Category Archives: medical care

Developing the Right Exercise Program For You

Muscle Training: At the beginning any heavy lifting with weights should be avoided. Small size weights (2-10 pounds) with small number of repetitions for each exercise offers a good place to start. You can join an exercise group, join a gym which will have professionals skilled at weight training and other forms of exercise, or you can develop your own program working from descriptions and photos or videos of workouts shown on various Internet sites that are not difficult to find. Gradually you will pick up the pace and develop a specific program emphasizing different muscle groups on different days of the week.

Try to do a 20 min workout with weights three times a week at the beginning. You can emphasize two muscle groups for each of the three sessions. For example, on day one you can emphasize arms and shoulders; day two, chest and back and on day three, core and leg muscles. Arms, shoulders, back and chest muscles can be done with dumb bells or bar bells. So can core and leg exercises, but with both core and leg muscles you have many more options. There are a substantial number of core exercises such as crunches, sit-ups, plank, side-bends and so-forth that can be done with and without weights. Many of these can be combined with a small of large heavy ball held in the hands. Read in othere Internet sites about the use of the “medicine ball” and the “Swiss ball.”

For legs, in addition to various resistance machines in gyms, you can use both dumb bells and bar bells as well. However, during our waking hours we use our leg muscles nearly all the time when we are walking about or running or cycling. When getting started as I noted in yesterday’s blog post a half mile to a one mile walk each morning or evening will harden up the leg muscles substantially over the first month of your new exercise routine. Gradually, you can add some running to the daily routine or you can ride a bike. Either of these strategies will increase your use of specific leg muscles that are used not quite as much in simple walking. It is not uncommon to develop cramps in specific leg muscles if your approach this phase of activity with greater zeal than you should at the outset. Once again, start slow and pick this up the pace as you become used to the workout.

Eventually, you can walk or run or run-walk or simple fast walk 4-5 miles a day. This may take about an hour or less. Humans walking at a fast pace will walk about 4 miles and hour. At a relatively leisurely pace 2.8-3.0 miles per hour is easily achieved.

If you want to monitor your walking independently various devices are available which will help you keep track of your steps, mileage and/or calories burned during the walk. The best of these in my view is a FitBit, that is worn on your wrist. It may linked to your computer, tablet or phone to keep tabs on the numbers of steps or miles walked as well as the numbers of calories burned each time you go our for a walk. You computer will keep track of everything, even the number of steps taken each time you go to the bathroom during the night.

Another alternative to keep track of the leg exercises is to use a treadmill. You can vary the speed and most treadmills will monitor heart rate and allow you to go at a “fat burn” pace which is 60 percent of your maximum age-adjusted heart rate or a little faster up to about 80 percent of maximal heart rate for briefer periods. In the latter case, slowly working up to an 80 percent rate after about 12-15 minutes and staying there for 3-5 minutes is an excellent invigorating exercise that will keep the heart muscles fit. Once you are in pretty good shape from a combination of weight loss and exercise you may want to try this (provided your heart is generally healthy and your physician agrees). I personally do this 2-3 times a week. In addition, these strategies on the treadmill represent an alternative to the other walking, running or other leg exercise routines noted above, and should not be done in addition. You may also wish to substitute some of the above leg weight training with cycling.

During all resistance training with weights as well as roadwork, drink plenty of water. A rule of thumb is 6-8 oz glasses of water for one who is at or near optimal weight. Initially though, if you are over weight then add an additional 8 oz glass of water for each 5 pounds you are overweight. Thus, if you are 20 pounds overweight and on an exercise program approximated by the above, you should drink about 10-8 oz glasses of water (or about 80 oz of water a day) Coffee and tea and all other liquids consumed during the day should not be counted as part of this total.

In general, you should eat sensibly consuming relatively more protein and fiber at the expense of carbohydrate and fat. Drink small amounts of coffee or tea and no caffeinated soft drinks if possible. Keep your consumption of alcohol down as well. We’ll come back to dietary issues in a subsequent blog post.


Balancing Fruits And Vegetables And Glycemic Index.

In general, for every meal or snack during the day you should plan to have some vegetables and fruit. Over the day these may balance out to be about equal portions of each, but some days you may eat more fruit and fewer vegetables or the other way around. Some of these may be chosen because they provide a hefty dose of soluble fiber or insoluble fiber. Each are beneficial in aiding digestion. Some will have high concentrations of antioxidants and vitamins that are beneficial to health as well. In addition, you should take note of the glycemic index (GI) for each vegetable or fruit. Most of the fruits or vegetables should have a low GI. Some may have a medium GI and a few, generally very few may have a high GI.

The Glycemic Index scale is one which generally varies from 1-100 and is a measure of the extent to which the fruit or vegetable contributes to increasing blood sugar concentrations. Persistently high blood sugar concentrations contributes to insulin resistance. Initially, insulin is elevated until blood sugar concentrations are reduced after eating. If blood sugar remains persistently elevated, insulin resistance to the uptake of sugar by cells develops and it also becomes difficult for the body to burn fat. Type 2 diabetes then for some is not far behind. There is an increasing desire for sugar, obesity may develop with hypertension and diabetes. Heart disease may also develop as well even in the short term.

In general, low GI vegetables and fruits reduce overall caloric intake while giving one a full feeling after meals and snacks. These are low caloric density foods. Low GI is 1-50, medium GI is 50-70 while high GI is 70-100. We are fortunate to have many low GI fruits and vegetables. For example, broccoli, cabbage, mushrooms, onions and sweet red peppers all have GI values under 10. Peas, carrots, cherries, grapefruit, prunes, apricots, apples, strawberries, oranges and pears all have GI between 20 and 40. Corn, beets, mangoe, bananas, papaya, raisins, kiwi, figs, cantaloupe and pineapple all have medium GI values between 50 and 70.

For breakfast today I had I had cooked steel cut oats over a bed of fruit: banana, kiwi, strawberries and dark seedless grapes, all low or medium GI fruits, filled with vitamins and some minerals as well. For a morning snack I have a small blueberry, yogurt, honey muffin. Blueberries have antioxidants which are good for memory and brain function and in addition have good fiber content.

Lunch is leftover from last night: a few beets with about a quarter of a baked acorn squash mixed with rice, cheese, red sweet pepper, onion and garlic. While the beets and squash have medium GI the remaining vegetables are low GI. Beets and squash have good dietary fiber and all have good vitamin concentrations.

For an afternoon snack I had A mixture of whey protein and plain low fat yogurt to which I added nuts and raspberries. The latter is perhaps the best fiber among fruits and is also loaded with antioxidants. The late afternoon snack plate — also doubling as a happy hour dish — contained sweet raw red pepper slices, Bartlett pear slices, cucumbers, strawberries, beets, broccoli, cauliflower, and cherry tomatoes all of which have low or medium GI with plenty of fiber and antioxidants in one or another of these.

For dinner a wild rice chicken soup contained a large number of vegetables (corn, swiss chard, onions, carrots, celery, garlic, tomatoes, portobello mushrooms, sweet red peppers, broccoli, as well as chicken cut into small sections, again a combination of mostly low and medium GI vegetables.

Reversing Chronic Disease Associated With Obesity

We know now that the overweight condition leading on to obesity slows us down, changes our habits, puts a definite strain on our physiologic systems and may gradually or even rather quickly lead into diabetes, cardiovascular and renal disease, and eventually cancer. These are all regarded as chronic diseases, that is disorders that are not immediately life threatening, but which in longer term will exact a considerable toll.

These consequences as they follow on from overweight/obesity are different from person to person, but on average everyone is somehow affected — some more seriously that others, some sooner than others. In general, in the United States persons who are highly overweight or obese incur on average several thousand dollars more in medical expenses when compared with others who have normal weight. The overweight/obese person does not necessarily die earlier than a person of normal weight but is on average sicker than a person of normal weight. Genetics as usual will play an important role as well, protecting some and accelerating the consequences of overweight/obesity in others.

Becoming overweight or obese does not happen overnight, and the changes that occur in our physiology occur slowly as well. The stresses and strains of being 50 pounds overweight for example often do not seem that great when we finally get there as those pounds will have been added quite slowly. However, if you want to see the burden you’ve assumed, pick up a 50 pound sack of potatoes and try carrying around on your back for the day. You will notice the burden it produces. However, if you add just a potato or two to a sack you carry around with you for the next 30 years or so then the overall added 50 pounds won’t seem like quite so much. You will have become used to the added weight very gradually. Your muscles may even get stronger, but generally that won’t happen because you’ll adjust to the added weight by sitting more than you stand or walk about.

As you add weight you have likely eaten or drank many sugary items. Your body will try to help you by suppressing the entry of sugar into cells where it can be metabolized to fat and stored — a complex process we may come back to later. The cells that allow sugar to enter are stimulated generally by insulin and so slowing down the entry of sugar into those cells is mainly about making them insulin resistant. Once insulin resistance starts type-2 diabetes is not far behind. Later other changes in metabolism start occurring and these produce both cardiovascular and renal effects. Overall, the way your body produces and regulates its energy becomes confused. The fat which accumulates puts a general stress on the liver and in turn on other physiologic systems as well as on the strength and stability of the vascular system. Reversing the serious changes that are occurring is a tall order, but it can be done.

As I noted in the last blog post this is preferably done by eating 5-6 times a day, the total amount of calories in which are about 200 – 400 below what you need to get through the day. This is not too hard to do, but it seems so in the beginning. The hard part is thinking through how many calories you burn in a 24 hour day. Once you do that you will find out how much you can eat during the day (200 – 400 less than you burn). You can look this up on the Internet. Everything counts: eating, sleeping, doing housework, exercising, preparing meals and eating them, walking and all other forms of exercise. The more you weigh to begin with the more you burn in an hour — even sleeping. Do the numbers.

If you are very inactive — sleeping and sitting in the couch most of the day while others bring you meals — you’ll have to pick up your activity level. Divide the day into three sections at least: 8 hours sleeping, 8 hours of the equivalent of sitting on the sofa and 8 hours doing something more strenuous. You’ll get your ideas from looking at the tables you’ll find on the Internet. At the beginning you want to get to at least 2500-3000 cal per day. This may not be that hard for many, but it could be. That means the you will need to decide what you can then eat at meals and snacks during the day.

Let’s say you can eat about 2200-2300 calories per day. That will give you about 500 for each meal and about 250 calories for each snack. That’s a good place to start. You could always do a little less for snacks and a little more for meals, say 600 and 150, respectively. Then develop your portions and meals around that. You have many options. Just remember the general rules — no white sugar, no junk food, stay with lots of vegetables and fruits, very little dairy, little or no red meat, some fish, chicken. Whey protein is a good protein supplement. Vegetables and fruits should have a low glycemic index (GI). Drink plenty of water. By eating less more often and drinking the water your basal metabolic rate will increase. Overall, this may be a big change for you. Just get started. See how it goes. Make the necessary adjustments as you move along. Weigh in once a week and after a month or so the scale will help with the next round of decisions.

Getting What We Need — Natural, Untainted Organic Foods

For those who live long enough to begin to think about life-long objectives a lengthy, generally healthy, relatively stress-free existence into old age would seem an appropriate overall objective. Eventually, we all die of course, and while we don’t get to pick an choose how that will go down, many of us would prefer to simply go off in our sleep one night having never suffered the pain of long-term debilitating disease.

Of course, that’s not all that occupies our thoughts: how long we will live and how we will die. Indeed, we tend not to think about such things that much. It does come up though when we fall ill, especially if it’s with something serious or potentially life threatening. Then we might think about such matters a lot. Of course, if we become ill with something that is chronic, requiring longer-term attention to what we have to do to recover, we may think about death and dying quite a bit. But generally speaking getting sick whether for a short spell or in longer term, tends to be treated by us as an incovenience, something which interferes with out work in the world or how we want to live our lives. Getting sick frankly takes us off stride. It gets in our way. But that’s something that is happening quite a bit these days because people are frankly not taking their health as seriously as they should.

For many reasons, but mostly from the way the food industry and distribution has developed, most of us are being presented with bad or unhealthy choices. Our health may suffer as a result. We are eating generally far too much of the wrong kinds of foods. Many are becoming overweight, even obese, as a result. This has many attendent negative consequences both in the short and long term. Before we know it we are having trouble getting around. Exercising becomes a thing of the past and we get nervous about it and often just continue to eat more and more as we gain more and more weight. If we are lucky we begin to see that can’t continue and we make a commitment to change our direction. The first thing we find out is that it’s a great deal more difficult to take off the weight than it was to put it on. With luck though we stay with it, eating less, eating the right kind of foods, and exercising more and more. Those who succeed will have made getting the right kinds of foods a good habit and will have developed just the right mindset that’s needed.

Obesity is unfortunately a disease. It changes our metabolism. Gradually the excessive sugar we’ve been taking in teaches our cells to reduce the effect of insulin. We develop insulin resistance. Type-2 diabetes is not far behind. Then because of our obesity our body starts handling fat differently. The fat cells start sending fat over to the live which begins to be mildly congested. More fat is moving through the vessels using its complex transport mechanisms. The vasculature becomes affected. We carry more cholesterol-containing particles, and the vessels begin to pick them up. We’re moving into the early stages of cardiovascular disease. Later the kidney (renal) system may be affected by different mechanisms but relatable back to all that is happening. Thus, diabetes, cardiovascualar disease and renal complications are all coming down the pike, all stemming from the obesity. We begin to see elevated cholesterol and higher blood pressure. These, in fact, may be among the earliest signs. Often much later, but sometimes not too far away, we may develop early signs of cancer. Our systems are a bit clogged up and we may have been having difficulty for years trying to clear out and eliminate carcinogenic metabolites we may have taken in from the food we’ve been eating. However, in spite of all this it may not be to late. But, we do have to change our diet, exercise, loose the weight and get our systems unclogged and functioning again.

The best strategy is to cut out the processed foods, lower the carbohydrate intake substantially. Simple sugars are a primary problem. We need more protein and fiber and less carbohydrate and fat. Fruits and vegetables, grains and beans, less dairy and lean meat and fish or the alternative in eggs and a whey protein supplement perhaps. Importantly, we need almost nothing that we find at the typical supermarket: no processed food if it can be managed, certainly nothing with large amounts of additives the food chemists have put there for a variety of reasons.

This is a tall order, which most people believe make it necessary for them to shop at places like whole foods or other high end organic food markets; places where only the upper middle class and wealthy can afford to go. This also creates the impression that the poor and uneducated have no other option than to go where they can buy inexpensive but relatively unhealthy food. That’s not what has to happen, but adjustments have to be made and everyone will eventually make their commitment in their own way. Rich people as well as poor people are both needing to do this.

First, when cost is a serious issue then in addition to making hard choices, you can visit farmer’s markets and other wholesale venues, buy organic if you can, but buy items that keep well in larger amounts. Some can be frozen or kept with plenty of food value in other ways, such as in a root cellar. You can grow many items even in pots out back if you do not have space for a big garden. Usually seeds are inexpensive, and available in the quantity you will need. If gardening is new to you, you will have to learn about it. You can also grow and dry or freeze your own herbs, and many root crops such as beets and onions quite easily. Of course, notthing beats the taste of freshly picked tomatoes. At any level, gardening will save you quite a bit of money.

If gardening on your own is not your style, and you have neighbors or friends who need the same regimen as you do, then collaborate with them. Grow things in vacant lots, in nearby woods or even at the side drainage ditches along roadsides. Items like squash, pumpkins, melons and cucumbers grow well in such locations and don’t need too much regular tending. No chemicals, sprays or hard fertilizers, just use simple mulching strategies and mix organic refuse with a little manure and turn it now and then until it begins to look like soil. You have no trouble generally finding a farmer who will give you a scoop or more of cow or horse manure.

We are increasingly pressed for time and money, but you can really grow a lot of food in some of the most unespected places. Expand your territory. Find options.

Future Of The Coal Industry

Coal has a long history as a dirty fuel, which from the outset of it’s heavy use at the outset of the Industrial Revolution has exacted a heavy cost on human health. Gradually, as coal furnaces became more and more effective, toxic gases and other products were efficiently trapped, and the heavier ashes were routinely separated into several usable sub-fractions. Some of these are now being processed to obtain specific products for sale. Currently the trapping of ashes and their partial conversion into usable products for resale has had the effect of reducing the amount of ash that goes into storage by about 40 percent. Total storage needs can be considerably decreased if the conversion of ashes into usable products for resale is undertaken at all sites where power plants generate ash, and further if strategies are undertaken to remove and use both toxic metals and strategic rare earth metals from some ashes. Overall, the use of coal ash in the manufacture of alumina, silicates, cements, numerous toxic metals as well as rare earth elements is key to the continued use of coal. Rare earth elements have many strategic uses. As a result of their rare occurrence, these elements garner increasing prices in world markets. It is likely that rare earth elements can be as effectively mined from coal ash as they can be from natural sources. By processing nearly all of the ashes produced at coal fired plants the amount of ash by-producets that will need to be disposed of may be reduced to perhaps 20 percent of the amount of ash we currently have to deal with.

To put this in perspective, if in fact we currently process as much as 40 percent of coal ash, then by advancing to 80 percent, but importantly with removal of all toxic metals and rare earth elements, then we could gradually reduce the amount of ash that has to be buried or stored by a substantial amount. More importantly, all, or nearly all, of the toxic metals will have been reduced to trace amounts. If we assume the use of coal as an energy generating fuel remains at its current level, that would mean that the 140 million tons of ash generated from the burning of coal per year would be reduced to about 30 tons. More importantly, it will have been stripped of almost all of it’s highly toxic components. Thus, the threat to the environment going forward is highly reduced. Indeed, it is like going from a highly difficult threat to one which is like no threat at all. Once these measures in handling coal ashes are routinely in place we can go back and recapture the coal ash stored in the most dangerous of the 1100 sites in the country where it is placed currently. We would start with 100 or more of the the most toxic sites first and then deal with the others subsequently and in due course.

In my mind, the above strategy represents a reasonable plan going forward to deal with the toxic ash waste coming from coal fired power plants. Without implementing something like this the future of coal is doomed. People are not going to tolerate even “accidental” spills and the costs associated with clean up. As the costs of generating energies from renewable sources continues to decline it is likely that within a decade or two, most nations will convert to alternative and less costly renewable strategies for power generation. As things are at present, the toxic ash problems associated with coal fired power generation will accelerate it’s demise as a form of energy generation. While carbon dioxide release into the environment as well as toxic gases are still released at some plants not yet modernized, these problems still dim in comparison to the problems of mountains of toxic ash. Further, these problems are magnified, and the urgency of doing something about ash toxicity and storage are increased, by the serious ash spills from storage sites that occurred in Tennessee in 2008 and in North Carolina only recently in 2014.

The remaining problem is the enormous amounts of carbon dioxide that are released into the atmosphere if we continue to burn coal at the current rate. Indeed, the carbon dioxide can be routinely sequestered (liquified) and and stored. Although carbon dioxide is a terminal oxidation product for carbon the carbon dioxide still has a number of uses. It can be also be incorporated into stable carbonates that can be used as components of building materials. Some of it can also be used to stimulate and accelerate the growth of plants, especially to stimulate small trees in enclosed environments to provide starter shoots to be used in more extensive reforestation projects. Liquified carbon dioxide can also be used as a solvent in industrial scale chemistry, which may become a stimulated field in the event that liquified carbon dioxide were to become available free of charge. Nevertheless, with all these uses some of the liquified carbon dioxide would likely evaporate more rapidly than if it were simply stored as a liquid in side by side tanks or in enclosed pressurized locations underground.

There are other issues to consider, but these seem minor. Some coal is partially combusted to drive out gases and produce incompletely oxidized carbon products that are then used in the pharmaceutical and other chemically based industries. Some of the same or similar products are generated from petroleum. Also, some coals are used to make liquified natural gas which is used as cleaner fuel. Such uses would likely be balanced out as we go forward if the major issues of dealing with the substantial amounts of toxic coal ash is considered, and if most of the carbon dioxide and toxic effluents currently released into the air are reduced to near zero.

Proceeding in the manner considered here it is possible the coal industry can help move us forward in a useful way, but without change it is likely doomed to obsolescence within a few decades. Such a fate is accelerated by the continued release of toxic and environmentally damaging effluents into the atmosphere and by the potentially extreme difficulties associated with the accidental released of toxic coal ash into rivers and streams.

Can We Handle The Problems Of A Really Large Older Generation

In 2011 the oldest of the Baby Boomer generation began reaching the age of 65. This is the largest American generation to reach this advanced age and on average 10,000 of them will reach 65 each day until the year 2030 when the oldest members will be 84. The decline and instability of advancing age may as obvious and prevalent within this group as it has been in earlier generations. It may be even more obvious than it has ever been owing to the fact that there are simply more members in this group than there have been in any previous generation. We estimate that about 78 million will pass into this age group between 2011 and 2030.

Many may not make it until 2030 and those that do will suffer decline and instability. We may see greater numbers with dementia and many other manifestations of poor health. However, many will survive and go well beyond the 2030 and reach centenarian status between 2046 and 2065 when we could see more centenarians living simultaneously that we have ever seen in any previous age.

Many will remain resilient as they age. Many will live lives through fulfilling relationships, but many may slide off to themselves. They may lose contact with friends or former co-workers or simply fail to remain in touch for a variety of reasons. They then fail to make new contacts and thus not replace their social alliances. Living alone and not actively maintaining or rebuilding social capital can be a killer for the elderly. It’s almost as though one deliberately grows oneself into an underprivileged social or socioeconomic status.

One becomes lonely, loses sleep, experiences stress of various forms. Slowly the immune system loses its strength and perhaps other physiological manifestations occur as one loses appetite and becomes inattentive to the important details of life such as eating properly and at even bathing regularly. One may experience extreme loneliness and experience at times a cold, miserable existence. Some will snap out of this dangerous lethargy, others may not.

This is a form of psychological trauma but with clear physical manifestations that can be life threatening. Those who fall into this state would be well-advised to build new social contacts with others. These may be the keys to living long and loving the time you have. Go for regular exercise at a local gym. Talk to people there. Work on community gardening projects with others — or any kind of community project in which interactions with others are required. Whatever you do, avoid a sedentary lifestyle — take a walk every day if you do nothing else. Finally, eat well if sparingly, plenty of water, fruits and vegetables.

Because the Baby Boomer generation is so large, we may see an equally large manifestation of the troubling psychological problems discussed above. In anticipation of seeing this evolve as a growing problem, it would be wise to begin an extensive consideration of how it might be handled as we move toward the time when it will be most in evidence. In my view we may need volunteers and a great many of them to create a social network around the anticipated large numbers who may need their help. Obviously, we cannot require this to happen, but we can begin to think about how we might bring that about.

Limits Of Aging: Centenarians And Beyond

In 2012 the U.N. estimated the existence of 316,600 centenarians among the world seven billion inhabitants. A little over 53,000 of them are in America, more than in any other nation. In 1950 there were only 23,000 centenarians in the world or about fourteen times fewer than we see presently. Yet, the world contained less than four billion people in 1950 and population has only doubled since then. We can then easily see that the centenarians are growing far more rapidly than the population as a whole.

In a general way it is easy to see why this is the case. Improvements in medicine and public health have led the way. Increasingly, the factors that appear to cause people to live past 100 years favor a diet heavy in grains, fish and vegetables, but light in meat, eggs and dairy. They generally have low stress lifestyle, and have rarely been seriously ill. They have generally lived in caring, socially harmonious communities and have always had a high activity level which may include walking and gardening. They often have an active spiritual life which also reduces stress.

Aging is a hopefully slow, yet unremitting march toward eventual death which we all hope will come later rather than sooner. We succumb from genetic defects, inherited or acquired over time, infection, poor metabolism, accidents or chronic disease. Improved medical care, vaccines hat protect against infectious disease, improved diet, safe food, removal of toxins from the environment, and reduced tobacco use have helped expand life expectancy.

Anti-aging drugs are being considered as are even nanotechnologies & nanorobotics which many have suggested may further remedy the effects of aging by 2030. Use of stem cells, tissue engineering strategies, removal of chromosomal altering machinery that may be activated later in life, targeted killing of harmful cells, and subtle immunotherapy all sound like impossible strategies now, but are nevertheless coming and are likely allow many of us to live live longer and longer into the future. Some of this to both us and to our decendents will likely appear as indistinguishable from magic as we begin to see such strategies unfold.

The maximum theoretical life span in years may be much longer than we can presently imagine. Yet it may be longer that we might guess but certainly not infinite. We may extend and repair, tweaking our biological mechanisms until we can no longer squeeze out any more time.