My life-long relationship with exercise

As you have read in many of my prior blog posts, I believe very strongly in the overall health and also the specific heart health benefits of frequent exercise. 

I've been exercising for years. It has not been consistent or easy but it's always somehow a part of my life. 

Throughout high school I played organized team sports. In college, I played intramural and pickup basketball. I also was introduced to weight lifting in college. In medical school, although time began to be more and more scarce, I still wanted to and made time to play pickup basketball and intermittently work out in the gym. I also started mountain biking. I started running short and medium distances in my final year of medical school. 

During residency, I continued to run short and middle distances but lost touch with playing team sports. During fellowship, I continued to run (I did find time to train and run a 1/2 marathon) but did so sparingly and inconsistently. I tried playing in a basketball league but had difficulty due to my ridiculously busy schedule. 

The first 9 years of being in private practice and being the father of three young girls, I exercised very infrequently (although I thought about it every day). The only consistent thing was playing doubles tennis every Tuesday night during the Fall, Winter and Spring months. 

However, the last year has been different. Instead of sticking with what I had been doing for the past 15 years, I decided to start shaking things up. It started with rediscovering my love of basketball. I started playing pick up basketball at my gym on Tuesdays and Thursdays. I then rediscovered my love of biking in the form of formal spin classes. I also started taking a once a week boot camp class. I am now doing personal training twice a week before work and mixing in running/spin/yoga with FitStar App guided workouts the other days of the week. 

Clearly there are some people that are just born to exercise. They make time for it rain or shine, irrespective of how busy they may be. That's not me. Although I may think about it almost daily, I'm someone that can easily talk myself out of doing it for a whole host of excuses. 

I have learned over the past year that I need company (friends, family, trainers) to keep me motivated. I love that after 17 years of marriage, spin class is finally an activity something my wife and I enjoy doing together. I love the motivation that my trainer gives me to push myself harder and harder. I love the sweat, pain and laughter of playing basketball with a group of guys. 

Some of the other benefits of consistent exercise:

- I am proud of the example I'm setting for my girls

- I love how well I sleep the days I work out

- I love how good I feel after a workout (even though getting myself out of bed on a dark 10 degree morning was sheer torture)

- I look forward to the stress release it provides me

The only thing I don't like is how my body hurts (knees, shoulders, back...). Getting older hurts...

Well, that's the story of my relationship with exercise. What's yours? What helps you start and keeps you moving? What holds you back?

Simple Rules for Healthy Eating — from the New York Times

I think this recent article in the New York Times by Dr Aaron E. Carroll is brilliant. I will be sharing it with my friends, family and patients. It fits very much with my typical dietary recommendations which I give to patients: try and consume a Mediterranean style/mostly plant based/whole grain diet. 

I hope you enjoy this article as much as I did. 

Simple Rules for Healthy Eating

Over the past few months, I've written a number of times on how nutrition recommendations are seldom supported by science. I've argued that what many people are telling you may be inaccurate. In response, many of you have asked me what nutrition recommendations should say.

It's much easier, unfortunately, to tell you what not to do. But here at The Upshot, we don't avoid the hard questions. So I'm going to put myself on the line. Below are the general rules I live by. They're the ones I share with patients, with friends and with family. They're the ones I support as a pediatrician and a health services researcher. But I acknowledge up front that they may apply only to healthy people without metabolic disorders (me, for instance, as far as I know).

These suggestions are also not supported by the scientific weight of rigorous randomized controlled trials, because little in nutrition is. I've inserted links to back them up with the available evidence. They are not "laws" and should not be treated as such. No specific nutrients will be demonized, and none will be held up as miracles. But these recommendations make sense to me, and they've helped me immensely.

Full disclosure: I did not invent most of these. I've developed them from reading the work of others, including what may be the most impressive "official" nutritional guidelines, those of Brazil, as well as from earlier suggestions from readers, as in this great NYT interactive graphic. It captures readers' responses to food rules by Michael Pollan. He is, of course, the promulgator of the well-known advice: "Eat food. Not too much. Mostly plants."

1. Get as much of your nutrition as possible from a variety of completely unprocessed foods. These include fruits and vegetables. But they also include meat, fish, poultry and eggs that haven't been processed. In other words, when buying food at the market, focus on things that have not been been cooked, prepared or altered in any way. Brown rice over white rice. Whole grains over refined grains. You're far better off eating two apples than drinking the same 27 grams of sugar in an eight-ounce glass of apple juice.

1b. Eat lightly processed foods less often. You're not going to make everything yourself. Pasta, for instance, is going to be bought already prepared. You're not going to grind your own flour or extract your own oil. These are meant to be eaten along with unprocessed foods, but try to eat less of them.

1c. Eat heavily processed foods even less often. There's little high-quality evidence that even the most processed foods are dangerous. But keep your consumption of them to a minimum, because they can make it too easy to stuff in calories. Such foods include bread, chips, cookies and cereals. In epidemiologic studies, heavily processed meats are often associated with worse health outcomes, but that evidence should be taken with a grain of salt (not literally), as I've written about before.

2. Eat as much home-cooked food as possible, which should be prepared according to Rule 1. Eating at home allows you to avoid processed ingredients more easily. It allows you full control over what you eat, and allows you to choose the flavors you prefer. You're much less likely to stuff yourself silly if you eat home-cooked food. I'm not saying this is easy. Behavioral change takes repetition and practice. It also, unfortunately, takes time.

3. Use salt and fats, including butter and oil, as needed in food preparation. Things like salt and fat aren't the enemy. They are often necessary in the preparation of tasty, satisfying food. The key here is moderation. Use what you need. Seasoning is often what makes vegetables taste good. Don't be afraid of them, but don't go crazy with them either.

4. When you do eat out, try to eat at restaurants that follow the same rules. Ideally, you should eat at restaurants that are creating all of their items from completely unprocessed foods. Lots and lots of restaurants do. Follow Rule 1 even while out to dinner. Some processing is going to be fine, but try to keep it to a minimum.

5. Drink mostly water, but some alcohol, coffee and other beverages are fine. As I've pointed out before, you can find a study to show that everything either prevents or causes cancer — alcohol and coffee included. But my take is that the preponderance of evidence supports the inclusion of a moderate consumption of most beverages.

6. Treat all beverages with calories in them as you would alcohol. This includes every drink with calories, including milk. They're fine in moderation, but keep them to a minimum. You can have them because you like them, but you shouldn't consume them as if you need them.

7. Eat with other people, especially people you care about, as often as possible. This has benefits even outside those of nutrition. It will make you more likely to cook. It will most likely make you eat more slowly. It will also make you happy.

I've avoided treating any food like the devil. Many nutrition experts do, and it may turn out they're right, but at this point I think the jury is still out. I've therefore tried not to tell you to avoid anything completely. My experience tells me that total abstinence rarely works, although anecdotes exist to support that practice. I think you'll find that many other diets and recommendations work under these rules. These are much more flexible and, I hope, reasonable than what some might prescribe.

All of these rules are subtly trying to get you to be more conscious of what you're eating. It's far too easy these days to consume more than you think you are, or more than you really need, especially when eating out. I've found that it's impossible to tell any one person how much they should be eating. People have varying requirements, and it's important for all of them to listen to their bodies to know when they should eat, and when they should stop.

One other thing: Don't judge what others eat. One of my closest friends has been avoiding carbohydrates for months, and has seen remarkable results. Another was a pescatarian — a person whose only meat dishes are fish — for a year and was very happy with that. I, on the other hand, avoid no food groups in particular.

People are very different. Some may have real problems consuming even the smallest amount of carbohydrates. Others may be intolerant of certain foods because of allergies or sensitivities. It will most likely take a bit of experimentation, on an individual level, to find the actual diet within these recommendations that works for you. But the above rules should allow for a wide variety of foods and for remaining healthy. At least, I hope so.

I'm curious what readers think of these. I welcome your comments to this column, as well as tweets to me in response.

http://mobile.nytimes.com/2015/04/21/upshot/simple-rules-for-healthy-eating.html?referrer=

Article: Women Having A Heart Attack Don't Get Treatment Fast Enough

Women Having A Heart Attack Don't Get Treatment Fast Enough
http://www.npr.org/blogs/health/2015/04/06/397281837/women-having-a-heart-attack-dont-get-treatment-fast-enough

Exercise May Boost Mobility in Old Age

http://goo.gl/rcIpXl

Exercise May Boost Mobility in Old Age

WebMD News from HealthDay

By Steven Reinberg

HealthDay Reporter

WEDNESDAY, March 11, 2015 (HealthDay News) -- Staying physically active as you age may ward off brain damage that can limit mobility, a small study says.

Small areas of brain damage called white matter hyperintensities are seen in MRI scans of many older patients, according to scientists from Rush University Medical Center in Chicago. Higher levels of this damage have been linked to difficulty walking and other mobility problems, the researchers said.

"Preserving motor function is just as important as preserving mental function to maintain independence and quality of life in older age," said lead researcher Debra Fleischman, a professor in the departments of neurological sciences and behavioral sciences.

"Our results suggest that daily physical activity may be able to protect motor function from age-related injury to the brain," she added.

The study, published March 11 online in the journal Neurology, involved 167 patients, average age 80.

For the study, Fleischman's team had participants wear movement monitors on their wrists for up to 11 days. These devices measured exercise and non-exercise activity. Participants also took 11 tests of movement ability, and researchers used MRI scans to assess the level of white matter hyperintensities in the brain.

The researchers found that those seniors who exercised the most, even if they had high levels of brain damage, maintained their scores on the movement tests. However, for those who exercised less, brain damage was associated with lower scores on the movement tests.

The findings held after the researchers adjusted for other factors that might influence exercise, such as weight, depression, and conditions that affect blood circulation.

Dr. Sam Gandy, professor and associate director of the Mount Sinai Alzheimer's Disease Research Center in New York City, called this an "extremely important" study.

"Virtually everything about Alzheimer's and other dementia appears to be mitigated by physical exercise," he said. "I think that this study serves to make that case even more compelling."

The bottom line, Fleischman said, is to do some kind of safe and enjoyable movement daily to protect motor function from brain injury that may occur as you get older.

The message she said she gives patients is: "You do not have to be marathon runners."

Fleischman cautioned that this study does not prove that physical activity directly preserves movement ability, it only shows an association between the two.

Although there are good treatments for conditions that impair movement, such as Parkinson's disease and arthritis, age-related movement problems are common and often left untreated, she said.

"Until we have a more complete understanding of the biological mechanisms underlying chronic late-life motor impairment, and have developed effective drug treatments to lessen the effects of brain injury on motor function, efforts to encourage an active lifestyle in older adults will be a critical element in meeting this public health challenge," Fleischman said.

Circadian Surprise: How Our Body Clocks Help Shape Our Waistlines

Just yesterday I wrote about the importance of sleep on our overall health and specifically on its influence on our weight. How timely then that this segment appeared on NPR this morning. I hope you enjoy and find it helpful. 

Circadian Surprise: How Our Body Clocks Help Shape Our Waistlines
http://www.npr.org/blogs/thesalt/2015/03/10/389596946/circadian-surprise-how-our-body-clocks-help-shape-our-waistlines

Possibilities

I'm very excited about the Apple Watch. I can see endless possibilities for its applicability towards moving health forward. 

As a busy clinician, being able to quickly and discreetly glance at my wrist for a notification (phone call, text or email) from a patient, other physician or my office staff without have to pull my entire phone out of my pocket will enable me to spend more time focused on the patient in front of me and less time looking at my phone. 

As a health and fitness tool, I see the watch being able to help my patients move more and eat better. Already there are applications designed to track general daily activity, specific exercise tracking, and even app's to help with cooking and food intake tracking. 

In combination with the newly announced Reseach Kit platform, medical researchers will be able to use data from the Apple Watch and the iPhone in new and imaginative ways. 

However, I believe this is just the tip of the iceberg. Just as none of us could have envisioned the iPhone to become ubiquitous in our society (2 year olds and 90 years old use them just as easily) so too will devices like the Apple Watch become a part of us. Given a platform like the Watch, the real breakthroughs will come from the engineers at Apple continuing to push the device forward and from the app developers imagining new and innovative ways to use the device. 

The Importance of Sleep

On the way home from a trip to Rhode Island, my wife and I listened to an amazing TED talk by Russell Foster titled "Why do we sleep."

I am aware of the link between sleep deprivation and obesity. I am aware of the link between sleep in teenagers testing scores and employees productivity and creativity. 

I spend a lot of time talking to my patients about sleep but in the past, the conversation mostly focuses mostly focuses on their risk of sleep apnea, If they do no have sleep apnea, I typically have let sleep issues fall by the way side. 

Now, it is clear to me that sleep needs to be discussed along with not smoking, maintaining a healthy weight, heart healthy eating, low consumption of alcohol and lots of exercise as the keys towards leading a healthy and long life. Specifically, for all those patients that are trying to lose weight, ensuring that they get at least 7-9 hours of sleep a night will help combat the hormonal disregulation for which sleep deprivation leads to  increased appetite (specifically for carbs), increased adipose (fat) deposition around the waist, increased inflammation, increased irritability and leads to lack of energy zapping the oomph for physical activity.