Fitness Rocks

Adventure Racing

Phil Walker, a listener from Australia, sent me a link to his recent race report from a 24-hour adventure race in which he participated.  The race involved hiking/running, path finding, open ocean kayaking, and keen survival skills.

Click here to read Phil's excellent narrative of the event.

Thanks to Phil for sharing this incredible experience with us.  I really admire the effort and determination that goes into competing in such an event - but after reading about the experience I think my indoor spinning cycle, or a run down by the beach, is all the adventure exercise I will attempt.

Click here to vote for Fitness Rocks at Podcast Alley.

Monte

Are All Sugars the Same?

There is a discussion going on in the Fitness Rocks forum about sugar, and different ways to sweeten foods.  In answering one of the questions I quoted from a book by Andrew Weil.  I am providing a link to his book at Amazon here:

Eating Well For Optimum Health: The Essential Guide to Bringing Health and Pleasure Back to Eating

Dr. Monte

The Evidence against Eating Meat

I don't want to come across as a crazed vegetarian warrior trying to convert the world to my particular point of view - I just find the evidence in support of diets that are heavy on plant-based foods and light on meat to be...well...remarkable.

Two studies I looked at today bear this out.  The first is a review article that looked at the potential benefits of eating very small amounts of meat, or no meat at all.  The consensus of the data from six different studies appears to reveal a significant increase in longevity associated with eating diets low in meat.  People with very low meat consumption sustained over a couple of decades gained about 3.6 years of extra life.

I'm not as focused on life extension as I am on improving the quality of life and reducing the burden of chronic diseases like type 2 diabetes, high blood pressure, heart disease, and cancer. 

Just getting old may not be such a great thing, but being able to get old and remain robust, vigorous, and independent - that would be good.  Being old and not having your day planner filled up with visits to all of your different doctors is an achievable goal. 

What's the best policy to address the rising cost of prescription drugs?  How about the one nobody is talking about - stay healthy.

A plant-based Mediterranean-style diet is an essential part of a program to keep you healthy as you get older.  Regular exercise is another critical piece of the plan, as is maintaining a healthy weight.

Components of a Mediterranean diet are:

1. High consumption of fruits, vegetables, beans, nuts, whole grains, and olive oil.
2. Moderate consumption of fish - once or twice a week.
3. Low consumption of meat, eggs, and dairy products - if you eat dairy, eat low-fat or non-fat products.
4. Limit alcohol consumption to one drink a day.
5. Make olive oil and other healthy unsaturated plant-based fats the primary source of fat in your diet, and limit saturated fat to 7% of total calories.

The second study I looked at today assessed the benefit of eating a Mediterranean diet in people who had coronary heart disease.  Greater adherence to a Mediterranean diet, as described above, was associated with a significant decrease in death rates from heart disease and all other causes as well.  The more a person's diet conformed to the Mediterranean diet; the lower was their risk of death.

The data for the health benefits of plant-based diets and regular exercise is simply overwhelming, and should not be ignored.

References:

Does Low Meat Consumption Increase Life Expectancy in Humans?

Mediterranean Diets and Survival among Patients with Coronary Heart Disease

Oldways Preservation Trust

Weight Loss Drugs - for Dogs?

Please - I can't stand anymore of this. 

The FDA has approved a weight loss drug, Slentrol, for your dog.  Slentrol, manufactured by Pfizer, will cost about a dollar per day and is indicated for dogs who are more than 20% above ideal weight. 

How long before we have canine liposuction and gastric bypass surgery?

Around 40% of dogs are overweight or obese - a consequence of having their human owner's lifestyle imposed upon them.  What better evidence could there be that the human epidemic of obesity is a medical problem we have created for ourselves - not one that was dealt to us by a bad set of genes?  We have provided our dogs with an overabundance of food and an inadequate amount of exercise and they have gotten fat.  I couldn't have designed the experiment any better.

One article I read quoted a veterinarian as saying the drug was an encouraging development because obesity in dogs is such a big problem.  He was also a paid consultant for Pfizer.  Such ethical dilemmas are everywhere in the healthcare professions.

Overweight dogs suffer all the same complications that overweight humans do - type 2 diabetes, high blood pressure, heart disease, increased rates of cancer, and osteoarthritis.

Evidently, many people believe that it is a good idea to "treat" their dog to a meal at their favorite fast-food restaurant on a regular basis - to show their love!  How is slowly killing your dog by feeding him/her burgers and fries a loving act?  When did taking your dog for a walk or playing fetch cease to be an appropriate method of showing affection?

Here are a few Fitness Rocks tips to help with the growing problem of dog obesity:

1.  Your dog can't open the refrigerator or drive the car to McDonalds.  In fact, your dog can only eat what you feed him, and when you feed him.  If we can't keep our animals from overeating how can we possibly hope to prevent ourselves from overeating?

2.  Maybe if you got off the sofa and took your dog for a walk you could both lose some weight.

3.  Get over the idea that overfeeding your dog, your family, and yourself is a way of expressing affection or "rewarding" yourself for whatever you've done well.  How about just patting yourself on the back, or rubbing behind your ears?

4.  The evidence is now overwhelming - not only are burgers, fries, and other fast food bad for humans - they're bad for all living creatures.  Take them off your menu.

5.  Stop hoping for magic that will allow you and your dog to continue living a sedentary, overindulgent lifestyle without ill-effects.

Express your love for your dog, and yourself, by eating a healthy diet and exercising every day.  Obesity is a complicated medical problem with a very straight-forward solution.

The Fitness Rocks audi download "Successful Weight Loss" provides a great discussion and information on making healthy choices for a weight loss program.  Click the icon on the sidebar for more details.

References:

Slentrol Goes to the Dogs

Now Dogs Have Weight Loss Pills

My own article on weight loss drugs for humans

Dr. Monte

Download the Audio File of the Fitness Rocks Teleconference on Successful Weight Loss

Now Available

This is a 90 minute recording of the recent Fitness Rocks teleconference on weight loss.  The teleconference includes a panel discussion between the Fitness Rocks team of experts including a registered dietitian, an exercise physiologist, two psychologists, and me, Dr. Monte.  There is also a 30 minute segment of audience questions and answers.

The program is available for immediate download, just click on the "buy now" link.

Spinach - It's Still a Good Thing

Spinach is loaded with nutrients that will keep you healthy.  We've all heard about the abundant vitamins and minerals in spinach - vitamin C, beta-carotene (a precursor to vitamin A), riboflavin, folate, vitamin B6, and magnesium.  But spinach is also filled with disease-preventing phytonutrients like lutein and zeaxanthin.  These phytonutrients are especially important in preventing macular degeneration, a leading cause of blindness (see my blog about diet and eye health).  The mix of phytonutrients in a diet filled with a variety of different kinds of fruits and vegetables are essential to good health and preventing a host of chronic diseases, including heart disease and some cancers.

Unfortunately, spinach lately has been loaded with E-coli bacteria resulting in several illnesses and even some deaths.  This has made a lot of people, including me, afraid to eat spinach. 

But there is good news in this month's issue of the University of California Berkeley Wellness Letter.  They report that there has never been a case of an E-coli outbreak coming from frozen spinach.  According to the article in the Wellness Letter, frozen vegetables are not only washed before freezing, but they are also "blanched" in boiling water which generally kills most bacteria.

Cooking spinach also helps to kill any remaining bugs.

There is a lot of enthusiasm these days for eating vegetables raw.  Here's an interesting fact - many of the nutrients in spinach, and other vegetables, are not absorbed well by our digestive tract unless the vegetable has been cooked (not overcooked).  The carotenoid phytonutrients in spinach are fat-soluble which means that they will be better absorbed by our body if they are cooked with a small amount of olive oil.

So that's the news for today - the Wellness Letter says frozen spinach is okay.

Monte Ladner, M.D.

Genetic Modification of Food Crops

In follow-up to yesterday's blog I have received two responses to e-mails I sent out to the scientists in the NPR report on declining nutrient levels in fruits and vegetables.  Today I will post the response (with permission) of Dr. John Juvik, a plant geneticist at the University of Illinois.  The text in black is my questions; the text in red is Dr. Juvik's answers.

1.  The differences in glucosinolate levels in broccoli you mentioned as being a consequence of genetics and environment.  Are these naturally occurring genetic differences, or the result of genetic modification?  Or both?

We have surveyed over 50 genotypes (varieties) of broccoli and observed substantial "natural" genetic variability in tocopherol (vitamin E), carotenoid (including vitamin A precursors), and glucosinolate form and content in the heads. Depending on the compound the concentrations ranged between the lowest and highest genotypes from 3 - 20 fold. Again, depending on the particular compound the proportion of the variation attributed to genetic differences among the varieties ranges from about 25-75%, with most of the remainder of variation due to the growing environment.  These differences are due to natural occurring variation that was fixed into these lines during the process of their selection in plant breeding programs to develop commercial varieties. 

There are currently no existing broccoli commercial genotypes that carry transgenes or are considered genetically engineered (GMO).  All have been developed through conventional sexual hybridization and selection by man. I am making the assumption when you use the term genetic modification you are referring to genetic engineering via plant transformation with a "transgene". Technically, conventional breeding is also genetic modification.     

2.  When a food crop is genetically engineered to be more resistant to insect infestation, I would assume this is done by boosting the plant's production of particular chemicals that are toxic to the insects.  What are the implications of this for humans who eat the plant?

Not necessarily, the current GMO example that is in broad commercial use involves corn, soybean, potato, cotton, etc. (but not broccoli or other fresh vegetables) varieties that have been transformed with the Bt endotoxin protein.  This protein is synthesized in extremely low concentrations in these transformed plant tissues and is not toxic to mammals at doses thousands of times greater. Development of crops by conventional breeding with resistance to insects has on some occasions been due to increasing the concentration of phytochemicals that are toxic to the insect. More often the mechanism of resistance is unknown or related to a change in the plant that renders it less attractive or palatable to insects. In the case of the glucosinolates and some other compounds enhancing concentrations will result first in increasing anticancer activity and health promotion, further increases will result in reduced advantageous bioactivity, and ever higher levels could lead to toxicity. Obviously any such modifications must be carefully evaluated prior to commercial release.  

3.  Most, if not all studies, looking at the health benefits of diets rich in fruits and vegetables have shown convincing evidence of improved health among people with primarily plant-based diets.  Conversely, there is essentially no good evidence that taking mega doses of single nutrients in the form of dietary supplements is good for us, and in some cases may be harmful.  The conclusions of many epidemiological researchers has been that it is the mixture and proportions of nutrients occurring naturally in plants that makes them good for us.  If we genetically engineer a plant to produce more of a particular phytonutrient - beyond its normal production and out of proportion with other nutrients in the plant won't we be creating a "supplement phenomenon" and very likely be doing more harm than good?

This is a question that has not been resolved.  Current information suggests that many dietary supplements are not very effective because they suffer from reduced uptake or poor targeting of bioactive components to necessary organs. This also results in a "burst" of  bioactive compounds in regions of the gut (stomach or small intestine) that may have limited effectiveness for uptake.  It is believed that health promoting phytochemicals that are presented and integrated in a masticated food matrix show improved uptake in more absorbent portions of the gut.  This form of presentation is also more gradual and can result in a greater dose of uptake due to longer duration of the compounds in more areas of the gut. Many of the compounds that researchers are working on in fruits and vegetables related to improving their health promotion are no where near levels that would cause any toxicity even with dramatic enhancement. 

It is my belief that it is not necessary to use genetic engineering to improve the health promoting properties in our fruits and vegetables. Existing variation can be utilized in conventional breeding programs.   

4.  The evidence for the benefits of a plant-based diet is clear and convincing.  I don't think the problem is in the random variation in nutrients among vegetables, I think it is that so few people eat a plant-based diet.  Wouldn't we be better off letting plants keep the genetic make-up they evolved with (the same genetic make-up we evolved to eat)?

Of course, this is the core of the problem, but what is a more achievable approach - dramatically changing the diet of the majority of humans or breeding a fruit or vegetable that is only eaten once a week or month to deliver more of the compounds that can reduce the incidence or cancer or heart disease?

5.  What are your concerns about the genetic modification of food crops regarding the implications for human health?

I think that any such modification, even through convention breeding, must be approached with great caution and careful evaluation for possible antagonistic outcomes.  

Are vegetables as nutritious today as they used to be?

National Public Radio did a report this past week that I am sure will become part of a new marketing campaign for the dietary supplement industry.  Researchers looking at archived USDA data from 1950 and 1999 regarding the levels of 13 nutrients in fruits and vegetables found that 6 of the 13 nutrients showed declining levels over time.

The claim that fruits and vegetables no longer contain adequate amounts of essential nutrients has already been in the marketing message of supplement manufacturers; I expect this will only add fuel to their fire.

Before you stop buying fruits and vegetables and start stocking up on supplements, let's try to look at the facts.  First of all, there are hundreds, if not thousands, of different phytochemicals in plants.  This study looked at thirteen nutrients and minerals.  We don't know about the others.  Secondly, there are several studies looking at the health of people consuming primarily plant-based diets during this time frame from 1950 to 1999, and beyond, and the overwhelming evidence is that these people are much healthier than people who don't eat fruits and vegetables. 

One genetics researcher mentioned in the report talked about the wide variation in broccoli content of plant compounds called glucosinolates - phytochemicals linked to a possible reduction in the risk of some cancers.  He pointed out that between individual broccoli plants there may be as much as a fifty-fold difference in glucosinolate content based on genetic differences between the two plants and the environments in which the two plants were grown.  As far as I can tell this is a naturally occurring difference and the obvious answer to this problem is to make sure you eat broccoli, and other plants, several times a week.

There is abundant evidence for the health benefits of diets high in fruits and vegetables.  There is scant, if any, evidence for the health benefits of taking supplements that provide mega doses of single nutrients, and in some cases (beta-carotene) mega doses of single nutrients may be harmful.

I have e-mailed three of the researchers involved in this report with questions about this issue.  If I get any responses I will report them here in this blog.

In the meantime, it is a very safe bet that eating apples and broccoli is still way better for you than eating cheese balls and candy bars.

Monte Ladner, M.D.  

Effective Weight Loss Strategies

A listener wrote me recently about his struggle to lose a lot of weight.  He was proposing to follow a couple of the popular fad diets - I won't mention which ones in order to avoid the wrath of supporters of these diets.  For the record - I think all of the "lose-weight-quick" diets should be avoided in favor of developing sensible eating and exercise habits. 

For the inaugural Fitness Rocks blog I thought I would post my response to his e-mail question about how to proceed with the challenge of losing weight and regaining health.  Here it is: 

Dear Fitness Rocks listener (not his real name), 

Before I answer your question let me say that a really good book to get you going in the right direction is Eat, Drink, and be Healthy by Walter Willett, M.D. 

The two popular diets you mention have both been shown to result in weight loss at six months that is greater than other diets - but by one year the results of most popular diets are about the same - and pretty modest.  All fad diets have dismal long-term adherence rates. 

All of the discussion in the popular media about which fad diet is the best for quick weight loss completely misses the point.  The real answer is about developing a sustainable and healthy lifestyle. 

When I talk to people about weight loss I tell them the real goal should be developing healthy eating patterns and regular exercise, the weight loss will come as a secondary phenomenon.  That may sound like an irrelevant distinction, but let me tell you why it's not.  Being overweight or obese increases your risk for type 2 diabetes, high blood pressure, heart disease, prostate cancer, colon cancer, breast cancer, and other cancers, as well as osteoarthritis, and other unwanted chronic diseases.  Weight loss will bring those risks down - but the way you lose weight is important in how much you bring those risks down.   

For example, insulin resistance is common in overweight people and can lead to full blown type 2 diabetes.  Starting an exercise program will almost immediately reduce insulin resistance.  This reduction in insulin resistance will begin even before you lose a single pound purely as a consequence of the physiologic effects of exercise on your muscles. 

Changing your diet to a primarily plant-based diet with lots of fruits and vegetables (8 - 10 servings per day), along with whole grains, nuts, beans, only small amounts of lean meat, and nonfat or at least low-fat dairy products (if you eat dairy products) will begin to lower your blood pressure within two weeks - even if you haven't lost any weight at that point!  Losing weight will lower your blood pressure even more. 

This same plant-based diet (the so-called Mediterranean diet) will also give you a more favorable cholesterol panel, and is associated with lower premature death rates. 

Don't misunderstand me - your long-term health depends on you losing weight and maintaining that weight loss.  But if you work to change your food choices to healthier ones you will be creating habits that will improve your health and help you lose weight. 

Remember that there is more in food than just calories, fat, carbohydrates, and protein.  Fruits, vegetables, nuts, beans, and whole grains are loaded with hundreds, maybe thousands, of "phytonutrients," plant chemicals, that are essential to good health.  You can't get these in pills in the same way that nature gives them to us in whole foods - so don't waste your money on expensive supplements to make up for a bad diet! 

Typical American processed foods not only have the wrong kind of carbohydrates (highly refined white flour), and the wrong kind of fats (saturated and trans fat), but these processed foods are devoid of the health-promoting phytonutrients that whole grains, fruits and vegetables give us. 

Here's another example:  You're overweight and that is associated with an increased risk of prostate cancer.  While you are working to lose weight doesn't it also make sense to be eating whole foods that are known to decrease the risk of prostate cancer - like tomatoes? 

More good news about selecting plant-based foods as the mainstay of your diet is that they are relatively low in calories.  If you consider what a powerful nutritional punch they provide you're really getting the most bang for your buck with fruits and vegetables at a comparably low caloric cost.  Example: an average candy bar can have around 240 calories, and absolutely nothing in it that is good for you.  That is about the same number of calories that you would get by eating four medium sized apples!  And the apples are loaded with nutrients that promote your health.  Eat an apple, save 180 calories, and get healthier in the process. 

When a person gets around to deciding to take control of their weight what they really need to do is take control of their health, let the weight loss come as a side effect of healthy living.   

Work closely with your doctor who can monitor you for all of the obesity-related chronic diseases that we mentioned above.  You will benefit from having your doctor follow your blood pressure, blood sugar, cholesterol and other important markers for disease.  While you're going through the process of changing your lifestyle and losing weight your doctor may discover that your blood pressure is too high, you already have type 2 diabetes (an estimated six million Americans have type 2 diabetes and don't know it), or your cholesterol is too high.  In these cases your doctor may prescribe medication to control these - that is a good thing and not necessarily a permanent thing.  If you successfully change your lifestyle, and lose weight, you and your doctor may be able to eventually get you off the medication. 

Your doctor will also send you to a registered dietitian who will be very useful in helping you plan your meals and select healthy foods. 

Start exercising, but not until after your doctor has evaluated you for obesity-related diseases and "cleared you" to begin exercise.  Regular exercise is essential for good health and successful long-term weight control.  There is no substitute for regular exercise, you have to do it. 

Don't forget to do all the simple things you've heard about to increase physical activity throughout your day - walk instead of driving whenever you can.  Take the stairs.  Park at the far end of the parking lot when you're shopping.  Turn your breaks at work into mini-exercise sessions by pacing the halls of your office building instead of chowing down on cookies and watching the television in the office break room.  It's all obvious and simple - but people don't do it. 

Form a support group of friends and family who are interested in losing weight and getting healthy.  This is

America - you don't have to look any further than the person sitting next to you to find someone who should be taking better care of themselves. 

Shameless plug for Fitness Rocks - post your story in the Fitness Rocks forum and start building an online support group. 

Finally, don't get discouraged.  This is a long fight - a lifelong fight.  You can be successful if you design a lifelong plan at the beginning.  Weight loss and weight control are not things you do for three months; you do them every day for the rest of your life.  The better you become at doing these things, the longer, and healthier, the rest of your life will be. 

Have a great workout, 

Dr. Monte 

References:

Dietary Approach to Stop Hypertension - article from NEJM

Dietary Approach to Stop Hypertension with Sodium Restriction - article from NEJM

Mediterranean Diet, Lifestyle and Risk of Premature Death among Elderly European Men and Women

Dietary Supplements and Weight Loss - Not Likely to Help - American Journal of Clinical Nutrition

A Descriptive Study of Individuals Successful with Long-Term Weight Loss - American Journal of Clinical Nutrition

Liposuction Does Not Improve Obesity-Associated Metabolic Abnormalities