Happy Healthy Long Life

Painless Calorie Restriction for People Who Love to Eat - Lessons for Health, Longevity, and Disease Prevention from the NIH CALERIE Study

Calorie Restriction Without Counting Calories - A 6 Cup Salad, Eggplant Lasagna, a 27 ounce Green Smoothie, & Fruit for Lunch & Dinner

 

 "I didn't think calorie restriction worked in humans until I started working with people who'd been doing it for years.

They are among the healthiest people I've ever known.  Their heart function is similar to people 15 years younger, they have very low levels of inflammation and very few get cancer."

-Dr. John Holloszy, M.D., lead CALERIE investigator, Washington University, St. Louis, Missouri-

 "In terms of cardiovascular diseases - the No. 1 cause of death: 4 out of 10 people die of it in the U.S. and Europe - we know that they (Calorie Restriction Society members) will not die of cardiovascular death."

 "..every day doctors are publishing hundred of papers on circulation research and medications that are lowering blood pressure or cholesterol by a small bit. And here we have such a powerful intervention that is basically cleaning out the arteries."

 "I don't know why anyone would take drugs when they could do something like this."

-Dr. Luigi Fontana & Dr. Susan Roberts, Washington University & Tufts University, investigators for the NIH-funded CALERIE Study-

 

9/21/10 update: Bill Clinton's CNN interview.  Why he's eating plant-based.  His stent wasn't going to cure his cardiovascular problems.  He wanted a long-term solution.  Click here.

Update 9/25/10:  Click here for my latest post about Bill Clinton's Diet and Wolf Blitzer's Interview with Drs. Esselstyn & Ornish.

 

Back to October 11, 2009 - Revisiting the CALERIE Study

One of my all-time favorite posts was almost a year ago--about the CALERIE Study that's been ongoing at Washington University in St. Louis (a shout-out to Wash U!), Tufts University in Boston, and the Pennington Biomedical Research Center in Baton Rouge.

I was totally intrigued by these 132+ people who were cutting their calories by 25%, eating a nutrient-dense diet, and getting super healthy all at the same time.  But, honestly, it sounded like a whole lot of measuring, weighing, calorie counting, and constant hunger.  Back then I didn't seriously think it was something I could ever do it.

Fast forward to June 18, 2010 when I decided to up the ante on my plant-based diet, and take Dr. Caldwell Esselstyn's challenge to cut out oils, nuts, and avocados from my already healthy diet.  That was 3 months ago--my 4 week "experiment" is over, but I'm still going strong with this eating lifestyle.  (update Aug. 2012:  Still going strong with the plant-based no-added-oil diet, 2+ years later & cannot see ever changing)

  Weight-loss is always a huge motivator.  I got on the scale today and I was 121 pounds--unbelievable for me--and that's with plenty of muscles, I'll have you know!  Down 10 pounds in 13 1/2 weeks, and I'm not counting calories or depriving myself one bit. (update Aug. 2012: I've stabilized at around 118 pounds, with plenty of lean muscles & a pretty flat belly & I eat a lot!)

I love how my clothes fit--I love that my blood pressure is consistently low normal--that my resting pulse is around 56--my cholesterol is just fine, I've got plenty of energy, the toxic belly fat is almost gone, as well as my extra tush cushioning--and guess what?  I didn't set out on this diet to lose weight.  I figured I was fine just the way I was--at 131 pounds--OK for a sixty-year old. (Update Aug. 2012: Now age 62.5 at 118)

I set out on this path for the same reason that Lisa Walford did.  She's the 55 year-old daughter of the late Dr. Ray Walford, one of the first researchers to look at the benefits of caloric-restriction.  Lisa has followed a 25% calorie restricted diet for over 20 years and at 4 foot 8 inches, she weighs in at a diminutive 80 pounds, and eats around 1500 calories a day.  If Lisa wasn't trying to lose or gain weight--her "set point" would be 95 pounds and she'd be consuming 2000 calories a day.

 

"Personally, I don't do it in hopes that I live longer.  I do it so that I can liver better now!  If I do live longer, it'll be a nice bonus."   Lisa Walford

 

My Unintentional Calorie-Restriction Experiment

 

Without intending to, it turns out that I'm following many of the precepts of calorie restriction, as well as the guidelines of the CALERIE Study (the Comprehensive Assessment of the Long Term Effects of Reducing Intake of Energy). 

 

• Sticking to the most nutrient-dense foods like fruits, vegetables, whole grains, and legumes--although the CALERIE study is not vegan or vegetarian.
• Eating foods that are filling, appealing, low in calories, and nutrient-rich.
• Eating lots of fiber--at least 50 grams a day (for me) without counting grams or even trying.  Fiber is key to keeping satisfied and full--and it likely activates the satiety receptors in the lower intestine.  My husband is a huge fan of eating a big bowl of high-fiber cereal (Uncle Sam's & Ezekiel's) with oat milk as a dessert, or when he craves a snack.
• I've easily cut my calories by 25% just by eliminating the high calories of oil, avocados, chocolate, sugar, and nuts. I'm consuming around 1400-1600 calories of very filling, nutrient-dense & high-fiber foods without counting a single calorie.
• Why I wasn't losing weight on a plant-based diet. To maintain my previous weight of around 131 pounds I was eating around 2000-2200 calories a day, and exercising around 5 days a week.  Sure, I had been eating mostly plant-based since March 2008--but I still used olive & canola oils, salad dressings, ate avocados, nuts, nut butters, chocolate, and didn't scrutinize labels for added fat.  I never lost a pound.
• Eliminating high-calorie-low-nutrient foods. By just cutting out the added oils in my food and in my cooking, eliminating nuts (except for small amounts of walnuts in recipes), avocados, vegan mayo, my beloved Terrapin Ridge Chipotle sauce, my favorite Whole Foods prepared deli vegan fare, hummus with tahini, and chocolate--I've naturally cut my calories to about 1400 a day without counting a calorie, or missing a thing!  Believe me, I never thought I could cook without oil, or live without nuts.
• I eat whenever I'm hungry and as much as I want.

If you had the chance to stay healthy and lean as you aged--free from the diseases of aging, like diabetes, cancer, and cardiovascular diseases--and all you had to do was cut out 25% of your daily calorie intake--would you do it?

Oh--and if you could also fit into cool clothes, drop to your high school weight,  & enjoy super energy?  Would you be willing to do it?

Why Is Calorie Restriction on My Mind Right Now?

A few weeks ago I picked up the Sept/Oct issue Natural Health and zeroed right in on their cover story "Eat Less, Live Longer" by  Catherine Guthrie.   And then I watched the 2010 Milken Institute panel, "The Science of Longevity", that featured my favorite calorie restriction expert from Washington University, Dr. Luigi Fontana.  I highly recommend viewing this video if you ever have 70 minutes to spare.  Right!

August 2012 Update:  I just watched the 2012 Milken Institute Panel, "Getting to 100: Your How-To Guide" with Dr. Luigi Fontana & others.  Excellent 1 hour presentation.  That summary will appear in a future post.

If you aren't seeing the 2012 Milken Institute video on your screen, click here.

 

 

Here's what I learned from the 2010 Milken Institute:

1.  Your body has a natural set point weight.  That's the weight your body would naturally gravitate to if you weren't trying to lose or gain weight.   If you want to lower your calories by 25%--you first need to know how many calories you typically eat to maintain your "natural set point" weight.

2.  Short-term pleasure vs long-term benefits.  To make this work, you have to be willing to sacrifice the short-term pleasure of chocolate cakes for the long-term benefit of good health.  Easier said than done.  It's also not just a calorie-cutting game--it's eating the most nutrient-dense foods possible.  Otherwise you end up malnourished.

3.  Why does calorie restriction confer good health?   Most researchers in the field believe it's because low-calorie nutrient-dense foods stave off oxidative stress, which is the damage caused by free radicals--a natural byproduct of the body's metabolism.  Catherine Guthrie offers an elegantly simple explanation of the process.

"Think of free radicals like the carbon dioxide produced when you burn gas driving a car.

By restricting the amount of calories entering the body, cellular engines are forced to be more efficient (hybrid vs SUV), and the entire body hums like a well-oiled machine.  More efficient cellular engines mean less metabolic waste and fewer free radicals spewed into the body.

Since free radicals (and inflammation) play a role in nearly all age-related diseases, especially cancer, heart disease, and diabetes, the result is healthier aging."

4. Caloric restriction slows aging. According to Dr. Luigi Fontana, caloric restriction is the most powerful tool we have to slow aging, and reduce disease.  All the cardiac risk factors are reduced significantly, type 2 diabetes is reduced to zero, arteries are clean, and cancer causing hormones are down-regulated.  Right now the average life span in the U.S. is 80 years.  The average health span is 50 years--after that it's doctor visits, prescriptions & treating disease.  We need to bridge that gap.  Fontana's latest article on "Extending Healthy Life Span--From Yeast to Humans"  is published in Science 2010 Apr 16;328(5976):321-6. Click here.

5.  Animal protein & cancer.  Reducing the amount of animal protein we eat to 10% of calories eaten reduces risk factors for prostate, breast, and colon cancers, and neurodegenerative diseases.  Animal protein increases IGF-1, a growth factor associated with these diseases. (Fontana)  Click here to read more.

6.  A Flat Belly Means a Healthy Body.  BMI is a crude way to measure health.  Waist circumference is better.  A flat belly means you are eating just the right amount of calories you need. Yikes!  A round belly means you are eating too much. (Fontana)

7.  If you have a family history of cancer, eating a high animal protein diet is not a good idea. (Fontana)

 

And now for the original post from Oct. 11, 2009.  It will explain a lot.

CALERIE: The NIH Calorie-Restriction Experiment. Lessons for Health, Slowing Down the Aging Process, Longevity, and Disease Prevention

Photo credit: Reinhard Hunger NYT 10/11/09

  

"In terms of cardiovascular diseases - the No. 1 cause of death; 4 out of 10 people die of it in the U.S. and Europe - we know that they (Calorie Restriction Society members) will not die of cardiovascular death."

"... subjects have cholesterol around 160, blood pressure around 100 over 60, high HDL, low triglycerides and very low levels of inflammation."

"...every day doctors are publishing  hundreds of papers on circulation research  and medications that are lowering blood pressure or cholesterol by a small bit.  And here we have such a powerful intervention that is basically cleaning out the arteries."

"I don't know why anyone would take drugs when they could do something like this." 

Dr. Luigi Fontana & Dr. Susan Roberts, Washington University & Tufts University investigators for the NIH- funded CALERIE Study,   NYT 10/11/09

If you had the chance to stay healthy and lean as you aged--free from the diseases of aging, like diabetes, cancer, and cardiovascular diseases--and all you had to do was cut out 25% of your daily calorie intake--would you do it?  Oh--and if you could also fit into cool clothes, drop to your high school weight,  & enjoy super energy?  Would you be willing to do it?

We know that careful calorie restriction--eating a nutrient-dense-low-calorie diet--works in rodents and those University of Wisconsin rhesus monkeys--but will it work for humans who are constantly tempted by cheeseburgers, pizzas, office parties, and dinners out with friends?  (Read about the Rhesus Monkey 20 year follow-up here)

 

According Dr. Susan Roberts, one of the principal CALERIE investigators, when it comes to animals,  "They don't just live longer, they are healthier.  They actually aged biologically slower.  Their hair has gone gray less quickly.  Their hormones have stayed at their youthful profile and their immune function has stayed good."

I'd heard for years about too-skinny "calorie-restriction groupies" who were out to beat death with a miserably low-cal boring diet.  It held no appeal for me.  I love food too much!

But, I've got to tell you, after reading about the National Institute of Aging's ongoing calorie-restriction  experiment known as CALERIE  (Comprehensive Assessment of Long-Term Effects of Reducing Intake of Energy)--I'm rethinking this whole calorie-restriction scene!  This is not excruciating or boring at all!  And since I started on my "veganish" adventure in March of 2008--I'm not that far away from the CALERIE model already!

Take a look at Jon Gertner's fascinating story, "The Calorie-Restriction Experiment" in the October 11, 2009 New York Times Magazine, here. 

Honestly, I'd describe it as Weight Watcher's on steroids--with help from physicians, dietitians and counselors.  There's even room for an occasional Uno's pizza, Haagen Dazs ice cream bar, bratwurst, or beer.

The first participants are finishing up their 2-year trial and the results are promising.

 

What is the CALERIE Study?

• Since it's virtually impossible to follow people over a lifetime to find out if restricting calories by 25% would slow aging, drastically reduce diabetes, cardiovascular diseases, and cancer--CALERIE aims to follow a select group (right now there are 132 enrolled) for two years to find out if the biomarkers for aging can be modified when calories are restricted.
• The study will measure if inflammation, insulin levels, blood pressure, core body temperature, and body weight can be lowered simply by reducing calories by 25%.
• Where are the sites?  Tufts University in Boston; Washington University in St. Louis; Pennington Biomedical Research Center in Baton Rouge.
• Who is eligible?  20-50 year olds who are healthy and not too fat or too thin--having a BMI of 22-27.9.  Participants also have to be motivated, organized (they have to measure & record every morsel they eat for 24 months), have stable jobs with little travel, and a supportive family.

 

What's the Diet Like?

• So, do you think you know how many calories you eat every day?  Think again.  Most participants guessed wrong.  Using a high-tech lab technique that involves swallowing water with rare isotopes, the researchers are able to figure out precisely how many calories each participant is typically consuming.  Then they cut it down by 25%.  
• Liz Ewen, a molecular biologist, was eating 2,226 before CALERIE--now she's at 1,670.  Dr. Jeff Peipert, an OB-Gyn, was consuming a whopping 3,300 a day pre-CALERIE--now he's at just under 2,500. 
• For the first 28 days participants get all their meals & snacks cooked for them and at no cost--based on their individual calorie counts.  This gets them accustomed to portion sizes and adjusted to eating the kind of foods that will keep them filled and satisfied.  And this food isn't spartan:  Mediterranean-style fish with Greek-style potatoes, or Farfalle with Pesto & Diced Chicken, for example.  After 28 days--they buy and prepare their own food--with regular help and guidance from dietitians and a support group.
• The Key to eating 25% less:  eat foods that are nutrient rich and high in fiber, like vegetables, fruit, high fiber cereals, and soups.  Aim for foods that weigh as much as what you were eating before the diet--but lower in calories--to keep you full and satisfied.  Favorite food for keeping hunger at bay:  apples.   Everyone in CALERIE has become a big fan of apples. 
• The 4 Rules for Eating Less:  Eat Foods That Are Filling, Appealing, Low in Calories, Nutrient Rich!
• Dr. Susan Roberts of Tufts says, "If you don't change your diet to a high-satiety diet you will be hungry, and you will fail."  Fiber One, the breakfast cereal, or Nature's Path Organic Smart Bran--both with soluble & insoluble fiber, "have a unique  effect in helping calorie-restriction subjects feel fuller, probably because they activate certain receptors in the lower intestine."

To see some of Dr. Roberts' satiating snack recipes in my previous post click here: "The Instinct Diet Helps Us Combat Our Hard-Wired Food Cravings - And Satisfy Our Cravings for Something Spicy, Salty, Crunchy, & Chocolate"

• CALERIE tip: Save up calories if you have a special occasion or celebration coming up.  Want a bratwurst or Haagen-Dazs?  Save up those calories.  Decide what's more satisfying--170 calories for a gin & tonic, or a  190 calories for a  Haagen Dasz ice cream bar.

 

What Is the Hardest Part of the CALERIE Diet?

• Surprisingly, no one complains of raging hunger.  But most everyone felt hungry for the first few weeks.  When I joined Weight Watchers years ago to lose pregnancy weight I felt exactly the same way.  But then you just get used to less calories and learn to eat more filling foods.
• The hardest (& most annoying) part is getting used to measuring the food, preparing the food, and keeping track of the calories.

 

Why is CALERIE Working For Most of Its Participants?

• There's accountability. 
• You have to submit a weekly food diary.
• Attend weekly weigh-ins
• Once or twice a week you must attend individual counseling sessions
• Group counseling sessions give participants an opportunity to swap strategies and get support from fellow dieters.
• There's a battery of medical tests every 6 months.  Cognitive tests.  Blood tests.  Bone-mineral density tests.  Measurements of resting metabolism, respiratory output, and internal core temperature.

 

What About Weight Loss?  What About Health Improvements?  What About Energy? 

• Most participants met their weight loss goals.  They were told to expect to lose about 15% of their weight during the first year.  After that initial drop they would plateau to "weight stability".
• Doug Hansen started out at 198 pounds and dropped to 168--near his plateau--after 6 months.  Jeff Peipert began at 174 pounds--dropped to 151 after 52 weeks--and was projected to plateau at 147 pounds.
• Benefits.  For example: Peipert's blood pressure started out at 130 over 80.  Now almost a year into CALERIE, he's at 110 or 115 over 54. At age 49 his weight is what he weighed in high school.  Same for Brad Beggs. He is down to wearing a size medium shirt--a size he hasn't worn since high school.  And Beggs adds, "I've never gotten so much pleasure in my life."

 

Dr. Jeff Peipert, a Washington University CALERIE participant

 

Wondering about energy?  Check out how Dr. Jeff Peipert spent a recent day off:

1.   18 holes of golf

2.   Biking 8 miles back & forth to his office just to pick something up

3.   Cutting his 1 acre lawn

4.   Pulling out tree roots with his son for over an hour

5.   40 minute after-dinner walk with his wife.

6.   This "calorie-incinerating machine"  was wondering why he felt particularly hungry the next day,  resulting in his eating a bowl of cereal in the middle-of-the-night.  Both my husband & I have definitely noticed the huge uptick in our appetites the day after long work-outs.  It makes sense to us.

Is Calorie-Restriction Possible for the Average American?

• The Naysayers:  Dr. John Holloszy, a Washington University lead investigator thinks 99% of Americans can't stick with it.  Other doctors think calorie-restriction requires too much individual effort--too much in medical resources--too much in counseling.   Dr. Robert Krikorian, a neuropsychologist who happens to be a long-time follower of a calorie-restriction diet himself-- thinks that most people won't pay attention to how much they eat--and they would refuse to keep up the organizational requirements necessary for such a diet.
• The Boosters:  Many doctors involved in CALERIE are surprised & encouraged at the high level of compliance with the diet.
• The Participants:  All of the subjects that Times writer Jon Gertner spoke with intended to continue with calorie-restriction when the trial ended.  Liz Ewen likened it to Weight Watchers (& I agree).  Given the right online tools, some sort of infrastructure, group meetings, and dietitians available for support, Ewen thinks it's suitable for many people.  "It's really not much more than embarking on a diet that teaches you how to eat normal foods but make better choices!"
• Some of the  first of the group to finish:  Most of "first finishers" plan to keep up the diet--but switch to estimating the calories, rather than counting them precisely.  Josh McMichael finished up with CALERIE in September.  In the few weeks since ending the program he gained eight pounds--but it's now mostly gone.  "I tried the new massive burgers at Burger King,"  he said.  "Twice.  Wasn't worth the side effects.  I think I've gotten over things like that.  For the most part."

 

Words of Encouragement from the Lead Investigators

• Dr. Luigi Fontana of Washington University in St. Louis.  "My perception right now is the effects of calorie restriction are multiple, so I think it is highly difficult to find one, or two, or three drugs that will mimic such a complex effect."  And although he isn't optimistic that calorie restriction will gain traction in the general public, he does believe an important common sense lesson will be learned from the experiment:

"Eating less is better than eating more, especially if it's a nutritious mix of whole grains, fruits, vegetables and the like.  The evidence is overwhelming now that it will improve your health and will improve your chances of living healthier and probably longer."

• Dr. Susan Roberts of Tufts University in Boston:  Roberts thinks the study will have greater effects than the average clinical trial.  "I don't know why anyone would take drugs when they could do something like this--calorie-restriction,"  said Roberts.

 

The Healthy Librarian Weighs in on Calorie Restriction

For my money, the folks in the CALERIE study are following a plan that seems very similar to:

• Dr. Joel Fuhrman's Eat for Health: Lose Weight, Keep It Off, Look Younger, and Liver Longer
  
• Dr. Susan Roberts'  (a CALERIE lead investigator) Instinct Diet
• Dr. Caldwell Essestyn's Prevent and Reverse Heart Disease
• The Weight Watcher's diet plan

 

Easiest way to cut calories:  ditch added fats, like butter, margarine, mayo, cooking oils, salad dressings, desserts, high-fat dairy like cheese & ice cream, and the after-dinner snacking.

Foods highest in nutrient density:

*Dr.Fuhrman’s  Aggregate Nutrient Density Index
Top 30 Super Foods Score

1. Collard, mustard, & turnip greens 1000
2. Kale 1000
3. Watercress 1000
4. Bok choy 824
5. Spinach 739
6. Brussels sprouts 672
7. Swiss chard 670
8. Arugula 559
9. Radish 554
10. Cabbage 481
11. Bean sprouts 444
12. Red peppers 420
13. Romaine lettuce 389
14. Broccoli 376
15. Carrot juice 344
16. Tomatoes & tomato products 190-300
17. Cauliflower 295
18. Strawberries 212
19. Pomegranate juice 193
20. Blackberries 178
21. Plums 157
22. Raspberries 145
23. Blueberries 130
24. Papaya 118
25. Brazil nuts 116
26. Oranges 109
27. Tofu 86
28. Beans (all varieties) 55-70
29. Seeds: flaxseed, sunflower, sesame 45
30. Walnuts 29

 

Drugs or Diet?  I find it interesting that the only cure for celiac disease (the inability to digest gluten) is to follow a gluten-free diet.  There are no pharmaceutical or surgical cures.  People with celiac who want to get better just follow a gluten-free diet.

Yet, when it comes to the diseases of aging, like Type 2 diabetes, some cancers, and cardiovascular diseases--most physicians find that the majority of people are unwilling to follow a diet even if it promises to free them from these diseases.  Oh well!

Do you think such a diet is ready for Prime Time?  Would you be willing to give it a try?

 

 

The Latest Framingham Heart Study. Brain Shrinkage? Atrophy of the Brain? Getting to the Heart of the Matter - It's All About the Cardiac Index

Left Image:  Normal Brain  Right Image:  Atrophied Brain  

"Those with the lowest cardiac index and the middle group both had smaller brain volumes than those with the highest cardiac index.  (Cardiac Index is the measurement of blood flow from the heart, based on one's body size.)

Our results definitely suggest that cardiac health is related to brain health.

These participants are not sick people.  A very small number have heart disease.

The observation that nearly a third of the entire sample has a low cardiac index and the lower cardiac index is related to smaller brain volume is concerning and requires further study.

The structural (brain) changes may be early evidence that something is wrong.  There are several theories for why reduced cardiac index might affect brain health.  For instance, a lower volume of blood pumping from the heart might reduce blood flow to the brain, providing less oxygen and fewer nutrients needed for brain cells. 

It is too early to dole out health advice based on this one finding, but it does suggest that heart and brain health go hand in hand."

Dr. Angela L. Jefferson, lead investigator, Boston University, "Cardiac Index is Associated with Brain Aging.  The Framingham Heart Study",  published online August 2, 2010, Circulation.

This just-published article in Circulation certainly got my attention.  Who wants brain shrinkage a.k.a. brain atrophy?   Not if there is something you can do to prevent it.

OK, we've been hearing this for years, "What's good for the heart is good for the brain."  And although the authors are quick to say "further investigations into the mechanisms and clinical significance of the association between cardiac index and brain aging is merited",  Dr. Angela L. Jefferson says flat out:  "Generally speaking, it seems that heart and brain health are related, so proper management of cardiovascular risk factors may have important implications on brain health."

Bottom line here:  Those study participants whose hearts pumped less blood, had brains that appeared older than the brains of those whose hearts pumped more blood--to the tune of two years worth of brain aging. 

The biggest surprise to the researchers was that of this group of 1504 mostly healthy middle-aged volunteers--all offspring of the original Framingham Study volunteers--not only did the folks with lowest cardiac index show significant brain volume shrinkage, but so did the folks with a cardiac index in the middle range!  Only those with the highest cardiac index showed significant retention of their brain volume.   

"We expected an association between the lowest levels of cardiac index and smaller brain volumes, but we were surprised to find people on the lower end of normal cardiac index also have smaller brain volumes when compared to people with the very healthiest cardiac index."  Dr. Angela Jefferson

The researcher's other big surprise was the high number of "normal healthy" adults who had a cardiac index below normal.  Around 30% of these seemingly healthy middle-aged adults had a low cardiac index. 

"In light of the current observation that cardiac index is associated with cross-sectional markers of accelerated brain aging, such a high proportion of cardiac index values below clinical criteria warrants further investigation."  (excerpted from the article)

It's important to remember that these were pretty healthy participants.  The study excluded anyone who had a previous history of stroke, TIAs, dementia, or significant cardiovascular disease.  Only 7% of the group had any heart disease at all, 10% were smokers, 9% had diabetes, and 28% had high blood pressure.  And all these risk factors were controlled & adjusted for when the results were compiled.

The researchers also tested the cognitive function of the participants with 5 different neuropsychological tests. 

The good news (sort of), was that the folks with the smallest brain volumes didn't yet show any obvious cognitive deficits.  But, one function, how quickly one can process information, had a positive correlation to brain volume.  Less brain shrinkage equaled faster processing speed.  And who doesn't have a little slow processing speed as they get older?

The bad news: The researchers question exactly how precise these standard neuropsychological tests are when it comes to picking up subtle early cognitive deficits.  Were the tests powerful enough to pick up underlying deficits?

The jury's still out about the future brain function of those who exhibited decreased brain volume. 

"We observed (that the) cardiac index is related to structural changes in the brain, but not cognitive changes.  The structural changes may be early evidence that something is wrong."  Dr. Angela Jefferson

The Cardiac Output-Brain Shrinkage Connection

Here's what the authors think might be going on:  "The mechanism accounting for associations between cardiac index and markers of brain aging is unknown; however, reduced systemic blood flow may contribute to subclinical brain injury because of its impact on cerebral blood flow hemostasis.

My Mother's Brain

When my mom was in her late seventies she had a CAT scan (not an MRI as in the Framingham Study) of her brain to see if there might be a reason for her strange constellation of symptoms:  unexplained dizziness, some unsteadiness, a few minor falls & the occasional odd experience of her body tipping to one side while she sat on the couch.

The results:  The doctor said the CAT scan didn't show a thing.  She was just fine.  Just normal brain shrinkage from aging--everyone has that, he told us.  No one connected any dots back then that perhaps her "normal brain shrinkage" might have had something to do with her heart disease, her earlier severe blockage of the left main coronary artery, for which she had an angioplasty, or her hypertension. 

Within a few years of that CAT scan her memory slowly declined, tiny subtle strokes accumulated, and the results were the usual story of a slow downward health spiral--without hope of turning it around.  This new Framingham Study is one more bit of evidence that demonstrates just how interconnected brain health is to heart health.  It's all in the plumbing!  Consider yourself warned.

What Can We Do With This Information?

Dr. Ralph Sacco, the president of the American Heart Association, and the co-author of the Circulation editorial that accompanies the Framingham article, says:

"It will take years to know the fate of all 1504 Framingham participants. 

Whether lower cardiac index leads to reduced brain volumes and accelerates neurodegeneration on an eventual path to dementia is not yet clear.

What is known is that various vascular risk factors, including declines in cardiac function, are determinants of dementia--both Alzheimer's disease and variants of vascular cognitive disorders.

This is an interesting, strong association.  Just as we measure someone's weight, blood pressure and cholesterol to assess their heart disease risk, we now have numbers for cardiac index and brain volume.

The key message for the public is the connection between heart vascular issues and brain vascular issues. 

The things that affect the heart can affect brain health. 

Exercising regularly, eating right, maintaining a healthy weight, not smoking, and managing high blood pressure, cholesterol, and diabetes--will all lead to better heart, blood vessel, and brain health.

Know that these things are important, not just for the heart but also for the brain."

I got into this whole exercise-healthy-diet-gig for stroke prevention and cognitive retention.  Needless to say, I'm feeling even better about staying the course.  Brain shrinkage--who needs it? 

Can't help wondering how the MRIs of cardiac output & brain volume would look in long-time exercisers, and for those with pristine heart health.  

Skip the ice cream, cheesecake, and cheeseburger this weekend.  Go out and exercise.  If not for your heart, then for your brain.

To read more about the heart-brain health connection read: Concerned About Brain Health, Alzheimer's or Dementia? Some Q & A with Dr. Randolph Schiffer of the Cleveland Clinic Lou Ruvo Center for Brain Health

What Does Katy Butler's "My Father's Broken Heart" Have to Do With Following a Heart Disease Prevention Diet, Meditation, Yoga, Osteoporosis & Movies?

 

photo by Eugene Richards for the New York Times

"The pacemaker bought my parents two years of limbo, two of purgatory and two of hell.  In 2005, the age-related degeneration that had slowed my father's heart, attacked his eyes, lung, bladder, and bowels. 

Clots as narrow as a single human hair lodged in tiny blood vessels in his brain, killing clusters of neurons by depriving them of oxygen...A few months later, he forgot his way home from the university pool.  He grew incontinent.  He was collapsing physically, like an ancient, shored up house."

Katy Butler, "My Father's Broken Heart: How Putting in a Pacemaker Wrecked My Family"  New York Times Sunday Magazine, June 20, 2010

If you've received this post via email, click here to get the web version with all the links.

Two weeks ago while I was still vacationing in Maine I received an email from Katy Butler, the author of this not-to-be-missed memoir in the New York Times.  Click here to read it.

Hi there, thanks for your comments on my piece for MORE on silence.
You sound like a kindred spirit.

Please read my upcoming piece next Sunday online if you don't get the Times.
Food for thought. warmly, Katy

"My Father's Broken Heart: How Putting in a Pacemaker Wrecked My Family," runs June 20 in the New York Times magazine.  I hope you get to read it, especially if you have elderly parents."

"One October afternoon three years ago, my mother made a request I dreaded and longed to fulfill. She had just poured me a cup of Earl Grey from her Japanese iron teapot, shaped like a little pumpkin; outside, two cardinals splashed in her birdbath in the weak Connecticut sunlight.  Her white hair was gathered at the nape of her neck, and her voice was low. "Please help me get Jeff's pacemaker turned off," she said. I nodded, and my heart knocked.
Upstairs, my 85-year-old father Jeffrey, a retired Wesleyan University professor who suffered from dementia, lay napping in what was once their shared bedroom. Sewn into a hump of skin and muscle below his right clavicle was the pacemaker that had helped his heart outlive his brain....."

Uh. I had to think long & hard to remember who Katy Butler was, & what I had written about her.  Aha!  It was her brilliant piece about silence, "How to Access Your Inner Calm"--her experience at a 6 day silent meditation retreat back in 2008.  To read her thoughtful piece that appeared in More, click here and the article is on pgs. 96-100. 

Little did I know what difficulties, sadness, and frustrations were going on in Katy's life at the time she wrote that article.  No wonder she was at a meditation retreat.  

And speaking of meditation--yesterday evening I had a chance to listen to the podcast of Diane Rehm's NPR broadcast on the Power of Meditation.   Click here  to listen to her hour-long interview of three top meditation researchers, experts, & practitioners--or just download it through iTunes and listen to it on a nice relaxing meditative walk.  Thanks to hubby for the tip about Diane's show.

"Millions of Americans practice some form of meditation to promote relaxation and reduce stress. But claims for greater health benefits are in need of further study." 

So, Why Am I Recommending That You Read Katy's Memoir?

"When people tell me my diet's extreme, or too strict, I ask them, 'How would you like to spend your last years in a nursing home, sitting in a wheelchair, incontinent, immobile, unaware, with saliva dribbling out of the side of your mouth?'"

The paraphrase of comment Dr. Caldwell Esselstyn made to me a few months ago.

Katy's story is a variation of my family's story.  My dad survived a massive stroke at age 69, just as life was starting to get nice-and-easy for him.  Both daughters were married, he could work less, and his first grandson (my now 30 year old son) was just 9 months old. Time for the travel my parents had always put off.

He lived on for 16 years after that initial stroke, until age 85, without being able to speak, read, or understand language--and reading was his joy--especially the New York Times.  He lost mobility, and everything else that makes life worth living.  My dad was kept alive by powerful anti-seizure medicines that prevented the severe seizures that were caused by the strokes' damage to his brain.  Later, he was kept alive with the help of a feeding tube.

My mom lovingly and without a single complaint took care of my dad at home for over 10 years, seeing her own health decline, and her world close in. Care-giving stress brought her weight loss, friend-loss, and unknown to her at the time, she was having her own silent imperceptible micro-strokes, as well as angina, osteoporosis and high blood pressure.  A year after my dad passed away those tiny strokes had started to take their toll on both her physical balance & memory.  After a number of falls, bone fractures, and full-blown strokes she spent her last year in that wheelchair, just as Dr. Esselstyn had described.

Read Katy's story if you have older parents, or an older spouse.  Read it for yourself, for goodness sakes.  Read it if you want the motivation to finally take your health into your own hands.  Read it if you want to understand why our medical system and Medicare lean toward expensive medical devices and expensive interventions that aren't always in our best interests. 

As for me, if there is anything that I can do that will prevent me from experiencing the same slow half-dead-half-alive fate that my parents had to experience in their final years, I'm going to give it my best shot.  Cheeseburgers & sausage pizza aren't worth the price.  And if I can prevent my husband & children from experiencing the incredible stress of care-taking--I'm going to give that a shot, too.

"It doesn't take a scientist to figure out that the possibility of death has been holding pretty steady at 100% for quite some time.  There's only one thing that we have to do in life, and that is to die.

I have often met people who use this fact to justify their ambivalence toward health information.  But I take a different view.  I have never pursued health hoping for immortality.

Good health is about being able to fully enjoy the time we do have.  It is about being as functional as possible throughout our entire lives and avoiding crippling, painful and lengthy battles with disease.

There are many better ways to die, and to live."

-Dr. T. Colin Campbell, "The China Study"  Dallas, TX: Benbella Books, 2006, pg. 75-

Katy's story expertly weaves together her families' most private emotions, with an explanation of how 21st century medicine has come to trap us into a cascade of expensive procedures, devices, and drugs at the end of our lives, that often extends our years, but not the quality of our lives.  She's a beautiful, poetic writer and has shared the most intimate details of her families' life to benefit others.  Read it!

Excerpts from "My Father's Broken Heart":

• I don't like describing what dementia did to my father--and indirectly to my mother--without telling you first that my parents loved each other, and I loved them.
• Anton Chekov, who died of tuberculosis in 1904, wrote:  "Whenever there is someone in a family who has long been ill, and hopelessly ill, there come painful moments when all timidly, secretly, at the bottom of their heart long for his death."  A century later, my mother and I had come to long for the machine in my father's chest to fail.
• I watched (my parents) lose control of their lives to a set of perverse financial incentives--for cardiologists, hospitals and especially the manufacturers of advanced medical devices--skewed to promote maximum treatment.
• Thanks to advanced medical technologies, elderly people now survive repeated health crises that once killed them, and so the "oldest old" have become the nation's most rapidly growing age group.  Nearly a third of Americans over 85 have dementia. 
• (M)y 77-year-old mother found herself on duty more than 80 hours a week.  Her blood pressure rose and her weight fell.  On a routine visit to Dr. Fales, she burst into tears.  She was put on sleeping pills and anti-depressants.
• If (Dr. Fales) had had a chance to sit down with my parents, he could have explained that the pacemaker's battery would last 10 years and asked whether my father wanted to live to be 89 in his nearly mute and dependent state.
• In a fee-for-service medical economy...communication is haphazard...thinking is often short-term.  Nobody makes money when medical interventions are declined; and nobody is in charge except the marketplace.
• Medicare rewards doctors far better for doing procedures than for assessing whether they should be done at all.  The incentives for overtreatment continue...because those who profit from them--specialists, hospitals, drug companies and the medical-device manufacturers--spend money lobbying Congress and the public to keep it that way.
• And so my father's electronically managed heart--now requiring frequent monitoring, paid by Medicare--became part of the $24 billion worldwide cardiac-device industry and an indirect subsidizer of the fiscal health of American hospitals.
• The pacemaker bought my parents two years of limbo, two of purgatory and two of hell.
• Of the 17 cardiologists who wrote the 2008 guidelines on pacemakers for the American College of Cardiology, 11 received financing from cardiac-device makers or worked at institutions receiving it.  Seven, due to the extent of their financial connections, were recused from voting on the guidelines they helped write.
• We learned that if we called 911, emergency medical technicians would not honor my father's do-not-resuscitate order unless he wore a state-issued orange hospital bracelet.
• More than half of heart-bypass patients suffer at least a 20% reduction in mental function.

Yikes, I started out writing this post as a brief segue into my first week following Dr. Esselstyn's heart-disease-reversal-and-prevention diet, and it just morphed into something else. Can you tell how much I adored Katy's article?

Sorry,  more about the Tips, Tricks, How-Tos of the Diet tomorrow, or later this week.  My son, daughter-in-law and adorable grandson arrive here late on Monday night, so I guess blogging may once more take a back seat.

Quick Diet Update:  So far so good.  This is definitely a lot easier than I thought it would be, thanks to all of Ann Esselstyn's amazing tips.  I have noticed that I definitely need to eat before I get hungry--because when I get hungry--I'm ravenous.  I'm noticing that I'm staying up about one hour longer each day than before.  No idea if that's diet related or not.  Loving fat free roasted red pepper humus, Ezekiel wraps & English muffins.

Sample Menu This Week

Breakfast:  Steel-cut oats, with dried apples and flaxmeal.  I never get tired of this!

Snack split over mid-morning & mid-afternoon:  My green smoothie made with kale or chard, apple, grapefruit, berries, and carrots.

Lunch: Giant salad of mesclun greens, roasted corn, steamed lentils (Trader Joe's precooked), tomatoes, cucumbers, Trader Joe's Corn Salsa & balsamic vinegar.  Plus, an Ezekiel-brand sprouted grain English muffin.

Dinner: Bok Choy with portobello mushrooms, carrots, ginger, pea pods, barbecued seitan, and soba noodles.  Fabulous!  A variation of Rip Esselstyn's recipe.

Additional snacks:  Cherries, watermelon, whole wheat pita, baby carrots, cucumbers with fat-free red pepper hummus

Update on Dr. Loren Fishman's Osteoporosis Study

The study is still open if you are interested in participating, and you will receive Fishman's DVD of 10 minutes of daily poses. Details on the study are here.

To enroll, email Dr. Fishman at:  [email protected]

You will need to send copies of the SMA-18 (electrolytes & blood chemistry); CBC (complete blood count);  TSH (thyroid-stimulating hormone); Vitamin D 1,25-dihydroxy;  ESR (erythrocyte sedimentation rate); parathyroid hormone test, and DEXA scan results, before you can enroll and receive the DVD.

I'm planning to enroll as soon as I can get together all the tests results.

I still don't have an answer about whether 2 or 3 times a week of hour-long classes would provide the same positive results as the 10-minute every day practice.

Movies I've Loved This Summer

City Island--do not pay attention to negative reviews.  This is a winner.  Everyone I know who has seen it has loved it.

Please Give with Catherine Keener--more than meets the eye.

Enjoy this lovely weekend!

The Great Kitchen Cholesterol Clean-Up - Parchment Paper, the No-Oil Saute, and Munching on the Top Cholesterol-Cutting Foods

 

 

 

There's only one thing that we have to do in life, and that is to die.  I have often met people who use this fact to justify their ambivalence toward health information. But I take a different view.  I have never pursued health hoping for immortality.

Good health is about being able to fully enjoy the time we do have.  It is about being as functional as possible throughout our entire lives and avoiding crippling, painful and lengthy battles with disease.  There are many better ways to die, and to live.

 

 

-Dr. T. Colin Campbell, The China Study-

 

Not to worry.  I haven't gone off the deep-end with my diet.  But those recent cholesterol test results have given me some "food for thought".  I'm an experimenter at heart--and I'm ready to try some new tactics. Time to rethink what I'm eating when I go out to restaurants.  Time to figure out what cooking techniques I can easily change in my kitchen  Time to reconsider what foods I absolutely do not want to give up--at least until I'm convinced otherwise. And time to look more seriously at what foods naturally clobber cholesterol.

Last week I went on a Cooking Experimentation Rampage to explore the world of no-fat cooking.  Here's what I found out.

What can I easily change?

 

•  

  Can I cut out using cooking oil for browning and roasting?  I admit it--I have always resisted this practice.  Seems too hard--and a flavor sacrifice.  Too over-the-top.  But I tried it--and with the right techniques--it works beautifully!  Really!  And it's so much cleaner.
  

Parchment paper is amazing for non-stick oven roasting & browning.  Butternut squash, potatoes, asparagus, and eggplant roasted up beautifully.   The Silpat experiment failed.  I used some maple syrup when I roasted up butternut squash & cleaning my Silpat was way too hard.  I'm sticking with parchment paper.

Butternut Squash Browned Without Oil on a Silpat--Too Hard to Clean

And here's a tip from my sis--the professional baker.  Don't waste your money on parchment paper from the grocery store.  It's too expensive.  It's all rolled up & doesn't easily lay flat.  Buy it from a restaurant supply store where it comes in flat sheets--in a large quantity--and is a lot cheaper.  Split a box with a friend.  It will last for more than a year.

  Lentil Dal Burgers Browned Without Oil on Parchment Paper

My other WOW Parchment Paper revelation was how beautifully my Lentil Dal Burgers browned up in the oven.  Not a smidge of oil.  Not a smidge of oil spray.  Who needs to fry?  Who needs the oil splatters on the stove--and the clean-up?  Who needs the 520 extra calories from the 1/4 cup of oil needed for frying?  I never would have believed it if I hadn't seen it with my own eyes!

And even my veggies browned up on the parchment paper paper without oil or oil spray.  My oven was hot--400-425 degrees, and they did  need to be turned over midway.

 

• Can I successfully saute veggies without oil?   Oh yeah!  I got this cooking technique from a reader named Max--and it really worked well.  First heat up the pan (medium high) to the point where onions will sizzle when you put them in the pan.  Keep moving the onions around with a spatula until they start to release some of their own liquid.  They won't stick. Don't add any extra broth or liquid too soon or it will have more of a braise than a saute flavor.  And if you want to caramelize the onions, add a teaspoon or more of dark brown sugar, maple syrup, or molasses after the onions have cooked for 5-7 minutes.  When the veggies started to stick to the pan I added some Imagine No-Chicken broth.  I sauteed in an enameled cast iron pan.  Max uses a non-stick one.

Amy Cramer, a professional vegan chef, always steers clear of oil.  She uses "Better Than Boullion Veggie Base for sauteing and it lasts a year in her refrigerator.  She mixes up 8 oz of broth at a time--and adds some to the veggies to keep them from sticking as she sautes.

Isa Chandra Moskowitz (Veganomicon author) has another less-purist tip for cooking with less oil:  "When sauteing onions & garlic as the base for a soup or a stew you can get away with one teaspoon or two of oil.  Put a teaspoon in a pool on one side of your pan-- don't coat the entire pan.  Saute in that little corner of the pan, preferably with tongs.  When moisture begins to release from the onions, usually after 3 minutes or so, you can spread them out, and add a little broth to cook them further, if needed."

Sauteing Onions, Carrots, Garlic, & Jalapenos Without Oil

 

What do I absolutely not want to give up--at least until I'm convinced otherwise?

• Nuts!  I love them--and I don't overindulge.  They add to my satiety, and they add flavor & crunch to recipes. Plus, my fave Larabars (just fruit & nuts) really come to the rescue when I'm out & I need food fast!  And conveniently for me--a new study just appeared in the May 10th, 2010 issue of the Archives of Internal Medicine   which provides even more supporting evidence that eating about 2.3 ounces of nuts a day  -- a third of a cupful -- reduced total cholesterol levels by 5.1% and "bad" LDL cholesterol by 7.4%.

  That amount of nut-eating also improved the ratio of LDL cholesterol to "good" HDL cholesterol by 8.3% and caused a decrease of 10.2% in triglyceride levels among people with high levels of those blood fats. 

But be an informed consumer:  2.3 ounces of nuts are a lot of nuts--the equivalent of almost 400 calories--practically a meal--and if you just tack that amount on to all the other foods you are eating--guess what?  You're going to gain weight! 

Full Disclosure: this study was sponsored by the International Tree Nut Council Research and Education Foundation.

"Nuts are a matrix of healthy nutrients, and the most obvious reason for the cholesterol-lowering effect is their unsaturated fat content.  Nuts also contain fiber, vegetable protein, phytoesterols and other antioxidants."

 

Dr. Joan Sabate, chairman of the Nutrition Department at the Loma Linda University School of Public Health in California and co-author of the article.

 

• Avocados!  Sure they contain fat--but avocados aren't just empty calories.  They got a bad rap back in the 1980's, but their omega-9 fat has also been shown to lower LDL's & triglycerides, while raising HDLs.  It contains beta-sitosterol, a natural substance that lowers cholesterol, and is also prostate-protective. 

And there's more:  Like lutein for the eyes, fiber, potassium, Vitamin E, B-vitamins and folic acid.  Avocados also act as a "nutrient booster" by helping the body to better absorb more fat-soluble nutrients, such as beta-carotene, vitamin E, vitamin D, and lutein.  1/5th of an avocado=50 calories & 4.5 grams of fat, in case you're wondering.  And just a bit spread on a sandwich, or on top of black beans or chili is so delicious--and stomach-satisfying. Not an everyday indulgence--but something I don't want to give up.

What foods can I add to help naturally lower my cholesterol?

Why can't I also start to just eat a little smarter?  Dr. David Jenkins of St. Michael's Hospital of Toronto is the researcher behind the Portfolio Diet--published in many of the top medical journals--and most recently in the Proceedings of the Nutrition Society  69(1):39-44, 2010, "CVD, Diabetes & Cancer.  A Dietary Portfolio for Management & Prevention of Heart Disease"

Jenkins has pit his plant-based Portfolio Diet against the American Heart Association diet, and even against a combination of 20 mg of Lovastatin + the AHA diet.  The Portfolio diet always beats the AHA Diet, & it works just as well as taking Lovastatin combined with eating a low-fat diet.   Followers of the Portfolio Diet have consistently cut their cholesterol level by about 30%, without the side effects of statins.

 Jenkins Portfolio Diet:

• Soluble fiber foods:  Oats, barley, beans, eggplant, okra, psyllium (Metamucil)--14-16 grams of soluble fiber a day
• Soy foods:  soy milk, tofu, tempeh, soy burgers, soy yogurt, soy sausage--14-16 grams of soy protein a day--the equivalent of 2 glasses of soy milk a day.
• Total fiber--31-37 grams a day (includes insoluble & soluble fiber)
• Raw unblanched almonds--14-16 grams a day=about 1/2 an ounce=88 calories a day.
• Plant sterols--these are the cholesterol-blocking plant substances added to margarine (Benecol & Take Control) & orange juice (Minute Maid Heartwise).  But why eat caloric margarine or drink caloric juice  when you can take sterols staight-up in supplement form before a meal?  Check out Phytosterols made by Endurance Products  The Portfolio diet provided about 1 gram of sterols a day--the equivalant of 3 phytosterol tablets a day.
• Lots of fruits & vegetables & primarily a vegetable protein diet.
• Click here to see Dr. Jenkins' articles on the Portfolio Diet

Janet Brill's Cholesterol Down! diet uses the Portfolio Diet guidelines--here are her recommendations.

 

Twice a day:

1 gram of phytosterols or phytostanols

10 grams of soy protein

3 grams of psyllium in am & pm

Once a day:

Oatmeal with oat bran

2 TBS Flax seed

1/2 C beans

handful of almonds (1-1 1/2 oz.)

1 apple   

Harvard Heart Letter's Top 11 Foods That Lower Cholesterol--vol. 20(2): Oct. 2009

1.  Oats - soluble fiber

2.  Barley & other whole grains - soluble fiber

3.  Beans - soluble fiber

4.  Eggplant & Okra - soluble fiber

5.  Nuts - 2 ounces a day can lower LDLs by about 5% (based on previous research)

6.  Vegetable oils - I'm not advocating this one, but it's on the Harvard list as a replacement for butter, lard, & shortening

7.  Apples, grapes, strawberries, citrus fruits - these fruits are rich in pectin, a soluble fiber that lowers LDL

8.  Foods fortified with sterols and stanols - 2 grams a day can lower LDL cholesterol by about 10%.  My comment:  skip the fortified margarine & juice & take them in supplement form

9. Soy - consuming 25 grams of soy protein a day (10 ounces of tofu or 3 cups of soy milk) can lower LDL by 5-6%

10.  Fatty fish - the omega-3s lower LDLs & triglycerides.  My comment: skip the fish & go for high-grade pharmaceutical quality fish oil, or the algae vegetarian equivalents.  Note: recent research by Dr. Christopher Gardner of Stanford University has shown that flax does not come anywhere close to the triglyeride-lowering effect of fish oil. Very disappointing. 

11.  Fiber supplements - the least appealing way to get soluble fiber.  2 tsp a day of psyllium, which is found in Metamucil, provides 4 grams of soluble fiber

Last Week's Successful Cooking Experiments:

• Roasted Asparagus Soup - no oil
• Moroccan Stew - no oil
• All-American Amazing Fantastic Chili - no oil
• Homemade Italian Vegan Sausages ala Isa Chandra Moskowitz - just a tiny smidge of oil
• Herbed Ricotta (Boursin Cheese-like) - no oil, made from tofu
• "Sausage Cheese" Pizza with artichoke hearts & roasted red peppers made with a delicious oil-free Kabuli crust.
• Homemade Larabars - made with chia seeds, cocoa, almonds, & dates.  Yum!
• Oil-free humus--didn't miss the tahini--and a great way to add beans to the diet

For now, I'm thinking oats, beans, barley, eggplant, okra, apples, grapefruit, oranges, strawberries, soy, and a few nuts.  Not a bad way to naturally cut the cholesterol.

 

The Healthy Librarian's Friday Four: Diet & Lifestyle Affect Telomere Length, the Multivitamin & Breast Cancer Connection, Estrogen & the Brain of Normal Weight Women, and Olive Oil's Anti-Inflammatory Effects

"When the telomeres become short, then you start cutting into actual chromosomes where there are genes essential for our body.  To prevent the fraying DNA in all those aging cells from seeding maliganant tumors, the body turns them dormant. Your body shuts down more and more cells every day and you become old."

-Emmuanel Skorkalakes, of the Wistar Institue in Philadelphia-

"if too much telomere DNA is lost--for instance, due to excessive cell division--the chromosomes can become unstable, which can increase the risk of cancer.  Where we have been able to look...telomere shortening appears to be a very early and common event in the development of cancer."

-Dr. Alan Meeker, Johns Hopkins researcher who studies telomere shortening-

Four new published studies caught my attention this week when they passed my desk.  Together they add one more piece to the puzzle of how lifestyle & diet so strongly affects our health--and there is no escaping the effect of health on happiness.

• Waist Size, Omega-6 Oil Consumption, & Fiber Intake Affect Telomere Length.  This study was based on measurements of the telomere length in 2284 female participants from the Nurses' Health Study.  The women who had the highest intake of cereal fiber had the longest telomeres.  As intake of  polyunsaturated fats (omega-6s) increased,  and the waist circumference expanded (>32 inches)--telomere length shortened.  The authors say the associations were modest, but "support the hypothesis that body composition and dietary factors are related to leukocyte telomere length, which is a potential biomarker of chronic disease risk."--American Journal of Clinical Nutrition (2010) 91:1273-80, May.  "Association between diet, lifestyle factors, and telomere length in women"  Previous studies have shown that increases in exercise & omega-3 consumption also increase telomere length.  Click here and here

• Multivitamin Use Is Associated with a 19% Increase in Breast Cancer Risk in a Swedish Study.  This study followed 35,329 cancer-free Swedish women for 9 1/2 years to determine if there was any relationship between multivitamin use and breast cancer.  Although the study found a 19% increase risk of breast cancer associated with multivitamin use--the authors can only speculate as to the reasons.  Because the multis contain so many different vitamins & minerals it's difficult to know what might be responsible for the breast cancer association.  The authors speculate that folic acid might be a "suspect".

"Folic acids in supplements could possibly increase the risk of breast cancer.  High doses of folic acid from supplements or fortified foods are of concern because synthetic folic acid is more bioavailable than folate from natural food sources and, hence, potentially more potent in promoting cancer growth."  (note: The U.S. fortifies processed foods & cereal products with folic acid.  Sweden does not.)

"Findings from animal studies showed that folic-acid deficiency reduced chemically induced mammary cancer."

Additional studies have shown increased breast cancer with folic-acid supplementation (synthetic), but decreased breast cancer when folate from food sources was increased.

Other adverse components of the multivitamin that the authors consider are: iron and zinc.  Multivitamin use has also been associated with a significant 5.3% increase in mean breast density--which is a risk factor for breast cancer. 

It's difficult to draw conclusions here--and as researchers ALWAYS SAY, "Further study is warranted."  Especially since more than 40% of women take multivitamins.  Article cited: American Journal of Clinical Nutrition (2010) 91:1268-72, "Multivitamin use and breast cancer incidence in a prospective cohort of Swedish women"

Bottom Line: Eat food--not supplements.  As Dr. Joel Fuhrman says, "Only by eating an assortment of natural foods that are micronutrient-rich can you get enough of these compounds to protect yourself from the common diseases that afflict Americans."

• Declines in Estrogen Really Can Affect Your Thinking--If You Have a Normal Weight.  Postmenopausal women with normal body mass indexes (BMI) of 18.5-25 experience more rapid declines in memory, verbal fluency, and visual-spatial processing than women with BMIs above 25.  It's the estrogen, baby!  Women with higher BMIs don't necessarily experience the "estrogen brain drain" because they have more circulating estrogen being produced by their fat tissue.

I discovered this provocative study through a Medscape blog authored by Dr. Alan Jacobs, a specialist in clinical neuroendocrinology--a combo of neurology, psychiatry, ob/gyn, and medical endocrinology. 

Here's a Dr. Jacob's brain tip: Because of his extensive research he personally takes 600-800 mg/day of DHA (Omega 3's contain both DHA & EPA) for brain health.  For his patients with mild cognitive impairment he prescribes 2000 mg/day of DHA to protect against Alzheimers.  

He also notes:  "Current neuroscience views a likely window of benefit lasting approximately 7 years post-menopause where estrogen replacement therapy may protect a woman from AD/unhealthy brain aging for decades down the road, and that this protection, however strong or slight, cannot be attained by starting estrogen at 65 or 70--and that estrogen need not be taken all the way up to the age of risk for AD (ie>65)  For Dr. Jacobs blog  (look under physician blogs--Diabetes & Endocrinology. Click here  You will have to register for Medscape if you want to access his blog--but it's free & easy to do.  If the link doesn't work--google: Heads and Tales: The Neuroendocrine Blog of Alan R. Jacobs, MD   Article cited: Psychoneuroendocrinology (2010) 35:516-524, "Accelerated postmenopausal cognitive decline is restricted to women with normal BMI: Longitudinal evidence from the Betula project.  For more on the brain & estrogen connection click here.

• Extra-virgin Olive Oil That is High in Phenols (anti-oxidants) Can Turn-off Pro-inflammatory Genes--Offering a Possible Explanation for Olive Oil's Health Benefits.  This was a small study, run on 20 people-all with metabolic syndrome--comparing the effects of eating high-phenol extra-virgin olive oil to that of low-phenol extra-virgin olive oil.  Note:  It's likely that the extra-virgin olive oil commonly available in grocery stores does not have a high-phenol content.  As mentioned in a previous post on wine & olive oil--high-phenolic olive oil is the green first-harvest-press variety.  Click here for that post.  But don't forget that olive oil is still 120 calories a tablespoon & 14 grams of fat.There are many other fruits & vegetables that exceed olive oil in anti-oxidant/phenol content!  Tipster for this article: Medical Librarian Mary C.

If you're looking for a green first-press olive oil, M.G. recommends  Bariani  It's a cold extracted first-press green olive oil produced in California, and available in the U.S.  Article cited:  BMC Genomics (2010) 11:253 "Gene expression changes in mononuclear cells from patients with metabolic syndrome after acute intake of phenol-rich virgin olive oil"

"We identified 98 differentially expressed genes when comparing the intake of phenol-rich olive oil with low-phenol olive oil. Several of the repressed genes are known to be involved in pro-inflammatory processes, suggesting that the diet can switch the activity of immune system cells to a less deleterious inflammatory profile, as seen in metabolic syndrome."

"These findings strengthen the relationship between inflammation, obesity and diet and provide evidence at the most basic level of healthy effects derived from virgin olive oil consumption in humans," study leader Francisco Perez-Jimenez of the University of Cordoba, Spain.

Saturday Shares: Brain Science Podcast on the Myth of Alzheimers, Alkalol for Cold Control, Too Much Alcohol Shortens Telomeres, Entertaining without Cheese or Cake, and Kathryn Stockett's "The Help"

Click here to go to the web version of this post with all the links if you've received this via email.

What a terrific Saturday it was.  Jam-packed with finishing-up reading Kathryn Stockett's, The Help, for book club.

Then about a 1/2 hour on my computer to catch up on a couple of new health studies that grabbed my attention. 

Followed up with an hour long walk in light rain--while I listened to Dr. Ginger Campbell's interview with Alzheimer's expert, Dr. Peter Whitehouse--before heading off to an all-afternoon bridal shower.

Then it was stopping off at Trader Joe's to load up on healthy fare--to feed the book club crew who were coming to my house at 7:30 pm.

Get home--unload groceries--straighten up the house--bring more chairs into the family room--quickly down some black bean soup for "dinner"--and set-up the book club smorgasbord on my kitchen/family room island.

By then I was definitely starting to feel a bit of a cold coming on--and I had just enough time to get in a quick neti pot saline/Alkalol nasal cleansing to nip that cold in the bud.

So there you have it. 

My Saturday.  And my show-and-tell for the day.

• From my walk: Dr. Peter Whitehouse's not-to-be-missed interview about Alzheimer's and brain aging.
• From my computer reading: A study just-presented at the annual meeting of the American Association of Cancer Research about the negative effects of too much alcohol on our telomeres--which are strong markers for aging.
• Alkalol--my new favorite 1897 pharmacist-developed "nasal douche" to ward off colds
• From my book club smorgasbord:  My first-ever book club "hosting" where I didn't serve any food that I wouldn't eat myself.  No cookies.  No soda pop.  No cheese.  No junk.
• The Help, by Kathryn Stockett.  This is only the 3rd time in the 17 years since this book club has been meeting that all ten of us--men & women--liked the book.  Not everyone LOVED it--but everyone finished it--enjoyed reading it--and we had so much to talk about.

My Saturday Share Number One:  Brain Science Podcast - Dr. Peter Whitehouse on The Myth of Alzheimer's: What you aren't being told about today's most dreaded diagnosis

I'm a big fan of Dr. Peter Whitehouse--he's the real deal--a geriatrician, Alzheimer's expert, researcher, clinician--and he tells it like it is.  Alzheimer's is just a label for a constellation of dozens of different brain conditions that all add up to brain aging.  Whitehouse doubts that we're ever going to find a "one shot" magic bullet to "make it go away"--and throwing money looking for a cure isn't the best use of resources.

I wrote about Whitehouse's book two years ago when I first started this blog--so here's my handy "Cliff Notes" synopsis of what he's all about:

Dr. Peter Whitehouse, one of the leading experts on Alzheimers has pulled down the Alzheimer's curtain in his new book, The Alzheimers Myth.   He frankly charges that the advocacy groups, the researchers, and the pharmaceutical industry all have a vested interest in raising funds for a disease that will be impossible to "cure".  The hope lies in prevention and care.  Be sure to check out his web site.

Why is a cure so elusive:

1. Alzheimers is not one singular disease.  It's impossible to differentiate it from brain aging - it is brain aging.  At age 85-95 it's normal for the brain to age.  If you've seen one Alzheimers patient, you've seen one Alzheimers patient.  There's no one biological profile.

2. What we call Alzheimers is caused by multiple assaults to our brains; including vascular dementia (caused by silent, tiny or large strokes) or atherosclerosis; inflammation; environmental toxins like lead, poor diet, head injuries and just plain normal aging.  Many of these processes start early in life.

3. We don't really know how to diagnose this disease. We all get some of the so-called characteristic plaques and tangles of the brain--it's just a symptom of aging, not  the cause of Alzheimers.  Autopsies of perfectly normal functioning adults have shown the same plaques and tangles as seen in Alzheimers patients.

4. To cure Alzheimers, we'd have to arrest the process of brain aging.

If brain aging and dementia is a concern or interest of yours, be sure to take a look at the link to the Brain Science Podcast's April 14, 2010 eye-opening interview with Dr. Whitehouse that I listened to--along with a helpful transcript.  Click here for that link--which contains additional links to Whitehouse's blog

The Whitehouse Interview Highlights:

1.  What about the genetics of Alzheimer's?  What if you've inherited the "dread Apo E4" gene? Genes Aren't Destiny.

Dr. Whitehouse:  Now, we are increasingly realizing genes modify our risk for diseases—they’re called genetic susceptibilities—that aren’t causative.

And so, there are genes that, if you have them, can modify your risk for getting a late-life dementia, but don’t necessarily cause it. I’ll illustrate that with the strongest associated one—apolipoprotein E4.

Apolipoprotein is a fat-related protein that relates to cholesterol transport. We all have one version of it—either a 2, or a 3, or a 4 (1 went away somehow).

If you have the 4 kind, everybody can transport their cholesterol OK, but that kind makes you more at risk for bad things to your brain as you get older.

And I put it that way because it’s not only so-called Alzheimer’s and memory problems, it’s stroke and it’s other diseases. It’s also bad for your heart. So, if you’re an ApoE 4, you may be more at risk for various heart conditions.

That’s a susceptibility gene.

Dr. Campbell: So, it’s very important, I think, to emphasize that increased risk
is not the same as predicting disease. Genes are not destiny.

2.  What Can You Do to Reduce Your Risk of "Alzheimer's" or Brain Aging? (from the transcript)

• Keep Your Mind Active Doing Something You're Passionately Interested In--That Benefits Your Community.  There are computer programs you can try. Do you do crossword puzzles? Do you
  do Sudoku? I don’t think what you do with your brain is really that important, as long as you enjoy it and do it. I would have a caveat to that, and say if you use your brain to help other people, that’s probably best, because every sage, every religious leader says helping other people is the best way to help yourself. So, keeping your brain active in a community helping other people, I think, is the most important thing.
• The Importance of Exercise.  People have a sense that being physically fit is important for your health in general. But I think it’s important to emphasize it’s particularly important for your brain, not only because it supports your heart and the pump to the brain, but also because of a lot of evidence that exercise, itself, helps brain function.
• Low Glycemic Mediterranean Diet.  I’m (Dr. Whitehouse) personally a believer in something like the Mediterranean diet, which is not what most of us follow, and getting rid of too much red meat, too many processed foods, foods that are high in sugar. So, a low glycemic index, roughage, fruits and vegetables, that’s the way to go.  A just published (early release) Columbia University study in the Archives of Neurology shows a 40% reduction in the risk of developing Alzheimer's with a plant-heavy Mediterranean diet--including omega-3s, nuts, cruciferous vegetables, fruits, and dark leafy greens.  Click here for the Columbia study and my earlier post with Dr. Gomez-Pinilla's advice on "feeding" the brain.
• A Good Healthcare Provider.  I would add number four is have a good healthcare provider that you trust to have a relationship with, because there obviously are things that go along with brain aging where you need a doctor’s attention occasionally, and you should have that relationship to build on.

3.  Making Money on Alzheimer's Disease

Dr. Peter Whitehouse:  I think we have amazingly distorted our notions of health because of an unholy alliance between two isms—scientism and capitalism.

Now, I’m a scientist, and I believe that science can do powerful things. Scientism is the religion that science can do more than perhaps we are right to believe that it can. So, it’s the faith that science, with enough money, can do anything.

And, of course, short-term capitalistic approaches to health have led to the dominance of multinational pharmaceutical companies, and to the "commodification"—to use that word—of everything medical.

So, doctors do what they get paid for, and drug companies use direct-to-consumer marketing to convince people that their pills are wonderful. Frankly, I think we should get rid of direct-to-consumer marketing in this country.

We’re only one of two countries in the world that have it, and I think it is basically a social harm.

Dr. Campbell: Related to that is the fact that every time we see a patient, because of the way reimbursement works, we are forced to label them with a diagnosis, because we have these thick books full of codes for diagnoses. And so,doctors are sort of pushed into labeling people ‘Alzheimer’s disease,’ to a certain extent, aren’t they?  Even the doctors who don’t have any financial rewards from, say, prescribing drugs or whatever, still are sort of being cornered.

My Saturday Share Number Two:  Cutting Back On Alcohol Can Prevent Your Cells From Aging Before Their Time.  Too Much Alcohol Damages Our Telomeres--The Protectors of Our DNA--Speeding Up Aging & Cancer Risk

I'm fascinating by the whole science of telomeres.  They are markers of how fast (or how well) we are aging--they normally shorten the older we get.  But "good behavior" has been shown to lengthen them: Like eating lots of omega-3s and exercising regularly.  So, now we know to watch out for drinking too much alcohol--because it shortens telomeres--speeding up aging--and increasing cancer risks.  Definitely something to share with any teen-agers or twenty-somethings you happen to know who are tipping a few too many.  For the NPR summary click here.  For the American Association of Cancer Research press release click here. To read my earlier posts on telomeres, click here here and here.

My Saturday Share Number Three:  Alkalol--My New Favorite Cold Crusher/Cure

 

Back in December, when I was moaning about how I missed my now-off-the-market Zicam Nasal Gel, a New York reader wrote to tell me:  "Also try using Alkalol with your Neti pot. It's a very popular remedy in our neck of the woods here in NY!"

I passed his recommendation on to a friend when she had a terrible cold--and her neti pot was not doing the trick.  She was an instant fan.  So, one day when I felt a cold coming on--in spite of using a neti pot to "nip it in the bud"--I headed over to CVS to give Alkalol a try.  OMG!  It's amazing.  It opened my sinuses, and it kicked any newbie cold germs right out of my nasal passages. In other words--the cold vanished.

It was developed by a Massachusetts pharmacist, James P. Whitters, back in 1896--and it's still family-owned by Whitters' grandson, James P. Whitters III.

It's made with methol, eucalyptus, thymol, camphor, and oils of wintergreen, spearmint, pine, and cinnamon.  Its "an alkaline saline solution specifically formulated to clean and moisturize the nasal passages, dissolve mucus, kill germs and bacteria, and provide natural relief from the symptoms of sinusitis and allergies."  You can even use Alkalol as a mouthwash or gargle.

You definitely need to dilute it with water--or you'll get the same strong sinus popping sensation you can get when you eat strong horseradish or wasabi.  I mix 1 ounce of Alkalol with 7 ounces of warm water, together with my neti pot mixture of 1/2 tsp. salt, and 1/4 tsp. of baking soda.  Click here for my neti pot/cold prevention post.  Click here to read more about Alkalol.

One last thing: I had to ask the 70-something pharmacist for Alkalol--it was behind the counter and he was the only one in the store who even knew what it was.  They keep a very small supply.  My friend had to have her pharmacist order a bottle--but it was there the next day.  I paid about $5.00 for a 16 ounce bottle.

Saturday Share Number Four:  My Book Club Smorgasbord Goes Healthy.  No Cheese.  No Cookies. No Brownies. No Soft Drinks.

My "Old" Unhealthy Book Club Smorgasbord

Feeding the 5 couples that make up this over-17-years-standing book club has always been a "piece of cake".  Just pick up some good cheese, hummus, baba ganoush, fruit, veggies, crackers, cookies, brownies, candy, nuts, sugar-free Fresca & Coke, and a bottle of wine.  Spread it all out on the island in my family room & Voila! Easiest entertaining you can imagine.

Last Saturday I decided that I couldn't feed this kind of junk to my friends any longer.  Enough already. 

This time I spread the family room island with strawberries, blackberries, clementines, crusty bread, healthy blue corn chips, "homemade" guacamole, salsa, Dr. Kracker Klassic 3 Seed Flatbreads, hummus, Trader Joe's Red Pepper Spread with Eggplant & Garlic, Trader Joe's Bruschetta, Trader Joe's Roasted Red Pepper & Artichoke Tapenade, miniature red, yellow, & orange sweet peppers, and as a concession to giving up the cookies,  I broke up bars of Trader Joe's Swiss 71% Dark Chocolate.

Instead of Fresca & Diet Coke, I had sparkling water with cut-up lemons & limes--and a great pinot noir called:  Cloudline.

No one complained a bit--they loved the spread (I think) and we ate almost everything up!

My Saturday Share Number Five:  Kathyrn Stockett's The Help.  When 10 men & women with diverse reading tastes all like a book--it's got to be good.

Rarely does everyone in my book club unanimously like a book.  We've got our distinct camps: those who like the dysfunctional family stories; those who like non-fiction--biographies, current events, science, history--and those who just want a "rattlin' good yarn".

This book filled the bill for all of us.  Who couldn't resist a novel set in 1962-64 pre-civil rights Jackson, Mississippi--with a story told from the perspective of the maids who work for the bridge-party Junior League set, raising & loving their children and keeping their family secrets?

It's was the time of Jim Crow laws--Medgar Evers' bullet-in-the-back assassination by the Ku Klux Klan--a time when a maid could go to jail on the accusation that she stole a piece of silverware from her employer--and a time when a young man could get his face bashed in if he used a toilet reserved for whites.

Lots to talk about.  And for me, this was one of the most enjoyable reads I've had in a year--and when I finished, I was reading through tears.

The book is more than a story of pre-civil rights Mississippi.  It's about taking risks to move forward--and change your life.  It's about strong friendship--how women support one another--and how it makes life's worst bearable.  It's about how we're unknowingly shaped by the culture and companions that surround us.  And it's about how easy it is to make assumptions about someone else's life--and be dead wrong.

"There is so much you don't know about a person. I wonder if I could've made her days a little bit easier, if I'd tried.  If I'd treated her a little nicer.  Wasn't that the point of the book?  For women to realize, We are just two people.  Not that much separates us.  Not nearly as much as I'd thought."

The Healthy Librarian's Brain Back-Up: Sugar Raises Triglycerides, Fat Damages the Brain, Marriage and Health, Tips From Integrative Medicine Physicians, Estrogen and the Brain

"Once You're Through Learning, You're Through"

-John Wooden, retired UCLA basketball coach, age 99-

If you received this via email Click Here to get the web-version of this post--with all the links.

OK, guys, bear with me.  I'm going to do something I rarely do--be brief.

I'm long on information and short on time.

If I don't blog now about some of the thought-provoking new articles I've read this week--and some recommendations from readers--they'll get pushed aside by the next new studies or articles to cross my path.

So here's what I've been reading this week:

It's Time to Ditch the Sugar Once and For All!  Sugar is Shown to Increase Triglycerides, Lower HDLs, and Increase the Risk of Metabolic Syndrome, Cardiovascular Disease, and Stroke.

We already know that excess sugar can pack on the pounds, put you at risk for type-2 diabetes, and cause blood sugar spikes that damage the brain--no I'm not making that last one up--click here for "that story".

But here's the "hot off the press" news just published today in JAMA  showing that sugar can raise triglycerides and lower HDLs, increasing our risk of heart disease and stroke.

The JAMA article is based on the latest analysis of data from the 1999-2006 National Health and Nutrition Examination Survey (NHANES)--and it backs up recent findings from the Framingham Heart Study. 

Bottom Line:  Increased sugar consumption promotes elevated triglycerides and lower HDLs--which are strong markers for metabolic syndrome and cardiovascular disease.  And if you want to know exactly why high triglycerides are so nasty read my earlier post: "Why You Might Want to Keep Your Triglycerides Under 80. Following the New AHA "Ditch the Sugar" Guidelines Will Help!"

And there's more bad news when it comes to high triglycerides--it increases the risk for strokes. "Bad News: High Triglycerides Are Linked to Stroke Risk. Good News: You Can Do Something About It!"

Being Fat Is Bad for the Brain--New York Times'  writer  & evolutionary biologist Olivia Judson has compiled the latest research on why belly fat is bad for the brain.  Click here for her article, Brain Damage in the April 21, 2010 New York Times.

• Belly fat at age 40 puts one at a higher risk for dementia in one's 70's--California study.
• Folks who were overweight in their 40's had a more rapid decline in their brain function as they aged--compared to their thinner counterparts.  Swedish study.
• A study of middle-age people (44-66 years old) found "that the obese tended to have smaller, more atrophied brains than thinner people."

Judson's well done piece continues with more studies, complete with journal citations, and she speculates as to the reasons why overweight people are at a greater risk for dementia--and more importantly--is it possible to turn the process around?   Seems fairly obvious to me--inflammation, elevated cholesterol, hypertension, type-2 diabetes all affect the blood vessels of the brain--as well as the heart.

To read more about the belly fat--brain connection click here and here.

Is Marriage Good For Your Health?  That All Depends.  But It Pays To Be Nice To Your Spouse!

Tara Parker-Pope's article, Is Marriage Good For Your Health, published in the April 18, 2010 New York Times Sunday Magazine is fascinating.  Click here for the article.

It's a worthy read, based on 30 years of stress/immune function research conducted by the Ohio State University duo, viral immunologist Dr. Ronald Glaser, and his wife, psychiatrist Dr. Janice Kiecolt-Glaser-- as well as researchers from the University of Chicago, the University of Utah, and the University of Virginia.

• Your marriage affects your immune system--for good or for ill.
• A good marriage brings health & well-being--with less chance of having pneumonia, surgery, cancer, and heart attacks.
• A troubled marriage, or a nasty divorce will adversely affect your immune system.
• If you're single and never married--you're apt to be healthier than those who have divorced.
• Any health advantage from marriage comes from the quality of the relationship--not the institution of marriage.

Here are some gems:

1. The Glasers conducted a fascinating experiment on married couples to measure how quickly their skin healed when their arms were subjected to eight tiny blisters--using a dermatologic blistering device.  After the procedure the couples were asked to talk for 30 minutes.  At one session they were asked to talk about subjects that evoked conflict and tension.  At another session they discussed topics that evoked pleasant, loving, supportive feelings.  The results were remarkable.  When couples argued it took a full day longer for the blisters to heal, than when they discussed something pleasant.  The couples who exhibited the highest hostility when they argued, took two full days longer to heal their blisters, than those who had less animosity.

2. "Kiecolt-Glaser told [Parker-Pope] that the overall health lesson to take away from the new wave of marriage-and-health literature is that couples should first work to repair a troubled relationship and learn to fight without hostility and derision.  But if staying married means living amid constant acrimony, from the point of view  of your health, 'you're better off out of it."

3. From Timothy W. Smith's research on couples who have been happily married for around 36 years:  Smith found the quality of one's marriage even affected coronary calcium scores. "The solution isn't to stop fighting.  It's to fight more thoughtfully.  Difficulties in marriage seem to be nearly universal.  Just try not to let the fights be any nastier than they need to be.  Saying, "Honey, you're driving me crazy!", a pat on the back or a squeeze of the hand, all signal affection in the midst of anger. "Most of the literature assumes that it's how bad the arguments get that drives the [negative health] effect, but it's actually the lack of affection that does it."

Advice from the Glasers based on 30 years of studying the effects of stress on health & marriage:

• Take time off together and make sure disagreements don't degenerate into personal attacks.
• Don't fight dirty.  Never go far enough down the road where you hurt each other.  Know enough to avoid those kind of arguments.
• Some level of stress is inevitable--even in the happiest of marriages.  So use those moments of stress as an opportunity to repair the relationship--rather than damage it.
• An on-going disagreement is so uncomfortable.  "It's a pit-in-your-stomach kind of thing.  But when your marital relationship is the key relationship in your life, a disagreement is really a signal to try to fix something."

Advice from Six Top Minnesota Physicians Who Practice Integrative Medicine.

A big "Thank You" to the Minnesota reader who sent me this Minnesota Monthly article, Heal Thyself, by Sarah Moran, that appears in the magazine's May 2010 issue.   Click here to read the sage advice of these six physicians.

"People are clamoring for--doctors who uncover the root cause of illness instead of just treating or masking the symptoms--physicians who take body, mind, and spirit into account and look carefully at the influence of lifestyle habits like diet, activity, and rest."

Dr. Thomas Sult on Digestive Health:

• For digestive health eat whole foods. Unprocessed fruits, vegetables, nuts, seeds, lean protein, and whole grains result in more probiotics, the "good" bacteria in your gut that detoxifies, improves immune function, and aids digestion.
• Choose foods with soluble fiber, like shallots, bok choy, chicory, garlic, and onions.  They encourage growth of good bacteria.
• Eat fermented foods regularly.  Make or find live fermented vegetables, sauerkraut, kefir, kimchi, and miso, which breed probiotics.

Dr. Carolyn Torkelson on Breast Cancer Prevention:

• Maintain a healthy weight.  There's a connection between obesity and breast cancer.  Estrogen production in fatty tissue may be to blame.
• Reduce omega-6 fatty acids, found in fast food, and polyunsaturated vegetable oils, and increase omega-3 fatty acids, found in cold-water fish.  Consider daily supplements of 1-2 grams of fish oil.
• Ask your doctor to check your vitamin D level.  There may be a relationship between low levels and breast-cancer risk.
• Drink green tea.  Its antioxidant properties may decrease risk.

Dr. Henry Emmons on Dealing With Depression and Anxiety:

• Exercise. Mild aerobic exercise quells anxiety.  Vigorous aerobic exercise reduces sluggishness.
• Take a daily B vitamin complex, 2,000 mg of an Omega-3 fatty acid supplement, and 2,000-4,000 IUs of vitamin D
• Calm your mind with meditation, breathing, and yoga practice.
• Develop close, meaningful relationships.
• Eat healthy foods.  Learn your Ayurvedic type to further tailor your diet.

Check out the entire article--it's a quick worthwhile read!

Hormone Replacement and the Post-Menopausal Brain.  Why Timing Is Everything!  Here's Hoping.

Don't miss Cynthia Gorney's balanced ground-breaking article, The Estrogen Dilemma, that appeared in the Sunday April 18, 2010 New York Times Magazine.  Click here for the article.

Millions of women either stopped taking hormones--or decided not to start them after the Women's Health Initiative was abruptly ended in 2002.  Too bad it was studying the wrong kind of hormone replacement--estrogen from the urine of pregnant mares--and a synthetic progestin--Wyeth's Premarin and Prempro.

Gorney does an excellent job of explaining why the W.H.I. didn't end up telling us what we really need to know about the benefits of hormone replacement--or how estrogen can benefit the post-menopausal brain when hormone replacement is started at the right time--within a small window of time--when a women is in her fifties.  But timing seems to be everything.  And the hormone replacement needs to be the bio-identical kind--estradiol and natural progesterone.

"That’s why University of Southern California brain scientist Roberta Diaz Brinton says that the timing hypothesis — the proposition that estrogen could bring great benefit to a woman who starts it in her 50s while having the reverse effect on a woman 10 years older — makes sense even though it is still experimental.

She and other scientists know there are ways estrogen improves and protects the brain when it is added to healthy tissue. It makes new cells grow. It increases what’s called “plasticity,” the brain’s ability to change and respond to stimulation. It builds up the density and number of dendritic spines, the barbs that stick out along the long tails of brain cells, like thorns on a blackberry stem, and hook up with other neurons to transmit information back and forth. (The thinning of those spines is a classic sign of Alzheimer’s.)

But when estrogen hits cells that are already sick — because they’re dying off as part of the natural aging process or because they’ve been damaged by beta amyloid — something else seems to happen. Dropped in as a new agent, like the wrong kind of chemical solvent sloshed onto rusting metal, estrogen doesn’t strengthen or repair. It appears useless.

Sometimes it sets off discernible harm. You may recall additional W.H.I. news a few years ago about hormones increasing the risk for aging-related dementia; those stories emerged from a subgroup of W.H.I. participants who were all at least 65 when they started the hormones. There are arguments about that data, like nearly everything else connected to the W.H.I., but the age factor alone reinforces what Brinton and other timing-hypothesis researchers observe in the labs when they give estrogen to ailing cells.

“It’s like the estrogen is egging on the negative now, rather than the positive,” she said.

“We know that if you give neurons estrogen, and then expose them to beta amyloid, many more will survive. But when we expose them to amyloid and then give them estrogen — now you don’t have survival of the neurons. In some instances, you can actually exacerbate their death.”

And since once again it will be years before we get to the bottom of the estrogen dilemma--and find out if the combination of right timing and taking natural hormones at ever-decreasing doses as one ages--is a wise decision--Gorney leaves us with this to consider:

"Every midlife woman I know keeps redrawing for herself the defensible lines of intervention in the “natural” sequence of human aging.

Obsessive multiple plastic surgeries are silly and desperate. Muscles kept in good working order are not.

Where on that spectrum is a hormones-saturated pharmaceutical patch? What if the timing hypothesis is even partly right?

Suppose all we learn about replacement estrogen, in the end, is that if it’s started early enough it might protect the heart and the brain, and that its chemistry makes some of us feel more the way we did at 40 than the way our mothers did at 65?  Not an elixir of youth. More like . . . reading glasses."

Certainly something to think about!

To read more about the estrogen debate check out:  "Is It Time to Reconsider Hormone Replacement Therapy? Winnifred Cutler's "Hormones and Your Health: The Smart Woman's Guide to Hormonal and Alternative Therapies for Menopause"

There are even more excellent reads in the April 18, 2010 New York Times Magazine "The Science of Living a Healthy Life"

Consider taking a look at:

Weighing the Evidence of Exercise--Does working out really help your lose weight--or keep it off?

Dr. Does-It-All: He publishes books, writes for magazines and newspapers, hosts TV & radio shows nd still performs surgery every Thursday.  How Mehmet Oz became America's doctor.

Oops!  I did it again.  Thought I'd knock this off in one hour.  Not even close.  Sorry!

A Nitric Oxide Vascular Booster Shot. Remembering My Dad and Father-in-law with a Sardine Swiss Chard Gratin

1.  Nitric oxide is absolutely essential to vascular health--a finding that won the Nobel Prize for Medicine in 1998.

2.  It relaxes blood vessels, selectively boosting blood flow to the organs that need it.  It prevents white blood cells and platelets from becoming sticky, and starting the buildup of vascular plaque.  It lowers blood pressure.

3.  But with every meal of processed oil, dairy or meat we eat, within minutes there is damage & injury to the "life jackets" of our vascular health--which is the single layer of endothelial cells that line all of our blood vessels.

4.  The essential building block for nitric oxide production is an amino acid that is found in rich supply in plant foods.

5. And what can you eat to insure that your endothelial cells will have the raw materials to produce this healing nitric oxide?  Beans & leafy greens.  Load up on kale, collards, Swiss chard, bok choy, & beans and you will be well on your way to healing the linings of your blood vessels.

6. Dr. Esselstyn's patients who adopted a strictly plant-based diet brought about rapid restoration of their endothelial cells' capacity to manufacture nitric oxide--and restore circulation.

-Dr. Caldwell B. Esselstyn, Jr., M.D., Prevent and Reverse Heart Disease-

If you received this post via email, click here for the web version.

Lately, I've been craving Swiss chard.  It's in my shopping cart every time I go to the grocery store--and believe me--I go to the grocery store a lot.

Provencal Greens soup--made with just Swiss chard, dandelion greens, leeks, and vegetable broth.  Can't get enough of it.  Click here for the recipe

So when I saw Martha Rose Shulman's recipe for a Sardine and Chard Gratin in the New York Times on March 29, 2010 I knew I was going to give it a try.  

Now that was a pretty crazy thing for me to do--because number one:  I've never let a sardine pass my lips, ever!  Sardines were my dad's all-time favorite food--but as a kid, their fishy smell and the whole slimy look of canned sardines sent me running out of the kitchen. And number two:  I rarely eat fish these days.

And for years I wouldn't give Swiss chard the time of day, either!  My father-in-law LOVED Swiss chard, and grew it in his summer garden before he retired to Florida.  He was always trying to get me try his chard.  Never even took a single bite.

Now it's always in my fridge, and I blend it into Green smoothies, saute it with garlic, and use it anyway I can think of.  Love it.  If only my father-in-law could see me now.

As soon as I read that Martha Rose Shulman's gorgeous gratin would take 3 pounds of Swiss chard to make--I was bound and determined to give it a try--in spite of those sardines.

My dad and my father-in-law both died from massive strokes--long before we knew a thing about nitric oxide, Swiss chard, or omega 3s.   If only they had known what we know now.

I made my chard gratin when Passover ended--and I could top it with bread crumbs. 

Two days after we enjoyed the Swiss chard gratin I came across this article published last January in the Journal of the American Geriatric Society, with a most appropriate title:  "Impaired Endothelial Nitric Oxide Bioavailability: A Common Link Between Aging, Hypertension, and Atherogenesis?"   So does this mean that you're only as young as your nitric oxide supply holds out?

"Chronological age should no longer be viewed as an irreversible cardiovascular risk factor.  The concept of "vascular age" may be a more useful construct in determining vascular risk.

Accelerated vascular aging and the "age related" vascular disease processes of hypertension and atherosclerosis are associated with impaired endothelial nitric oxide bioavailability at relatively early stages. 

Pharmacotherapeutic intervention aimed at improving endothelial nitric oxide bioavailability has the potential to alter these related disease process."

And who says you need a drug to improve endothelial nitric oxide bioavailability?  A plant-based-diet with plenty of Swiss chard, kale, collards, bok choy, legumes, and beans does a fine job--without the side-effects!  Just ask Dr. Caldwell Esselstyn, Jr. if you don't believe me.

As for the Gratin--it was everything Martha Rose Shulman had promised: 

"This is unbelievably easy to make and so delicious I can hardly believe it's made with sardines from a can. The recipe is a simplified version of a traditional Provencal dish made with fresh sardines and spinach  You can easily throw this dish together on a weeknight."

For the vegans who are reading this--please forgive me for the sardine slip-up.  That's what happens when you're "veganish".  I still do occasionally eat fish--about once every-other-month.  Blame it on my 8 day Passover fast from beans, grains, legumes, and rice.  I needed some protein.

But honestly, I loved those sardines!  I truly am my father's daughter.  And eating them made me think of him and put a big smile on my face!  Sis--have you ever tasted sardines?

And I know I will also lose points for including a recipe that requires a bit of olive oil to give it a true  Provencal taste.  And I'm sure it could be left out.

There's no denying that cold-water fish contain heart healthy omega-3s that have been shown to lower triglycerides, decrease inflammation, as well as reduce the risks of heart disease, stroke, and hypertension.  And even the Environmental Defense Fund puts sardines into the "eco-best category.  Because they are lower on the food chain they have less contaminants.

This dish is dedicated to my Dad who loved sardines, and my father-in-law who loved Swiss chard.  And now I finally understand why.

Dad's Sardine and Swiss Chard Gratin

adapted from a recipe by Martha Rose Shulman

1 3.5-ounce can boneless, skinless sardines packed in olive oil (Martha recommends 2 cans of oil-packed--no need)

1 3.5-ounce can boneless, skinless sardines packed in water

2 1/2 to 3 pounds Swiss chard (about 3 bunches) stemmed--but leave a few inches of stem intact--and wash carefully

1-3 tsp. of olive oil--your choice  (Martha uses 1 TBS.)

1 medium onion finely chopped

2 to 4 garlic cloves, minced

1 TBS. fresh thyme leaves, roughly chopped (or 1 tsp dry)

1/2 cup low-fat unsweetened soy milk

Salt & freshly ground pepper to taste

1/4 cup fresh or dry whole grain bread crumbs.

1. Preheat the oven to 425 degrees. Lightly spray a 2-quart gratin or baking dish. (I used a 10 inch square baking dish) Drain the sardines over a bowl, and separate them into fillets. Set the oil aside.

2. While the chard is still wet from washing, heat a large, heavy skillet over high heat. Working in batches, pile a few handfuls into the pan and stir until the chard begins to wilt. Cover the pan for a minute, then uncover and stir the greens until they have wilted. As each batch collapses, transfer it to a bowl. When you have wilted all of the chard, rinse briefly with cold water, squeeze out excess water and chop medium-fine.

3. Either heat the olive oil (not the oil from the sardines) (or use 1/4 cup of vegetable broth in lieu of oil) in the skillet over medium heat, and add the onion. Cook, stirring, until tender, about five minutes. Add a generous pinch of salt, stir in the garlic and thyme, and cook, stirring, until fragrant, 30 seconds to a minute. Add the chopped, wilted chard and salt and pepper to taste. Stir together for one minute until everything is blended. Add the milk, and stir together for about one minute until you no longer see liquid in the pan. Remove from the heat. Taste, and adjust salt and pepper.

4. Spread half the greens in the bottom of the baking dish. Top with the sardine fillets in one layer. Drizzle a tablespoon or less of the oil from the can over the sardines (or skip this all together), then top with the remaining greens in an even layer. In a small bowl, mix the breadcrumbs well with a small amount of oil--either the reserved sardine oil or fresh olive oil, before sprinkling the crumbs over the chard. 

5.  Place in the oven, and bake 15 minutes until sizzling. Serve hot or warm.

Yield: Serves four to six.

Advance preparation: You can assemble this up to a day ahead of baking. Keep well covered in the refrigerator.

Nutritional count is based on 4 servings per recipe.

Nutrition Facts The Healthy Librarian's Dad's Sardine and Swiss Chard Gratine
Serving Size: 1 serving
Amount Per Serving
Calories	188
Total Fat	9.7g
Saturated Fat	2.5g
Trans Fat	0g
Cholesterol	25mg
Sodium	462mg
Carbohydrate	14.7g
Dietary Fiber	4g
Sugars	3.9g
Protein	14.1g
Vitamin A 167% Vitamin C 75% Calcium    20% Iron 21%

Dr. Ken Fujioka of the Scripps Clinic. Advice on Exercise and Weight Loss for the Middle-Aged Set. High-Intensity and Interval Training is a Must!

 

"Exercise is not real great at causing weight loss.  But every study has shown that if you want to keep the weight off you have to exercise. "

-Dr. Ken Fujioka, Director of Nutrition & Metabolic Research, and the Director for Weight Management, Scripps Clinic, La Jolla, CA-

Click here to go the the web version of this post if you've received this via email.

When I wrote last week's post, Want to Prevent Weight Gain As You Age? Plan on 60 Minutes a Day of Exercise, Kick It Up a Notch, or Consider Interval Training"  I wanted to include what I had learned from Dr. Ken Fujioki's March 17th NPR interview with Allison Aubrey.  I couldn't track it down at the time--but I finally located it.

For me, Fujioka really adds another dimension to my understanding of why high-intensity exercise is so important as we age, and why it's so darn hard to shed pounds as I get older.

• When we lose weight--our metabolism goes down.
• When we lose weight--our body will make us think a lot about food.
• As we age, our maximum heart rate continues to drop--making it harder to burn calories
• If you want to lose the dangerous visceral abdominal fat--you have to exercise
• If you want to burn fat--you need to kick it up a notch--with intervals getting your heart rate into the 85% range.

If you feel like you're exercising a lot--and not shedding the pounds--read what Dr. Ken Fujioka has to say about getting older--and heavier.

Why You Need to Exercise If You Want to Keep the Weight Off

If you lose weight from dieting, or just by eating less, or by starting a more healthy diet, there is no way to get around all the metabolic and chemical processes going on in your body that will conspire to put that weight right back on--unless you exercise!

If you lose just 10% of your weight--a very common weight loss--the body will do two things.

1.  It will make you think more about food--encouraging you to put that weight right back on--which is why it's so important to have good dietary habits.  Think low caloric density fruits and vegetables & low glycemic high fiber foods.

2.  When you lose just 10% of your weight--your body will lower your metabolism more than 10%--more than the weight you've lost.  So now you're stuck with a slower metabolism--and unless you are exercising to burn more calories, there's no way you can maintain your weight loss.  You're doomed to stop your weight loss at that point--and you'll start regaining.

How Interval Training Can Help Keep Your Weight Off

According to Dr. Fujioka, when you drive up your heart rate in interval training--into the 85% of your maximum heart rate zone--there are a couple of things that start going on.

1.  First of all you turn on a protein in the muscles that will literally direct calories toward the muscles, and not toward your fat cells.  This happens for about 2 to 2 1/2 hours after you exercise.

2.  Fujioka is a big fan of interval training, as opposed to moderate intensity exercise.  This idea of trying to exercise in the "fat-burning zone" around 65% of your maximum heart rate--the so-called "moderate exercise"--clearly won't help you with weight loss in the way that getting your heart rate up to and above 85% of maximum will. 

3.  According to Fujioka, there are very good studies that have looked at this, and have shown that if you want to lose weight and keep your weight down with exercise--that you really have to drive the heart rate up much higher than the "fat-burning zone", that unfortunately is on most of the treadmills and stationary bikes in most gyms.   Just forget about it!

4.  And don't forget about Professor Steve Boutcher's research at the University of New South Wales.  According to Boutcher our bodies produce higher levels of a chemical compound called catecholamines  during heart-rate-raising sprint-type intervals.   "These are hormones that tell the fat cells to release their fat."

How Safe Is Interval Training for Folks Who Are Just Starting Out?  Can Anyone Do It?

"This is a really tough one," says Fujioka.  "Obviously, as someone gets heavier,  they have more risk factors, whether it's diabetes, high cholesterol, or high blood pressure.  There are some risks to doing exercise--but they're low."

At the Scripps Clinic, Fujioka & his colleagues see from 50-100 patients a day who are trying to lose weight.  When they start to exercise their heart rate goes right up--because they are overweight and out-of-shape to begin with.  So, unknowingly, they are going to drive their heart rate up in the very beginning.  Which is exactly why exercise doesn't feel fun for them--because they aren't trained for it.  So, in effect, when someone is out-of-shape--they are actually exercising in the 85%+ zone when they start out.

But bottom line, Fujioka says, "Whether we can say it's safe or not is a tough call for a physician--but the risks are relatively low as long as you aren't someone who has known heart disease and risk factors."  

The Australian Interval Exercise Study Just Looked at Women.  Do Men Benefit From Interval Training?

Not only will men benefit from interval training, when it comes to weight loss, but they will likely benefit even more than women--because they naturally have higher metabolic rates.  Men are set up better for fat-burning than women.  Blame it on their testosterone and our estrogen.

Getting Rid of Nasty Visceral Belly Fat with Exercise

Forget about looking at the scale when it comes to exercise and weight loss.

When you look at the connection between weight loss to exercise--you may not see changes on the scale--but you'll see changes in inches, because you're losing the visceral fat (central fat) which is the really bad fat that releases free-fatty acids that then drive up cholesterol and blood pressure--and give you heart disease and diabetes. 

Pay attention to this one!  Exercise--particularly this aerobic high-intensity exercise--is especially good for helping to banish belly fat, because it burns those free fatty acids so well.

And guess what?  It will help even more in people prone to putting weight on in their abdominal area.  Fujioka isn't talking the kind of fat you can pinch--like love handles--he means the deep down fat that surrounds our organs.

The latest research to show the benefits of high-intensity exercise on belly fat can be found in:  Hiroyuki Sasai  et al,  "The effects of vigorous physical activity on intra-abdominal fat levels: a preliminary study of middle-aged Japanese men"  Diabetes Research and Clinical Practice  88:34-41, 2010. 

Bottom Line: Time spent in vigorous exercise, over 6.1 METS was significantly related to reductions in intra-abdominal fat, suggesting that vigorous exercise should be prescribed to improve cardiovascular risk factors.

In case anyone has doubts about the need to ditch the belly fat--remember that it is linked to stroke, dementia, heart disease, metabolic syndrome, cancer and diabetes.  Read "This Belly Fat is Going to Be the Death of Me and Now I Finally Understand Why"

What About Centenarians Around the World?  They Stay Slim and Healthy Without High-Intensity Aerobic Exercise. 

Absolutely true!  But they have a completely different lifestyle--an active lifestyle--so they don't have to be marathon runners to keep their weight down.

And yes, the active lifestyle approach can also work.  That is, if you live in a community where you can walk everywhere--as in Europe.  Through the course of the day the long-living centenarians of Sardinia or Okinawa are doing physical work, and walking everywhere, to do their shopping, visiting, and daily work.

In the U.S. we drive everywhere, and we're always trying to figure out the closest place to park our cars, to find the quickest way to get from Point A to Point B.  Time is of the essence.  This is not exactly a lifestyle conducive to losing weight. 

Remember,  people who have successfully maintained their weight loss burn off 2800 calories a week--which is quite a lot--and most of it comes from taking 11,000 steps a day (that's 5.5 miles), in addition to high intensity exercise for at least 2 days a week--in the range of 6 METS--like jogging for about 1 hour.  Click here to read "Everything You Ever Wanted to Know About Losing Weight, Exercise, Stress, and Cardiovascular Risk from an Expert, Dr. Sharon Alger-Mayer. The Best Diet, How Much Exercise, the Hormone Stress Connection, the Best Phytonutrients, and the Healthiest Carbs"

 

Fujioka also reminds us of the Okinawan custom, "hara hachi bu",  which is eating until you are only 80% full--or leaving 15-20% of the food on your plate.  In the U.S. we are "plate cleaners", which is just one more reason why we have to resort to high-intensity exercise.

That Annoying Decreasing Maximum Heart Rate --Why It Makes Weight Loss So Tough As We Get Older

Now this is depressing! 

Think about the standard formula to calculate your maximum heart rate.  Take 220 and subtract your age.  If you're 60 years old--like me--your maximum heart rate becomes 160.  If I'm going to exercise in intervals of 85% of my maximum, that means I need to get my heart rate up to 136.  (Truth be told--since I've been exercising for years--I kick this up a notch--to 148--because 136 feels more like moderate to me)

Compare this to someone who is 30 years old.  85% of their maximum heart rate is 161.  When I've taken hour-long spinning classes with my daughter-in-law, who is 31, she can easily burn in the range of 600 calories an hour.  I'm working and sweating just as hard as she is, and the best I can do is get that calorie burn up to 340 calories for an hour--and that's really kicking butt.  The depressing news is that it only gets harder to kick that heart rate up the older we get.

Here's what Dr. Fujioka has to say about the heart rate as we get older.

"Now it gets really hard to drive your heart rate way up as you get older.  The formula for figuring out your maximum heart rate is 220 minus your age.  As you can see, as you get older you just can't  get your heart rate way up there to drive those calories down."

"So now you're looking more at also trying to get active throughout the day.  (Think: adding a step counter to your repertoire--click here) 

And that's in addition to exercise.  You start to need the cumulative effect of an active lifestyle plus the workout the older you get.  This is so unfair.

My Big Tip:  Get Yourself a Heart Rate Monitor.  There is no better way to know exactly how hard you are exercising.  There is no other way to do interval training.  How else are you really really going to know if you are working at 85% of your maximum heart rate, or when you need to dial it down to the 65% zone.  I've been using a heart rate monitor for years--I'm now on number 2.  My battery just died on Thursday and I need to get it replaced ASAP.  It's just no fun not knowing how hard I'm working, and how many calories I've burned. 

My Must-Have All-Time Favorite Equipment - I wouldn't want to exercise without my F6 Polar Heart Rate Monitor.  It's set up for my fitness level, my minimum &  maximum aerobic heart rates, my age, and weight.  It records how long I'm working out in the aerobic range, my highest, lowest, & average heart rates, and how many calories I'm burning.  I know when I need to kick it up a notch, and when I'm working too hard. And all my exercise sessions are saved so I can see what I've done for the past week.  It's motivating & keeps my honest.  For a great guide to exercising with a heart rate monitor, click here.

Cost:  I got mine for about $100 online. 

My Passover gripe.  It is really hard to eat a "veganish diet" while keeping Passover.  No beans.  No soy.  No rice. No corn.  No grains of any kind.  Thank goodness for quinoa.  No dairy, or eggs, or cheese, or fish, or chicken, or meat.  I'm sick of whole wheat matzoh & almond butter.  I'm sick of just salads.  And yes I've eaten some salmon, cooked with eggs, and made a scrumptious Mina de Masa.

Want to Prevent Weight Gain As You Age? Plan on 60 Minutes a Day of Exercise, Kick It Up a Notch, or Consider Interval Training

 

"As American women age many begin a war with their weight.  A new study shows for normal weight middle-aged women and older who eat a regular diet, 60 minutes of daily exercise is recommended just to maintain and not gain weight as they age.  For overweight or obese women exercising 60 minutes wasn't enough to maintain weight over time."

-Dr. I-Min Lee, Division of Preventive Medicine Medicine and Aging, Brigham and Women's Hospital, Harvard Medical School, "Physical Activity and Weight Gain Prevention," JAMA March 24/31, 2010, 303(12):1173-79

If you've received this via email, click here to get to the web version of this post.

This article appeared in JAMA while I was in the North Carolina mountains for a week, helping my sister-in-law prepare for--and then celebrate my niece's wedding. 

The only exercise I did for 6 days in NC was stuffing guest bags with homemade butter cookies, M & M trail mix, and chocolate covered pretzel sticks, in between eating the homemade butter cookies and M & M trail mix.  And that doesn't count the caramelized onion heirloom mashed potatoes, creamed winter spinach and rainbow chard with Parmesan, macaroni & cheese with white truffle oil, and the amazing caramel creme brulee wedding cake served at the reception.  And yes, I did order the vegetarian meal.

Dancing non-stop for three hours at the wedding reception definitely wasn't enough to burn the calories of everything I ate over six days!

When I got on the scale yesterday I had gained 3 pounds!

I'm here to tell you that Dr. Lee's research is right on the money--in my humble experience.  I don't diet, but I do exercise in that over 21 MET/week range--and I haven't lost a pound in twenty years!  But neither have I gained any weight in twenty years.

Can Exercise Prevent Middle Age Weight Gain?

Dr. Lee's research group had a brilliant idea.  They knew that being overweight was a huge health risk factor.  And they also knew that most diet & weight loss efforts don't last for long.  First you lose, and then you gain it all back.

"We thought, wouldn't it be better to prevent the weight gain in the first place so you don't have to worry about sustaining the weight loss after that?"  Lee said.

To that end, these researchers followed over 34,000 women, starting at around 54 years old, and followed them for 13 years.  All the women ate their normal diet, recorded their weekly physical activity, and weighed in every three years.  The women were divided into three groups based on how much they exercised: 

• The most dedicated exercisers: 420 minutes a week or 60 minutes a day of moderate intensity exercise, like brisk walking; or an equivalent, like 30 minutes a day if they were jogging or running.  This translates into 21 or more METS/week.

• The average exercisers:  150-420 minutes a week or about 20-60 minutes a day of moderate intensity exercise.  This translates into 7.5 to less than 21 METS/week.

• The low volume exercisers:  less than 150 minutes a week of moderate intensity exercise.  This translates into less than 7.5 METS/week.

*Note:  The study actually measured METS (metabolic equivalents) rather than minutes to create a level "playing field". 

Here's how that works out:  The 60 minutes/day group exercised for 21 METS/week.  If you're a walker, that would be the  equivalent of a 3 mph pace (a 20 minute mile) for 60 minutes a day which equals 3 METS.  If you exercise more vigorously, like jogging at a 12 minute mile pace, you could reach 21 METS in just 2 1/2 hours.

Bottom Line:  Only the women who started out with a normal weight (a BMI lower than 25), and exercised in the hard core range of 60 minutes a day (420 minutes a week) were able to either maintain their weight or gain less than 5 pounds over the 13 years--only 4,540 women or 13.3%  of the study participants.  The women with BMIs over 25 continued to gain weight even if they exercised for 60 minutes a day.   To keep weight off as you age--get into the exercise habit early--and keep the BMI below 25!

National Exercise Guidelines Will Get You Healthy--But Don't Expect to Lose Weight!

The Federal government, the American College of Sports Medicine, and the American Heart Association have all advised us to exercise at moderate intensity for a minimum of 150 minutes a week to obtain "substantial health benefits".  According to this study--that's just not enough, if you also want to prevent weight gain.

The Institute of Medicine has recommend that we need 420 minutes of moderate exercise a week  (almost 3 times what the U.S./ACSM/AHA recommends) if we don't want to become overweight. According to this study--that's still not enough, unless you are already at an ideal weight.

The depressing news for all of us who exercise is that we need to kick it up a notch.  Increase the exercise intensity & decrease the calorie intake.

"As people age it's clearly harder to keep the same weight so you have the option of exercising every day for an hour, really understanding that calorie restriction [might] need to be a huge part of your lifestyle because your natural tendency is to gain weight,"  according to Dr. Suzanne Steinbaum, Director of Women and Heart Disease at Lenox Hill Hospital in New York City.

There's No Escape From Exercise If You Want Good Health

Dr. Lee stressed that you shouldn't become discouraged if you can't reach the 60 minutes a day of exercise goal.

"It's very clear that even the lower levels of physical activity reduce the risk of important chronic diseases, including cardiovascular disease and certain types of cancer.  There are still some health benefits."

Bottom Line:  OK exercise might not keep you from gaining weight if you're taking in more calories than you can burn--but the benefits of exercise are tremendous.  Exercise will decrease your risk of heart disease, type 2 diabetes, stroke, dementia, and some cancers.  It will also lower your risk of anxiety and depression.  Read "How Exactly Does Exercise Make Us Healthy?  The Scientific American Asks the Experts" Click here

As Dr. Tim Church reminds us:  "But to me, the most important element of exercise is healthy aging.  There's no pill that assures that you'll be able to play with your grandkids or go duck hunting when you want to go duck hunting or get up and down stairs safely.

And there is one strategy which we know, which works great for aging, and that is being physically active and maintaining physical activity throughout a lifetime."

Why We Gain Weight As We Age

The JAMA article reminded me of an NPR interview I heard a month ago with Dr. Cheryl Phillips, president of the American Geriatrics Society, Dr. Jonathan Wanagat, a UCLA researcher, and Dr. Gail Greendale, UCLA geriatrician and researcher.

Dr. Cheryl Phillips: 

• "There are some particular biological changes that happen as we age.  For one, aging muscles actually contribute to the increase in the amount of fat we store in our bodies."
• "So, if you look at a woman who is 70 years old and compare her to what her body was like at 25 years of age, even though her weight may be exactly the same, she had more percentage of muscle in her body when she was 25 than she does when she's 70."

Dr. Jonathan Wanagat:

• We lose muscle cells as we age, and as older muscles cells get damaged they just don't get repaired as quickly as when we were younger.  We don't know exactly why older muscles start shrinking--but they do. 
• When older muscle cells aren't repaired, Wanagat says "they sort of whittle away and die."  We can blame the loss of muscle fiber & the lack of muscle cell repair on decreases in growth hormone, testosterone, and estrogen.

Dr. Cheryl Phillips:

• "If you think of muscles as being the energy powerhouse of our body, that's where most of our calories are burned. And when we talk about metabolism, what we're really talking about is how efficiently those powerhouse cells--the muscle cells of our body--burn the energy we bring in.
• "If you keep your caloric intake exactly the same as you get older, those unburned calories end up as fat."

Dr. Gail Greendale:

• Exercise is the antidote for weight gain and muscle atrophy! 
• "Countless studies have shown that exercise--even in people in their 80's--works.  It actually helps the muscle cells get bigger and stronger."

Dr. Jonathan Wanagat:

• "We aren't sure exactly how exercise makes muscles stronger--but weightlifting at any age offers low risk and great benefit."
• "We know that exercise actually helps the muscle cells become bigger--and stronger."

Dr. Gail Greendale:

• "As we age the immune system can get out of whack, turning on an inflammatory response when there are no bacteria or viruses to kill, or keeping it on long after the body's invaders have left.  Such inappropriate inflammatory response can actually damage one's own cells in whatever part of the body the inflammation occurs, whether it's in muscles, joints, or organs."
• According to Greendale, strengthening muscles through exercise can help prevent this type of inflammatory cellular damage, as well as the inevitable arthritis that often occurs with aging. 
• Exercise, and muscle strengthening also helps our joints to tolerate the stresses and strains of movement.
• Greendale is currently working on a study to figure out which yoga poses are best for the aging body.  "What are the muscles and joint forces generated by each yoga pose, and will these muscle and joint forces be strong enough to be a training stimulus--that is to say, make people stronger?"  Stay tuned!  I'll definitely be interested in the results of this study.

Kicking It Up a Notch--Interval Training For the Middle-Aged and Slightly Plump

Last week I happened to listen again to an NPR Your Health podcast from August 24, 2009, "Interval Training for the Middle-Aged and Slightly Plump".   I think this just might be the perfect tool for our middle-age tool box.

Here's the pitch:

Steve Boutcher, a professor of exercise science at the University of New South Wales, has research showing that interval training might be exactly what the middle-aged body needs to lose weight.

Professor Boutcher has documented the health and weight loss benefits of performing 20-minute interval workouts on stationary bikes 3 times a week.  He had his participants alternate between 12 seconds of slow, gentle pedaling, and 8 seconds of intense sprints, pedaling as hard as they can.  To read his article published in The American Journal of Physiology, click here.

"The 8 second sprint is doable by all the groups we've looked at--old people, and overweight people.  Everybody, so far, we've tested has been able to do it.  And in the 20-minute bout, the actual heart exercise is only eight minutes.  So it's not actually that much exercise." 

Bottom Line:

"Over the course of four months, participants lost an average of 6 pounds of body fat.  By comparison, those who cycled at a steady pace for 40 minutes, without mixing in the interval sprints, lost less than 2 pounds." 

And it gets even better.  Participants improved both blood pressure and blood sugar readings.

What's Going On?  It's the Catecholamines.

According to Boutcher our bodies produce higher levels of a chemical compound called catecholamines during sprint-type intervals that raise our heart rate.

"These are hormones that tell the fat cells to release their fat,"  according to Boucher.

But you don't need cycle to get that catecholamine-effect.  According to Dr. Tim Church of the Pennington Biomedical Research Center, it's all about the interval--not which sport you pick.  Try fast walking--just throw in some hills and pick up the pace--at intervals, of course.

The goal is to get your heart rate up to about 85% of maximum for short intervals, and then slow your pace back down to slow or moderate.  Church says it's a very efficient way to increase fitness quickly.  That's exactly the routine we follow in my spinning classes. 

So, there you have it.  Now we have even more "must do" activities to fill our days.  Add sixty minutes a day of exercise--unless we decide to pick up the pace and start running (don't think so!)--or switch to interval training.  And don't forget about strength training, to maximize the caloric burn--gotta keep our body's "energy powerhouses" properly stoked if we want to burn up the inevitable goodies that will eventually come our way, like wedding cake.