How to Garden without Breaking Your Back

Now that the weather is starting to warm up, a lot of our patients are heading out into the garden. Who can resist the allure of fresh air, sunshine, the feel of dirt in their hands, and the promise of delicious, homegrown fruits and vegetables? It's a wonderful thing to grow some of your own food. But gardening is an inherently challenging activity for people who have any kind of weakness in the back, so it's important to take precautions while in the garden.


Why does gardening cause back problems?
Part of the reason gardening causes back problems is that it's a weekend warrior activity. You go for months and months without gardening, and then you end up doing a physically demanding activity for an extended period of time that your body isn't used to doing. In particular, gardening involves a lot of forward bending, which loads a tremendous amount of pressure on the discs and joints. The Oklahoma State University website does a good job of explaining this phenomenon:

Think of your back as a lever. With the fulcrum in the center of the lever, it only takes ten pounds of pressure to lift a ten pound object. However, if you shift the fulcrum to the side, it takes much more force to lift the same object. Your waist actually acts like the fulcrum in a lever system, and it is not centered. In fact, it operates on a 10:1 ratio. Lifting a ten pound object actually puts 100 pounds of pressure on your lower back. When you add in the 105 pounds of the average human upper torso, you see that lifting a ten pound object actually puts 1,150 pounds of pressure on your lower back.[i]

Oftentimes, not only are you bent forward when you're gardening, but you're attaching something to the end of your hand, like a shovel with a mound of dirt, which makes the lever even longer and thus puts even more pressure on your back.

[1] Oklahoma State University. Back Safety. http://ehs.okstate.edu/kopykit/Back%20Safety.pdf

Tips for pain-free gardening

1. Be careful of forward bending for too long
Don't bend over in an uncontrolled position for hours and hours. Either kneel, sit on a little stool, or figure out what the best posture position is for you.

2. Take frequent breaks
Every 30 minutes, get up and stretch your back. Even short breaks can prevent back injuries.

3. Do backward bending exercises
To counteract all that forward bending, do some backward bending exercises if they work for you.

4. Hire out the hard stuff
If you need to do some digging, and digging is really hard on your back, hire someone to dig for an hour for you. The rest will be easy!

5. Quit when your back feels tired
If you feel your back starting to get tired or painful, stop. Frequently injuries happen when the back is tired.

Remember, a lot of chronic back problems start with either minor tears in the discs or strains to the ligaments, and those things can easily occur with gardening. That doesn't mean you shouldn't garden. Gardening gives you an opportunity to connect to the earth in a very profound and deep way. So do it, just take care of yourself while doing it!

Sincerely,

Marc Heller Matt Terreri

What you eat can improve your health, mind, and appearance

For many, springtime means revamping exercise regimens, improving appearance, reading more books, taking on a new hobby, and improving dietary habits.

Great news is that following good-for-you food goals will help your whole body -- from your skin to your brain -- so you can tackle those other resolutions with ease.

"The best way to have healthy hair, eyes, and skin is to take good overall care of yourself. That means eating well," said Dr. David L. Katz, director of the Yale Prevention Research Center at Yale University. So whether it's your heart, brain, bones, eyes, skin, or hair you seek to nurture, there are foods up to the task.

"The more colors you get into your diet, the better," Katz said. A variety of fruits and vegetables supplies antioxidants and vitamins that are most powerful when working together. Daily servings of whole grains, lean protein, and dairy round out your body's needs. A diet rich in fresh, whole foods, full of colors and rich textures, satisfies with abundant flavor, and nourishes every part of your body.

For Silky Skin and Hair

Antioxidants like lycopene and vitamin C, as well as soy protein and omega-3 fatty acids, help keep skin glowing. Antioxidants have long been the rage in topical skin care, but those same nutrients work even better from the inside out. When skin (the body's largest organ) is exposed to the sun's rays, free radicals can develop, Katz explained. "These free radicals attack the skin and impair blood flow to the area, causing premature aging. Antioxidants fight that process."

Vitamin C, found in citrus fruits, facilitates collagen production, a critical component for vibrant skin. Another antioxidant, lycopene, found in foods like canned tomatoes and red grapefruit juice, also promotes skin health. Tofu is a good option since its omega-3 fatty acids help regenerate new skin cells and reduce inflammation, while its soy protein has been shown to boost collagen.

Shiny, healthy hair starts with the vitality of cells in the hair follicle, where hair is manufactured, says Katz. Eat foods high in calcium and quality protein like eggs, dairy, or fish. Eggs also provide biotin, a structural component of both bone and hair. Vitamins B6, B12, and folate nourish follicle cells, too.

Eat For Your Eyes

According to a study published in the Archives of Ophthalmology, people who ate two servings of fish weekly benefited from an almost 50 percent decrease in the risk of age-related macular degeneration (AMD), said Dr. Emily Chew, deputy director of the division of epidemiology and clinical research at the National Eye Institute. Eggs, leafy greens, broccoli, winter squash, and Brussels sprouts all contain the antioxidants lutein and zeaxanthin (both associated with eye health), as well as vitamins C and E, zinc, and beta-carotene.

Scientists are still investigating how these foods promote eye health. Observational studies show they likely reduce the risk of AMD, Chew said. No one knows exactly what lutein and zeaxanthin do for the eye, but it's thought they filter damaging light and support cell structure. Expect more answers in 2012, when Chew and colleagues hope to publish research on the effects of lutein, zeaxanthin, and omega-3 fatty acids from a study following 4,000 patients for five years.

Build Better Bones

Calcium, vitamin D, and phosphorus work together to build strong bones. Even though green leafy and cruciferous vegetables (like spinach and broccoli) contain calcium, the body absorbs it best from dairy products, said Joan Lappe, a bone health researcher and professor at Creighton University in Omaha, Nebraska.

Dairy products offer a package deal: they are abundant in phosphorous, and vitamin D added to milk and dairy products aids in calcium absorption. Some nondairy foods high in calcium include canned salmon, sardines, and calcium-fortified firm tofu.

Greens are still good bone foods, however. Broccoli, kale, and bok choy may provide little calcium, but they offer plenty of vitamin K. Research is showing promise that vitamin K -- or some antioxidant or phytochemical in foods high in the vitamin -- boosts bone mineralization. Research published last year in Osteoporosis International followed postmenopausal women for three years, and found that those taking supplemental vitamin K maintained or enhanced bone strength, compared to those on a placebo.

Heart Helpers

Whole grains, fatty fish, and fresh fruits and vegetables are the keys to keeping your heart in prime condition.

A recent review of seven studies showed that two and a half servings of whole grains per day reduced heart attack and stroke risk by 21 percent, said lead author Dr. Philip Mellen, then an assistant professor at the Wake Forest School of Medicine in Winston-Salem, North Carolina. Whole grains are rich in antioxidants, especially vitamin E (also found in almonds, peanuts, and green leafy vegetables), which helps maintain healthy blood vessels. And soluble fiber from fruits, vegetables, and nuts helps lower harmful LDL cholesterol and control weight, both of which have a positive impact on heart health.

Further cut your risk of a heart attack by eating fish, especially those high in the omega-3 polyunsaturated fats like salmon, mackerel, or rainbow trout. Omega-3s make platelets in the blood less sticky, reducing clotting and the likelihood of a heart attack.

Brain Boosters

Omega-3 fatty acids and whole grains are good for your heart -- and they're good for your brain and mental health, too. "People who are heart healthy are brain healthy," said Dr. Joseph S. Kass, assistant professor of neurology at Baylor College of Medicine in Houston, Texas.

Kristen E. D'Anci, a research psychologist in the Nutrition and Neurocognition Laboratory at Tufts University and professor of psychology, noted, "Diets rich in vitamins C and E are consistently associated with lower levels of cognitive impairment in aging." Abundant in fruits, vitamin C may also reduce the risk of stroke.

Additionally, vitamins B12, C, E, and folate may play a direct role in keeping your mind sharp. Research shows that B12 (found in lean protein like turkey) and folate (found in many grains fortified with the vitamin) help improve memory and lower the risk of Alzheimer's. They may also help people over age 60 with learning, attention, and response speed, according to study results from Tufts University.

The pleasure of posture awareness

By Julie Duck

Maybe it is a childhood thing to slouch. Or simple laziness on the part of anyone, young or old, who finds themselves slumped in their seat. However you look at it, good posture plays an important role in overall wellness, including spine health. When your patient is not standing up straight, it is time to educate him on the reasons why he should, and guide him toward simple solutions to help raise his posture awareness.

The slump
Have you ever been told to sit up straight or stop slouching? There is more to it than manners, because good posture helps the body to stay in alignment, and contributes to everything from walking and running, to sitting and sleeping. Unfortunately, bad habits can lead to poor posture, and subsequent problems with the back, shoulders and neck.

Where does bad posture begin? It starts with being unaware of the body’s position. Slouching is simple and easy to revert to unless one is paying attention to their posture. Additionally, people with depression, spinal issues and those who are obese are at greater risk for poor posture because they tend to hunch down. Have you ever tried to “hide” yourself with a slouch?

To help your patients become more aware of their posture, point out the little things – the everyday occurrences – that can contribute to slouching, and show them how little changes can make big differences in their posture.

Bag the bag
Some of the biggest contributors to bad posture are the millions of heavy briefcases, handbags and backpacks that are lugged around by men, women and children every day. Stuffed to the gills, and generally oversized for fashion reasons, many of today’s bags are just too big to carry and get away with it. Slinging heavy objects, such as an overloaded backpack or humongous purse, over one’s shoulders puts a disproportionate amount of weight across one side of the body, leading to slumping shoulders, hunched backs and strain. The result is painfully poor posture.

Ideally, the weight of any backpack, bag or briefcase should be dispersed via two straps, but because most purses and messenger bags are not made that way, the next best thing is a bag with a wide, padded shoulder strap that allows one to pull it over the head and sling it across the body. There are several ergonomically correct bags available on the market that address the issue of posture, of which you can provide to patients who need to put more effort into their awareness. Or, suggest that the patient carry only what they need for the day in their bag, instead of the whole kit and caboodle, to promote good posture habits.

The super six-pack
Core strength can make a difference when it comes to bad posture and back pain. Without strong abdominal muscles, the back becomes weak and unable to optimally support the spine. Additionally, the muscles that reside closer and deeper to the spine have a greater overall effect on posture and, subsequently, a healthy back. By exercising on a regular basis, the stomach muscles can become strong, holding the spine correctly and allowing for naturally good posture. This knowledge alone, however, might not be the trick to getting your patients to do their crunches.

Let them know that good posture that is supported by regular exercise, can contribute to a more slender-looking body and reduce the appearance of a potbelly. This alone could motivate many patients who want to appear slimmer to stand up straight.

Healthy posture, healthy spine
Of paramount importance is spine health. Poor posture can be the culprit for spinal pain and problems with the shoulders and neck, as well as contribute to the worsening of pain that is already present. And because many people spend large chunks of time at their desks, slouching in their chairs, or performing repetitive lifting without good form, there is quite a bit of back pain all around. For these patients, teaching them about the benefits of good posture can help them to begin to utilize posture awareness to prevent possible future injury and additional pain. By simply keeping a neutral spine, your patients may finally realize just how superior good posture can feel

Fiber supplements lay foundation for health

In the world of wellness, the benefits of fiber may be too easily forgotten. After all, there is nothing flashy about fiber. In comparison to dietary stars such as “super foods” and antioxidants, fiber may appear downright pedestrian.

Years of solid research and scientific investigation, however, prove that fiber is no flash in the pan. In fact, this food staple helps lay a strong foundation for good health, as fiber has been linked to a number of physical benefits.

According to the Mayo Clinic, a diet high in fiber can decrease cholesterol, help with regularity, aid in the prevention of constipation and speed up the passage of material through the GI tract. It also may decrease your risk of digestive conditions, such as irritable bowel syndrome and hemmorhoids. Experts report that the consumption of fiber can slow the absorption of sugar as well, which is good news for diabetics and for the prevention of type 2 diabetes.

Added on to the list of benefits associated with fiber is the fact that it can help you feel full for a longer period of time, which may lead to weight loss. Plus, as people choose foods that are high in fiber, they usually are choosing foods that happen to be lower in fat, sodium and other unhealthy components as well. For example, good choices for high-fiber foods include grains, whole-grain products, fruits, vegetables, beans, peas, legumes, nuts and seeds.

However, not everyone may be able to meet their daily fiber needs through food intake. In this case, it is important to look toward fiber supplements to do the trick. Health experts recommend that men to get 30 to 38 grams of fiber per day, and that women get 20 to 25 grams per day. Study your diet, and figure out whether a fiber supplement would contribute to overall wellness.

In order to understand the importance of consuming adequate amounts of fiber, it’s important to know the definition of fiber. The Mayo Clinic defines it as “all parts of plant foods that your body can't digest or absorb.”

“Unlike other food components such as fats, proteins or carbohydrates — which your body breaks down and absorbs — fiber isn't digested by your body,” the Mayo Clinic reports. “Therefore, it passes virtually unchanged through your stomach and small intestine and into your colon.”

Fiber frequently is classified into two types: soluble and insoluble. Soluble fiber, found in foods such as oats, peas, beans, apples, citrus fruits, carrots and barley, dissolves in water to form a gel-like substance.

Insoluble fiber, on the other hand, does not dissolve in water. This type of fiber, found most often in foods such as whole-wheat flour, wheat bran, nuts and many different vegetables, promotes the movement of material through your digestive tract. It also increases stool bulk, which can be beneficial for those who have irregular stools or constipation.

The benefits of fiber are many, especially as it addresses the risk factors tied to so many diseases, including heart disease, diabetes, diverticular disease, constipation and metabolic syndrome.

If you do decide to up your fiber intake, be sure to choose a broad-spectrum dietary fiber supplement, which contains both soluble and insoluble fiber.

Study: Fruit and vegetable consumption inadequate worldwide

A new study that looks at the fruit and vegetable consumption of nearly 200,000 people finds that the prevalence of inadequate diet is “remarkably high” across the globe.

Overall, 77.6 percent of men and 78.4 percent of women consumed less than the suggested five daily servings of produce.

“Low fruit and vegetable consumption is a risk factor for overweight and obesity, and adequate consumption decreases risk for developing several chronic diseases,” said lead author Spencer Moore. “The release of the 2002-2003 World Health Survey data provided a unique opportunity to examine global differences in low fruit and vegetable consumption in a way that has until now simply not been possible.”

Moore is an assistant professor in the School of Kinesiology and Health Studies at Queen’s University in Ontario, Canada. He and his colleagues looked at data from 196,373 adults in 52 mainly low- and middle-income countries.

The study appears in the May issue of the American Journal of Preventive Medicine.

There were wide variations among nations, ranging from 37 percent of men in Ghana who did not meet that standard — to 99 percent of Pakistani men. The researchers saw similar findings in women with the same two countries at the high and low ends

The prevalence of low fruit and vegetable intake increased with age and decreased with income. These results surprised Moore, as surveys from the United States and other developed countries consistently show that fruit and vegetable intake increases with age.

“Most people regardless of the country that they live in simply do not meet the recommended guidelines for adequate fruit and vegetable consumption,” said co-author Justin Hall, a graduate student at Queen’s University. “Some countries appear to be better off than others in relative terms, but the overall prevalence of low fruit and vegetable consumption is remarkably high across the globe.”

Tim Byers, M.D., interim director of the University of Colorado Cancer Center at Denver, said that this study argues against the stereotype that those in tropical climates have better diets because fruits and vegetables surround them.

“Although the survey deals mainly with developing countries, their results are not substantially different from those we have seen in other surveys done in Europe or the United States,” said Byers, who was not involved in the study. “This is telling us that dietary quality is a global problem.”

Hall JN, et al. Global variability in fruit and vegetable consumption. Am J Prev Med. 36(5), 2009.

Cubicle stretches

By Jeannine Stein
March 2, 2009

If you don't move around nearly enough during the workday, you might need to compensate with these flexibility-enhancing moves. Some require minimal equipment such as dumbbells; others can be done at one's desk or against an unoccupied bit of wall space. Sure, the moves may raise a few eyebrows in the office, but while everyone else is reaching for pain relievers, you'll be sprinting out the door ready for after-hours socializing.

Pete McCall exercise physiologist with the American Council on Exercise, and a San Diego-based personal trainer:

For clients who sit all day, I like to do three different exercises.

* The first is a bridge, where you lie on your back with your feet on the floor, legs bent and push your hips up to the ceiling while squeezing the glutes. The activation of the glute muscles sends a signal to the hip flexors to relax, and it allows them to lengthen. Push the hips up on a one-two count, hold for about a second, and take about three to four seconds to come down. Do that about 12 to 15 times, and really emphasize the contraction of the glutes.

* The next one is a quadruped, or a bird dog. Begin on hands and knees, making sure your wrists are under your shoulders, knees are under your hips and your head and neck are aligned with your spine. Extend your right arm and left leg straight out at the same time. While you're doing this, contract your ab muscles and feel the stretch through the upper chest muscles and the hip flexor. Do this about 10 to 12 times on each side, either alternating, or staying on the same side and then switching.

* The third one is a plank. The body is supported on the forearms and the toes, and you should try to keep the hips and the shoulders at the same height. Contract the core muscles, and the glutes and the quadriceps. As with the bridge, as the glutes contract the hip flexors relax and lengthen. Do these about two to three times and hold for about 15 seconds. To modify this, drop down to your knees, but watch the hip position and avoid bending the body at the hips. You should still feel the extension in the hip flexors.

Then, for a great stretch for the neck and shoulders, let your left arm hang down at your side, and look over your right shoulder. Press your right hand into your chin. Do the other side as well. That gets the levator scapulae and the scalene muscles -- smaller muscles in the neck that get tensed up a lot.

For help with rounded shoulders, stand two to three feet in front of a wall, with your back toward the wall. Rotate the body to the right side and reach up and touch the wall with your right hand as if reaching for something on a shelf. Do the same on the left. This opens up the pectoral muscles and the obliques in the abdomen. It's also a good stretch for the hip flexors.

Tasha Turner

Personal trainer, t:

* The hip flexors tend to get tight if you sit all day, so you want to release that tension and stretch and strengthen them as much as possible. Before you do strengthening exercises, you want to stretch them out with something like a bridge.

* I love squats for strengthening the hips, and you can do them with just your body weight. Three sets of 20 reps is good, or you can try doing them continuously for one minute. If you want definition in your legs, do them with weights for three to four sets of eight to 10 reps. As you progress, increase the weight to shock the system and avoid plateaus.

* I'm a die-hard fan of lateral raises to strengthen the shoulders, but doing them with bent elbows really isolates the shoulder muscle and takes the strain off the neck. Start by holding light dumbbells (about 3 to 5 pounds) by your side, with elbows bent. Raise the arms, making sure the elbows and shoulders are in a straight line -- never go any higher than that. Hold that position for two seconds, then take the arms down slowly. Do three sets of 15 to 20 reps. You can do this standing or sitting, but sitting may be a little more challenging because you're less likely to use momentum to move the weights. This will take the pressure off the neck, especially if you sit at a computer all day and strain your neck trying to read the screen.

* In general, it's a good idea to work on core exercises. You move through your core, and you need a strong core for everything -- walking, standing, even sitting.

Eric Fleishman

, Powerhouse Gym, Burbank:

* One good quick stretch is putting your leg up on a desk or a chair and, keeping the knee slightly bent, reaching down and trying to grab your toe. This allows your hamstrings to get a stretch, which is good if you've been sitting all day. You'll really feel it in the back of your leg, and it has a great effect on the lower back because it promotes blood flow to the region. Then do the other leg. * You should pay attention to your posture, which is incredibly important for body alignment and feeling good, and how you're sitting. We do an exercise at the gym where we take a small bottle of water that's about one-third full and place it on someone's head and have them walk around, which is very "My Fair Lady," but it teaches you what proper posture feels like. You can do the same thing sitting at a desk.

* There's almost nothing better to stretch your shoulders, your trapezius muscles and your back by finding a chin-up bar and allowing yourself to hang. It's almost like picking up a necklace from a table -- it allows the spine and vertebrae to fall into place. It's important not to hold your breath, and you can hang anywhere from eight to 15 seconds. For a more advanced move, swing a little bit back and forth.

Next up on Ask the Trainers: exercises for people always on the move.

Getting health benefits from chocolate

Joe Graedon, Teresa Graedon, The People's Pharmacy
March 30, 2009

A column described health benefits from chocolate. Would high-quality chocolate include Snickers bars? What would be a moderate amount, to get the health benefits?

High-quality chocolate is dark chocolate (at least 70% cocoa solids, and not alkali processed). A good "dose" is 5 to 15 grams daily, which should be just under 100 calories. This is not a large piece of chocolate.

A traditional Snickers bar contains milk chocolate, weighs 58.7 grams and has 280 calories. Milk chocolate does not have the same benefits as dark chocolate.

::

I have been taking Protonix for heartburn. After I learned that long-term use might lead to complications, I tried to stop taking it. After about a week, I had to start taking it again due to severe heartburn. I asked my pharmacist how to discontinue acid-suppressing drugs, but she was unable to find out.

Rebound heartburn may make it difficult to stop medications such as Aciphex, Nexium, Prevacid, Prilosec and Protonix. As a result, people sometimes end up taking such drugs for years. The consequences might include an increased risk of pneumonia, hip fractures and vitamin B-12 deficiency.

Dr. Tieraona Low Dog, director of education for the Arizona Center for Integrative Medicine, recommends a gradual approach for discontinuing acid suppressors. She suggests taking ginger capsules and chewing DGL (deglycyrrhizinated licorice) tablets as you phase out Protonix. Probiotics also may be helpful.

Joe Graedon is a pharmacologist and Teresa Graedon is an expert in medical anthropology and nutrition. www.peoplespharmacy.com

Tea: Some like it hot, but that raises cancer risk

By Karen Kaplan

Los Angeles Times

Is there anything left that isn't linked to cancer?

Not hot tea, apparently. An international group of scientists has connected it with esophageal cancer. The problem doesn't appear to be the tea but the temperature at which it is consumed, the study found.

Residents of Golestan province in northern Iran have one of the highest rates of esophageal squamous-cell carcinoma in the world. They don't drink alcohol or smoke — the two primary risk factors for the disease in the West — but they do consume tea. Lots of it. Nearly 1.2 liters a day, on average.

Local researchers set out looking for a connection.

They recruited 300 esophageal-cancer patients who were diagnosed at the only gastrointestinal-specialty clinic in the eastern part of Golestan and matched them up with 571 healthy controls who shared their age, gender and place of residence. All but one drank tea, and they gave interviewers information about their tea consumption and brewing habits.

Teaming up with investigators from the United States, England, France and Sweden, the researchers calculated that people who said they drank "hot" tea — 149 to 156 degrees Fahrenheit — were more than twice as likely to develop esophageal cancer as people who said they drank the beverage "warm" or "lukewarm": less than 140 degrees.

Those who said they took their tea "very hot" — at least 158 degrees — were more than eight times as likely to get esophageal cancer, according to the study, published online Thursday in BMJ, formerly the British Medical Journal.

The researchers also asked people how long they waited to drink their tea after pouring it. Those who said they waited two to three minutes were nearly 2.5 times more likely to develop the cancer compared with people who said they waited at least four minutes. Impatient tea drinkers who waited fewer than two minutes were 5.4 times as likely to be diagnosed with esophageal cancer, the study found.

The study didn't assess the mechanism linking hot tea to esophageal cancer, but the researchers said the temperature of the liquid was almost certainly to blame rather than the compounds in the tea.

In an editorial accompanying the study, David Whiteman of the Queensland Institute of Medical Research in Brisbane, Australia, advised tea drinkers in Iran and elsewhere to simply exercise some patience and wait at least four minutes before enjoying their favorite beverage.

Fish oil pills don't boost benefit of heart drugs

By MARILYNN MARCHIONE

AP Medical Writer

ORLANDO, Fla. —

Heart attack patients who are already taking the right medicines to prevent future problems get no added benefit from taking fish oil capsules, a large study in Germany finds.

The study tested a 1-gram daily dose of a prescription version of highly purified omega-3 fatty acid - the "good fat" contained in certain oily fish that is thought to help the heart.

Researchers led by Dr. Jochen Senges of the University of Heidelberg gave fish oil or dummy capsules to more than 3,800 people who had suffered a heart attack in the previous two weeks. About 90 percent were already receiving all the medicines recommended to prevent a second attack, including aspirin, anti-clotting and cholesterol drugs.

After a year, it made no difference whether these patients took fish oil or dummy capsules. In both groups, fewer than 2 percent had suffered sudden cardiac death, 4 percent had another heart attack, and fewer than 2 percent had suffered a stroke.

If recent heart attack patients are already getting good care, "there is almost nothing you can do better on top of this" to further lower risk, Senges said. He presented the results Monday at an American College of Cardiology conference.

The research doesn't mean that fish oil is of no value, and the study didn't address whether it can help prevent heart disease in the first place, doctors said.

The prescription version used in the study, sold as Omacor and Lovaza in the United States and as Zodin in Europe, is a highly purified and standardized form, different from what many consumers buy off the shelf.

Omega-3 fatty acids also are found in wild oily fish such as salmon, tuna, mackerel, sardines and herring. Scientists think it raises HDL, or good cholesterol, lowers harmful fats called triglycerides and slows the growth of plaque that can clog arteries.

The American Heart Association recommends adults eat fish at least twice a week, said Alice Lichtenstein, a Tufts University nutrition professor and Heart Association spokeswoman. For people with heart disease, the association advises 1 gram of omega-3 a day.

"A modest, 3-ounce cooked salmon has a little more than a gram," she said.

Fish oil capsules are not for children or women who are pregnant or nursing, because the pills pose a bleeding risk. Taking more than 3 grams a day from supplements should only be done under a doctor's orders, the heart association warns. The capsules also should be stopped a week or so before surgery because of a risk of bleeding.

The German study shows that "we need to be a little more cautious about the prediction of individual benefit of any nutritional supplements," said Lichtenstein, who had no role in the research.

"We see this pattern - people are so willing to embrace the simple answer," as if it's possible "to crack a capsule over a hot fudge sundae" and undo the harm of harmful diets and lack of exercise, she said.

---

On the Net:

Cardiology meeting: http://www.acc.org

Heart Association advice: http://tinyurl.com/25x6z

Believing in Treatments That Don’t Work

April 2, 2009, 10:46 am

Believing in Treatments That Don’t Work

As Washington debates health care reform, emergency room physician Dr. David H. Newman explores how medical ideology often gets in the way of evidence-based medicine.

By David H. Newman, M.D.

In the early throes of a heart attack, caused by an abruptly clotted artery, the stunned heart often beats quickly and forcefully. For decades doctors have administered “beta-blockers” as a remedy, to reduce consumption of limited oxygen supplies by calming and slowing the straining heart. Giving these drugs in the early stages of a heart attack represents elegant medical ideology.

But it doesn’t work.

Studies show that the early administration of beta-blockers to heart attack victims does not save lives, and occasionally causes dangerous heart failure. While two studies support the use of beta-blockers after heart attack, there are 26 studies that found no survival benefit to administering beta-blockers early on. Moreover, in 2005, the largest, best study of the drugs showed that beta-blockers in the vulnerable, early hours of heart attacks did not save lives, but did cause a definite increase in heart failure.

Remarkably, the medical community has continued to strongly recommend immediate beta-blocker treatment. Why? Because according to the theory of the straining heart, the treatment makes sense. It should work, even though it doesn’t. Ideology trumps evidence.

The practice of medicine contains countless examples of elegant medical theories that belie the best available evidence.

• Recent press reports detailing the dangers of cough syrup for children have noted that cough syrup doesn’t work. True: No cough remedies have ever been proven better than a placebo, either for adults or children. Yet their use is common.
• Patients with ear infections are more likely to be harmed by antibiotics than helped. While the pills may cause a small decrease in symptoms (for which ear drops work better), the infections typically recede within days regardless of treatment. The same is true for bronchitis, sinusitis, and sore throats. Unnecessary antibiotics are still given to more than one in seven Americans each year for these conditions alone, at a cost of more than $2 billion and tens of thousands of serious adverse medication effects requiring treatment.
• Back surgeries to relieve pain are, in the majority of cases, no better than nonsurgical treatment. Yet doctors perform 600,000 of these surgeries each year, at a cost of over $20 billion.
• More than a half million Americans per year undergo arthroscopic surgery to correct osteoarthritis of the knee, at a cost of $3 billion. Despite this, studies show the surgery to be no better than sham knee surgery, in which surgeons “pretend” to do surgery while the patient is under light anesthesia. It is also no better than much cheaper, and much less invasive, physical therapy.

Treatment based on ideology is alluring. Surgeries to repair the knee should work. A syrup to reduce cough should help. Calming the straining heart should save lives. But the uncomfortable truth is that many expensive, invasive interventions are of little or no benefit and cause potentially uncomfortable, costly, and dangerous side effects and complications.

The critical question that looms for health care reform is whether patients, doctors and experts are prepared to set aside ideology in the face of data. Can we abide by the evidence when it tells us that antibiotics don’t clear ear infections or help strep throats? Can we stop asking for, and writing, these prescriptions? Can we stop performing, and asking for, knee and back surgeries? Can we handle what the evidence reveals? Are we ready for the truth?

The administration’s plan for reform includes identifying health care measures that work, and those that don’t. To place evidence above ideology, researchers and analysts must be trained in critical analysis, have no conflicts of interest and be a diverse group.

Perhaps most importantly, we as doctors and patients must be open to evidence. Pills and surgery are potent symbols of healing power, but our faith in these symbols has often blinded us to truths. Somewhere along the line, theory trumped reality. Administering a medicine or performing a surgery became more important than its effect.

During the first week of 2009, in what may be a hopeful sign, hospital administrators around the country received a short, unceremonious e-mail from the Centers for Medicare and Medicaid Services. The e-mail explained that, due to recent evidence, immediate beta-blocker treatment will be retired as a government indicator of quality care, beginning April 1, 2009. After years of advocacy that cemented immediate beta-blockers in the treatment protocols of virtually every hospital in the country, the agency has demonstrated that minds can be changed.

The much more important question for health care reform is, can ours?

Dr. Newman is author of “Hippocrates Shadow: Secrets From the House of Medicine.”

Find your balance

By KATE HANLEY

As happens with so many things in life, we rarely think about balance until we lose it. Yet balance is crucial to our wellbeing—it prevents falls, helps us navigate uneven terrain, and keeps us upright when walking, running, biking, dancing, or skiing.
FIGHT GRAVITY. Stability exercises can help you be more sure-footed. “The best way to work on your balance is to put yourself in unstable situations that force you to improve your relationship with gravity,” says Jen Weck, a Bosu ball master trainer. “This will strengthen your stabilizer muscles, improve your range of motion, and solidify your core.”
STEADY YOURSELF. Anything that challenges your proprioception (your body’s sense of where it is in space) will hone your sense of balance. This includes working out on an uneven surface like a wobble board or Bosu ball (ask a personal trainer to show you how). As your balance improves so will your posture and your ability to negotiate ski slopes, hiking trails, and neglected city sidewalks. Weck, who recommends doing exercises that challenge your balance two to three times per week, suggests you get started with this move.

Single Leg Balance
“This simple exercise is much more challenging than it sounds,” says master Bosu ball trainer Jen Weck. “Standing with all your weight on the unstable surface of the Bosu ball tones your core, legs, ankles, and feet. If practiced regularly, it can improve your balance, coordination, and posture.”
1. Stand up straight on top of a Bosu ball with your left foot on the center of the ball and your right foot resting next to your left foot. Shift your weight to your left leg and bring your arms straight out to your sides at shoulder height.
2. Point your right toes and either rest them on the side of the dome or, for more of a challenge, lift your right leg slightly out to the side. Aim to hold the position for 30 seconds. To increase the diffi culty, close your eyes and try to hold the position for 10 seconds. Repeat on the other side.

3 WAYS TO HOLD STEADY
1. TRY TAI CHI. Studies show that regular tai chi practice reduces falls and improves balance and leg strength. With its slow, rhythmic movements, tai chi offers a safe, effective way to build proprioception.
2. GO BAREFOOT. Whenever it’s convenient and safe (around the house, for example), kick off your shoes. “The soles of your feet have touch receptors that send information to the centers of your brain responsible for balance,” says Sandra Blakeslee, coauthor of The Body Has a Mind of Its Own (Random House, 2008). “The more signals you send, the more you will keep your sense of balance tuned and the steadier on your feet you’ll be.”
3. SEEK OUT UNEVEN SURFACES. You don’t need special equipment: If you walk for exercise, take a dirt path or stroll on the beach. “Walking on uneven surfaces challenges your proprioception, which keeps your balance sharp,” Blakeslee says.

Heart organization sets walking record

By Taylor Chen

On a cold morning in early January, 64 Americans participated in setting a world record for walking the greatest distance (128 miles—the record is currently awaiting approval by Guinness World Records) covered by partners on a treadmill, at Grand Central Station’s Vanderbilt Hall. Sponsored by the American Heart Association (AHA) as well as Subway Restaurants, Healthy Choice, and AstraZeneca, Start! is an ongoing campaign that invites Americans to lead heart-healthier lives by walking. On April 8th, National Start Walking Day, designated Start! walking paths in local communities will be unveiled throughout the country.

How they did it: The AHA set up two treadmills side by side, which operated 16 hours without pause. Pre-selected pairs took turns walking in 30-minute increments, demonstrating how effortlessly you can incorporate a half-hour walk into your day—reducing the risk of heart disease, stroke, high cholesterol, and high blood pressure.

Who did it: Suzanne Elliott, an executive vice president at the nonprofit Dress for Success, was one of the participants. “Being a runner, I really liked the idea of showing other people how easy it is to stay active: You don’t need to do a marathon—you only need to walk for 30 minutes a day,” she says.

Walk online: The record-breaking event marked the successful launch of MyStart! Community (startwalkingnow.org), a virtual tool that lets you track walking activities and distance, plot walking routes, and even connect with other people walking in your neighborhood. Recent surveys show that Americans are 76 percent more likely to walk if someone else is expecting it of them. The 20,000-plus members of the online community provide support and motivation, and offer praise when you reach your goals.

Be accountable: “MyStart! Community helps you find a buddy and be accountable to each other, but also be accountable to yourself should you choose to track and post your information,” says Timothy Gardner, M.D., president of AHA. “If you show the world your exercise accomplishments, that confidence helps you tackle your next big walk.” Elliott says she loves the social aspect of exercising with friends. Plus, it helps her stick to her routine.

Get started: To register, set up a profile and map your route. The technology can even track your daily calories. Need encouragement? Connect with others using the online conversation tool. Elliott signed up after the event at Grand Central station, and hasn’t stopped using it since. “Walking is a big part of my daily routine, but it’s hard to keep track of it. With the MyStart! tool, I now know I walk almost two miles,” she says.

12 ways to rein in your health care costs

Economists agree that American health care reform will falter unless health care spending is brought under control. Moreover, even people with good health insurance are paying a larger fraction of their health care bills these days, in the form of co-pays, deductibles, and other out-of-pocket expenses. The editors of the Harvard Health Letter, in consultation with the doctors on its editorial board, propose 12 ways you can help curb health care spending, saving society—and perhaps yourself—some money. The recommendations, published in the March 2009 issue, include these:

Develop a good relationship with a primary care physician. A primary care doctor who knows you, your medical history, and your circumstances stands a better chance than a stranger does of making decisions and giving advice that will keep you healthy. He or she can take care of you in context.

Don’t use the emergency department unless absolutely necessary. Call your doctor and try to get some advice over the phone or in person.

Get and stick with the program. Taking prescribed medications, getting regular check-ups, and adhering to lifestyle changes can keep chronic diseases under control at relatively modest cost.

Don’t go directly to a specialist without checking with your primary care doctor, even if insurance allows it. Whenever possible, let your primary care physician coordinate your care. If he or she doesn’t know what’s going on, it can lead to wasteful—and possibly harmful—overtesting and duplication of treatments.

Go generic. Generic drugs cost less than their brand-name equivalents. Also, most insurers have higher co-pays for brand-name drugs. Check with your doctor about generic options.

Fight inertia. If you’re taking a medication, discuss with your physician how long you’ve been taking it, whether it’s working, and, if it isn’t, not taking it anymore.

Question the need for expensive tests. Don’t push to get new, expensive tests just because you think new is better. If your doctor orders an expensive test like an MRI or CT scan, ask why it’s necessary and how it will make a difference.

Stay healthy. Quit smoking, eat right, exercise, and get enough sleep. You’ll reduce your risk for conditions that require medical care.

Vitamins and Minerals: What you need to know

Understanding how vitamins and minerals interact in our body gives us a valuable means of taking our health into our own hands. Research into the effects of these micronutrients has been enlightening. For example, we now know that a large fraction of Americans are not getting enough vitamin D, and the range of consequences may be far greater than we thought. Recent studies suggest that vitamin D does more than help build strong bones; it may help to prevent hypertension, certain types of cancer, and some autoimmune diseases. We also believe, with an increasing degree of certainty, that getting enough folic acid can counteract some of the adverse effects of consuming alcohol.

Researchers are constantly making such discoveries, and often their findings have far-reaching effects. But it’s worth keeping in mind that while nutrition research can yield powerful answers, it also raises new questions. Nutrition is endlessly complex, and the research is invariably in a state of flux. Not only do nutrients interact with one another (making it difficult to isolate their effects) but they also interact with genes, drugs, and even lifestyle factors. For some nutrients, such as selenium, there’s a narrow range between too little and too much, and that amount varies from person to person.

This Special Health Report provides the latest evidence and mineral and vitamin information so that you can make healthy choices about what foods to eat and what supplements to take. Because nutritional science continues to evolve, this report also contains tips on how to judge new studies on vitamin benefits and put the findings in context.

Prepared by the editors at Harvard Health Publications in consultation with Meir J. Stampfer, M.D., Dr.P.H., Professor of Epidemiology and Nutrition, Harvard School of Public Health. 45 pages. (2008)

5 easy steps to prevent sinusitis

A cold that lingers—and lingers—isn't something that happens only in winter. It may not even be a cold. It could be sinusitis, an inflammation of the sinuses and nasal passages. You can relieve the symptoms of this common infection with several easy treatments, reports the March 2009 issue of Harvard Women’s Health Watch.

When the sinuses become blocked, viruses or bacteria in the nose can become trapped in a pool of mucus with nowhere to go. The germs can grow out of control, causing infection and inflammation. The result: swelling, which causes headache and facial pain; mucus buildup, which produces congestion; and an influx of white blood cells to fight the infection, which thickens and tints the mucus. Other symptoms may include loss of smell or taste, bad breath, fever, and fullness in the ears.

The main cause of blocked sinuses is swelling produced by the common cold. More serious sinusitis can result from a deviated septum or nasal polyps.

Here are some suggestions from Harvard Women’s Health Watch for reducing your chance of developing sinusitis or relieving early symptoms:

Bathe your nasal passages daily. Use a small pot or squeeze bottle to run water into the nasal passages. This helps clear excess mucus and moisten membranes.

Drink lots of water. Good hydration helps keep mucus thin and loose.

Inhale steam. Linger in a hot shower. Or bring water to a boil, pour it into a pan, place a towel over your head, and bend over the pan to inhale the steam.

Avoid dry environments. A humidifier by your bed or at your desk can help keep nasal passages from drying out.

Sleep with your head elevated. Mucus pools when your head is down.

The 10 commandments of cancer prevention

About one of every three Americans will face some form of cancer during his or her lifetime. You can help beat these grim statistics by taking steps to protect yourself right now. In fact, up to 75% of cancer deaths in the United States can be prevented, reports the April 2009 issue of Harvard Men’s Health Watch. Here are 10 ways to get started.

1. Avoid tobacco in all its forms, including exposure to secondhand smoke.
2. Eat right. Reduce your consumption of saturated fat and red meat. Limit your intake of charbroiled foods, and avoid deep-fried foods. Eat more fruits, vegetables, and whole grains. And don’t forget to eat fish two to three times a week.
3. Exercise regularly. Physical activity has been linked to a reduced risk of colon, prostate, breast, and reproductive cancers.
4. Stay lean. Obesity increases the risk of many forms of cancer. Calories count—if you need to slim down, take in fewer calories and burn more with exercise.
5. Limit alcohol consumption. Excess alcohol increases the risk of cancers of the mouth, larynx, esophagus, liver, and colon; it also increases a woman’s risk of breast cancer. If you choose to drink alcohol, the limit should be one to two drinks a day for men, no more than one a day for women.
6. Avoid unnecessary exposure to radiation. Wear sunscreen to protect yourself from ultraviolet radiation. Get medical imaging studies only when you need them. Check your home for radon.
7. Avoid exposure to industrial and environmental toxins such as asbestos, benzene, aromatic amines, and polychlorinated biphenyls (PCBs).
8. Avoid infections that contribute to cancer, including hepatitis, HIV, and the human papillomavirus (HPV).
9. Consider taking low-dose aspirin. Men who take aspirin or other nonsteroidal anti-inflammatory drugs may have a lower risk of colon and prostate cancers.
10. Get enough vitamin D. Taking 800 to 1,000 international units (IU) daily may help reduce the risk of prostate and colon cancers.

Sugar Detox

If you’re run-down, overweight, or moody, you could be suffering from sugar overload. Our expert plan will help you rid refined sugar from your diet, lose weight, feel great, and still lead a sweet life.

By HILLARI DOWDLE

If it’s impossible to slim down despite your best efforts, your problem may be fructose. This simple sugar occurs naturally in fruits, sweet vegetables, and honey, but is also added as high fructose corn syrup to most baked goods, drinks, sauces, and prepackaged foods.
Recent studies have found that fructose very quickly turns into body fat, in some cases never even yielding energy for the body to use, says Richard Johnson, author of The Sugar Fix (Rodale, 2008). Fructose also puts a damper on a hormone called leptin, which signals our brain that we’re satiated and it’s time to stop eating. To end your own sugar fix and lose weight, follow this plan from Johnson:

1 Cut down on fructose. Start by avoiding high fructose corn syrup and table sugar. Look for these in any processed food, including ketchup and other condiments, sauces, salad dressings, jams, peanut butter, meat products, and commercially produced desserts. Eat no more than 35 grams of fructose per day.

2 Say no to sugary drinks. Sodas are obviously out—12 ounces of cola has more than 20 grams of fructose— but pay attention to juices. One eight-ounce serving of orange juice has 10.7 g of fructose, cranberry juice can have up to 13 g, and apple juice 16. Avoid smoothies, sweetened coffee beverages, wine coolers, and any bottled drink that lists high fructose corn syrup on the label. Stick to water, and unsweetened coffee and tea, instead.

3 Eat some starch. Starchy foods (whole wheat pasta, potatoes, and even whole-grain bread) may stay on the menu. They are rich in glucose, which stimulates insulin release, “a normal and healthy physiologic reaction,” says Johnson.

4 Take care of yourself. Boost your metabolism with 30 minutes of exercise per day, Johnson says. Get 10 to 15 minutes of sun twice a week for vitamin D (your body makes it from sunshine), and 250 mg of vitamin C daily for the antioxidants. Eat small amounts of dark chocolate on occasion— it helps lower blood pressure.

5 Take the no-fructose challenge. Eating fructose triggers the body to produce more of the enzymes that metabolize it, which leads to more cravings. You can break this cycle by going cold turkey for two weeks. Skip sweetened food and drinks, including desserts, fruit and fruit juice, even honey. Read labels and don’t eat anything with high fructose corn syrup. (You can still eat potatoes, pasta, rice, vegetables, meat, fish, legumes, nuts, and cheese.) After two weeks, eat fructose in moderation.

Is sugar . . . MAKING YOU FAT (AND SICK)?
Fructose is added to everything, says Johnson, and while it may have helped our ancestors prepare for winter or famine, that need no longer exists. Having too much fructose in your diet can set you up for a cluster of health concerns that increase your risk of heart disease and type 2 diabetes. Look for these symptoms and get tested for the following:
►Excess weight, especially near your waist
►Low HDL or “good cholesterol”
►High blood pressure
►High blood glucose levels and/or insulin resistance
►High levels of triglycerides (energy stored in fat cells) in your blood

FINDING FRUCTOSE
Johnson recommends eating less than 35 g of fructose a day, but keeping track of it can be tricky. Here’s a handy list of fructose-rich foods, excerpted from Johnson’s book, The Sugar Fix:
TABLE SUGAR, 1 tablespoon 2.0
PINEAPPLE, 1 slice 4.0
MOLASSES, 1 tablespoon 5.5
GRANOLA, 1/2 cup 7.0
BANANA, 1 medium 7.1
RAISIN BRAN, 1 cup 7.6
APPLE, medium 9.5
WATERMELON, 1/4 melon 11.3
GRAPES, seedless, 1 cup 12.4
APPLE PIE, 1 slice 16.5
CARROT CAKE, 1 slice 27.0
CHOCOLATE CAKE, 1 slice 37.0

5 Tips for Staying Active With Kids and Family

By Amanda MacMillan

During American Heart Month, it’s important that we think not only of our own cardiovascular health but also that of future generations. A study last year found that obese children and teens have as much plaque in their arteries as a 45-year-old adult, setting them up for heart disease and other serious health conditions much earlier than their parents.

If you’ve got kids, of course you want to make sure they grow up fit and healthy. But you also know it’s hard to juggle work, family, and physical activity—for you alone, never mind for you and your kids. Setting a healthy example is a good start; research shows that parents who are physically active increase the likelihood that their kids will be active as well. But if you’re looking for ways to get your kids involved, check out these tips.

1. Plan outdoor activities
Set aside one day a weekend to do something active as a family: swimming in the summer, sledding or hiking in the winter, or biking in the spring and fall. Taking along a picnic lunch—and splurging on some healthy snacks after a good workout—will help the day go by without a complaint.

2. Take classes together
Ask around at fitness clubs and community centers in your area about yoga or aerobics classes offered to parents and kids together. If your little one is too young to participate, look for classes that help you burn calories with your baby by incorporating them into your yoga moves or pushing them along during stroller workouts. No kids? Check out partner yoga or even “doga”—yup, yoga for you and your dog.

3. Redo your family room
Too often, family rooms are the center of laziness in a home: a comfy couch, a video-game console, a shelf full of DVDs, and nothing to encourage fitness or physical activity. There are ways to add in subtle reminders, however, without overhauling your entire room or dragging in a giant piece of workout equipment. Set a time limit on weekly television and incorporate these Skinny House essentials to keep your whole family moving.

4. Make chores fun
Instead of relegating each member of the family to doing separate chores by themselves, turn chores into a game you can all do together. Race to see how fast you can get the house cleaned, and then try to beat your old time the next week. Play music while you’re doing laundry, and enlist the kids to sing and dance while helping to fold and put clothes away. Take the dog for walks together, and squeeze in some running, roller-skating, or jump rope while you’re at it.

5. Make over your meal plan
This isn’t necessarily a fitness tip, but it’s also worth mentioning: Families that eat healthier also tend to have other healthy habits, such as regular physical activity. If you want to slim down after having a baby or just want to eat better overall, get your entire family involved and you’re more likely to succeed. Take kids to the farmers market, let them pick their own fruits and vegetables, and involve them in the food preparation. They’re much more likely to enjoy their meals—and to clean their plates.

Good posture is the secret

Good posture is the secret to more energy, less pain, and a healthy heart.

By SIMONE SAMANO

My posture problem began at puberty when I witnessed the unwelcome arrival of womanly attributes on my tomboy chest. That was the start of a self-induced slump that lasted until college.
Post-college, the rounded shoulders gradually returned after I started an office job. I didn’t give my hunching much thought until my mother was diagnosed with lung cancer. As part of her treatment, she met with a physical therapist who encouraged her to sit as straight as possible because slouching compresses the lungs and makes the heart work harder. Additionally, correct posture—by enhancing breathing and reinforcing your optimal physical alignment—can ease pain, reduce strain on muscles and joints, and increase energy. Now I’m committed to standing straight everyday. Here’s how:
Take a breath test. For a visceral sensation of the benefits of good posture, try this experiment from Z. Annette Iglarsh, P.T., Ph.D., professor of physical therapy at Simmons College in Boston. Sit or stand normally, then drop your chin toward your chest and take a breath. Now stand or sit up straight and take another. If you’re like me, you’ll be surprised at the depth of that second breath.
Start now. Slumping muscles are never too far gone, says chiropractor Steven P. Weiniger of body zone.com and author of Stand Taller—Live Longer (BodyZone Press, 2008). “Posture can be strengthened by adding daily exercises that promote moving well and standing strong.”
Do this exercise. I devote just one minute, three times a day, to an easy exercise from Weiniger: Stand straight, tighten your stomach, and lift one knee up at a right angle to your body. Hold it for 30 seconds or less, bracing on a wall if needed. Then repeat the exercise on the other side. It helps restore balance to my body and strengthen my core.
Adopt these habits. I change positions every 15 minutes; sitting or standing in one position too long tires muscles. I keep my chin parallel to the ground to keep my head in line with my spine and take stress off my neck. I wear supportive shoes like Keen’s and take a break from heels to help my spine align. I also sleep on a firm mattress and maintain a healthy weight

since extra pounds strain abdomen muscles.
Be patient. Developing good posture takes time. But, if progress is too slow, visit a chiropractor (amerchiro .org) or find an Alexander Technique teacher (alexandertech.org) who can help you regain your natural poise.

Burn calories at the office

Burn calories at the office

People who sit less weigh less. Follow these steps to increase your activity at work.

By Kate Trainor

In a 2005 study, James Levine, M.D., professor of medicine at the Mayo Clinic, confirmed that people who are less sedentary are less likely to gain weight. Subjects were overfed by 1,000 calories a day and wore sensors that monitored their movement. “In the people we studied, there was a tenfold variability in body-fat gain,” says Levine. “We had one person who ate those excess calories and stored every single one of them as body fat. Another person essentially burned off all the extra fuel. How? Through NEAT.”

Non-Exercise Activity Thermogenesis, or NEAT as Levine dubs it, refers to the calories you burn living your life: doing the laundry, making your bed, mowing the lawn. The more active you are the less likely you are to put on weight. “People who can switch on their NEAT are able to remain thin, despite periods of overfeeding,” says Levine. The trick is to become more active in your day-to-day life.

One of the best places to start is at the office, where we spend most of our day sitting. To implement a NEAT-friendly environment, Levine suggests making the following pitch to your boss who may be more open to the idea than you think. “You’ll find that most bosses will respond positively,” says Levine. “No one wants to be seen as the unhealthy boss.” Schedule a walking meeting with your boss to give your game plan a trial run, and share this set of reasons why NEAT is good for business.

1. NEAT is low-budget. “It doesn’t cost any money at all,” says Levine. It may even help save on couriers, electricity, and delivery fees. Propose small changes on a trial basis, like creating a walking track with tape.

2. NEAT saves time. Walking meetings save staff from dull PowerPoint presentations and prevent unproductive e-mails.

3. NEAT improves relationships. Face time enhances relationships with colleagues and clients.

4. NEAT enhances productivity. NEAT cuts down on idle web surfing, and physical movement awakens the body and mind. You’ll be more alert and creative, and less apt to daydream.

5. NEAT is contagious. Start a walking club to rally support and show the benefits of NEAT to your colleagues. When you share NEAT, it starts a trend. “We call that the NEAT ripple,” says Levine. “It always ripples to someone else.”

The super vitamin

The super vitamin

Vitamin D helps prevent cancer, diabetes, and more. Here's how to be sure you're getting enough.

By KAREN ASP

New research reveals that vitamin D may play a more significant role in preventing certain kinds of cancer than previously suspected. Part of the steroid hormone family, which includes cortisol, estrogen, progesterone, and testosterone, vitamin D may be the most potent cancer prevention available today, says James E. Dowd, M.D., clinical associate professor of medicine at Michigan State University and author of The Vitamin D Cure (John Wiley and Sons, 2008).
WHAT IT PREVENTS: A 2008 study from Breast Journal involving women in 107 countries found that the incidence of breast cancer was about nine times higher in women who lived in areas with the least amount of sunlight (e.g., Iceland, England, New Zealand). Low vitamin D levels have also been associated with poor bone health, heart disease, colon cancer, diabetes (type 1 and type 2), depression, high blood pressure, arthritis, autoimmune disorders, and obesity.
GET TESTED: Some 60 percent of Americans are deficient in vitamin D, according to the Centers for Disease Control and Prevention. To find out if you're at risk, ask for the 25-hydroxy test, a simple blood test. Your level for optimal health should be above 35 ng/mL.
GET THE RIGHT DOSE: Current guidelines call for women ages 19 to 50 to get 200 IU daily, but experts recommend an extra 2,000 IU a day if you have some sun exposure (about 20 minutes a day), or more if you have little or no sun exposure. In winter, most people need 5,000 IU daily, says John Jacob Cannell, M.D., of the Vitamin D Council. Consider taking a supplement, but make it vitamin D3 (cholecalciferol, derived from animal products), which your body makes.
EAT YOUR VITAMIN D: Certain foods can boost your vitamin D intake. They include milk (100 IU per eight-ounce glass), cold-water fish (250 to 650 IU per 3.5-ounce serving), egg yolk (100 IU), and dried shiitake mushrooms (1,600 IU of D2 per 3.5-ounce serving).
GET SOME SUN: The Vitamin D Council recommends 15 minutes of daily direct midday sunlight. (Protect your face and hands with sunscreen, says Cannell.) Once you get your dose of natural light, apply sunscreen or get out of the sun.

The Basics of Vitamin D
ROLE: Significant in bone health, and reduces your risk of developing breast cancer, prostate cancer, colon cancer, diabetes, depression, high blood pressure, arthritis, autoimmune disorders, and obesity.
DOSAGE: Many experts suggest a minimum of 2,000 IU per day (through supplements), though current guidelines call for 200 IU daily for adult women.
SUN EXPOSURE: Your body uses sunshine to make vitamin D. Aim to get at least 15 to 20 minutes in the midday sun every day before applying sunscreen.

Sniff a lemon

The zingy fresh scent of a lemon may help elevate your mood. Scientists have discovered a link between depression and our sense of smell: Citrus fragrances—lemons in particular—directly affect neurotransmitters in the brains of mice. The aromas help boost serotonin, a feel-good hormone, and reduce levels of norepinephrine, a stress hormone.

Omega 3 Fatty Acids

What are omega 3 fatty acids?

You've probably been hearing about omega 3 fatty acids in recent years. The reason? A growing body of scientific research indicates that these healthy fats help prevent a wide range of medical problems, including cardiovascular disease, depression, asthma, and rheumatoid arthritis.

Unlike the saturated fats found in butter and lard, omega 3 fatty acids are polyunsaturated. In chemistry class, the terms "saturated" and "polyunsaturated" refer to the number of hydrogen atoms that are attached to the carbon chain of the fatty acid. In the kitchen, these terms take on a far more practical meaning.

Polyunsaturated fats, unlike saturated fats, are liquid at room temperature and remain liquid when refrigerated or frozen. Monounsaturated fats, found in olive oil, are liquid at room temperature, but harden when refrigerated. When eaten in appropriate amounts, each type of fat can contribute to health. However, the importance of omega 3 fatty acids in health promotion and disease prevention cannot be overstated.

The three most nutritionally important omega 3 fatty acids are alpha-linolenic acid, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).

Alpha-linolenic acid is one of two fatty acids traditionally classified as "essential." The other fatty acid traditionally viewed as essential is an omega 6 fat called linoleic acid. These fatty acids have traditionally been classified as "essential" because the body is unable to manufacture them on its own and because they play a fundamental role in several physiological functions. As a result, we must be sure our diet contains sufficient amounts of both alpha-linolenic acid and linoleic acid.

Dietary sources of alpha-linolenic acid include flaxseeds, walnuts, hemp seeds, soybeans and some dark green leafy vegetables. Linoleic acid is found in high concentrations in corn oil, safflower oil, sunflower oil, and canola oil. Most people consume a much higher amount of linoleic acid than alpha-linolenic acid, which has important health consequences. For more information on the proper ratio of these fatty acids in the diet, see our FAQ entitled, A New Way of Looking at Proteins, Fats, and Carbohydrates

The body converts alpha-linolenic acid into two important omega 3 fats, eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA). These fats can also be derived directly from certain foods, most notably cold-water fish including salmon, tuna, halibut, and herring. In addition, certain types of algae contain DHA. EPA is believed to play a role in the prevention of cardiovascular disease, while DHA is the necessary for proper brain and nerve development.

How it Functions

What are the functions of omega 3 fatty acids?

Every cell in our body is surrounded by a cell membrane composed mainly of fatty acids. The cell membrane allows the proper amounts of necessary nutrients to enter the cell, and ensures that waste products are quickly removed from the cell.

Find Balance

Find your balance between food and physical activity.

Becoming a healthier you isn't just about eating healthy—it's also about physical activity. Regular physical activity is important for your overall health and fitness. It also helps you control body weight by balancing the calories you take in as food with the calories you expend each day.

• Be physically active for at least 30 minutes most days of the week.
• Increasing the intensity or the amount of time that you are physically active can have even greater health benefits and may be needed to control body weight. About 60 minutes a day may be needed to prevent weight gain.
• Children and teenagers should be physically active for 60 minutes every day, or most every day.

CONSIDER THIS:

If you eat 100 more food calories a day than you burn, you'll gain about 1 pound in a month. That's about 10 pounds in a year. The bottom line is that to lose weight, it's important to reduce calories and increase physical activity.

Marketing Poor Health to Kids

Marketing Poor Health to Kids

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According to a recent report released by the Federal Trade Commission, advertising food products to children (an estimated $1.6 billion business annually) is all about integrated ad campaigns that combine traditional media, such as television, with packaging, in-store advertising, sweepstakes and the Internet. The executive summary of the report provided one example of this “cross-promotional” marketing:

“Cross-promotions were widespread in 2006, tying foods and beverages in all of the covered categories to about 80 movies, television shows, and animated characters that appeal primarily to youth. Superman Returns and Pirates of the Caribbean were prominent that year – promoting QSR [quick-service restaurants] children’s meals, frozen waffles, fruit and fruit snacks, breakfast cereals, popcorn, lunch kits, candy, carbonated and non-carbonated drinks, pasta, snack chips, and milk. Superman and the Pirates characters appeared in ads on television, in movie theaters, on the Internet, and on packaging and in-store displays. Companies created special limited-edition snacks, cereals, frozen waffles and candies based on the movies. Children or adolescents could go online to play ‘advergames’ related to the characters and their stories and to enter contests or sweepstakes using special codes obtained from food packages or beverage containers. Prizes ranged from video games to trips to Disney parks to a $1,000,000 reward for the ‘capture’ of Superman villain, Lex Luthor. Related premiums included skull-shaped bowls, bandanas, strobe light key chains, movie posters, outdoor flying toys, Superman action figures, activity books, and digital downloads.”

The biggest category of marketing expenditure for the 44 companies surveyed, $492 million, was carbonated-drink advertising. By comparison, the Dairy Association’s “Got Milk?” ads cost approximately $67 million in 2006. In terms of where the money is spent, the report noted, “Television advertising still dominates the landscape of marketing techniques used to promote foods and beverages to youth; companies reported spending $745 million, or 46% of all reported youth marketing expenditures, on this medium. More than 50% of the television advertising was directed to children under 12, with breakfast cereals and restaurant food accounting for more than half of that advertising. Carbonated beverages and restaurant food dominated adolescent-directed television advertising. All told, traditional ‘measured media’ (television, radio, and print) accounted for $853 million, or 53% of the reported youth-directed marketing expenditures.

The report recommends various steps be taken to improve this situation, including mandating “meaningful, nutrition-based standards for marketing products” to children under age 12; improving the nutritional profiles of products marketed to children; stopping in-school promotion of products that fall below accepted nutritional standards; and urging media and entertainment companies to restrict character licensing to healthier foods/beverages marketed to children. To learn more, visit www.ftc.gov/opa/2008/07/foodmkting/shtm.

Staying Healthy During Tough Economic Times

Staying Healthy During Tough Economic Times

By Dr. David Seaman

Many of us are feeling the economic crunch. Money is tight and the bills continue to arrive in our mailboxes. Stressful times like these demand resiliency on our part. Interestingly, a mentally stressed state can promote systemic inflammation.^1-4 Avoiding mental stressors is not likely to be easy during these times, so we must consider the importance of avoiding systemic inflammation caused by a lack of exercise and a poor diet.

Our mechanically oriented training leads us to view inflammation as a consequence of an identifiable physical injury. However, inflammation is more complex than this. We promote development of chronic, systemic subclinical inflammation by avoiding exercise and remaining sedentary.^5-8 In other words, we can become chronically inflamed without physical injury. Not surprisingly, we should exercise daily to help prevent inflammation, and we must also modify our dietary habits.

Pro-Inflammatory Nutrition Is Expensive

Chronic, systemic subclinical inflammation is also promoted by subsisting on the average American diet, which is high in calories and low in fiber and nutrients. Approximately 80 percent of the calories consumed by Americans are derived from refined flour products, refined sugar, refined seed oils (concentrated source of omega-6 and trans fats) and fatty meat.⁹ It is now common knowledge that eating excess calories from sugar and fat leads to postprandial systemic inflammation,¹⁰ which is thought to function as in insidious promoter of heart disease, diabetes, osteoporosis, osteoarthritis, rheumatoid arthritis, Alzheimer’s disease, obesity, hypertension, asthma, depression, inflammatory bowel disease, psoriasis and cancer.^7,9-12

Anti-Inflammatory Nutrition Is Inexpensive

Lean meat, fish, chicken, fruits, vegetables and nuts form the foundation of a diet that blunts a postprandial inflammatory response. This is referred to as an “anti-inflammatory diet.”10 Not surprisingly, this diet is recommended to help prevent the above-mentioned pro-inflammatory diseases, the treatment of which represents a massive drain on financial resources, both personally and for businesses.^7,9-12

A common argument is, “I can’t afford to eat lots of fruits and vegetables,” or “Healthy foods are expensive.” I tend to strongly disagree with these arguments. A cup of coffee and a doughnut can cost up to $5. A bottle of 20 oz. soda costs more than $1. In contrast, a 5-pound bag of frozen carrots, broccoli and cauliflower costs $5 at Sam’s Club. A 1-pound container of pre-washed organic salad greens costs about $4. A large sweet potato that can be split between two meals costs about 75 cents. While certain nuts are very expensive (macadamias, for example), many are very reasonable. Lean meats, fish and chicken are reasonably priced and can be added to the vegetables and sweet potatoes. Fresh fruit remains very reasonable and should be one of the snacks of choice.

Dark chocolate is inexpensive and can be mixed with raw nuts and raisins for a great snack or dessert. I often melt a 50-calorie piece of dark chocolate with a little coconut oil and add some nuts and raisins. I place this combination on a piece of wax/freezer paper and place it into the freezer for about 10 minutes. My reward is an anti-inflammatory candy bar.

In short, it is not more expensive to eat anti-inflammatory, if one shops wisely. Certainly, preventing the expression of chronic disease will save countless dollars and heartaches associated with the accelerated morbidity and mortality associated with pro-inflammatory living. In short, we cannot afford to eat any other way but anti-inflammatory.

Inexpensive Supplements for Health Promotion

Unlike what I once thought, nutritional supplements typically do not function as substitutes for medications, particularly when inflammatory dietary habits are maintained. There is no supplement that will lower blood pressure as consistently as medications. No supplement can influence blood sugar like Metformin. While ginger and turmeric inhibit cyclo-oxygenase, it is not with the same power as nonsteroidal anti-inflammatory drugs.

The key really seems to involve the adoption of an anti-inflammatory diet and taking key supplements that support the reduction of inflammation and free-radical generation. The basic supplements include a multivitamin without iron, magnesium, fish oil and vitamin D.^13-19

Fortunately, the basic four supplements mentioned above are reasonably priced. The cost is approximately $60 to $80 per month, which is less than $3 per day. If a patient can only afford one supplement, vitamin D seems like the best choice because research has demonstrated that vitamin D insufficiency is pandemic. The next best financial choice for a supplement would be a multivitamin/mineral without iron. After that fish oil should be added and finally magnesium. If a fifth supplement can be afforded, probiotics are the best choice as they have a strongly anti-inflammatory effect in the gut.

If money is not at issue, additional supplements should be considered, including coenzyme Q10, lipoic acid, acetyl-L-carnitine, ginger, turmeric and garlic. These supplements help to promote ATP synthesis and reduce free radicals and inflammation.

Conclusion

While finances are tight for many due to external economic forces, we can easily make this situation a lot worse by pursuing disease expression due to a pro-inflammatory lifestyle. Medical care for pro-inflammatory diseases is extremely expensive and generally preventable by adopting an anti-inflammatory diet that is no more expensive than one that is pro-inflammatory. Key supplements can be added based on financial ability.

We should consider that paying for expensive medical care will put most of us into debt even when economic times are good. So, it makes no sense to pursue disease and expensive medical care with a pro-inflammatory lifestyle when economic times are not so good. Share this information with your patients and let them know nutrition does not need to be compromised, even when the economy is down.