Prevention. Wellness and Early Childhood Nutrition

The major focus of medicine is on treating the illness. While prevention and wellness have received more attention recently, they have not yet become key components of the medical care physicians provide routinely to their patients.  More often prevention and wellness are treated as the responsibility of patients. Although we are improving our understanding of what is necessary to maintain good health, we continue to have high rates of preventable death and a system which arguably remains overly focused on treating illness.  For no group is a prevention and wellness strategy more important than it is for our children

Our most consistent and effective prevention strategy is undoubtedly in the area of childhood immunizations.  But even in this area many are left out, particularly children of foreign guest workers, illegal immigrants or the uninsured, all of whom tend to come into the health care system only in cases of emergency. We risk their health and wider scale transmission of childhood communicable diseases by not including them.

We have been far less successful in influencing childhood nutrition. Poorly prepared, over-cooked, and highly processed foods devoid of nutritional value pervade our ubiquitous fast food, drive through, quick service economy. Such food fills children up without providing  the nutrients they need to nourish their growing bodies. There are about 40 important micronutrients present in fruits and vegetables which are all but absent (particularly vegetables) in the diet of many children. Without these nutrients, even children who overeat routinely can be malnourished.  Coupling that with the increasingly sedentary nature of children’s activities has resulted in a childhood obesity epidemic which is all too obvious. Reversing obesity in children will require the concerted and cooperative efforts not only of physicians and parents, but schools, businesses, communities, the media, and children themselves.

Micronutrients are implicated in more than the obesity problem. Missing these important elements may also affect development of both the nervous system and the immune system, making children more prone to both affective brain disorders and infectious disease, respectively. While the connections are not entirely clear, there is an increased incidence of both among children despite the fact that we have better drug treatments for these conditions than ever before.

We can and we should do a better job with early childhood nutrition. Four to six portions of fruits and vegetables per day is something to shoot for—those low in starch are preferred (lower GI index). Make a list.  Find out what your child likes and keep good choices available. Also, if you are a woman in her child bearing years, keep a good nutritional profile. You need fresh fruit and vegetables as well as adequate protein, too.  It is better to present the fetus with adequate nutrition from the start, than to wait until your doctor puts you on a pre-natal nutrition enhancement program.

It should be pointed out that getting essential micronutrients through adequate amounts of fruits and vegetables in the diet also decreases cancer risk, and is, therefore, important throughout the life span.  In the United States, cancer and heart disease account for about two-thirds of all deaths. Further, about half of all reported deaths are from preventable causes, nearly 70% of which are due to tobacco use, poor diet and associated physical inactivity.  While in the past tobacco use was the more important cause, poor diet and associated physical inactivity have been catching up.

 

 

Reducing the Development and Progression of Alzheimer’s Disease with Exercise & Nutrition

Alzheimer’s disease is a slow-onset, progressive dementia produced by neurodegenerative changes. It usually occurs in the elderly, though there are some cases of earlier onset. In its initial stages the symptoms can be slowed by various drugs. The more residual function that remains the better the drug therapy is at extending cognitive function. However, drugs do not slow down or stop the underlying degeneration, and there is no cure.

Our knowledge of the underlying neurological damage done to the brain in Alzheimer’s disease suggests that most neurons destroyed are involved in learning and memory. True Alzheimer’s disease has a genetic component and can run in families. But the origin of some dementia is uncertain.  It can be vascular—insufficient blood flow to allow oxygenation of the brain. There is also an old idea that has never been disproven, that the disease may be caused by a lenti-virus (a slow-acting virus).  However, little is known of the factors that reduce the incidence of Alzheimer’s dementia.

It is known that people who exercise regularly and are on a Mediterranean type diet are at less risk for Alzheimer’s disease. In a study reported in JAMA, 1,880 New Yorkers in their early 70s were enrolled and followed. Their level of exercise and the quality of their diets were evaluated. Within five years, 282 members of this group had an Alzheimer’s disease diagnosis. Those with the best diets had a 40% less chance of being diagnosed with AD than those with the worst diets, while those who had the most exercise were 37% less likely to be diagnosed with AD than who exercised least. When the group was divided into the top 1/3 with best combined diet and exercise characteristics and compared with the bottom 1/3 of the group based on diet and exercise characteristics, the top 1/3 was 59% less likely to be diagnosed with AD. The combination results showed a magnified effect, presumably because each factor (diet and exercise) contributed something unique to the outcome.

In addition to the observations made in the JAMA New York study, we know that the level of education or level of brain work generally lessens both the incidence and severity of AD later in life.

 

Increasing Your Basal Metabolic Rate

As we age, most of us become less active and sedentary. We may not have always been that way, but with time increasingly with little opportunity to move about, we’ve become that way. We occasionally work overtime. We skip meals and later overeat, as though we could catch up with what we missed, or we snack on something sweet. We tend to be happy about our condition until we realize we’ve gained a lot of weight and don’t look the way we want to look.

Estimates have put about 60% of the American adult population in the sedentary category. And, in that regard, it’s not too surprising that about 60% of the population is either overweight or obese. Clearly, under-activity is the most important contributor. Exercise of any kind increases the effect of insulin-promoting fat loss and development of a leaner, more muscular appearance. Our metabolic rate, which is accelerated by exercise, is the most important means of preventing fat build up or promoting fat breakdown. We do tend to slow down with age, and our base-line metabolism, sometimes called basal metabolic rate (BMR), decreases at about 5% per decade after our 20^th birthday. But it doesn’t have to be that way.

Exercise and physical activity every day are contributing factors in BMR, but not the only contributors. Eating and the digestive processes are as well. When we eat our bodies activate our metabolism—quiet cells and tissues become active, and we burn more calories while digestion occurs. The worst eating behavior is skipping meals and subsequently overeating or binging on junk food until we get to the next meal when we can overeat again.  This is a nasty recipe for getting fatter and sending our metabolism into hiding. We can reverse the trend, but it requires increasing your BMR.

The best initial strategy to increase BMR is to increase your activity level. Shun the sedentary style. Use the stairs, not the elevator. Go for a walk.  Don’t slump down into a chair after dinner. Find something else to do. When you add activities, you should aim for 30 min or more of moderate physical activity every day.

Set up an exercise program. Weights are not necessary, but some kind of hard effort is required, e.g., heavy gardening, chopping wood, fast bike riding. Either weights or resistance training and cardio-aerobic activity such as running or fast walking can elevate your BMR for hours afterward. But weights or resistance training can activate BMR for up to a day, whereas your cardio-aerobic efforts will only last one to six hours. Weights or resistance training will build new muscle and increase you metabolism. New muscle will burn an addition 500 cal or more a day at rest. Thus, you get both a short term and long metabolism boost with weights/resistance efforts. Weight training will generally increase muscle tone, trim the physique, and give one a sense of well-being. Frankly, you’ll look better and feel better as well.

Food elevates metabolism. This is a major reason why eating every few hours is preferable to longer intervals between meals. Never give your body the chance to think it is starving. That will slow your BMR immediately and even cause you to overeat later. Vegetables and fruits contain complex carbohydrates that are burned or digested slowly. There is no big glucose release into the blood. This eliminates a need for spike in the insulin concentration. Eat low glycemic index foods and lower the amounts of fatty foods combined with sugar. Add high fiber foods such as beans, nuts, grains, and some cereals.  Cut sugar, fat, refined flour, but increase fiber, especially when combined with fruits and vegetables. Cut carbohydrates, especially the high starchy vegetables (potatoes, rice, or corn). It may be useful to aim for 15-35 % of diet as carbohydrates. Keep carbohydrates but keep them lower than usual as a percentage of the total caloric intake. Increase protein especially if you are doing some weights or resistance work.

Eat 6 times a day if you can: 3 meals plus 3 snacks. But reduce the size of portions especially if you are already overweight. Stop the junk food! No sugar drinks. Minimum alcohol, coffee, tea are advisable. And stay away from all dietary supplements. They are unnecessary and there are no quick fixes. Drink water as much as possible. Stay hydrated. Remember water accounts for 2/3 of body weight. Water assists in building muscle tone, fat removal, removes (flushes out) toxins. Drinking water will help whatever your plan.  About a gallon a day is reasonable place to start. Some recommend more but a gallon is probably far more than most people usually drink.

 

Diabetes II and Obesity

If you are 30 pounds or more overweight, you are at least significantly overweight but also probably close to obese. If you have been that way for a while and you have not seen a doctor lately, you may be showing the signs of type II diabetes and not be aware of that. Significantly increased weight will generally produce increased blood pressure and a gradual shift in metabolism characterized by increased dependence on fat and decreased dependence on glucose to meet your energy needs. Plasma glucose concentrations gradually rise, and in response insulin-dependent receptors begin to decline. This produces a diabetic condition which, unlike childhood diabetes, is insensitive to insulin. This type of diabetes is thus hard to treat, but treatment can be achieved generally through dietary manipulation. A least two well known popular diets can be applied to the early treatment of obesity-induced type II diabetes—the Schwarzbein diet and the Adkins diet. There are other diets as well, but the Schwarzbein and Adkins diets are those with which I am most familiar.

In general, both diets promote increased protein and fat and decreased carbohydrate. The latter is reduced to as little as 15% of the daily calorie intake. One emphasizes meat, cheese, eggs and other high protein foods and non-starchy fruits and vegetables with a low glycemic (GI) index. This index refers to the ease with which carbohydrates are turned into blood glucose. Low, medium and high GI foods are characterized as < 20, 20-60, and > 60. These numbers roughly refer to the percentage of the complex carbohydrate which becomes plasma glucose. In both the Swarzbein and Adkins diets low GI fruits and vegetables are the most used, but some smaller use of medium GI fruits and vegetables are allowed. Some low GI vegetables are asparagus, bean sprouts, beet greens, broccoli, celery, cucumber, mustard greens, radishes and spinach. Medium GI vegetables include Brussels sprouts, chives, kohlrabi, leek, onion, parsley, peas, peppers, and beans. Common fruits are mostly medium GI and include apples, peaches, cherries, grapefruit, strawberries, blueberries, blackberries and bananas.

Both the Schwarzbein and Adkins diets will reduce plasma glucose levels and after a while normal plasma glucose is achieved allowing a gradual movement away from their deranged metabolism. If one couples these diets with increased exercise, reduced dependence on stimulants, adequate water ingestion, and some emphasis on stress management, then one can begin to lose weight. To re-emphasize, one does not lose weight until the calories in food are consistently less than calories used to get through the day. Thus, increased exercise is important. Eliminating obesity will often eliminate signs and symptoms of diabetes II.

Why We Should Avoid Starvation Diets

When you starve yourself, your body tries to use fat as an exclusive energy source. You can do it in the short term, but your body loses all or most stored carbohydrate within the first day. Then energy needs of some organs and tissues that critically need glucose are met by breaking down muscle protein and using the liberated amino acids to synthesize the necessary glucose.

If you exercise, your muscles will start using fat breakdown products nearly exclusively to meet its energy needs. This spares glucose for the brain and other tissues not able to shift quickly to fat breakdown products. Gradually, nearly all tissues will move over to using fat breakdown products to meet energy needs and thus spare the glucose synthesized from skeletal muscle breakdown—allowing the glucose to be utilized nearly exclusively by the brain and the kidneys, and eventually only the brain. In true starvation even the brain will eventually go over to using fat breakdown products as the continuing breakdown of skeletal muscle will endanger and weaken posture.

Actually, about 10 days into a starvation diet the extensive breakdown of fat will begin to simulate the metabolic conditions in diabetes. Indeed, after about 8-10 days you might pass out in the shower and be mistaken for a diabetic about to go into a coma. Certainly, no one wants to induce this condition deliberately, even though it may cause you to lose weight initially at a prodigious clip. Your body will recognize what you are doing and will slow down your metabolism. You will be too weak to exercise vigorously and you will start to thus slow or cancel out subsequent weight loss.

Indeed, if you can’t exercise but continue to starve yourself, your body will not only break down fat but will also start to re-synthesize it. This re-synthesized fat won’t wind up entirely back in fat tissue, but some will be stored in elsewhere, mostly in the liver. This isn’t a permanent condition. Still, it shows that a more sensible strategy would be to lose excess weight slowly and not use the liver as a way-station for the fat you need to eliminate.

It’s also beneficial to try to avoid excessive breakdown of skeletal muscle by starving yourself, but rather go more slowly and rebuild muscle as you go along with exercise and by increasing the relative amount of protein in the diet.

These are problems that attend starvation, which can be completely avoided by shooting for losing about 1-2 pounds a week instead of 4-5 or more. Don’t try to go at break-neck speed and crash-land into your final goal a few months later. It’s not worth it.  Take your time.

Rather, reduce calorie intake slowly. A reduction of about 500-600 calories per day will yield about 1 pound per week. An average of about 1 pound per week will result in the loss of those 100 pounds in about 2 years. In truth, you may lose 1-2 pounds per week initially and then less, until you get to maybe 1-2 pounds per month as you ease into your final goal.

Over the course of a year or two you’ll become accustomed over that longer period to a new body and a new way of life, having put your body under far less stress in the interim.

What to eat (6 times a day) to lose weight or maintain ideal weight:

If we consume our calories in 6 meals-snacks and stay hydrated, we can accelerate metabolism, particularly if we combine these habits with a sensible exercise program. Indeed, if we spread out some intense exercises throughout each day and remain active, we can generally lose weight at a steady pace when we eat sensibly. We need to pay attention to portion sizes. It helps to use small plates or bowls until you get used to how much should be eaten at each meal.

If you eat well and often, you will not be constantly hungry. You will get the right level of protein, carbohydrate and fat in the meals suggested below. You will likely eat more protein than you have been eating, while your carbohydrate and fat uptake may be moderately or substantially reduced. You’ll probably feel better, you won’t feel starved and you’ll lose weight, slowly.

In general, if you have been significantly overweight for some time but you are not yet showing signs of type II diabetes, it may be useful to begin the diet described below. If you don’t know whether you are a type II diabetic or you have not seen a doctor in some time, you should make an appointment and be evaluated.

If you eat about the right amounts over the course of the day, there will still be some variation and you’ll likely still consume between about 1800 and 2700 calories a day.  To determine the number of calories you should consume to lose sensibly, start by multiplying your current weight by 15. The resulting number is a fair estimate of the number of calories needed to maintain your current weight. Begin your weight loss program by trying to eat 400-500 fewer calories than this each day. Don’t miss meals. Also, as I’ve suggested elsewhere, leave a bite behind at two or three of those meals, but try to stay within those 1800-2700 calorie limits. You are not going to count calories, so the only way to know how you’ve been doing is to let your scale tell you what’s going on.

Weigh in once a week in your birthday suit at the same time of day and watch your weight. If you don’t lose at least 2-3 pounds per month, start eating a little less at each meal. Still, you’re not counting calories. You are going to try to hit a rough target (between 1800 and 2700 calories). If you are on average about 400-500 cal below the number it takes to maintain your current weight, then you will lose weight at about one pound per week.

In the meals described below and their variations, you’ll be shooting for portion sizes that will lead to the above calorie limits:

Breakfast                           300- 450

Mid-morning snack       100- 200

Lunch                                   400-600

Mid-afternoon snack     200-300

Dinner                                  700-1000

Late evening snack          100- 150

There are a lot of variations, and you may shift a few calories from breakfast, lunch and dinner to the snacks, eating less at what are normally the larger meals and relatively more at what are normally considered times for light snacks.

Before Breakfast:

When you awaken have a small glass of water—then maybe a cup of coffee or tea (preferably green tea). You’ll drink more water during the day, but keep coffee and tea to a minimum. More green tea is preferable to more coffee.

Breakfast Alternatives (no more than about an hour after waking)

a.   Small bowl of whole grain cereal or granola—add some chopped almonds, a little flaxseed, several kinds of fruit (bananas or peaches—kiwi—strawberries, raspberries,  or blackberries (or a little of each)—or maybe some dark red sweet cherries—pitted of course). Add some milk, but no white sugar or honey.

b. Oatmeal—instant or cooked whole oats. Add a few raisins, brown sugar, chopped almonds, and a little butter or margarine and milk

c.  Poached or basted eggs (1 or 2) over a slice of whole grain wheat toast

d.  Egg white omelet and fruit—like in part a

e.  In a parfait glass, layer cereal, yogurt, and fruit, nuts as in a above.

Mid-morning snack (accompanied by another glass of water)

a.  An apple or an alternative piece of fruit or a mixture of fruit (if absent at breakfast)

b. Protein smoothie or whey protein powder (vanilla or chocolate flavor) with ice water

c. Protein smoothie with protein powder, add fruit (especially fresh frozen berries), little fruit juice, yogurt—preferably stirred in a blender. You can also add some egg whites for extra protein—it all gets mixed up. If you make too much save the rest in the fridge, but drink later on the same day.

Lunch (drink1-2 glasses of water before after or during lunch)

a. A multi-colored salad built on a small plate—topped with cut up chicken, turkey, salmon or tuna (for extra protein). Vegetables can be lettuce, cucumbers, tomatoes, carrots, radishes, various colors of sweet peppers (or hot if your taste permit), green onions, fresh spices like parsley, sweet basil, and dill. You can also add some cold and previously cooked yellow or green beans, and beets. Top with a small scoop of cottage cheese, and the meat or fish as noted above. You can also sprinkle in some nuts (cut almonds, or walnuts) and some freshly cut chives or wheat grass you may have growing on the kitchen windowsill Then drizzle with oil/vinegar or low cal or even high cal dressing, but maybe use a little less of the latter.

b. Lots of variations on a.: Use less or more of any vegetable—or you can turn the salad into a cold plate with previously cooked items from the fridge with a sliced turkey roll-up on the side.

c. You can also make a cold plate or microwave-warmed or stove-warmed plate with leftovers from dinner on the previous night.

d.  Sandwich with lean meat cuts and plenty of salad vegetables added. Use multi-grain high fiber fresh bread. If you are out, go to a place known for their excellent sandwiches (and good breads), but stay away from heavy, high calories sauce additions.

Mid-afternoon snack (drink another glass of water)

a. Protein bar or part of a protein bar if you need to be calorie conscious

b. Protein smoothie—as in AM snack, especially if just returning from work-out.

c. Little cheese & crackers or alternatives with a glass of wine (preferably red) unless as part of your diet you prefer to cut out alcohol altogether

Dinner (have 1-2 glasses of water with the meal)

a. Plan to have a green vegetable (broccoli, Brussels sprouts, green beans, spinach)—can add in or substitute cooked beets & greens, carrots, cooked sweet potatoes, red or black beans over white or wild rice.

Add meat (preferably lean cuts) or fish.

Add a small salad—all on the same plate with all of the above.

Add a glass of red wine, if the meal seems to warrant.

b. Creative variations on the above themes—but avoid heavy sauces for meat or vegetables, as well as butter and sour cream, as they introduce a heavy calorie burden

c.  You can occasionally add a cup of homemade soup to a meal, or have a stir-fry or some bean-meat tomato sauce based concoction over a nice pasta (like whole-wheat linguini or angel hair pasta or just whatever rice you like)—but it’s very difficult to know the calorie count in these dishes—so have only a modest helping and save the rest for others

d. If you’re out for dinner, order light—and leave a little behind even if it tastes sooo-good

Evening snack (no water or very little water after 7 PM–don’t interrupt your sleep with needless trips to the bathroom)

a. Small bowl of strawberries

b. Alternative fresh fruits—cut up peaches, apples, kiwi or combinations

c. Mix above with small scoop of sherbet or frozen yogurt or occasionally a favorite ice cream

Considering Your Eating Habits

It’s best to spread out eating during the day and just eat one large meal a day while starving yourself otherwise. The best strategy is to have breakfast, lunch and dinner with snacks in between as well as a late night snack.  Keeping meals and snacks as simple as possible is also a good strategy. If you are at or near your target weight, you will eat a little differently than if you are trying to lose weight. In the latter case, you’ll be reducing portion size appropriately.  In either case, you’ll want to be certain you get enough protein—most people do not get enough protein in what they eat, and get more carbohydrate than is appropriate.

Taking the simple view, you should eat modestly, mostly green leafy stuff or food as close to the natural state as possible. Any “food” from a package with a list of ingredients your eight-year-old can’t pronounce should be avoided.

Some general thoughts to keep in mind are as follows:

1. get protein mostly from a high protein source such as lean meat, fish, egg whites or a protein powder supplement,

2. get fiber from oatmeal, beans, whole grain breads,

3. get green leafy and other vegetables and fruits mostly with a low GI (glycemic index)

4. keep starchy (high GI)  foods to a minimum

5. season food with dried or fresh spices avoiding excess salt

6. drink plenty of water

7. limit or reduce coffee to one-two cups a day. Tea, especially green tea, is good with the late afternoon snack

8. blueberries and kiwi are excellent antioxidant fruits

There is much detail published elsewhere on how to prepare modest meals with plenty of variety. An excellent book with advice on spreading out meals and snacks while dieting is “The Abs Diet” by David Zinczenco.

Finally, don’t worry about counting calories. Just weigh in now and then. If you are gaining weight or just not losing weight as you wish, then adjust your eating and exercise accordingly.

Some Critical Aspects of Prevention and Wellness

Prevention of significant medical costs is vital in any society. We know that regarding preventable illness obesity and tobacco addiction are among the most important issues to consider first. If we cannot stem the tide of the array of conditions associated with the wide spread occurrence of obesity, the associated lack of physical activity and the use of tobacco then we may not be able to provide basic medical care to many others. Without making such an attempt the society is potentially doomed to grim choices. To lower the significant costs associated with many conditions we may be able to prevent, one has to change behavior. We must face facts. Unless we improve the efficiency in producing desired medical outcomes, we won’t be able to do everything.

Obesity

One of the consequences of the current obesity epidemic is the significant additional medical costs associated with obesity in the longer term. This condition is associated with elevated blood pressure, stroke, cardiovascular difficulties, renal dysfunction, type II diabetes, and some hormone-sensitive cancers. A recent study showed that about $1,500 annually in additional health care costs are added each year for each obese patient. These costs appear to be even higher for obese older patients. Prevention and/or reversal of obesity, particularly in the growing number of obese children, is critical to reducing these health-care costs.

Obesity is in theory a completely preventable condition, but almost all of us know it to be far easier to become obese, than it is to reverse the condition. We are built for activity, but we are increasingly sedentary. Our environment is not well planned to promote exercise to work off the extra calories we consume. We tend toward processed foods with high calorie content, and it is just too easy to consume more than we require.

Indeed, if we just consume about 30 calories more each day on average (equivalent to finishing that last bit of your ham sandwich) than we need, then over a year we may gain a little under three pounds. Over 10 years that’s about 30 pounds or about 90 pounds over thirty years. If you started this habit when you were 15 and weighed about 140, then by the time you are 45 you’d tip the scales at about 230. Of course, if that ham sandwich was really loaded and you got about 60 extra calories a day instead of 30, then you wouldn’t weigh in at 230 when at 45, but rather you’d weigh in at about 320 lbs.

Now many people think that if you restrict food intake severely or even moderately that anyone can lose weight—even a large amount of weight. Crash diets of all forms with or without supplements, strange concoctions or natural preparations reputed to assist, have been applied. Many people have lost 40-50 or even a hundred pounds only to be seduced into thinking things were fine—then they revert to earlier form and the pounds start to come back. Indeed, as many as 80-90% of those who lose large amounts of weight regain it subsequently.

Sadly, it’s never over. It’s a little like stopping smoking for  a considerable length of time  and then taking a cigarette some years later only to find you are back to a pack a day within the week. It’s sort of that way with food. I know, for example, I can never again buy and eat an Einstein’s Brothers chocolate mudslide cookie—valued at 346 calories with 17.5 gms of fat, 50 gms of carbohydrate and 10 gm protein. One would mean I’d need another and then where would I be.

Tobacco Addiction

The additional medical costs associated with tobacco use are considerable, but quite difficult to calculate. It’s been variously estimated that 40-50% of all cancers are triggered by tobacco. Cardiovascular as well as lung diseases are at least exacerbated by tobacco use.

Expensive treatment of emphysema is possible using drugs; however, by continuing to smoke most patients can cancel out the positive effects of such therapy. Indeed, many clinicians will ask patients to stop smoking before beginning a course of treatment. In the case of chronic obstructive pulmonary disease (COPD), a leading cause of death among those with lung disease, only symptomatic treatment is possible. Smoking is a major factor in the progression of the disease, and stopping smoking is a major goal of treatment. There is literally nothing the clinician can do that is more valuable than this step which patients can take and must take on their own.

 

Watching Your Cholesterol

A sedentary life style can lead to a slow, but steady increase in weight. Inadequate physical activity and excess weight both lead to an elevation of the cholesterol associated with LDL—the so-called bad cholesterol. LDLs are low density lipoproteins which carry the majority of cholesterol in the blood and are responsible for carrying cholesterol between organs and tissues of the body. For most individuals, weight increase will also raise blood pressure. Being as little as 10 pounds overweight can produce significant increases in LDL-cholesterol and blood pressure, which spells long term concern to your physician? Both elevated LDL-cholesterol and blood pressure are conditions associated with increased risk of cardiovascular disease and stroke.  However, rather than initially use drugs to address either problem, your physician may elect to start you off with a diet and exercise program. If you can lose the weight and achieve a higher level of activity at the same time, it is possible that both your LDL levels and blood pressure will fall back into normal range. If you do lose the weight and your numbers are still borderline high, an additional dietary regimen may be helpful, particularly in regard to LDL levels.

Various foods or behaviors favor reduction of LDL.  Reducing LDL concentrations lowers the chances of cardiovascular disease and stroke.  There are four points of interest: (1) maintaining proper weight and physical activity level, (2) reducing high cholesterol foods to a minimum, (3) emphasizing foods that facilitate the clearance of LDL from the plasma, and (4) emphasizing foods that accelerate BMR (basal metabolic rate) and limit the absorption of cholesterol.  While all of these approaches can be in use simultaneously, the major initial emphasis is on losing weight and achieving higher levels of physical activity.

While losing the weight, an increase in your exercise level and BMI are both desired. Both contribute to lowering LDL cholesterol.  Some foods like peppers and mustard and the frequency of meals during the day can accelerate BMR. Caffeine in small amounts can do the same, but caffeine can also have an opposite effect on increasing blood pressure.

In some individuals, severely limiting cholesterol in the diet can be helpful. This means limiting butter, cheese, eggs as well as some fatty meats, especially sausage, liver and kidney. This step also helps in the reduction of saturated and so-called trans-fats. In general, fish, poultry and lean cuts of meat are important. They increase uptake of polyunsaturated fatty acids, which can lower LDL concentrations. Increased fruits and vegetables are important as well. Blueberries and kiwi have significant amounts of antioxidants which can be particularly helpful. Many fruits and vegetables contain both soluble and insoluble fiber that helps retard the gastrointestinal absorption of cholesterol. Foods like oatmeal and high fiber breads can also be very useful. Apples, pears, prunes, grapefruit, spinach, and even tofu are particularly good choices. These fruits and vegetables also have low glycemic index (GI). In general, lowering both alcohol intake and total carbohydrate, particularly carbohydrate from starchy high GI foods is a good idea. They should not be eliminated, just de-emphasized.

Finally, some recommend increasing foods with essential fatty acids (sometimes referred to as omega-3 fatty acids). These essential fatty acids are integrated into the structures of the LDL and help to remove them from the plasma more quickly—thus lowering LDL-cholesterol concentrations. These essential fatty acids can be added to the diet at the necessary levels by eating fish 1-2 time per week. Salmon and halibut are good choices. Use of olive oil, especially extra virgin olive oil, as a butter substitute is a good idea as well, as are nuts and seeds. Almonds and walnuts are excellent additions. Almond butter is a good replacement for peanut butter. Flaxseed, sunflower seeds, pecans, hazelnuts, pine nuts, pistachio nuts are also useful. You can add them sparingly to cereals and salads.

As noted earlier foods such blueberries and kiwi, that are both high in fiber as well as in antioxidants, can have a dual effect. The fiber helps to limit cholesterol absorption while antioxidants appear to slow the oxidation of surface molecules on LDL. When oxidation occurs on the surface of these cholesterol-bearing particles, they spend a longer time in plasma before they are removed. Oxidation is a much bigger problem when essential fatty acids are added to the diet and antioxidants are useful in suppressing oxidation. Thus, the beneficial effects of increases in essential fatty acids in the diet are likely maximized by also increasing our intake of natural antioxidants.

When all of these strategies are applied to an overweight and sedentary individual substantial reductions in LDL-cholesterol can result. However, if reduction of LDL-cholesterol is insufficient, drugs are available for further reduction. Those which are most useful are the statin drugs (such as Lipitor or Crestor), which help to limit liver synthesis of new cholesterol.  By following use of the above behavioral and natural foods one may be able to lower the amounts of statin necessary to produce a favorable, that is, therapeutic effect.  Keeping statin concentrations as low as possible may be useful in reducing side effects—such as muscular pain. It should be noted also that part of the reason for muscular pain may be associated with statin-induced reduction of CoQ10 in muscle. CoQ10 is a conditional vitamin—we need more of it when we are active and we may not synthesize enough. CoQ10 is available as a natural supplement. In summary, if your LDL cholesterol is not controlled by the naturalistic strategy given above, you and your doctor should consider the use of at least low doses of a statin and possibly a low dose CoQ10 supplement to keep the often severe muscular pain side-effect of the statin at bay.

The Wisdom of the Personal Trainer

For years after I got into physical fitness and I thought I knew something. It turned out that I didn’t. I knew a few things, but nothing compared to what I would learn from a personal trainer whom I hired for 16 half-hour sessions.

First, I need to remind you that I’m a guy and I chose a lady to be my trainer. Why? Well, I observed her first. She was all business. She seemed to do well with other guys as well as with women. But some of the male fitness trainers never seemed to be at a good place with guys they were coaching. There was a little too much ego challenge in the instruction.  With the guys they often seemed to be at an inappropriate level; that is, they pushed harder than they should have or didn’t push hard enough. This wasn’t a universal problem but looking at those interactions, I thought I’d do better with a female personal trainer. I was right.

There were several important corrections she made with me early on.  I hadn’t expected that. First, she helped me correct both my balance and posture. She had evaluated my core strength first and gave me some additional exercises to help develop some of the weaker muscles and thus provide more balance.  Balance and posture were both continuing themes as the core was strengthened. We then worked on specific muscle groups, but for me the major adjustment had been core strength and posture correction. I had spent much of my working life hunched over a computer eight or more hours a day. Straightening my back and neck required a conscious effort. She wanted me to engage a stronger core and improve in both these areas until muscle motor memory took over. Fortunately, I had good physical strength, I listened well, and I was in the hands of an excellent teacher.

She also taught me the value of interval aerobic exercise to complement my resistance training and core and balance work. I found that I improved further with my core, balance and flexibility by engaging in a yoga program. But initially under my trainer’s tutelage, I’d worked in more stretching before, in between and after my weight routines and aerobics. I haven’t been excessive about aerobics, but two or three days a week of interval training to exercise the heart is important, especially now as I’ve advanced to septuagenarian status.

On balance, no pun intended, I’m really pleased that I decided to invest in a personal trainer. Had she managed to correct any one of the several physical problems I had, she would have been worth her weight in gold. In fact she managed to make several improvements simultaneously.