Monday, April 4, 2011
"Let Them Eat Celebration Cake"
When told that the peasants were starving and had no bread, the cruel French artistocrat Marie Antoinette responded "Let them eat cake." Or so the legend goes. Soon thereafter, the Parisian citizens exacted their revenge in a barbaric form of weight-loss surgery not covered by current medical insurances. Of course times have changed, and today, the New York City Health Department issued new rules for their own staff. According to the Daily News, employees received a brightly-colored pamphlet which spells out a set of regulations guaranteed to cure obesity at the workplace: 1) Tap water must be served as a healthy (?) alternative to other fluids. All beverages must be less than 25 calories per 8 ounces. 2) "Cut muffins and bagels into halves or quarters or order mini-sizes. " 3) No deep-fried foods can be served. 4) For celebrations, cake and air-popped popcorn "popped at the party and served in brown paper lunchbags" are permitted. 5) If a "celebration cake" is served, cookies are not permitted. Here is an excellent example of your tax dollars at work. You might not have known about the health benefits of zero-calorie water or smaller-sized muffins if the medical researchers and exercise physiologists at the NYC Health Department had not done their homework. Yesterday, cookies were a choice--now their illicit use is regulated by the same individuals who have turned second-hand smoking into a frightening toxin...and have ignored epidemic pediatric diabetes for decades. Perhaps with added civic revenues and governmental controls, a child's "celebration cake" will be available only from the Department of Health. Parents may need to have their child weighed by designated civil servants, and once his or her BMI is calculated, an appropriately sized/calorized pastry can be purchased. But no cookies ! And small-sized balloons at the party. How far we have come since the days of the Ancien Regime of Marie Antoinette and Louis XIV. Or, as these beheaded artistocrats might have put it before their demise, plus ca change, plus la meme chose.
Monday, March 28, 2011
Notes on "The Park Avenue Diet Show: Controversies in Weight Loss"; March 27, 2011
From its very earliest days the world of weight loss has been filled with controversy. The very first diet doctor was Banting, and he wasn't even a physician. Banting was an undertaker in the mid-1800's who invented a primitive form of the low carbohydrate diet. In fact the term "banting" was synonymous with dieting for many decades. Just as Dr. Robert Atkins did in the late 1960's, Banting advocated eating a disproportionate amount of protein. Most modern nutritionists would find this alarming, for among other things this program increases the risk of gout and kidney stones. When he was the on-site physician for Bell Telephone, Dr. Atkins adapted Banting's philosophy into a more concise set of recommendations. Controversy followed Dr. Atkins throughout his professional career. And the arguments still rage eight years after his death. You can buy Atkins Bars virtually everywhere, but are they correctly utilized by purchasers in the context of a low carbohydrate diet or assumed to have magical weight loss properties despite the high fat content? The Kempner Rice Diet, the bill of fare at the same-named institute at Duke University, seems like a sensible therapy. You check in prepared to eat nothing but steamed rice for several weeks and hope that the pounds melt off as quickly as possible. Sounds like a winner, no? But as Dr. Atkins himself told me, the "patients" must leave a urine sample in a jug outside their door at the end of every day. Lab technicians will test the urine for protein, something that is totally absent in steamed rice. But where would such protein be coming from? A tech-savvy patient could use his or her smart phone to find any one of dozens of gourmet restaurants surrounding the Kempner Institute. Dr. Atkins told me that the overweight comedian Buddy Hackett used to switch his urine sample with that of his neighbors after a delicious forbidden meal. Fast forward to 2011 when obese individuals who have had lap band surgery have devised a multitude of ways to have their liquified cake and eat it. Who is being cheated by this type of irrational behavior? The manufacturer of the lap band? The surgeon? The insurance company that paid for the procedure in the first place? The other policy holders in that insurance plan who must contribute additional moneys in their premiums to support such behavior? The scientific community encourages healthy debate in order to find the objective truths in the areas of health care of most benefit to society. You'll find very little objectivity in the world of weight loss. From banting to bariatrics, controversy have raged for almost two hundred years. Plus ca change, plus la meme chose.
Monday, March 21, 2011
Notes on "The Park Avenue Diet Show: The Capacity for Close Relating"; March 20, 2011
What are the most important defining characteristics of someone who has lost weight, changed his or her image, and maintained their new-found health consistently? Surprisingly, this subject has rarely been addressed at the annual convention of the American College of Physicians, a convocation I have attended almost continuously since 1983. But this year at the upcoming meeting in San Diego in a few weeks, an answer might be forthcoming.
In a seminar entitled "Treatment of Obesity", Dr. Robert Kushner will present data that provide a fascinating but not surprising set of answers. He asks: "What behavioral issues need to be appreciated for successful weight loss?" And he provides a partial list, one that dovetails remarkably with the philosophical and psychological infrastructure of The Park Avenue Diet.
First we should mention what is not important or predictive of success, namely the macronutrient food constituents of a weight-loss program. Endless ink has been spilled over the supposed benefits of the American Heart Association/ Atkins/ South Beach/ Weight Watchers/ Pritikin/ etc program--take your pick because their results are almost uniformly identical and depressing: a 5-10% "success" rate, with "success" being defined as approximately 10-15 pounds in one year, hardly a remarkable achievement. The American College of Physicians and the AMA have stated that they will not be accepting papers for presentation on the supposed benefits of any of these programs anymore. There is no point comparing one "therapy" to another when none of them isn't even remotely beneficial to a majority of people.
On the other hand Dr. Kushner provides a list of seven defining characteristics of the successful weight-loss patient, and here they are exactly as enumerated:
1) Coping capacity
2) Self-efficacy
3) Autonomy
4) Healthy narcissism
5) Motivation for weight loss: more confidence
6) Stability in life
7) Capacity for close relating
Virtually all of these are covered in one way or another in The Park Avenue Diet by either the famed humanistic psychologist Dr. Stanley Krippner or the glamorous, wise socialite Tinsley Mortimer. And the publication of the book predates this ACP academic presentation by two years.
Several of the behavioral issues might be defined by Dr. Krippner as offshoots of personal myths, the rulebook, narrative, or code we have formulated based on our life experiences and upbringing. Autonomous, efficacious people are self-reliant and self-motivated. Those of us who are better at coping with stress may avoid relying on "comfort foods" or high-calorie snacks for temporary pleasure during life crises. And more self-confidence means more pride in appearance, behavior, and physicality.
But it is the inclusion of "the capacity for close relating" that most interested me. One's need for intimacy, close relationships, bonds based on trust and affection--this is also crucial for maintenance of weight, a matter I can attest to professionally and personally. The converse situation, wherein an individual eats, relaxes and sleeps alone, is sometimes a scenario for introversion, loneliness, carelessness, self-neglect, depression, and an unhappy existence.
Except for The Park Avenue Diet I have never seen "the capacity for close relating" applied to any medical condition. But it certainly is important for one's health, especially as defined by the World Health Organization. "Physical, mental and social well-being, and not merely the absence of disease." Social health depends in part on self-confidence and good interpersonal skills, two of the seven most important components of image. And social health is a dynamic construct--you cannot measure it by weight, height, or a blood test value. You must actually do something, namely interact well with others on a professional, familial, and personal/intimate level.
We'll return to this topic after I return from my ACP conference in about three weeks. But you can certainly learn a lot from my guest expert Bernadette Penotti--in our book, on the radio, on her website, or in person !
In a seminar entitled "Treatment of Obesity", Dr. Robert Kushner will present data that provide a fascinating but not surprising set of answers. He asks: "What behavioral issues need to be appreciated for successful weight loss?" And he provides a partial list, one that dovetails remarkably with the philosophical and psychological infrastructure of The Park Avenue Diet.
First we should mention what is not important or predictive of success, namely the macronutrient food constituents of a weight-loss program. Endless ink has been spilled over the supposed benefits of the American Heart Association/ Atkins/ South Beach/ Weight Watchers/ Pritikin/ etc program--take your pick because their results are almost uniformly identical and depressing: a 5-10% "success" rate, with "success" being defined as approximately 10-15 pounds in one year, hardly a remarkable achievement. The American College of Physicians and the AMA have stated that they will not be accepting papers for presentation on the supposed benefits of any of these programs anymore. There is no point comparing one "therapy" to another when none of them isn't even remotely beneficial to a majority of people.
On the other hand Dr. Kushner provides a list of seven defining characteristics of the successful weight-loss patient, and here they are exactly as enumerated:
1) Coping capacity
2) Self-efficacy
3) Autonomy
4) Healthy narcissism
5) Motivation for weight loss: more confidence
6) Stability in life
7) Capacity for close relating
Virtually all of these are covered in one way or another in The Park Avenue Diet by either the famed humanistic psychologist Dr. Stanley Krippner or the glamorous, wise socialite Tinsley Mortimer. And the publication of the book predates this ACP academic presentation by two years.
Several of the behavioral issues might be defined by Dr. Krippner as offshoots of personal myths, the rulebook, narrative, or code we have formulated based on our life experiences and upbringing. Autonomous, efficacious people are self-reliant and self-motivated. Those of us who are better at coping with stress may avoid relying on "comfort foods" or high-calorie snacks for temporary pleasure during life crises. And more self-confidence means more pride in appearance, behavior, and physicality.
But it is the inclusion of "the capacity for close relating" that most interested me. One's need for intimacy, close relationships, bonds based on trust and affection--this is also crucial for maintenance of weight, a matter I can attest to professionally and personally. The converse situation, wherein an individual eats, relaxes and sleeps alone, is sometimes a scenario for introversion, loneliness, carelessness, self-neglect, depression, and an unhappy existence.
Except for The Park Avenue Diet I have never seen "the capacity for close relating" applied to any medical condition. But it certainly is important for one's health, especially as defined by the World Health Organization. "Physical, mental and social well-being, and not merely the absence of disease." Social health depends in part on self-confidence and good interpersonal skills, two of the seven most important components of image. And social health is a dynamic construct--you cannot measure it by weight, height, or a blood test value. You must actually do something, namely interact well with others on a professional, familial, and personal/intimate level.
We'll return to this topic after I return from my ACP conference in about three weeks. But you can certainly learn a lot from my guest expert Bernadette Penotti--in our book, on the radio, on her website, or in person !
Wednesday, March 16, 2011
The Last Word on Stress (for now)
The topic of stress can not be covered in too great detail. There are so many aspects to the subject, neurochemical, behavioral, hormonal, pathological, social--such that any brief discussion might seem overly simplistic. Moreover an academic presentation might leave out what readers or listeners need the most, namely practical advice.
Coping with stress is a learned skill. One needs multiple attempts, failures, and successes before having a confident approach to life's trials and tribulations. This is a learning curve that never ends because the stresses of adolescence, challenging as they may appear, have little relationship to the stresses one encounters late in life. But the self-confidence we gain by learning "not to sweat the small stuff" is a way to become better equipped for dealing with more momentous issues.
As a physician I have always felt that the stress of illness is the most important stess to learn to cope with. A young child overreacts instinctively to a slight accident or infinitesimal bodily harm. A fall in the playground will result in minutes of loud crying for no apparent purpose. A mother knows her duties well: not just soothing the area but giving psychological support. "Awww, it's okay." or "This is not something to cry over." I'm sure you've heard these before even if you don't remember. And your mother's advice on how to cope with stress is probably not too far from the truth right now as well.
The pre-eminent psychologist Jean Houston teaches people to view stressful situations in an unusually objective way. She instructed one of her colleagues (currently the Secretary of State) to put her problems in an imaginary box when dealing with other matters. The problems have not been solved, but they are seemingly isolated, to be dealt with at another time. She also teaches people to bolster their own self-confidence by dealing with complex issues as if they were famously self-assured celebrities.
We naturally gravitate to movie heroes who never reflect stress in their physical demeanor or conversation. Think of Gary Cooper in High Noon, Sigourney Weaver in Alien, Daniel Craig in Casino Royale or any other of your favorites. They do not ponder or complain about problems. They solve them. And part of coping with stress is not repeatedly enumerating all of one's current stressful issues, especially at 1 a.m., the worst time possible.
Psychotherapists, physicians, and in fact all health care providers must be able to offer constructive and user-friendly techniques of coping with stress to their patients. A personal favorite of mine was Albert Ellis, who certainly understood the ways that negative thinking can actually inhibit people from finding an appropriate solution to a troubling issue.
But you don't need a professional license to be able to offer good advice to a stressed-out friend. The most serious challenges of life must be handled in a calm and rational way. As an emergency room physician, I learned that speech patterns and body language can be equally as calming as the actual message. Even in dealing with your own problems, slow, calm, and methodical thinking is the first order of business no matter what the stress is. And the stronger and healthier you are physically, the more this will be reflected in mental acuity and a rational approach to stress.
Let's leave this subject for now. Stress will not go away, as you can see right now on the front page of any newspaper in the world. But coping with stress is an ongoing learning process, so pick some examples of "easy" problems and think of how you can frame them, analyze them, and solve them in a rational and healthy way. Your physical well-being depends on it.
Coping with stress is a learned skill. One needs multiple attempts, failures, and successes before having a confident approach to life's trials and tribulations. This is a learning curve that never ends because the stresses of adolescence, challenging as they may appear, have little relationship to the stresses one encounters late in life. But the self-confidence we gain by learning "not to sweat the small stuff" is a way to become better equipped for dealing with more momentous issues.
As a physician I have always felt that the stress of illness is the most important stess to learn to cope with. A young child overreacts instinctively to a slight accident or infinitesimal bodily harm. A fall in the playground will result in minutes of loud crying for no apparent purpose. A mother knows her duties well: not just soothing the area but giving psychological support. "Awww, it's okay." or "This is not something to cry over." I'm sure you've heard these before even if you don't remember. And your mother's advice on how to cope with stress is probably not too far from the truth right now as well.
The pre-eminent psychologist Jean Houston teaches people to view stressful situations in an unusually objective way. She instructed one of her colleagues (currently the Secretary of State) to put her problems in an imaginary box when dealing with other matters. The problems have not been solved, but they are seemingly isolated, to be dealt with at another time. She also teaches people to bolster their own self-confidence by dealing with complex issues as if they were famously self-assured celebrities.
We naturally gravitate to movie heroes who never reflect stress in their physical demeanor or conversation. Think of Gary Cooper in High Noon, Sigourney Weaver in Alien, Daniel Craig in Casino Royale or any other of your favorites. They do not ponder or complain about problems. They solve them. And part of coping with stress is not repeatedly enumerating all of one's current stressful issues, especially at 1 a.m., the worst time possible.
Psychotherapists, physicians, and in fact all health care providers must be able to offer constructive and user-friendly techniques of coping with stress to their patients. A personal favorite of mine was Albert Ellis, who certainly understood the ways that negative thinking can actually inhibit people from finding an appropriate solution to a troubling issue.
But you don't need a professional license to be able to offer good advice to a stressed-out friend. The most serious challenges of life must be handled in a calm and rational way. As an emergency room physician, I learned that speech patterns and body language can be equally as calming as the actual message. Even in dealing with your own problems, slow, calm, and methodical thinking is the first order of business no matter what the stress is. And the stronger and healthier you are physically, the more this will be reflected in mental acuity and a rational approach to stress.
Let's leave this subject for now. Stress will not go away, as you can see right now on the front page of any newspaper in the world. But coping with stress is an ongoing learning process, so pick some examples of "easy" problems and think of how you can frame them, analyze them, and solve them in a rational and healthy way. Your physical well-being depends on it.
Wednesday, March 9, 2011
How to Cope With Stress (Part Three)
Stress is such an important topic that two lengthy discussions of the subject are a mere introduction. I have lectured on this topic frequently, and Dr. Krippner and my DOROT Institute co-presentation from 2004 can be heard on my website. Our recent follow-up discussion is the March 13th WOR broadcast of "The Park Avenue Diet Show".
What is the biochemistry of stress? Although incompletely understood, it can be simplified by focusing on three discrete body parts: the hypothalamus, the pituitary, and the adrenal gland. Let's start at the top, namely the cerebral cortex, the outermost part of the brain where we do most of our thinking. As we view challenging situations or think stressful thoughts, impulses are sent to the hypothalamus, a tiny organ at the base of the human brain.
In addition to dozens of other known and unknown functions, the hypothalamus will secrete a chemical called corticotropin releasing hormone. This will travel a very short distance to the pituitary gland nearby, which will in turn secrete ACTH, adrenocorticotropin hormone. And this chemical in turn will stimulate the adrenal glands adjoining the kidneys to release cortisol.
You may not have heard of any of these chemicals before, and you are probably not aware of this cascade of hormones that rapidly follows exposure to a stressful situation. But you certainly know the feelings that they engender: nervousness, palpitation, dizziness, forgetfulness, and unremitting worrying.
Human neurochemistry is an extremely complex topic, as is physiological psychology, although both are extraordinarily interesting. Why we think what we think is an amalgam of neurotransmitters, hormones, behavioral patterns, social relationships, and personal mythology. Yet no one needs to be told what stress feels like. Everyone experiences it from cradle to grave.
Sometimes we can get used to stress and become less worried under a given set of circumstances. This is called desensitization. New Yorkers for example are accustomed to hearing car horns, police sirens, and other noises that might be startling to someone from a quiet rural area. Emergency room physicians are unaffected by beeps, buzzers, flashing lights, and other noises that might startle or frighten an already tense patient.
The stress response that is "pre-installed" in our bodies was a protective mechanism in our pre-historic past. "Fight or flight" might have been a daily activity in the dangerous world of cavemen and cavewomen. The adrenal gland was thus a lifesaver: this organ which sits on top of both kidneys is the control center for dealing with pre-historic environmental crises. Not only would it allow humans to flee dangerous animals by increasing cardiac and respiratory rates, it would allow the glucose supply to be rapidly increased, fueling the leg muscles so they could work in overdrive.
But these days, although we may have severe stress throughout the day, we certainly do not need excessive blood sugar, a racing heart, or hyperventilation. A simplistic definition of anxiety might be excessive secretion of cortisol and adrenaline when none is necessary.
Anxiety is also a complex topic, one usually discussed by prominent psychologists like Dr. Stanley Krippner rather than physicians. Needless to say anxiety like many other mood disorders depends in part on altered or dysfunctional neurochemistry.
People who suffer from unremitting anxiety may also have certain generalized fears, sometimes worsened by stress. Acrophobia (a fear of heights) is actually quite normal: extremely few people feel comfortable standing on a cliff overlooking Grand Canyon. But agoraphobia (a fear of public places) can be extremely debilitating and frightening. Acute and/or chronic stress can make certain individuals extremely reclusive, prohibiting them from virtually all social interactions.
Stress can affect one's perception of one's own health. Unremitting anxiety can lead to a somatization disorder, when an individual seeks medical attention repeatedly for an illness that doesn't exist. Another possible scenario is called a conversion disorder where neurological symptoms such as paralysis, numbness, or apparent blindness are a direct result of extreme personal stress.
These are considered psychiatric conditions, but stress unfortunately can be a co-factor in dozens of medical ailments. Excessive cortisol can decrease the production of mucus that lines the stomach and protects it from highly caustic hydrochloric acid. In this way, stress causes ulcers, a subject which I unfortunately am an expert in (having suffered an attack in 1991).
Stress is translated into hair loss for many people. How do you know if this is affecting you? When you run your hands gently through your hair, if 5 out of 12 hairs become loosened and fall out, stress may be the reason. And how does stress cause hair loss? "Growing" hairs are converted into "resting" hairs (which are not implanted as well) and fall out.
One of the most fascinating medical expressions of stress can be seen in a hyperventilating patient. Due to carbon dioxide and calcium imbalances, an extremely stressed out person may develop main d'accouchment [delivery hand, namely the hand shape that an obstetrician uses].
But enough talk about the neurochemistry, physiology, and pathology of stress. I'm sure that you are familiar with a great deal of this already. Did you know that the human body also has embedded anti-stress hormones and "software"? We have focused primarily on the sympathetic nervous system, which is responsible for "fight or flight". It has a mirror-image in the parasympathetic nervous system, a parallel set of nerves, neurotransmitters, hormones, and physiologic responses.
By gently rubbing one side of the neck near the carotid artery, a cardiologist or emergency room physician is able to stimulate an "anti-adrenaline" mechanism when faced with a patient with an extremely rapid heart rhythm. Don't try this, but gentle pressure on the eyes elicits a similar response, namely stimulation of the vagus nerve, the superhighway of the parasympathetic nervous system.
Another outstanding example is the "diving reflex". When certain birds and animals plunge into ice water, their heart rate, breathing rate, and metabolic rate all rapidly decrease. One of the extremely rarely used emergency room treatments for palpitations due to life-threatening arrhythmias is to plunge the patient's face into a basin of ice water, eliciting a type of "diving reflex" in a human being. Do not try this at home.
These examples although quite dramatic will show you that there exists in the human body a neurochemical balance to the stress mechanisms we have already discussed. Of course these emergency room heroic techniques are inappropriate for solving personal problems or coping with daily stresses. I'm sure you probably have not been aware of this unusually complex interrelationship.
Depersonalization, however, is a common and rather unconscious technique of coping with stress. This can be broadly defined as a technique of forgetting about one's self and directing one's thoughts totally externally. And I'm sure you have done this rather frequently in the last few months. Going to an exciting sports event, watching a thrilling James Bond movie, even reading a gossip magazine--all of these are activities that allow us to escape from our problems and briefly enter a "parallel universe" nearby. The stressful problems we are temporarily escaping will still be there later on, but our bodies are refreshed by the relief from unremitting bombardment by stress.
Alpha waves in the brain appear on EEG's when people are in a relaxed state, and quite often people can be taught how to achieve this level of psychological comfort. One classic way is through meditation, which can be somewhat duplicated by repeating a particular word or phrase over and over. Recent research has focused on endorphins, neurochemicals that are associated with positive and pleasurable feelings. You have no doubt heard that aerobic exercise, particularly jogging, is associated with the release of endorphins. Moreover, aerobic exercise "tones down" the sympathetic nervous system. This partially explains why "cardio" is a useful ancillary therapy for high blood pressure and heart disease.
Many people feel that coping with stress is best achieved through the use of minor tranquilizers such as Valium or Xanax. But I think it's more important to understand the neurochemical, physiological, and psychopharmalogical aspects of the topic rather than simply resorting to the simplistic therapy of prescription medication. Let's leave our discussion of this extraordinarily important issue at this point. We will continue at another time. Now go have a totally stress-free day!
What is the biochemistry of stress? Although incompletely understood, it can be simplified by focusing on three discrete body parts: the hypothalamus, the pituitary, and the adrenal gland. Let's start at the top, namely the cerebral cortex, the outermost part of the brain where we do most of our thinking. As we view challenging situations or think stressful thoughts, impulses are sent to the hypothalamus, a tiny organ at the base of the human brain.
In addition to dozens of other known and unknown functions, the hypothalamus will secrete a chemical called corticotropin releasing hormone. This will travel a very short distance to the pituitary gland nearby, which will in turn secrete ACTH, adrenocorticotropin hormone. And this chemical in turn will stimulate the adrenal glands adjoining the kidneys to release cortisol.
You may not have heard of any of these chemicals before, and you are probably not aware of this cascade of hormones that rapidly follows exposure to a stressful situation. But you certainly know the feelings that they engender: nervousness, palpitation, dizziness, forgetfulness, and unremitting worrying.
Human neurochemistry is an extremely complex topic, as is physiological psychology, although both are extraordinarily interesting. Why we think what we think is an amalgam of neurotransmitters, hormones, behavioral patterns, social relationships, and personal mythology. Yet no one needs to be told what stress feels like. Everyone experiences it from cradle to grave.
Sometimes we can get used to stress and become less worried under a given set of circumstances. This is called desensitization. New Yorkers for example are accustomed to hearing car horns, police sirens, and other noises that might be startling to someone from a quiet rural area. Emergency room physicians are unaffected by beeps, buzzers, flashing lights, and other noises that might startle or frighten an already tense patient.
The stress response that is "pre-installed" in our bodies was a protective mechanism in our pre-historic past. "Fight or flight" might have been a daily activity in the dangerous world of cavemen and cavewomen. The adrenal gland was thus a lifesaver: this organ which sits on top of both kidneys is the control center for dealing with pre-historic environmental crises. Not only would it allow humans to flee dangerous animals by increasing cardiac and respiratory rates, it would allow the glucose supply to be rapidly increased, fueling the leg muscles so they could work in overdrive.
But these days, although we may have severe stress throughout the day, we certainly do not need excessive blood sugar, a racing heart, or hyperventilation. A simplistic definition of anxiety might be excessive secretion of cortisol and adrenaline when none is necessary.
Anxiety is also a complex topic, one usually discussed by prominent psychologists like Dr. Stanley Krippner rather than physicians. Needless to say anxiety like many other mood disorders depends in part on altered or dysfunctional neurochemistry.
People who suffer from unremitting anxiety may also have certain generalized fears, sometimes worsened by stress. Acrophobia (a fear of heights) is actually quite normal: extremely few people feel comfortable standing on a cliff overlooking Grand Canyon. But agoraphobia (a fear of public places) can be extremely debilitating and frightening. Acute and/or chronic stress can make certain individuals extremely reclusive, prohibiting them from virtually all social interactions.
Stress can affect one's perception of one's own health. Unremitting anxiety can lead to a somatization disorder, when an individual seeks medical attention repeatedly for an illness that doesn't exist. Another possible scenario is called a conversion disorder where neurological symptoms such as paralysis, numbness, or apparent blindness are a direct result of extreme personal stress.
These are considered psychiatric conditions, but stress unfortunately can be a co-factor in dozens of medical ailments. Excessive cortisol can decrease the production of mucus that lines the stomach and protects it from highly caustic hydrochloric acid. In this way, stress causes ulcers, a subject which I unfortunately am an expert in (having suffered an attack in 1991).
Stress is translated into hair loss for many people. How do you know if this is affecting you? When you run your hands gently through your hair, if 5 out of 12 hairs become loosened and fall out, stress may be the reason. And how does stress cause hair loss? "Growing" hairs are converted into "resting" hairs (which are not implanted as well) and fall out.
One of the most fascinating medical expressions of stress can be seen in a hyperventilating patient. Due to carbon dioxide and calcium imbalances, an extremely stressed out person may develop main d'accouchment [delivery hand, namely the hand shape that an obstetrician uses].
But enough talk about the neurochemistry, physiology, and pathology of stress. I'm sure that you are familiar with a great deal of this already. Did you know that the human body also has embedded anti-stress hormones and "software"? We have focused primarily on the sympathetic nervous system, which is responsible for "fight or flight". It has a mirror-image in the parasympathetic nervous system, a parallel set of nerves, neurotransmitters, hormones, and physiologic responses.
By gently rubbing one side of the neck near the carotid artery, a cardiologist or emergency room physician is able to stimulate an "anti-adrenaline" mechanism when faced with a patient with an extremely rapid heart rhythm. Don't try this, but gentle pressure on the eyes elicits a similar response, namely stimulation of the vagus nerve, the superhighway of the parasympathetic nervous system.
Another outstanding example is the "diving reflex". When certain birds and animals plunge into ice water, their heart rate, breathing rate, and metabolic rate all rapidly decrease. One of the extremely rarely used emergency room treatments for palpitations due to life-threatening arrhythmias is to plunge the patient's face into a basin of ice water, eliciting a type of "diving reflex" in a human being. Do not try this at home.
These examples although quite dramatic will show you that there exists in the human body a neurochemical balance to the stress mechanisms we have already discussed. Of course these emergency room heroic techniques are inappropriate for solving personal problems or coping with daily stresses. I'm sure you probably have not been aware of this unusually complex interrelationship.
Depersonalization, however, is a common and rather unconscious technique of coping with stress. This can be broadly defined as a technique of forgetting about one's self and directing one's thoughts totally externally. And I'm sure you have done this rather frequently in the last few months. Going to an exciting sports event, watching a thrilling James Bond movie, even reading a gossip magazine--all of these are activities that allow us to escape from our problems and briefly enter a "parallel universe" nearby. The stressful problems we are temporarily escaping will still be there later on, but our bodies are refreshed by the relief from unremitting bombardment by stress.
Alpha waves in the brain appear on EEG's when people are in a relaxed state, and quite often people can be taught how to achieve this level of psychological comfort. One classic way is through meditation, which can be somewhat duplicated by repeating a particular word or phrase over and over. Recent research has focused on endorphins, neurochemicals that are associated with positive and pleasurable feelings. You have no doubt heard that aerobic exercise, particularly jogging, is associated with the release of endorphins. Moreover, aerobic exercise "tones down" the sympathetic nervous system. This partially explains why "cardio" is a useful ancillary therapy for high blood pressure and heart disease.
Many people feel that coping with stress is best achieved through the use of minor tranquilizers such as Valium or Xanax. But I think it's more important to understand the neurochemical, physiological, and psychopharmalogical aspects of the topic rather than simply resorting to the simplistic therapy of prescription medication. Let's leave our discussion of this extraordinarily important issue at this point. We will continue at another time. Now go have a totally stress-free day!
Tuesday, March 8, 2011
Notes on "The Park Avenue Diet Show: How to Cope With Stress (Part Two)"; March 13, 2011
Stress. You can't live with it, you can't live without it. But what is it?
Stress may be an acute reaction to a traumatic event or the breaking point when multiple challenging issues overwhelm a given individual. Stress varies from person to person, age group to age group, country to country, and continent to continent. It is classically thought of as a psychological disorder yet there is strong evidence for biochemical mediation. Everyone experiences stress at some time in his or her life, with only about 5-10% of the population experiencing severe recurrent symptoms.
What may provoke stress in one person may not necessarily affect others the same way. Yet no one would deny that these are especially stressful times. In addition to the unavoidable personal issues we may struggle with, there are plenty of problems locally and internationally to complicate the picture: terrorism, financial instability, chronic diseases, international conflicts.
While you may not know the names of the areas of the brain associated with feelings of stress (the hippocampus, amygdala, and cerebral cortex) you certainly know the feelings: restlessness, exhaustion, inability to concentrate, labile emotions, insomnia, incessant worrying. Some people may react to stress with emotional detachment, carelessness, and depersonalization. The latter describes a type of flight from reality, where the person temporarily escapes anxiety-provoking situations by retreating into an imaginary world.
Stress, however, is definitely a more serious problem when it creates or worsens medical conditions. Virtually every known illness can be affected negatively by stress. Blood pressure may rise, glucose levels may double, coronary arteries may narrow, and breathing may become difficult. Stress may also create or worsen lifestyle patterns such as overeating (or paradoxically anorexia nervosa) and may unfortunately lead to substance abuse as the individual self-medicates his or her anxiety with alcohol, cigarettes, or illegal drugs.
As you are well aware the primary treatment of stress in the United States is with prescription medication under the supervision of a psychopharmacologist. Supportive psychotherapy is not part of a typical visit to an internal medicine specialist. Moreover, since the average length of such a medical visit is only eight minutes long in 2011, the physician has absolutely no time to discuss his or her patient's life stressors. Not surprisingly, physicians too have stressful lives. If you don't believe me, read Uncle Vanya by Anton Chekhov.
Just like watching your weight and doing structured physical exercises, learning how to cope with stress is a skill that is necessary for optimal health. It is not merely a useful tool, it is a necessary technique for survival. Debilitating stress can derail any of our long-term personal or career goals quite rapidly. And simplistically relying on tranquilizers, sedatives, or antidepressants does not change the nature of the stress or give us guidance in how to resolve challenging issues.
I have been lucky to know Dr. Stanley Krippner since 1967 when I was his file clerk at Maimonides Medical Center during my high school years. As one of the most esteemed humanistic psychologists of the recent past, he has written dozens of books and hundreds of articles about mood disorders and how they affect an individual's thinking, interpersonal relationships, creative work, and community activities. We have discussed this enormous topic in various venues, and although we are seemingly experts in the field, we still experience enormous stress for which we must continually reinvent our own coping mechanisms and positive strategies.
Some of these are explored in our WOR radio interview and our lengthy lecture at the DOROT Institute, both of which you can hear on this website. You will never be able to totally eradicate stress from your life. You will certainly have something stressful happen to you within the next twenty four hours, hopefully minor. But you must not avoid learning and relearning how to cope with stress. And if you are suffering from palpitations, hair loss, insomnia, feelings of worthlessness, extreme sadness, or similar symptoms, the time to learn how to cope with stress is right now.
Stress may be an acute reaction to a traumatic event or the breaking point when multiple challenging issues overwhelm a given individual. Stress varies from person to person, age group to age group, country to country, and continent to continent. It is classically thought of as a psychological disorder yet there is strong evidence for biochemical mediation. Everyone experiences stress at some time in his or her life, with only about 5-10% of the population experiencing severe recurrent symptoms.
What may provoke stress in one person may not necessarily affect others the same way. Yet no one would deny that these are especially stressful times. In addition to the unavoidable personal issues we may struggle with, there are plenty of problems locally and internationally to complicate the picture: terrorism, financial instability, chronic diseases, international conflicts.
While you may not know the names of the areas of the brain associated with feelings of stress (the hippocampus, amygdala, and cerebral cortex) you certainly know the feelings: restlessness, exhaustion, inability to concentrate, labile emotions, insomnia, incessant worrying. Some people may react to stress with emotional detachment, carelessness, and depersonalization. The latter describes a type of flight from reality, where the person temporarily escapes anxiety-provoking situations by retreating into an imaginary world.
Stress, however, is definitely a more serious problem when it creates or worsens medical conditions. Virtually every known illness can be affected negatively by stress. Blood pressure may rise, glucose levels may double, coronary arteries may narrow, and breathing may become difficult. Stress may also create or worsen lifestyle patterns such as overeating (or paradoxically anorexia nervosa) and may unfortunately lead to substance abuse as the individual self-medicates his or her anxiety with alcohol, cigarettes, or illegal drugs.
As you are well aware the primary treatment of stress in the United States is with prescription medication under the supervision of a psychopharmacologist. Supportive psychotherapy is not part of a typical visit to an internal medicine specialist. Moreover, since the average length of such a medical visit is only eight minutes long in 2011, the physician has absolutely no time to discuss his or her patient's life stressors. Not surprisingly, physicians too have stressful lives. If you don't believe me, read Uncle Vanya by Anton Chekhov.
Just like watching your weight and doing structured physical exercises, learning how to cope with stress is a skill that is necessary for optimal health. It is not merely a useful tool, it is a necessary technique for survival. Debilitating stress can derail any of our long-term personal or career goals quite rapidly. And simplistically relying on tranquilizers, sedatives, or antidepressants does not change the nature of the stress or give us guidance in how to resolve challenging issues.
I have been lucky to know Dr. Stanley Krippner since 1967 when I was his file clerk at Maimonides Medical Center during my high school years. As one of the most esteemed humanistic psychologists of the recent past, he has written dozens of books and hundreds of articles about mood disorders and how they affect an individual's thinking, interpersonal relationships, creative work, and community activities. We have discussed this enormous topic in various venues, and although we are seemingly experts in the field, we still experience enormous stress for which we must continually reinvent our own coping mechanisms and positive strategies.
Some of these are explored in our WOR radio interview and our lengthy lecture at the DOROT Institute, both of which you can hear on this website. You will never be able to totally eradicate stress from your life. You will certainly have something stressful happen to you within the next twenty four hours, hopefully minor. But you must not avoid learning and relearning how to cope with stress. And if you are suffering from palpitations, hair loss, insomnia, feelings of worthlessness, extreme sadness, or similar symptoms, the time to learn how to cope with stress is right now.
Tuesday, March 1, 2011
Notes on "The Park Avenue Diet: A Tale of Two Books"; Sunday, March 6, 2011
How do you define "health"? The arrival of spring is the perfect opportunity to consider this issue. I tend to agree with the definition as articulated by the World Health Organization: "Physical, mental, and social well-being, and not merely the absence of disease." Dr. Stanley Krippner reminds his students and readers of the extreme importance of social well-being, something that has obviously had a tremendous impact on my personal and professional philosophy.
Health is definitely an evanescent entity: one minute you have it, the next minute it may be lost. I learned this first-hand as a medical student at Maimonides Medical Center. I also learned that health is an ongoing responsibility. If you relax your efforts and vigilance, you may not be able to regain lost ground.
I have had the honor of having two books published consecutively by the erudite company, Hatherleigh Press. They are The Little Book of Big Medical Emergencies and The Park Avenue Diet. Does the topic matter for these books seem wildly divergent to you? One of the editors at Hatherleigh Press asked me if the two books had anything in common. Of course they did, I said, they are both about health.
The Little Book of Big Medical Emergencies, which I wrote with Mark Steisel, is a user-friendly guide to the most serious and life-threatening health issues. It reflects my four years as an emergency room attending physician at Cabrini Medical Center where I worked between 1983 and 1987 for 600 twelve-hour shifts. Naturally I saw every conceivable type of medical, surgical, orthopedic, urological, and psychological emergency, just to name a few.
But what seemed most crucial to me was the patient's ability to minimize or avoid debilitating consequences, if possible, by recognizing the onset of the medical emergency. Certainly many emergencies can not be predicted, such as accidental falls or fractures. But others such as cardiac problems, back pain, and fainting might require immediate attention and first-aid before an ambulance is called.
The Little Book of Big Medical Emergencies is a concise guide to a complex subject, written in easy to understand terms and covering hundreds of possible scenarios. The book was originally published in 2002 by Barricade Books: the legendary publisher Lyle Stuart personally selected it for his catalogue, one of the greatest honors of my life. Hatherleigh Press published an updated and more elegant edition in 2007. For this version I asked fourteen different academic physicians to proofread and add comments as they felt necessary. The contributing physicians, all brilliant and generous colleagues, included famed diabetologist Dr. Philip Felig, pioneering surgeon Dr. Avram Cooperman, pediatrician Dr. Amy Glaser and superlative orthopedist Dr. Jacob D. Rozbruch.
Simply put, this is a book that belongs in every home, and here is one way to get a copy:
The Park Avenue Diet is also ground-breaking, albeit in a totally different way. I had been approached by numerous publicists and publishers to write a diet book after my nine year professional relationship with Dr. Robert Atkins. Most weight loss books seemed too monolithic to me: they were essentially a list of recipes, some pseudo-scientific gobbledygook, and perhaps a few semi-fictional case studies. Moreover, study after study in respected medical journals conclusively proved that the constituents of a weight loss menu have no predictive outcome in an individual's ability to become thinner. Macrobiotic=low carbohydrate=low fat. Even worse, diets that are food-centric have a 95% chance of failure. The "cure" rate of obesity is approximately the cure rate for lung cancer, namely 5%.
The only people who successfully lose weight and maintain their new-found body shape have undergone changes in their philosophical approach to physical, mental, and social health. In common parlance, they have adopted a "healthy lifestyle." That's why I set out to write not merely a "diet book" but a guide to changing one's entire image.
As with The Little Book of Big Medical Emergencies, I sought input from multiple experts, this time in unusually diverse fields. The Park Avenue Diet is thus the only book of its kind to juxtapose advice from celebrities such as Tinsley Mortimer, Laura Geller, and Joel Warren with personal health specialists such as Dr. Stanley Krippner, Berrnadette Penotti, and Chef Marie Annick Courtier. As a bonus, internationally respected fashion consultant Helene Hellsten is there to show you how to choose the most flattering clothing.
And here's how to get your own copy.
It's even available as a Kindle download.
And that's "A Tale of Two Books".
Health is definitely an evanescent entity: one minute you have it, the next minute it may be lost. I learned this first-hand as a medical student at Maimonides Medical Center. I also learned that health is an ongoing responsibility. If you relax your efforts and vigilance, you may not be able to regain lost ground.
I have had the honor of having two books published consecutively by the erudite company, Hatherleigh Press. They are The Little Book of Big Medical Emergencies and The Park Avenue Diet. Does the topic matter for these books seem wildly divergent to you? One of the editors at Hatherleigh Press asked me if the two books had anything in common. Of course they did, I said, they are both about health.
The Little Book of Big Medical Emergencies, which I wrote with Mark Steisel, is a user-friendly guide to the most serious and life-threatening health issues. It reflects my four years as an emergency room attending physician at Cabrini Medical Center where I worked between 1983 and 1987 for 600 twelve-hour shifts. Naturally I saw every conceivable type of medical, surgical, orthopedic, urological, and psychological emergency, just to name a few.
But what seemed most crucial to me was the patient's ability to minimize or avoid debilitating consequences, if possible, by recognizing the onset of the medical emergency. Certainly many emergencies can not be predicted, such as accidental falls or fractures. But others such as cardiac problems, back pain, and fainting might require immediate attention and first-aid before an ambulance is called.
The Little Book of Big Medical Emergencies is a concise guide to a complex subject, written in easy to understand terms and covering hundreds of possible scenarios. The book was originally published in 2002 by Barricade Books: the legendary publisher Lyle Stuart personally selected it for his catalogue, one of the greatest honors of my life. Hatherleigh Press published an updated and more elegant edition in 2007. For this version I asked fourteen different academic physicians to proofread and add comments as they felt necessary. The contributing physicians, all brilliant and generous colleagues, included famed diabetologist Dr. Philip Felig, pioneering surgeon Dr. Avram Cooperman, pediatrician Dr. Amy Glaser and superlative orthopedist Dr. Jacob D. Rozbruch.
Simply put, this is a book that belongs in every home, and here is one way to get a copy:
The Park Avenue Diet is also ground-breaking, albeit in a totally different way. I had been approached by numerous publicists and publishers to write a diet book after my nine year professional relationship with Dr. Robert Atkins. Most weight loss books seemed too monolithic to me: they were essentially a list of recipes, some pseudo-scientific gobbledygook, and perhaps a few semi-fictional case studies. Moreover, study after study in respected medical journals conclusively proved that the constituents of a weight loss menu have no predictive outcome in an individual's ability to become thinner. Macrobiotic=low carbohydrate=low fat. Even worse, diets that are food-centric have a 95% chance of failure. The "cure" rate of obesity is approximately the cure rate for lung cancer, namely 5%.
The only people who successfully lose weight and maintain their new-found body shape have undergone changes in their philosophical approach to physical, mental, and social health. In common parlance, they have adopted a "healthy lifestyle." That's why I set out to write not merely a "diet book" but a guide to changing one's entire image.
As with The Little Book of Big Medical Emergencies, I sought input from multiple experts, this time in unusually diverse fields. The Park Avenue Diet is thus the only book of its kind to juxtapose advice from celebrities such as Tinsley Mortimer, Laura Geller, and Joel Warren with personal health specialists such as Dr. Stanley Krippner, Berrnadette Penotti, and Chef Marie Annick Courtier. As a bonus, internationally respected fashion consultant Helene Hellsten is there to show you how to choose the most flattering clothing.
And here's how to get your own copy.
It's even available as a Kindle download.
And that's "A Tale of Two Books".
Monday, February 21, 2011
Notes on "The Park Avenue Diet Show: The Mathematics of Dieting"; February 20, 2011
The subject of weight loss lends itself to analysis from an anatomical, physiological, sociological, biochemical, pathological, psychological, histological, and epidemiological point of view--one at a time, please.
But mention "The Mathematics of Dieting" and even the most frustrated overweight people become fascinated with the intricate workings of the machine we all inhabit, the human body. Like a car, a television remote, and a NASA rocket, we too need fuel, and as one would expect, there are relatively strict numerical formulations involved in the conversion of food to energy. The energy was may utilized immediately during a calisthenics class--or the "energy" may be stored visibly as body fat, encircling one's body like a corset of AA batteries.
3500 calories equals one pound in either direction. To gain a pound, the American equivalent of falling off a log, one must eat an excess of 3500 calories over one's metabolic needs. To lose a pound, not as easy as it seems, one must burn off 3500 calories--by swimming for 6 hours, for example.
How many calories do you eat per day? You can find this number approximately by multiplying your weight by 15. Therefore, a 200-pound individual is ingesting 3000 calories daily in order to stay the same weight. Any physical exercise must be taken into account and additional caloric requirements considered. But the math is still the same, and since many American do minimal if any physical exercise daily, the above calculation is quite accurate...and startling.
A 300-pound worker at my radio station was totally fascinated by "The Mathematics of Dieting" like a child hearing about Santa Claus or the Easter Bunny. And no cross examination was needed: he silently added up his foods for the day and the math was correct. And if that person were to cut out 500 calories per day from any meal or snack, he would lose one pound per week.
Let's invert the formula and express it a different way. Since there are 365 days in a year and 3500 (let's pretend 3650) calories in a pound, any additional of 10 calories per day results in a one-pound weight gain in one year. A single 20 calorie biscuit per day will add two pounds per year. A 150 calorie can of soda per day will make anyone gain 15 pounds per year.
Review your daily food habits with this in mind. Are the extra pounds (daily or yearly) worth it? You might find ways of cutting back on calories that seem insignificant, yet it all adds up. Enjoying flavored seltzer (no artificial sweeteners, please) instead of juice or soda could remove 15 pounds of visible or visceral fat--all by itself.
"The Mathematics of Dieting" is a practical way of explaining that your weight is an understandable phenomenon. There will be a variation amongst people of about 15% due to slow metabolism, certain satiation hormones, and other biochemical parameters. But the basics are most definitely real, so write down what you eat, calculate your energy intake per day (weight times 15), see if exercise or its absence needs to be accounted for...and change for the better.
What's the first step in understanding the metabolic workings of your own body? Do the math !
But mention "The Mathematics of Dieting" and even the most frustrated overweight people become fascinated with the intricate workings of the machine we all inhabit, the human body. Like a car, a television remote, and a NASA rocket, we too need fuel, and as one would expect, there are relatively strict numerical formulations involved in the conversion of food to energy. The energy was may utilized immediately during a calisthenics class--or the "energy" may be stored visibly as body fat, encircling one's body like a corset of AA batteries.
3500 calories equals one pound in either direction. To gain a pound, the American equivalent of falling off a log, one must eat an excess of 3500 calories over one's metabolic needs. To lose a pound, not as easy as it seems, one must burn off 3500 calories--by swimming for 6 hours, for example.
How many calories do you eat per day? You can find this number approximately by multiplying your weight by 15. Therefore, a 200-pound individual is ingesting 3000 calories daily in order to stay the same weight. Any physical exercise must be taken into account and additional caloric requirements considered. But the math is still the same, and since many American do minimal if any physical exercise daily, the above calculation is quite accurate...and startling.
A 300-pound worker at my radio station was totally fascinated by "The Mathematics of Dieting" like a child hearing about Santa Claus or the Easter Bunny. And no cross examination was needed: he silently added up his foods for the day and the math was correct. And if that person were to cut out 500 calories per day from any meal or snack, he would lose one pound per week.
Let's invert the formula and express it a different way. Since there are 365 days in a year and 3500 (let's pretend 3650) calories in a pound, any additional of 10 calories per day results in a one-pound weight gain in one year. A single 20 calorie biscuit per day will add two pounds per year. A 150 calorie can of soda per day will make anyone gain 15 pounds per year.
Review your daily food habits with this in mind. Are the extra pounds (daily or yearly) worth it? You might find ways of cutting back on calories that seem insignificant, yet it all adds up. Enjoying flavored seltzer (no artificial sweeteners, please) instead of juice or soda could remove 15 pounds of visible or visceral fat--all by itself.
"The Mathematics of Dieting" is a practical way of explaining that your weight is an understandable phenomenon. There will be a variation amongst people of about 15% due to slow metabolism, certain satiation hormones, and other biochemical parameters. But the basics are most definitely real, so write down what you eat, calculate your energy intake per day (weight times 15), see if exercise or its absence needs to be accounted for...and change for the better.
What's the first step in understanding the metabolic workings of your own body? Do the math !
Monday, February 14, 2011
Notes on "The Park Avenue Diet Show: What Should I Have for Lunch?"; February 13, 2011
Lunch means different things to different people. Having traveled the world and temporarily becoming immersed in dozens of different civilizations. I have experienced as wide of a variety of noon-time meals as anyone I know. In Mexico I enjoyed ceviche, raw fish served as a beach food on the sands of Puerto Vallarta overlooking the Pacific Ocean. In Sherpa villages near Mount Everest, Nepal, I enjoyed momos, a type of dumpling. And in Ouarzazate, Morocco, I dug into chicken tajine, a hearty stew eaten native-style with both hands.
None of these exotic lunches is available in the United States. Moreover, these meals are part of a total cultural experience. A visitor to New York City from Puerto Vallarta, Nepal, or Morocco would probably be fascinated by and drawn to the same fast food franchises that millions frequent every day.
When I was about ten years old, a drive-in hamburger joint named Wetsons opened on Empire Boulevard and Flatbush Avenue, near my home. My mother was shocked that anyone would deny himself or herself the pleasures of a home cooked meal for a boxed cheeseburger and greasy fried potatoes. Unfortunately this was the shape of things to come, as H. G. Wells might have said.
The shape of things to come might also have included the shape of 21st century Americans. Although you can download, print, or read the nutritional content of your local chicken/burger/pizza/hero sandwich menu, few people if any read the fine print.
Except in individuals with highly physical jobs, lunch should never exceed 500 calories. Inattention to caloric content has immediate implications for weight. Inattention to salt and/or macronutrient content has immediate implications for blood pressure, fluid balance, and blood sugar. A high triglyceride level after a meal usually means that the person has the metabolic syndrome and is rapidly transforming dietary glucose into circulating, potentially dangerous fats.
A healthy lunch is not impossible to find. The choice is up to you. Please consider substituting the immediate gratification of fast foods for the delayed gratification inherent in longer life and better health. Which will you have for lunch?
None of these exotic lunches is available in the United States. Moreover, these meals are part of a total cultural experience. A visitor to New York City from Puerto Vallarta, Nepal, or Morocco would probably be fascinated by and drawn to the same fast food franchises that millions frequent every day.
When I was about ten years old, a drive-in hamburger joint named Wetsons opened on Empire Boulevard and Flatbush Avenue, near my home. My mother was shocked that anyone would deny himself or herself the pleasures of a home cooked meal for a boxed cheeseburger and greasy fried potatoes. Unfortunately this was the shape of things to come, as H. G. Wells might have said.
The shape of things to come might also have included the shape of 21st century Americans. Although you can download, print, or read the nutritional content of your local chicken/burger/pizza/hero sandwich menu, few people if any read the fine print.
Except in individuals with highly physical jobs, lunch should never exceed 500 calories. Inattention to caloric content has immediate implications for weight. Inattention to salt and/or macronutrient content has immediate implications for blood pressure, fluid balance, and blood sugar. A high triglyceride level after a meal usually means that the person has the metabolic syndrome and is rapidly transforming dietary glucose into circulating, potentially dangerous fats.
A healthy lunch is not impossible to find. The choice is up to you. Please consider substituting the immediate gratification of fast foods for the delayed gratification inherent in longer life and better health. Which will you have for lunch?
Monday, February 7, 2011
Notes on "The Park Avenue Diet Show: The Hidden Cost of Being Overweight"; February 6, 2011
"A tsunami of obesity" is how an editorial last week in the British medical journal The Lancet described the latest worldwide statistics. One in three people on Earth is overweight, one in nine people is obese. That this could happen in previously healthy, relatively isolated populations is indeed quite shocking. Even more frightening is the fact that the percentage of obese individuals doubled since 1980. "Worldwide" now has another meaning.
No one in the United States will be surprised since here the percentages of overweight and obesity are both 33%. We always stay ahead of the pack! At least initially, because residents of Pacific island nations currently have the highest BMIs on the entire planet. If Mutiny on the Bounty were being filmed today, the romantic scenes might not seem as glamorous.
Everyone will have his or her own explanation of this sorry state of affairs, whether socioeconomic, geopolitical, culinary, or biochemical. That doesn't change the fact that this "tsunami" is a mere harbinger of worse to come. As reported by various experts in the American College of Physicians, obesity is a risk factor for 40 illnesses in 9 different organ systems. Most people are aware of the most prevalent ones, namely hypertension, diabetes, high cholesterol, and circulatory illnesses. Yet obesity is unique in being directed implicated in breast cancer and prostate cancer, diseases worsened by diametrically opposite hormones. Also on this list: asthma, atrial fibrillation, colon cancer, sleep apnea, mood disorders etc...Such is the nature of visceral fat, a topic covered in depth elsewhere on this website and on the WOR radio show.
"The Hidden Cost of Being Overweight" refers to the various medications, emergencies, and hospitalizations due to the aforementioned illnesses. There cannot be a price on human suffering, for every life is precious--and good health is a priceless gift. The media at times have raised fear of global warming to a near hysterical pitch. In epidemic obesity, we have a health crisis that will affect younger generations within several decades. Meteorology is a most elusive science. Internal medicine is not, and unfortunately, things may have to get worse before they get better.
Just this once, please don't think about the rest of the world. Think about yourself !
No one in the United States will be surprised since here the percentages of overweight and obesity are both 33%. We always stay ahead of the pack! At least initially, because residents of Pacific island nations currently have the highest BMIs on the entire planet. If Mutiny on the Bounty were being filmed today, the romantic scenes might not seem as glamorous.
Everyone will have his or her own explanation of this sorry state of affairs, whether socioeconomic, geopolitical, culinary, or biochemical. That doesn't change the fact that this "tsunami" is a mere harbinger of worse to come. As reported by various experts in the American College of Physicians, obesity is a risk factor for 40 illnesses in 9 different organ systems. Most people are aware of the most prevalent ones, namely hypertension, diabetes, high cholesterol, and circulatory illnesses. Yet obesity is unique in being directed implicated in breast cancer and prostate cancer, diseases worsened by diametrically opposite hormones. Also on this list: asthma, atrial fibrillation, colon cancer, sleep apnea, mood disorders etc...Such is the nature of visceral fat, a topic covered in depth elsewhere on this website and on the WOR radio show.
"The Hidden Cost of Being Overweight" refers to the various medications, emergencies, and hospitalizations due to the aforementioned illnesses. There cannot be a price on human suffering, for every life is precious--and good health is a priceless gift. The media at times have raised fear of global warming to a near hysterical pitch. In epidemic obesity, we have a health crisis that will affect younger generations within several decades. Meteorology is a most elusive science. Internal medicine is not, and unfortunately, things may have to get worse before they get better.
Just this once, please don't think about the rest of the world. Think about yourself !
Tuesday, February 1, 2011
Notes on "The Park Avenue Diet Show: The Salt of the Earth"; January 30, 2011
I haven't touched a salt shaker since 1976 when, as a medical student at Maimonides Medical Center, I saw the immediate effects of sodium chloride on blood pressure and fluid retention. When was the last time you used a salt shaker? Did you stop in 1976 as well?
What were those early clinical experiences that so alarmed me? One had to have been repeatedly seeing elderly people rushed to the emergency room after a large salty meal. The patients were sitting upright gasping for breath, blue in the face, alarming their family and friends. Pulmonary edema, commonly referred to as "water in the lungs" was what these unhappy people were experiencing. There was literally a parade of ambulances and stretchers on Christmas Eve after the Feast of the Seven Fishes. That enormously salty meal resulted in fluid retention and terrifying medical emergencies.
Sodium chloride exerts its dangerous effects via an osmotic affinity with water. That's why the people almost drowned internally after overeating on Christmas Eve. The same osmotic effect is responsible for sodium chloride's ability to preserve food. Did you know that? When added to a can of recently cooked string beans, for example, salt will draw fluid from any nearby bacteria, thus dehydrating and killing them. This property has been known for thousands of years and is exactly why Austrian "cavemen" and Roman soldiers learned to use salt as a means of preserving fresh foods. It certainly was not added to make the items taste better.
How much salt do you need in a day? Very little, because our kidneys miraculously extract just the right amount from what we eat. Rarely can adding salt to food be considered life-saving or essential (the only examples of the contrary would apply to people who have fainted or have severe diarrhea or dehydration).
Since only 2,000 milligrams of sodium is recommended per day, why would anyone throw caution to the wind and eat foods that have unnecessarily high amounts included? I have no idea. Even the innocuous gesture of adding salt to water when making pasta needs some re-evaluation. Do you know why salt is added? It's to raise the boiling point of the water. In that way the pasta will cook more quickly and thoroughly, especially if it is preferred "al dente". If salt were added simply for taste, it could just as easily be added afterwards.
Salt and its effect on weight is well documented. The last thing that someone struggling with weight needs is fluid retention. Therefore please consider doing what I did in 1976 and give up table salt for the next thirty-five years. And in thirty-five years, ask me whether or not to continue this way.
What were those early clinical experiences that so alarmed me? One had to have been repeatedly seeing elderly people rushed to the emergency room after a large salty meal. The patients were sitting upright gasping for breath, blue in the face, alarming their family and friends. Pulmonary edema, commonly referred to as "water in the lungs" was what these unhappy people were experiencing. There was literally a parade of ambulances and stretchers on Christmas Eve after the Feast of the Seven Fishes. That enormously salty meal resulted in fluid retention and terrifying medical emergencies.
Sodium chloride exerts its dangerous effects via an osmotic affinity with water. That's why the people almost drowned internally after overeating on Christmas Eve. The same osmotic effect is responsible for sodium chloride's ability to preserve food. Did you know that? When added to a can of recently cooked string beans, for example, salt will draw fluid from any nearby bacteria, thus dehydrating and killing them. This property has been known for thousands of years and is exactly why Austrian "cavemen" and Roman soldiers learned to use salt as a means of preserving fresh foods. It certainly was not added to make the items taste better.
How much salt do you need in a day? Very little, because our kidneys miraculously extract just the right amount from what we eat. Rarely can adding salt to food be considered life-saving or essential (the only examples of the contrary would apply to people who have fainted or have severe diarrhea or dehydration).
Since only 2,000 milligrams of sodium is recommended per day, why would anyone throw caution to the wind and eat foods that have unnecessarily high amounts included? I have no idea. Even the innocuous gesture of adding salt to water when making pasta needs some re-evaluation. Do you know why salt is added? It's to raise the boiling point of the water. In that way the pasta will cook more quickly and thoroughly, especially if it is preferred "al dente". If salt were added simply for taste, it could just as easily be added afterwards.
Salt and its effect on weight is well documented. The last thing that someone struggling with weight needs is fluid retention. Therefore please consider doing what I did in 1976 and give up table salt for the next thirty-five years. And in thirty-five years, ask me whether or not to continue this way.
Monday, January 10, 2011
Notes on "The Park Avenue Diet Show: Log Cabin Exercises"; January 9, 2011
When Americans think of exercise, if indeed they do, it is viewed as a chore or a hardship or an unpleasant atonement for the sin of sloth. Our mechanized society, where transportation is totally automated and home conveniences make housework almost unnecessary, has resulted in epidemic overweight and obesity. But that's not true in other parts of the world.
Having traveled to remote, challenging locations throughout the world, I appreciate the role of daily exercise in the maintenance of good physical health. There are no weight-loss clinics in the villages near the highest Himalayan mountains. I took a two week trek to the base camp of Mount Everest about twenty years ago which I described to friends as the ultimate Stair Master. The Sherpa people, the famed indigenous population of this Shangri-la, do not suffer weight problems at all.
Even in the "lower" ranges of the Austrian Alps or the Moroccan Atlas mountains, everyone appears fit and trim. A walk to the local store in Badgastein takes one down a forty-five degree angled street for twenty minutes. No matter what Viennese pastry one might eat as a snack, it is thoroughly burned off after the ascent back to the train station. Was it worth it? I could hardly move my legs the day after I tried this for the first time, despite going to a New York City gym daily for twenty years.
According to the American College of Physicians, via their workshops and seminars, exercise is much less important than diet if someone is obese. Caloric control is therefore a necessary first step in any attempt to lose weight. However, as one gets closer to an ideal weight or a realistic goal, exercise becomes mandatory. Regular structured exercise is necessary for weight maintenance, for which reason I sometimes call those "last ten pounds" "exercise pounds".
All exercise programs must include strength training and cardio, and the most skillful personal trainers have learned how to teach these to their clients simultaneously. Attention must also be paid to flexibility and balance; these are extraordinarily important for aging baby boomers, especially those born in Brooklyn.
Are there psychological benefits to exercise? I feel that the ability of skeletal muscles to use lactic acid as a fuel (a property that must be developed through cardio exercise) makes an individual more energetic and upbeat. Other researchers feel that endorphins are released during exercise, but I favor the reduction of lactic acid levels as a biochemical explanation of the beneficial psychological effects.
A good personal trainer is not merely a human textbook of calisthenics. He or she must be a motivational speaker and somewhat of a psychologist. Most people who do not exercise need to be inspired, and this will jump start their participation in physical activity. For the 67% of adult Americans who are overweight or obese, this needs to be more than a temporary New Year's resolution. I didn't like to exercise at all when I was in high school and college. Then I grew up. Now it's your turn.
Having traveled to remote, challenging locations throughout the world, I appreciate the role of daily exercise in the maintenance of good physical health. There are no weight-loss clinics in the villages near the highest Himalayan mountains. I took a two week trek to the base camp of Mount Everest about twenty years ago which I described to friends as the ultimate Stair Master. The Sherpa people, the famed indigenous population of this Shangri-la, do not suffer weight problems at all.
Even in the "lower" ranges of the Austrian Alps or the Moroccan Atlas mountains, everyone appears fit and trim. A walk to the local store in Badgastein takes one down a forty-five degree angled street for twenty minutes. No matter what Viennese pastry one might eat as a snack, it is thoroughly burned off after the ascent back to the train station. Was it worth it? I could hardly move my legs the day after I tried this for the first time, despite going to a New York City gym daily for twenty years.
According to the American College of Physicians, via their workshops and seminars, exercise is much less important than diet if someone is obese. Caloric control is therefore a necessary first step in any attempt to lose weight. However, as one gets closer to an ideal weight or a realistic goal, exercise becomes mandatory. Regular structured exercise is necessary for weight maintenance, for which reason I sometimes call those "last ten pounds" "exercise pounds".
All exercise programs must include strength training and cardio, and the most skillful personal trainers have learned how to teach these to their clients simultaneously. Attention must also be paid to flexibility and balance; these are extraordinarily important for aging baby boomers, especially those born in Brooklyn.
Are there psychological benefits to exercise? I feel that the ability of skeletal muscles to use lactic acid as a fuel (a property that must be developed through cardio exercise) makes an individual more energetic and upbeat. Other researchers feel that endorphins are released during exercise, but I favor the reduction of lactic acid levels as a biochemical explanation of the beneficial psychological effects.
A good personal trainer is not merely a human textbook of calisthenics. He or she must be a motivational speaker and somewhat of a psychologist. Most people who do not exercise need to be inspired, and this will jump start their participation in physical activity. For the 67% of adult Americans who are overweight or obese, this needs to be more than a temporary New Year's resolution. I didn't like to exercise at all when I was in high school and college. Then I grew up. Now it's your turn.
Monday, January 3, 2011
National Diet Day
January 2nd has been renamed National Diet Day, at least in my own imaginary calendar. I invented this non-existent holiday 20 years ago as the Associate Medical Director of the Atkins Center when I noticed patients' remorse over dietary indiscretions during the holiday season. The same people who had over-indulged in eggnog, candy-canes, and Chanukah chocolates now felt sorry for themselves. And like penitents confessing a minor sin while omitting a larger one, they "promised to themselves" a more healthful future.
This is properly labeled a New Year's Delusion, something Dr. Stanley Krippner might call a negative personal myth. The mere act of "repenting" is a supposed antidote to the wretched excess of the past few weeks or months. Self-esteem is falsely boosted by the individual's newly found self-observation, as if that in itself melts the pounds away.
And then comes January 2nd, when one's conscience and seemingly the entire "diet" industry revs ups their engines to promote weight-loss plans for all palates and sizes. The American College of Physicians notes that 95% of these programs fail their followers...or is it the other way around? When an industry giant like [name redacted] promises weight-loss via lasagna, cookies, and pizza, who can resist?
You can, if you realize that none of these supposedly "nutritious" programs dare to publish their statistics of success and failure. In tiny type, there is a message flashed on your TV screen for a microsecond: "results not typical", which I rephrase as "it is not typical for you to get results", a perfectly legal recasting of their devilishly insincere message. Those exercise programs like [redacted] and [redacted]? January is an unusually busy month for sign-ups at your local health-club, but lifting the pen to sign a contract is unfortunately the last exercise many people will do there.
Without simultaneous attention to all the components of image, not just the one an overweight post-holiday dieter might focus on, nothing will ever be lastingly accomplished. National Diet Day (and Month, actually) is therefore a form of mock penitence that cannot lead to better health. Our bodies are not aware of any holidays; diabetes and its complications can occur at any time of year. The Angel of Death, unlike many public service union members, goes to work every single day.
My imaginary holiday, National Diet Day, is a reaction to the cyclical nature of many overeaters' thought processes--eat, drink, and be merry, for tomorrow you die(t). But for the 33% of adult American not affected by overweight or obesity, National Diet Day is every day of the year. And for them, the celebration of health--and life--takes precedence over the temporary pleasures of high calorie foods. Statistically, the better your weight is, the more likely it is that you will celebrate many more January 2nds. Now there's a great reason to say "Happy New Year"!
This is properly labeled a New Year's Delusion, something Dr. Stanley Krippner might call a negative personal myth. The mere act of "repenting" is a supposed antidote to the wretched excess of the past few weeks or months. Self-esteem is falsely boosted by the individual's newly found self-observation, as if that in itself melts the pounds away.
And then comes January 2nd, when one's conscience and seemingly the entire "diet" industry revs ups their engines to promote weight-loss plans for all palates and sizes. The American College of Physicians notes that 95% of these programs fail their followers...or is it the other way around? When an industry giant like [name redacted] promises weight-loss via lasagna, cookies, and pizza, who can resist?
You can, if you realize that none of these supposedly "nutritious" programs dare to publish their statistics of success and failure. In tiny type, there is a message flashed on your TV screen for a microsecond: "results not typical", which I rephrase as "it is not typical for you to get results", a perfectly legal recasting of their devilishly insincere message. Those exercise programs like [redacted] and [redacted]? January is an unusually busy month for sign-ups at your local health-club, but lifting the pen to sign a contract is unfortunately the last exercise many people will do there.
Without simultaneous attention to all the components of image, not just the one an overweight post-holiday dieter might focus on, nothing will ever be lastingly accomplished. National Diet Day (and Month, actually) is therefore a form of mock penitence that cannot lead to better health. Our bodies are not aware of any holidays; diabetes and its complications can occur at any time of year. The Angel of Death, unlike many public service union members, goes to work every single day.
My imaginary holiday, National Diet Day, is a reaction to the cyclical nature of many overeaters' thought processes--eat, drink, and be merry, for tomorrow you die(t). But for the 33% of adult American not affected by overweight or obesity, National Diet Day is every day of the year. And for them, the celebration of health--and life--takes precedence over the temporary pleasures of high calorie foods. Statistically, the better your weight is, the more likely it is that you will celebrate many more January 2nds. Now there's a great reason to say "Happy New Year"!
Subscribe to:
Posts (Atom)
