Extreme Fatigue is one of the most common complaints heard from patients during chemotherapy treatments but there are ways to help alleviate this uncomfortable side effect without adding additional medications into their day. Numerous studies have shown the merits of exercising throughout treatment to help maintain a normal level of activity. These studies have also shown that continuing to follow an exercise program after treatment may help cancer survivors maintain a quality of life similar to that found before diagnosis.

Exercise can do more than just help reduce fatigue. It can also help many patients address the emotional issues that come with a cancer diagnosis and treatment. Issues such as weight gain, muscle loss, and postoperative healing can create a distorted body image, which may lead to depression. It is widely known that exercise can aid in weight loss and that weight bearing exercises can increase muscle mass but during exercise, the body also releases endorphins that create an elevated mood. This elevated mood could help patients see their situation in a more positive light and aid in their recovery.

Although some form of activity is recommended daily, each patient will require a different exercise program dependent on his or her disease and current treatments or if they are currently in a survivorship plan. For example, a patient receiving Mesothelioma treatment must be more cautious of activities that apply a greater strain on the heart or lungs while a patient being treated for Bone Cancer would avoid any high impact exercises that could lead to a fracture.

Because of these risks, many people choose to have a trainer help them design an appropriate exercise routine. This is a wonderful idea but it is important to remember that the trainer must understand the specific requirements of cancer patients. According to an article published on the National Cancer Institute’s website, the American Cancer Society has developed a certification program for trainers wishing to help cancer patients and survivors. This program ensures that cancer patients and survivors are receiving the best care possible.

by David Haas. David is a writer for the Mesothelioma Cancer Alliance.  Please follow David on Twitter @haasblaag.

Almost Everything You Ever Wanted to Know About Fruits and Vegetables

Research shows that people who eat even 2½ cups of fruits and vegetables a day have only half the cancer risk of those who eat less than one cup a day.  Hundreds of studies show that increased fruit and vegetable consumption may also help prevent heart disease, stroke, hypertension, birth defects, cataracts, diabetes, obesity and other serious conditions.

Healthy Fruits and vegetables are nutritional powerhouses which:

• Are excellent sources of vitamins and minerals and contain disease fighting fiber
• Contain antioxidants and phytochemicals
• Are virtually fat-free (exceptions: coconut, olives & avocado) and cholesterol-free
• Are helpful in weight management, due to their high-fiber, high-water, and low-fat content

Vitamins and minerals: Are essential in maintaining the health of the brain, heart, bones, teeth and nerves; making/repairing red blood cells; regulating body’s balance of fluids; and in other vital functions.

Many healthy fruits and vegetables are particularly good sources of vitamins A, C, E and K, some B vitamins, and many important minerals needed for healthy bodies.  Beta-carotene and related compounds called carotenoids are converted by the body to Vitamin A. Carotenoids are found in high concentrations in carrots and other orange and yellow vegetables and fruits such as winter squash and cantaloupes.  Dark green, leafy vegetables, such as spinach, kale, broccoli, and other members of the cabbage family, also contain high concentrations of carotenoids.

Dark green vegetables are also excellent sources of folic acid (a B vitamin needed during pregnancy to reduce the risk of neural defects in the fetus), Vitamins E and K, and minerals such as calcium, magnesium, manganese, iron, and potassium.  Many fruits are also a good source of minerals, such as chromium (grapes), iron (cherries), manganese (pineapple), and potassium (apricots, bananas, orange juice, peaches and prunes).

Citrus fruits are good sources of Vitamin C, as is the family of plants that includes tomatoes, red and green peppers, potatoes, and eggplant.  Other good sources of Vitamin C include papayas, strawberries, kiwis, cantaloupe, and the cabbage family, including broccoli, cauliflower and Brussels sprouts.

While there is overlap in the vitamins/minerals supplied by fruits and vegetables, you need a wide variety of colorful healthy fruits and vegetables to fully benefit from the various nutrients they contain.

Antioxidants: Disease-fighting compounds found in many foods, especially healthy fruits and vegetables. Antioxidants neutralize free radicals (compounds that damage cells and lead to cardiovascular disease, cancer, cataracts, premature aging, and impaired immunity.)  Antioxidants include vitamins A, C, and E; beta carotene, minerals (selenium, copper, zinc, and manganese) and some of the phytochemicals.

Phytochemicals: From plants, “plant chemicals” are recognized as powerful disease-fighting compounds. Fruits and vegetables contain thousands of different phytochemical compounds. Categorized as carotenoids, flavenoids (compounds that give flavor/colors to fruit/veg), and other compounds, such as allicin, indoles, lycopenes, lutein, and phenols.  Scientists studying phytochemicals are finding an impressive range of health benefits.

Not all foods listed above, even within the same group, have the same health benefits.  Foods with the same phytochemicals may contain different concentrations of the phytochemicals, and the compounds may be absorbed differently.  Even different varieties of foods within the same category (such as different varieties of apples or lettuce) may contain widely varying concentrations and kinds of phytochemicals.  However, those darker in color usually contain higher concentrations.  So think “more color and more variety” in making your selections!

What is considered one serving of fruit?

• • 1 medium whole fruit (apple, banana)              • ½ cup of fresh, frozen or canned fruit
• • 6 oz. (¾ cup) 100% fruit juice                             • ¼ cup of dried fruit

What is considered one serving of vegetables?

• • 1 cup of raw, leafy vegetables                 • ½ cup cut up fresh, frozen or canned vegetables
• • 6 oz. (¾ cup) 100% vegetable juice         • ½ cup cooked beans, peas, or lentils

How Can I Get More…Healthy Fruits and Vegetables in My Diet?

At home:

• • Top your hot or cold cereal with fresh fruit.
• • Enjoy a glass of 100% real fruit or vegetable juice with breakfast.
• • Make smoothies with fresh or frozen fruits and juices for a great breakfast or lunch choice.
• • Choose hundred percent fruit and vegetable juices as delicious alternatives to soft drinks.
• • At dinner, include salad/raw veggies; use low-fat or non-fat dressing to reduce fat and calories.
• • Steamed vegetables are always a good side dish.
• • Add vegetables to your favorite entrees, like tacos, lasagna, casseroles, and pasta dishes.
• • Add pureed vegetables to sauces to fortify them.
• • Try more vegetarian meals, like tofu, rice or pasta with vegetables, and Asian stir-fry dishes.
• • For dessert, bake sweet potatoes, apples, peaches, pears, or bananas, or make fruit cobblers.
• • Discover some of the many cookbooks that specialize in fruits and vegetable recipes.
• • For a snack or when you’re on the go:
• • Choose fruits and vegetables that can be eaten out of hand, like apple wedges, baby carrots, broccoli spears, or cherry tomatoes, grapes, bananas, and seasonal items like peaches and plums.
• • In place of candy, choose dried fruit (easily packs in a bag/take on the road or eat at office.

When dining out:

• • Order a dinner salad to begin your meal.
• • Request an extra serving of vegetables as a side dish.
• • Order meals that include vegetables or fruits as a major component. To keep fat and calories in check, request vegetables steamed without the addition of butter, oil or cream sauce.
• • Ask for extra lettuce and tomato (or other vegetables) on sandwiches and burgers.
• • Choose healthful desserts; fresh fruit, sherbet, sorbet, or angel food cake topped with fruit.
• • Choose dishes on the nutrition charts of Healthy Dining Finder that have more servings of fruits/vegetables.

by Charles Boren

The ancient Greeks used running as a form of training and competition. It was a way to test personal fortitude and improve physical health. Many of the health benefits of running were known even in those ancient times. In modern times, many start running for the same reasons. They run to improve their physical endurance, lose weight and build muscle. While these common health benefits of running influence many to start running, runners are surprised to learn just how extensive the health benefits are. Running improves the quality of sleep, fights off depression and anxiety, and improves joint health and stability.

Sleep disorders affect a surprising percent of the population today. There is good news to those who suffer from them. Running can actually improve the decrease the symptoms of sleep disorders and improve the quality of sleep. It also appears to help people sleep more efficiently. That is, the amount of time spent actually sleeping while in bed increases. Running helps people fall asleep more quickly, toss-and-turn less through the night, and wake up more rested than those who do not run.

The runner’s high is a well-documented phenomenon, and major benefit, of running. This is a unique feeling often reported during long, strenuous amounts of exercise. The feeling can range from relaxed and peaceful to intensely euphoric. It is produced when endorphins flood the brain as part of a stress response to running. These endorphins are the natural drugs of the body. They reduce pain and are responsible for the happy and content feelings similar to many those produced by narcotics. While many runners experience this phenomenon, many do not realize the long-term positive effect that is has. Over time, the regular doses of endorphins to the brain can combat both anxiety and depression. In fact, many studies have shown that following a regular running program markedly reduces the symptoms of these disorders.

A common misconception is that the high-impact nature of running negatively affects the joints in the body. The truth is that running may actually improve joint health and stability. (1) This is done in a number of ways. First, running helps keep excess weight off. Just a ten-pound increase in body weight can cause a 45-pound increase in stress on the knees (2).  Second, running causes cartilage to expand and contract with the natural movements created while running. This forces nutrients and oxygen into the cartilage cells. Without this, the cells will slowly die from oxygen depletion and starvation. Third, running strengthens the tendons and ligaments that support and stabilize joints. This prevents injury in the long-term. Overall, running greatly improves joints and prevents the onset of arthritis.

Building muscle, losing weight, and strengthening the heart are the health benefits that motivate people to start running. However, it is the unspoken benefits that keep them running. As a whole, runners have better sleep, improved mental states, and healthier joints. Many runners feel that they are taking responsibility for their health by running. They physically feel better, less stressed and they have peace of mind. This is a reward all in itself.

Bio: Charles spends much of his free time running. On the side he also runs an automotive company, where he purchases vehicles.

So what are the benefits of resistance exercise?  Actually they are multiple, some obvious and others less obvious.

• Resistance Exercise Builds Strength:  This is one of the obvious benefits, but some aspects may not be appreciated. One aspect that some may not fully appreciate is that this benefit does not go away with age.  One study of the elderly (average age 87) showed that an 8 week program of resistance training 3x/ week increased strength by over 100%, increased walking speed by 12%, and reduced the incidence of falls.  With the sedentary life style many jobs enforce, and the lack of outdoors physical work by many of us, resistance training can make a huge difference in the way we feel, in our functional capacity to do tasks without hurting ourselves, and in our overall functional capacity.
• Resistance Training Builds Bone Strength:  Bones are a living tissue, constantly remodeling based on the stress loads placed upon them.  Resistance training while bearing weight can lead to increased bone strength and help prevent the fractures of osteoporosis as we age.
• Resistance Training Helps Lower Mild Hypertension:  Aerobic exercise is the backbone of maintaining cardiovascular health, but resistance training also helps reduce blood pressure to at least some degree.
• Resistance Training can Increase Metabolic Rate:  Aerobic exercise is again the mainstay of weight control and maintenance, but there is considerable evidence that resistance training when combined with aerobic training leads to higher metabolic rate and more weight loss than aerobic training alone.
• Improved Self Image:  This is just my opinion and experience, but I believe that maintaining strength, physical capability and muscle mass is has a positive effect on self-image.  I know I feel better about myself when I feel strong and fit.  Resistance exercises are a key to this for me.

If you believe in the benefits of resistance exercise how should you go about setting up a program?  First be real with yourself.  Set goals that you believe are possible, sustainable and affordable.  You can go to a gym, buy free weights or machines for home, or simply do exercises using your own body weight like pushups, pull-ups, and squats.  Rubber band type resistance equipment is inexpensive and very effective.  Secondly aim for 3 days a week for resistance exercise.  Taking a day between training sessions gives the muscles exercised time to recover and grow.  Third learn from Milo of Croton in that progressive overload is the principle behind steadily increasing strength. You don’t need a calf to carry every day until it has grown.  Just start with exercises where 8-15 repetitions lead to fatigue.  Once this is easy, slightly increase the resistance.  Keep increasing the resistance as the exercise becomes easy.  Last if a certain exercise leads to persistent pain, change something rather that thinking you can work through the pain.  Often some minor change may avoid an overuse injury.

Add resistance training to your regular exercise to reap the full benefits of exercise.  Enjoy.

1. Don’t let the holiday with the sometimes strong emotions, family discord, or memories tempt you to fall back to destructive habits like alcohol or tobacco.  I see too many patients after the holidays each year who have relapsed at this time of year.
2. If you have congestive heart failure, don’t eat too much high sodium food. Emergency rooms see patients every holiday who consume too much hidden salt in foods at their family feasts, and decompensate.
3. If you travel don’t forget your medications.  If you do forget, figure out a way to get needed meds.  Find out if your pharmacy can transfer your prescription to a pharmacy near where you are staying.
4. Be aware that holidays can be emotionally challenging.  If you struggle with depression, be aware that this time of year can be difficult.  Take care to get enough sleep, enough exercise, to eat well, and just take good care of yourself.  If you feel terribly depressed, and suicide is a concern, get help.  Watch out for depression in those around you.
5. Overeating is typical at holiday get-togethers.  Accept this, and focus on the rest of the holiday period.  Don’t let one or two meals get you out of your usual healthy eating routines.
6. New Year’s resolutions are fine, but don’t let the anticipation of a New Year’s resolution lead you to completely overdoing it regards to eating and drinking up until Jan. 1.

If you have good ideas to add to the list, please leave a comment.

October 20, 2010, 12:01 am

Do Women Sweat Differently Than Men?

October 6, 2010, 12:01 am

Phys Ed: Free the Free Radicals

By GRETCHEN REYNOLDS

In this week’s issue of the Annals of Internal Medicine (unfortunately you need a subscription to see the article)  Dr. Andrew Gray MD, and Mark Bolland PhD write an interesting editorial called Vitamin D:  A Place in the Sun. In it they discuss the current flood of claims for health benefits of vitamin D.  When analyzing a finding such as the link between Vitamin D levels and a disease state, one of the most difficult aspects is to control for “confounding variables.”  The definition of a confounding variable in The Free Dictionary online is, “interference by a third variable so as to distort the association being studied between two other variables, because of a strong relationship with both of the other variables.”   Low vitamin D levels are associated with such potential confounding variables as obesity, sedentary lifestyle, and lack of sunlight exposure.  These conditions and others are potentially associated with depression, diabetes, and many of the other conditions for which low vitamin D levels has been suggested as a risk factor Hence the concern about confounding variables not accounted for in the association of these conditions with vitamin D.  This is elegantly stated in these authors middle paragraph of their editorial:

“Although some evidence from preclinical studies suggests that components of the vitamin D system might impact favorably on some diseases,⁴ it seems intuitively unlikely that a singlehormone could play a substantial role in preventing or ameliorating the diverse range of diseases that have been linked to low levels of vitamin D. A more plausible and prosaic explanation for thefindings of the observational vitamin D studies is the presence of common confounders. Vitamin D levels are directly related to sunlight exposure and physical activity, and inversely related to adiposity.^5-6 It is likely that less healthy individuals, who are more likely to subsequently experience morbid events, will be heavier, less active, and more sunlight-deprived than healthier ones and therefore have lower levels of 25(OH)D. This notion is supported by previous studies⁷and by the study of Llewellyn et al,² in which several indices of poor health were more commonly observed at baseline in those with lower levels of vitamin D. Thus, low vitamin D levels may simply be a marker for lower health status rather than a cause of it. Healthiness is difficult to measure and adjust for, as illustrated by the disparate results of observational studies and randomized controlled trials (RCTs) of postmenopausal hormone therapy and cardiovasculardisease or antioxidant treatment and cardiovascular disease and cancer.^8-11 We should therefore treat the data from observational studies of vitamin D with caution.”

Although low vitamin D levels are associated with multiple conditions it will be interesting to see if supplementation of vitamin D lowers the risk of these conditions or whether only improving the confounding conditions, like more exercise, lower levels of obesity, more sunlight, etc. works to prevent the medical conditions.  It will sure be nice if just taking those nice small, easy to swallow yellow capsules works, but as for me I remain skeptical.

July 7, 2010, 12:01 am

Your Brain on Exercise   originally from the NY Times

By GRETCHEN REYNOLDS

What goes on inside your brain when you exercise? That question has preoccupied a growing number of scientists in recent years, as well as many of us who exercise. In the late 1990s, Dr. Fred Gage and his colleagues at the Laboratory of Genetics at the Salk Institute in San Diego elegantly proved that human and animal brains produce new brain cells (a process called neurogenesis) and that exercise increases neurogenesis. The brains of mice and rats that were allowed to run on wheels pulsed with vigorous, newly born neurons, and those animals then breezed through mazes and other tests of rodent I.Q., showing that neurogenesis improves thinking.  Read the full article

Enemas of all types:  Naturally things come out of the anus, and move from top to bottom on the gastrointestinal tract.  Is there much less natural than squirting stuff up your rectum?  I hear about coffee enemas, and nearly every web site about naturopathic remedies has an enema product to sell usually priced at $60-80 for proprietary ingredients. The theory is that somehow removing the waste material from the distal bowel improves bowel function and overall health.  Does it work?  I doubt it, but whether it works or not, it is a stretch to call it natural to squirt coffee up your rectum.

Mega doses of vitamins:  Naturally our food contains small to modest doses of vitamins. There is some evidence in this day of eating a lot of refined foods we may miss out on some trace minerals and vitamins. A multiple vitamin daily is probably reasonable for many people.  There is some evidence that higher doses of some vitamins, especially vitamin D is beneficial.  Yet I see many patients who spend a large percent of their limited income on large amounts of redundant vitamins, usually of a proprietary and therefore expensive brand, in hopes of improving their health.  This is both unnatural and of unproven efficacy.  I often see patients on a multiple vitamin, two or three types of B-complex vitamins, supplemental vitamins C, D,E, B-12, co-enzyme Q-10, calcium, other minerals, and often also mixtures of so many other ingredients I cannot read all the labels in less than several minutes.  This seems nuts to me. Spending this money on fresh fruits and vegetables would be far more likely to help, and would truly be natural.

Natural herbal supplements:  Somehow if a substance is derived from plant matter it seems to be assumed to be healthy.  Obviously some famous  exceptions exist, hemlock, nightshade, etc.  I appreciate that Eastern medicine, and possibly native American healers have some basis for their remedies, but I doubt that the sales people at the mega-supplement stores have the expertise to help patients be more healthy, and instead primarily make their bosses more wealthy.  Taken at the recommendation of a bonefide naturopathic practitioner or other expert these may be reasonable, but taken at the advice of a retail salesperson they are sketchy at best.

April Fool’s Day Myth-Information  – by Brooke Douglas RD

From ‘loading up on grapefruit’ to ‘fasting in order to jump start your diet’, how do you separate fact from fiction? In the spirit of April Fool’s Day – let’s turn our focus to some of the most pervasive diet and exercise myths and put them to rest — once and for all.

Myth #1: To jump-start your diet, you should fast.
 
Fact: Not so fast! Skipping meals for extended periods of time is actually the best way to sabotage a diet! Though fasting may temporarily help you lose weight, it’s predominantly water weight.  Not eating for extended periods can cause mild to severe fatigue and dizziness.  Once you become ‘over-hungry’ all common sense is lost. This is when what I call ‘defensive’ eating sets in.  Often excessive hunger, deprivation and physical weakness makes you respond like a Hoover vacuum and you’re bound to reach for high-calorie, high-fat and nutritionally poor choices in that state of mind. So, in fact, the more you don’t eat, the more likely you are to overeat in the end.
Myth #2:  Calorie restriction is the key to weight loss.

Fact: While nutrition is more than half the weight loss battle, drastic caloric restriction is not the way to win the war. By dropping your caloric intake below 1200, you run the risk of slowing down your metabolism. As a result, your body will use your hard earned muscle for energy instead of fat.

In addition, extremely low calorie restrictive diets are hard to stick to, leave you feeling deprived, and usually end in disappointment. If that isn’t enough, when calorie consumption is too low you lack the energy to power through your workouts.
Having said that, you would be surprised how fast the calories add up. So keep a food record and stick to your maximum calorie, fat and fiber goal numbers, as established with a Registered Dietitian or call Brooke!
Myth #3:  Low-Carb (high protein) diets are the most effective route to weight loss.

Fact: Before you ban your bread, consider this: Research used to suggest that obese people could lose more weight on a low-carbohydrate diet than on a conventional low-fat diet.  Yet, the benefits demonstrated turned out to be small and short-lived.  Multiple long-term studies which compared low-carb dieters to low-fat dieters found that low-carb dieters began regaining the weight they lost after six months.  Worse yet, by the end of the year, they were no better off than the low-fat group. And here is my point about moderation not deprivation, because the dropout rate among all groups studied was extremely high. Proof that it really is about striking a balance between what you consume and what you burn.  To do that for the long haul, you have to choose a diet that is sustainable, hence moderation! 

Myth #4:  Eating grapefruit will help you burn fat.
 
Fact: That eating grapefruits will help you lose weight is one of the most persistent among diet myths — and just when you think it’s gone, it resurfaces and becomes all the rage again every few years. There is no food that has intrinsic “fat-burning enzymes” that magically melt fat from your body. There was one study that demonstrated the effectiveness of a grapefruit inclusive diet, however, it was small, isolated, and there is some question as to whether the citrus industry sponsored the research. If you want to eat grapefruit as part of a well-rounded diet, go for it. Ruby Red grapefruits are rich in lycopene — an antioxidant that protects against heart disease and breast cancer – incorporate it and other lycopene-rich foods such as tomatoes and watermelon into your diet each day.
 
Have you met with a Registered Dietitian lately? 
www.NutritionAuthority.com

1. Starting early with prevention of obesity is key. Once overweight it is far more difficult to prevent further weight loss. Multiple prior studies have demonstrated how difficult it is to achieve sustained weight loss.
2. Calorie restriction is needed to prevent weight gain once overweight. Exercise alone is not sufficient.

The conclusion of this study sums it up pretty well.

“In conclusion, in this large prospective study of women consuminga usual diet, sustained moderate-intensity physical activityfor approximately 60 minutes per day was needed to maintainnormal weight and prevent weight gain. These data suggest that the 2008 federal recommendation for 150 minutes per week, while clearly sufficient to lower the risks of chronic diseases, is insufficient for weight gain prevention absent caloric restriction.Physical activity was inversely related to weight gain onlyamong normal-weight women; among heavier women, there was norelation, emphasizing the importance of controlling caloricintake for weight maintenance in this group.”  JAMA. 2010;303(12):1173-1179

 March 16  2010, 1:07 pm

Doctors and Patients, Not Talking About Weight

By RONI CARYN RABIN

Doctors recognize obesity as a health problem. So why is it so hard for them to talk to their patients about it?

A new report released on Tuesday by the STOP Obesity Alliance, a collaboration of consumer, provider, government, labor and business groups, suggests both doctors and patients are frustrated with the conversations they’re having about weight.

The results of two surveys, one of primary care physicians and the other of patients, found that while most doctors want to help patients lose weight and think it is their responsibility to do so, they often don’t know what to say. The vast majority of doctors have little or no training in weight management and nutrition and, they say, they’re not likely to have anyone else in their practice who can be of help.

So while doctors may tell patients they are overweight, the conversation often ends there, said Christine C. Ferguson, director of the alliance. “It’s like going to the doctor and being told, ‘Oh, your blood sugar is high,’ and that’s the end of the conversation,” without being told about options for diabetes, she said. “Doctors don’t feel they have good information to give. They felt they didn’t have adequate tools to address this problem.”

The lack of dialogue hurts patients, too. The patient survey, of over 1,000 adults, found that most obese patients — a definition that would apply to someone who is 5-foot-6, for example, and weighed 190 pounds or more — aren’t even getting the message that they’re obese. Only 39 percent of obese people surveyed had ever been told by a health care provider that they were obese.

Of those who were told they were obese, 90 percent were also told by their doctors to lose weight, the survey found. But it’s not like they weren’t already trying: Most have tried to lose weight and may have been successful in the past — and many are still trying, the survey found. And many understand that losing even a small amount of weight can have a positive impact on their health and reduce their risk of obesity-related diseases like hypertension and diabetes.

Dr. William Bestermann Jr., medical director of Holston Medical Group, in Kingsport, Tenn., which ranks 10th in obesity among metropolitan areas in the United States, said the dialogue had to be an ongoing one and could not be dropped after just one mention of the problem. “If you’re going to be successful with helping your patients lose weight, you’re going to have to talk to them at virtually every visit about their progress, and find something to encourage them about, find progress in some aspect of their care and coach them,” he said.

He acknowledged that many doctors tend to be very pessimistic about the prospects of helping their patients lose weight. “I’ve had colleagues tell me, ‘You can’t get people to lose weight.’ ”

He has helped many of his patients lose weight, he said, by talking to them about what to eat, not just how much to eat. It’s also important to understand the role that many medications, especially diabetes medications, play in weight gain, he said.

“Part of this is that there’s this common belief, and doctors are burdened by it, too, that heavy people are weak-willed and just don’t have any willpower and are self-indulgent and all that business,” he said. “If you’re thinking it’s their problem, that they’re just self-indulgent and weak-willed and they’re not going to lose weight anyway, you’re not going to spend time having a productive conversation.”

By Todd Neale, Staff Writer, MedPage Today
Published: March 02, 2010

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.

SAN FRANCISCO — Contrary to conventional thinking, drinking lots of coffee appears to be associated with a lower risk of hospitalization for an arrhythmia, researchers found.

In a long-term prospective study, patients who reported drinking at least four cups of coffee a day were 18% less likely to be admitted with a heart rhythm disturbance than those who drank no coffee at all (RR 0.82, 95% CI 0.70 to 0.90), according to Arthur Klatsky, MD, a senior consultant in cardiology at Kaiser Permanente Division of Research in Oakland, Calif.  Tea consumption did not have a similar effect.

The findings, which were presented at the American Heart Association’s Conference on Cardiovascular Disease Epidemiology and Prevention here, were unexpected, Klatsky said, because patient reports of palpitation or forceful heartbeat after drinking coffee are not uncommon.

People who can’t tolerate coffee or caffeine should avoid both, Klatsky said in an interview, advice that should not change based on the results of the study.  But, he said, people who regularly drink a moderate amount of coffee should be reassured.  “There’s no reason, even if they have a heart rhythm problem or risk of a heart rhythm problem, why they have to give up the coffee,” he said.  However, he continued, “we’re not going to recommend that people drink coffee to prevent rhythm problems.”  Kenneth Ellenbogen, MD, director of the electrophysiology and pacing lab at Virginia Commonwealth University in Richmond, said the findings contradict what clinicians have been telling patients with arrhythmias — that they should avoid coffee.

“I think the take-home message from this very important epidemiologic study is that most people can drink coffee, even several cups of coffee, without increasing their risk of having a significant heart rhythm disturbance that would require hospitalization,” said Ellenbogen, an AHA spokesman.

Although conventional wisdom dictates that coffee can increase the risk of arrhythmia, few studies have explored the relationship, according to Klatsky.

So he and his colleagues analyzed data on 130,054 men and women who were treated at Kaiser. As part of a baseline medical check-up between 1978 and 1985, all participants completed a questionnaire that included information on coffee, alcohol, and tea consumption. Most were not asked to differentiate between caffeinated and decaffeinated coffee.

Through follow-up, 2.6% were hospitalized for an arrhythmia; half had atrial fibrillation.

When coffee drinking was evaluated as a continuous variable, increasing consumption was associated with decreasing risk of hospitalization (P<0.001).

The findings were consistent across types of rhythm disturbance and patient subgroups. In particular, patients with cardiorespiratory symptoms, or a history of such symptoms, at baseline had a similarly reduced risk.

Controlling for smoking, age, sex, ethnicity, alcohol, body mass index, and education did not substantially affect the findings.

In the small subset of 11,656 patients who provided specific information on their coffee consumption, it appeared the risk reduction was primarily attributed to caffeine, Klatsky said, although the small numbers precluded drawing firm conclusions.

The observational study could not establish a causal relationship, but Klatsky said it was plausible that caffeine could protect against arrhythmias by blocking the action of adenosine.

Adenosine is a nucleoside that causes drowsiness and sleepiness in the brain, and caffeine counteracts its effects by attaching to its receptors.

The chemical also has actions in the heart, affecting the conduction system, endothelial function, and recovery time of the cardiomyocytes. Caffeine’s antagonistic effect on adenosine could affect the development of arrhythmias, although this is speculative, Klatsky said.

“I do think this [study] is going to surprise people,” he said. “I think conventional wisdom is that coffee can cause palpitations and it can cause rhythm problems. I think, though, that conventional wisdom is not always right, and the data that were available before this study really do not support the idea that moderate amounts of coffee provoke rhythm problems.”

The study was supported by a grant from the Kaiser Foundation Research Institute and the Robert Wood Johnson Foundation.

The authors did not make any financial disclosures.

Primary source: American Heart Association’s Conference on Cardiovascular Disease Epidemiology and PreventionSource reference:
Hasan A, et al “Coffee, caffeine, and risk of hospitalization for arrhythmias” CCDEP 2010; Abstract P461.

Sponsor: green coffee bean

]]> http://drpullen.com/good-news-for-coffee-drinkers/feed 1 http://drpullen.com/brooke-douglas-on-portion-control http://drpullen.com/brooke-douglas-on-portion-control#comments Mon, 01 Mar 2010 14:47:32 +0000 Brooke http://drpullen.com/?p=415

Brooke Douglas

Portion control is one of my problems. Most foods seem like Lay’s potato chips to me, I can’t have just one. Brooke has suggestions.

PORTION CONTROL: Don’t Go Overboard!

No one wants to gain 10# at the end of one year?  But in order for the weight to ‘creep’ on, all you have to do is eat 100 extra calories per day.  If you want to lose 20# at the end of one year?  Then eat 200 less calories daily.  Healthful living involves nutrition education not just on WHAT you eat, you must also become more aware of HOW MUCH you eat!

The next time you pour yourself a bowl of cereal, STOP before you pour the milk on.  Get out a measuring cup and see how much your ‘typical pour’ is?  Is it ¾ cup or is it 2½ cups?  Most cereals call for about a cup – about the size of a tennis ball.  For meat, you want about 3 oz/meal – about the size of a deck of cards.  Portion size makes a big difference when you are adding up the calories per serving.  Especially when you discover that you are eating 4 or 5 servings … according to the label.

We all eat in food ruts. We eat the same foods every week to ten days. So take the time, (just once or twice) to check the true quantity you are eating.  Then do the math! It’s a great idea to write down what you eat in any given day in order to figure out how many calories you are eating.  Can you shave 100 calories from each meal by eating a smaller portion?  If you saved 300 calories a day you could lower your blood sugar, blood pressure, cholesterol levels and lose 30# in just one year without too much effort! 

 Here are some tips:

 Use smaller plates and cups

• Read Nutrition Facts Labels
• Order small or a la carte
• Beware of big baked goods
• Share large entrees
• Don’t eat out of the bag
• Don’t eat in front of the TV
• Eat before you go out

 The difference between a smaller portion and a super-sized portion could be much more than you realize.  For example:

                                                             Large                                      Small

French fries                                         570                                          250

Burger                                                 730                                          260

Soda                                                    310                                          150

Cookie                                                 470                                          110

Ice cream                                             560                                          230

  Totals                                                  2,640                                       1,000

 Awareness is key!  Becoming more aware of common portion sizes is a good idea, especially if you have never paid attention in the past to how much you are really eating!

 Brooke Douglas, RD

www.nutritionauthority.com

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]]> http://drpullen.com/brooke-douglas-on-portion-control/feed 5 http://drpullen.com/darkchocolatebenefits http://drpullen.com/darkchocolatebenefits#comments Sun, 14 Feb 2010 14:24:01 +0000 Dr. Pullen http://drpullen.com/?p=350 Dark chocolate.  How can you not love it.  Treat your valentine with a relatively healthy treat, and feel good about it.  All things in moderation of course.  About.com has a good sumary of the research supporting the health benefits of moderate consumption of chocolate.   This post is only half “tongue-in-cheek.”

Health Benefits of Chocolate

By Mark Stibich, Ph.D., About.com Guide

Updated April 26, 2009

Why is Dark Chocolate Healthy?:

Chocolate is made from plants, which means it contains many of the health benefits of dark vegetables. These benefits are from flavonoids, which act as antioxidants. Antioxidants protect the body from aging caused by free radicals, which can cause damage that leads to heart disease. Dark chocolate contains a large number of antioxidants (nearly 8 times the number found in strawberries). Flavonoids also help relax blood pressure through the production of nitric oxide, and balance certain hormones in the body.

Heart Health Benefits of Dark Chocolate:

Dark chocolate is good for your heart. A small bar of it everyday can help keep your heart and cardiovascular system running well. Two heart health benefits of dark chocolate are:

• Lower Blood Pressure: Studies have shown that consuming a small bar of dark chocolate everyday can reduce blood pressure in individuals with high blood pressure.
• Lower Cholesterol: Dark chocolate has also been shown to reduce LDL cholesterol (the bad cholesterol) by up to 10 percent.

Other Benefits of Dark Chocolate:

Chocolate also holds benefits apart from protecting your heart:

• it tastes good
• it stimulates endorphin production, which gives a feeling of pleasure
• it contains serotonin, which acts as an anti-depressant
• it contains theobromine, caffeine and other substances which are stimulants

Doesn’t Chocolate Have a lot of Fat?:

Here is some more good news — some of the fats in chocolate do not impact your cholesterol. The fats in chocolate are 1/3 oleic acid, 1/3 stearic acid and 1/3 palmitic acid:

• Oleic Acid is a healthy monounsaturated fat that is also found in olive oil.
• Stearic Acid is a saturated fat but one which research is shows has a neutral effect on cholesterol.
• Palmitic Acid is also a saturated fat, one which raises cholesterol and heart disease risk.

That means only 1/3 of the fat in dark chocolate is bad for you.

Chocolate Tip 1 – Balance the Calories:

This information doesn’t mean that you should eat a pound of chocolate a day. Chocolate is still a high-calorie, high-fat food. Most of the studies done used no more than 100 grams, or about 3.5 ounces, of dark chocolate a day to get the benefits.

One bar of dark chocolate has around 400 calories. If you eat half a bar of chocolate a day, you must balance those 200 calories by eating less of something else. Cut out other sweets or snacks and replace them with chocolate to keep your total calories the same.

Chocolate Tip 2 – Taste the Chocolate:

Chocolate is a complex food with over 300 compounds and chemicals in each bite. To really enjoy and appreciate chocolate, take the time to taste it. Professional chocolate tasters have developed a system for tasting chocolate that include assessing the appearance, smell, feel and taste of each piece.

Chocolate Tip 3 – Go for Dark Chocolate:

Dark chocolate has far more antioxidants than milk or white chocolate. These other two chocolates cannot make any health claims. Dark chocolate has 65 percent or higher cocoa content.

Chocolate Tip 4 – Skip the Nougat:

You should look for pure dark chocolate or dark chocolate with nuts, orange peel or other flavorings. Avoid anything with caramel, nougat or other fillings. These fillings are just adding sugar and fat which erase many of the benefits you get from eating the chocolate.

Chocolate Tip 5 – Avoid Milk:

It may taste good but some research shows that washing your chocolate down with a glass of milk could prevent the antioxidants being absorbed or used by your body.

]]> http://drpullen.com/darkchocolatebenefits/feed 0 http://drpullen.com/acl-injury-prevention-in-female-athletes http://drpullen.com/acl-injury-prevention-in-female-athletes#comments Sun, 07 Feb 2010 15:41:03 +0000 Dr. Pullen http://drpullen.com/?p=320 Female athletes, especially basketball and soccer players have up to 6 times as many ACL tears as their male counterparts at similar competative levels.  We are way past deciding if girls/women should be involved in sports like soccer, basketball, lacrosse, and other rigorous sports.  What we need to recognize is that men’s bodies and women’s bodies are different in more ways that their reproductive organs.  When my daughter, who was 13 at the time, had an ACL (anterior cruciate ligament) knee injury I was amazed to learn that this was extremely common.  Women have different anatomy that puts stresses on their knee ligaments than men experience.   There are many theories as to why women are more prone than men to have ACL tears.  The wider pelvis, leads to a different knee angle, leading to more stress on the ACL ligament in women.  In addition the ACL itself is just smaller in women.  Some evidence suggests that hormonal changes with the menstrual cycle may weaken ligaments like the ACL.  Studies show that female athletes doing similar athletic activities are far more likely to have ACL injuries than men.  To read more about the theories as to why, read an article by Dr. Richard Parker on the Cleveland Clinic web site.   

There is an increasing body of evidence that gender specific training measures to reduce the incidence of ACL injuries in girls and women are effective.  An example is the Santa Monica ACL Prevention Project.   None-the-less these training measures are not widely accepted.  I suspect a part of this is that it is not PC (politically correct) to treat girls differently.  To me it is counterproductive to shy away from the realities of gender differences.  We need to get past the issues that are left over from civil rights, feminist, and other movements with issues like this.  All our young athletes deserve what is best for them, which is sometimes not equal treatment but rather the best treatment specific to the training needs of our young female and male athletes.

]]> http://drpullen.com/acl-injury-prevention-in-female-athletes/feed 2 http://drpullen.com/vitamin-d-remains-in-the-news http://drpullen.com/vitamin-d-remains-in-the-news#comments Sat, 06 Feb 2010 23:22:21 +0000 Dr. Pullen http://drpullen.com/?p=305 Yet one more Tara Parker-Pope NY Times article.  A good discussion of the pros and cons of Vitamin D.

 February 1, 2010, 4:42 pm

The Miracle of Vitamin D: Sound Science, or Hype?

By TARA PARKER-POPE

Imagine a treatment that could build bones, strengthen the immune system and lower the risks of illnesses like diabetes, heart and kidney disease, high blood pressure and cancer.

Some research suggests that such a wonder treatment already exists. It’s vitamin D,a nutrient that the body makes from sunlight and that is also found in fish and fortified milk.

Yet despite the health potential of vitamin D, as many as half of all adults and children are said to have less than optimum levels and as many as 10 percent of children are highly deficient, according to a 2008 report in The American Journal of Clinical Nutrition.

As a result, doctors are increasingly testing their patients’ vitamin D levels and prescribing daily supplements to raise them. According to the lab company Quest Diagnostics, orders for vitamin D tests surged more than 50 percent in the fourth quarter of 2009, up from the same quarter a year earlier. And in 2008, consumers bought $235 million worth of vitamin D supplements, up from $40 million in 2001, according to Nutrition Business Journal.

But don’t start gobbling down vitamin D supplements just yet. The excitement about their health potential is still far ahead of the science.

Although numerous studies have been promising, there are scant data from randomized clinical trials. Little is known about what the ideal level of vitamin D really is, whether raising it can improve health, and what potential side effects are caused by high doses.

And since most of the data on vitamin D comes from observational research, it may be that high doses of the nutrient don’t really make people healthier, but that healthy people simply do the sorts of things that happen to raise vitamin D.

“Correlation does not necessarily mean a cause-and-effect relationship,” said Dr. JoAnn E. Manson, a Harvard professor who is chief of preventive medicine at Brigham and Women’s Hospital in Boston.

“People may have high vitamin D levels because they exercise a lot and are getting ultraviolet-light exposure from exercising outdoors,” Dr. Manson said. “Or they may have high vitamin D because they are health-conscious and take supplements. But they also have a healthy diet, don’t smoke and do a lot of the other things that keep you healthy.”

]]> http://drpullen.com/vitamin-d-remains-in-the-news/feed 3 http://drpullen.com/drive-thru-nutrition http://drpullen.com/drive-thru-nutrition#comments Mon, 01 Feb 2010 14:47:23 +0000 Dr. Pullen http://drpullen.com/?p=293 Brooke Douglas, an excellent nutrition expert, wrote this article from my office’s newsletter, and I think it’s worth sharing with a broader audience.  Though I’m convinced the way to eat healthy is to shop and prepare our own meals, here are some hints for when you do find yourself looking for fast food.

Drive-Thru Nutrition: Fast And Healthy!

While a super-sized value meal can give you a day’s worth of calories and fat in just one meal, you can exit the drive-thru with a healthier meal.  With fast food chains an accepted part of our busy lifestyles, it’s important to learn how to make good choices. Here are some ways to make fast food work for you and your family.
Drinks – Don’t Drink Your Calories
It might cost only a few dimes more to guzzle down a large soda instead of a small one, but your waistline and, more importantly, your overall health will be paying the real price.  Soda pop is filled with empty calories from sugar. For the most part, we shouldn’t drink our calories. Diet soda pop is full of artificial sweeteners.  In moderation these non-nutritive sweeteners will not hurt us, but only if the freedom of one or two diet pops daily is not abused.  Another thought to be concerned about is the phosphorus content in both diet and regular soda pop.  This phosphoric acid binds calcium and prevents it from doing what calcium does best– strengthen bones!  Did you know that not only is adult onset diabetes occurring in young kids and teenagers, but so is the brittle bone disease Osteoporosis?   One way to make a fast food meal healthier is to opt for a drink other than soda. Try water, unsweetened iced tea or a chocolate milk.  Juice is another OK choice, but only in moderation.  Juice is packed with calories and it’s better to get your vitamin C from the whole fruit, which also contains fiber!  Water is always the best choice, hydrating your body while also aiding in digestion.
 
Fruits and Vegetables – Tried and True
Try to include at least one serving of fruits or vegetables with your drive-thru meal.  And no, French fries do NOT count as a healthy vegetable!  Load your burger with extra tomatoes.  Enjoy a side of fresh fruit instead of fries or chips.  If you are having a sandwich, load up on lettuce (speak up for spinach lettuce instead of iceberg), peppers, shredded carrots, even cucumbers.  Most fast food chains now offer delicious fruit sides and entrée salads. Including these with your meal is a great way to add lots of vitamins for fewer calories.  Just make sure not to smother your greens with cheese, eggs, bacon, fat-filled dressing, or toppings, such as fried chicken and croutons. Once a week, buy a small bag of seedless mandarin oranges or small apples and keep them in your car!  You will be surprised how ‘handy’ this becomes by complimenting a quick meal or as a snack on the go!

Portion Control – Just Say No!
One of the biggest problems people face when eating fast food is out-of-control portion sizes. As a nation, we are eating 24% more calories than we did only a generation ago.  Stop and think…you don’t have to get the value meal with the big burger, bigger fries and even bigger drink. Instead, try a child-sized meal. You still get the burger, fries, and drink, but consume about half of the fat of the full-sized version.  Ordering small is automatic portion control—you won’t be tempted to overeat.  Also, don’t forget to split an order of fries with a friend.  You’ll still enjoy that salty crunch without consuming all of the calories of a full order.  As a final tip, whether it is breakfast, lunch or dinner – always eat your high fiber foods first (fruit, vegetable, whole grain). These start to bulk in your belly and you will eat less of the higher fat entrée.

Extras Are Not Freebies!
The “extras” can really pack on the fat-laden calories. A tablespoon of mayo will add on an extra 57 calories. Make that another 106 calories for a single slice of cheese!  Instead of smothering your burger with high fat condiments, opt for mustard (about 10 calories).  Forgo the sour cream and three kinds of cheeses on your taco, and add flavor with low-calorie salsa.   Go easy on the ranch dressing and the saltshaker.  These little substitutions can really add up!  Don’t be fooled by healthier-sounding meats.  While breaded/fried chicken may seem healthier than a beefy burger, these sandwiches often have just as many, if not more, fat-laden calories than your average beef burger.  Try grilled versions of your favorite sandwiches instead.  Speak up and say no to cheese, mayonnaise-based sauces and fried foods!
 
If you would like to have a private one-on-one nutrition consult, talk to your doctor or feel free to visit  www.NutritionAuthority.com. 

Brooke Douglas | Registered Dietitian | Nutrition Authority
Phone 253.227.8284 | Fax 206.350.2612
brooke@nutritionauthority.com | www.nutritionauthority.com

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