Wednesday, March 4, 2020

Thursday, January 10, 2019

Exercise Will Lengthen Your Life and Prevent Disease – A Good Return on Investment

“Lack of activity destroys the good condition of every human being, while movement and methodical physical exercise save it and preserve it.” (Plato, about 400BCE)

A more modern statement was in Time magazine, 

“… the most effective, potent way that we can improve quality of life and duration of life is exercise. The price is right too.” (Oaklander The New Science of Exercise, Time Health, Sept 12, 2016)

In an earlier article, I discussed nutrition and its importance as the first key in slowing the aging process and preventing late age-prevalent chronic illnesses. The second key is exercise, movement. We are a sedentary population; from bed, to breakfast chair, to car, to desk, to car, to chair for dinner, to sofa for TV and finally to sleep. This is completely different from our recent forebears who were up and about nearly all day long. 

There is good experimental evidence regarding the critical role of exercise in maintaining good health. For example, when a group of mice whose genetics caused them to age prematurely were divided into two groups, one group that exercised three times per week and one group that was sedentary, the results were striking.  At the end of five months the sedentary mice were shriveled, had less functional hearts, a coarse and gray fur, thinned skin and hearing loss. The mice that exercised were healthy, indeed as healthy as normal mice, and despite their genetic predisposition to aging rapidly, they did not. This is another example that genetics need not be destiny.

 “Sitting is the new smoking.” Sitting for long periods (over one hour) is a major risk factor for various diseases, poor health overall and for an earlier death. Chronic sitting increases death rates as much as smoking! Inactivity doubles the risk of general poor health. Just standing up rapidly activates the body systems that control blood sugar, cholesterol and triglycerides. Exercise improves the cells’ ability to respond to insulin; sitting increases the propensity toward insulin resistance (and later diabetes.) In essence the human body needs to move in order for its cellular and metabolic processes to work normally. Sitting has the opposite effect. 

It is well known that exercise is valuable to heart health, that it reduces blood pressure, strengthens and preserves muscle size and strength, reduces blood sugar and body fat. It also preserves and amplifies brain function and size. In short, 

If it were a drug, exercise would be considered a miracle drug for health preservation.” (Austad, S, A Young Field about Growing Older: Six Ways Research Is Changing How We Age, Huffington Post, October 12, 2016)

Only a small proportion of Americans get the recommended levels of exercise per week – 150 minutes of both aerobic exercise (30 minutes five days per week) plus resistance exercises two or three times each week.  What is also important is not to just schedule some time each day – although that is clearly advisable – but all day long to get up and move about at least every hour for five-ten minutes. Remember that exercise improves all body functions, not just muscles. For example, it benefits the structure and function of brain, skin, heart, lungs, even eyes – every part of the body.
You already know that exercise has been well documented to help prevent the most important age prevalent diseases such as heart and lung disease, cancer, dementia and diabetes. This reduction in prevalence is “dose dependent,” i.e., the more exercise (up to a point), the less the disease rate. Too much exercise is not healthy but as a general rule, most individuals will never get to the “too much” level. 

At the other end, is there a lower limit below which exercise is of no particular value? The answer is probably no but it is clear that even short bouts of activity are valuable. That said, it is certainly best to obtain the recommended intervals. Less is still valuable but more is definitely much better. 

“Physical activity is one of the best modifiable factors for the prevention of noncommunicable disease and mortality.” (Eijsvogels, T, J of the Amer Med Assoc, 2015))

Here are the basics that everyone should follow. Start with aerobic exercise for thirty minutes five or six days per week. The aerobic exercise can be something as simple as walking at a reasonably brisk pace for thirty minutes. If you have a fitness monitor, try to achieve at least 10,000 steps per day. More would be even better.  Don’t sit for long; stand up at least every hour, more often if possible. Move about before sitting again. Perhaps you can set up your desk so that you can work standing up.
There is an advantage of some “extra push” every so often consistent with High Intensity Interval Training (HIIT.) Assume you are using a stationary bike. Set it to a reasonable level and exercise at a comfortable speed for two to five minutes to warm up. Then push as hard as you can for 30 seconds. Then return to the slower rate for 90 seconds. Repeat for eight cycles. Initially you may not be able to do but a few cycles, but with time, you can build up and increase the resistance level. During the rapid exercise, your heart rate will increase and you will find yourself breathing rapidly and deeply. At the end, you will feel tired and will have sweated. Repeat this program twice each week.

These are very potent exercises that offer great benefit in a short period. Among other things, HIIT leads to improved muscle growth and strength and production of growth hormone and myokines that are anti-inflammatory and which reduce insulin resistance and indeed increase insulin sensitivity so that blood sugar (glucose) can be better utilized within the cells.
Add in resistance or weight bearing exercise two to three times per week. If you want to increase your muscle mass and strength, it is best to push up to a weight that you can only do for up to 12 - 15 repetitions.  This pushing to muscle exhaustion both with aerobic exercise as part of HIIT and in resistance (weight) training recruits what are called the white fibers rather than just the muscle red fibers. It is this stress on the white fibers that leads to muscle strength and with it an increase in growth hormone.  You want the growth hormone effect to persist for a few hours so it is best to not eat a meal immediately after exercising. More specifically you want to not eat sugars or other easily digestible carbohydrates (such as in sports drinks) that once absorbed will lead to an insulin spike. Insulin levels and growth hormone levels counter each other. So, if insulin rises, growth hormone levels will rapidly decline negating the effect you worked so hard to achieve with exercise. 

Remember – this is information, not medical advice. For that you need to talk with your personal doctor or nurse practitioner. There may be some approaches mentioned here that the doctor will discourage you from doing based on your health, so do that review now. Start out slowly; there is no need to create sore muscles. Find a setting that feels appropriate for your needs and personality. Although most people find exercise stimulating and relaxing, it may not seem that way at first; there may be an emotional barrier that needs to be overcome. A personal trainer might be very valuable, especially at first. He or she can give you good advice, help you devise a program that works for your needs and personality and can “keep you accountable” – in a nonjudgmental manner. Remember, getting started now will lead to benefits that compound over time just as a monetary investment for retirement compounds greatly over the years. So start now.
It is worth repeating that sitting is unhealthy. Getup. Move around. “Sitting is the new smoking;” don’t let it get you.

Wednesday, December 26, 2018

Should you eat only low fat or no fat dairy products? The answer may surprise you.

This advice plus other advice to limit saturated fats rapidly led to a massive shift in America to use of low and no fat dairy products from whole fat diary. Unfortunately, for whatever reasons, today America has an epidemic of obesity, overweight, metabolic syndrome, diabetes and perhaps now an increasing incidence of cardiovascular disease.   

Was the dairy advice correct or not? A recent perspective article in the J of the American Medical Association asked experts and suggests that the answer is simply not clear. 

One observation is that Americans use cheese primarily to create pizzas, cheeseburgers and junk foods, while Europeans use cheese as cheese itself.

What is known about the health benefits or non-benefits is based on observational studies which amount to associations rather than clear cause and effect as would be found in a randomized trial where some group gets full fat diary and the other does not. Still, observational studies at least give directions for consideration. 

In the PURE study of 136,000+ individuals 35-70 years of age, a higher intake of dairy fat was actually associated with lower risk of cardiovascular events and mortality. “Whole fat dairy seemed to be more protective than nonfat or low-fat dairy”

Another approach is to look at biomarkers, in this case by examining the blood content of three specific fatty acids are primary derived from dairy products. It turned out that when 16 such studies were pooled with 63,00 participants, those with higher levels of the three fatty acids were less likely to develop diabetes during the time of the trial. 

What about weight gain? It turns out there is no clear-cut evidence that full fat dairy is more likely to lead to weight gain than low fat or no fat diary consumption. An expert quoted in the article noted that there is no strong data to show that full fat diary leads to more weight, more cardiovascular disease or more metabolic syndrome. Rather observational studies suggest just the opposite. 

Another expert interviewed suggested that the key is not to worry about any one ingredient in the diet but what is most important is the overall dietary pattern. This makes good sense to me.

Rubin, R, Whole-fat or nonfat dairy? the debate continues, J Amer Med Assoc, 2018; 320:2514-2516

Some 40 years ago, the Dept of Agriculture recommended a switch to no or low-fat milk and dairy products as part of the effort to reduce the consumption of saturated fats.

Sunday, December 23, 2018

New Years’ Resolutions for Health and Wellness

It is just about the first of January so this might be a good time to think about New Year’s resolutions related to health and wellness.

But first where did the concept of resolutions begin? We know the Babylonians used them in about 2,000 BC during the spring planting time. In their system they promised the gods to pay their debts and to do well by others.

Many cultures worried that the sun would not come back after the winter solstice. Perhaps the days would stay short or even get shorter. So, they prayed to the various gods to have the sun return. 

Julius Cesar started what we know today as the solar calendar. January was the first month and it was named after the god Janus who was two-headed. He could see the year to the rear and the year ahead. He was the god of doors and arches because, again, he could see forward and back. He was also very importantly the doorkeeper to heaven. So, the Romans promised Janus with resolutions of good character and to be good to others. 

In the Jewish tradition in the past and still today one spends the time from Rosh Hashana (the Jewish New Year) through Yom Kippur (the day of atonement) in prayer and reflection. Is it a time to ask forgiveness and to grant forgiveness and to look toward how one can do better in the coming year. 

As the Roman Empire embraced Christianity, the Roman form of resolutions was discarded in favor of reflecting on past mistakes and resolving to improve over the coming year. In the middle ages, the knights took what was known as the “peacock oath” - to maintain the tenants of chivalry.
Today most resolutions are not a compact with a God but rather with one’s self; the resolutions are mostly secular and focus on self-improvement. 

One might think it easy to keep a resolution that you have created for yourself; but it is not. In a 3,000 person poll a few years ago, fifty-two percent said at the beginning of the year that they were confident that they could keep their resolution(s.) However, eighty-eight percent failed. One technique that did help with success was to tell the resolution to others, to make it public. 

Since most of us would like to remain as healthy as long as possible and with that perhaps live a longer time then may I suggest that you consider “The 7 Keys to Healthy Aging” that have been noted here and there in these posts. Remember that they all involve lifestyle modifications toward good nutrition, regular exercise, stress reduction, enhanced sleep, no tobacco, intellectual challenges and social engagement. For more see "Longevity Decoded - The 7 Keys to Healthy Aging"  

As a resolution or two, consider to eat modestly, eat a wide variety of vegetables and fruits, and cut way back on sugar and white flour. Do not forget that healthy fats are important; they can be found in foods such as fish, nuts and seeds, avocados and olive oil. Include a long period of time between the last meal of the day and the first meal of the next day. Breakfast is “breaking the fast” and if that fast can be at least twelve hours that gives time for the cells of the body to do repair and maintenance, a very important function. 

As for exercise, it is worth doing both aerobic and resistance exercises on a regular basis. Just walking for thirty minutes five or six times per week is sufficient for aerobic exercise and doing some form of resistance exercise two or three times a week rounds it out. Sone high intensity interval aerobics twice a week will further augment value. There are many resistance exercises that one can do at home such as the plank, sit-ups, push-ups, and squats but it is worthwhile going to a local fitness center to get a more well-rounded muscular work-out. Push your muscles to exhaustion by 12 to 15 reps; take a break and repeat three or four times. 

Reducing chronic stress is absolutely essential but under emphasized. Among the possibilities are meditation, yoga, tai chi, massage, exercise again and deep breathing. 

Most people do not get enough sleep. Adults need about seven and half hours per night, more as an adolescent. This is when your brain cleans out toxins and organizes memory and sort of tamps down the negative emotional issues of the previous day or weeks. Commit to getting good sleep and in part do so by keeping the bedroom dark and quiet with no light or sound interruptions by cell phones, TV sets, etc. In the time before going to bed, avoid overly stimulating movies or TV shows. 

It is essential to have no tobacco at all. Those who smoke have about a decade less longevity. IT is not just lung cancer but many cancers and especially coronary artery disease and stroke. For the 20% of you who still do smoke, look for a smoking cessation counselor who can give you the assistance you need. 

The five keys just reviewed go for all parts of the body. The brain however needs those five plus two more. These are intellectual challenges and social engagement. Like any other organ it needs to be used to be maintained and strengthened. This might be with music, art, dance, learning a new language, whatever, as long as the brain is kept active and stimulated. As to social engagement, humans need to interact with others in an effective manner. The simplest approach here is to make and keep your friends. 

So, there it is, some health and wellness ideas for you to consider for  New Year’s resolution(s). Remember – do not try to do too much. Do not set yourself up for failure. Maybe you want to commit to going to the fitness center three days a week. Maybe getting out more with your neighbors and by interacting in various activities. Maybe working on better sleep. Whatever it is remember to say it out loud to others that this is something that you are going to be focused on. Your success rate will be much better. Making progress on any of these will benefit your health now, assist in preventing the onset of disease in later years and add to your longevity. Best wishes for your resolution successes. 

Praise for Dr Schimpff

The craft of science writing requires skills that are arguably the most underestimated and misunderstood in the media world. Dumbing down all too often gets mistaken for clarity. Showmanship frequently masks a poor presentation of scientific issues. Factoids are paraded in lieu of ideas. Answers are marketed at the expense of searching questions. By contrast, Steve Schimpff provides a fine combination of enlightenment and reading satisfaction. As a medical scientist he brings his readers encyclopedic knowledge of his subject. As a teacher and as a medical ambassador to other disciplines he's learned how to explain medical breakthroughs without unnecessary jargon. As an advisor to policymakers he's acquired the knack of cutting directly to the practical effects, showing how advances in medical science affect the big lifestyle and economic questions that concern us all. But Schimpff's greatest strength as a writer is that he's a physician through and through, caring above all for the person. His engaging conversational style, insights and fascinating treasury of cutting-edge information leave both lay readers and medical professionals turning his pages. In his hands the impact of new medical technologies and discoveries becomes an engrossing story about what lies ahead for us in the 21st century: as healthy people, as patients of all ages, as children, as parents, as taxpayers, as both consumers and providers of health services. There can be few greater stories than the adventure of what awaits our minds, bodies, budgets, lifespans and societies as new technologies change our world. Schimpff tells it with passion, vision, sweep, intelligence and an urgency that none of us can ignore.

-- N.J. Slabbert, science writer, co-author of Innovation, The Key to Prosperity: Technology & America's Role in the 21st Century Global Economy (with Aris Melissaratos, director of technology enterprise at the John Hopkins University).