Category Archives: Health & Fitness

If my Facebook feed is any indication, cold and flu season is far from over, even though we are experiencing warmer weather. Unfortunately, the natural spread of cold and flu viruses at this time of year can interfere with your springtime activities. Getting a flu vaccine is the most important thing you can do to prevent seasonal influenza (flu). If you didn’t get a flu shot this year, there is still much you can do to reduce your risk of getting sick.

This is the topic of my Health & Fitness column in the Aiken Standard this week.

For starters, you can protect yourself by not touching your eyes, nose, or mouth and by washing your hands frequently with soap and water or using an alcohol-based hand sanitizer. But there are additional steps you can take to fight cold and flu viruses.

Exercise can have a positive effect on your immune system. People who exercise on a daily basis have fewer and less severe colds and have up to 50% fewer sick days than those who aren’t regularly active. Research in animals and humans shows that exercise increases the activity of certain immune cells called helper T cells. This makes the immune system’s response to viruses, like the cold and flu, more robust. The strongest evidence is seen when the exercise is moderate in intensity and duration, such as a 30–60 minute walk or jog each day.

More exercise isn’t always better, though. Very vigorous and prolonged exercise can have the opposite effect. Athletes who engage in long, intense training tend to be more susceptible to upper respiratory infections. Research shows that immune function is depressed in the weeks leading up to and after running a marathon, resulting in an increased risk of becoming sick. The bottom line is that while exercise improves your immune system, very vigorous exercise may not.

Regular exercise also enhances the immune system response to the influenza vaccine. This means that the flu vaccine can be more effective in people who exercise. If you don’t exercise already, you can still benefit: one study showed that a single 45 minute exercise session can improve the immune response to the flu vaccine. You can get this benefit by going for a brisk walk before your flu shot, something to think about next fall.

Good nutrition is also important for optimal immune system function. Deficiencies of certain nutrients can have a negative effect on immune function, so eating a balanced diet is essential. That said, there is no support for “boosting” the immune system by taking high doses of vitamins, minerals, or other supplements, despite the claims made by supplement companies.

You can get benefits from two more common-sense recommendations: getting adequate sleep and reducing stress. Poor sleep habits are associated with suppressed immunity and more frequent illness. Sleep deprivation can also reduce the positive immune response to a flu shot. High levels of stress increase susceptibility to colds and flu and can lead to more sick days from work or school. Stress and poor sleep habits tend to occur together, creating a double negative effect on the immune system.

You should definitely follow the traditional advice of getting a flu shot and washing your hands frequently. In addition, to have your best chance of staying healthy you should also exercise every day, eat a healthy diet, manage your stress, and get enough sleep. As a bonus, many of these habits will also help you lose weight and reduce your risk of diabetes, heart disease, and some cancers along with keeping you healthy this cold and flu season.

Nutrition, exercise, and health information can be confusing. 
But it doesn't have to be that way.
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 drparrsays@gmail.com | @drparrsays

Everyone knows that exercise is good for you, both for fitness and health. Exercise can improve your strength, endurance, and flexibility. These results can be realized relatively quickly, depending the type and intensity of exercise you do. As a general rule, if you start an exercise program today, you should expect to experience some improvements within a few weeks.

That may mean running or walking at a faster speed, lifting heavier weights, or coming closer to touching your toes. Aside from these improvements, participating in exercise should help you feel better doing everyday activities with fewer aches and pains.

Being active can also help you lead a longer, healthier life with a lower risk of developing chronic conditions including high blood pressure, high blood cholesterol, diabetes, and obesity. Regular physical activity can also reduce your risk of having a heart attack, stroke, or developing many types of cancer. And even if these conditions do occur, they are likely to happen later in life and be less severe. While it is relatively easy to see results in strength, flexibility, and endurance, it is difficult to “see” the improvements in health that come from regular exercise. This is the topic of my Health & Fitness column in the Aiken Standard this week.

Take blood cholesterol, for example. A cholesterol test really includes several different measures of blood lipids including LDL and HDL cholesterol. LDL is called “bad” cholesterol because it tends to contribute to atherosclerosis, the process in your arteries that leads to many heart attacks and strokes. HDL has an opposite effect, reversing cholesterol deposits in arteries, so it is called “good” cholesterol. Changes in diet and certain medications, including statins (Lipitor is an example), have been widely used to lower LDL cholesterol and, to a lesser extent, raise HDL.

Exercise is also recommended to improve blood lipids, too. However, the effect of exercise is far less impressive than even a single medication. For example, some statin drugs can lower LDL by as much as 50%, which can have a huge impact on heart attack risk. By contrast, daily exercise might only lower LDL by 10%.

There aren’t as many ways to raise HDL, but regular exercise can increase HDL by about 10%. This is dose-related, so higher doses of both drugs and exercise can have a bigger effect. But the amount of exercise most people are likely to do will have a modest effect on blood lipids.

Some people, including many physicians, see this less potent effect as evidence that exercise simply doesn’t work as well as drugs for improving blood lipids. That’s true, if you just look at the numbers. But the health benefits of exercise on these blood lipids goes beyond the total LDL and HDL.

It turns out that HDL and LDL exist in different forms. Some subtypes of LDL are more atherogenic, meaning they increase heart attack risk to a greater extent, than others. Similarly, HDL comes in different subtypes, too, some of which can reduce the risk of heart attack more.

It is becoming clear that exercise can shift the prominent subtypes of HDL and LDL to the more beneficial types. This means that even though exercise may not result in significant changes in the total LDL or HDL on your blood lipid test, it can make LDL less bad and HDL better, reducing your risk of a heart attack or stroke. Similarly, exercise also seems to have beneficial effects on blood vessels and blood glucose beyond the numbers your doctor monitors for hypertension or diabetes. So, even if your test results don’t change much, know that the benefits of exercise go beyond the numbers!

Nutrition, exercise, and health information can be confusing. 
But it doesn't have to be that way.
What can I help you with?
 drparrsays@gmail.com | @drparrsays

Coronary artery disease or heart disease is caused by atherosclerosis, a process which involves the accumulation of cholesterol plaques in the arteries that supply blood to the heart. These plaques can narrow the blood vessels and reduce blood and oxygen delivery to the heart, leading to symptoms like chest pain (ischemia). The plaques can also rupture and form a blood clot, blocking oxygen delivery and causing a myocardial infarction—a heart attack.

If you experience symptoms such as chest pain or have a high risk of heart disease due to family history and other risk factors, your doctor may recommend a diagnostic test. In a graded exercise test (GXT), or “stress” test, a person exercises, typically walking on a treadmill, at increasing speed and grade while heart rate, blood pressure, and heart rhythm are monitored by a doctor or exercise physiologist. Changes in these variables, as well as the person’s exercise capacity, can be signs of ischemia and impaired heart function. Often, a GXT is combined with another diagnostic technique, such as nuclear imaging, which shows areas of the heart that do not receive enough blood flow, or an echocardiogram that uses ultrasound to show the heart beating and ejecting blood.

Based on the GXT results, a cardiologist may recommend an angiogram, in which a catheter is inserted into an artery and threaded into the coronary arteries, dye is injected, and the coronary arteries are viewed through X-ray imaging. This allows cardiologists to see the extent of the narrowing in the coronary arteries.

You can be diagnosed with heart disease based on the results of an angiogram or if you had a heart attack. During the angiogram, a cardiologist can perform an angioplasty in which a balloon catheter is inflated to open narrowed arteries. A mesh stent may also be placed to help keep the vessel open for longer. In other cases, coronary artery bypass surgery may be indicated. Considered open heart surgery, this procedure actually bypasses narrowed sections of coronary arteries using another vessel, often a leg vein. Both angioplasty and bypass surgery can restore adequate blood flow to the heart and treat ischemia and heart attacks.

Many people consider the treatment complete after the heart attack has ended and the angioplasty or bypass surgery is complete. The truth is that the long-term outcomes are largely based on what happens next. Traditionally, heart disease patients were told to rest and not stress their hearts, a belief that many still hold today. But exercise-based cardiac rehabilitation programs are key to improving heart health and preventing future complications.

Most cardiac rehabilitation programs include several phases. Phase I programs start in the hospital and focus on getting out of bed and performing self-care activities and some walking. Phase II cardiac rehab involves closely-monitored exercise, usually for 12 weeks following a heart attack or surgery. Phase III involves longer exercise sessions with greater independence and transitions into Phase IV, a lifelong exercise program. Education about exercise, nutrition, weight control, stress management, proper medication use, and psychosocial wellbeing are essential in all phases of cardiac rehabilitation.

The benefits of cardiac rehabilitation are well-established through research and practice. In fact, many patients credit cardiac rehabilitation with saving their lives, even if they had bypass surgery. Despite this, less than a third of patients who are eligible for cardiac rehabilitation actually attend a program. If you or someone you know has had a heart attack or surgery, encourage them to ask their doctor about cardiac rehabilitation—it is likely to be the best way to improve quality of life and avoid future heart problems.

February is American Heart Month, an ideal time to assess your risk of heart disease and take steps to improve your health. When it comes to heart disease, there are several numbers, including your blood pressure, cholesterol, and glucose, you (or your doctor) may be monitoring. But there is another set of numbers that are equally important for preventing and treating heart disease: 0, 5, 10, 25, and 30.

0 is for no smoking. Cigarette smoking more than doubles your risk of heart disease and stroke, is by far the leading cause of lung cancer and other lung diseases, and is responsible for over 400,000 deaths per year. If you smoke, quitting now is one of the most important steps you can take to improve your health. Nicotine replacement therapy in the form of gum, lozenges, and patches as well as prescription medications can help, but quitting really does require serious dedication. It’s well worth the effort and some benefits of quitting can be realized almost immediately.

5 is for eating five fruits and vegetables each day. A healthy diet is an essential aspect of good health. While there is no one single measure of a healthy diet, adequate fruit and vegetable consumption is widely considered to be essential for good health. Fruits and vegetables contain vitamins, minerals, and fiber and most are low in calories. At a minimum, you should eat five servings per day with an emphasis on fresh fruits and vegetables. Your real goal should be to include fruits and vegetables in all meals and snacks, but five servings per day is a good start.

10 is for 10,000 steps per day. Regular physical activity is essential for good health. Almost any activity counts, and a good goal is to be as active as possible throughout the day. You can track your physical activity using a pedometer (step counter) or an app on your phone. A target of 10,000 steps per day is a commonly cited goal, but you should try to take as many steps as possible. You can do this by minimizing the time you spend sitting, taking the stairs instead of the elevator, and walking instead of driving when possible. More steps are better, even if you don’t get to 10,000.

25 is for maintaining a healthy body weight, or a body mass index (BMI) of less than 25. The BMI is a measure of weight relative to height. A BMI of 18–25 is considered healthy, 25–29 is considered overweight, and 30 and higher is considered obese. The risk of health problems like diabetes, heart disease, and some cancers goes up with BMI, so maintaining a healthy body weight is good for your health. If you are overweight you should lose weight, even if you don’t make it to an ideal weight.

30 is for 30 minutes of exercise per day. In addition to being as active as possible throughout the day, you should dedicate a minimum of 30 minutes for exercise or other activity. Considerable research shows that that as little as 30 minutes of moderate to vigorous activity leads to improved fitness and health with greater benefits coming from longer duration or higher intensity activity. This can include exercise—a brisk walk or jog, lifting weights, or other aerobic exercise—as well as other activities like housework and yard work. Your goal should be to sit as little as possible, move as much as possible, and make time each day to be active.

Making healthy food choices is never easy. It is made more challenging by the fact that some foods that appear to be a smart choice may be less healthy than you think. Often, prepackaged fruits and vegetables contain added sugar, fat, or salt, making them less healthy than eating them fresh.

Consumption these foods can also make it less likely that people—especially children—will eat fresh fruits and vegetables when they are available. Here are some examples of foods that may appear to be healthy but, upon closer examination, turn out to be less nutritious than we might think.

Fruit snacks: These gummy fruit treats are a favorite among kids. If you check the package you will probably see that they contain real fruit or fruit juice, so they must be healthy, right? While there is variation among different brands, in most cases these snacks contain little, if any, actual fruit. If you read the ingredients you will see that they do contain lots of added sugar, meaning that many of these snacks are essentially candy. In fact, if you compare some brands of fruit snacks with something that is easily recognized as candy, such as gummy bears, you will see that they have a similar sugar content.

Fruit drinks: Not everything that looks like fruit juice is actually juice. Take orange “juice” drinks like Sunny D and Hi-C for example. These popular orange drinks contain mostly added sugar and water—and only 5% juice. By contrast, real orange juice is 100% juice. You might think that because Sunny D and Hi-C have less sugar and fewer calories they are a healthy alternative to real orange juice. Don’t be fooled! When you look at the ingredients you will realize that these drinks are far from real juice, essentially orange soda without the bubbles!

There are two problems with this. First, some foods that appear to be healthy because they either claim to or actually do contain fruit are actually less healthy than we might believe. Considering that fruit snacks and fruit drinks are likely to be consumed as alternatives to real fruit juice or a piece of fruit as a snack, these foods could lead to poor nutrition. This is especially true in children.

Second, sweetness is one of the most important tastes we respond to. Consuming food and beverages that are flavored like fruit but are actually much sweeter may make real fruit less palatable. Again, this is especially true for children who may develop an expectation that strawberries should taste like strawberry-flavored fruit snacks or that orange juice should taste as sweet as Sunny D. These kids are likely to prefer the sugar-sweetened version over the real fruit. Since these sugar-sweetened “fruits” tend to be higher in calories, consumption of these foods is one contributor to childhood obesity.

This isn’t just the case with fruit. Adding salt and sauces to vegetables makes them more flavorful, to the point that many of us don’t eat plain vegetables very often. The majority of potatoes are consumed in the form of French fries, loaded with both fat and salt. This has changed how we expect potatoes to taste so that now we typically eat baked potatoes “loaded” with butter, sour cream, cheese or bacon. When was the last time you ate a plain baked potato?

But there are some simple steps you can take to get back to eating real fruit and vegetables. Look for 100% fruit juice or, better yet, a piece of fruit instead of fruit-flavored drinks. Instead of sugar-sweetened fruit snacks, try dehydrated fruit. Cut back on the salt, butter, and other toppings you add to vegetables or purchase frozen vegetables without added sauces.

Nutrition, exercise, and health information can be confusing. 
But it doesn't have to be that way.
What can I help you with?
 drparrsays@gmail.com | @drparrsays

There are numerous community and workplace weight loss competitions and fitness challenges underway in our area right now. These programs are a popular way to start making health improvements with friends or coworkers. Many people find the competition aspect of these programs to be motivating. Even those who are reluctant to start a diet or exercise program are more likely to give it a try. But this raises the question, are “biggest loser” type weight loss programs effective at promoting lasting weight loss? Does winning the competition make maintaining a healthy body weight any easier?

The short answer is probably not. Remember, the goal of any diet should be for you to lose weight and keep it off. The majority of people who lose weight will eventually gain it back, plus some extra. This is more of a problem for programs that emphasize rapid weight loss. As a general rule, the quicker someone loses weight, the quicker they are likely to gain it back. So, an eight-week weight loss competition is likely to promote rapid weight loss followed by weight gain when the program ends.

There is a practical reason why this happens. In order to lose weight and keep it off, people need to learn a whole new lifestyle involving what, when, why, and how to eat and exercise. These lifestyle changes are difficult to make and can take months or years to fully adopt. It is unlikely that trying to win a weight loss competition, which emphasizes quickly losing weight over learning new skills and behaviors, would support that outcome. In addition, some contestants may follow inappropriate diets or participate in exercise that is too intense. This could lead to injury, illness, or, at the very least, a failed weight loss attempt.

That’s not to say that these weight loss competitions don’t have benefits. There are certainly participants who would not otherwise consider losing weight at that time. Many programs organize participants into teams and the benefits of group support in promoting weight loss are well established. Some programs provide incentives for participating like access to exercise facilities or personal training sessions, which may encourage people to be more active. Others provide monitoring and education to promote success beyond the program. For example, the 12-week YMCA Team Lean program includes weekly education sessions and weigh-ins, a strong group dynamic, and monitoring to prevent rapid, unhealthy weight loss. Other programs, however, are shorter in duration and provide little in the way of education or support for making long-term lifestyle changes.

And don’t think that you are likely to achieve similar results to the contestants on the reality TV shows. The environment on those shows is so different from real life—constant supervision, guidance by experts, and the ever-present cameras, which make the contestants accountable to millions of viewers. The fact is that many “biggest losers” regain all the weight they lost after the show ends. Despite the intensive education and intervention, many contestants are not prepared to make the type of lifestyle changes needed to maintain weight loss in the real world.

There is a simple solution if your goal is to lose weight and keep it off: participate in the competition, take advantage of the resources, but don’t focus only on winning. Instead, use the program to develop healthy eating and exercise habits.  You will find that concentrating on modifying your behaviors is the key to success. Whether you win or not, know that the end of the program is just the beginning of your weight loss journey.

Nutrition, exercise, and health information can be confusing. 
But it doesn't have to be that way.
What can I help you with?
 drparrsays@gmail.com | @drparrsays

Do you need to exercise every day? Or could you exercise on just a couple of days instead? According to a recent study, Saving your exercise for the weekend can give you the same health benefits as spreading your exercise out over multiple days. However, becoming a “weekend warrior” might not be the best approach for you.

Current physical activity recommendations call for us to accumulate 150 min/week of moderate-intensity activity or 75 min/week of vigorous activity. Typically, this would be done on multiple days per week (walking 30 min per day on 5 days, or jogging 25 min on 3 days). This study answers an important question about physical activity and health—can you get away with only exercising a couple of days per week instead of the recommended 3-5 days? It also included people who do some, but not enough, activity throughout the week.

This study looked at how physical activity pattern was linked to the risk of death from all causes, cardiovascular disease (CVD), and cancer, a common way of examining the effect of physical activity on health in large populations. The study compared the risk of death among four physical activity pattern groups: inactive, insufficiently active (some activity, but not enough), regularly active (meeting PA recommendations throughout the week), and weekend warriors (meeting recommendations in just 1-2 days per week).

The results show that, compared to the inactive group, the risk of death was lower in the insufficiently active, regularly active, and weekend warrior groups. This was true for deaths overall as well as deaths from CVD and cancer. Furthermore, the reduced risk was similar for the three activity patterns, but lowest in the regularly active participants.

This confirms what we already knew from numerous other studies: regular physical activity promotes longevity. The study also suggests that being active throughout the week, but not enough to meet those recommendations, is also associated with some reduction in risk. We knew that, too. What this study adds is that meeting the recommendations by doing the activity on 1-2 days, the “weekend warrior” pattern, is beneficial, too. In fact, this activity pattern seems to be about as good as being active most days of the week. This is good news for people who aren’t active on a daily basis!

That said, this study only examined mortality, meaning the number of people who died during the follow-up period. It doesn’t tell us much about how these activity patterns affect health the way most of us would consider it: controlling blood pressure, diabetes, blood lipids, or depression. It also doesn’t say anything about weight control or improving strength, endurance, or flexibility, which are important reasons many people are active. In both cases, exercising regularly is the key to realizing the benefits!

Additionally, the typical “weekend warrior” tends to engage in exercise that is more intense and/or longer duration than what they might do if they exercised regularly. Indeed, the study indicates that almost all (94%) of the weekend warriors played sports and relatively few (31%) walked for exercise. While this is fine for most people, participating in vigorous, prolonged exercise can lead to a greater risk of injury, especially in people who aren’t in good shape to begin with.

So, people who are weekend warriors should select activities they will enjoy, and focus on duration over intensity. A long walk, hike, bike ride, or kayak trip on the weekend is something most people can do without too much risk. But the best approach is to be active throughout the week as much as possible and use weekends for more ambitious exercise sessions.

Nutrition, exercise, and health information can be confusing. 
But it doesn't have to be that way.
What can I help you with?
 drparrsays@gmail.com | @drparrsays