Vol. 164 March 1, 2017 The Exercise Paradox

January 31, 2017

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“You can’t outrun a bad diet”

It appears that an African native chasing a wounded giraffe through the bush and over the plains for 12 hours in order to get food for himself and his family burns the SAME NUMBER OF CALORIES per day as the modern couch potato. Researchers measuring the urine excretion of two radioactive isotopes of water ingested by the subjects (the “gold standard” of measuring energy expenditure) have confirmed this fact as postulated previously by several studies. These African hunter-gatherers burned about 2,600 calories a day, about the same as average adults in present day U.S. and Europe.

The researchers were looking to measure the size of the “energy shortfall” in Westerners to explain the global rise of obesity. They found none. In fact, another review of almost a hundred (98) world-wide studies of energy expenditure (calories burned per day) revealed that “the persons with all the modern conveniences have similar energy expenditures to those with more physically demanding lives in less developed countries.”  Therefore, “obesity is a disease of gluttony, not sloth.”

Physical activity does NOT cause weight loss, but exercise can help prevent weight gain.  A JAMA 2010 study of 34,000 middle-aged U.S. women showed that 60 minutes a day of moderate exercise (walking) prevented weight gain in those on a normal diet who had previously lost weight through dieting.

As someone who collected articles about  bad things happening to joggers to justify my ignoring Society’s “persistent call to go running”, this is music to my ears. The evidence that exercise, including just walking, is good for you is absolutely true and well accepted. It just doesn’t help you lose weight. Again, as someone who has made a resolution every January to lose weight by going to the gym only to peter out by the end of every March, this made me feel less inadequate, or at least less guilty.

Humans have a fixed rate of energy expenditure which is independent of their physical activity. A subsequent study of 300 people wearing Fit-bits showed that those doing moderate activity  (some exercise and always taking the stairs) burned only 200 more calories than couch potatoes. People doing intense physical activity did NOT burn more calories than the moderately active people. Again, the African bushman burns the SAME number of calories walking a mile as does the Westerner.

Studies of energy expenditure in zoo animals compared to animals in the wild reveal the same constancy. How can this be? No one really knows, but the authors speculate that since human energy expenditure is quite constant (and constrained), we modern adults who are not chasing wounded giraffes over the veld have evolved metabolic adaptations that spend our calories on supporting brain functions (the oxygen you take in with every fourth breath is needed just to feed your brain) , running our inflammatory processes (exercise may prevent inflammation by diverting energy from it), producing more and bigger babies, and living longer. But, I am not sure that I am any smarter than the African bushman who lives to 70 in his world, and many of them do.

Humans have learned to cook which increases the caloric value of many foods and makes them more efficiently digested.
We also have evolved to be fat. Our tendency to store fat is probably an adaptation for surviving lean times.
During lean times our survival is enhanced by us sharing what food there is.
Apes do not share.

“Exercise to stay healthy and vital;
focus on diet to look after your weight.”

References:
1. The Exercise Paradox, Herman Pontzer, Scientific American, Feb. 2017, 28-31

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Vol. 159 December 1, 2016 Dementia Is Going Down, Weight Will Go Up

December 1, 2016

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The incidence (number of new cases per year) of dementia in the U.S. is apparently declining.

The Framingham Heart Study which has been monitoring 5,200 adults and 5,000 of their off spring since 1975 revealed in February 2016 that the decrease in the rate of new dementia cases was about 20% per decade. The FHS statistics are based on a variety of data sources including questionnaires, medical records, and some direct examinations.

A more recently published study using direct testing of a larger (21,000), more diverse, over 65 year old (average age: 75) U.S. population reveals that the incidence of dementia decreased from 11.6% in 2000 to 8.8% in 2012. In case you want to “study up” for your test, it included:
recalling 10 nouns immediately and then a little later
serially subtracting 7 from 100
counting backwards from 20

Those with more years of education had a lower risk of dementia. (better “test takers” obviously).
Diabetes increased the risk for developing dementia by 39%. Ominously the incidence of diabetes in this studied population increased greatly from 9% in 1990 to 21% in 2012. Despite that, the overall incidence of dementia did decrease. Nobody knows why.

The Framingham Heart Study findings showed that obesity increased the risk of dementia. In this study obese people had a 30% lower risk for dementia, and in fact, underweight people had a 2.5 fold increase in their risk!

As Dr. Denis Evans, one of the study’s authors, said, “Its very complex.”

dementia-cartoon

Speaking of obesity, the holiday eating season is upon us. Almost all of us expect to put on a little weight. Three scientists from three different countries (Finland, France, and U.S.) nicely graphed the average weight gains by month in three countries (Japan, Germany, and U.S.). No surprise. The Christmas season was the winner in all three countries, but Germany was the leader.

holiday-weight-gain

That Golden Week spike in Japan at the end of April and first week of May is when 5 of the 9 official Japanese holidays are clustered and most people take the whole week off.  (NEJM 375:12 Sept. 22, 2016, p. 1201)

Though the graph is impressive with its spikes and valleys the average weight gain in the U.S. measured in the 10 days after Christmas was only 0.7% or 1.33 pounds; much, much less than the 7-13 pound gains per week or two reported by some cruise ship travelers.

The bad news is that even though half of your holiday weight gain is lost shortly after the holidays, half of the weight gain remains until the summer … and beyond, which resets your baseline weight for the next year.
Oh, well. “Life is short. Have dessert first.”


Vol. 140 January 15, 2016 A Review of 2015 Hubslist Blogs

January 15, 2016

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Click on the date to see the full blog

 

January 1 – 5 out of 10 of my resolutions were “kept”. You guess which ones.

January 15 – 6 reasons why patients are non-compliant , excuse me, “non-adherent”- the new PC term, with their medications.

February 1 – incidence of sudden death while watching the Super Bowl (Patriot fans probably don’t have to worry about that THIS year.)

February 15 – some myths revealed about cholesterol in your diet, global warming, measles vaccination rates, herbal supplements, and Dr. Oz, vendor of snake oil(s).

March 1 – 8 new causes of death caused by cigarette smoking added to the previously identified 12; a total of 20.

April 1 – Athena Health purchases MySpace which raises more concerns about privacy of health care data (April Fools edition).

April 15 – what does a “board certified physician” mean, and what does it have to do with Presidential candidates (Rand Paul)?

May 1 – physicians’ prognoses are often too optimistic for the same reasons patients’ are.

May 15 – E-cigarettes open new avenues for adolescent use of marijuana and synthetic cannabinoids (“bath salts”).

June 1 – annual review of sunscreens and bug repellents plus less universities providing student access to tanning booths.

June 15 – new forensic techniques of identifying individuals by bacterial, viral, and DNA “fingerprints”.

July 1 – 6 positive access outcomes and 4 positive health care delivery outcomes of Obamacare at 5 years of age.

July 15 – dangers of synthetic cannabinoids (attn: Chandler Jones?) and the minimal (“pending”) review of sunscreens by FDA.

August 1 – two websites with the best “symptom diagnosis” track record for helpfulness, and the one that is the worst.

August 15 – [ family vacation in a lighthouse without electricity or running water]
DSC01581

September 1 – why new drugs cost so much, no “gay gene” identified yet, and the myths of low testosterone, chronic Lyme, and  8 glasses of water a day.

September 15 – The health benefits of our “microbiome” and the “microbiome” of the New York City subway.

October 1 – the misleading, untruthful attacks on Planned Parenthood.

October 15 – the scope and magnitude of adverse effects of dietary supplements.

November 1 – transgender, transsexual, transvestite, and hermaphrodite, oh my!

November 15 – toddlers shooting people and other “norms” of gun deaths – “By Degrees“.

December 1 – changing advice about what NOT to eat during the holidays.

December 15 – the benefits of research using fetal tissue, short history of political attacks on Planned Parenthood, and why if you are NOT fat and live a long life you should thank your parents.

HAPPY NEW YEAR


Vol.138 December 15, 2015 Who Buys Baby Parts?

December 15, 2015

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The Colorado gunman who shot and killed three people at a Planned Parenthood clinic in Colorado Springs is reported to have said “no more baby parts.”

 

The distorted flap about Planned Parenthood “selling baby parts” continues. On December 3 the Senate ( Republican-led) voted to strip Planned Parenthood (PP) of government funding. President Obama (a Democrat) will veto it if it reaches his desk. (I’m not suggesting that this is a political issue, of course) Planned Parenthood received $528 million from the U.S. government in 2014 to help support 700 clinics providing health services to mostly poor women. Why so much money? Basically because PP is providing subsidized women’s health services that in every other developed country except ours is provided by the government. The Congressional Budget Office estimates that if Congress were to succeed in blocking Medicaid patients from obtaining care at PP health centers 390,000 women would lose access to preventative health care in the first year alone. (1)

Who wants “baby parts”?

In 2014 NIH funded 164 research projects using fetal tissue with about 0.27% of its total grant money. (2) These projects were researching HIV/AIDS (39%) , eye development and disease (32%), Hepatitis C and other infections, (13%), diabetes (8%), and miscellaneous others including Alzeihmer’s and Parkinson’s. “Fetal tissue is a flexible, less-differentiated tissue … and it is a tool for research that can’t be replicated with adult tissue.” (3) It is different from stem cells, a medical tissue that came under attack back in W. Bush’s administration.

Use of fetal tissue has been legal since 1993 when Congress passed the NIH Revitalization Act which permits the tissue from any type of abortion to be used for fetal tissue research. The law requires complete and detailed informed consent from the woman to donate tissue from the abortion after she has made the decision to have an abortion. The law allows clinics to recover “reasonable payments” ($45-60 per specimen at PP) for providing the tissue to biological-research supply companies. The companies process the tissue and provide it to the researcher for about $800 per specimen. (I wonder if any Republicans have stock in some of those companies).

An estimated 5.8 Billion (yes, a “B”) people have received vaccines made with the two cell lines derived from fetal tissue. (Oh, NO, another red flag! “VACCINES”, “Guns”, “abortions” – all mentioned in the same blog! It’s almost enough to make you believe that there is a government conspiracy to enslave us all.)

“People are talking about fetal tissue, but really what the discussion is about is abortion.” (4) ( Duh!!)   3% of PP services are abortions, done in 1% of the clinics, and in just 2 states. (5) Planned Parenthood leaders have now instructed any PP clinic providing fetal tissue NOT to accept the measly 60 bucks.

Planned Parenthood has experienced 15 smear campaigns in 10 years according to its medical director (5). The current campaign has included:
1) six votes in Congress to restrict woman’s health care,
2) five Congressional committees currently investigating PP,
3) submission of 25,000 pages of documents by PP, and
4) 5 hours of testimony to one committee by its president.

Abortion politics appear to be as complex and almost as emotionally provocative as Presidential election politics, but the outcome of election politics will immediately affect only two women, not hundreds of thousands.

A HOLIDAY DIVIDEND:
Another learned cardiologist has reaffirmed the Hubslist axiom: “Just pick your parents right .” Dr. Lee Goldman, Dean of Columbia School of Medicine, explains that obesity is due to our genes in his new book, “Too Much of a Good Thing: How Four Key Survival Traits Are Now Killing Us.” He thinks that our overreaction to stress and our cravings for sweet, fatty, and salty foods all served us well in the cave man years when we had a life-span of 30 years, but that these “survivor genes” are now mismatched with our environment as we live into the 80’s. Of course, being a modern scientist he knows it is too late to “pick your parents”, so he is placing his hopes on future drug therapies that will turn off or block specific genes. Dr. Goldman says, “Gaining weight doesn’t mean that you are a terrible, non-virtuous person. This is the way you were built.” (6)

So, my holiday (includes New Year’s eve, of course) mantra for me and you is:
“Merry Christmas. Don’t beat yourself up. YOU are NOT in control.”

References:
1. CBO cost estimate on H.R. 3134, Defunding Planned Parenthood, September 16, 2015
2. Nature Magazine, Dec. 9, 2015, Meredith Wadman
3. Carrie Wolinetz, Associate Director for Science Policy, NIH
4. Shari Gelbar, MD. Weill-Cornell Medical College
5. Tearing Down the Fetal Tissue Smokescreen, NEJM, December 10, 2015, p.2376, Reagan McDonald-Mosley, M.D., M.P.H.
6. Boston Globe December 14, 2015 , B11


Vol. 137 December 1, 2015 Holiday Season Eating Advice

December 2, 2015

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“WHY LISTEN TO SO-CALLED HEALTH ‘EXPERTS’
WHEN THEY ARE ALWAYS CHANGING THEIR MINDS
ABOUT WHAT’S GOOD OR BAD TO EAT?”

With the passing of the Thanksgiving turkey we are officially in the “holiday season”. Weight gain during the 6 week holiday season represents 51% of our annual weight gain which is actually only about a pound or two on average. Much less than the average weight gain during a 7-day ship’s cruise of a pound a day. So, what foods should be avoided in the next 6 weeks?

JUNK FOOD?
Junk Food has been the traditional scapegoat for our increasing obesity. But, what is junk food? Decades ago I remember a very savvy pediatric endocrinologist, Dr. Gilbert Forbes, challenging a forum of physicians at a national pediatric meeting to define junk foods.
“Food high in sugar and carbohydrates”, was our immediate response.
“Like grandma’s apple pie?” was Dr. Forbes’ equally quick reply.
“Oh… high starch foods” was our second try.
“Like potatoes? How come all Germans aren’t fat?”
Our working definition after an hour or more of back and forth boiled down to “anything wrapped in cellophane or delivered by a vending machine.” Dr. Forbes’ point was that it is the total number of calories ingested and not any particular food that contributes to obesity.
Today that definition still holds true

In its inexorable march towards the truth medical science has just thrown a stone at the junk food glass house. A Cornell study (1) based on nearly 5,000 surveys done by the CDC in 2007-2008 surprisingly showed that for 95% of the people their BMI  (a measure of obesity) was NOT linked to soda, fast food, or even candy. The researchers expected to find that the more junk food people ate the more apt they were to be obese. Instead they found no correlation between eating junk food and a higher BMI; no link between junk food and obesity. The researchers concluded that it was our increased intake of grains and added fats that was driving up the number of calories consumed by the average American.  “Junk foods may not be the central difference between fat and thin. Limiting those foods is a part of a healthy diet, but it might not be the whole thing.” (2)

 SUGAR?
Sugar continues to get a bad rap, and we consume more and more sugar substitutes. But, as we say in medical science, “there ain’t no free lunch”. Studies showing that Canadian lab mice were more prone to develop bladder cancer if fed saccharine (Sweet and Low) certainly caused a bit of a flap until someone calculated the comparative human doses to be several shovelfuls a day. Sucralose (Splenda) is now under investigation because its effect on our gut bacteria may make us more prone to gain weight and develop diabetes. Like Fox radio news says, “We report, You decide.”

SALT?
Excess (added) salt does seem to correlate with higher blood pressure.  I don’t have the space here to summarize again the whiplash swings of research on salt and disease, but I can tell another story from the past that makes the point more succinctly.
A bunch of physicians (all male – I told you this was a story from the past) who were having lunch at the same table in a hospital cafeteria started remarking about the prodigious amount of salt a cardiologist was pouring on his food. As the discussion heated up, the cardiologist looked up from his plate and stopped it with a question, “How many of you have talked to your father in the past year.” Half of us raised our hands. “You guys can eat what you want. The others better watch their diets. You just have to pick your parents right.”

EGGS?
After decades of branding eggs as “bad” because of its cholesterol the federal government’s Dietary Guidelines Advisory Committee reported in 2015 that “eggs are OK.” A 1999 Harvard study showed that there was no correlation between an egg a day and the risk of heart disease in healthy people (3). 90% of our cholesterol is manufactured by our own liver as directed by our genes. Restricting our intake of certain fats can normally decrease our cholesterol level by about 10% at most.

WINE or BEER?
Previous studies have shown that wine drinkers seemed to experience less heart disease and certain cancers. Efforts to analyze why wine seemed so healthy resulted in tagging resveratrol, a chemical in grape skin, as the “active ingredient”. Dozens of nutritional supplements containing resveratrol ($12 – $25 for a month’s supply) immediately hit the market. Four Danish scientists thought that answer might be too simple and launched a study of what else those wine drinkers were buying at the food store. After examining 3.5 million store receipt transactions from 98 supermarkets they found that wine drinkers were more apt to buy olives, low-fat cheese, fruits and vegetables, low-fat meat, spices, and tea. Beer drinkers were more likely to buy chips, ketchup, margarine, sugar, ready-cooked meals, soft drinks, and, of course, beer. (4)

BOTTOM LINE for this holiday season?
“PICK YOUR PARENTS RIGHT, AND EAT AND DRINK IN MODERATION.”

References:
1. Boston Globe, B12, November 23, 2015, Megan Scudellari
2. David Just, Cornell University Professor of Applied Economics and Management
3. Boston Globe, March 15, 2015, Walter Willett, MD, Professor of Nutrition and Epidemiology, Harvard School of Public Health
4. The Dorito Effect: The Surprising New Truth About Food and Flavor, Mark Schatzker, May 2015 as reported in The Atlantic, June 2015


Vol. 114 June 1, 2014 Much Ado About Nothing

June 1, 2014

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“[In response to] an announcement from another U.S. infant formula manufacturer
about its plans to decrease the caloric density of some of its formula to 19 kcal/fl. oz,
Mead Johnson Nutrition (MUN) would like to assure youthat we have
NO plans to modify the density of our formulas from 20kcal/fl oz to 19 kcal/fl oz.”
-Mead Johnson news bulletin to pediatricians, April 1, 2014

 

My last two blogs discussed the evils of added sugar documented by the movie “Fed Up” and the possibility of an FDA ban of added trans fats in manufactured foods.  Both describe politically correct responses to the growing awareness of U.S. and global obesity rates and prevalence. We are urged to become ingredient list readers and to “buy healthier” as a defense against food corporations’ slick advertising and successful lobbying against transparent ingredient lists.

Abbott is the latest food corporation to claim to save us all from the scourge of infant obesity, all by reducing its Similac calories by  1 kcal/fl. oz.   Mead Johnson’s (Enfamil) rebuttal warns that reducing the formula calories means that infants would need to consume 1.5 more ounces per day to “meet their daily energy requirements during the first six months.”  All my kids have left more than that on their bibs  and chins every day, or as Stephen Colbert might say,  “Give me a f&*king break!”

Abbott’s stated reason for the formula change, already labeled by Abbott as “Innovative”, is to help decrease excessive infant weight gain by matching its formula content more closely to breast milk. In my increasingly skeptical (cynical) view Similac is merely adding new marketing buzz words to the current debate about what makes obese infants and do they become obese adults?

It is hard for me to get too excited about minimal formula calorie changes when I remember that one can of Coke, Pepsi, or Sprite contains more sugar than  100% of the total daily requirement of sugar as defined by the American Heart Association (36 g).  Mayor Bloomberg’s campaign against the super-size soda which contains 128g of sugar and the efforts to remove soda vending machines from schools even make some sense. One kcal/fl oz. or 1.5 more ounces of formula a day certainly pales by comparison on the spectrum of “sublime to ridiculous”.

One of the perks of being a pediatrician is being reminded daily about the flexibility, innate wisdom, and versatility of infants and toddlers. In a two-page  news announcement peppered with scientific journal citations the American Academy of Pediatrics Committee on Nutrition notes that ” the number of formulas choices have increased and the selection process is more complicated”.  It concludes in one of its more common-sense statements that “infants appear to eat to satisfy energy needs and will compensate for low food energy density … by increasing food intake.” Duh? More importantly,  “Neither parents nor pediatricians should assume that newer and more expensive products have health benefits for infants.”


Vol.113 May 15, 2014 More “Bad Stuff” For You

May 15, 2014

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“I have a chef who makes sure that I’m getting the right amounts of carbs, proteins and fats
throughout the day to keep me at my max performance level.”
Barry Bonds

My last blog reviewing the movie “FED UP” listed many of the compelling reasons why “added sugar” is bad for you and why food manufacturers keep adding it. Just as I was getting used to looking for the total grams of sugar on processed food labels, some active health food advocates are urging the FDA to declare partially hydrogenated oils (“trans fats”) as bad too. Now I will have to start scanning ingredient lists for that!

These particular “health food advocates” happen to be two scientists from Stanford University and Temple University writing an article in the New England Journal of Medicine (1). This bicoastal duo reports that since 1911 food companies have been adding artificial trans fats to foods to prolong shelf life, improve stability during deep-frying, and enhance taste. Unfortunately, added trans fats alter the balance of good and bad cholesterol in a harmful direction. The CDC estimates that 20,000 coronary events and 7000 deaths per year could be prevented by NOT ADDING trans fats to processed food. Denmark banned it in 2003. New York city banned it in restaurants in 2006, and California did so in 2008.

In 2006 the FDA required food processors to list trans fat as an ingredient, and many manufacturers reduced the amount added to their products to avoid having to declare it as an ingredient. Recently the FDA has proposed a regulation removing trans fats from its “GRAS” category (“Generally Regarded As Safe”) and declaring partially hydrogenated oils (trans fats) as “unsafe” in any food sold in the U.S.

The authors note that “over the past few decades, food-safety concerns have expanded from issues of food borne illness and contamination … to the effects food ingredients have on chronic diseases such as heart disease.” They end their essay optimistically with “regulatory reconsideration of ingredients such as sugar, caffeine, and salt may well be next on the agenda.”

Reeling from this latest disclosure of potentially dangerous things that I unknowingly put into my mouth, I sat back in my recliner with a relaxing glass of red wine only to read in WIRED magazine that wine is not the pure libation that I thought it was! Some of the FDA-approved additives in wine include:

  • sulfur dioxide to kill microbes and prevent oxidation,
  • ammonium salts to revive dying yeast to enhance fermentation,
  • pectic enzymes to improve clarity and color,
  • oak adjuncts (chips, sawdust, or oak “essence”) instead of oak barrel maturing,
  • gum arabic to soften a bitter wine,
  • Velcorin (dimethyl dicarbonate) to kill a half-dozen different bacteria and yeasts,
  • and, of course sugar.

Added sugar  from beet, cane, or corn syrup increases the alcohol content from fermentation. The process is called “Chaptalization”, invented by a Frenchman and illegal in California, Italy, and Australia.

It is simply a wonder that any of us live to be over 65.
I think I’ll just pop open a beer and settle back to read yet another article about how the ills of the elderly are bankrupting our country.
… Or better yet, a martini.
I almost have my physician convinced that gin is “a clear liquid”.

 

References:
1. NEJM 370:19, May 8, 2014, Brownell and Pomeranz)
2. WIRED, April 2014


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