Fighting Evolution

Fighting obesity means fighting evolution’s urges to gorge, according to David Tichansky, MD. “We’re all genetically programmed to eat as much as we possibly can at every possible opportunity, and when we’re given a choice to select the sweetest-tasting choice.”

We need to learn to distinguish between “brain hunger” and “stomach hunger.” Ways to do that include controlling portion size, eating slowly and waiting thirty minutes before eating something else. People can drink hundreds of calories a day, often mindlessly.

It takes a lot of work to combat genetics, not to mention the additional psychosocial, societal and cultural factors. The TV ads for restaurants (mainly fast food and pasta emporia) are non-stop. Super-size drinks are never a good idea. Comfort food from the old country used to be a rare treat, not a daily event. In the old days, cake was only served on a birthday.

We are also losing sight of what is a good weight. A person will often think that he looks OK, even if his body mass index is well above the upper goal of 25. Clothing manufacturers are using vanity sizing: what used to be a women’s size 8 is now a size 4. Men’s trousers are “full cut,” code words for bigger than advertised.

Everyone should be thinking about maintaining a healthy weight. People with a body mass index (BMI) of 25 to 30 should lose weight with diet and exercise and not wait until they are in trouble with a BMI greater than 30.

Calculate your  BMI.

Sugar Alcohols

Foods that are marked “no sugar added” are not without sweeteners – instead of the usual table sugar (or another sweetener such as honey) the food is made sweet with a sugar alcohol. It’s easy to spot the products: on the ingredient label you will see substances that end with “ol” such as sorbitol, mannitol or xylitol.  These additives are not calorie free! Sugar alcohols contain two calories per gram; regular sugar has four calories per gram.

Many of these sugar alcohols are derived from fruit, but some may be made in the lab.  The chemical structure is a blend of a sugar molecule and an alcohol molecule. The sugar alcohols are listed on the Nutrition Facts label under the sugars line as part of the total carbohydrates. They do count as carbohydrates.

The sugar alcohols are not usually added to ‘regular’ foods – they are found in snack bars, candies, frozen treats and some beverages. In excess, they can have a laxative effect.

I am not a big fan of engineered food. Sugar alcohols can be helpful to diabetics, since they decrease the total carbohydrate content of food. For the average person, eating half a serving of real food will also decrease the carbohydrates in half and will taste much better. Best of all – no nasty side effects.

Moving interrupts life

This is the time of year that many people move – the school calendar sets many schedules. That first lease signed after college graduation sets the timetable for all subsequent moves and no one wants to disrupt a child’s school year. Even with optimal timing, it’s never easy to move.

Moving to a new community is one of the most stressful experiences a family faces (and a family might be a singleton). Moves are even more difficult if accompanied by death, divorce, loss of family income and change of job/school. Many people don’t anticipate the physical and emotional toll of moving.

It’s important to plan and to break things down into smaller tasks. It’s crucial to communicate with others – having a grand plan is of little use if no one else knows how to help. Be kind to one another – alleviating a child’s stress will help the entire family. Share happiness as well as concerns. Set reasonable goals and reasonable boundaries. Reality shows are not real – don’t expect to host a housewarming party in a beautifully decorated home two weeks after the moving vans pull away.

After the move, spend time together getting to know the new area, even if it’s only a few blocks from the old home. Get involved in the new community as quickly as possible, but be sure to take breaks to regroup and recharge.

Moving disrupts the everyday routines that add order to our lives. We develop confidence when the home life is stable. Try to maintain a good exercise regimen and make wise food choices. Get enough sleep. Try to find some fun among the chaos. Moving is not easy, but staying put is not an option. 

Dr. Oz

I recently saw a cartoon in a magazine targeted to physicians: an older male doctor is speaking to a middle-age woman. On the wall is a poster, “Please don’t tell me what Dr. Oz said.”

My colleagues find the cartoon to be apt. Let’s skip the stereotypes: older male doctor, middle age female patient, and get to the point. Those of us actually treating patients practice in a different world than that of Dr. Oz and his boss, Oprah.  Dr. Oz is fortunate that he is able to buy the freshest, most exotic food stuffs and prepare them in an ecologic sensitive manner. There is plenty of time to exercise. There is no need to discuss Oprah – she truly has unlimited resources to maintain health.

However, this is not my biggest complaint about Dr. Oz. He is a well-trained surgeon and generally ‘gets’ the big picture about health. He tries to educate his television audience. What he does not do is choose his words carefully; I cringe when he goes off-script. When discussing a medical topic, he makes a casual statement (every woman should be tested for xxxx) that has a kernel of truth but is terribly incorrect.  Patients will come to the office requesting unusual, inappropriate, unavailable tests and are disappointed when their doctors are not quick to order those unusual, inappropriate and/or unavailable tests. Precious office time is spent discussing why Dr. Oz’s recommendations and why they are not a good idea.

Very few people have the resources of Dr. Oz and even fewer the wealth of Oprah. Rather than give blanket recommendation or glib opinions, I would rather see a less casual and more scientifically focused program. Perhaps Dr. Oz should watch Dr. Nancy Snyderman on NBC. 

The Million Hearts Campaign

The Million Hearts Campaign is an initiative that aims to prevent a million heart attacks and strokes over the next five years.  The campaign seeks to empower Americans to make healthy choices, such as avoiding tobacco use and reducing sodium and trans-fat consumption, as well as to improve care for people who need medical treatment. The Million Hearts campaign focuses on the "ABCS": Aspirin for people at risk, Blood pressure control, Cholesterol management and Smoking cessation, addressing the major risk factors for cardiovascular disease.

The Million Hearts website offers interactive tools to assess the future risk of a heart attack, as well as educational resources to reduce the risk.

Electrocardiogram

The electrocardiogram  (ECG or EKG) records the electrical activity of the heart. The ECG is used to measure the rate and regularity of heartbeats, as well as the size and position of the chambers, the presence of any damage to the heart, and the effects of drugs or devices used to regulate the heart, such as a pacemaker.

During each heartbeat, a healthy heart will have an orderly progression of electrical activity that starts in the pacemaker (natural or artificial), spreads through the upper chambers and then travels to the lower chambers. The lower chambers (ventricles) provide the main pumping action of the heart.

The ECG can measure and diagnose abnormal heart rhythms caused by electrolyte imbalance or damage to the heart muscle. In the event of a heart attack, the damaged area can be identified. The ECG can also discern scar tissue resulting from a heart attack.

Serial ECGs are a valuable diagnostic tool. Comparison of an ECG during chest pain to one performed during a health examination can help determine if the chest pain is cardiac. In the case of a heart attack, the progression can be mapped over time or can monitor therapeutic interventions.

The ECG is also of great value in evaluating valvular heart disease, thickening of the heart wall and inflammation around the heart.  A stress test will measure electrical activity when the heart is working hard, a resting ECG is just that.

More about ECG and stress tests.