SOME HEALTHY SNACKING STRATEGIES

                           

How can you keep snacking from derailing your healthy eating program, not to mention weight control? Try these tips.

Don’t skip meals. Skipping meals may seem like a good way to cut calories, but in fact this just makes you so hungry later in the day that you’re vulnerable to devouring mega-portions of snack food in order to supply your body with easily digested sugars.

Keep junk food out of the house. There’s a lot of truth to the old joke about the “see-food diet” — you see food and you eat it. The opposite is also true. If you don’t have junk food lying around, the sight of it won’t tempt you, so don’t even bring it home. After all, you can’t eat what isn’t there. Or, if someone in your household tends to have chips or other unhealthful snacks, put them out of sight.

Snack mindfully. Have you ever watched a show on television with a bag of chips or pint of ice cream in hand, only to find that it was all gone before you knew it? This type of mindless eating can pack on a lot of unwanted calories. The solution is simple. Try not to snack while doing something else like surfing the Web, watching TV, or working at your desk. Instead, stop what you’re doing for a few minutes and pay attention to your snack. Savoring a piece of fine chocolate can be more satisfying than gobbling down a whole chocolate bar.

Remember, you can take it with you. Think ahead and carry a small bag of healthful snacks in your purse or the glove compartment of your car. If you have a healthy snack handy — preferably, one you really like — you won’t turn in desperation to the calorie-laden cookies at the coffee counter or the candy. My preference is a wide variety of nuts—peanuts, pistachios, etc. It’s best to consume them in their salt-free form. Popcorn is also a viable option, but again without salt or other high caloric additives. Additional ideas are provided in a previous post: http://www.mortontavel.com/2015/04/05/

Zero in on hunger. Before you snack, ask yourself, “Am I truly hungry?” Many of us mistake emotions, such as stress and fatigue, for hunger. If the answer is yes (your stomach feels hollow, your head is achy), make sure you’re not confusing hunger with thirst. Drink an 8-ounce glass of water, then wait 10 to 15 minutes. If you’re still hungry, have a healthful snack.

Know your cravings. If you want a snack, but you’re not hungry, attack cravings from a psychological level. Ask yourself how you’re feeling. Lonely? Bored? Stressed? Then, ask yourself the bigger question: Will food fix this problem? The answer is always no. Eating a cookie, for example, won’t address a problem at work that you’re worried about. Go for a walk around the block, do a few stretches, put on some music, or choose another simple activity that might distract you or boost your mood. Then if you still want the food, fine. Ask yourself what food you really want. Then eat only a small amount, and make it good. If you’re craving chocolate, for example, eat one small square and savor it. It’s important that you snack on what you’re craving rather than deny the craving. Eating around a craving may only cause you to eat more because the craving isn’t satisfied.

Hopefully, these tips might make life a bit more pleasant and free of that undesirable excess weight!

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Health benefits of physical activity: A recent update explaining how much and what kind is most effective.

   A recent review clearly explains the health benefits of physical activity and exercise; virtually everyone can benefit from becoming more physically active. Most international guidelines recommend a goal of 150 min/week of moderate-to-vigorous intensity physical activity. Many agencies have translated these recommendations to indicate that this volume of activity is the minimum required for health benefits. However, recent evidence has challenged this threshold-centered messaging as it may not be evidence-based and may create an unnecessary barrier to those who might benefit greatly from simply becoming more active. This review summarizes recent information that has examined the relationship between physical activity and health status.

The Findings

Assessment of a large body of data (based largely on epidemiological studies consisting of large cohorts) have demonstrated a dose–response relationship between physical activity and premature mortality and the primary and secondary prevention of several chronic medical conditions. The relationships between physical activity and health outcomes are generally curvilinear such that marked health benefits are observed with relatively minor volumes of physical activity. These findings challenge current threshold-based messaging related to physical activity and health. They emphasize that clinically relevant health benefits can be accrued by simply becoming more physically active. This information is summarized nicely on the following Video:    http://links.lww.com/HCO/A42.

Conclusion: There’s hope for us all!

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DIETARY FATS AND HEART HEALTH: HERE ARE THE FACTS

The American Heart Association (AHA) has issued a new “Presidential Advisory” on dietary fats and cardiovascular disease to “set the record straight” on the dangers of saturated fats.

The statement by the American Heart Association, June 15, continues to strongly recommend replacing saturated fats with poly- and monounsaturated vegetable oil to help prevent heart disease.

The statement also recommends that the shift from saturated to unsaturated fats should occur simultaneously in an overall healthful dietary pattern, such as DASH (Dietary Approaches to Stop Hypertension) (http://www.mortontavel.com/2013/05/02/) or the Mediterranean diets, and that “good carbohydrates,” such as whole grains and whole fruits, are other appropriate foods to substitute for saturated fats.

“We want to set the record straight on why well-conducted scientific research overwhelmingly supports limiting saturated fat in the diet,” stated lead author, Frank Sacks, MD, professor of cardiovascular disease prevention at the Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

Outside nutritional experts were fully supportive of the advisory, describing it as “an outstanding paper,” “exacting in its review of the evidence,” and “full of common sense.”

The AHA leadership decided that they needed to put out a new advisory on diet — particularly fats — because of various commentators on nutrition suggesting that saturated fat was innocuous, which has been widely covered in the media, but these comments were not scientifically based.

Unfortunately, a great deal of attention has been paid to controversial new studies that are not scientifically rigorous. A growing trend of media articles focusing on small studies suggests that some saturated fats are “good for you.”  Some people suggest that eating butter and full-fat milk is beneficial. And coconut oil is a fad right now — but it is actually a saturated fat, which raises your LDL [low-density lipoprotein], so the AHA wanted to look at the issue again.

The AHA president issued an advisory identifying this as a key issue that needed attention. Conclusions were based on careful scientific review, organized in a very systematic way, involving experts from a wide range of fields who have looked very carefully at the literature. Then the recommendations were thoroughly vetted and passed through multiple levels of peer review and scientific advisory committees across the entire AHA. This statement focused on fats — what fats should we be eating — and they concluded very strongly that we all should eat less saturated fats, and these can be replaced by polyunsaturated and monounsaturated fats. This recommendation was supported by multiple scientific studies that demonstrated that by lowering intake of saturated fat and replaced it with polyunsaturated vegetable oil, cardiovascular disease is reduced by approximately 30%. In addition, several studies found that coconut oil — which is predominantly saturated fat but widely touted as healthy — raised LDL cholesterol the same way as did other saturated fats found in butter, meat, and palm oil.

Their message is that “polyunsaturated fats are the best fats to eat. They are found mainly in vegetable oils such as soy bean oil, peanut oil, corn oil. Monounsaturated fats, found in sunflower oil, olive oil, nuts, and avocado, are also okay — much better than saturated fats, and may be as healthy as polyunsaturated fats.”

The last few years has seen an increase in knowledge on benefits of polyunsaturated fats. They are associated with a reduction in total mortality and no compensatory increase in death from other causes; they are also associated with a reduction in insulin resistance, helpful in combating diabetes.

   The AHA document is full of common sense. It is not controversial, but saturated fat is scientific code for animal fat. This statement is telling us to eat less meat, but they are not actually using those words, possibly to avoid alienating livestock farmers. There is now a weight of evidence that plant foods — which are very low in saturated fat — are beneficial. It has been shown time and time again that these foods can reduce heart disease.

    Thus here is a clear statement that should allow us all to react sensibly!

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ANTACID DRUGS: SOME MAY NOT BE SO SAFE

       From a recent analysis of a large amount of data, researchers discovered an increased risk of death among PPI type antacid users. That includes the popular drugs–Nexium, Protonix, Prevacid, Prilosec, Kapidex, and others. When researchers compared those agents with the other type of antacids, the H2 blockers (Zantac, Pepsid, Tagamet, Axid and others),  those taking PPIs for one to two years were found to have a 50 percent increased risk of dying over a five year period. People may have the idea that PPIs are very safe because they are readily available, but there are real risks to taking these drugs, particularly for long periods of time.

Previous published studies had linked PPIs to kidney disease, and other researchers have shown an association with other lesser health problems.  Although prior research had disclosed that each of these side effects carried a small risk of death, this study suggested that together they may affect the mortality rate of PPI users.

To find out, the researchers sifted through millions of de–identified veterans’ medical records in a database maintained by the U.S. Department of Veterans Affairs. They identified 275,933 people who had been prescribed a PPI and 73,355 people prescribed an H2 blocker between October 2006 and September 2008, and noted how many died and when over the following five years. The database did not include information on cause of death.

They found a 25 percent increased risk of death in the PPI group compared with the H2 blocker group. The researchers calculate that, for every 500 people taking PPIs for a year, there is one extra death that would not have otherwise occurred. Given the millions of people who take PPIs regularly, this could translate into thousands of excess deaths every year.

The researchers also calculated the risk of death in people who were prescribed PPIs or H2 blockers despite not having the gastrointestinal conditions for which the drugs are recommended. Here, the researchers found that people who took PPIs had a 24 percent increased risk of death compared with people taking H2 blockers.

Further, the risk rose steadily the longer people used the drugs. Within 30 days, the risk of death in the PPI and H2 blocker groups was not significantly different, but among people taking the drugs for one to two years, the risk to PPI users was nearly 50 percent higher than that of H2 blocker users.

Researchers concluded that a lot of times people get prescribed PPIs for a good medical reason, but then doctors don’t stop it and patients just keep getting refill after refill after refill, there needs to be periodic re–assessments as to whether people need to be on these.

As compared with the H2 blocker group, people in the PPI group were older and also somewhat sicker, with higher rates of diabetes, hypertension and cardiovascular disease. But these differences could not fully account for the increased risk of death.

From this information, I would conclude that for most conditions helped by the relief of excessive gastric acidity, stick with H2 blockers whenever possible, but if one must take any of the PPI group, try to limit their use to less than one month each time.

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IS CHIROPRACTIC TREATMENT BOGUS?

At its core, all chiropractic is based on an unscientific theory of human disease— that all or most disease results from faulty alignment of vertebrae. If chiropractic manipulation appears to solve one’s back pain, it probably wasn’t medically significant to begin with. One of the problems with chiropractic treatment is that evidence for its effectiveness is entirely anecdotal. This is because it is nearly impossible to analyze chiropractic with double blind, placebo controlled studies. If such studies could be done, they would likely prove either that chiropractic was no better than a placebo or that it offered no measurable advantage over a massage. The practice’s founder, D.D. Palmer, created the practice based on the flawed notion that the root of all human illness lies in so-called “misalignments” of the spine (as opposed to things like germs and viruses and genetic anomalies.) Palmer sold his method of “adjustments” to correct these misalignments as a way to “naturally” cure people of problems — He even went so far as to make the dubious claim of curing deafness the first time he ever laid hands on a patient

But at present, chiropractors are hot: According to the Bureau of Labor Statistics, they rake in about $81,210 per year, and their ranks are expected to grow expected to grow 17 percent in the next few years.

And it’s primarily because humans have terrible backs. We just haven’t evolved to keep up with the physical stress of gravity on a straight back, combined with desk jobs that have us crunched over computers for hours on end. A full 80 percent of Americans will deal with back pain at some point in their lives; one in five people reported back pain in the last year alone. About one-third of those folks saw a chiropractor or other alternative practitioner to deal with their back pain in 2016.

But does chiropractic work? The industry is, by definition, an alternative to evidence-based medicine, and aspects of it can be pretty worrying. At the same time, some experts say this treatment has a place.

Even in 2017, chiropractors are full of odd ideas, with many patients reporting being routinely hurt and misled. The Mayo Clinic warns that chiropractic adjustments can cause herniated disks or make already herniated discs worse. Chiropractic patients also often suffer compressed nerves, even strokes. A colleague of mine, a neurosurgeon, informed me that he has personally observed patients who have been rendered quadriplegic (paralyzed from the neck down) following chiropractic manipulation of the neck. The former chiropractor and skeptic Sam Hamola writes that many chiropractors engage in aggressive and scammy behavior to separate patients from their cash.

One of the most disturbing complaints I hear comes from chiropractic patients who have paid thousands of dollars in advance for a course of treatment lasting several months — after succumbing to a high-pressure sales pitch involving scare tactics. These patients have usually opted to discontinue treatment because symptoms have either worsened or disappeared. Most have signed a contract, however, that does not allow a refund, even if the treatment regimen was not completed. Some have used a chiropractic “health care credit card” to borrow the advance payment from a loan company, leaving the patient legally bound to repay the loan.

Edzard Ernst, an expert in pain and its treatments, who has studied the effectiveness of chiropractic medicine, has written columns suggesting that chiropracters often do more harm than good. “You will lose some cash,” he tells a questioner via email of what a typical patient might expect if they see a chiropractor. “You might get some relief in the case of back pain, but not for other conditions …In the worst case, you might be in a wheelchair for the rest of your life.”

But as those numbers above show, chiropractors are doing great financially and patients are flocking to them. There’s about one of them for every two dentists in this country. Wander around any American city or suburb and you’ll likely spot their offices sandwiched between the local FedEx and Panda Express. They’ve even found their way into hospitals, where they work alongside regular doctors and nurses. And here’s where the big BUT comes into play: Some of those doctors actually like it.

Stuart Kahn is a doctor and professor of rehabilitation and physical medicine at Mount Sinai Hospital in New York City. He treats patients with debilitating lower back pain all day. If your back goes out, he’s the guy you want to see. And, every once in a while, he sends patients to chiropractors, stating “The best thing you can do is diagnose what the cause of the back pain is, and then you can try to treat it.” And that’s something only a doctor is qualified to do. When a patient walks into his office with back pain, Kahn’s first task is to rule out cancers, infections, fractures, and other disorders that require specialized treatment. He can also prescribe anti-inflammatory medicines that can reduce swelling and pressure on the spinal cord, saving patients from further pain and damage. But most of Kahn’s patients fall into two baskets: Either they will live with chronic back pain for the rest of their lives, or they have some acute problem, like a slipped disc, that needs to be dealt with. For the latter group, he works on building a treatment regime that can lessen their daily pain and improve their range of motion and quality of life. The most important part of that regime is usually physical therapy. After a period of work, he said, “they’re more flexible, their core is stronger, they have better posture at work, they try to cut out the exercises that trigger the episodes.”

But the former group consists of a narrow subset of those patients who require management not only for pain, but for accompanying stress and emotion, and this is the group that he thinks might be helped by chiropractic management. In these cases, improvement is likely attributed largely to the so-called “placebo effect,” i.e. the emotional lift that can make a useless “treatment” actually suppress physical pain. As I have described in detail¥, the placebo effect can be quite powerful, especially when accompanied by an attentive and sympathetic therapist combined with physical contact (“laying on of hands”). There is none better positioned to fulfill these criteria than a chiropractor. Thus there does seem to be some people who a few chiropractors can help, but truly physical benefit is questionable. In any case, however, those adjustments should be part of a course of treatment recommended by a medical expert, not the bloke hawking $10,000 neck twists next to Denny’s.

CONCLUSION: If your back hurts, see a doctor (MD type), and then let him/her decide whether you should consider a chiropractor. My preference, however, is to stick with a licensed physical therapist and forgo chiropractic entirely.

 

 

¥ Tavel, ME, “Snake Oil is Alive and Well: The Clash between Myths and Reality. “Reflections of a Physician”. Brighton Press, Inc. Chandler, Arizona, 2012

Tavel ME. The Placebo Effect: The Good, The Bad, and The Ugly. The American Journal of Medicine. 2014; 127(6):484–488

 

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