Monday, October 25, 2010

Notes on "The Park Avenue Diet Show: The Only Thing Constant is Change"; October 24, 2010

“The only thing constant is change.”

This famous quotation attributed to Herakleitos (written 2500 years ago) has implications that are philosophical, existential, and medical. It appears in Lives of the Philosophers by Diogenes Laertius. Other translations: “Only change is unchanging”. “Nothing is permanent except change.”

We tend to think of our bodies almost as statues, impervious to outside influences and figuratively fixed in stone. You know however that virtually every component of human anatomy and biochemistry is renewable as growth and metabolism proceed.

Sometimes we cannot see change. If you look in the mirror every day, the person staring back at you always looks the same. But take a look at your photos from ten years ago and you’ll have to admit that things are different. I certainly hope they are better.

On the other hand, if the tensions of life and misplaced priorities have led you down the path of dietary indiscretion, you certainly need change—primarily a change in your personal mythology, your personalized rule book or code of behavior. Change occurs with every chronic illness, although the illnesses due to obesity change very quickly and seriously.

At a recent convention of the American College of Physicians, data was presented that shocked the world of endocrinologists: at the time of diagnosis of a typical type 2 diabetic, 60% of damage to the major blood vessels and the heart has already happened. In essence, the disease has been diagnosed at an advanced state and there are already potentially fatal complications.

Moreover even if the patient is taking prescription medication, diabetes is constantly worsening although blood sugar values may be deceptively normal. These findings provide a frightening view into the nature of some bodily disease processes, but unfortunately in diabetes the only thing constant is change.

http://www.ajmc.com/supplement/managed-care/2006/2006-11-vol12-n14Suppl/Nov06-2399ps369-s381

Here’s another quotation from Herakleitos: “One’s bearing shapes one’s fate” which can also be translated from the ancient Greek as “character is destiny.” This is reflected in The Park Avenue Diet by my own philosophy that your lifestyle is reflected not only by external and internal characteristics but also in your opportunities and relationships.

“You cannot step into the same river twice” as Herakleitos reminds us. This is certainly true because new waters are continuously flowing past your feet. It is also true because of the element of time. And for the human body, time means aging.

Knowing this, you need to be proactive in matters that concern your health. Just like diabetes having a long, silent “waiting period” before complications occur, so too do problems of physical, mental, or spiritual illness have a “calm before the storm.” Don’t wait therefore for problems to arise. Your vigilance and attention to health must be constants despite the ever-changing nature of our world, your environment, and the human body.

Monday, October 18, 2010

Notes on "The Park Avenue Diet Show: All About the Abs"; October 17, 2010

The abdominal muscles are necessary parts of your anatomy. They are also featured in book titles, exercise routines, and vitamin advertisements. But for 67% of the adult American population, abdominal muscles are sandwiched between layers of subcutaneous and visceral fat, a most unhealthy sandwich indeed.

Epidemiologists have determined how to answer the most profound question of the 21st century: "How do you know if you're fat?" Here are several ways of answering this:

1. Waist circumference, where normal for men is under 40 inches and for women is under 35 inches.

2. Waist-to-hip ratio (abnormal is greater than 0.9 in women, greater than 1.0 in men). This measurement correlates strongly with the most significant complications of obesity because upper body fat (visceral fat) is more dangerous than leg or buttocks fat (subcutaneous fat).

3. Look at yourself sideways in the mirror.

The abdominal muscles support the front of the upper body, thus helping breathing, and also support the spine and lower back muscles, helping your posture. The abdominal muscles also help with balance and flexibility.

Since you are probably envious of people with well defined abdominal muscles, it might be motivating to learn their proper names. The innermost is the transverse abdominus, a band of muscles that totally encircles the lower body. Nearby are two internal oblique muscles and on top of these are two external oblique muscles. The latter can sometimes be seen in well developed athletes.

The most famous abdominal muscle of all is the rectus abdominus, a long, flat band of muscles that extends from the ribs to the pelvis. These muscles are crossed by three tendons called the linae transversae. This structure has the appearance, as you well know, of a "six-pack".

People who are physically fit know that there is no single exercise for the abdominal muscles. Quite the contrary, all exercises should utilize the abdominal muscles. For example curls with hand weights do not merely strengthen the biceps. The exerciser should also maintain a perfectly flat abdomen during biceps curls for stability and isolation of the arms. The abdominal muscles do not participate in the active movement of the weights but they certainly receive a workout.

What other exercises are good for the abdominal muscles? The plank, the "bicycle", the crunch, the extended-arm crunch, and "sit-ups" using an exercise ball. All of these are described in detail on various sites on the internet. Bernadette Penotti, my brilliant colleague and health expert, favors the plank for beginners and seasoned athletes.

Your abdominal muscles will not see the light of day until you lose weight, so make that your number one priority for shaping up in general. In "The Park Avenue Diet" is an entire 42 day exercise plan that takes you from beginner to expert. By the end of the book you will be able to duplicate, albeit slowly, the exact routine that Bernadette Penotti does herself.

It's all about the abs, so get started on improving yours today.

Monday, October 11, 2010

Notes on: "The Park Avenue Diet Show: Eggs-istentialism"; October 10, 2010

Misinformation and misunderstanding about eggs represent errors in thinking that confuse the American public and lead to poor nutritional recommendations. For several decades many people have been lead to believe that eggs cause hardening of the arteries, coronary artery disease, strokes and other cardiovascular abnormalities. The simplistic reason? Since eggs contain cholesterol, they are inherently unhealthy.

The truth is quite the opposite: cholesterol is not a poison but an important component of many crucial bodily hormones. Moreover, as has been determined from research on the metabolic syndrome, weight gain and high calorie diets trigger insulin resistance which in turn elevates dangerous lipoprotein levels in the bloodstream.

What do you eat for breakfast? If you check out the breakfast menu of your local fast food franchise, you will find numerous items whose caloric content may be seven to ten times more than that of a hard boiled egg. For people struggling with weight, a high protein, low calorie food is indeed the perfect choice, and that’s exactly what eggs are.

Here are several scholarly articles on the subject. Note that in no case do the researchers recommend egg-white omelets or avoiding eggs entirely.

The first article, dating from 1999, was a trailblazing study that upset the nutritional applecart. Egg consumption was found to have any impact on the risk of serious cardiovascular illnesses.

http://jama.ama-assn.org/cgi/content/abstract/281/15/1387


A more recent article in The American Journal of Clinical Nutrition came to the same exact conclusion. Here the blame for atherosclerotic disease is attributed to saturated fats and trans fats. The latter two are supplied in abundance in those 1,000 calorie breakfasts that many Americans unreservedly embrace.

http://www.ajcn.org/cgi/content/full/87/4/799


An article in Circulation in 2008 studied the effect of egg consumption on heart failure. Once again there was no causal relationship.

http://circ.ahajournals.org/cgi/content/full/117/4/512


Here is the most important study that we discussed this week, published in the journal Risk Analysis. Eating one egg per day is responsible for less than 1% of the risk of coronary heart disease in healthy adults. On the other hand, poor lifestyle choices (unhealthy diet, smoking, obesity, physical inactivity) contribute 30-40% of heart disease risk. The remaining 60-70% of heart disease risk is due to unavoidable factors (genetics) and potentially treatable risk factors (diabetes, high blood pressure). Next to those numbers, the 1% risk attributed to eggs seems extraordinarily small. Perhaps someone can explain why diabetes is treated so flippantly in some circles—on “diet” magazine covers that promote “healthy” chocolate cakes—yet eggs are still considered nutritional pariahs.

http://www.physorg.com/print148641987.html


The larger issue, once we accept the fact that eggs have a place in virtually everyone’s diet, is: where does the average American turn when there is so much misinformation in our media-cluttered society? Unfortunately, it is up to you to refer to trusted sources of health information exclusively, no easy task. Sorting through supposedly conflicting data and controversial issues—that’s my responsibility. Your responsibility? Eat a healthy breakfast!

Monday, October 4, 2010

Notes on "The Park Avenue Diet Show: What Should I Have for Breakfast?"; October 3, 2010

My grandmother said it, and so did yours: “Breakfast is one of the most important meals of the day.” Although somewhat simplistic, this statement reflects not only old-world values but physiologic biochemistry.

People who begin their day with a breakfast that is nothing more than a junk heap of refined carbohydrates are truly starting off on the wrong foot. Carlton Fredricks, the famed nutritionist, was one of the first people to speak out against America’s overindulgence with sugar. Not only are most breakfast foods highly caloric, they have the ability to set into motion insulin resistance and a pattern of glucose instability throughout the day.

Donuts, pancakes, French toast, waffles, bagels, syrupy coffee concoctions all have in common an absolute lack of nutrition and a 100% composition of sugar. Take a look at the shape of people who start their day with these foods. Or better yet, take a look at yourself. “Saving money” by making a glazed donut your breakfast will be offset eventually by the high price of prescription medication for one or more of the illnesses caused by the metabolic syndrome.

A healthy breakfast should be a balanced one, namely one that includes good carbohydrates and protein. The caloric total should not exceed 500 calories, since this is 25% of one’s daily needs. A very healthy breakfast might even “weigh in” with 250 calories. Now take a look in person or online at the calorie content of breakfasts foisted on you by the fast food industry. Who needs 800 to 1100 calories upon waking up from a deep sleep? Perhaps a construction worker, an athlete, or a hiker in the Himalayas. Certainly not you or your children.

If you want to know if a friend or colleague has good nutritional insights, the easiest way is simply to ask him or her what was for breakfast. And if you are struggling with weight, changing your breakfast is probably the first thing you should do.

Here are some great ideas that can start you on the road to enlightenment. The longest journey begins with a single step. The pathway to better health should start with your next breakfast.

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And now here are some excellent breakfast tips from an honored colleague:

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Hi everyone, this is Jennifer, and you may have heard Dr. Fischer mention my name on this week’s show. I have been very fortunate to work with Dr. Fischer as his practice nurse for the past 2 ½ years.

I would like to share with you some of my favorite breakfast items. For starters I always enjoy a cup of Jasmine-Green tea without milk or sugar (this is such a flavorful tea that additives are unnecessary).

On mornings when I may not have much of an appetite I will have a vanilla yogurt with a few blueberries added in. This will run you anywhere from 150-200 calories.

There are other mornings that I wake up and require something a little more substantial. On these days I may have a frittata (a baked omelet) made with egg whites, tomatoes, spinach and feta cheese; about 230 calories. One of my other recommendations is actually my favorite of breakfast items and that is one poached egg over a bowl of steel-cut oatmeal. For a little extra flavor I sometimes sprinkle Parmigiao-Reggiano cheese right over the top; for a total calorie count of 230 calories. Besides being absolutely delicious, the combination of protein and carbohydrates will keep your appetite satiated right till lunchtime.

A healthy breakfast is exactly what you need to start your day off right.