Archive for May, 2011

Does Weight Gain Influence Urinary Control Issues?

May 28, 2011

“I have more flesh than another man and therefore more frailty.”

William Shakespeare (King Henry the Fourth)


The prevalence of obesity is increasing and has reached epidemic proportions in the United States.  The burden of extra pounds is an important risk factor for many health problems, including the development of a variety of female pelvic disorders—urinary incontinence (leakage problems) and pelvic organ prolapse (the descent of pelvic organs including the bladder, uterus and rectum).

Although I practice general urology, my fellowship training and subspecialty is female urology, particularly incontinence and pelvic prolapse.  My other passionate interest is public health, wellness, health maintenance and disease avoidance.  These two seemingly disparate disciplines actually interface quite profoundly, as incontinence and female pelvic floor disorders have clearly been shown to be causally related to weight gain and obesity, although there are many other factors involved.  The other key determinants in the occurrence of incontinence and pelvic organ prolapse are child-bearing, aging, menopause and any source of chronic increase in intra-abdominal pressure such as straining with bowel movements, coughing, etc.

There are two main types of urinary incontinence in women, stress incontinence and urgency incontinence.  Stress incontinence is leakage with exertion, jumping, running, sneezing, coughing, etc., and is usually due to weakened pelvic support of the urethra (the tube running from the bladder out).  Urgency incontinence is the sudden and urgent desire to urinate with the inability to get to the bathroom in time to prevent leakage—it is often due to abnormal contractions (squeezes) of the bladder, essentially a bladder that contracts without its owners’ permission—often referred to as an overactive bladder.

Why is there a relationship between being overweight and incontinence?  Increased BMI (Body Mass Index) increases the pressure within our abdomens.  Obesity puts mechanical pressure on the pelvic floor because of excessive intra-abdominal pressures that promote the development of stress incontinence and pelvic organ prolapse.  The bladders of obese women have been shown to have chronic low-grade inflammatory changes that can trigger the symptoms of an overactive bladder—frequency, urgency, night-time urination, the need to literally run to the bathroom, and leakage occurring before arrival in the bathroom.

Obesity has many other associated negative effects with respect to the diagnosis and management of incontinence and pelvic organ prolapse.  It is much more difficult to do a satisfactory pelvic exam on an obese woman.  The results of surgical treatment of stress incontinence are not as effective in overweight women.  Higher doses of bladder relaxant medications are often required in the obese population.  Anesthetic risks are greater as well.  Overweight and obese women have an increased prevalence of Type 2 diabetes, which is a common underlying cause of incontinence because of the havoc that diabetes wreaks on the complex nerve supply to the bladder, urethra, and pelvic muscles.

The good news is that weight loss has been proven to be a helpful part of the overall management of urinary incontinence and pelvic organ prolapse.  Most cases of incontinence and pelvic prolapse are readily treatable.

The following are links to videos that I have created that will provide further insights into stress incontinence, overactive bladder, bladder prolapse and pelvic floor exercises:

Female stress urinary incontinence:

http://www.youtube.com/watch?v=kXBeBFfP6GQ

Overactive bladder:

http://www.youtube.com/watch?v=B_wD2o-rWro

Prolapsed bladder:

http://www.youtube.com/watch?v=bAYsx0RlKws

Pelvic floor exercises I:

http://www.youtube.com/watch?v=5IbliBiRzOw

Pelvic floor exercises II:

http://www.youtube.com/watch?v=y6-2JRJOV_A

This is just a taste of what you will find in Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food. The website for the book is: www.promiscuouseating.com.   It provides information on the book, a trailer, excerpts, ordering instructions, as well as links to a wealth of excellent resources on healthy living.  It is also available on Amazon Kindle.

Is Processed Food Really Any Different From Tobacco?

May 21, 2011

Both tobacco and processed foods share many qualities. Whether it is nicotine or a formulated glob of processed sugar, fat, and salt—cravings, dependency and addictive and habit-forming behavior can result—perpetuating the desire for more and more of the product.  There are 46 million smokers in the USA and surveys show that 70% desire to quit, 40% per year try to quit, and 2.5% actually succeed.

Clearly, tobacco is very bad for our health, with 400,000 Americans succumbing to smoking related diseases each year, and there is no need to dwell on this subject.  But at one time we simply were ignorant about the ill effects of tobacco—now we are educated and informed—so lack of knowledge is no longer a valid excuse for smoking.  Nowadays, those who choose to smoke make a conscious choice of ignoring available information about the harms of tobacco as opposed to the ignorance of years ago.

I contend that the consumption of unhealthy processed foods is no less toxic and harmful to our health than tobacco is.  Of course it is difficult to quantify—I do not know the relative harm of a Hostess Twinkie as compared to a few cigarettes—but with the knowledge that we now have, it is crystal clear that both habits are pernicious to our good health.

It took many years to come to an understanding of the incredible health risks due to tobacco and how far tobacco companies went to wantonly inflict these hazards upon us.  In response to a Reader’s Digest 1952 article entitled “Cancer by the Carton” which revealed the dangers of smoking, big tobacco started mass-marketing filtered cigarettes and low-tar formulations that promised a “healthier” smoking experience.  In 1964, it was concluded that cigarette smoking was causally related to lung cancer in men on the basis of carcinogens including cadmium, DDT, and arsenic. In 1965, Congress passed the Federal Cigarette Labeling and Advertising Act mandating the surgeon general’s warnings on all cigarette packages. In 1971, all broadcast advertising for tobacco was banned and in 1990 smoking was banned on all interstate buses and all domestic airline flights lasting six hours or less.

In 2006, a federal judge named Gladys Kessler ordered strict new limitations on tobacco marketing, punishing the cigarette manufacturing companies for their disingenuous behavior and forcing them to stop labeling cigarettes with deceptive descriptors including “low tar,” “light,” or “natural.”  The tobacco industry was demonstrated to have “marketed their lethal product with zeal, with deception, with a single-minded focus on their financial success and without regard for the human tragedy or social costs that success exacted.”  Judge Kessler concluded that “cigarette makers profit from selling a highly addictive product that causes diseases leading to a staggering number of deaths per year, an immeasurable amount of human suffering and economic loss, and a profound burden on our national health care system.”

The industrial food complex (IFC)—a small group of multi-national corporations that are responsible for most of our foods—are similar to big tobacco in their size, power, and resources—commanding the whole food system from seed to supermarket.  It is becoming increasingly evident that the IFC controls the farming and meat industries, which are no longer so much farms and ranches as they are manufacturing plants.   Much of our food comes from huge assembly line factories where, to put it bluntly, both animals and workers are treated very poorly without the respect, dignity and common decency that they are owed.  The IFC conducts their business with opaqueness and does not care for us to know the truth about what we are consuming and the means by which we have come to consume it, very similar to the attitude of Big Tobacco towards cigarettes.   The IFC’s goal is to make produce or livestock bigger, fatter, cheaper and brought to market faster—all with the intent of increasing their bottom line—with significant collateral costs to us in terms of damage to our ecosystem and health-related problems including bacterial contamination of our food and the increasing prevalence of obesity, diabetes and cardiovascular diseases.

The IFC also share with the cigarette manufacturing companies a propensity for disingenuous and deceptive behaviors.  Many processed products that are perilous to our health are neatly packaged and boxed with marketing claims that can be described as sly-manipulative-spun-hyped subterfuge.  There is often a sleight of hand applied to the number or the size of servings delineated on the package, with a realistic-sized serving being much larger and higher in calories than stated.    Another example is the ingredient listing on the package, ingredients being listed in descending order of predominance.  Many breakfast cereals are predominantly sugar, but if sugar were listed as the primary ingredient, many consumers would choose to leave the product on the supermarket shelf.  So the IFC’s magic trick of deception is to use multiple sweeteners and list them separately—sugar, brown sugar, high fructose corn syrup, corn sweetener, molasses, and honey are the typical menu of sweeteners.  By using more than one sweetener, they drop down the order list and are seemingly less predominant components.   Like Big Tobacco, Big Food also uses many deceptive descriptors including: “fortified”, “lite”, “multigrain”, “all natural” and “organic”—they sound great for our health, but really are just words without substance.  The term “all-natural” resonates nicely but is meaningless—many things are all natural including E. coli O157:H7 and melanoma.   “Multigrain” conjures up images of a mélange of farm-fresh healthy grains, but in reality translates to made from more than one grain, all of which may be highly processed.  “Organic” is a powerful term that evokes thoughts of food grown without the use of chemical fertilizers, growth hormones, antibiotics, or pesticides.  However, understand, for example, that when I walk my English Springer spaniel to do his “business”, he leaves a large, steaming pile of organic material on the ground!

It is now common knowledge that tobacco is deleterious to our health and we are slowly coming to an understanding that processed foods are equally harmful.  However, it took years for public attitudes to change and for a grass roots understanding and acceptance of tobacco as a malignant addiction to solidify—to wit, when the surgeon general’s warning first proclaimed that smoking was bad for your health in 1964, 42% of the adult population smoked, and now in 2009, about 20% does so.   Ultimately, anti-tobacco forces and government assailed smoking from a number of different angles—prohibiting smoking in public venues and restaurants, higher taxes, banning commercials and mandating warning labels on packs—cumulatively acting to gradually erode the smoking base.  In a similar vein, it will likely take some time for the public to recognize and accept that processed foods are harmful to our health and existence.  Mark my words—there will come a day when processed foods will be understood to be as harmful as tobacco—it may take years for this transformation to occur, but it will ultimately come to fruition when the coalition of government and community advocacy groups join ranks to change the food culture of our society.

In 2003, the Big Tobacco Company formerly known as Philip Morris changed its name to Altria in order to rid itself of the “scarlet letter” tainting its public image that was so tarnished because of its cigarette business.  Same company—new name—how calculating and disingenuous can you get?    Will the Big Food Industry companies be following suit?  What game playing and charades!

The tobacco industry has been shown to be irresponsible and just recently—finally—the government rose to the occasion with sweeping new legislation to control it.   Half a century after the surgeon general first warned about the deleterious health effects of tobacco, and despite the opposition of the omnipotent tobacco lobby, 2009 ushered in the passage of landmark new laws that gave the FDA new and comprehensive powers to oversee and regulate tobacco.  The government first required warning labels to be printed on cigarette packages in 1965 and updated them in 1984.   Now, regulators will control the amount of addictive nicotine in each cigarette and how cigarettes are packaged, marketed and promoted.   Larger and more graphic warnings of the perils of smoking will be on every pack of cigarettes.  Now banned are fruit flavored cigarettes and using, for advertising purposes, cartoon characters that are attractive to youngsters (like Joe Camel)—restrictions aimed at preventing children from picking up this horrendous habit.

I foresee the day when—like the tobacco industry—the  industrial food complex will be censured and intensely regulated for zealous and deceptive marketing practices and for their primary focus on their own prosperity with patent disregard to the human tragedy and social costs resultant from that prosperity. We are in dire need of legislation capable of preventing children from starting down the misdirected path that can lead to obesity, diabetes, cardiovascular disease and premature death.  Hopefully happening sooner rather than later, these regulations and restrictions directed at the industrial food complex will force transparency; big and obvious warning labels instead of enticing catchwords; control of the amount of high fructose corn syrup, partially hydrogenated vegetable oils, enriched wheat flour, and the many other harmful component ingredients; and regulation of packaging, marketing and promotion.   I anxiously await the time when the public understands that highly processed foods—in similar fashion to tobacco—can be extremely addicting and contribute insidiously to diseases leading to an astonishing number of deaths, human suffering, economic loss and a significant burden on our health care system.

I look forward to the day when unhealthy foods bear the surgeon general’s warning.  There are currently four such warning on cigarettes that are rotated from pack to pack: Smoking Causes Lung Cancer, Heart Disease, Emphysema And May Complicate Pregnancy; Quitting Smoking Now Greatly Reduces Serious Risks to Your Health; Smoking By Pregnant Women May Result in Fetal Injury, Premature Birth, And Low Birth Weight; Cigarette Smoke Contains Carbon Monoxide.  Perhaps the warning label will read something like: Consumption of processed foods may contribute to obesity, diabetes, cardiovascular disease, cancer and death; or alternatively, Quitting consumption of processed foods now greatly reduces serious risks to your health.  In my opinion, that day cannot arrive soon enough.
 

This is just a taste of what you will find in Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food. The website for the book is: www.promiscuouseating.com.

It provides information on the book, a trailer, excerpts, ordering instructions, as well as links to a wealth of excellent resources on healthy living.  Promiscuous Eating is also available in e-book format on Amazon Kindle.

Maximizing Our Beach Body Appearance

May 14, 2011

Michelangelo’s “David” was at one time a mere solid block of marble.  The master artist crafted this magnificent sculpture by knowing exactly what to carve away—what did not belong. In the words of Antoine de Saint-Exupery (author of Le Petit Prince): “Perfection is not when there is no more to add, but when there is no more to take away.”  How does this relate to our current physical state of affairs?  Essentially, we all have potential “beach bodies” obscured beneath our winter-weighted physiques.  We may be a bit flabbier and less toned than desirable, but somewhere hidden within is a sinewy, tight, and lean figure.  The million-dollar question is what to do to bring out this inner beach body—to allow us to feel confident, svelte and shapely since swimsuit season is right around the corner.  Read on!

A great body (and more importantly, a healthy body) usually demands a lifestyle encompassing a responsible diet and a disciplined exercise regimen—this is a process incorporated into the daily existence of those who respect themselves and are committed to being their own wellness caretakers.  Realistically, this is a lifetime pursuit—major changes are not going to occur in 6 weeks of “cramming” to achieve a respectable appearance at the beach or pool! However, all journeys start with small steps and with diligence, some real and measurable progress towards that beach body can be made even after a few weeks of effort.  Within a month or so of consistent healthy eating and exercise, we should note the pounds peeling off, better muscle tone, and increased energy levels.   It comes down to the basics of watching what and how much we eat and ramping up the sweating.

Nutrition to Maximize Our Beach Body Appearance

To help carve down our bodies to reveal the “David” or “Venus de Milo” within, we are going to need healthy fuel to serve as energy and to provide the basic building blocks for the reconstructive and regenerative processes that are ongoing in our bodies.  For weight loss, we will need reduced caloric consumption—3500 calories less per week intake will result in a one-pound loss, a very realistic, reasonable goal.  As weight gain is gradual, so should weight loss be.  No fads, no gimmicks, no nonsensical, unbalanced, ridiculous diets—just a sensible reduction in calories and an effort to eat healthy, nutrient-dense, natural and unprocessed foods.  Keeping a food diary in which we record what we eat, why and when, is a very useful and eye-opening tool to document our intake—often very surprising when we see it in print!

Since portion control rules, a really easy diet is simply to reduce portions to one-half to three-quarters of our normal size helpings.  When it comes to snacking, we should make every effort to eat wholesome fresh vegetables and fruits instead of processed junk that often contain a load of unhealthy fats, salt and carbohydrates.  It is never a bad idea to provide positive imagery by placing a photo on the fridge—one of us from previously leaner times, or perhaps one of someone whom we would like to resemble.  It is important to make smart choices and often our intuition will suffice to guide us.  For example, our thought process might be: if we want to look good in our bathing suits, what food will better serve us… a carrot or a piece of carrot cake?

Lean sources of protein such as egg whites, wild salmon (or any other wild fish that is grilled or broiled), skinless chicken, turkey breast, fat-free yogurt and soy products such as tofu and edamame are healthy and desirable macronutrients.  We should be judicious with meat and dairy intake because they are rich in saturated fats and high in calories.  Vegetables are a much healthier source of fat—think nuts, avocados and olives.  High fiber foods—vegetables, fruits and legumes including lentils, peas and beans—are very filling and the fiber regulates the rate of carbohydrate absorption. Intake of a variety of brightly colored fruits and veggies will ensure getting ample doses of phyto-nutrients and anti-oxidants.   We need to attempt to minimize the rich sauces and fattening dressings put on otherwise healthy foods…if we cannot avoid them, then we need to use them in moderation.   It is important to be careful with our sodium intake as it causes fluid retention, bloating, weight gain and a number of potential medical issues.

And now for a brief but important discussion of the science of fat: Our hormone insulin has much to do with the way our bodies store or burn fat—when insulin levels are elevated, we accumulate fat; when levels are low, we burn fat as fuel.  Our insulin levels are more-or-less determined by the carbohydrates we eat…the more carbs we eat, the sweeter they are, the easier they are to digest, the greater the insulin levels and the more that fat accumulation is driven.  To reiterate, insulin secretion caused by eating carb-rich foods—flour and cereal grains, starchy vegetables like potatoes, sugars and high-fructose corn syrup—makes us fat.  The sweeter the food, and the easier it is to digest, the fatter it will make us, and liquid carbs such as sodas, fruit juices and beer are probably the biggest culprits.

So, we need to try to steer clear of refined carbohydrates, substituting whole grain products for white bread, refined pasta, white rice, etc.   It is very important to minimize sugar intake since sucrose is fructose/glucose and fructose gets metabolized much differently from glucose, pushing our bodies towards fat deposition…the same thing goes for high fructose corn syrup (HFCS), which should be avoided like the plague.  Let fruits be the source of fructose for our bodies, not refined sugars and HFCS.  It is imperative that we carefully read food labels to know what we are consuming!

To repeat a very important principle if we want a beach body…we do NOT want to drink our calories—actively avoid liquid calories such as soda, juices, processed iced tea, etc.  The best drink is water or seltzer—we can spritz them up with a lemon or lime.  Lots of water will serve to keep us well hydrated, will dampen our appetites, and will quell our thirsts, which are sometimes confused for hunger.  Remember that liquid calories include alcohol—a beer belly is the opposite of a beach belly!  It is best to be moderate with alcohol consumption during the beach body training period—reducing alcohol will also help us maintain our discipline, which can easily be thrown by the wayside due to the disinhibiting effects of alcohol.  Sobriety will go a long way towards molding that beach body!

Exercise to Maximize Our Beach Body Appearance

We are designed to be physically active and a “use it or lose it” approach applies.  Our bodies are remarkably engineered to adapt to the stresses placed upon them with compensation—they adapt to exercise with increased muscle strength and fitness.  The general rule of thumb is to think “athletics” and the “aesthetics” will follow.   The key to exercise is diligence—carving out the time—and variety—strength  (resistance) training, cardiovascular (aerobic) training and core (abdominal and torso) conditioning.  A core synergistic exercise regimen, which is a combination of the aforementioned three types of exercise, provides a great overall workout.  It’s a wonderful idea to keep an exercise diary to document your hard work…and boost motivation.

Muscles play a key role in our metabolism: they are extremely metabolically active, each pound of lean muscle burning 37-60 calories/day.  With a sedentary existence and aging, there is a gradual loss of muscle mass and a resultant slowing in our resting metabolic rate.  By building and maintaining our muscle mass with strength training, we will raise our resting metabolic rate and burn more calories.  Additionally, exercise serves to increase the “insulin sensitivity” of muscle, which means that are muscles become more efficient at burning off carbs as fuel, before they have a chance to become stored as fat.

We can measure our maximal heart rates by doing an aerobic activity, such as swimming, running or cycling full throttle until we can’t go on, and then taking our pulses.  In our workouts, if we can achieve a heart rate of 75% of our maximum rate and sustain that for 30-60 minutes daily, it is easily conceivable to burn 600 or more calories per day.   High intensity interval training—alternating between extremely intense exertion and regular “normal” exertion—can rapidly help propel us towards the beach body within.

Stuck inside on a rainy day? Go to beachbody.com, the company that provides the P90, P90x, P90x plus and Insanity workouts, for supremely effective routines to whip your body into shape.  I adore P90x and P90x plus and have been using them for several years now…they are a terrific value and provide a total, balanced workout.

Integrational exercise—incorporating non-gym physical activities into our daily lives—is an alternative form of exercising that burns calories and gets us moving just the same.  These include gardening, house chores, vacuuming, walking the dog, chopping down trees, etc.  It has even been shown that fidgeting will do the trick.  The key is to get off the couch and get moving!

Maximize Our Beach Body Appearance: Miscellany

Maintaining good posture like a ballet dancer will help with the beach body mode—David and Venus certainly do not slouch forward with rounded shoulders.  To this end, yoga and Pilates are wonderful forms of exercise.

Getting enough rest and sleep is also imperative.  Insufficient sleep makes it difficult to exercise and the fatigue eating that often ensues can often be detrimental to our goals.

We must completely shun tobacco…nothing more needs to be said about this!

It is important to attempt to minimize the stress and negativity in our lives. Our stress hormone—cortisol—functions to stimulate our appetites and cravings and promotes fat deposition and weight gain. Stress can be managed in a healthy fashion through exercise as opposed to the unhealthy habit of stress eating.

There are less than 6 weeks to go to summer.   Today is as good a time as ever to shape up for this fast approaching season, but also to start on a lifetime program of healthy living through the practice of responsible eating, daily exercise and intelligent lifestyle choices.  There is no magic bullet to achieving that perfect beach body—the answer is simply fueling the body properly, living a balanced life and sweating out the demons through regular physical activity…make this your modus operandi and you’ll always be ready for any time of year!

This is just a taste of what you will find in Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food. The website for the book is: www.promiscuouseating.com.  It provides information on the book, a trailer, excerpts, ordering instructions, as well as links to a wealth of excellent resources on healthy living.

Andrew Siegel, M.D.

May 14, 2011

Have A Very Sweet Mother’s Day….But Not With Too Much Fructose

May 8, 2011

Ivan Royster is the founder of an outstanding and immensely popular Face Book page called BAN OF HIGH FRUCTOSE CORN SYRUP (http://www.facebook.com/BanOfHFCS).  His mission is to spread awareness about the dangers of HFCS and ultimately to get the substance banned.  Ivan might be a David against the Goliath of Big Food, but his activism is paying off  as we are coming to understand and appreciate that HFCS is a key contributor to many public health issues that America is facing today. If you have never visited the page, it would be well worth doing so; click the “like” button and an abundance of relevant information will appear on your news feed.  The New York Times ran an article which profiled Ivan’s story: entitled: For Corn Syrup, the Sweet Talk Gets Hard, http://www.nytimes.com/2010/05/02/business/02syrup.html?_r=1

I recently had the opportunity of being interviewed by Ivan regarding the dangers of HFCS.

Q: What is HFCS (High Fructose Corn Syrup)?

A: HFCS is a gooey liquefied sweetener that is abundant in processed foods and beverages. The typical American consumes an astonishing 50-100 pounds of HFCS per year!

The derivation of HFCS: Corn is milled to cornstarch, a powdery substance that is then processed into corn syrup.  Corn syrup consists primarily of glucose. Through a complex chemical process, the glucose in the corn syrup is converted to fructose.  HFCS results from the mixing of this fructose back in with glucose in varying percentages to achieve the desired sweetness: 55% fructose/45% glucose ratio of HFCS is used to sweeten soft drinks; 42% fructose/58% glucose ratio of HFCS is used in baked processed foods.

 Q: Why does the processed food industry adore HFCS?

A: First, it is cheaper than sugar because of huge corn subsidies and sugar tariffs.  Second, the liquid syrup lends itself to ready transportation in those enormous storage vats within 18-wheelers, similar to how gasoline is hauled.  Third, fructose is incredibly sweet and does not crystallize or turn grainy when cold, as sugar can do.  Fourth, because HFCS is very soluble and retains moisture, it makes for softer and moister processed baked goods.  Fifth, it acts as a preservative that extends the shelf life of processed foods and helps to prevent freezer burn.  Finally, HFCS is a key ingredient in many processed junk foods, which are addictive and promote cravings and continued consumption.

Q:  Why is HFCS so dangerous to our health?

A: There is a good reason why HFCS is so demonized: while HFCS may help “preserve” processed foods, it does not help “preserve” us!  In fact, a diet high in HFCS will help accelerate our demise.

Importantly, fructose is metabolized very differently from glucose.  Every cell in our bodies can metabolize glucose, but it is primarily the liver that metabolizes fructose. Fructose does not stimulate insulin release as does glucose, nor does it stimulate leptin (our satiety hormone).  Fructose, more readily than glucose, replenishes liver glycogen, and once the liver is saturated with glycogen, triglycerides (fats) are made and stored. So, too much HFCS and we end up with a fatty liver…and body!

The bottom line is that HFCS ingestion pushes our metabolism towards fat production and fat storage, potentially leading to obesity, diabetes, elevated cholesterol, high blood pressure and cardiovascular disease.  HFCS should be thought of as toxic to our health, in precisely the same way that tobacco and alcohol are.

Q: If fructose is the main sugar in fruit, how can it be bad for us since fruit is a natural product?

A: Fructose is indeed the predominant sugar in many fruits, hence the term fructose. One difference between the fructose contained within fruit as opposed to that within a bottle of soda is that fruit fructose is natural and not created in a chemistry lab.  Additionally, the concentration of fructose in fruit is significantly less than that contained within the soft drink.

Let’s do the math comparing an apple to a bottle of soda: An average-sized apple has about 80 calories: 20 grams of sugar consisting of 4 grams of sucrose (equivalent to 2 grams fructose and 2 grams glucose), 5 grams of glucose, and 11 grams of fructose, for a total of 13 grams of fructose.  A 20-ounce bottle of soda has about 240 calories: 60 grams of sugar all from HFCS (55% fructose / 45% glucose) for a total of about 35 grams of fructose. 

Furthermore, the fructose in beverages is a source of “empty” calories—essentially liquid candy—as they do not contain health-promoting ingredients present in fruit including fiber, anti-oxidants, vitamins, minerals and other phyto-nutrients. Because of the fiber content of the apple, the sugars are slowly absorbed whereas the “naked” sugars in beverage form are rapidly absorbed, providing a “load” of fructose to the liver.

More than being just empty calories, fructose is a source of poisonous calories that promote obesity…think of fructose as fat.

Bottom line: Enjoy your apple and avoid products that contain HFCS like the plague!

Q: Is HFCS any worse for us than sugar?

A: Table sugar (sucrose) is a refined and processed product that is a 50-50 mixture of glucose and fructose; the biological effects of both sugar and HFCS are virtually identical, with both potentially harmful to our good health.  The reader is referred to Dr. Lustig’s awesome lecture that can be viewed on YouTube—it just might change your life: http://www.youtube.com/watch?v=dBnniua6-oM

Q: How does your book, Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food, relate to this?

 A:  I use the termpromiscuous” eating to mean an unhealthy relationship with food: a lack of commitment to quality foods and to eating for the right reasons, in the right quantities and in the right manner. It often entails the reckless consumption of food at unsuitable speeds, times and places, often without enjoyment of the eating process and without regard to consequence. It often leaves us feeling bloated, stressed and guilt-ridden. After a bout of promiscuous eating, we do not feel good about ourselves the next morning.  Clearly, consuming HFCS is promiscuous eating…and oftentimes, when eating promiscuously, it is precisely these HFCS-containing, processed junk foods that are consumed.

Promiscuous Eating examines our relationship with food.  For too many of us, this has gone awry, promoting obesity, high blood pressure, diabetes, cardiovascular disease and cancer.  Certainly, HFCS figures prominently in this relationship and our bad eating behaviors.  By understanding the intricacies of our behaviors with respect to food, we are enabled to amend this relationship with the resultant change in diet and eating habits being transformative—if not life saving.

The website for the book is: www.promiscuouseating.com. It provides information on the book including a trailer; excerpts; ordering instructions; blog; and links to a wealth of excellent resources on healthy living.  The FaceBook page for the book will provide a “tip of the week”:  http://www.facebook.com/promisceating

So you want to drop a few pounds: what’s more efficient…eating less or exercising more?

May 1, 2011

A recent article in the International Journal of Obesity by Dr. David Katz entitled Unfattening our Children: Forks over Feet (Int J Obesity 2011; 35: 33-37) concluded that when it comes to weight loss, diet plays a more important role than exercise.

To directly quote Dr. Katz’s conclusion:  “Feet and forks are master levers of medical destiny. Diet and physical activity patterns exert powerful influences on weight and health. There can be no choosing between them when it comes to overall health: physical activity is the vital, conditioning work of the human machine, diet is its fuel. But forced to choose a side of the energy balance equation to favor in weight control, it is forks over feet for fundamental reasons of modern living. One may readily out-eat even somewhat extraordinary levels of physical activity, but most will find it very difficult to out-exercise even fairly ordinary levels of dietary intake.”

If you would like to read the full article, which I strongly suggest you do, visit:

http://www.nature.com/ijo/journal/v35/n1/full/ijo2010218a.html

Dr. Katz’s article confirmed what I reported in Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food.  The following paragraph is a verbatim excerpt from pages 117-118 from the chapter entitled “Raw Facts and Truths”: 

As important as exercise is, calorie restriction is the most efficient means of achieving weight loss: exercising restraint over eating trumps exercising our bodies in terms of weight loss.  This is not to denigrate exercise in any way, as getting moving and active is a fundamental part of any weight loss regimen. Exercise is incredibly important to our health, fitness and well being and can aid the process of weight loss. There are a host of compelling reasons to exercise, including the following: augmented caloric expenditure; aerobic and cardiovascular fitness; improved strength, physical conditioning and self-image; and a productive means of dealing with many of the emotions that drive eating. Ironically, though, burning calories via exercise will leave many of us with a vigorous appetite that can be potentially detrimental to a weight loss program. As important as exercise is, it is not very efficient in terms of weight loss. It takes a great deal of effort to burn a lot of calories and the resultant increased hunger can often negate the effort. For example, I can run for 30 minutes at a good clip and burn 300 calories. By the same token, I could consume 300 calories in two minutes by eating a few cookies. When it comes down to degrees of ease, it is a lot easier to take calories in by eating than it is to expend calories by exercising. Therefore, as important as exercise is, with respect to weight loss, a reduction in caloric intake is of paramount importance and is more efficient than exercise.

The bottom line:  If you want to drop the pounds, drop the fork…and the most efficient exercise vis-a-vis weight loss is to exercise restraint in terms of eating.  It is simply very difficult to “out-exercise” dietary intake.

This is just a taste of what you will find in Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food. The website for the book is: www.promiscuouseating.com. It provides information on the book, trailer, excerpts, ordering instructions, as well as links to a wealth of excellent resources on healthy living including my blog.  Dr. Katz, a Yale University physician and editor-in-chief of Childhood Obesity and author of the aforementioned article, upon receiving a copy  of Promiscuous Eating, commented: “I look forward to giving it the time that your book deserves.”

Promiscuous Eating is also for sale in my office at 20 Prospect Avenue in Hackensack, New Jersey; on Amazon/Kindle; in BookCourt in Brooklyn, New York; and in The Lobby Corner Shop  and  Tomorrow’s Children Foundation at the Don Imus/WFAN building, both on campus at Hackensack University Medical Center.  Other platforms are being developed so that the ebook will soon be available on Apple, Sony and Nook devices.