About stoneagedoc

Pediatric infectious diseases specialist, author and public speaker. After 35 years in clinical practice including 40 years in academic pediatrics I now share that experience in helping others to enjoy a long, healthy life without the burden of chronic disease.

Carvings  April 1, 2022

In the news

More on COVID-19 and diabetes – and a heads-up on screening

            In the last post I mentioned that in some persons who experienced abnormally high blood sugar after having been infected by the coronavirus, their sugar metabolism returned to normal. That left the rest with persistent elevations, meaning that they had developed type 2 diabetes. This has been confirmed by physicians at the VA health facility in St. Louis, Missouri.

            Among more than 180,000 persons with prior COVID-19 infection many still had a diabetes profile at the end of one year. Nearly all had type 2 diabetes. That surprised me, since some observers noted that this coronavirus damaged insulin-producing cells of the pancreas, a hallmark of type 1 diabetes. But then, these cases didn’t entirely resemble the pattern of type 2 diabetes either. The good news is that we can expect to learn much more about both types of diabetes, an eventual benefit for mankind.

            I have long encouraged annual diabetes screening for persons at greater risk as early as age ten!: those who are overweight, of black, Hispanic or Pacific Islander ancestry, persons with a family history of type 2 diabetes. Everyone over the age of 40 should be screened every year. You can add another group that should be screened: anyone who has experienced COVID-19, even if the symptoms were mild. Remember that prediabetes or the early stages of type 2 diabetes show no symptoms but the diagnosis can be made in many cases with a simple blood test and in nearly everyone with the next level of testing.

Lifestyle

Low-carb diet can include good carbs

Your grocery cart should be full – of fruits and vegetables. That might seem to be a challenge for persons on a low-carb diet that limits even the beneficial carbs in plant foods, especially in the early phases of the diet. However, the South Beach Diet lists 83 (!) legumes and vegetables that can be eaten in Phase One. The key, of course, is to limit the serving size to no more than ½ cup of legumes and two cups of vegetables with any meal. Two cups may sound like a lot for a weight-reduction diet but it is not a lot of calories because vegetables are comprised mostly of water and fiber.

            A two-cup “serving” is about the size of a medium-sized person’s fist. You can confirm the size of your own fist by putting 2 cups of water in a 4-cup measuring cup. Immerse your fist and see where the water level ends up. Your fist then becomes a practical guide to a 2-cup serving size. If you’re a big guy it might be only 2/3 of your fist; if you are small-framed it might be a little more. Don’t get hung up on small differences!!

            Vegetables – and even fruits — have very few calories per ounce; their fiber and water content give you a feeling of fullness that goes a long way to relieving hunger and especially, cravings. And the more colorful they are the higher content of antioxidants. Plants give us more vitamins than any other food and although they lose some of these in storage and shipping, only whole grains even come close. And junk food? Forgeddaboutit!

Carvings March 15, 2022

In the news

COVID-19 is the gift  that keeps on giving – confusion. Early in the course of the pandemic persons with type 2 diabetes were at much greater risk of dying from the infection but the situation is complicated. They were also more likely to be older, to be overweight or obese and have heart disease, all of which are additional risk factors. Patients with very high blood sugar levels were at similarly very high risk. Then it was discovered that some persons with no history of diabetes were found to have unusually high levels of blood sugar, putting them at risk as well. There was speculation that the virus destroyed insulin-producing cells in the pancreas, spawning a new cohort of type 1 diabetics.

Some good news has emerged from Massachusetts General Hospital in Boston. About 40 percent of newly diagnosed patients with diabetes reverted back to normal about a year after recovering from their illness. It’s important to note, however, that 56 percent of them remained diabetic. (Two patients could not be classified after nearly one year.) The story isn’t over – we won’t know what the long-term effects are for years. These seemingly recovered persons may have impaired sugar metabolism that will reappear years or decades from now.

An altogether separate but disturbing finding is that the incidence of type 2 diabetes – what was once called adult-onset diabetes – has doubled during the pandemic and the most dramatic increases have occurred in black teenagers, the majority of whom were not infected with the coronavirus. Even worse, there has been an alarming increase in the percentage of hospitalized youths with diabetic ketoacidosis – sometimes referred to as diabetic coma – a five-fold increase in one medical center. What’s going on?

Researchers are scrambling to unravel these developments. The isolation, the lockdown and the interruption of schooling are taking their toll. Less physical activity, more screen time, less sleep and a diet heavy of junk food most likely are contributing to the increase in type 2 diabetes, already an epidemic of its own.

Although what is needed is a massive public health effort to address this and other issues that have arisen since the outbreak of the pandemic, we are faced with enormous distractions: war in Ukraine, inflation, supply shortages, the chaos of an election only a few months away. In the meantime, as individuals we need to maintain our own good health which means a healthy diet and plenty of vigorous exercise.

Why these coronaviruses, i.e., the original virus and all its mutations, will never go away.

             Coronaviruses were found in turkeys in 1951 and since then all kinds of animals have been found to be infected, some 29 species so far. Our family dogs, our farm animals and the ones that we see in zoos are known to carry the virus, guaranteeing that after this pandemic phase has ended the coronavirus will be an endemic disease.

            Will it spread from these animals to humans? Probably, since we know that at least one person has apparently been infected after close contact with a deer – I have no details on that but it’s likely to have been a hunter. Is that a big deal? Probably not, since most mutations are lethal for the virus. My optimism is based on the knowledge that over several decades during which millions of birds have been infected with the “bird flu” virus, it has not emerged as a threat to humans. Cross your fingers!

Carvings March 1, 2022

In the news

The COVID silver lining

            A very large percentage of persons who have had symptomatic COVID-19 infection are still suffering from Long COVID, a condition with many and varied symptoms that include fatigue, headache, fuzzy thinking, joint pains, poor appetite, continued loss of sense of taste and smell, memory loss and a host of others. Scientists are beginning to unravel this problem but long COVID will probably require several approaches to treatment.

            One possibility is that the virus has damaged some organs and their recovery is a long process. This coronavirus targets blood vessels that are critical to the nourishment of cells and to the removal of their waste products.

            Another proposal is that the coronavirus reactivates another virus that lies dormant in the body. The best example of such a hidden virus is the common disease called shingles (nothing to do with roofs but that is a story for another blog) that results when the chickenpox virus emerges from its sanctuary in the nerves alongside the spinal cord to cause a painful, sometimes debilitating skin eruption, especially in older persons. In the case of long COVID one suspect virus is the Epstein-Barr virus, the agent of infectious mononucleosis – the so-called kissing disease because of its prevalence among adolescents. Infectious mononucleosis is almost universal;most of us have been infected but have had few symptoms. E-B virus infection also sometimes causes weeks of extreme fatigue, although without the other symptoms of long COVID.

            Yet another possibility is autoimmunity, wherein the immune system mistakenly causes damage to various organs in the course of attempting to overcome a viral assault. Autoimmune diseases include rheumatoid arthritis, lupus and multiple sclerosis as well as type 1 diabetes, the last of which has increased markedly since the pandemic began.

            If we can determine what causes long COVID we’re likely to learn how to treat it, and the silver lining is beginning to emerge.  

Lifestyle

Exercise Tips

                Is it pain or just soreness? When you work a muscle hard, especially if it’s the first time, you know how sore it feels the next day and possibly for several days. That is normal and it is known as Delayed Onset Muscle Soreness (DOMS). You can avoid it if you begin an exercise program – or a new type of exercise – with very low weight. I recommend that you go through a routine either with no weight at all or an empty barbell or dumbell in your hands or the lowest setting on a weight machine for at least two weeks to open up existing blood vessels and grow new ones. Walkers and runners should start with low speeds and short distances. That may not completely eliminate DOMS but it sure will help.

            Pain is different. It sometimes comes on suddenly during or after an exercise, and it’s usually asymmetric – involving only one side of the body, e.g., one shoulder.

            Do not try to “work through” DOMS or pain. In the former it’s just not worth the discomfort and in the latter you are likely to make the injury worse.

Carvings January 15, 2022

In the news

So where do we go from here?

            The SARS-CoV-2 pandemic is without a doubt the most confusing event that the medical  profession has ever faced – and the most humbling one. Much of the devastation wrought by this virus is due to the behavior of politicians – sometimes overreacting and sometimes failing to act in a timely manner. It’s easy to apply hindsight to malfeasance such as the nursing home debacle of New York state and the closing of California’s beaches but flip-flopping by respected organizations such as the CDC has reached embarrassing new heights.

            The refusal of healthcare workers to be vaccinated is a puzzlement. Now that nearly ten BILLION doses of the vaccine have been administered with the number of deaths caused by the vaccines  in the low thousands, it must be remembered that the observed complications, myocarditis, Guillain-Barre syndrome and blood clotting events are many-fold higher among infected persons than in those who have received the vaccine.

Two recent articles illustrate the confusion. One is titled Common Cold Could Prevent Against COVID-19, Study Says. The other, Common Cold Antibodies May Hinder Defense Against SARS-CoV-2 shows the opposite. My advice: ignore the articles about the common cold.

            It’s disheartening to learn that persons who have received three or even four doses of a vaccine may develop infection, and that some have died. We need to recognize that the overwhelming number of those deaths have occurred among persons with conditions that were very uncommon a century ago: obesity, type 2 diabetes, kidney disease and hypertension.

            We do know that masks are somewhat effective but that inadequate materials, poor fit, wearing them below the nose, and prolonged use severely impair their effectiveness. And in the words of one researcher “a cloth mask is nothing more than a facial ornament”. But if you must be in a crowded area, it does make sense to wear a properly constructed (i.e. N95) mask, to apply it properly and to avoid  touching it (that’s tough!).

            Spend as much time outdoors as possible. Wash your hands several times a day with plain soap and water. Avoid crowds when you can but don’t become a hermit. Eat healthy foods – that means lots of fruit and vegetables, a variety of protein foods (especially wild salmon and smaller fish) and lose some weight. Considering that nearly 80 percent !!!!!!!!! of Americans are overweight and that excess fat is a serious contributor to the dreaded cytokine storm, that recommendation apples to just about everybody.

            And for heaven’s sake – get the vaccine!

Lifestyle

Go Mediterranean!

            I have been promoting olive oil for years and a recent report adds to the evidence that olive oil is an important element in a healthy diet. The study was done among more than 90,000 American health professionals over nearly 20 years. Numerous studies have  shown than those who enjoy the TRUE Mediterranean Diet – not what you get at your favorite pizza place – have a lower risk of heart attack and stroke.

            Even though the amount of olive oil consumed by Americans is much less than that taken in Spain or Italy, for example, the results could not be ignored. As little as a half-teaspoon a day was associated with (but did not necessarily cause) lower incidence of cardiovascular disease (heart attack and stroke), cancer, neurodegenerative diseases such as dementia and Parkinson’s disease and respiratory disease.

            There are four nutrients in olive oil that together contribute to its health benefits. It contains both monounsaturated and polyunsaturated fats, the latter being precursors to omega-3 fats that have a  major role in limiting inflammation, in supporting the immune system and in protection of the heart from rhythm abnormalities.

            It is rich in polyphenols, nutrients that are important in many chemical processes, especially in limiting inflammation. Chronic inflammation is a major driver of heart disease, stroke, cancer, autoimmune diseases such as multiple sclerosis, lupus and rheumatoid arthritis, and osteoporosis.

            Squalene, a chemical originally derived from sharks’ livers appears to protect us from certain forms of cancer.

            But there’s more to the story. Persons who adhere to a Mediterranean diet – and that was true in the subjects of this review – are  more likely to be of normal weight, to exercise, to eat less red meat, less saturated fat and more fruits and vegetables. Simply adding a teaspoon or two of olive oil to your diet isn’t likely to lengthen your life but making all those other lifestyle changes will.

            And of course, having a little red wine every day can’t hurt.

Carvings January 1, 2022

In the news

Let’s begin the New Year with some uplifting news: the COVID-19 Silver Lining

            Pandemics, like wars, call forth imagination and innovation and this pandemic has advanced areas of science whose fruits might not have emerged for years, perhaps decades.

            The structure of DNA was elucidated by Watson and Crick only a couple of years before I began medical school. My course in genetics included the study of pea plants, whose patterns of inheritance were recognized by a European monk before the American Civil War. In contrast, the genome – the genetic pattern of SARS-CoV-2 – was determined within weeks of the virus’s isolation and newer variants are being decoded within days.

            One major benefit is the ability to identify the presence of the virus within minutes, a process that took days only a couple of decades earlier. Although tests vary in their accuracy and reliability the ability to identify persons who are capable of spreading the virus has doubtless saved lives.

            Advances in vaccine development are mind-boggling. No less than 350 candidate vaccines were in development two years ago. Most of them were found wanting but the fact that we have given more than 8 billion doses of the approved vaccines with dramatic effectiveness – at least in the short term – with fewer side effects than had been anticipated, is remarkable. And those drop-out vaccines? I have no  doubt that some of those research efforts will turn out to be successful with other diseases and after even more research has been carried out on them.

            Until recently I had been disappointed that no drug treatment had been discovered that could stop a viral infection as quickly and completely as antibiotics have done with bacterial diseases such as pneumonia and tuberculosis, the worst killers of the 19th century. But before this new year has ended it’s likely that there will be more than a few effective treatments for this pandemic virus. That, of course, has tremendous importance in the fight against diseases such as rabies and other kinds of encephalitis.

            This virus attacks blood vessels and especially the lungs of its victims. Initial attempts at ventilation were rather clumsy but experience has enabled more effective ventilator therapy.

            All this makes me hopeful that we will be better prepared when the next pandemic arrives, as surely one will within the next few years.

Lifestyle

            If your New Year’s resolution is to lose weight you might want to think about how you approach it. Exercise is not the key to weight loss but it’s important for another reason. The sad truth is that even moderately intense exercise has a limited effect on weight loss. For instance, when I pedal on the stationary bike with the incline setting at maximum, the monitor tells me that I have only burned a little more than 100 calories. ☹ (You can find lots of information on exercise and calories on Google.) Pick an exercise that you feel that you can do most days of the week from now on.

            Exercise does matter if you also restrict calories because by cutting back on intake to about 1200  calories per day, unless you exercise with moderate intensity the weight that you lose will come from glycogen, water, muscle tissue and fat, pretty much in that order. Simply put, significant calorie restriction results in the loss of lean body mass, mostly muscle, before the fat begins to melt away.  

            Also, keep in mind that as you lose weight through calorie restriction AND exercise, you will gain some muscle as you lose fat, so that you might not see much of a drop when you step on the scale. You WILL see that your waist size is smaller, since abdominal subcutaneous fat is the first to go.

            If your goal is to lose 50 pounds in 2022 and you can only lose 15, remember that even such seemingly small decreases in body fat will lower your blood pressure and your blood sugar. And that’s the good news for this New Year’s Day.

Carvings December 15, 2021

In the news

Nag, nag, nag – but someone has to do it!

            Three disturbing news stories emerged in the past couple of weeks and each one referred to articles that I have posted since the onset of COVID-19, whose sad anniversary occurred this month. Perhaps the most concerning news is that the rates of both type 1 and type 2 diabetes have increased dramatically in the past year and the adolescent black population is being hit especially hard. In persons below the age of 19, type 2 diabetes has almost doubled – 95 percent! In one large medical center it tripled in just one year. And  these kids are sicker – five (!) times as many presenting with so-called  “diabetic coma” than in previous years. As noted in previous posts, young persons with type 2 diabetes get complications such as kidney failure and blindness faster than those who develop it in their 50s or 60s, which had been the pattern of the 20th century.

            The International Diabetes Federation has just published a report noting that the rise in type 2 diabetes continues to increase among all ages and is also being seen in pregnant women who develop “gestational diabetes”, which is associated with serious complications for their infants. According to the IDF, one in ten adults in the world now has diabetes.

            And now we learn that the coronavirus can hide in fat cells and that fat stores harbor immune cells whose overactivity can lead to the fatal condition known as cytokine storm.

            There is a growing consensus among health educators that this is a wake-up call, a stimulus for a strong effort to reduce the rate of obesity – now a staggering 42 percent of American adults. As a nation we simply cannot afford the cost of treating persons with the complications of obesity and type 2 diabetes – soon to reach one trillion dollars a year.  

Lifestyle

If you’re an average American you probably don’t like fish, or you have it only a couple of times a month. Big mistake. Fish is one of the best sources of protein on the planet and it comes with a very small amount of saturated fat. Most of the fat that we find in fish is the polyunsaturated omega-3, which in my humble opinion is the single most important nutrient that is lacking in the American diet. (Actually, it’s the opinion of scores of nutritionists.)

            Unless you’re pregnant, about to be, or under the age of 5 you don’t have to worry about mercury. Non-pregnant grownups can tolerate levels of mercury that are considerably higher than that found in most fish, especially the smaller ones like salmon and sardines.

            Half of the salmon in U.S. restaurants is farmed. Fish raised in pens are often fed grain, not what fish eat in the ocean or in lakes and streams.  Eat wild when you can.

Carvings November 15, 2021

Stop the Bleed: when knowing what to do isn’t enough

            Stop the Bleed is a program that began after the murder of 20 schoolchildren and 6 school staff members in Sandy Hook, Connecticut in 2012. Recognizing that a victim of a stabbing, shooting, car accident or workshop mishap can die within 4 or 5 minutes from blood loss, and that 40,000 (!) persons die that way in the U.S. annually, the Department of Defense, American College of Surgeons and other organizations put together a course that teaches the simple steps that could save thousands of lives every year.

            The methods are simple and take only minutes to learn, although the hands-on practice that all students demonstrate in order to obtain a certificate of completion takes a little longer. The techniques shown in the program are only meant to control deadly hemorrhage in the few minutes before emergency responders arrive: Press, Pack, Tourniquet.

            As many of you know, I began a CPR training program at our church in 2001. Since then we have trained more than 700 members of the parish in this lifesaving skill. We began to teach Stop the Bleed just before the pandemic began and have trained more than 100 persons so far.

            Knowing what to do is important but you need to have access to the means of stopping extreme loss of blood. That requires such things as gauze pads or rolls and tourniquets. Do you have these items in your home, your car, your office, your boat or your RV? I didn’t think so!

            Acquiring these items won’t drain your savings. Start with a small pouch, or even a Ziplock bag. Several rolls of 3- or 4-inch gauze, two tourniquets and cheap scissors are the basics. You might want to include a pressure dressing or Israeli bandage but applying these takes training and practice.

            Why two tourniquets? Because one might not be enough to stop the bleeding, because the plastic windless might break, or there might be a second wound or a second victim.

            Why scissors? Because you need to expose any site of bleeding and cutting clothing is the fastest way.

            At St. Thomas More church in Oceanside we have four Red Bags, enough materials to treat several victims. They are placed at opposite ends of each of our two campus buildings in order to maximize speedy access and to provide redundancy in case one is not accessible. I mention this because you might want to consider doing the same at your place of worship or your workplace.

            You can obtain further information at www.stopthebleed.org.

            If you are in the San Diego area and would like to organize a Stop the Bleed class, let me know. Classes are limited to six persons because I only have one set of materials. However, I can do more than one class, since the total time involved is about one hour. The cost is $10 per person to cover the cost of supplies and you will receive a certificate of completion. Unlike the CPR class, the items I need for presenting the PowerPoint are easy to transport, so I can come to any location within the county, home, business, church or school. All proceeds go to our account at the church.

In the news

Why a little bit of fat matters. Prepare to be offended.

            In the past couple of posts I have argued that one cannot be fit and fat and that the research that appears to support the idea that excess body fat is not a detriment to longevity has serious flaws. Obesity is a markedly complex issue that can hardly be discussed in depth in a blog as brief as this one but some recent news helps to clarify at least one issue, the high mortality of SARS-CoV-2 in obese persons and how that might apply to other health matters.

            Some caveats, comments and concessions: (1) the terms “overweight” and “obese” are somewhat arbitrary but necessarily so in order to form baselines in research. (2) Body Mass Index (BMI) is of limited usefulness for reasons noted in earlier Carvings blogs. (3) All body fat is not the same; subcutaneous fat is not by itself associated with diseases such as coronary artery disease, stroke, cancer and type 2 diabetes but visceral fat, which is interspersed within the abdomen is. (4) Genetic factors play a large role in the interaction between fat stores and disease. (5) Skeletal size and body type blur the definition of “overweight,” which demographers generally consider to be ten pounds over the actuarial norm but that is somewhat arbitrary.

            In an article at www.medscape.com posted today, November 1, 2021, researchers from Stanford University analyzed autopsies of persons who died of COVID-19 and noted: “Infection of fat cells led to a marked inflammatory response, consistent with the type of immune response that is seen in severe cases of COVID-19.” The authors note that this may explain why obese persons do so poorly during infection with this virus.

            Perhaps this observation and a hypothetical illustration will explain why persons who have only a little more body fat than nature intends are not as healthy as they like to think they are.

            Let’s use the example of identical twin men (A and B) – which eliminates genetic influences — age 50 who live in adjoining homes. Both are engineers, work in the same company, have similar pastimes and physical activity and are married to twin sisters. Their diets are identical and the sisters are excellent cooks, follow the same recipes and like the same foods. However, Wife B has a talent for making her dishes look more appetizing so that Husband B eats just a little more than Husband A. Not much more, mind you, only about 7 or 8 calories per day more that he doesn’t burn off with exercise. (That’s a little less than a single bite of a banana or not even one-third of a teaspoon of sugar.) Unfortunately those few calories have allowed Husband B to gain a little less than one pound a year over 30 years so that he now weighs 20 pounds more than Husband A. (See below for the math.)

            What do those 20 pounds consist of? The answer is fat, most of which is (relatively harmless) subcutaneous fat but some is the nasty visceral type. That’s why Twin B, to his chagrin, has a waist size two inches or so bigger than Twin A. Hardly noticeable, right? But as noted above, visceral fat produces inflammatory chemicals that are associated with coronary artery disease, stroke, cancer and type 2 diabetes as well as several autoimmune diseases such as rheumatoid arthritis and multiple sclerosis.

The conclusion: Twin B is not as healthy as Twin A. Not by a lot, and if he exercises regularly, he might live to a ripe old age. Maybe.

I’m quite aware that there is a gradation between normal, overweight and obese. The latter two categories, though not precisely defined, comprise more than 75 percent of the U.S. population. Of the fifteen leading causes of death in the U.S., most are directly or indirectly linked to obesity.

Curious about the math? Seven calories per day for 365 days equals 2555 calories. Over 30 years that’s 76,650 calories, equivalent to 21.3 pounds of fat. Isn’t that a bummer!

Carvings       October 15, 2021

In the news

Fit and fat – missing the point – again!

            Two weeks ago we wrote about about the misleading claim that one can be overweight or obese and be fit at the same time. Although carrying extra weight does not preclude the possibility of being free from the immediate risk of heart attack or stroke, or not having the markers of type 2 diabetes, longer follow-up studies uncover the dangers of extra weight in later years.

            In just the past few days, on October 12th, another such misleading article appeared in the San Diego Tribune, a reprint of an item that was published in the New York Times. I am no expert in human metabolism, obesity or type 2 diabetes but some of the errors made in these articles should be obvious to anyone with a minimal education in these areas.

            I remain puzzled about the overwhelming reference to the BMI (Body Mass Index) in so many studies. The BMI was devised more than 150 years ago by a French demographer who applied this tool in the analysis of populations. The BMI was never intended to be applied to individuals and I explained why, in detail, in the October 1st post.

            Of the several articles that I have reviewed, the concept of Normal Weight Obese has not been addressed. Simply stated, a person whose weight is normal according to standard actuarial tables but whose level of body fat exceeds normal is considered NWO. In a study from a major medical center, twenty percent of women whose weight was normal by the usual standards were carrying extra body fat. The scale says that they are normal but the tape measure does not; they almost always have large waists, indicating the presence of visceral fat. A personal anecdote illustrates the problem. At a book signing at my alma mater – my 50th college reunion – a classmate came by and said “Phil, life just isn’t fair. I weigh the same as I did when you and I graduated 50 years ago but I have diabetes.” I had to bite my lip to keep from saying “You might weigh the same, but you’re not shaped the same.” In that half-century he lost muscle mass but replaced it with fat. Since fat takes up more space than muscle does, he needed a bigger belt. Further, muscle burns sugar but fat does not.

            The article that argued that being overweight or obese can allow a person to remain healthy cited a grossly misleading reference. Persons undergoing liposuction with the removal of several pounds of fat had no improvement in their markers of heart disease. Of course not! Subcutaneous fat is not associated with heart disease and stroke but visceral fat – that which accumulates around the loops of intestine and that is overwhelmingly associated with cardiovascular disease, is left in place during fat removal.

            The authors of that misleading study gave another example that they claimed “underscored the futility of workouts for weight loss.” Among women who walked 30 minutes a day three times a week: “After 12 weeks a few of them had shed some body fat, but 55 percent of them had gained weight.” Ninety minutes of walking in a week is a paltry figure; hunter-gatherer women are documented to walk an average of nine miles a day, often carrying an infant as well as the day’s harvest. Please!!

            Also cited was the claim that losing weight does not lower the risk of heart disease, stroke or early death. Examples included the loss of up to 5 percent of body weight among exercisers. Unnoticed is the fact that a 250-pound person who loses even 25 pounds – ten percent, not five – is still grossly overweight and likely to have type 2 diabetes and heart disease.

            In summary, carrying excess weight is detrimental to health and there are hundreds of well-conducted studies that show that this is so. It’s correct that exercise by itself leads to little weight loss but it does increase muscle mass, helps to control blood sugar levels and reduces the risk of heart disease and stroke.

Lifestyle

You probably already know the difference between aerobic and resistance exercise, but most people that I talk to don’t do both! That’s unfortunate because nature has programmed our bodies to have both – every day. Luckily, we can get by very well by exercising about 4 or 5 days a week, provided that it’s varied and that each session lasts 30 minutes or more.

            There are plenty of forms of aerobic exercise. Heck, even pushing around a vacuum cleaner for 45 minutes counts! So does yard work – which might also involve some resistance exercise. Walking, biking, swimming and tennis are great. (Sorry – golf is just so-so!) The important point is that we need to do aerobic exercise to keep our heart and lungs in good shape, and resistance exercise that will work every muscle group at least a couple of times a week to maintain balance and bone strength, as well as give both our immune system and our brain a boost.

Carvings     October 1, 2021

In the news

The myth of fit and fat: the last nails in the coffin

            When a team of researchers from the National Institutes of Health (NIH) stated that being overweight was not only unrelated to heart disease but that such persons had a longer lifespan, media journalists (most of whom happen to be just as overweight or obese as their fellow Americans) rejoiced. By the time the director of the NIH held a news conference to disavow the findings the damage had been done. For the next couple of decades the iconoclasts continued to claim that it was OK to be overweight as long as your blood pressure and blood sugar remained at normal values. Similar studies followed with the same misinformation.

            Studies from six countries have finally demolished that myth. It turns out that the spurious studies just didn’t last long enough – some only for five years. A decade or two later those fit and fat – the medical term is Metabolically Healthy Obese — were headed toward stroke centers and coronary care units.

            Research based on several million persons from six countries (U.S., U.K., Denmark, Canada, France and Scotland) verify what many of us have maintained: carrying extra fat puts one at higher risk of cardiovascular disease, stroke, type 2 diabetes and a shortened lifespan. The reports claiming the opposite suffered from several flaws, including that persons with congestive heart failure tend to lose weight as their illness progresses, and so do persons with type 2 diabetes. Some trials were done among selected groups and others relied on self-reporting, a notoriously error-prone method.

            The message is clear: overweight persons who are “metabolically healthy” do not remain so.

            Interestingly, only one of these studies acknowledged that BMI (Body Mass Index), the standard that has been used in scores of research protocols for decades, is an “inappropriate surrogate” for adiposity. The BMI was developed more than 150 years ago by a French demographer who used it to gather information about population groups. It was never intended to apply to individuals although it is typically used these days by physicians, nutritionists, fitness instructors and others in their research. The reason is simple and it should be obvious: it determines the ratio of weight to height and does not take into consideration the fact that two persons of equal weight and height, with the identical BMI, can have markedly different health profiles. As an example, a six-foot, 200-pound bodybuilder and a six-foot, 200-pound couch potato have the same BMI. But the former might have about 10 percent body fat, the latter perhaps 50 percent. Do you think that they will have the same health issues?

            Let’s hope that this myth will go to its grave early so that fewer of us will do likewise.

Lifestyle

            Beware of any diet program that claims that you will lose 5 or 10 pounds per week. That’s possible, but it isn’t safe or wise. Your target should be about two pounds per week. After all, that’s about 50 pounds in six months, 100 pounds in a year, and there is no reason to go beyond that. You will still amaze your friends and we’re months away from bikini season!

            If you push your body into starvation mode you will lose a great deal of lean body mass, which includes muscle as well as tissue from other organs. There is also a much greater risk of gallbladder disease when weight loss exceeds 2 pounds per week.

            Cravings are inevitable when you cut calories drastically but by substituting calorie-sparse foods like fruits and vegetables for calorie-dense refined carbohydrates like anything made with white flour or any form of sugar, those cravings will disappear. Plant foods take up a lot of space, so feel free to snack on them throughout the day. Even though fruit has some sugar, it’s almost never more than about 75 calories – about one-third as much as there are in a bagel – without the cream cheese!

            Fatigue and irritability also accompany marked weight loss. The former will jeopardize your job and the latter your relationships. It just isn’t worth it.

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