Tag Archives: healthy-living

Affordable care acts

The Affordable Care Act is in the news again, this time because the U.S. Supreme Court recently ruled on the legality of subsidies offered to help people afford health insurance. Health care has long been an important and contentious topic in both political and social circles. Given the importance that accessing quality health care has for everyone, it is unfortunate that promoting good health has turned into a political debate.

In addition to expanding access to health care, the Affordable Care Act should also make it easier for people to get preventive care. This is important since preventable chronic diseases including diabetes and heart disease, are among the leading causes of disability and death as well as contributing to high health care costs. It turns out that adopting some simple lifestyle modifications can go a long way toward making you and your family healthier, as well as saving money.

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

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Here are a few affordable care acts you can implement today:

1. Move more

Significant health benefits, including weight loss and improved fitness, can be achieved with as little as 30 minutes of activity per day, but more is better. The activity doesn’t have to be “exercise.” It can include walking the dog, yard work, or house work. Research shows that sitting too much is just as unhealthy as not exercising. Spending less time sitting at work, home, or in the car is another easy way to improve health. And getting up and moving for even a few minutes is better than staying seated for long periods of time. Every little bit of activity really does count.

2. Eat smart

Making dietary changes can be difficult, but a few simple changes can lead to big benefits. Eating more real food including fruits, vegetables, whole grains, and lean meats and less added sugar is a good place to start. Fresh fruits, vegetables, and whole grain bread, pasta, and cereals are rich in vitamins, minerals, and fiber and most are low in calories. Eating less added sugar in sweets and processed foods can help you cut down on calories and lead you toward healthier food choices. Controlling portion sizes plays as big of a role in weight gain and loss as the types of food you eat, so pay attention to how much you eat, especially when you eat out. Chances are, it is more than you think!

3. Chill out.

Reducing and managing stress is essential for good health. Uncontrolled stress can lead to high blood pressure, poor immune function, and weight gain. Daily exercise will help, as will using stress management techniques like progressive relaxation. When you can, avoiding stressful situations is wise. Taking time to do something you enjoy each day is a good idea, too. Getting enough sleep (most adults require 7–9 hours) is also important for good physical and mental health.

4. Don’t smoke

Cigarette smoking more than doubles your risk of heart disease and stroke, and is by far the leading cause of lung cancer and other lung diseases. If you smoke, quitting now is one of the most important things you can do to improve your health—and the health of those around you. Nicotine replacement therapy and prescription medications can help, but quitting really does require serious dedication. It’s well worth the effort and the benefits of quitting can be realized almost immediately.

Regular activity, quitting smoking, managing stress, and the types of dietary changes described here can have a profound effect on preventing and treating many health problems. Best of all, these affordable care acts are basically free to implement and can lead to both health and financial savings now and in the future.


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

Start making deposits in your fitness bank

Saving money for emergencies is good advice and important for maintaining quality of life in the event of a lost job or other financial crisis. While this may seem like common sense, many people have been caught without enough savings when they needed it and found it difficult to meet basic needs.

This principle can also be applied to fitness. When you are healthy, you can maintain a high level of fitness. This makes your day-to-day activities easier and serves as a reserve or “bank” to draw on when you need it. Your good fitness now can get you through a health crisis just like saving money can help you through a financial crisis. This health crisis could come in the form of an injury or illness that keeps you from being active for several days or a hospitalization that keeps you in bed for a week, a month, or longer. This is the topic of my Health & Fitness column in the Aiken Standard this week.

The problem with periods of inactivity, like bed rest or hospitalization, is that there are severe physiological effects that occur within days and get worse over time. You may have noticed this as weakness and fatigue after spending a few days in bed with a cold. Muscle strength declines at a rate of over 1% per day of bed rest, and can be 50% lower following as little as three weeks. That 50% reduction in strength could limit a person who was already deconditioned to a point where he or she would have difficulty completing the most basic activities of daily living.

A person who was fit and strong when they went into the hospital would certainly be better off when released. And older adults fare worse than younger individuals. According to one study, the decline in strength seen in older men in just 10 days was equivalent to the change measured after 28 days in men 30 years younger.

It’s not just the muscles that are affected, the bones get weaker, too. In fact, 12 weeks of bed rest can reduce bone density by as much as 50%, exposing patients to a greater risk of fracture. This is due to the reduced stress on the bone from not standing and walking as well as the lack of muscle activity. Two of the most effective ways to build bone density are putting stress on bones through weight-bearing activity and the action of the muscles pulling on the bones from resistance training. Because bed rest eliminates both of these stresses, bone density declines rapidly.

One unique study had healthy young men complete three weeks of bed rest back in the 1960s. They all experienced a rapid decline (over 20%) in their aerobic fitness, but recovered quickly after the experiment ended. These individuals also had their fitness tested again 30 years later. It turns out that the decline in fitness in those young men in three weeks of bed rest was greater than the decline in fitness that occurred over 30 years of aging!

The good news is that most patients are encouraged to move around as much as possible. Some receive in-patient physical therapy or rehab, even after major surgery, to help lessen the effects of prolonged bed rest. It is important to take advantage of these opportunities if you, or a loved one, are hospitalized.

There are many reasons to exercise and be fit, but the most important reason may be to develop a fitness “bank” you can draw on if you become injured or hospitalized. Since the effects of bed rest are seen in people of all ages, everyone can benefit from a good fitness foundation. Just like putting money in the bank, doing a little now can have great benefits later when you need it most.

Finally, some smart advice: First, achieve and maintain a high level of fitness now, just as you would save money for a rainy day. You never know when you will need it. Second, if you are hospitalized, take advantage of opportunities to move, whether that is limited to moving from bed to a chair or if it includes short walks or even inpatient exercise–if the medical staff approves, of course. While many well-meaning friends and family members will tell you to rest and not move, true bed rest is almost the worse thing you can do.

For example, inpatient cardiac rehabilitation targets patients who are recovering from heart attacks and even open heart surgery. The goal is to get these patients up and moving as quickly as possible to prevent long-term consequences of bed rest.


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

The prescription your doctor should give you, but probably won’t.

What if there was a prescription your doctor could give you that would lower your risk of heart attack, stroke, and most cancers? What if that prescription could also prevent and treat high blood pressure, high cholesterol, and diabetes as well as reduce your risk of developing Alzheimer’s disease, decrease depression, and improve cognitive function and memory better than any other available treatment? Would you be interested in that prescription?

Imagine that prescription could also help you maintain a healthy body weight, increase your strength, and improve your fitness. And provide all of these benefits without negative side effects. Are you interested now?

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

exercise-rx


That prescription exists, but it isn’t a drug or other medical treatment. It is regular physical activity! Research shows that if you have a low level of physical activity you are at greater risk of dying than if you smoke, are obese, or have high blood pressure or cholesterol. In fact, physical inactivity is now thought to be the leading cause of preventable deaths in the United States.

If you didn’t know this, you are forgiven. Much attention is given to diseases such as diabetes, high blood pressure, high cholesterol, and obesity—with good reason, of course—at the expense of focusing on health behaviors like physical activity. This is partly because of the “education” provided by pharmaceutical companies, who develop drugs to treat these conditions and advertise them widely. But physical inactivity has a huge impact on health, largely because a lack of regular exercise can cause or exacerbate these other diseases. Unfortunately, modern medicine tends to focus medications and surgical procedures, so a low-tech approach like taking a 30 minute walk every day is often overlooked.

Even if you do take medications to treat a chronic condition, regular physical activity is still beneficial. In fact, people who exercise are less likely to require medications for high blood pressure, type 2 diabetes, or high cholesterol. Many people find that they can rely on lower doses of some medications and may be able to stop taking some altogether if they exercise regularly (under the advice of a physician, of course).

May is Exercise is Medicine Month, a time to help everyone recognize the valuable health benefits of regular physical activity. Exercise is Medicine is an initiative focused on encouraging physicians and other health care providers to include exercise in health assessment and in treatment plans for all patients. Unfortunately, the benefits of physical activity and exercise recommendations are not emphasized in medical education. The result is that only about a third of US adults report having received exercise counseling at their last physician visit.

The amount of exercise needed for health benefits is lower than you might think. The Physical Activity Guidelines for Americans recommends that all adults participate in a minimum of 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic physical activity per week. This can be met by going for a 30 minute brisk walk on five days each week. For children, 60 minutes or more of moderate or vigorous physical activity every day is recommended. For everyone, additional health benefits come from doing more, either higher intensity exercise or longer duration activity and limiting sedentary time.

The Exercise is Medicine initiative aims to increase physician awareness of the health benefits of exercise, but it will probably be some time before exercise counseling becomes the norm. In the meantime, you should ask your doctor about including exercise in your personal health care plan. Then, go for a walk!

Exercise, like all prescriptions, only works if you use it as directed.

Earlier this week  I wrote about the Exercise is Medicine initiative and why physicians should prescribe exercise to all of their patients.

Despite the widely-known benefits of exercise, many physicians—and people in general—believe that chronic health conditions should be managed using medications, not  proper nutrition and physical activity. This is a misguided approach considering that weight gain and health conditions related to weight gain  accumulate over a period of years, resulting from eating too much combined with low levels of activity.

One reason that physicians are hesitant to prescribe exercise (and, similarly, good nutrition) is that in their experience, it doesn’t work. What they mean is that the results they see after recommending lifestyle modifications are typically not sufficient. So the assumption made by doctors and patients is that lifestyle modifications don’t work. But this is not necessarily the case

This debate comparing lifestyle modification with medical management of chronic diseases is familiar. Consider statins, the popular lipid-lowering medications that are currently among the most-prescribed drugs (examples include Lipitor, Zocor, Crestor and Vytorin). The effect of statin drugs on lowering blood lipids is significant in most patients. This, together with clever marketing to both patients and physicians, explains why they are so widely used.

It is possible to lower blood lipids as much as statins by carefully controlling diet and regular exercise, but it is difficult. How difficult depends on the individual, but everyone would agree that successful lifestyle modification takes more effort and dedication than taking a pill. In order for any treatment to work, it has to be followed. A patient who doesn’t follow their diet or exercise program is no different from a patient who doesn’t take their medication as directed. In both cases, the response to the treatment will fall short of expectations.

If someone didn’t take their statin medication and their blood cholesterol didn’t go down, no one would label the drug a failure. The medication may well have worked if the patient took it. But people routinely claim that diet and exercise don’t work, when the real problem is that these treatments aren’t followed. This could be because the patients weren’t provided with appropriate and actionable information or because they didn’t faithfully follow the instructions they were given.

The problem isn’t that lifestyle modification isn’t effective, it’s that people don’t implement healthy changes for the long-term. Whereas a statin drug results in rapid changes, the benefits of behavior change are realized more slowly. This can lead to the incorrect conclusion that diet and exercise aren’t working, even though they are.

In reality, medication can be part of a treatment plan, but should not be the only prescription.  Long-term health benefits come from changing eating and activity patterns. Medications should be used as a  “jump start” to treating a condition, with a goal of developing a new way of eating and regular activity as the long-term treatment.

For example, medications like statins can lower cholesterol quickly. Then, lifestyle changes can keep the cholesterol down, reducing the need for the drug. Since side effects depend on the dose and duration of treatment, this approach would reduce the risk of potentially dangerous side effects.

For many patients, lifestyle changes are effective on their own, meaning the medication isn’t necessary. And consider this: maintaining a healthy body weight, proper nutrition, and regular exercise has been proven to be the best—and at this point, only—way to prevent most of the health problems most of us will face. Good nutrition and physical activity really are the best medicine!

When it comes to making good food choices, knowledge is power.

My Health & Fitness column in the Aiken Standard this week is about making smart food choices and how the nutrition information we are provided with can complicate that process.


Making smart decisions about what you eat is an important step in losing weight, feeling better, and preventing and treating a host of health conditions. But doing so requires that you have the knowledge to make those healthy decisions. Unfortunately, most people don’t have a good education in nutrition, forcing them to rely on information provided to them.

Some of this information comes from reputable sources and is based on research and experience. More often, though, nutrition information is provided by food manufacturers whose interests may not be consistent with providing smart recommendations. The end result is that consumers (that’s us) may not understand the information they get or know how to use it to make healthy choices.

A good example is the health claims about whole grains found on many food packages, including breakfast cereals. “A good source of whole grains,” is a common claim. Most people would reasonably interpret as a sign that the food inside is healthy, or at least is healthier than similar foods that don’t contain whole grains.

These types of claims are allowed by the FDA, but they refer only to what is in the food, not whether it is healthy or not. Many of the foods bearing this claim probably are healthy choices, but this isn’t always the case.

For example, Lucky Charms cereal contains whole grains. In fact, whole grains are the first ingredient, as the claim on the box indicates. Sounds good, right? But, when you read the Nutrition Facts panel on the side of the box you will find that the second ingredient is marshmallows! Does that sound like a healthy breakfast? (Hint: It’s not!)

Lucky_Charms package

 

This is the problem. If you are like most people, you won’t take the time to read the ingredients or the nutrition information on the back of the package. And even if you do, you may find that information to be confusing. Even if you wanted to make healthy choices, you might not have the knowledge to interpret and apply the available nutrition information.

This general lack of knowledge we have about nutrition has led to situations in which some foods are restricted or banned. Recently, the city of Berkeley, California voted to impose a tax on soda and other sugary drinks in an effort to keep people from consuming too much sugar and too many calories.

This effort, and others like it, have contributed to a vigorous debate about personal choice and freedom for people to make their own decisions about what to eat and drink. One argument against these types of restrictions is that if people have the nutrition information about soda (or any other food) they can make informed choices.

This is a nice idea, but it simply isn’t fair to expect people to make good decisions if the information isn’t available or is not easy to understand. Worse, misleading information can lead to making bad decisions.

Help may be on the way. The FDA is working on a redesigned Nutrition Facts panel that should help us make better food choices. In particular, the amount of sugar added to foods will be listed. This change alone will help identify foods that may appear to be healthy, like Lucky Charms which contain whole grains, but are actually high in added sugar. Additional changes include more realistic serving sizes and better information about fat content.

It is unclear when the updated nutrition facts panel will be implemented. In the meantime, do your best to read labels and use common sense as your guide: The addition of marshmallows does not make any food any healthier, no matter how much whole grain it contains!

Don’t wait until you get sick: What you can do to prevent heart disease.

I have been writing recently about heart disease, how it is diagnosed, and what you and your doctor can do to treat it. In order for your doctor to start treating you for heart disease risk factors such as high blood pressure, high cholesterol, or diabetes you need to be diagnosed with one of these conditions. This requires proactively seeing your physician for screening before you start experiencing the consequences of these conditions.

But most people don’t visit their doctor until they have symptoms, and many wait until a more serious event (a heart attack, for example) occurs to seek medical attention. By this time, the disease process has progressed and managing it becomes the goal. It is possible to prevent both the conditions that lead to heart disease as well as reduce the risk that you may have a heart attack or stroke.

Your risk of heart disease is largely determined by health-related attributes and behaviors called risk factors. Some of these risk factors cannot be changed, including age, sex, and family history. Other risk factors are modifiable, meaning you can change them to reduce your risk. These modifiable risk factors include smoking, high blood pressure, high cholesterol, diabetes, obesity, and physical inactivity.

While there are medications that can lower blood pressure and cholesterol and treat diabetes, these modifiable risk factors are best addressed by lifestyle changes. Adopting healthy habits has the potential to have a bigger effect on heart attack risk than medical management. There are three important health behaviors that, together and separately, have a powerful effect on reducing heart attack risk:

Stop smoking. There is no way around this one. Quit! Ask your doctor about prescription medications that can make quitting easier. Nicotine replacement therapy in the form of patches, gum, and lozenges can help manage cravings and are available over the counter. Ultimately, though, quitting smoking is a behavior change that takes motivation, willpower, and time. But it is worth it—your risk of heart attack can drop 50–70% within five years of quitting.

Be active everyday. The importance of physical inactivity as a risk factor for heart disease is often overlooked. But make no mistake, being active on a regular basis is one of the most important things you can do to improve your heart health. Whether you have other risk factors or not, physical activity can reduce your chance of having a heart attack. And if you do have a heart attack, your active lifestyle improves your chances of survival and returning to a normal lifestyle.

The benefits of exercise are well-established and impact heart disease risk in a multitude of ways. Physical activity helps with weight control, lowers blood pressure, improves blood lipids, and prevents and treats diabetes. Think of this as a great health “deal.” By modifying one risk factor—inactivity—you can also promote beneficial changes in four others—obesity, hypertension, high cholesterol, and diabetes. There is no other treatment, drugs included, that can have such a broad impact on heart disease risk!

Improve your diet. If you are like most Americans, your diet is too high in saturated fat, salt, and added sugar and lacking adequate whole grains, fruits and vegetables, and fiber. This type of diet is associated with obesity, high blood pressure, high cholesterol, and diabetes. All of these conditions are risk factors for heart disease, so you may literally be eating your way to a heart attack.

It turns out that adopting a healthier eating pattern is important in reducing your risk of heart disease. Saturated fat intake can lead to abnormal blood lipids and high salt intake is linked to high blood pressure. While eating sugar doesn’t cause diabetes, the type of diet described above is associated with weight gain and diabetes. Just like with physical activity, a healthy diet can lead to improvements in several other risk factors.

The potential impact of these three health behaviors is great. Even modest changes in diet and activity can lead to improvements in risk factors and reduced heart attack risk. More intensive lifestyle modification can produce even greater benefits. In one famous study, daily exercise, a low-fat vegetarian diet, and stress management actually caused regression of heart disease, meaning that the blockages in the coronary arteries were smaller following treatment. While you may not follow such a strict program, becoming more active, eating a healthier diet, and quitting smoking can go a long way to improving your heart health.

Much ado about nothing: Supplement-free dietary supplements

Dietary supplements, including vitamins, minerals, and herbs, are used by millions of people every day. In fact, over 50% of Americans regularly take dietary supplements. Maybe you are one of them. If so, you should be aware of some recent news that once again raises concerns about supplement use.

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


 

Miracle cure pill bottle

The most common reason people report taking dietary supplements is to improve or maintain their health in general, but many take them for specific reasons such as bone health or weight loss. Anecdotal evidence suggests that people who take supplements are healthier than people who don’t. However, supplement users are more likely to eat better, exercise, and not smoke, all of which contribute to good health. [more details here.]

Given the claims made by supplement manufacturers, you may be surprised to learn that there is very little evidence to suggest that taking dietary supplements can improve your health. In fact, no scientific organization recommends the routine use of dietary supplements. Among the few exceptions is folic acid supplementation for women who are or who may become pregnant to prevent neural tube defects in the developing fetus. There aren’t many others.

While there is support for using vitamin or mineral supplements to address individual deficiencies, there is no reason to believe that taking supplements will do much to make a healthy person healthier. The fact that all supplements contain the statement, “This product is not intended to diagnose, treat, cure, or prevent any disease,” should tell you something. At best, taking dietary supplements will cause few, if any, benefits; at worst, they may do harm.

There have long been concerns about the safety and efficacy of dietary supplements. Ironically, this is by design. According to the 1994 Dietary Supplement Health and Education Act (DSHEA) manufacturers do not need to prove that their products are effective, only that they are safe. That said, there are instances in which the safety of dietary supplements has been questioned. [you can find tips for using dietary supplements safely here] Some can interfere with the way that other prescription and over-the-counter drugs work. Others may make certain health problems, like high blood pressure or diabetes, worse. And there is a concern that people might use dietary supplements to treat a condition rather than seeking medical help.

You may have seen in the news recently that the New York Attorney General is taking action against four major chain retailers for selling fraudulent and contaminated dietary supplements. DNA analysis showed that many of the supplements examined were completely lacking the active ingredient and contained other ingredients not listed on the label. In one case, a sample of St. John’s Wort contained no actual St. John’s Wort extract, but did contain the extract of a common house plant!

Some supplements undergo quality testing by independent labs, including U.S. Pharmacopeia and NSF International, and have labels which suggest that you are purchasing the actual substance. Keep in mind that this does not guarantee that the supplement will be safe or effective, just that it has been tested for purity.

Despite these questions about supplement purity, safety, and health benefits, there is nothing necessarily wrong with taking dietary supplements. If you choose to take supplements be aware of potential health risks, know that you may not be getting what you pay for, and don’t expect any miracles. And always make sure you tell your doctor which supplements you take to avoid any adverse reactions with other medications.

Finally, remember that no amount of dietary supplements can match the health benefits of good nutrition and regular physical activity.