Chronic disease is exactly that, chronic. Therefore, a diagnosis of any "chronic" disease is a life-altering circumstance. I spend the majority of my days doing my best to take care of patients with diabetes (among other conditions such as thyroid disorders, pituitary disorders, etc...). It is not uncommon for myself, as well as other physicians, to characterize a patient as non-compliant. Essentially, this means that the patient is not following the physicians recommendations. Many times, these patients' condition is not controlled due to barriers that are preventing their success, such as depression, lack of dedication, poor insight into the disease, failure to adjust to the change in lifestyle that comes with the condition, or denial about long-term health consequences. Addressing these barriers will hopefully facilitate future success in preventing complications. In an attempt to live the life of one of my patients I recently wore an insulin pump for 72 hours; this was an extremely insightful experience!
The hours leading up to the insertion of the insulin pump, which is a small catheter underneath the skin (smaller than an IV) connected to a reservoir of insulin (for me it was saline), was surprisingly nerve racking. I was uncertain what it would feel like physically and emotionally to be connected to this device. What would it feel like to check my own blood sugar? To actually go through the motions of counting carbs to figure out my correct "insulin" dose? My co-Fellow and I met with the Medtronic rep who walked us through the information of how to use the pump...basal/bolus settings/adjustments, etc. Already I had learned a lot, and felt better prepared to treat my patients, and the pump wasn't even inserted yet. Next, the pump was inserted underneath my skin. It was basically painless...in a geeky short of way, I was actually excited to go through this exercise.
It was late afternoon, a few hours since the pump had been inserted, I started feeling hungry and sensed that maybe my blood sugar was running low (I have been told I get "cranky" when this happens). I scrambled to grab my supplies to self monitor my blood sugar for the first time (this means taking a lancet and pricking my finger and using the blood to be read by a machine, for those of you not familiar). Since I had never done this on myself before, I failed miserably...At first not enough blood, then the finger at the wrong angle. Whew, I finally got it. I was relieved that my blood sugar was in the normal range. I can imagine that over time this may get easier to do, but also may become harder (both emotionally and physically). Off to dinner I went...
The menu arrived and I picked out my appetizer and main course. I subsequently pulled out my carb counting book. Wow, that is a lot of carbs I ordered. I figured about 130 carbs, so I programmed the pump to give the correct units (somewhere around 10 units). It felt like I was giving myself a lot of units, despite the fact that many of my patients are on much higher amounts of insulin. I wondered how my patients feel as they go through this process of checking their blood sugar prior to eating at a restaurant and then have to time the insulin appropriately to cover the meal. I imagine everyone probably has their own routine (go into the bathroom at a certain point, etc...). So far I was off to a decent start. I was determined to keep up my "compliance."
Prior to bedtime I struggled to successfully check my blood sugar again, I just need some practice I guess. Oops, I forgot to log into my blood glucose book. This is the finger stick diary that we rely on patients to bring to their appointments so we can adjust their blood sugar (the machine and newer devices work well, too). Changing for bed, without getting into too much detail, was slightly challenging with the plastic tubing but I eventually figured it out.
Prior to working out the following morning I set my temporary basal rate, which made me feel proud that I had done as I was taught. I think doctors tend to have a type A personality and probably obsess about doing well in tasks, maybe this is no different. Although, it is common to hear that doctors are generally not always the best patients. I wonder what characteristics are common in "good" patients, or are there a set of unifying traits?
The last 36 hours of my social experiment to live the life of one of my patients went relatively smooth. I settled into the role and at times forgot that I was attached to the pump, except when I ate and gave myself the "insulin" dose. I had some powerful interactions with patients during these days. I showed 2 of my patients who currently have uncontrolled diabetes that I was wearing the pump, and they were amazed that I was going through the process of checking my finger sticks as well. This opened up a discussion about what it felt like to be wearing the pump, what it is like to sleep with it on and remove it prior to a shower, and so on. I know for sure, that one of these patients is in the process of being set up for a pump which will ideally improve her diabetic control and hopefully prevent long-term complications of this chronic disease.
I like to think that I always have respect and empathy for my patients, however, I now have a whole new perspective. I now know what it feels like to wince prior to checking the blood sugar in anticipation of the needle stick, the feeling of people looking at you as you read your carb counting book in a restaurant, and continuously feeling that in order to take care of yourself requires a lot of work and commitment.
While the diagnosis of a chronic disease certainly requires a new dedication to an individual's health, preventing chronic conditions (at least those that are preventable) also takes motivation.
As we approach 2012, it is inevitable that most people will have a New Year's Resolution that entails a health related goal. For those with a chronic disease, keep working to gain the best control possible by eating right (e.g. low salt for hypertension, or less sweets for those with diabetes), increase physical exertion (for everyone), and discuss any barriers that you may be having with your physician.
I realize it has been almost a year since I have written an entry, it has been tough to be compliant! Twitter has been the downfall to these entries, much less time consuming to tweet. Hope you got something out of this, I certainly did.
Happy and Healthy to everyone!
Monday, December 26, 2011
Saturday, January 29, 2011
Recipes for Longevity!
Fresh and inspired from a trip to two of the must see world destinations-The Galapagos Islands and Machu Picchu! During our trip several fellow travelers mentioned these as being on their "bucket list," essentially places to visit before they die (for other examples see the movie with Jack Nicholson and Morgan Freeman). Of course, the topic of creating a "bucket list" got me thinking about life expectancy. Typically diet, exercise and genetics are the focus when discussing longevity in our society. I wondered about the longevity of the species in both these "bucket list" places.
The Galapagos Archipelago contains a fascinating array of species, mostly studied and classified by Charles Darwin. Birds, reptiles, fish and mammals all coexist in an ecosystem that is magical to observe. The process of evolution is clear-everything from the mating techniques to the diet. Swimming with sharks, watching the sea lions play in the sand/water and observing the various birds (blue footed boobies, frigates,etc.) are experiences that I will always remember but it was the tortoises that were most intriguing for me based on their longevity.
A Galapagos tortoise has a life expectancy of over 100 years with some living for 170 years! Of course I questioned why tortoises outlive humans, even by a lot, when we humans have the benefit of extensive medical knowledge and resources. Our naturalist guide told us that tortoises can slow their metabolic rate when needed and their heart may only beat a few times over 10 minutes. They are herbivores that feed on primarily cactus, vegetation and berries. On wetter islands they are found in herds (good social support) and on the drier islands they can go up to 18 months without food and water by breaking down fat to create water. Interestingly studies of human centenarian hot spots, called Blue Zones, demonstrate that those that live the longest have a plant based diet, a strong investment in family, and consistent low-intensity activity-sounds similar to the tortoise existence. The message is clear, a focus on lifestyle can help prevent chronic disease (not always) and taking a multitude of medications may only be putting a band aid on the underlying issues (poor diet, stress, etc). The lessons for longevity from the animals of the Galapagos Islands were further confirmed as we traveled through the gorgeous landscape of Peru.
Everyone who has visited the mountains of Peru, specifically Machu Picchu, have similar comments about it being a spiritual and magical destination and I am in total agreement. After reaching the top of one of the Inca ruins (about 11,000 feet above sea level), our tour guide stated that Inca's usually lived over 100 years of age. The Inca civilization reached its apex in the mid-late 1400's so surely they didn't have access to the medical treatments we have today. Again, I wondered why these people outlive many humans today in the 21st century. While reviewing some of the characteristics of the centenarians in the blue zone areas it appears that purpose and hard work are important characteristics in longevity.
The Inca people lived, and live, an existence rich in symbolism. It is impossible to walk the streets and explore the ruins without identifying the main symbols of this culture. The main symbols are the lama, puma, snake and condor. The lama signifies an unconditional love of service-the Inca people use its wool, meat and milk to survive. The lesson of the puma is passion to be eternally present, essentially to live in the moment. The snake represents a love for wisdom and reminds the people to learn and teach something daily. The condor reminds the Inca people of a will of liberation and spiritual transformation as they glide through the air. These principles remain in the Inca descendants of today. The streets are filled with both men and women in their late 70's-80's (at least) who sell their fruits, vegetables and crafts in markets after usually walking miles to get there early in the morning. I was certainly impressed by the strength and passion of this population.
The lessons I took home from both of this places, and will attempt to practice, are too extensive to try and put into words. My main goals as I return to my reality is to embrace my sense of purpose in society, to work hard at my profession, spend valuable time with friends and families, live in the present (my biggest challenge) and continue to focus on a healthy diet of fruits and vegetables.
I hope this entry was valuable and will help us all add both quantity and quality to our lives.
The Galapagos Archipelago contains a fascinating array of species, mostly studied and classified by Charles Darwin. Birds, reptiles, fish and mammals all coexist in an ecosystem that is magical to observe. The process of evolution is clear-everything from the mating techniques to the diet. Swimming with sharks, watching the sea lions play in the sand/water and observing the various birds (blue footed boobies, frigates,etc.) are experiences that I will always remember but it was the tortoises that were most intriguing for me based on their longevity.
A Galapagos tortoise has a life expectancy of over 100 years with some living for 170 years! Of course I questioned why tortoises outlive humans, even by a lot, when we humans have the benefit of extensive medical knowledge and resources. Our naturalist guide told us that tortoises can slow their metabolic rate when needed and their heart may only beat a few times over 10 minutes. They are herbivores that feed on primarily cactus, vegetation and berries. On wetter islands they are found in herds (good social support) and on the drier islands they can go up to 18 months without food and water by breaking down fat to create water. Interestingly studies of human centenarian hot spots, called Blue Zones, demonstrate that those that live the longest have a plant based diet, a strong investment in family, and consistent low-intensity activity-sounds similar to the tortoise existence. The message is clear, a focus on lifestyle can help prevent chronic disease (not always) and taking a multitude of medications may only be putting a band aid on the underlying issues (poor diet, stress, etc). The lessons for longevity from the animals of the Galapagos Islands were further confirmed as we traveled through the gorgeous landscape of Peru.
Everyone who has visited the mountains of Peru, specifically Machu Picchu, have similar comments about it being a spiritual and magical destination and I am in total agreement. After reaching the top of one of the Inca ruins (about 11,000 feet above sea level), our tour guide stated that Inca's usually lived over 100 years of age. The Inca civilization reached its apex in the mid-late 1400's so surely they didn't have access to the medical treatments we have today. Again, I wondered why these people outlive many humans today in the 21st century. While reviewing some of the characteristics of the centenarians in the blue zone areas it appears that purpose and hard work are important characteristics in longevity.
The Inca people lived, and live, an existence rich in symbolism. It is impossible to walk the streets and explore the ruins without identifying the main symbols of this culture. The main symbols are the lama, puma, snake and condor. The lama signifies an unconditional love of service-the Inca people use its wool, meat and milk to survive. The lesson of the puma is passion to be eternally present, essentially to live in the moment. The snake represents a love for wisdom and reminds the people to learn and teach something daily. The condor reminds the Inca people of a will of liberation and spiritual transformation as they glide through the air. These principles remain in the Inca descendants of today. The streets are filled with both men and women in their late 70's-80's (at least) who sell their fruits, vegetables and crafts in markets after usually walking miles to get there early in the morning. I was certainly impressed by the strength and passion of this population.
The lessons I took home from both of this places, and will attempt to practice, are too extensive to try and put into words. My main goals as I return to my reality is to embrace my sense of purpose in society, to work hard at my profession, spend valuable time with friends and families, live in the present (my biggest challenge) and continue to focus on a healthy diet of fruits and vegetables.
I hope this entry was valuable and will help us all add both quantity and quality to our lives.
Wednesday, August 25, 2010
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!
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!
Wednesday, August 18, 2010
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?
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?
Monday, June 28, 2010
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.
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.
Thursday, May 13, 2010
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...
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...
Monday, April 26, 2010
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.
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.
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