Saturday, August 21, 2010


yes, it's what you do or don't do with your time, money, and mouth. yes, there are many options available and many influences that often direct your time, money, and mouth away from healthier choices. but...can society, politics, and the private sector work together to reverse the trend toward obesity in america effectively? can it, or should it? two separate questions. of course, if you believe as i do, that we're all in this together - we healthy people pay for the choices of others even by our own private health insurance, and even life insurance, policy premiums because of demographic statistics that are actuarialized to determine rates. furthermore, any public health costs are escalated to bank-busting levels by choices made, and fostered, by the many systems in our society.

this article in the Times addresses the possibility that the public and private sectors could re-tool themselves to improve our diet and our physical activity habits. it's by no means comprehensive in this endeavor but it's a start in getting folks thinking that maybe there are things that can, someday, be done to reverse the slide into obesification:

Tuesday, August 17, 2010

type 2 diabetes drugs and bone breaks

there are many drugs for almost any disease, but none are risk free. type 2 diabetes (t2d) is a disease prevalent in the aging populations of industrial/developed nations largely due to lifestyle patterns of excess food intake and sedentary behaviors. some of the common drugs used to manage this disease have been shown to increase risk for bone fractures in women more than men, and some warnings are being posted to docs to consider to whom these drugs are prescribed: post menopausal women are at higher risk for both diseases (osteoporosis). read:

my view on the matter is the infamous Desiderata: ....change those things you can. we can't change aging, except by dying. we can change some of the effects of aging, esp if we start young, such as with proper diet and appropriate exercise/activity. but we can indeed change our risk for and need for meds for T2D, simply by, well, proper diet and appropriate exercise. even if you have the diagnosis, you can, esp early on, reverse it by simply losing weight through, well, proper diet and appropriate exercise. and you don't have to lose tons of it. but the choice, unlike that of living, dying or aging, is easier than the latter, and proper diet and appropriate exercise results in nearly-immediate changes in blood sugar levels that, in due, but short, time could reduce the need for meds and put you back in the game of life....which is, after all, what it's all about.

Monday, August 9, 2010

weight management/loss

the age-old debate - less carbs vs less fat - has been undergoing much new study since dr. atkins first proposed a lo carb diet back when my mom was trying to drop pounds for my bar mitzvah. (yes, for a couple years there, she was doing that yo yo thing simply to look hot for my and my brother's bar mitzvahs. when i look at the photos of those events, it's clear she, too, was a by product of an era when thin was beginning to be in. shame - some things have only gotten worse with time.)

most good research on wt loss has concluded that (1) most other studies are too short to be of value; (2) most long term studies show significant wt loss early with substantial wt re-gain later, esp for the more extreme diets; and (3) calories in, calories out is the only way to reduce wt effectively.

and here's a new study, reported in the ny times, that demonstrates no superiority between diets:

now, you might be thinking that hi pro/low carb diets are better because they raise HDL. maybe so, but the article here does not tell us to what extent. we know that simply losing wt lowers LDL and in some cases raises HDL. so the actual difference b/w the two diets may be "significant" but not a lot, that is, not enough to be clinically significant. we just can't tell from this piece of news.

however, there are better and more effective ways to raise HDL, and to lower wt. it's called exercise and balanced eating. we know all about exercise, right? but do we really know what balanced eating is; my guess is, no.

balanced eating is any form of eating that includes those bedeviling foods that one can't help but call - carbs. yes, carbs - fruits, veggies, and whole grains. hundreds of studies show the vast benefits of diets hi in these items. yet, any low carb diet restricts these - esp the grains- early and even throughout the diet period. thus, the diets are boring and eventually unsustainable.

now, one does not need to go to the full lengths of the books to achieve favorable results. in fact, most hi pro diets start feeding you more veggies and some 'special' fruits after a while. but, if carbs are kept to below 40% of your caloric needs, not only are you risking some nutritional deficiencies - esp if you're eating low enough calories to continue losing wt- but maybe even risking losing out on some very well-proportioned and as yet undetected phytonutrients that will help you fight off all kinds of diseases. and they may even help your bad breath.

balanced eating; balanced exercise; balanced living.
what a concept!!!!

Wednesday, August 4, 2010

obesity, again

another article on rising obesity rates -

what's a country to do?

for one thing, some soon-to-be unfolded efforts to tag foods in the stores based on a 0-100 scale (100 being excellent for health) may help folks make better dietary choices. and if that weren't enough, there's now more discussion on making developments - neighborhoods - more activity friendly, tho that's a way in the future dream. for the most part, getting mother nature to drop the temperature below 90 would be helpful but the reality is, no matter the outdoor temps, most americans simply don't move enough.

so, what's a country to do?

well, yesterday the voters of missouri resoundingly voted against the federal health plan that mandates purchasing a health insurance plan. that will be the crux of the many lawsuits aiming to gut the program. and i'm sure there are good, and bad, arguments for and against it. but i'm not so sure it's one that law alone should manage. of course, being a nation of laws, that's not an option unless this blog can convince my fellow americans to reconsider their opposition to a plan that will help keep costs down by providing some measure of health care prior to the end stages of disease, maybe mitigating the need for extreme measures. let me expound.

joe eats too much junk food, drinks too much beer, and sits around watching too much tv. joe's formerly fit athletic body is now fat and plaque-laden. he is totally entitled to his choices, his lifestyle, and i don't begrudge him that...until he goes to the doctor. whether or not he is insured, the drug, insurance, and medical conglomerates will prosper on his life choices, driving up the costs for all of us who may or may not be choosing similarly disease oriented lifestyles. why? because of basic economics: supply and demand. you see, joe has to have more and better drugs to manage his deteriorating body; his insurance is paying out more than he can afford to put into it monthly; and the medical community, short of hours and long on modalities, will make a killing on his conditions. thus, the costs are shared by those of us who hardly use or abuse the system both in drug development, costs, distribution, and reimbursement; in insurance premiums; and in the ever-constant struggle by docs to get reimbursed by the insurance industry, and to prevent lawsuits by providing best of care vs best of prevention, which combined drive up costs for all.

now i know the argument - and concur in its rationality - that ever since medicare and medicaid, government subsidization has driven the cost of health care beyond previous amounts. so, in the 1960s, your doc lived next door; today, he lives in the finest of mansions in the best of neighborhoods, regardless of his clientele. and that's one of those unintended consequences of good programs and bad policies. but here we are, and going back to the way it was - when docs took $10 for an office visit - is not an option. neither the docs nor their technologies can be bought for 1960s prices. so, what's all this have to do with obesity? wellllllll

we have a choice in this country: we can allow individuals to choose to live unhealthfully, or we can encourage and SUPPORT healthy living, as a nation. there are costs all along either path, so let's face that reality. if 25 states opt out of the mandate for health insurance, then, should someone from that state travel to my state and have an attack or injury or event requiring health care, which state is going to cover the costs? for all intents and purposes, even a citizen of missouri would be like an illegal mexican when it comes to health care: no contribution, my costs.

it behooves us all to be patriotic in our observance of healthy lifestyles. it behooves our leaders to consider rewarding such lifestyles and even punishing unhealthy ones. there are rational ways, dollar-ways, to make folks understand that their choices affect not just them but us. and that there are valid reasons as to why we can make reciprocal demands upon them to comply more with what are generally considered hallmarks of a healthy lifestyle. as such, we can demand that junk foods not be included in school lunches, at work site eateries, or interspersed in aisles and media so that the attraction is harder to avoid. (i say this knowing full well that the marketplace will think i'm a socialist. i counter by saying the nation's wellbeing should not be subjugated to the financial interests of a few any more than its security should be subjugated to the religious fanatacism of a few.)

and let's reward movement - encourage it in kids (how about neighborhood schools again?), in neighborhoods (sidewalks anyone? police walking the beat?), and in adults (workplace supports). and discourage sedentary behavior with financial and workplace disincentives. (what would you be willing to sacrifice in your lifestyle for a paid vacation day? better yet, would you be willing to engage in healthy choices for an extra few days off?)

this is not the answer to all questions in this issue. it's really just a provocation for you the reader to think about how we're going to handle this epidemic. i'm going to do a 15 minute indoor bike ride now. good nite.