Archive for July, 2012

Human Building Blocks

July 28, 2012

Blog # 68  Andrew Siegel, M.D.

 

I no longer give a lot of thought to healthy eating, but instead react in habit-like fashion to whatever food that is in front of me.  I don’t think big picture, I don’t think long-term and I don’t think about weighing myself often.  When it comes to food and nutrition, I like to be in the moment and think about the present—the here and now.  Most of the time, I don’t think forest, I don’t think trees, but I think leaves.

Over the years, I’ve put a lot of conscious thought into eating and nutrition and the important role it plays in determining our health destiny.  I have carefully read food labels and educated myself through paying attention, reading and research. What has happened is that conscious thought processes have evolved into subconscious actions—habits.  Now, when I consider putting some food into my mouth I reflexively and subconsciously weigh its benefit as a potentially valuable building block that will be used by my body as fodder to restore, replenish and regenerate those cells and tissues that are undergoing constant turnover.  Like parts for my car or home, I want to use the highest quality materials.  I recognize that in my lifetime I will have many cars and probably several homes and I will endeavor to take excellent care of them, but I have only one body, so I want to make an extraordinary effort to treat it with the utmost of respect and stewardship.  I don’t want a body that is a house of cards! As important as this concept is for full-grown adults, it is even more so for children who need healthy building blocks for actual growth and not just replacement.

So, if I have a handful of almonds or an apple or a Greek yogurt in front of me, my subconscious gives me a green light; if it is a doughnut, a greasy slice of pizza with pepperoni or a hot dog, my reflexes give me a red light.  Do I ever make exceptions?  My reflexes guide me, but of course I will have a slice or two or three of pizza (typically with veggies on top) and other indulgences that make me happy—such as chocolate or rum raisin ice cream—but my habits shepherd me to moderation.  If you take care of the leaves, you will have healthy trees comprising a hardy forest.

The following is an excerpt from The Huffington Post written by Dr. David Katz entitled: “Un-junking Ourselves.”  Although the subject of Dr. Katz’s discussion is a child, it is relevant to adults as well.  And yes, this excerpt was included in one of my blogs from a few weeks ago, but it’s so important that it is worth repeating:

Think about a child — or former child — you love. This should be pretty easy for any parent, grandparent, aunt, uncle, or just about anybody else who has known a kid or ever been one.

Now, think about that child’s growth from year to year and ask yourself: What were they growing out of? What was the construction material? Matter can’t be constructed out of nothing — it comes from somewhere. If a child’s head is four inches higher off the floor this year than last year, then that four-inch platform of extra kid was built out of… something. What?  Food and nothing else. Food is the construction material — the only construction material — for the growing bodies of children we love.

We are, no doubt, all familiar with the expression “you are what you eat,” but given how most of us eat, it’s quite clear we don’t take it very seriously. And for some pretty good reasons. The human machine, and human fuel tank, are stunningly forgiving. We can throw almost anything in the tank, and run reasonably well for decades. We can’t build a machine fractionally so accommodating.

And, of course, we don’t look like what we eat. We eat donuts, and don’t sport big holes through our middles. We eat French fries, and don’t sprout French fry antennae. But you can’t judge what we are made of by what we look like, any more than you can judge a book by its cover — or a house by its paint. Our houses are, often, made mostly of wood — but look nothing like trees. Trees are cut down and, if you will, “digested” in a timber mill to produce wood that is turned into lumber. The lumber is then used to build houses that look nothing like the trees. But if that lumber is rotten, the house in question may look all right at first — but it will fare quite badly when the first big storm comes along. The quality of a house is rooted in the quality of its construction materials.

Ditto for us. The growing body of a child is built out of food. Nutrients are extracted from food, just as wood is extracted from trees. Rotten wood makes rotten houses. Rotten food makes… sick kids. The kids may look, and even feel, fine for a while. But every cell their bodies build depends on the quality of the available construction material it is offered. Every muscle fiber, every enzyme, every brain cell, every heart cell, every hormone. Maybe not right away — but eventually, rotten construction material catches up with us all.

No one I know throws any old junk into the tank of a car they hope will run well for the foreseeable future. No one I know willingly builds a home out of junk, or of rotten wood. But food is the one and only building material for the growing body of a child you love. How’s “junk” sounding now? And, by the way, every one of us adults is turning over literally hundreds of millions of cells daily. These need to be replaced, along with spent enzymes, hormones, neurotransmitters and the like. Where do WE get the construction material for this job? Think about it.  Right you are.

Words to heed, to make part of your conscious and, ultimately, your subconscious, so that your food choices automatically become healthy ones.

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food

www.PromiscuousEating.com

Available on Amazon Kindle

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Sleep To Slim

July 20, 2012

Andrew Siegel, M.D.      Blog # 67

 

On many levels, sleep has a vitally important role. Our brains and bodies require this critically essential down time to “recharge.” Our sleep cycle includes restorative deep sleep phases and rapid-eye-movement sleep phases.  Our bodies need sufficient time to complete all phases of sleep to maintain our well being and to promote tissue repair, memory reinforcement and the release of hormones that function in regulating growth and appetite.

Who does not relish the blissful experience of a great night’s sleep, in which we awaken feeling alert, rested, energetic, optimistic and ready to tackle life with vigor? Throw in some great dreams and we have the recipe for the beginning of a wonderful day. Conversely, we have all experienced a very poor night’s sleep, in which we awaken feeling physically exhausted, mentally spent, lids heavy, dark circles under our eyes and in a disassociated state, totally unprepared and unenthusiastic about facing the new day.

Many of us do not realize the profound association between sleeping and eating.  The bottom line is that an adequate amount of quality sleep helps keep us on the healthy eating wagon, while insomnia and chronic sleep deprivation can throw us off it.  Fatigue eating is a very real phenomenon and is one of the circumstances that drive my own bouts of mindless, unnecessary eating.  Many of us, when physically and mentally exhausted, in a “zombie”-type state, often seek refuge in the refrigerator or pantry in spite of not being genuinely hungry. It seems that this FATigue—an altered state of mind and body—would best be served by seeking refuge napping in our beds, but mindless food foraging all too often serves as a surrogate activity.

In addition to the dis-inhibition of “eating discipline” that occurs with fatigue (similar to that which occurs with alcohol), there appears to be a physiological basis for this fatigue-driven eating. Fatigue or sleep deprivation causes the following:

  • decreased levels of leptin, our appetite suppressant
  • increased levels of ghrelin, our appetite stimulant
  • increased levels of cortisol, one of the stress hormones
  • increased  glucose (blood sugar)levels

Thus, fatigue results in internal chemical changes that can drive our eating.

Acute sleep disruption is associated with increased appetite and caloric intake and chronic sleep deficits result in an inability to be attentive and focused, interfering with our mindfulness, which can wreak further havoc with our eating.  The disassociated “zombie” state lends itself to dysfunctional eating patterns and, as such, weight gain is a predictable consequence. Additionally, a chronically fatigued state will also affect our ability to exercise properly, if at all.

The following are pointers to help achieve a good night’s sleep:

  • A quality mattress and box spring, topped by a cushioned mattress pad, are wonderful investments since we spend up to one-third of our lives sleeping; amortized over many years, they really prove quite a bargain.
  • Same goes for pillows—some like them firm, some fluffy, so you must find what works best for you.
  • Try to maintain a regular sleep schedule in terms of time going to sleep and time arising, making an effort not to disrupt the pattern too much on weekends.
  • Caffeine restriction after a certain hour, depending on the individual—this means coffee, tea, colas, and chocolate (which contains a caffeine-like chemical).
  • Limit daytime naps.
  • Don’t overdo it with alcohol during dinner and the evening hours; even though alcohol acts as a central nervous system depressant (which one might think would aid in sleep), in reality, it interferes with our natural sleep rhythms.
  • Easy on late-night eating—going to bed bloated with churning intestines is counter-productive in the effort of getting quality sleep.
  • Don’t overdo it with fluid consumption in the evening that can cause sleep-disruptive nocturnal urinating.
  • Exercise early since evening exercise tends to stimulate our brains and bodies and cause insomnia.
  • Keep your bedroom at a comfortable temperature—generally, a cool room promotes quality sleep.
  • Keep the room as dark as possible—black out shades are terrific.
  • Try to keep the ambient noise to a minimum so the sleeping environment is quiet.
  • For some, white noise can be very helpful—I go to sleep to the sound of machine-generated surf; not quite as good as when I lived in Manhattan Beach, California right on the ocean, but helpful nonetheless.
  • Have a pre-sleep relaxation and tension-reducing ritual such as reading, a hot bath, meditation, romance, etc.

Take home points:

— The fatigue resulting from insufficient sleep interferes with our mindfulness and can result in unnecessary eating as a surrogate activity for sleeping.

— There is a biochemical basis for this sleep-deprivation eating.

— When we find ourselves succumbing to fatigue eating, it is best to try to muster up the wherewithal to head to the bedroom instead of the refrigerator—we will feel much better about ourselves in the morning and will have saved ourselves needless calories!

— On a general basis, it is best not to use eating as a substitute for other activities.

—  Try to consistently get enough sleep in order to avoid FATigue and its many pitfalls!

Andrew L. Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food

www.PromiscuousEating.com

Available on Amazon Kindle

A Tribute To One Of The Father’s Of Public Health

July 14, 2012

A Tribute To  Lester Breslow

Andrew Siegel, M.D.      Blog # 66

 

The field of public health is of utmost importance to the vitality and well being of humankind. Public health and sanitation saved more lives than any other cause in the 19th century—the Century of Hygiene; in the 20th century—the Century of Medicine—vaccines, antibiotics, transfusions, chemotherapy, etc., helped contribute to longevity; the 21st century will be the Century of Behavior Change—where longevity will be furthered by reducing risky behavior and making positive changes with regards to exercise and nutrition.

One of the father’s of the field of public health, Lester Breslow, M.D., M.P.H., died earlier this year at the age 97.  Originally intent on becoming a psychiatrist, he changed to public health because he believed it was an appropriate match for his desire to be a political activist for disadvantaged people.  His seminal contributions to the health of our society are more than worthy of a blog.  He was one of the first to prove that we can live longer and healthier by modifying our habits including tobacco use, sleep and diet.  He changed the direction of public health from a discipline with an emphasis on communicable infectious diseases to a field focused on lifestyle, the effects of community and the environment and the emergence of chronic disease.

Dr. Breslow joined the California Department of Public Health in 1946 to found the Bureau of Chronic Diseases. He then became a professor at UCLA School of Public Health and subsequently chairman of the UCLA School of Medicine’s Department of Preventive and Social Medicine. He served as Dean of the UCLA School of Public Health from 1972 to 1980.  President Truman appointed him director of a commission to assess the health of the nation in 1952.  He was elected president of the American Public Health Association and was the founding editor of The Annual Review of Public Health and the editor-in-chief of The Encyclopedia of Public Health. He was also president of the International Epidemiological Association and the Association of Schools of Public Health.

In the 1940’s and 1950’s, he was responsible for some of the earliest studies on the hazards of tobacco and three of these were cited in the surgeon general’s report in 1964 linking tobacco to lung cancer.

One of his major accomplishments was the Alameda County Study, a long-term investigation of the lifestyles of almost 7000 residents of Alameda County, California.  Using quantitative analysis, the study unquestionably proved that one’s lifestyle strongly influences longevity.  The study concluded that to achieve maximal longevity, one must do the following: avoid tobacco; consume alcohol moderately; sleep seven to eight hours a night; exercise at least moderately; eat regular meals; maintain a healthy weight; and eat breakfast.  Dr. Breslow concluded that a 60-year-old man who heeded all seven recommendations would be as healthy as a 30-year-old man who heeded fewer than three.  Considering that this study was initiated in 1965, its results were quite remarkable, although in the 21st century, we take his recommendations for granted.

In 2010, at the ripe age of 95, he co-authored a paper on the life expectancy of a group of Californian Mormans.   The study, conducted during the previous 25 years, concluded that the Morman life expectancy exceeded the life expectancy of the general population of Caucasian males by 10 years on the basis of the Mormans’ clean lifestyle. Although not a Morman, Breslow practiced what he preached, even growing his own organic vegetable garden.  Given his longevity, his healthy lifestyle seems obviously to have supported many of his theories.  He was a man of enormous vision and his contribution to the field of public health was profound.

*Credit to Douglas Martin, writer of Dr. Breslow’s New York Times’ obituary, for much of this information.

Andrew L. Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food

www.PromiscuousEating.com

Available on Amazon Kindle


Heart Attacks Among My Fit Friends

July 7, 2012

Andrew Siegel, M.D.    Blog # 65

 

My good buddy V. had a heart attack a few weeks ago. He is a urologist in his mid 50’s, a non-smoker of medium build, and an avid recreational cyclist who puts in several hundred miles every week. If it wasn’t for his company and support, I would never have completed the 3 hour challenging bike ascent up Mt. Mitchell (elevation 6683 feet) in Asheville, North Carolina a few years ago.

After some intense cycling, he was taking a breather to wait for one of his cycling partners to catch up with the rest of the group when he developed extreme left shoulder pain and unrelenting sweating.  The unremitting pain was of intensity unlike any that he ever experienced, and in the ambulance in route to the hospital he gazed at his own EKG seeing the classic findings of a myocardial infarct.  He was given morphine for pain, nitroglycerin, aspirin and oxygen and after arriving in the ER was rapidly whisked to the cardiac catheterization lab.  He was found to have a complete occlusion of the right coronary artery and it wasn’t until a wire was passed through the occlusion that he felt dramatic pain relief.  After a stent was placed in the occluded artery, he was sent to the coronary care unit for monitoring.  He was discharged the following day on numerous medications and prescribed rest, time off work, and a specialized diet; he was also admonished to stop exercising until he finishes a program of cardiac rehabilitation.

When I spoke to him, he was extremely depressed about the situation, never having previously had any symptom of heart disease.  He had survived a life-threatening event, going from no medications to seven and having to severely restrict the physical activities that brought him so much pleasure.  To repeat, he was not overweight, not a tobacco user, and did not have high blood pressure, although his cholesterol ran on the high side of normal.  He did not have any family history of heart disease.  He had been a strong recreational cyclist for many years. He never paid attention to his diet because of his fast metabolism and vigorous exercise regimen, which always left him at a healthy weight.  V. is Italian and loves pasta, cheese and meat dishes and has always eaten anything and everything that he wanted.

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Now for the story of A., my good friend from surgical internship:  He became a heart surgeon and practiced in the Midwest for many years, but has recently relocated to the Southeast, where he is the Chief Medical Officer of a hospital.  Like V., A. was always in tip-top shape, a non-smoker and a running enthusiast.  As interns and surgical residents, we spent countless hours running the hills of the north shore of Long Island and each ended up having sibling chocolate Labrador Retrievers as pets.

A few years ago, several hours after a vigorous workout in his home gym, he was relaxing in the living room with his wife. As he stood up, he crumpled to the floor, obviously having passed out.  His wife found him to be pulseless and not breathing. Fortunately she was a RN and managed to maintain her composure and promptly initiated CPR after calling 911.  She continued the cardio-pulmonary resuscitation until the emergency team arrived.  When hooked up to a cardiac monitor he was found to be in a very abnormal rhythm called ventricular fibrillation.   After he was shocked, his heart resumed normal rhythm and he started breathing spontaneously.  Angiography in the hospital demonstrated severe coronary artery disease, and he underwent angioplasties and several stent placements.

A. was of average weight, a non-smoker, and a compulsive exerciser; however,  he had a strong family history of cardiac disease and never paid much attention to his diet. I recall his fondness for ice cream and his not uncommon consumption of a pint of Hagen-Daz at one sitting.

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The point that I wish to make is that maintaining a good weight, avoiding tobacco and pursuing regular exercise is not always enough for vitality and a healthy heart.  Particularly when there is a family history of heart disease, but also as a general health axiom, all efforts must be put in place to stem cardiovascular disease, the number one cause of death in the United States.  In addition to maintaining a good weight, avoiding tobacco and exercising, healthy eating is an indispensable and essential part of the effort—a sine qua non.

The quality and quantity of what we eat play an essential role in determining our health destiny.  The following is an excerpt from The Huffington Post written by Dr. David Katz entitled “Un-junking Ourselves.”  Although the subject of Dr. Katz’s discussion is a child, it is relevant to adults as well.

Think about a child — or former child — you love. This should be pretty easy for any parent, grandparent, aunt, uncle, or just about anybody else who has known a kid or ever been one.

Now, think about that child’s growth from year to year and ask yourself: What were they growing out of? What was the construction material? Matter can’t be constructed out of nothing — it comes from somewhere. If a child’s head is four inches higher off the floor this year than last year, then that four-inch platform of extra kid was built out of… something. What?  Food and nothing else. Food is the construction material — the only construction material — for the growing bodies of children we love.

We are, no doubt, all familiar with the expression “you are what you eat,” but given how most of us eat, it’s quite clear we don’t take it very seriously. And for some pretty good reasons. The human machine, and human fuel tank, are stunningly forgiving. We can throw almost anything in the tank, and run reasonably well for decades. We can’t build a machine fractionally so accommodating.

And, of course, we don’t look like what we eat. We eat donuts, and don’t sport big holes through our middles. We eat French fries, and don’t sprout French fry antennae. But you can’t judge what we are made of by what we look like, any more than you can judge a book by its cover — or a house by its paint. Our houses are, often, made mostly of wood — but look nothing like trees. Trees are cut down and, if you will, “digested” in a timber mill to produce wood that is turned into lumber. The lumber is then used to build houses that look nothing like the trees. But if that lumber is rotten, the house in question may look all right at first — but it will fare quite badly when the first big storm comes along. The quality of a house is rooted in the quality of its construction materials.

Ditto for us. The growing body of a child is built out of food. Nutrients are extracted from food, just as wood is extracted from trees. Rotten wood makes rotten houses. Rotten food makes… sick kids. The kids may look, and even feel, fine for a while. But every cell their bodies build depends on the quality of the available construction material it is offered. Every muscle fiber, every enzyme, every brain cell, every heart cell, every hormone. Maybe not right away — but eventually, rotten construction material catches up with us all.

No one I know throws any old junk into the tank of a car they hope will run well for the foreseeable future. No one I know willingly builds a home out of junk, or of rotten wood. But food is the one and only building material for the growing body of a child you love. How’s “junk” sounding now? And, by the way, every one of us adults is turning over literally hundreds of millions of cells daily. These need to be replaced, along with spent enzymes, hormones, neurotransmitters and the like. Where do WE get the construction material for this job? Think about it.  Right you are.

Bottom Line:  In the quest for fitness, vitality and health, it is necessary to maintain a healthy weight, exercise regularly and avoid tobacco. These efforts are important, but not sufficient to avoid cardiovascular disease; an essential additional factor is what we eat.  The quality of the foods that we ingest for fuel, metabolism and tissue rejuvenation are of great importance in terms of vitality and avoiding fatty plaque deposition in our arteries and cardiovascular disease.  It comes down to a largely plant-based diet with an abundance of different fruits and vegetables, whole grains, legumes, and lean protein sources.  Meat and dairy, unrefined carbohydrates, sugars, processed, junk and fast foods need to be consumed in moderation.  We literally are what we eat and the plaque lining our arteries is a reflection of our cumulative diet over our lifetime.  While genetics and luck are beyond our control, our lifestyle—including what or what not we decide to use as human building blocks—is well within our domain.  Today in my office, I skipped the Carvel ice cream cake and grabbed a Granny Smith apple instead…just not worth it!

My two friends are literally lucky to be alive as many are not so fortunate and succumb to cardiovascular disease.  A., being a cardiac surgeon and having put his event well behind him, has adapted well to his situation.  V. is currently somewhat depressed and is suffering from a form of post-traumatic stress disorder that not uncommonly follows the occurrence of a heart attack.  It behooves all of us to try to avoid potential life-threatening cardiac issues by maintaining a good BMI, eating healthy, exercising and avoiding tobacco.  We need to be especially vigilant when there is a strong family history and/or elevated cholesterol and under these circumstances, proactive cardiology care is certainly warranted.  Family history or not, it makes the utmost sense to keep in mind that “we are what we eat.”

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food

www.PromiscuousEating.com

Available on Amazon Kindle