scientific controversy). The answer seems to be what is best for you. The point is to commit to at least a few days per week for 30 minutes. A few findings that have been noted are that strength and endurance are greater in the afternoon but morning exercisers are more consistent.

I haven't been consistently writing entries these days, maybe slightly fatigued. Also, actively searching for new and exciting topics. Any ideas?

Five in Five!

Summer is here! For the majority of us this is the season that is defined by BBQ's, travel, long days at the beach, happy hours...We are all familiar with the planning of many of these events that commences as early as winter/spring time, both physically and emotionally. It is commonplace for many to begin dieting and exercising in the spring to prepare for the bathing suit season (refer to the previous blog entries if you are still awaiting to start this process) but maintenance of our general health and well being (and beach muscles) can be much more challenging then reaching the goals in the first place. Statistics on weight regain status post weight loss vary but basically demonstrate that the majority(upwards of 90%) of people that lose a significant amount of weight regain it within 1 to 5 years.

For those of you who have been reading this blog from its inception, you know that the concept was for me to live by my own advice as a physician. Well I am relieved to say that my energy level, clarity and waist line have all improved since taking this personal challenge. The fear is now that I have passed the honeymoon phase I will revert back to my previous habits (especially during the summer).

Thankfully I had the chance to go to the Bahamas for a trip last week. The weather was incredible, the water slides returned me to my youth, the black jack tables were not awful, the drinks were flowing and we had some awesome meals but there is no doubt I was mildly focused on not taking two steps back in my health related goals. When I returned home I stepped back on the scale and I weighed in at 5 pounds higher than before the trip, maybe this is one step back? Inevitably I felt somewhat disappointed by this objective evidence that I gained weight while on vacation, especially since my goal was to maintain, but I had an awesome time and this motivated me to kick back into high gear. Given this time of year (just like the holidays) features many opportunities to indulge I spent some time reflecting on the vacation and thinking of a few strategies to enjoy but in moderation.

Alcohol, larger portion sizes, inactivity and more alcohol lead to weight gain (shocking, I know). Based on this fact, I woke up an hour earlier on half the vacation days to work out and actually felt better on these days (maybe less guilt?). The crazy part to me is that I still gained weight even though I had probably burned 400 calories via exercise (half of one pina colada). When you expect to consume more calories at some point it makes sense to strategize beforehand so your previous health directed efforts don't go completely by the wayside. Activities such as swimming laps, tennis, long walks on the beach (had to throw that cliche in here) and paddle ball are all fun things to do in between sitting on a lounge chair reading a good book and cocktail hour. I am always surprised how many calories these types of activities can burn and sure beat running on a treadmill (pretty much most things are better than that).

Blame it on the alcohol (as Jamie Foxx said). The drinks that come with umbrellas usually taste outstanding but are definitely not less filling (since they are packed with sugar). A huge proportion of calories during vacations, BBQ, beach days, etc. usually comes from alcohol. Just as we should plan out our meals for the day it may also be wise to plan out our alcoholic beverages since there is a wide range in caloric content. For example a pina colada (a personal favorite) has approximately 644 calories! This is 100 calories more than a Big Mac. For those of us who enjoy Pina Coladas it would not be uncommon to have 2 of these a day (especially if they are weak) on a vacation day (almost a full day of calories). Some good poolside options include a light beer (Blue Moon-171 calories/Coors light-104 calories) or vodka on the rocks with soda and a splash of pineapple juice/cranberry juice. As far as cocktail hour/dinner drinks the calories generally climb exponentially with sweetness. This is because juices add 50-60 calories in addition to the alcohol (Cosmopolitan-143 calories). In an effort to cover all my readers alcoholic preferences, for you martini lovers the average calories per martini is about 150calories. Lastly, for those who love their grapes, a large class of dry red wine (166calories), a large glass of dry white (154 calories), Rose- a summer favorite (164 calories)...you get the point.

Logically we would think that we gain weight from alcoholic beverages because it is turned into fat but this is not the case. Less than 5% of alcohol is turned to fat but it is the active metabolite acetate that is the culprit. The formation of acetate via the liver becomes the bodies primary source of energy when it is available, therefore, we burn less fat during these times. In addition, the consumption of alcohol causes a drop in blood sugar (prevents sugars from being produced in the liver via glycogen breakdown) which triggers hunger and thus a larger consumption of food. A good trick may be to eat some food prior to having your first drink to compensate for the drop in blood sugar. As we have discussed previously, preventing spikes in our blood sugar levels will keep our metabolism in check.

It is always nice to take a vacation but it is always nice to come home too! Basically, my approach to getting back on track is to get back to my routine. As much as I love pina coladas and large meals it has felt good to return to a morning protein shake and eating a home cooked meal.

I wish you all an amazing summer! I hope you have the chance to take a trip and spend quality time with family and friends. With July 4th around the corner, it is a reminder of our personal Independence and the choices we are free to make for ourselves in both the physical and emotional aspects of our lives.

Please share your experiences, comments and questions.

A Big Bowl of Sugar

Hard work is generally motivated by the reward of the end goal (bonus, promotion, recognition, etc). As I have alluded to repeatedly in these blog entries, remaining healthy is hard work (especially these days). The majority of us probably enjoy eating fatty, salty and sugary food while lying on the couch but unfortunately the end point for this lifestyle is likely far from a reward.

The last few weeks I have been the senior resident on an inpatient general medicine service. It is always an interesting transition from outpatient medicine to inpatient medicine since there are often different goals. The acuity of a hospitalized patient requires a standard work-up (usually featuring many tests and blood work, anyone who has been hospitalized can attest to this) and establishing a discharge plan once stabilized. The most common hospital admissions on our service are pneumonia secondary to underlying lung disease (COPD), heart failure, chest pain, and uncontrolled diabetes. One common link exists between the majority of these patients and their ailments, lifestyle choices have negatively effected their health (smoking/poor nutrition).

On rounds the last couple of days, I have become focused on the breakfast trays of our various patients, specifically the types of carbohydrates the hospital was feeding these people. My focus was heightened since earlier in the week I heard an outstanding lecture by a leading physician in the field of obesity, Dr. David Ludwig from Children's hospital in Boston. The lecture focused primarily on obesity, specifically in children, and the toxic environment that in large part has perpetuated this decline in health in this country and across the globe. A large focus of the talk was on the benefit of the glycemic index, something we have continued to hear a lot about through various diets (South beach, nutrisystem, etc.).

The Glycemic index was created in the early 1980's by Dr. David Jenkins in order to determine the best foods for diabetics. The concept was to determine a score for carbohydrates based on their effects on blood glucose. Foods that are digested quickly, and thus lead to a rapid elevation in blood glucose, are given a higher score on the glycemic index. The standard foods used as a reference number are 50 grams of pure glucose (sugar) or 50 grams of white bread and these equal a score of 100. While this tool was initially created with diabetics in mind, studies have indicated that this approach to nutrition may help prevent cardiovascular disease and cancer.

After attending this lecture, I was extremely distraught that our patients were basically consuming trays full of high glycemic index foods. There has been a large movement over the last decade to control patients blood sugar levels while they are in the hospital because studies have shown better overall outcomes (specifically post-surgery) so there are protocols to use insulin for inpatients. The rationale for elevated sugars in the hospital is many times explained by a stress response based on illness, steroids, etc. but a large component may be that we are feeding this captive audience products instead of food.

Food politics continues to be an uphill battle for the public in this fight against obesity. It is hard to know what is good for us and what is not. As I have said previously, read the labels and if you don't know what some of the ingredients are then don't eat it. Are Cheerios good for me since on the box the cereal is in a bowl depicted as a heart or if it says low fat is it good for me? I plan to start using the glycemic index as a guide for myself and my patients to provide more meaningful information on carbohydrate choices since they are unavoidable (nor do I want to avoid them, as stated by my one of my entry titles "To carbs, I love you).

Here are some examples:(low GI <55, medium GI 55-69, high GI 70 and above)

Bakery products: pound cake (54), croissant (67), Doughnut (76)
Beverages: apple juice (41), grapefruit juice (48), orange juice (52)
Breads: multi grain (48), rye bread (64), baguette (95)
Breakfast cereal: Muesli (56), puffed wheat (74), rice crispies (82), corn flakes
(83)

Here is a link with a complete list: http://www.lowglycemicdiet.com/gifoodlist.html

By the way, the breakfast trays for many of my pre-diabetics/diabetics in the hospital on the pre-ordered diabetic diet was comprised of corn flakes/rice crispies (both high GI), a white roll (also high GI), a banana and orange juice (also both high GI). There has been a movement, rightly so, to prevent hospital re admissions through better discharge planning and follow up with physicians. Nutrition is a necessary entity in these patients health that needs to be prioritized and taught while they are in the hospital.

I plan on finding a way to address this with the people making the food choices for the patients in the hospital. Let us all begin to think about the glycemic index when we are making food choices so we can maintain the right direction or reverse a potentially dangerous course.

Thank you all for reading. Please continue to provide feedback and pass this on to those who may find it useful. Until next time...

More Than Beach Muscles

How many of us still lift weights in the gym? I personally gave up this activity years ago when I became more focused on a good cardiac workout. My focus has been to stay in shape and lose/avoid excess fat deposition. Also, I always feared that once I stopped lifting weights all the muscle I had developed would inevitably turn to fat so my thinking (stupid as it sounds) became not to build up excessive muscle. This rationale was completely wrong for me and for all of you based on a concept called sarcopenia.

Sarcopenia is the degenerative loss of skeletal muscle mass and strength that occurs with aging. It is associated with the frailty syndrome common in the elderly, however, this process unfortunately starts early. Beginning at around age 25, skeletal mass begins to diminish at 0.5-1% per year (or 10%/10 years). Based on these numbers by the time the average adult is age 70 their body is composed of comparatively more fat than muscle. This reversal in body composition predisposes people to falls secondary to poor balance and coordination. Additionally, skeletal muscle serves as a metabolic reservoir of proteins and metabolites so people with sarcopenia often have poorer outcomes from trauma and surgery.

With the loss of skeletal muscle there is a higher risk of osteoarthritis since the bones and joints carry more of the body weight. Osteoporosis (thinning of bones) is a condition that physicians have become more adept at screening and treating. Since bones and muscles work hand and hand the concept of sarcopenia is being realized as a crucial component to preventive health.

The goal, as always, is to prevent disease or at least prepare the body in the best way possible to do battle. Are those men and women at muscle beach in Venice or in the weight rooms at the gyms around the country "healthier" or fighting the aging process? In terms of preventing osteoarthritis (from wear and tear on joints/bones) and improving balance these people are likely doing their bodies a great service.

Much like many of you, I am sure, I was bored with running on a treadmill and lifting weights in the traditional manner. If you have been reading this blog since its creation you have learned about my new found love for spinning (a great cardiac workout). Now, I have been on a search for the anaerobic equivalent to spinning to build my overall muscle tone. Hopefully, with this information regarding skeletal muscle loss, sarcopenia, we will all be determined to prevent this condition's complications. Here are some tips that I have, and will, be using for anti-aging (as cliche as it sounds).

Resistance training appears crucial to prevent osteoporosis and osteoarthritis, probably in large part to building skeletal muscle. Balance exercises (standing from a seated position, walking on tip toes, etc.), floor exercises for building lower-body and abdominal strength (sit ups), and free weights are all beneficial to longevity. Personally, I have been doing half my cardiac work out then some strength training followed by completion of the cardiac exercise. This has kept the gym more "entertaining" since it includes much more variety.

Nutrition is another key component to maintaining a good balance of skeletal muscle to fat (it basically is always about diet and exercise). As we get older, our protein requirements will increase due to a reduction in the absorption. It is important to continue to maintain a well rounded diet high in fruits, vegetables and good sources of protein. Whey protein and the supplement glutamine are excellent sources of nutrition that are relatively easy to incorporate into everyday nutrition. I continue to have a protein shake (whey protein base) with a scoop of L-Glutamine every morning (I add a banana or other fruit for extra flavor).

Since it is baseball season I figured I should include some final comments on hormones, specifically steroids. As we age, our testosterone and growth hormones decline. With below baseline testosterone/growth hormone (matched against the same age group) it is difficult to build and maintain skeletal muscle. Blood tests are available, most routinely testosterone, which can be supplemented if deficiency exists. Testosterone may also play a role in cardiac health among other things (including the obvious).

Two links for you to check out:
1. www.cdc.gov/features/musclestrengthening (guide to various exercises, also can google resistance training and likely get some good exercise routines).

2. http://www.masssuit.com/ (some good friends of mine have developed and are selling this body suit specifically for resistance training). They have shown some incredible results.

My wish is that this knowledge is power. Now, time for us all to pump some iron. Your comments/questions on the entries is always encouraged. Please continue to share with your friends and families.

To Carbs, I Love You!

Americans are blessed (or maybe cursed) with an exorbitant amount of food choices on a daily basis. These options are multiplying on a daily basis. The sensory overload of perusing the aisles of a Whole foods, Trader Joes, or any major supermarket is likely commonplace for most Americans. Even the task of trying to make a decision about a drink in a take out deli can be a 5 minute process since there are at least 5different tea options and even multiple different brands of bottled water (some prefer their water from the island of Fiji others from the glaciers). For this entry, I will focus on the ever growing land of carbohydrates.

We all have a love hate relationship with carbohydrates. The nutritionists (including scientists, dietitians, physicians, etc.) are in large part to blame since we haven't been able to make up our mind. The recent theory is that it doesn't have to be all or nothing when it comes to carbs, sorry Atkins (although we now have the modified Atkins). Our bodies favorite source of energy is sugar in the form of glucose, therefore, we should not deprive our physical beings but rather ensure it has the right fuel to run.

Carbs got a bad name when they became refined/processed. Refined carbohydrates, much like most processed foods (as we have discussed) provide minimal nutritious value. In an effort to right the wrong of completely abandoning carbohydrate love the food industry (with the help of the scientific community) has made whole grain/wheat options that can help us balance our diet while still enjoying great taste.

However, not all whole grain/wheat options are created equal. The majority of us have stared at the multiple shelves of breads in the supermarket only to pick the one that has the most visually appealing wrapping (that's why there is money in advertising). While good looks can be persuasive they will likely not help your health (at least in terms of bread).

What does whole grain mean exactly? Well, "whole" essentially means not refined/processed. Whole grains contain all the original components (bran, germ and endosperm) and thus all the B vitamins, magnesium, selenium, iron and fiber that they were meant to deliver. The act of processing these grains results in the loss of the bran and germ components which contain the majority of the nutrients. So it seems clear that in terms of overall nutrition that we should choose whole grain over white floured (refined) carbohydrates but which whole grain is the best since there are so many options?

Choose the whole grain option (pasta, bread, cereal) with the most fiber. Fiber is something that we all know is supposed to be healthy but for many the reasons are not clear. Basically, fiber is a carbohydrate that cannot be digested. There are two forms, insoluble and soluble (meaning it can be dissolved in water). The more fiber a whole grain has the slower it will be digested. A slower rate of digestion is beneficial since it controls our bodies blood sugar spikes (along with insulin) that can be detrimental for weight and moods. As we have discussed previously, we generally want to avoid rapid changes in blood sugar (that is why we should eat something every 3-4 hours). Soluble fiber also binds to fatty substances in the intestines and carries them out as waste which results in lowering our bad cholesterol (LDL). Insoluble fiber helps move food through the intestines, thus maintaining regularity and preventing constipation.

For those of us that want to strive for maximum health (and at least have regular bowel movements) the current guidelines for fiber intake are 20-30 grams/day for women and 30-40 grams/day for men (varies by age). Some sources of soluble fiber include oatmeal, nuts and seeds, blueberries, strawberries and pears. Sources of insoluble fiber include whole wheat bread, brown rice, barley and tomatoes.

In my initial stages of this new lifestyle I attempted to avoid carbs. I have learned that they can't be avoided, nor should they be, if eaten correctly. Some refined carbs every once and awhile is also recommended, no reason to make ourselves crazy. If you haven't tried brown rice, a whole wheat bagel or whole wheat pasta give it a shot since you may be pleasantly surprised.

Please continue to pass the blog onto friends and family. Always love the comments and when I see new people have signed up to follow the blog and receive email updates. Thanks for reading!

Pay for Performance

Generally, people will work harder or make more of an effort at a given task if it is in their best interest. That, I believe, is part of human nature. While maintaining a healthy lifestyle is in our best interest and that of our families by itself alone, sometimes we need a small (or large) extra push. Incentives come in many forms, however, money may create the most significant results since it enables additional positive reinforcements (e.g. a nice vacation, new clothes, etc).

Pay for performance is a concept that continues to be discussed as far as our U.S. health delivery system. The idea is that physicians and hospitals should be paid for providing quality care, not necessarily quantity. For example, physicians that demonstrate improved diabetes control in their patient population may receive a higher reimbursement, etc. As for hospitals, those that reduce inpatient associated infections or blood clots may receive additional compensation. The specifics regarding these types of incentives are still mostly under discussion on a national level but certain hospital systems have enacted this principal with success. Fundamentally, I have always thought this idea makes sense from a patient-physician-health care system perspective. We all want the same thing, in theory, which is for the people of this country to live healthy and long lives.

Since the insurance companies, and the employers who pay for benefits, want their customers/employees to remain healthy (for many reasons) a few pioneers have adopted a similar pay for performance health incentive. An article on March 28th in the NY times business section "Carrots, Sticks and Lower Premiums by Steve Lohr described the success of some of these programs including General Electric and Safeway. One of the models used for these companies is based on the Virgin formula which focuses on promoting physical activity. Personal physical activity is measured using pedometers, accelerometers or heart-rate monitors and the data is uploaded into an individual account on the web. One of the participants interviewed in the article stated that the financial reward of a $100 decrease/month in health insurance premiums for her and her husband if she maintained her activity goal was a huge selling point (50-80% of eligible employees participate). Currently, she has lost 40 pounds and intends to lose 14 more.

Executives in these companies believe that the "carrot works better than the stick." The article explains that there are no penalty payments, only encouragement to convert to healthy habits. Some companies are offering cash carrots to smokers, some paying up to $500 for smokers to quit. It is not hard to fathom that there may eventually be "cash carrots" for participants who give up sodas, excessive alcohol and fast food. Sean Forbes, president of Virgin Health-Miles stated, "We're trying to create the good-driver discount for health but one reason that's been so difficult is there's never been a way to really measure things before, but that is changing because of technology."

One of the take home points for me is that we need objective information regarding our health to have lasting effects. I recently started using a polar heart-rate monitor (thanks to my wife, Alexis) that tracks my heart rate and calories burned during exercise. I know I need to achieve about 85% of my maximum heart rate during exercise for beneficial results and now I can keep track. Also, it has been rewarding to see that in a 1 hour spin class I have burned over 500 calories. While these devices are helpful, they are not essential. Find objective ways to track your health such as weighing yourself once per week, have your cholesterol checked and then re-checked, monitor your blood pressure at home, etc.

Opponents of health care reform have made the argument that we all should be responsible for our own individual health on some level. Many have asked why they should pay for others health care if they don't take it upon themselves to remain healthy. Well, I hope with wellness education and objective data we can all reach our individual health goals so we can continue to live fulfilling and productive lives.

Please share your comments/questions below. You and your friends can still sign up as a follower of this blog and also subscribe by email for updates at the top right corner. Thanks for reading!

Spring Forward

The phrase "Spring Forward" is one of my favorite phrases of the year. This phrase is classically related to advancing our clocks by one hour at the onset of spring, hence "spring forward." Other than the initial threat of a lost hour of sleep, this is generally a welcomed change for most people since it corresponds with the longer days of spring/summer. The concept of daylight savings was initiated during World War I with the intention of saving energy for war production. While it remains unclear whether daylight savings actually saves energy (in the form of electricity), I am always happy to welcome this time of year since it defines the end of the "fall back" period.

The Winter is probably a season of "fall back" not only in terms of changing our clocks backwards by an hour but also maybe a step back in our overall approach to health (probably more so in the cold climate regions). At least for me, I have always found it more difficult to make it to the gym and stay away from the comforts of sweets and alcohol (red wine/hot cider/chocolate, etc). The common New Year's resolution of losing weight/getting back in shape comes at the inopportune time of the heart of winter, football season, etc. Do people feel compelled to make these resolutions after the holiday season because of the excess weight/guilt related to all the parties? Maybe we can all start a new movement called the "Spring Forward Resolution."

The first entry of this blog titled "Knowledge is Power" describes my rationale for beginning this process. Basically, I felt I was not living by my own advice as a physician, I had accumulated excess weight that I wanted to lose and I was on the brink of a milestone birthday. The feelings related to these 3 things caused me to spring forward. Over the last few months I have regained my love for exercise through spinning (I now have the shoes/dri-fit shirts/heart monitor, etc.) and I have reached my previous level, if not best, level of fitness. Additionally, I am close to reaching my optimal weight. The challenges of changing my diet and getting back into shape continue to exist but have become much more of a way I choose to live my best life.

I propose that if you have not done so already please take the time to evaluate your individual health. The sun will continue to shine later in the day, the warmth will bathe our souls and the trees/flowers will be in full bloom for the next 6-7 months. This is an incredible time to have your spring forward moment. Walk home from work a few times per week, run in the park, find a nearby basketball/tennis court-the sky is the limit!

The opportunity to hear from patients, family and friends what spurred their lifestyle changes is always incredible. Most recently I have heard that a friend made drastic changes for his children, an older women wanted to feel better about herself, a middle aged man was scared about the onset of diabetes...

Daylight savings may not actually save energy but it may save lives! A reminder to learn your vitamin D level (maintenance 1000-2000 mg/day), have your cholesterol checked and get your daily dose of Omega 3 fatty acids.

We have previously discussed the effectiveness of positive reinforcement on diet and exercise, well, the same has been true for me writing this blog. The genuine praises and comments that reading these entries have made a difference in your lives is my main objective and means the world to me. All of this medical knowledge is useless without the opportunity to share it with others. I have loved using this avenue to spread health related wisdom. Thank you for reading and sharing! Please subscribe by email if you haven't done so and sign up as a follower of the blog at the top right corner of the page.

For the Love of Aging

With my birthday right around the corner I decided to write an entry that focuses on the aging process. For the majority of us the period around our birthday is a time of reflection and analysis of our lives. Everyone hopes that their future is bright and good health is a huge component of this wish.

For all of us that have spent time around women going through peri-menopause and menopause, or for those that have lived it, it is apparent that this is a difficult process. The initiation of hot flashes, mood swings, and weight gain are likely not pleasant symptoms of one of life's natural courses. For years, we all heard about hormone replacement therapy (HRT) with the replacement of estrogen that is lost during menopause. However, it has been revealed that HRT is a potentially dangerous therapy since it has been correlated with increased breast cancer, blood clots and heart disease in women. For the purpose of this blog I will discuss potential new therapies on the horizon to manage the weight gain that many women struggle with while getting older. Men, you are not in the clear from this whole estrogen as we age phenomenon and I will get to that soon so keep reading.

The hypothalamus is the region of the brain that controls energy regulation, thirst, hunger, etc. Remember that from high school science? Well, it is no surprise that this area of the brain is the focus of ongoing research to combat the battles of menopause. Research by Deborah Clegg at the University of Cincinnati demonstrated that is ESTROGEN receptors in the hypothalamic region of the brain that control energy regulation and body fat distribution. When these ESTROGEN receptors were destroyed in animals they began to eat more food, burn less energy and gain more weight. Therefore, it is reasonable to draw the parallel to the decrease in estrogen levels during menopause.

Estrogen receptors called ER-alpha are now being investigated in the ventromedial region of the hypothalamus (also involved in temperature regulation). Since we now realize the potential adverse reactions of supplementing estrogen in all receptors of the body researchers are hoping to determine a way to only stimulate the receptors in the hypothalamus. By achieving this goal, essentially the hypothalamus will still function at its pre-menopausal level. Thereby, helping to alleviate some of these difficult symptoms that women face during menopause. While many men experience these struggles of menopause vicariously through our partners we are not free from our own fight against hormonal changes with aging.

Men have the benefit of testosterone, at least while we are young. Testosterone helps to maintain muscle and aids metabolism. However, just as women have decreasing levels of estrogen as they age, testosterone levels also diminish in men. Interestingly, it is not just about this drop in testosterone but the mismatch with estrogen in older men that may cause problems. Yes, men have estrogen. At younger ages the testosterone levels are peaking so estrogen levels are lower in comparison.

The main active estrogen metabolite is estradiol. The main source of estradiol in men is aromatization, which is the conversion of testosterone to estrogen. The issue is that despite decreased production of testosterone from the adrenal glands and testes as men age the aromatization process continues which can result in a higher estrogen to testosterone ratio. One of the reasons that aromatase activity is persistent with age is an increase in belly fat. Estradiol levels correlate with subcutaneous abdominal fat. Some of the symptoms of excess estrogen in men include development of breasts, fatigue, having too much abdominal weight, loss of muscle mass and emotional disturbances. Research has always demonstrated (some conflicting) that excess estrogen in men may increase the incidence of stroke, heart attacks and prostate cancer. As always, I want to inform you all of possible solutions that exist to these problems.

As we have previously discussed, abdominal fat (visceral) is never protective. So first things first, try to lose the mid-section abdominal fat via methods that we have discussed in previous entries.

Estradiol is not the only culprit that may cause health problems. Specific estrogen metabolites may also initiate and promote hormone related cancers. Daily consumption of cruciferous vegetables such as broccoli, cauliflower and brussel sprouts convert dangerous estrogen metabolites to safer ones (always good to eat your greens). For those that actively avoid eating these types of green vegetables there are supplements that contain similar constituents to aid this process called indole-3-carbinol and sulphoraphane.

Just as there is estrogen hormone replacement for women there is also testosterone replacement for men in the form of an absorbable cream. Testosterone levels can be checked in the blood and if the level is much lower than the age matched average supplementation can be used. However, a follow up blood test within 30-45 days is required for dosing and also to ensure that the PSA (prostate specific antigen) has not increased. Estradiol levels can also be checked in the blood but this is definitely not routinely done by most doctors (as far as I know).

There are also now medications that are aromatase inhibitors (e.g. Arimidex) that lower the level of estrogen produced from testosterone. These medications are used primarily in breast cancer patients and I don't feel there is enough research out there yet to support using them in aging men.

Life is about balance and these hormones are no different. Too much estrogen can lead to heart attacks, stroke, etc. and too little can lead to osteoporosis and weight gain. It seems like there are some exciting research studies on therapeutics currently being done in this area so maybe aging will become even more pleasant in the future.

As always, comments and questions are appreciated. Don't forget to recommend the blog to your friends and family.

The Gut Brain

The brain is the organ responsible for our higher functioning in day to day life. The nervous system is obviously a highly complex unit that requires the coordination of many components. In order for the stimuli that we encounter to be incorporated into a functional signal we must ABSORB and translate that information into a language we can use. Well, the brain is not the only organ that functions in this manner. In fact, the body has another nervous system called the enteric nervous system. This is basically the brain of our guts.

In basic biology, physiology, etc. we all learn about this so called gut brain. This is essentially a system of neurons (long wires that transmit signals through chemicals). This system is the basis for digestion but also makes use of more than 30neurotransmitters. A few of these familiar neurotransmitters are serotonin and dopamine which are also found in the central nervous system.

These principles are basic facts that provide the background for the rest of this topic. I have been fortunate to spend time in the office of an integrative internist/cardiologist over the last few months and have learned a tremendous amount about how the function, or malfunction, of our digestive system plays a huge role in our daily lives.

The "leaky gut" is a theory that I had never heard much about in my traditional medicine training but I think it will start getting more attention. The hypothesis is that dysfunction in the barrier that lines the intestinal cells of the gastrointestinal tract creates a leaky gut (hyperpermeable) which can cause a widespread array of consequences. A few of the hypothesized consequences include irritable bowel syndrome, type 1 diabetes, asthma, and autism.

The million dollar question is, why would my gut be leaky? Possible infectious etiologies include viruses, bacteria and parasites (basically anything possible). Infectious sources appear to disrupt the tight junctions of the cells that form the intestinal barrier, specifically by altering the cytoskeleton. Many of us may not remember having this kind of infection but most of us have had some kind of "stomach bug." Also, the NY times editorial by Thomas Friedman this weekend illustrated the excessive amount of antibiotics used in our food supply due to the set-up for infections based on factory farming (another reason to consider eating organic when possible).

Alcohol consumption also induces a leaky gut which results in an inflammatory cascade (cytokines) and reactive oxygen species that can result in chronic diseases such as cancer. The majority of alcohol is yeast which I have learned is probably one of the largest causes for this phenomenon. Many of us may actually be allergic to the foods we eat in some way or another which successfully feeds this process. Symptoms such as blotting, gas, loose stools, etc. may indicate a yeast problem or food allergy such as gluten.

The common end point for most of these factors is that the gut is not able to absorb and function at its optimal level because of flattened villi. The main results that the doctor I was working with focused on were Vitamin D deficiency, low levels of serotonin and the resulting high epinephrine/low dopamine/low GABA. We have previously discussed the widespread Vitamin D deficiency in our society today and this may be a common reason. We simply are not able to absorb the Vitamin D that we are consuming in our diet.

Additionally, as I mentioned above, serotonin (the happy hormone) is produced by the intestines. If the intestines are not functioning at a high level, then clearly serotonin deficiency may exist. The result of low serotonin is a reflex elevation in epinephrine which may produce an anxiety state at baseline. A low level of dopamine may make it difficult to concentrate and a low GABA level will likely influence our sleep patterns. These are symptoms that many of us have and it would be nice to find out not only why, but also how we can improve them through lifestyle changes.

The current problem is that not many doctors are aware of this phenomenon and if they are not many evaluate for food allergies. The intestinal permeability blood test evaluates for up to 120 different possible food allergies (IgG mediated). Upon receiving the results, the doctor I was working with would go over it with the patient and advise the necessary dietary changes. The initial blood test also included a Vitamin D level (almost always deficient) and Homocysteine level (measures the amount of green vegetables consumed, also a marker for inflammation). Most doctors will screen for celiac disease (gluten allergy) so if you have any of these symptoms you should request this blood test.

The second million dollar question, how can I make my gut less leaky? Probiotics have hit the mainstream in foods such as yogurt (Activa) and are certainly available in most supplement shops. While the verdict had previously been out on the use of probiotics I think there may be more benefit then harm. Look for probiotics with colony forming units (CFU's) in the billions and that contain Lactobacillus GG and/or Bacillus Coagulans. I have started putting a 1/4 teaspoon in my protein shake in the morning. Also supplement your GI tract with L-glutamine which has both anti-inflammatory and anti-oxidative properties. Lastly, if your Vitamin D level is not increasing with oral Vitamin D (2000 units/day) then you may need to supplement with Vitamin D drops.

While this is certainly not a concept that we hear discussed frequently the results I witnessed in patients were simply astounding. The patients stated that their moods and energy levels were improved and the majority of them lost a significant amount of weight. One women in her late 60's had lost about 100 pounds in 1 year just by diet and people had thought she had undergone bariatric surgery.

I hope you all are continuing to learn from this blog. I am trying to provide a mix of more traditional information as well as things that we may find new and interesting. Thank you for reading and please pass the blog onto your friends and family. As always, you can subscribe by email at the top right corner.

Invest and Commit

The process of investing in our future makes sense in the long-run but that certainly doesn't make it easy in the present. Whether we are talking about a monetary investment or time spent it is usually easy to find ways we would rather use these means NOW. Despite the struggle we all face when we decide to invest in the future, it sure is a fantastic feeling when it pays off. Taking the annual trip, walking up to get that diploma, sending the kid to college, etc. these are rewarding ends. Well, it may be that above all health and longevity are the most important ends. If we are not healthy, or living, to enjoy our initial investments they certainly will not be as sweet.

A common theme throughout these blog entries is the effort required to fight for our health and well being. We discussed the additional expense and the extra time it may take to tip the balance in our favor. I recently experienced this process first hand by joining a gym that I had previously crossed off the list due to its high monthly fee. However, after going to the gym as a guest and taking a few of the classes it became clear that this would be a valuable investment.

The fact that I am now spending much more for this current gym than the previous one has pushed me to commit to using the facility to its full capacity. I have become borderline addicted to spinning and I have gone to a class almost everyday for the last week. When I skipped one day I missed it, although this is likely not a good balance. I have also bought a new pair of running shoes which I haven't done in probably 2 years and I am thinking about moving on from the baggy basketball shorts of my youth to more age appropriate gym gear. My point is that this investment forced to me to commit and I am very excited about this new life change. My goal is to match my previous physical condition of my teens and possibly surpass it.

From a very young age I was always engaged in group sports whether it was t-ball, junior high flag football, high school basketball, etc. My livelihood was competing in these sports and the camaraderie amongst my teammates. As I am sure many of us have faced, once we are out of school these activities often disappear or are harder to commit to on a regular basis.

My thought is that by participating in these classes I can gain back some of my excitement for exercise. I had become bored of the treadmill, elliptical, etc. I am looking forward to the NFL combine class, cardio blast, and kick boxing. One of my best friends found a kick boxing class that he loves and he wakes up at 5:30 am multiple times a week to go. This is commitment!

Based on this experience, I am going to begin encouraging my patients to invest (whether time or money) in their health by finding a physical activity that they enjoy multiple times a week. It can be an exercise video, yoga studio, wii fit, etc. The point is to extend our self and go for it!

What have you all done to invest and commit? As always, I would love for you to share your personal experiences in the comment section. We can all benefit from each other's successes.

Don't Disrupt Your Hormones

It was a proud moment for Endocrinologists when we were able to claim fat as the ultimate endocrine organ. Previously, adipose tissue (AKA Fat) was thought merely as an inactive tissue responsible for storing energy in the form of fat. Now it is known that our fat is much more active. Adipose tissue is a major player in the regulation of metabolism via the release of hormones such as leptin (we have discussed its role in satiety) and the cytokine TNF alpha (involved in systemic inflammation). Therefore it is not hard to fathom that any substance that interferes with our endocrine system will have potentially harmful effects on our metabolism. Well, recently it has become public knowledge that the majority of us encounter these types of substances on a minute by minute basis. The term endocrine disruptor chemical (EDC) is most likely something we will all be hearing a lot about now and in the future.

The basic definition of an endocrine disruptor is an exogenous (outside the body) substance that acts like a hormone in the endocrine system and disrupts the physiological function of endogenous (normally occurring) hormones. A few examples of EDCs include pesticides (DDT), polychlorinated biphenyls (PCBS,used as industrial lubricants and coolants), Bisphenol A (found in plastic bottles and baby bottles, dental materials, and food and infant formula cans), phthalates (soft toys, medical equipment, air fresheners) and phytoestrogens (soy). Initially the concern regarding EDC exposure was predominantly surrounding reproduction since hormones are the major contributing factor. EDCs have been identified as a likely culprit in the increased incidence of undescended testis in newborn boys, an overall decreasing sperm count, breast cancer and early puberty. These are no doubt very scary findings and now EDCs are being identified as one of the potential etiologies for the current obesity trend. The exponential increase in obesity correlates with the widespread use of industrial chemicals.

Studies in this area of research have demonstrated that the effect of EDCs occur at the fetal and neonatal stages of development which are obviously crucial stages. Increased exposure of these substances during these critical developmental stages in animal studies appeared to disrupt the normal process of fat regulation. Results demonstrated elevated levels of leptin and insulin at younger ages and prior to the development of obesity which indicates the presence of dysregulation. An alteration of genes governing metabolism during development may predispose people to a lifelong struggle with weight. The animal studies have shown that low birth weight animals exposed to EDCs develop weight rapidly, often doubling their weight in 7 days, and similar studies in low birth weight children are showing similar trends.

Given these implications it is reasonable to assume that people who eat "healthy" and exercise but continue to struggle with weight despite their greatest efforts may have been exposed to these EDCs at a young age or may have a high level of exposure currently. Unfortunately this seems to be yet another basis for confusion in this nutrition conundrum. I recently read an article in Men's Health Magazine called "The New American Diet" by Stephen Perrine and Heather Hurlock that provided some valuable insight into this new facet of nutrition.

Since pesticides and their metabolites can spur fat cell development at any age it is worth the extra price to go organic in certain areas. A study in the journal Environmental Health Perspectives showed that children who ate fruits and vegetables free of pesticides for just 5 days reduced their urinary levels of those pesticides to undetectable levels. According to the Environmental Working Group you can reduce pesticide exposure by 80% by knowing which fruits and vegetables to consume. Peaches, apples, celery, kale, strawberries, lettuce, cherries, carrots and pears are all high in pesticides so it may make sense to buy organic in these items.

We may not be tasting plastic but we are consuming it. 93% of Americans have detectable levels of BPA. Again, plastic mimics estrogen and can predispose to fat. A few points to consider, don't heat up plastic, try to avoid plastic wrapped meat and try to cut down on canned goods.

When it comes to meat, organic/grass fed is much better for a wide variety of reasons. In order to produce "fast" food conventionally grown beef is high in growth hormones that we are consuming. These hormones are obesogens that cause us to gain weight and experts have surmised this may be playing a role in the obesity epidemic.

In my opinion, I saved the best for last. Soy was the new health craze for the last decade. Thought to be good for the heart, specifically in women, many of us started drinking soy milk and eating more tofu and edamame. It turns out that soy is not all it was cracked up to be. Since we would have to eat about 2 pounds of soy per day to reap its heart benefit the American Heart Association withdrew its support of soy. Soy, specifically in men, causes the formation of more fat cells since it is estrogenic. Soy is present in french fries, salad dressing, baby formula and even chicken and fish since they now feed on soy to help them gain weight.

For me, this has been one of the most interesting entries to write since it is a relatively new body of information to consider and there is much more research to be done in this area. I also found in mind blowing!

Please continue to recommend this blog to your friends and family. Encourage them to sign up for email updates and as followers of the blog. I would love to hear your comments!

Seconds or Really Fourths?

Portion size appears to be the new food related hot topic in the media these days. As much as I have "enjoyed" learning a tremendous amount about the poor QUALITY of the processed food we are consuming in this country I am glad the focus has shifted to QUANTITY. Many times when I am out to dinner I am awe-struck by the huge portion sizes that we are all consuming. At any given meal at a restaurant we are most likely satisfying a large proportion of our daily calorie requirement (approx. 1500-2000 calories/day). Now that I have become more conscious of my nutrition choices, as I strive to live by my own advice, I have begun to wonder why portion sizes have become so large as well as why we all clean our plate most of the time.

One of the main lessons I have learned by delving into this nutrition world is that half the battle, if not more, is psychological. The whole concept of "Super Size" started in the fast food arena but it has quickly expanded into the whole food world (except those expensive French restaurants that give you a few fork fulls and leave you hungry). The etiology of increasing portion size stemmed from the fact that we all theoretically have a "fixed stomach" so we can only consume about 1500 pounds of food per year (I would bet this number is much higher now). Based on this concept the rate of growth of the food industry would only be 1% per year, which was not tolerable to Wall Street. Therefore, the food industry had to find a way for people to either consume more food or spend more money on the same food. The obvious choice was the latter.

Since the vendors and manufacturers understood that psychologically people may feel self-conscious about going for seconds they increased the size of the portions at a small cost to the consumer. For example, at a movie it is always tempting to get the Medium or Jumbo Popcorn and/or soda for only 25 cents more despite it being much more than we originally desired. It is not hard to fathom that this extra 25 cents/customer over the tens of thousands that see movies/day adds up to a nice sum of money. The fascinating point is that despite this larger popcorn or soda being more than we initially anticipated consuming most of us will finish it all. We tend to finish whatever food/drink is in front of us because we paid for it so we don't want to waste it and it temporarily makes us feel good (remember the release of serotonin and dopamine in response to sugar). The portion size issue goes way beyond restaurants and movie theaters since even the pre-packaged foods we purchase are misleading when it comes to quantity.

The New York Times recently ran a story about the FDA weighing in on the issue regarding serving size. The FDA wants to encourage manufacturers of food to post vital nutrition information, such as calories, on the front of boxes to better inform consumers but this highlighted the long standing issue that serving sizes are way too small. Therefore, the calorie counts that go with a specific serving size are misleading. For example, one serving size of a pre-packaged muffin may be half a muffin or one serving size of Tostitos may be 6 chips. Now, who eats only 6 chips! Most of us probably eat 1/4-1/2 a large bag of Tostitos which could be almost 1,000 calories (1/2 of a days requirement). This extends to the problem of childhood obesity because one serving size of cereal may be a reasonable 150 calories but the problem is that one serving may only be 3/4 a cup of cereal. In reality, children are most likely eating 2-3 servings of sugar cereals for breakfast. The classic example is the bag of chips or cookies that are so proud in stating they are only 100calories but in reality the whole bag may be 150 calories in total. The article elucidated the point that an inaccurate serving size makes people think they are consuming fewer calories than they actually are which may end up hindering their health.

There are so many barriers to remaining healthy these days. I am hopeful that as these issues continue to come to the forefront on a national level there will be positive implications for the health of this country. However, in the meantime we all need to educate ourselves and strive for our best health.

Over the last few weeks I have been focused on controlling the quantity of food I consume. One crucial step, as we discussed above, is to read the labels on food products with a focus on serving size so we are aware of how many calories we are consuming. Another approach I have taken in restaurants is to separate a "reasonable" amount of food for the meal and aim to take something home as leftovers. I am reading a fantastic book right now called "The End of Overeating" by David Kessler, MD who is a former commissioner of the U.S. FDA and his recommendation is to eat 1/2 of the usual amount at a meal and if you are satisfied for 4 hours then that is sufficient. If not, then next time try to eat 3/4 of the usual amount and so on. He states that a full meal should keep you full for about 4 hours and a good snack should satisfy you for about 2 hours.

I imagine that eating a smaller amount of a highly processed food is better for our health than eating a lot of that same food. However, as we all know this is much easier said then done.

If you have any useful tips to pass on to other readers please comment below the entry. Also, if you have not done so you can sign up for email updates and as a "follower" of the blog at the top right corner.

It's Good To Be Green

These days there seems to be a continuous message about the importance of "going green." While "going green" may be crucial to preserve our external environment it may also be paramount in conserving our internal environment. We have always heard about consuming adequate volumes of our GREEN vegetables to maintain iron and folic acid levels but there is also a GREEN beverage that has shown some health promise-Green Tea. As I have stated before in this blog, the premise of my writing these entries is a doctor taking his own advice. Since I have been trying to substitute green tea for coffee over the last year or so, not always successfully, I figured it was time to review the literature and pass it on to you all.

The last entry focused on supplements, specifically Vitamin D and omega-3 fatty acids, that have shown proven benefit in clinical trials and from my literature review green tea also has demonstrated impressive health results. After all, as I have alluded to before it is expensive to maintain our health these days so we only want to invest in products that are evidence based.

Green tea's health benefits are primarily based on its rich content of flavonoids, specifically catechins and their derivatives. Epigallocatechin-3-gallate (EGCG, since I refuse to type out the long version again in this entry) is a potent anti-oxidant (similar to Vitamins C and E) which scavenges free radicals in the body. Free radicals are basically a result of stress on the cellular level that can destroy various tissues in the body and lead to harmful conditions such as cancer, heart disease and diabetes.

Over the last few years some of the major medical journals have covered this green tea story. In 2006 in the European Journal of Clinical Nutrition a published study found that green tea is healthier than any other beverage, including water, because not only does it rehydrate but it also contains a rich supply of polyphenols protective against heart disease. Additionally, a 2006 Japanese study in JAMA suggested that drinking green tea lowered death due to all causes, including cardiovascular disease. That is pretty significant!

I am currently overwhelmed by the amount of research on green tea as I try and squeeze the pertinent information into this entry which is intended to be a quick read. Some other benefits suggested include lowering LDL (bad cholesterol), preventing blood clots, protecting the heart and brain during acute attacks (myocardial infarction and stroke), protection against cancer, weight loss and control of diabetes. As a physician and human being I am interested in all of these but I will focus on weight loss and diabetes since this is my career path.

We have previously discussed the importance of avoiding insulin spikes throughout the day to prevent weight gain. This is primarily achieved by eating frequent small meals that are high in protein and less simple sugars (processed foods). Well studies have shown that insulin is more effective in lowering blood glucose in the body when the diet is supplemented with green tea. For example, in a study whereby one group of rats ate a diet rich in high fructose corn syrup and the other group had the same diet but with the addition of green tea over 12 weeks it was found that the group with green tea supplementation had lower blood glucose, lower blood pressure and lower insulin levels than the other group. Maybe I should have been drinking green tea with my burgers and fries all these years!

It is only recently that I learned the difference between good fat and bad fat by working on a research project. Most of us have heard about the apple shape versus pear shaped obesity in terms of risk factors, or the term "skinny fat." The apple shape essentially means a high amount of abdominal fat (visceral fat) which is more metabolically detrimental because there is more turn over of cholesterol and higher insulin resistance. Actually peripheral superficial fat (the thighs, butt, arms, etc.) are protective because they serve as a cholesterol depot which means that there is a lower amount of fat circulating in the blood that can cause heart attacks, etc. Green tea has been shown to not only promote overall body fat loss, but specifically visceral fat (the most risky).

As any good doctor should do I must provide some warnings about consuming green tea. Green tea may lower the absorption of warfarin (coumadin-a common blood thinner), pseudoephedrine and codeine. Also should be cautious in those with iron deficiency anemia and limited in the first trimester of pregnancy. If you require high levels of caffeine to function then you will need to consumee double the green tea than coffee since there is about 1/2 the caffeine, although you will be very well hydrated and healthy! All this information is available on-line if you have further concerns.

I have thoroughly enjoyed writing these entries as I am learning valuable information through this process. Please continue to spread the word if you are enjoying and encourage people to sign up for email updates. Hopefully we can make an impact on the health of others through continuing to learn and educate.

The Verdict Is In, For Some.

Some simple math to start. "Nutrition" + "Pharmaceutical" = "Nutraceutical. A nutraceutical is defined as a food or food product that provides health and medical benefits, including the prevention and treatment of disease. Hippocrates, thought to be the father of Western medicine said, "Let food be thy medicine."


It is nearly impossible to walk the streets or malls of any major city and not come across a Vitamin Shoppe, GNC or some other supplement type store. The nutraceutical industry in the US is about $86 billion with nearly 2/3 of Americans taking at least one type of nutraceutical health product. When I recently walked into one of these stores to buy some recommended supplements for my morning protein shake the amount of inventory was overwhelming. Amino acids, probiotics, vitamins, etc. filled the shelves from floor to ceiling. This is clearly an industry on the rise but I wonder if this is money well spent.

Over the last year the news has been dominated by the struggling economy with the resultant unemployment and the debate over health care. I was surprised to read that while the economy has fallen vitamin sales have climbed. A story in the NY Times clearly demonstrated supplement consumers rationale. The people indicated that with higher deductibles or worse no health insurance at all it makes more sense to focus on prevention. Economist Uwe E. Reinhardt stated that he "sees the growing interest in vitamins and herbs as a logical extension of the concept consumer-directed health care." One person noted that he used to spend $50/month on various prescriptions for his chronic diseases but now spends $6/month on supplements. While I would definitely not recommend substituting "traditional" medicines with supplements I have always been an advocate for prevention of chronic diseases.

The argument against alternative medicine from allopathic physicians has always been that there is not enough evidence based research to support many of the claims. Based on this challenge many of these treatments have been and are currently being studied in clinical trials. The verdict is in that Vitamin D and omega-3 fatty acids are beneficial to long term health. These are two supplements that I believe everyone should take as a means of prevention.

Vitamin D is the "sunshine vitamin" because it is synthesized by humans when the skin is exposed to UV-B rays. Vitamin D assists in calcium reabsorption which is crucial for bone strength and thus the prevention of osteoporosis (thinning bones). It is additionally thought to strengthen the immune system and may prevent against high blood pressure, autoimmune diseases (such as multiple sclerosis and psoriasis) and may defend against certain cancers. The majority of people in the US have been found to be Vitamin D deficient either due to the Western diet, sunscreen (doesn't mean you shouldn't wear it) or the long winters. Based on this trend most primary care physicians are checking Vitamin D levels routinely and recommending 1000-2000 units of Vitamin D3 (not D2) per day as maintenance. Please ask your physician to check your level next time you get blood work.

Two essential omega-3 fatty acids are EPA and DHA which are present in cold water, oily fish (salmon, mackerel, herring) or in fish oil supplements. EPA has been found to be heart protective while DHA is beneficial to support the nervous system (brain function/development). Inflammation is major component of most chronic diseases and omega-3 fatty acids work to down regulate this process that can cause strokes, heart attacks, cancer, etc. Fish oil is very effective in regulating high cholesterol and this is certainly something to have tested by your primary care physician on an annual basis.

As a homework assignment I would recommend learning your Vitamin D level and cholesterol panel (LDL-"bad" and HDL-"good". Consider starting on the above mentioned supplements which I have done recently in order to continue to take my own advice. There is still debate about the benefits of antioxidants, probiotics, etc. but I will keep you posted.

Please comment about personal experience with various supplements and sign up for email updates (top right corner) if you have not already.

You Got The Right One Baby, Uh-NO!

Beverages were let off easy in this whole obesity epidemic for a long time but now they seem to have been brought to the forefront. A few years back I heard that if someone gives up 1 soda per day for a whole year they will lose something like 10 pounds. That seemed like a relatively large change for what seemed like a simple challenge. The reason for this large weight loss by eliminating regular soda from the diet is primarily high fructose corn syrup. We have pounded (pun slightly intended) the point home about the metabolic derangements from consuming high fructose corn syrup in previous posts so I will leave that alone. However, I had previously turned my head to the calories in juices, punches, sports drink, teas, etc. that I believe also make a tremendous difference as far as calorie consumption. I remember coming home from a long day of school and chugging a huge glass of Gatorade fruit punch even though I had not worked out which in the long run probably didn't do me much good. I certainly didn't need to replete my electrolytes from sitting in class all day. A study published in Obesity Research in November 2007 concluded that over the last 37 years our calories from beverage consumption have increased by 94% which amounts to 222 additional calories from beverages daily. This adds up to about 1 full day of eating per week. This begs the question, what about diet drinks (low to no calories)?

I always loved how people, myself included, go to McDonald's or some other fast food restaurant and order a huge greasy meal but order a diet soda. How does that work psychologically? Maybe we feel that it is OK to eat that triple Angus burger (or whatever the latest menu option) if we order a diet drink. I guess it is similar to drinking a regular soda or eating some sweets after working out. It is natural to always rationalize our intake. There is definitely psychological implications for choosing a diet/low calorie beverage but are there metabolic ramifications?

A study from Purdue University was published in the journal Behavioural Neuroscience that investigated the role of sweeteners versus real sugar in calorie consumption. The researchers determined that sucrose (real sugar) trained rats that were given a high-calorie chocolate pudding treat made them eat less afterwards whereas the saccharine (artificial sweetener) trained rats showed less restraint in what they ate next. The rational behind this difference is that our body uses the combination of calories and sweetness to regulate intake and when the two do not match up we tend to look for extra calories. Basically, diet beverages are sweet but don't match up in calories so our body sends us on a search to match up the calories with the sweetness until we feel full. Therefore, it seems that drinking a diet beverage by itself will tempt us to eat a high caloric food in conjunction.

Despite all these great new options to hydrate our bodies it seems that the good old fashioned H2O is the best. In addition to being the best way to remain hydrated it also is useful in maintaining calorie consumption within normal range. Many times when we feel hungry it is actually thirst. A natural response to dehydration is for our body to crave salty foods since excess salt causes the body to retain fluid. Therefore, when I have felt hungry on these long 12 hour shifts in the mid afternoon I have been drinking a bottle of water (thinking I am most likely dehydrated) and this has been satisfying.

To conclude I will quote from an email comparing water and coke that I received last week.

Water:
75% of Americans are chronically dehydrated/even mild dehydration will slow metabolism by 3%/lack of water is the number one trigger for daytime fatigue.

Coke: highway patrol carries 2 gallons of coke in the trunk to remove blood from the highway after a car accident/put a T bone steak in a bowl of coke and it will be gone in 2 days/to loosen a rusted bolt apply a cloth of coke for several minutes/the active ingredient in coke is phosphoric acid which can dissolve a nail in 4 days and is one of the leading contributors to osteoporosis.

I have basically eliminated soda from my daily routine for the last 6 months. Not sure if that has made me feel better but when I take a sip of a soda now it doesn't taste as good as it use to. Give it a shot.

Cycle for Survival

Cycle for Survival is a fundraising event to raise money for rare cancer research through Memorial Sloan Kettering. My sister-in-law put together a team to participate in this amazing event since she has battled a rare cancer called sarcoma (thankfully she is doing great!) and fortunately I was a member of this team. A special thanks to Laurie for her effort and passion in building our team of Laurie's Laughter. Our team raised about $7,000 and the total NY event raised $2.2 million. The event took place at Equinox gym and was a 4 hour event consisting of 4 spin sessions. With the music pumping throughout we all pushed ourselves physically to represent either ourselves or our love ones who have battled one of these diseases. In essence, I guess these fundraising events that are based on a strenuous physical task are to symbolize the battle many people fight to rid the cancer from their body. I was thinking about all the different fundraising events such as AIDS walk, the breast cancer runs, walk for mental health, etc. and wondering why all these events were based on a physical tasks. As I was becoming physically exhausted as I cycled against the resistance to reach the top of the metaphorical hill the symbolism became clear. In life, when we face any struggles with health there are both physical and emotional barriers that challenge us. At times it may be easier to give up but I think most people really find the passion to fight which is admirable. In the end, no matter how many people we have behind us, our health is a personal issue.

When I completed my portion of the cycle event I walked into the cheering area. I use the word walk but it was more of a drag, my legs felt like jello. Anyway, the cheering area was filled with all types of food and beverages. There were your classic foot long sandwiches, bins of yogurt, sports protein bars, bottles of water, sports drinks, etc. Of course, as a nutrition blogger (ha!) I began thinking about what are the best types of food to eat before and after exercise. Since I wasn't entirely sure of the correct answer I reviewed some literature when I got home and learned some of the following information.

Prior to exercise it is best to eat/drink carbohydrates (fruit, juice, pasta, crackers...). This is because the body digests carbohydrates much faster than protein and prefers to use carbs as fuel. If you are going to eat protein prior to exercise it is advisable to wait at least a few hours to allow the body time to digest. If you exercise prior to the majority of the digestion process you are likely to experience cramps since blood will rush to the GI system for digestion rather than the muscles that need them during exercise. For some reason I use to think that working out on an empty stomach was better, however, this makes little sense since the body needs fuel for physical activity. Additionally, working out on an empty stomach can cause nausea and lightheadedness due to hypoglycemia (low blood sugar). Another important factor in preparation for exercise is hydration. It is crucial that the body has enough water stores during exercise to prevent hypotension (low blood pressure-with severe dehydration), cramping, lightheadedness, headaches. The body needs volume to perfuse the tissues and if this volume is low, as with dehydration, side effects will occur. I would recommend drinking about 16 oz. of water prior to exercise and sipping water throughout. I did this prior to the event yesterday and I think it definitely helped while I was "climbing that mountain" on the stationary bike.

As far as after the work out, back to the cheering area. After exercise a meal with a balanced mix of carbs, protein and fat is optimal. Carbs are useful to replace the energy stores (glycogen) that had been depleted during exercise. Protein is important to help rebuild muscle. The best beverage remains water unless the work out was more than 1 hour at which point a sports drink is useful to replete electrolytes. Based on these points a whole wheat foot long turkey sandwich would have been a great thing for me to eat. However, while I was there I figured this would have been less than optimal. Oh well, next year! Sports bars are also good post exercise but make sure to check the calories. The sports bars they had were more like a meal replacement, 440 calories, so unless you are actually using it as a meal replacement I think I would go with something with less calories.

I have thoroughly enjoyed the process of writing this blog for the last week or so. I have learned a lot by thinking about these various nutrition related issues. I have become more vigilant in my daily life as I search for new and hopefully interesting topics. I hope you as readers are learning and enjoying these entries. Please continue to pass the link on to your friends and family if they may be interested. Also, encourage them to sign up for email updates and as "followers." You can also comment at the bottom of each entry.

Process This!

A multiple choice question to get us started.

Which of the following industries produce a product that contains many harmful ingredients and is meant to fuel addiction?

a)the tobacco industry
b)the food industry
c)both a and b
d)none of the above

The correct answer is C. Recently, the American public has come to realize that the food industry is in many ways the big tobacco of this generation. While we still continue to see many health related consequences of tobacco (lung cancer, heart disease, etc) we have launched a somewhat productive battle to educate people about these hazards. Now is the time to launch a full blown educational program about the inner workings of the food industry that will hopefully enable us to reverse the current trend of obesity. Journalists such as Michael Pollan and Eric Schlosser have done an incredible job of bringing this issue to the forefront with books such as "In Defense of Food" and "Fast Food Nation" as well as a powerful documentary that I highly recommend- "Food Inc." I have found that some background into this issue has helped me to understand the obesity epidemic and the manner by which I can enact personal change.

In the election year of 1970 Nixon worried that the farm vote was wobbling due a plummeting in farm income. The farmers had not planted enough crop and the cost of farming had soared. In order to combat this problem the government began to subsidize corn as a mechanism to produce more food at a cheaper price. The capability to grow a tremendous amount of corn turned this food into a commodity and the food industry was born. While this idea initially worked, many now believe that this solution has created our current problem. The World Health Organization has stated that processed foods are to blame for the sharp rise in obesity and chronic disease around the world.

Processing plants are also called wet mills. Their function is to turn one bushel of corn into the building blocks for companies like McDonald's and Coca-Cola. Chemists have learned how to break down long chains of carbohydrate molecules into 100's of different organic chemicals. Some few of the main products of the processing plants are corn meal, corn starch, corn syrup,...The prototypical processed food is breakfast cereal because for 4 cents of commodity corn it can be sold for $4/box. Corn is also in soda (100%-high fructose corn syrup), salad dressing (65%) and chicken mcnuggets (52%, along with 37 other ingredients).

Dr. Robert Lusting, an obesity expert, called processed food "toxic" because it is loaded with sugar and alters the bodies hormonal balance. Additionally, it creates an addiction to food since the high sugar content causes a spike in insulin and thus dopamine (a neurotransmitter that is associated with pleasure). One of the reasons that simple carbohydrates (white bread, white cookies, etc.) cause weight gain is that the high sugar content causes insulin spikes which essentially tells our body to store fat.

One last point to hopefully bring it home. I have read about the French paradox which asks, "how could a people eat such demonstratively toxic substances such as foie gras and triple cream cheese actually be slimmer and healthier than we are?" I think the answer is that they eat "whole" food, not processed foods.

I have come to actually enjoy when I read a label and I know (and can pronounce) all the ingredients. These are the foods I am trying to consume. Try reading the labels of everything you buy in the store, including beverages, and this will make a difference in your long-term health and well being.

9 AM to 9 PM

Life is constantly moving whether we like it or not and with this constant flux there is a vulnerability to stress. I have always liked the "coincidence" that when you separate the word "DISEASE" you get "DIS-EASE" which essentially means under stress. Since I have just started 2 weeks of a 9-9 hospital schedule I thought it would be appropriate to review how stress will effect my metabolism as well as the tools I can use to avoid any long-term effects.

The primary hormones involved in the stress response are cortisol, norepinephrine and epinephrine. We all learned of the flight or fight response in high school, etc. but how often do we actually think of it in terms of our overall health. There are many situations that elicit an increase in these hormone levels, many of which are warranted, but if we are under constant stress these can have serious long-term effects. A few of the ramifications of a sustained elevation in cortisol include high blood pressure, diabetes, stroke and osteoporosis. A large component of these medical illnesses is based on the fact that cortisol increases our visceral fat (abdominal fat) which is much more harmful than peripheral fat (arms/legs).

A change in our daily routine can disrupt our usual nutritional intake. With my change in schedule for the next 2 weeks I will usually be busy and may not have much time to sit down and eat. In order to prevent acute elevations in my cortisol level I will need to plan appropriately to keep my metabolism in check. This is similar to when we are traveling or running for work, etc.

Long periods of time without eating essentially creates stress for our body. We have discussed the hormones ghrelin (stomach growling hormone) and leptin (I'm full hormone) in previous posts and it is important to eat frequent/small meals to keep these balanced. Additionally, when our blood sugar drops due to not eating we get a surge in the production of our fight or flight hormones. Studies have shown that both humans and animals with elevated cortisol levels prefer to consume foods high in sugar and fat which is what we have talked about avoiding in excess. Therefore, by having a well thought out plan prior to potential stress induced schedules we can make an impact on our health. For example, by bringing a bag of almonds (good source of energy) or packing a healthy lunch (rice cracker with hummus or hard boiled eggs) for the day we can be prepared to eat quickly if needed. It will be beneficial to think of a few fall back meal menus that we can rely on throughout the week.

There are countless means to reduce stress but I think that has to be an individual decision. It is kind of like a doctor recommending diet and exercise, it is not that much help without details and a good plan. Activities such as breathing exercises, aerobic/anaerobic exercise (jogging/weight lifting), hobbies, etc. are all good options. Try these out and see how they work for you.

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Information Overload

Facebook, Twitter, email, text messaging...We are living in a world where information is now at our fingertips more than ever. The ability to process all this information into meaningful material is a challenge. A criteria for success now and in the future will be the ability to multi task. I have heard the phrase "mental obesity." Well, maybe the onset of "mental obesity" has contributed to "physical obesity" as we know it. A few recent statistics since numbers usually make an impact. Currently, the annual cost of obesity costs 10% of health care spending (about $147 billion). American adults who are obese has increased 140% over the last decade. We have the information but we need to turn it into knowledge.

There is an overwhelming amount of information out there telling us what we should be eating, where we should be eating, how we should be eating, etc. As a physician, I am constantly trying to decipher what the best information is for me and my patients. Should I be following The Atkins Diet, The South Beach Diet, The Mediterranean Diet, or Eat Right for Your Blood Type? In the mail yesterday I received 3 different medical journals with multiple articles comparing different diets and discussing the medical management of obesity with medications. It continues to remain unclear. The problem is that most physicians still are not confident in their ability to counsel about weight and even when we are there are many barriers to do so which include reimbursement, lack of time, etc. It is up to all of us to make sure our physicians calculate our body mass index (Based on weight and height) and we ask questions to encourage the discussion. We must find the best approach for us as individuals.

Since I started on this journey to really live by own advice last week I have been focused on eating a higher amount of protein and less carbohydrates (a modified Atkin's diet). I was pleased to read a study in the Archives of Internal Medcine yesterday that a low carbohydrate diet had similar effects on lowering blood sugar and cholesterol as a Low-Fat Diet Plus Orlistat (AKA Alli, weight loss medication that reduces fat absorption in the gut-->lower calorie intake). Additionally a low carbohydrate diet was more effective for lowering blood pressure. I find it has been productive for me to read the back of food labels for carbohydrate counts. My current goal is 20-40 total carbs/day (Total carbs-Fiber= "bad carbs"). One fundamental problem with all these diets (I don't like that word) is that the weight loss is not sustained. I believe it is OK to use some of these approaches, even medications, at the onset of a desired change but we need to focus on a lifestyle regimen that we can maintain or what is the point.

My goal is that we can all continue this discussion and work to instill real positive lifestyle changes. It is possible that this discussion will prevent a heart attack, a stroke, diabetes, etc. If you haven't done so already please subscribe for email updates and sign up as a follower of this blog. Also, I would love to hear pertinent stories and comments about these postings.

Thinning Sleep

We have all heard of beauty sleep. Is there such a thing as thinning sleep? While I was working overnight at the hospital I was wondering if a disruption in circadian rhythm may effect metabolism or how lack of sleep may attribute to weight gain. During these "graveyard shifts" I have noticed that there is always tons of junk food in the nursing stations and I tend to crave sugar. It is possible that we crave sugar both at night and during the day to keep us awake. We have all been known to experience an energy crash in the mid afternoon which triggers a trip to the coffee and sweet stand. Recent research has identified two important hormones that appear to play a role in the association between sleep and metabolism.

Ghrelin is a hormone that is produced in the gastrointestinal tract. It is the culprit for our stomach growling to notify us of hunger. It turns out that lack of sleep, or even restless sleep, increases our levels of ghrelin hormone throughout the day. Studies have shown that people with ineffective or lack of sleep have higher circulating levels of this hormone and tend to consume more high density carbohydrates. Therefore, they tend to be more overweight. We all know if we get less than 7-8 hours of sleep but many of us don't know if we have sleep disorders that effect our quality of sleep. A common sleep disorder is obstructive sleep apnea that is basically a cessation of breathing multiple times throughout the night due to relaxation of the neck muscles that protect our airways. This is a known risk factor for not only obesity but also heart and lung disease. People that snore heavily, have large necks or are overweight may have obstructive sleep apnea. This can be diagnosed with a sleep study and is a treatable disorder.

The other hormone of interest in this area is called Leptin. Leptin is produced by fat cells that are responsible for telling us when we are full, essentially the opposite effect of ghrelin. Interestingly, levels of circulating leptin have been found to be lower in people that are not well rested. Therefore, they can eat more without feeling the sensation of fullness. We are all starting to hear about insulin resistance as a cause of type 2 diabetes, well, now there is discussion about leptin resistance. This may be your first introduction to leptin but it is certainly something that you will hear more about in the future.

With all of life's stresses it can be very difficult to slow down our minds and bodies at the end of the day to ensure a restful nights sleep. Things such as breathing exercises, avoiding caffeine late in the day, and good sleep hygiene may help us to get the sleep that we need to keep our metabolism in check.

Thank you for all the positive feedback so far. I have added a new feature at the top right corner where you can subscribe to receive email updates with new entries.

The Power of Reinforcement

Wii fitness has revolutionized exercise. Prior to the Wii there were obviously work out tapes, etc. but the interactive element of the Wii takes it to a whole new level (I am not on the payroll of Nintendo). I first stepped onto the Wii fitness exercise console 9 days ago when it told me I was slightly overweight and much older than my actual age, really? Well, this triggered a reaction which spurred this lifestyle change and the decision to actually follow my own advice as a physician. This morning I stepped on again and was given positive reinforcement. I lost a few pounds (probably mostly water weight) but this has obviously encouraged my change in behavior. I have heard that people that weigh themselves regularly tend to stay within a more narrow weight range. It makes sense that having objective data will change our behavior. I guess ignorance is not bliss when it comes to our health. A great feature is that the Wii fitness tells you how many calories you have burned with a given exercise similar to a treadmill at the gym. One problem may be that many people do not know how many calories they should be consuming a day or how many calories there are in certain foods. Hopefully, this will change when more restaurants put their calorie counts on the menu which has been encouraged by health care professionals.

Hearing nutrition experts, friends and patients tell success stories it is clear that this is about changing an unhealthy lifestyle that may have been ingrained in many of us since we were children. The overwhelming data on childhood obesity elucidates this point. The negative connotation of the word "diet" is something that I have tried to avoid in both my own mind and when I discuss necessary changes with others. A nutrition education based on the psychology and physiology of food will certainly enable us to make more conscious decisions.

Moderation is key. Last night we had some friends over for dinner and it was clearly going to be difficult to avoid a bolus of sugar (spaghetti, wine, cheese, cookies...) so I focused more on portion size which is probably just as challenging as making healthy food choices. This morning I woke up feeling a little less light and energetic as I had during the previous days when I had eaten a protein for dinner. Although, had I eaten as much as usual I probably would have felt worse. Maybe this will serve as another element of reinforcement.

Please share your stories in the comment section so we can all benefit together. Questions and ideas for other topics are definitely encouraged.

All You Can Eat

The direct relationship between cost and quality of food has become more apparent to me over the last few months, specifically through my interest in food politics and obesity, but as I have attempted to live by my own advice over the last 48 hours it has become crystal clear.



Since I was a child I have heard the importance of eating a good breakfast, mostly from my dad who loved the analogy "the body is like a car, it needs fuel." My protein shake with a water base wasn't thick enough for my satisfaction and separated easily so I ventured out to the health food market for some almond milk. Go figure, all the foods I knew I should be eating were right there in that small store-almond butter, hummus, tuna fish, etc. At the start of a lifestyle change I think it is a good idea to check out one of these health food markets and stock the house with "good" snack food. One of my observations at this store was that the price of these items were much more expensive compared to your average grocery store. It is no wonder that there is a direct correlation between socioeconomic status and obesity. It is difficult to obtain fruits and vegetables in poorer neighborhoods and for the same $1 a family can buy 800 or so calories of junk food versus 200-300 calories of vegetables. Processing makes food cheaper because cheap corn results in cheap high fructose corn syrup. Thankfully, many obesity experts are aware of this and there has been a movement to bring farmers markets with healthier options into poorer neighborhoods that even take food stamps.



During these tough economic times we all want to get our moneys worth. We ventured out to an all you can eat and drink sushi restaurant last night with some friends. Even as I write "all you can eat" my immediate association is stuffing my face at a rapid rate. Our previous experiences with food have conditioned us to respond consistently to a given environmental stimulus. A buffet would be another example of a setting whereby we pile and pile food onto multiple plates to get all the value we can for our money. My natural inclination at this restaurant where you have 2 hours to eat as much as you can was to eat quickly. However, I tried to slow myself down to really enjoy the food (which actually tasted a little soapy for some reason) and so I could experience the fullness. One way to trick the body into eating more is too eat quickly because it takes time for the hormones to kick in to tell you that you are full. That is why I will be focusing on eating slowly and chewing every bite to entirety prior to taking another one during this "live by my own advice" process.



Food is much more than nutrition. We all have a relationship with food and sometimes relationships can be destructive. I will continue to evaluate this dynamic as I go through this process.



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