Kare about Health

In my practice as an exercise physiologist, I tried to let people know that they can eat their five portions of fruit and vegetables a day and exercise regularly, but healthy behavior means little if they continue to smoke.

There is no doubt that the number one way to be healthier is to stop smoking!

In my ex-husband’s practice as a surgeon, it was the number one indicator of complication rate. He dreaded operating on smokers, knowing that recovery would take longer and they would have more complications.

Cigarettes contain more than 4,000 chemical compounds and at least 400 toxic substances. When you inhale, a cigarette burns at 700°C at the tip and around 60°C in the core. This heat breaks down the tobacco to produce various toxins.

On average, each cigarette shortens a smoker’s life by around 11 minutes.

I thought about going in to all the risks of smoking; various cancers, cardiovascular disease and stroke, chronic obstructive pulmonary disease, high blood pressure, infertility, asthma, macular degeneration, cataracts, ulcers, peridontal disease, etc. I also thought about hitting the vanity issues; paler skin and more wrinkles (due to reduced blood supply to the skin and lowers levels of vitamin A), stained teeth and gums, and erectile dysfunction.

Woah. Wait a minute. What was that? Yes, gentlemen, for men in their 30s and 40s, smoking increases the risk of erectile dysfunction (ED) by about 50 per cent.

Erection can’t occur unless blood can flow freely into the penis, so these blood vessels have to be in good condition. Smoking can damage the blood vessels and cause them to degenerate: nicotine narrows the arteries that lead to the penis, reducing blood flow and the pressure of blood in the penis. This narrowing effect increases over time, so if you haven’t got problems now, things could change later.

Hmmm… do I have your attention?

Talk about saving money! Smokers can save tons of time and close to $2k/year by quitting!

Let’s look at what you can gain from quitting. (Source: Netdoctor)

Other benefits

Thanks so much to my friend Leisa, for pointing out a post from NaturalNews that discusses the Associated Press (AP) articles that the Arizona Daily Star is running on alternative medicine.  Now they are calling us to help them let the AP know we don’t appreciate such biased publications. Check it out.

Choice is one of the major freedoms we have as a free democracy. But it seems the AP has taken the side of the very powerful pharmaceutical industry to discredit anything that offers freedom of choice in our medicines and therapies.

It appears that the Associated Press is ignoring it’s ethical responsibility to to report the facts about what works. It doesn’t seem they are interested in giving the American public the option of exploring (in a non-biased way) natural or alternative therapies as ways to be healthy.

The AP is a big, powerful and global news source. Its stories are picked up and republished by thousands of newspapers around the world. Due to the fact that it creates “ready-for-publication” news stories to be dropped into newspapers or magazines, it is supposed to write objective news, without any level of editorializing that you might get from blogs like mine or even sites like NaturalNews.

So why is the AP is now prefacing many of their health stories with this stilted, opinionated and inaccurate statement concerning the alternative medicine industry?  I am not alone in feeling this is not a reliable new service. It is not just opinion expressed here, it is blatantly false information. Here’s a reminder of what that editor’s note said:

EDITOR’S NOTE: Ten years and $2.5 billion in research have found no cures from alternative medicine. Yet these mostly unproven treatments are now mainstream and used by more than a third of all Americans. This is one in an occasional Associated Press series on their use and potential risks.

Breast Cancer Screening

On another note: Is the U.S. Preventive Services Task Force’s new recommendations for less screening and later screening for breast cancer somehow biased by a thought to cut health care costs? The current recommendations for annual mammography screening for women over 40 is said to cause too many false positives and unnecessary biopsies. Getting a mammogram every other year from ages 50-69 saves an average of 5 lives per 1,000 screenings. Starting at age 40 and greeting annual mammograms may only save one additional life but lead to 470 false alarms for every 1,000 screened.

My question to you is: Do you want to be that one life that is not saved?

Supposedly the task force does not consider cost or insurance coverage in its review of data, but one cannot ignore the fact that any government-sponsored panel would most likely need to have the government’s bottom-line in mind.

What is your opinion on this? Will you continue to get a mammogram every year? If you are a medical profession that works in/with mammography, what are your thoughts?

On Monday, November 2, 2009 the Arizona Daily Star published an article, “Alternative-healing instruction in medical schools is questioned.” Right up front before the article, the following was seen: EDITOR’S NOTE: Ten years and $2.5 billion in research have found no cures from alternative medicine. Yet these mostly unproven treatments are now mainstream and used by more than a third of all Americans. This is one part of an occasional Associated Press series on their use and potential risks.

I was perplexed to say the least, since I have done medical writing and have been involved with some alternative therapy research that was shown to be highly effective.

Then, the next day an article “More insurers are covering alternative healing, at a cost,” with the same editor’s note staring you in the face before you read the article.

I am currently with no institutional backing to be able to do thorough research into recent clinical trials, but I was able to spend a few hours and find many clinical research journal articles that showed alternative therapies to be statistically significantly effective over either controls or conventional therapy. What bothers me is the technicality in that editor’s note about finding “cures.” That editor’s note has been worded to be manipulative through sensationalism. It shows obvious bias (which is why it is an editor’s note, I suppose) and is expressing that bias before the reader even gets a chance to read the article. You will not find a lot of “cures” in conventional medicine clinical trials either! Taking Lipitor for high cholesterol does not “cure” high cholesterol. Taking blood pressure meds does not “cure” hypertension.

So what predicts who will use alternative therapy? NCCAM (National Center for Complementary and Alternative Medicine – see below) found that predictors were: more education, poorer health, holistic orientation to health, had a transformational experience that changed their worldview, or classification in a cultural group identifiable by their commitment to environmentalism, feminisim, and interest in spirituality and personal growth psychology. Hmmm… now that’s a mouthful! A person is also more likely to seek alternative therapies for back problems, chronic pain and urinary tract problems. Interesting.

The bottom line is consumers are demanding alternatives to conventional medicine. In their annual survey, the NCCAM found that a full 38% of American adults used some form of alternative medicine in 2007. And it seems to be growing. Is is possible that we are not getting satisfactory results from conventional therapies and are searching for answers?

Alternative therapies like acupuncture are being used more and more.

Ten years ago the National Center for Complementary and Alternative Medicine (NCCAM) was established. The National Center for Complementary and Alternative Medicine’s mission is to explore complementary and alternative medical practices in the context of rigorous science, train CAM researchers, and disseminate authoritative information to the public and professionals. It is housed by the National Institutes of Health (NIH)—The Nation’s Medical Research Agency—which includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical, and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases.

It made merging alternative and mainstream medicine “a central and overarching goal” and gave $22.5 million to 12 medical schools, two nursing schools and the American Medical Student Association to develop curriculum plans.

“Consumers are demanding it,” and more research is needed to see what works, said Mary Jo Kreitzer, who directs the Minnesota school’s alternative-medicine curriculum. “Ultimately, we need to align policy” so that insurers pay for these therapies, she said.

“Complementary and alternative medicine (CAM), more recently known as integrative health or integrative medicine, is a diverse field comprising numerous treatments and practitioners of various levels of training. This review defines several of the main CAM modalities and reviews some of the research relevant to their clinical application. The goal is to provide healthcare providers with a basic understanding of CAM to start the incorporation of proven treatments into their clinical practice as well as guide them to working with CAM providers; ultimately, such knowledge is a fundamental part of a collaborative approach to optimal patient health and wellness.”

How anyone can say that medical doctors and nurses should not be made aware of CAM, is ludicrous. The last I read, knowledge is defined as acquaintance with facts, truths, or principles, as from study or investigation; the body of truths or facts accumulated in the course of time.  The number of visits per year of Americans to practitioners of CAM has risen to over 600 million in 2007. That exceeds the total visits to all US primary care physicians!  I sure want my doctor to know what other options are out there for me when he or she is unable to help me. Or just to know what other therapies may actually be better for my particular ailment.

Basically, there is no “alternative medicine.” There is scientifically proven, evidence-based medicine and there is unproven medicine for which scientific evidence may be lacking. Whether a therapeutic practice is traditional or unconventional is irrelevant (except for cultural interest). There are vast differences in skills, knowledge and capabilities of both “Western” practitioners and “alternative” practitioners. Bottom line is that we need to focus on the fundamental issues here — namely the patient and the target disease or condition — and what is the best way to restore health. Let’s not forget preventative medicine, which is a much larger component to health care than conventional medicine allows. CAM seems to address prevention on a much larger scale if practiced appropriately.

Please do not shout out that there have been no “cures” found even after 10 years and billions of dollars spent. Find the facts and present them scientifically. Let us make up our own minds as to whether we deem them worth trying or not. And please don’t limit the education of our doctors and nurses who are struggling within this health care “system” we are currently dealing with as much as we are.

Dear Editor,

Here are just a few studies I found in a quick search of the literature. They are all well-designed studies appearing in peer-reviewed journals. Some show statistically significant effectiveness, some do not. This is the kind of solid research that is needed to differentiate between what is evidence-based good medicine and what is not. The evidence is mounting.

1. Meta-analysis: acupuncture for low back pain.  Ann Intern Med. 2005 Apr 19;142(8):651-63.

The 33 randomized, controlled trials that met inclusion criteria were subgrouped according to acute or chronic pain, style of acupuncture, and type of control group used. CONCLUSIONS: Acupuncture effectively relieves chronic low back pain. No evidence suggests that acupuncture is more effective than other active therapies.

2. A Randomized Trial Comparing Acupuncture, Simulated Acupuncture, and Usual Care for Chronic Low Back Pain. Archives of Internal Medicine. 2009;169[9]:858–866.

People suffering from chronic low back pain who received acupuncture or simulated acupuncture treatments fared better than those receiving only conventional care according to a recent study published in the Archives of Internal Medicine. The study highlights central questions about the mechanisms of benefit seen in acupuncture studies.

3. Meta-analysis on acupuncture for treatment of depression in patients of poststroke

CONCLUSION: The therapeutic effect of acupuncture for treatment of the depression in patients of poststroke is superior to other common medicine with safety, but it still needs more large sample RCTs to verify.

4. Acupuncture provides pain relief and improves function for people with osteoarthritis of the knee and serves as an effective complement to standard care. This landmark study was funded by the National Center for Complementary and Alternative Medicine (NCCAM) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), both components of the National Institutes of Health. The findings of the study—the longest and largest randomized, controlled phase III clinical trial of acupuncture ever conducted—were published in the December 21, 2004, issue of the Annals of Internal Medicine.

5. NCCAM-funded researchers recently analyzed the use of prescription drugs and dietary supplements in a sample of 3,070 people aged 75 and older. Nearly 75 percent of the GEM study participants took at least one prescription drug and one dietary supplement. Approximately 33 percent used three or more prescription drugs and three or more supplements. Furthermore, 10 percent of the participants combined five or more prescription drugs with five or more dietary supplements. If this is happening, isnt it better for our doctors to know what the ramifications are?

The dietary supplement Ginkgo biloba was found to be ineffective in reducing the development of dementia and Alzheimer’s disease in older people, according to a study published in the Journal of the American Medical Association

Also, the use of St. John’s Wort for depression was not found to be any more effective than placebo.

But the use of Red Yeast Rice was found to be effective for lowering bad cholesterol (LDLs) in the blood compared to a placebo.

Studies have been completed, but no results posted yet from NCCAM, for the use of laser light therapy for various disorders. Light energy therapies have been in practice for decades and much research has been published especially in the last 10 years or so. I look forward to the NCCAM’s clinical trial results so that this important adjunct therapy may become more recognized.

For additional information, call NCCAM’s Clearinghouse toll free at 1-888-644-6226, or visit the NCCAM Web site at nccam.nih.gov. NCCAM 1999–2009: Celebrating 10 years of rigorous research.

Vitamin D has been getting lot of press lately. It seems that deficiency in this vitamin can cause more problems than just rickets. Vitamin D is one of the oldest hormones, having been produced by life forms for over 750 million years. Phytoplankton, zooplankton, and most plants and animals that are exposed to sunlight have the capacity to make vitamin D. In humans, vitamin D is critically important for the development, growth, and maintenance of a healthy body, from birth until death. To give you an idea of how the sun helps us in this regard, a light-skinned person will synthesize 20,000 IU of vitamin D in 20 minutes sunbathing on a tropical beach, at which point vitamin D synthesis shuts down for the day (it takes a dark-skinned person 6 to 10 times longer to make this amount). Also to give you an idea of how far off the Recommended Daily Allowances (RDAs) are; recommended doses are from 200-600 IU depending on age. Intake reference values for vitamin D and other nutrients are provided in the Dietary Reference Intakes (DRIs) developed by the Food and Nutrition Board (FNB) at the Institute of Medicine of The National Academies (formerly National Academy of Sciences). In 2008, the American Academy of Pediatrics (AAP) issued recommended intakes for vitamin D that exceed those of FNB. The FNB established an expert committee in 2008 to review the DRIs for vitamin D (and calcium). The current DRIs for this nutrient were established in 1997, and since that time substantial new research has been published to justify a reevaluation of adequate vitamin D intakes for healthy populations. Determinations of DRIs are based on indicators of adequacy or hazard; dose-response curves; health outcomes; life-stage groups; and relations between intakes, biomarkers, and outcomes. For vitamin D, the FNB committee will focus on (1) effects of circulating concentrations of 25(OH)D on health outcomes, (2) effects of vitamin D intakes on circulating 25(OH)D and on health outcomes, and (3) levels of intake associated with adverse effects [21]. The FNB expects to issue its report, updating as appropriate the DRIs for vitamin D and calcium, by May 2010.

Very few foods in nature contain vitamin D. The flesh of fish (such as salmon, tuna, and mackerel) and fish liver oils are among the best sources. Small amounts of vitamin D are found in beef liver, cheese, and egg yolks. Vitamin D in these foods is primarily in the form of vitamin D3 (cholecalciferol) and its metabolite 25(OH)D3]. Some mushrooms provide vitamin D2 (ergocalciferol) in variable amounts. Mushrooms with enhanced levels of vitamin D2 from being exposed to ultraviolet light under controlled conditions are also available. Fortified foods provide most of the vitamin D in the American diet.

A growing body of evidence suggests that Vitamin D deficiency is involved in a multitude of diseases and syndromes. From Alzheimer’s to autoimmune diseases, cancer and even the flu, it seems there is a connection with Vitamin D levels. There is good evidence that Vitamin D deficiency is a causal factor in some 15 different common cancers. (NEJM 2007;357:266–81.)

When scientists at the Australian Institute of Sport recently decided to check the Vitamin D status of some of that country’s elite female gymnasts, their findings were fairly alarming. Of the 18 gymnasts tested, 15 had levels that were “below current recommended guidelines for optimal bone health, the study’s authors report. Six of these had Vitamin D levels that would qualify as medically deficient. Unlike other nutrients, Vitamin D can be obtained by exposure to ultraviolet radiation from sunlight, as well as through foods or supplements. Of course, female gymnasts are not known for the quality or quantity of their diets, or for getting outside much.

But in another study presented at a conference earlier this year, researchers found that many of a group of distance runners also had poor Vitamin D status. Forty percent of the runners, who trained outdoors in sunny Baton Rouge, Louisiana, had insufficient Vitamin D. “It was something of a surprise,” says D. Enette Larson-Meyer, an assistant professor in the Department of Family and Consumer Sciences at the University of Wyoming and one of the authors of the study.

Vitamin D once was thought to be primarily involved in bone development. But a growing body of research suggests that it’s vital in multiple different bodily functions, including allowing body cells to utilize calcium (which is essential for cell metabolism), muscle fibers to develop and grow normally, and the immune system to function properly. Almost every cell in the body seems to have receptors for Vitamin D. “It can up-regulate and down-regulate hundreds, maybe even thousands of genes,” Larson-Meyer says. “We’re only at the start of understanding how important it is.”

But many of us, it seems, no matter how active and diligent we are about health, don’t get enough Vitamin D. Nowadays, many people aren’t going outside very much, and most of us apply sunscreen and take other precautions when we do. The Baton Rouge runners, for instance, most likely “ran early in the morning or late in the day,” Larson-Meyer says, reducing their chances of heat stroke or sunburn, but also reducing their exposure to sunlight.

Meanwhile, as suggested above, dietary sources of Vitamin D are meager. Cod-liver oil provides a whopping dose. But a glass of fortified milk provides a fraction of what scientists now think we need per day.  A major study published online in the journal Pediatrics last year concluded that more than 60 percent of American children, or almost 51 million kids, have “insufficient” levels of Vitamin D and another 9 percent, or 7.6 million children, are clinically “deficient,” a serious condition. Cases of childhood rickets, a bone disease caused by lack of Vitamin D, have been rising in the U.S. in recent years.

Although few studies have looked closely at the issue of Vitamin D and athletic performance, those that have are suggestive. A series of strange and evocative studies undertaken decades ago in Russia and Germany, for instance, suggest that the Eastern Bloc nations may have depended in part on sunlamps and Vitamin D to produce their preternaturally well-muscled and world-beating athletes. In one of the studies, four Russian sprinters were doused with artificial, ultraviolet light. Another group wasn’t. Both trained identically for the 100-meter dash. The control group lowered their sprint times by 1.7 percent. The radiated runners, in comparison, improved by an impressive 7.4 percent.

How much is safe?

So, maybe this is one area where supplements may be in order, but how much to take? “1,000 IU a day and much more for people who are deficient” is probably close to ideal, Larson-Meyer says. This, by the way, is about double the current

Most supplements are not adequate!

recommended daily allowance. Most experts anticipate that this allowance will be revised upward soon. “Well adults and adolescents should take 5,000 IU per day. Two months later have a 25-hydroxyvitamin D blood test, either through ZRT (see below*) or your doctor”, says John Jacob Cannell MD Executive Director, Vitamin D Council.

“National recommendations from the Food and Nutrition Board are 400 to 600 International Units (IU) a day,” Neil Binkley, MD, an Associate Professor in Geriatrics and Endocrinology at the University of Wisconsin said. “That’s simply not enough. Experts recommend somewhere between 1500 to 2600 IU daily. It’s considered a very safe vitamin. One would need daily doses of 40,000 IU or higher before seeing negative side effects.”

Vitamin D is essential for bone health, but Binkley discussed its role in improving muscle function. “One of the primary killers among older adults is falls,” Binkley said. “A sufficient amount of Vitamin D not only enhances bone strength but also improves muscle function thereby reducing the risk of fractures.”

Vitamin D receptors have been discovered in many tissues throughout the body. “There’s a lot that is unknown about vitamin D right now,” Dr. Binkley said. “But there is one certainty – its importance is widespread.” The ubiquitous effects of the “sunshine vitamin” are demonstrated by research studies associating lower circulating vitamin D levels with cancer, type 1 diabetes and cardiovascular disease.

No matter what the experts are saying, the current recommendation seems to be a far cry from what is ideal. Consult with your doctor before beginning supplements. Overdoses of Vitamin D are rare, but can occur.

Flu prevention?

Another side to this that has been getting not nearly enough press is that Vitamin D levels in the blood fall to their lowest point during flu seasons. Unable to be protected by the body’s own antibiotics (antimicrobial peptides) that this gene-expresser engineers, a person with a low vitamin D blood level is more vulnerable to contracting colds, influenza, and other respiratory infections, says Dr. Donald W. Miller, a cardiac surgeon and Professor of Surgery at the University of Washington in Seattle, and former head of cardiac surgery at the VA hospital in Seattle. (His web site is www.donaldmiller.com). There seems to be an interesting correlation between Vitamin D levels and immunity.Why is flu season when sunshine is at it’s lowest level in both hemispheres? Something that scientists are finally zooming in on.

Other things you can do to prevent the flu, according to Dr. Miller: “Avoid sugar. It suppresses immunity. Avoid Omega-6 vegetable oils (corn, safflower, sunflower, peanut, canola, and soybean oil). Americans consume 50 times more of these oils than are necessary for good health. In this amount they are powerful immune suppressants. Take a well-balanced multivitamin/mineral capsule on a daily basis. Eat garlic. Manage stress. Exercise. Get enough rest. And wash your hands. Viruses spread most often from touching contaminated objects, like doorknobs, phones, shared computer keyboards, and shaking hands.”  Hmmm… flu protection in a vitamin? So much safer and cheaper than flu shots, yes?

What can you do?

Get tested for your Vitamin D levels. The only blood test that can diagnose vitamin D deficiency is a 25-hydroxyvitamin D. Dr. Cannell, Dr. Miller, and others (including my MD colleagues at Canyon Ranch) agree that levels should be above 50 ng/ml year-round. Your doctor may try to tell you that anything above 30ng/ml is normal. But it seems that “normal” is not ideal. It can take 2-3 months for the right amount of supplementation to show up in the blood levels, so leave enough time before being re-tested.

* The Vitamin D Council has partnered with ZRT Labs to make a discounted take-home Vitamin D Test Kit that you can order on the Internet. A portion of the proceeds from the sale of each test will be donated to the Vitamin D Council by ZRT to help in their mission to end the worldwide epidemic of vitamin D deficiency. The tests will be available to order in either a quantity of one (1) or four (4). I checked the website today and the one-test kit was $65 and the 4-test kit $220. The 4 test kit is $10 less expensive per test. If you have insurance, you may just want to ask your doctor for a test. Make sure it tests for 25-hydroxyvitamin D.

So, the bottom-line (as I always like to give)… There seems to be balance and moderation in the amount of sunlight exposure (unprotected) that we need for our body to synthesize Vitamin D, and not to stimulate cancer cell growth. Gosh, that moderation thing just keeps showing up, over and over again!

How many of you have had your Vitamin D levels checked? Are (were) you deficient?  Do you care?

Sunshine and good health to all of you!

*** Remember… this is not meant to be a substitute for medical advice. Please discuss your individual situation with your doctor.

It’s Friday! Happy Halloween! Time to check in with our healthy behavior goals.

I maintain my beautiful weight this week. I am trying to look at it from that perspective right now. I am not gaining!  After 5 weeks of trying, I am only 2 lbs. down! Frustrating! Right now, I have been restricted in my physical activity and that, in turn, has caused me to have more nights at home not doing much physical activity and with more access to food! It has been a difficult struggle, but I am not giving up!

What I thought I would focus on this week, is healthy living in general. If you are familiar with Dr. Oz, he made these 5 simple recommendations on the Oprah Show a while back (before he got his own show). Not sure I completely agree with them all, but I think it is a good place to start. I took the liberty (forgive me Dr. Oz) of re-prioritizing them. But, it doesn’t matter what order they are in. If you pay attention to all 5 you will live a healthier life.

1. 

   Getting enough sleep is more important than you think!

   Sleep and Sex. I put this one first because you can do everything else, but you won’t feel good or be healthy if you don’t get enough sleep. Research has shown, that no matter what you think you have trained yourself to “get away with” sleep-wise, MOST adults need 7-8 hours of sleep a night.  There are very few exceptions. It is amazing what goes on in your body when you sleep.  Dr. Oz also recommends that you have sex 2-3 times a week (to garner all those health benefits I mentioned in an earlier article.)

2. Food. He recommends adding the following to your diet;  foods high in anti-oxidants (5-7 servings a day),  At
   

   Eat 5-7 servings of foods rich in anti-oxidants

   least 25g of fiber, 3g/day of omega-3’s (walnuts, flax seed, salmon), red wine or grape juice (1 glass a day), and 4 cups of green or white tea.

3. Exercise. Dr. Oz’s recommendations are for at least 30 minutes a week of strength-training and at least 3 times a week getting your heart rate up with aerobic exercise (60 minutes a week). He also recommends walking every day.
4. Meditate. Trying to reduce stress is important to keep healthy. Dr. Oz suggests that even 5 minutes a day of focused relaxation (meditation) can help you to reduce stress.
5. Vitamins. This is where Dr. Oz and I may differ. Vitamin crazes have come and gone so many times in my career as a health educator.  Does anyone remember Dr. Kenneth Cooper’s “Antioxidant Revolution”? Since his extreme vitamin recommendations back in 1995, we have found that it is not possible to get all of the benefits of these antioxidants in a pill form. There are too many other factors in the whole foods that require a balanced diet to be healthy. You can’t maintain your health by eating poorly and popping vitamins. However, a decent multi-vitamin supplement should suffice if you are maintaining that healthy diet. Some populations may require additional calcium and Vit D as well.

That’s it! Five things!  How many of them are you currently practicing?

Reminder: Please consult with your doctor or health practitioner for medical advice and treatment before starting any new program.

This morning on the Today Show, I watched an update that Matt Lauer did with David Zinczenko who has co-written the books and spearheaded the movement, called “Eat This, Not That”.

Some of the national chain restaurants that were targeted in the past, but have improved their menus in response to this (and a consumer movement) are Red Lobster, Romano’s Macaroni Grill, Starbucks, Jamba Juice, and Ruby Tuesdays.

The good news is that restaurants are responding! Since the first book in 2007, Eat This, Not That has helped call attention to restaurants that serve meals with trans-fatty oils, calorie-and sodium-counts reaching into the thousands, or are low in nutritional value but saturated (pardon the reiteration) with saturated fat.

Since the first published list of the 20 Worst Foods in America over two years ago, a full 10 of those dishes have either disappeared or have been altered significantly. The following items have disappeared from menus:

Baskin-Robbins Chocolate Oreo Shake (Large)
2,600 calories
135 g fat (59 g saturated, 2.5 g trans)
263 g sugars
1,700 mg sodium

Romano’s Macaroni Grill Kids’ Double Macaroni ‘N’ Cheese
1,210 calories
62 g fat
3,450 mg sodium

Ruby Tuesday Colossal Burger
2,014 calories
141 g fat
95 g carbohydrates

The Seared Sea Scallops Salad from Macaroni Grill, a “leafy abomination packed in 1,170 calories, 27 grams of saturated fat, and 2,680 milligrams of sodium” has undergone a 64 percent reduction in calories and an 85% reduction in saturated fat, making it the Most Improved Meal in America.

Eat This at Romano’s Macaroni Grill:

Scallops and Spinach Salad
420 calories
4 g saturated fat
1,510 mg sodium

Then there are the restaurants that refused to disclose (Chipotle comes to mind for me). Red Lobster was one of a handful of restaurant chains that refused to share their food’s nutrition information.  Hmmm… if you won’t talk, you must be hiding something. Fast-forward two years, and in their newest book, “Eat This, Not That! 2010,” Red Lobster has a score of A-. That’s the highest grade for any restaurant in America! It’s largely due to a host of incredibly lean seafood dishes, very few fried foods on the menu, and excellent, low-calorie sides. When at Red Lobster, they recommend you choose an item from the Wood-Grilled menu, and ask for a baked potato with pico de gallo on the side. You’ll consume around 500 calories for an entire meal!

Red Lobster is unique in that it’s a sit-down restaurant that offers nutritious and light sides. Unfortunately, most other restaurants don’t.

Starbucks has expanded its food menu recently and the Egg White, Spinach, and Feta Wrap has just 280 calories and 9 grams of fat, but it’s absolutely packed with 19 grams of protein and 8 grams of fiber. Both slow your digestion, which means you’re eating a light, low-calorie meal, but you won’t feel hungry again for hours. Exactly what you want for breakfast.

Eat This at Starbucks:

Egg White, Spinach, and Feta Wrap
280 calories

9 g fat (3.5 g saturated)

1,140 mg sodium

Here are 5 restaurant survival tips recommended by the authors:

Check the company’s website before you go out
Many of them are now listing the calorie counts, and you’ll know what you’re ordering when you go. If that information isn’t available, you’re at an enormous disadvantage and you may want to consider other options. ** My note: Frequent the restaurants that give that information. It will encourage others to follow suit!

Avoid anything with the word “crispy” or “crisper” in its name
That just means breaded, fried and loaded with bad-for-you fats.

Be careful what you drink
We now drink twice as many calories as we did 30 years ago — more than 400 calories a day! Switch to low-calorie options and you can lose a lot of weight without changing what you eat at all. Or, if you must have that full-calorie drink, order the small size. You might feel as if you’re not getting your money’s worth, but new research from Duke University shows that’s not actually the case. See, the researchers discovered that some fast-food chains are encouraging customers to buy larger soft drinks — which justifies higher prices — by increasing the number of ounces in all sizes of drinks. They know what you may not: Most people subconsciously pick the middle option without considering the actual amount.

Avoid combo meals
The average “value” meal packs 1,200 calories! You might be saving more money than if you had ordered all items in the meal separately, but that’s NOT a deal you want to make.

Remember that the waiter is a salesperson
It’s his job to get you to open your wallet. A 2005 study from the Journal of Retailing and Consumer Services found that you’re more likely to order a side dish when the server verbally prompts you. Remember this the next time you hear, “Do you want fries with that?”

Bottom line… Tucson Restaurants LISTEN UP!!  There is a growing contingent of customers who will greatly appreciate being able to make informed choices when it comes to eating out. I beg you, PLEASE, let us know what we are getting into! We may not make the healthiest choices, but at least we will know what we are doing!

Side Note: I have to give a plug here for Pastiche. I tend to go there more often and recommend it to others for several reasons; they offer “bistro portions” so that I can get a smaller serving, they are very community-minded; they are open till midnight; and they are becoming more “green” in their operations.  My plea to other Tucson Originals: Please offer smaller, healthier offerings and give us nutritional information! I will love you forever!

Oh… and Chipotle... give me nutritional information (at least online the way your previous parent company McDonalds does) and I will frequent and recommend your restaurant much more often! Love the food! Yes, you recycle, don’t serve artificial ingredients, and ad negligible trans fats, but that doesn’t help me know how many calories are in my favorite burrito (even if I get it without the tortilla!) And can’t we make those burritos half the size?

Recent research on happiness was brought to my attention and I looked back at my blog on Happiness to see how my readers fit in with what seems to be the key to happiness for human beings.

Researcher John T. Cacioppo, from the University of Chicago, explored the subject of happiness in a recent study which he wrote about in the article, ‘In Pursuit of Happiness.’ Recreating a prior population study done by CHASR (Chicago Health, Aging and Social Relations Study), Cacioppo and his team reinforced earlier findings which revealed a key ingredient to happiness: satisfying interpersonal relationships. Cacioppo explains: “People who had satisfying interpersonal relationships became happier over time whereas those who felt lonely or isolated, whether married or not, became less happy over time.”

The early study concluded as well that people with satisfying personal relationships were happiest overall.

Interpersonal relationships are the key to happiness!

Another area that directly related to happiness in the study is household income. In Cacioppo’s study, he found that quality of interpersonal relationships actually led to increases in household income.How does that happen? Well, it seems that the happier people are, the better relationships they form both socially and in the workplace.  These good relationships promote better job performance and that translates into more promotions and networking opportunities that lead to better financial compensation.

“These results suggest that sacrificing quality relationships with spouse, family and colleagues in pursuit of higher raises may be counterproductive,” Cacioppo concluded. “When you are happy with your personal relationships, you perform better at work … taking time to develop and maintain meaningful and personally satisfying relationships may pay great dividends.”

So how did we correlate? Well, even though the sample size is very small, 57% of you said that friendship/companionship was the main thing that made you happy. I guess my readers aren’t so weird after all! We find happiness as most other human beings.

My advice… Get out there and make new connections with other human beings, or re-connect with those you may have let go by the wayside. Increase your human connections and you will be on your way to being happier.

Call a friend or family member you haven’t seen in too long…

Make a point to get out and do something social at least once in the next week…

Happiness is my wish for all of you!

Happy Friday! Healthy Behaviors check-in day!

I am struggling. I felt I was so much better this week with my portion control and still no weight loss! I am still only 1.5 lbs down after 4 weeks! Yikes! I am not a very good example. I need help and encouragement from some of you!

I can try to blame a lot of it on my exercise restrictions. I am in the “healing” phase (hopefully) with my achilles and I am not able to run, walk, dance, play tennis at this time. I am restricted to the exercise bike and the pool. Neither of which I feel like I can get my heart rate up well enough. Plus they are very boring to me at this point! Oh well… I cannot make excuses! Onward! At least I can still do my weight training.

In the meantime, I need to get this done and get to the gym.

Keep up your healthy dreams!

Today, I decided to continue with the dietary thoughts from yesterdays post on fast food. We were discussing recommendations, so I thought these new guidelines might be worth reading.

New dietary guidelines from the U.S. Departments of Health and Human Services (HHS) and Agriculture (USDA) recommend fewer calories and smarter food choices.

Some of the key recommendations:

• Follow a balanced diet that is low in saturated and trans fats, cholesterol, added sugars, salt, and alcohol, such as the Dietary Approaches to Stop Hypertension (DASH) Eating Plan.
• Balance your calorie intake with exercise. Slowly decrease the amount of calories you take in while increasing exercise to prevent gradual weight gain over time. Exercise regularly and reduce activities in which you sit (such as watching TV).
• Eat 2 cups (4 servings) of fruit and 2 1/2 cups of vegetables (5 servings) per day for an average 2,000-calorie per day diet.
• Eat 3 or more ounces of whole-grain products per day.
• Consume 3 cups per day of fat-free or low-fat milk or milk products.
• Get fewer than 10% of calories from saturated fatty acids.
• Avoid trans fatty acids.
• Limit cholesterol intake to less than 300 mg/day.
• Make total fat intake no more than 20 – 35% of calories. Choose “good” fats such as fish, nuts, and vegetable oils containing polyunsaturated and monounsaturated fatty acids. Lean, low-fat, or fat-free meats, poultry, dry beans, and milk or milk products are preferable. Total fat intake can approach 35% if most of the fats are “good” fats.
• Stay away from added sugars.
• Consume fewer than 2,300 mg (approximately one teaspoon of salt) of sodium daily, and limit added salt when you prepare food.
• Do not consume more than 1 alcoholic drink per day for women, 2 per day for men. Certain people should not drink any alcohol.

So, there you have it. How many of these guidelines do you follow? Is any of this helpful to you? Are you surprised about any of the guidelines?

And most of all, how are you doing on your healthy behavior goals?  It’s not to late to begin, or start again! Till next week… keep fit, keep healthy.

Burlington, Vermont… #1 city to raise a family.

One of the criteria for why this city was chosen was that they have the lowest obesity rate of any city in the nation, and guess what? Burlington also has the the lowest number of fast food restaurants per capita! Hmmmm…

Speaking of fast food restaurants, I am finally going to submit my first entry in the socio-economic experiment. Fast food meals. I visited McDonald’s restaurants and Burger King restaurants in two different areas of Tucson to see what it costs for a family of four to eat at these convenience restaurants.  Prices were very similar except for the tax amount in the city of South Tucson is 8.1% vs. 6.1% in Pima County. I used the lowest prices for my comparison. Here are the criteria that I used:

• I tried to order both frugally and picking “better” choices when possible.
• I ordered for a typical family of four with two adults and one younger child and one older child.
• I did not include drinks unless they were part of a “Value Meal” that would have been more expensive to do separately. Drinks were only included in calorie counts for kid’s meals (since they came as part of it).
• Price totals include 6.1% tax.

Here are the details:

Burger King

"Have it your way"

1 Grilled chicken sandwich and small fries  –  $6.68

830 Cal, 38 g Fat, 30 g Pro, 95 g Carbs

1 Steakhouse Burger and medium fries  –  $6.58

1,430 Cal, 82 g Fat, 45 g Pro, 156 Carbs

1 Whopper Jr. and Value fries  –  $2.00

590 Cal, 32 g Fat, 21 g Pro, 59 g Carbs

1 Kid’s Meal (4 piece chicken tenders, value fries and milk)  –  $3.49

490 Cal, 23.5 g Fat, 15.5 g Pro, 57 g Carbs

Total Bill (including tax)  –  $19.89

Total Nutrition — 3,340 Calories, 175.5 g Fat (47%), 111 g Protein (13%), 367 g Carbohydrates (44%)

McDonald’s

"I'm Likin' It"

1 Angus Deluxe with side salad and ranch dressing   –  $ 5.98

940 Cal, 54 g Fat, 47 g Pro, 74 g Carbs

1 Southwest Salad with crispy chicken (low-fat Italian dressing)  –  $5.19          490 Cal, 22 g fat, 27 g pro, 38 g Carbs

1 McChicken sandwich with fruit and yogurt parfait –  $2.00

520 Cal, 18 g Fat, 18 g Pro, 71 g Carbs

1 Happy Meal (4 piece chicken nuggets, small fries,  milk) — $3.99

520 Cal, 25 g Fat, 20 g Pro, 52 g Carbs

Total bill (including tax) –  $18.21

Total Nutrition — 2,470 Calories, 119 g Fat (43%), 139 g Protein (23%), 235 g Carbohydrates (38%)

While we are looking at nutrition, let’s examine what percentages are considered healthy and appropriate for the various foods we eat.

It is widely recommended that a well-balanced diet will contain about 20-35% of total Calories from fat (heart-healthy diets are recommended to be 10-20%). As you can see, the meals from the fast food restaurants averaged between 43 and 47% Calories from fat. That is well above even the highest end of what is recommended. And more than double what would be prudent for heart health.  But we all know this, don’t we?And don’t even get me started on saturated fat. We should consume no more than 7% of our Calories from saturated fat. The above menus contain about 15% Calories from saturated fat. More than double.

Protein recommendations are a bit more complicated. It is recommended that we consume about 1 gram of protein for every pound of body weight. This is sometimes looked at as 0.8g per pound of muscle mass and of course athletes and body builders try to consume about 1.5g per pound of muscle mass. We will keep it simple. About 10-20% of your calories (no more than 30%) should come from protein. The meals above meet this requirement. The problem is the protein in these meals comes from non-lean sources as indicated by the total fat and saturated fat content. Most protein should come from lean sources (such as poultry, low-fat dairy, soy, egg whites, beans, lean beef and pork tenderloin).

It is recommended that 55-65% of Calories come from carbohydrates.  The meals above are lower in carbs than recommended, but it is due to the high fat content rather than protein sources. And once again, the source of carbohydrates is very important. Whole grain sources as well as fruits and vegetables should make up the bulk of your carbohydrate intake. Very little, if any, such sources found above.

Let’s not forget about vitamins, minerals and fiber. Three VERY important components that are sorely lacking in the fast food diet. Research is finding that you cannot get all the same benefits of whole foods vitamins and minerals from a pill. And If you do not eat foods which contain enough fiber you might end up with problems of the colon and rectum and will not be helping your cholesterol and heart health any. It is recommended that you consume 14g of fiber for every 1000 Calories.  To give an example, the Angus Deluxe and side salad above has 940 Calories and only 5g of fiber. That many Calories should have 13g of fiber. That’s not even half of what is recommended.

And don’t even get me started on the sodium!

If you’re looking at the Dollar Menu in terms of how much food (and Calories) you get it really appears as a good bargain.  But if you’re looking at it as how many nutrients are you getting for a dollar, it is the LEAST economical!

McDonald’s says it seeks to provide options for its customers, at both low and higher prices. “We’re proud of the choices we offer customers,” said Bill Lamar, chief marketing officer for McDonald’s United States business. “You can come in and order Apple Dippers, salads with low-fat dressing, yogurt, or you can order an Egg McMuffin, which is a very nutritious sandwich. People can make the decisions about how to eat for themselves.”

Two comments I have here. Even if you choose the lowest fat salad meal (that has protein) which is the Southwest Salad with Grilled Chicken and a low-fat dressing, you are still over the highest recommendation for fat (35%) since the salad and dressing come to 37% fat.  And we all know, very few people actually order the grilled chicken salad. Actually, since McDonald’s started advertising the Dollar Menu nationally, the double cheeseburger has become the chain’s most ordered item. The double cheeseburger weighs in at 47% fat. Almost half of the Calories are from fat!

The other comment is that in order to make “healthier” choices, it costs more.  At Burger King, in order to switch out the Value fries for Apple fries in a Kid’s Meal, it will cost you 79 cents more (that’s 23% more).  A budget-conscious family is going to order mostly from the Dollar Menu which has almost no healthy choices. The Fruit and Yogurt Parfait is the only exception. All in all, the high fat and low nutrition on the Dollar Menu is a recipe for disaster for the health of our community.

Bottom line, you can feed a family of four for under $20, quickly and easily. But at what health costs to you and your children? At what cost to your child’s development and future health? Not to mention the costs to our environment (see my article on The Cost of Eating Cheaply). I understand the convenience and ease of feeding your family this way when couples (or single parents) are working full-time and exhausted at the end of the day. And when kid’s activities pull you away from the kitchen. My hope is that with this information and armed with my recipes and tips in the next week or so, you will make this a rare event, rather than a regular one.

So, my job is to find easy, healthy, budget-conscious meals for a family of four for under $20. I think I can do it! Stay-tuned… the best is yet to come!

Happy Monday! Please forgive me for my absence on Friday, but life got in the way and I could not get my post out! But here I am to check in with you and see how we are progressing!

I weighed in on Friday at 1.5 pounds down from my starting weight. Slow, but sure is what I am going for here! I was able to lose that one pound while having two girls’ nights and a big dinner party this week! I am still working on the journaling and portion control. It is a work in progress!

This week I thought I would focus on exercise. What is keeping you from exercising? Believe me, in my time as a trainer and physiologist, I have probably heard all the excuses.  Let’s face the most common excuses one by one and try to see the reality.

I don’t have enough time

This is the most common excuse I hear. I understand that our lives are extremely busy and it IS very difficult to fit in exercise at times. But I truly believe that we make time for the things that are important to us.  Here are some tips:

Squeeze in short bouts of exercise during your day.

• Do some sort of exercise for 15 minutes before you start your day. It will energize you and get it over with, so to speak.
• Go for a ten-minute walk before lunch. Then find another ten minutes to stride around the block while dinner is in the oven.
• Perform some core body exercises during commercial breaks or try the footwork while watching “Dancing with the Stars”.
• Put in some music and dance with yourself, your family or your dog while dinner is simmering on the stove.

Combine Activities

• Use the treadmill or exercise bike while watching the news or your “soap”.
• Instead of catching up with a friend over lunch, meet for a walk.
• Have “walking meetings” with business colleagues.
• When looking for a parking spot, stop fighting for the place closest to the door. If you park farther away, you’ll get a mini-walk!
  

  Make exercise a family affair!

• Do family activities like playing in the park or a family hike or a family water exercise session. Quality time with your family becomes healthy time for your body as well.

Prioritize

• Schedule exercise on your calendar and don’t let errands or work sidetrack you. Keep this appointment with yourself the same way you would with your doctor or dentist! You are more important! That to-do list will still be there tomorrow. You’ll get more done after you’re energized with exercise anyway!
• Exercise first thing in the morning. Activities and obligations are less likely to get in the way and, statistically, early morning exercisers are more successful sticking with it.
• Keep a pair of athletic shoes and socks handy at work and in the car. That way you’re always ready to grab some exercise and fresh air, no matter where you are.

It’s Boring

• Find something fun! Dance class, hiking club, walking group, outside yoga, tennis, basketball, cycling group, Master’s swimming, water aerobics – the options are endless. Doing something in a group or class makes the time go much faster and you get social benefits, too. Not to mention people are expecting you so you are less likely to flake!
• As mentioned above, do exercise in small bouts so that you don’t have time to get bored. Just try to accumulate at least 30 minutes during the day.
• If you go to the gym, mix it up. Do 10 minutes on the treadmill, 10 on the bike, and 10 on the elliptical. Thirty minutes goes by very fast this way.
• Don’t do the same thing each day. Water exercise one day, walking another day, weight lifting the next day. The body likes new challenge and gets too used to the same thing anyway.

I’m too tired

Regular exercise will help you to sleep better, but in case you need more help to get that started:

• Exercise as early in the day as your schedule allows. As the day rolls on, fatigue sets in and it’s easier to talk yourself out of it.
• Recruit an exercise buddy. When you just don’t have the energy, you know they are depending on you and you can keep each other going. This could be a neighbor, family member, or how about the dog?
• If you’re planning on exercising after work, a late afternoon snack such as yogurt or half an energy bar will give you the energy you need to get to the gym and put in a good workout.
• Find activities that you enjoy or you can share with friends or family. Always wanted to learn ballroom dancing or tai chi? NOW is the time to sign up for a class. If you are getting immediate “fun” benefits it will give you more reasons to exercise on those low-energy days.
• Hire a personal trainer to help motivate and guide you. You’ll have a personalized coach who is monitoring your progress and expecting you to show up. Just make sure to look for a trainer who possesses an NCCA accredited certification, such as ACE or ACSM.
• Try to get enough sleep. Studies have shown that most people require 7-9 hours of sleep for optimum health, even if they have convinced themselves otherwise.

I’m too self-conscious or I’m not athletic

• Find activities you can do alone until you get your confidence up. Go for a walk, or get a piece of home exercise equipment. You can also exercise to a fitness DVD or television show.
• Everyone can walk. You don’t have to be athletic.
• If you are female, you may consider joining a female-friendly exercise club such as Curves.
• Find a group of people more like you that want to start healthy behaviors.
• Remind yourself what a great favor you’re doing for your cardiovascular health, or focus on how much stronger you feel after a workout. Praise yourself for improving your stamina and making a commitment to lifelong fitness.
• Go out with confidence and others will be inspired rather than ridicule. Think of yourself as a role-model for others that may be feeling the same way.

I can’t afford it

• Find things to do that don’t require much in the way of equipment. All you really need is some well-fitting, comfortable and supportive shoes.
• You can walk, jog, dance around the house, use soup cans and bags of rice for weights, go to the park and chase and kick a ball or use the outdoor fitness circuit at your local park.
• Invest in one or two good exercise videos you can do at home.
• Re-think your budget. Is there something you spend money on every week that could be changed? Many people find if they pack lunches, cook at home more often and stop going to Starbucks, they can save enough money in a month to pay for a gym membership. Some are as little as $24 a month.

The weather is bad

• Dress appropriately. Choose exercise clothes designed to keep you warm and dry in the cold, and cool in the heat.

• During hot weather, exercise first thing in the morning when the air is cooler and ozone levels are low. Or exercise in the evening. Find a shady course or park for walking or bike rides. Drink plenty of fluids before you leave home and carry a water bottle with you.
• Snowy, icy weather can create slippery surfaces. Choose an indoor option, or wear shoes with good traction. Remember that layering with jackets, hats and gloves keeps you protected when you leave the house, yet you can remove items as your body warms up.
• When the weather is really bad, find indoor options: fitness club, home exercise equipment, fitness videos or television shows.

It’s not safe in my neighborhood

• Recruit an exercise buddy or more. Two are always safer than one. A group is best. Walk tall and display confidence. Confident targets are less likely to be selected.
• Exercise in the morning. Based on crime statistics, it’s a safer time of day.
• Be aware. Trust your instincts. If someone or somewhere doesn’t feel safe, it isn’t!
• Don’t second guess yourself; leave immediately.
• Exercise in an area that’s well lit, with some foot traffic so you’re not alone. Many shopping malls open early and have security on duty. You’ll be surprised how many people take advantage of mall-walking programs.
• Carry pepper spray or a whistle in a handy place (for example, on a wrist bracelet or around your neck). Take your dog with you on your walk.
• Awareness and prevention are key. Take a self-defense course, but remember that it’s easier to avoid a high-risk situation than get yourself out of it.

I’m afraid to hurt myself/have health concerns

• If you have joint or muscle conditions such as osteoarthritis or low back pain, check with your doctor before beginning an exercise program. Ask for a referral to a physical therapist or exercise physiologist who specializes in your condition. You’ll learn targeted exercises that will strengthen the injured area and allow you to engage in an overall program of exercise.

• If you have knee problems you may still be able to do water exercise, cycling and chair exercises. Check with your doctor.

• Although many health conditions such as diabetes, cardiovascular disease and high blood pressure require certain modifications and precautions, these conditions can be significantly improved by regular exercise. Seek guidance from your doctor before starting a vigorous program.
• Don’t do too much too soon. Start with just 5-10 minutes of activity every other day and add only 10-20% in time or distance each week. Give yourself permission to “start low and go slow”. You’ll reduce your risk of injury and gradually build your body’s tolerance for a new active lifestyle.

So what is it that is your biggest barrier to exercise? I’d love to know if I have missed any!

With special thanks to American Council on Exercise for inspiration!