A healthy addiction

It’s only been a week, and I am hooked. Go to bed thinking about it. Wake up thinking about it. Trust it to watch over me while I sleep. Listen to it when it tells me to eat right and exercise. Beam with pride when it rewards me for losing 5 lbs (in one week, by the way). Allow it to help me make healthy choices while living in a hotel room and eating out every meal. I am a Fitbit user.

In case you’re unfamiliar with it, the Fitbit One is a pedometer. Shaped like a cross between a guitar pick and a baby carrot, it is made to sit in your pocket, connect imperceptibly to your smartphone or computer, and count your steps. In so doing, along with you actively entering data like what you eat, your age and weight, and your fitness goals, it becomes a pocket fitness instructor. Additionally, if you wear it on your wrist at night, it also monitors your sleep, counting how long you sleep, how often you wake, and how efficient your sleep is. It’s made me go to bed earlier, so as to not disappoint it.

The company makes several devices, including a wifi-enabled scale that, once sets up, know you when you step on it, and automatically sends your weight and percent body fat to the device. Lastly, the company hosts online groups of users, turn the process of getting in to shape into a social game. We need a Nantucket Fitbit Users Group. Anyone else out there?

I’m in talks with the company about becoming a wholesaler so I can supply them to patients in my next practice. The little device (at $99), by enabling and encouraging a healthy lifestyle, is likely more valuable than any pill I will prescribe.

Exercise for Satiety

It’s a new year. I’m planning my office. And, recognizing that sitting is the new smoking–a recent study showed that as many as 1 in 10 deaths are secondary to prolonged inactivity–it is time to get serious about exercise again. In planning my office, I’m considering getting a treadmill with a work desk attached to it. Have you seen these? It would take up enough space so as to make it hard to not get on it throughout the day. For example, this one. I also just ordered a pair of Fitbits. You have probably heard about these little electronic pedometers that sync with your smart phone and track your numbers, e.g., steps, miles, calories burned, etc. I’m excited to try out the gamification that comes with them. You can set up a network of friends and compete. Being a naturally competitive person, with a wife that works out most days, that should be good for me (to have to live up to her standards). And I’m excited to extend this network to other friends and patients. A challenge (first, I have to see if I can avoid embarrassment being compared to Amy).

A blog post in the NY Times this past week discussed the effect of exercise on appetite. Most people recognize that exercise is not, in itself, a good way to lose weight. In fact, sometimes it causes you to gain weight. Appetite causes a spike in ghrelin levels, a hormone that stimulates hunger. And if you give in to this, you can easily defeat your exercise. Classic scenario, you set the alarm, wake up early, go out for a run. On the way home, proud that you displayed such disclipine, you stop at the Flake on the way home, and get a single donut and a cup of coffee, and ingest more calories than you just burned!

The post summed up two recent research studies, however, that showed that, with time, certain types of exercise increases the levels of other hormones, the as yet not well understood satiety hormones that mute the effect of ghrelin. In short, persistent, moderate exercise (the equivalence of a brief, brisk jog), showed a suppression in their appetite, whereas those that only walked did not suppress their appetites.

The post quoted the researcher: Exercise “improves the body’s ability to judge the amount of calories consumed and to adjust for that afterward.”

Endless Summer

Scenes from today’s Ozone Surf Classic, Cisco Beach. Another wonderful, charitable local event. Hats off to the organizers!

Nantucket Triathlon, 2010

Great event. Congrats to the organizers and the local first-timers!

Nantucket Triathlon, 2009

UPDATE: Click here for the results.

Why Some Foods Are Hard To Resist

David A. Kessler,MD is a Harvard-trained doctor, lawyer, medical school dean and former commissioner of the Food and Drug Administration and to research his latest book, The End of Overeating, he turned to dumpster-diving.

He was researching the ingredients of dishes served at a neighborhood Chili’s, information he couldn’t get from the restaurant, looking for food labels on discarded boxes. As FDA Commissioner he had something to say about the nutritional labels on foods sold in retail stores, but had never required the same of restaurants. So in he went.

The labels showed the foods were bathed in salt, fat and sugars, beyond what a diner might expect by reading the menu. For example, the ingredient list for Southwestern Eggrolls mentioned salt eight different times; sugars showed up five times. The “egg rolls,” which are deep-fried in fat, contain chicken that has been chopped up like meatloaf to give it a “melt in the mouth” quality that also makes it faster to eat. By the time you finish this appetizer, you would’ve consumed 910 calories, 57 grams of fat and 1,960 milligrams of sodium.

Kessler delves into the psychology and neuroscience of our food cravings, seeking an explanation to the conundrum of the person whose “will-power” is strong on many fronts, but who finds it hard to resist unhealthy foods (I class myself among those people). He concludes that we’re extremely susceptible to reward-conditioning when the reward consists of foods that combine fat, sugar and salt, and that the food industry has evolved to deliver extremely efficient, super-sized portions of fat-sugar-salt bombs in a variety of satisfying textures and presentations. Through interviews with scientists, psychologists and food industry insiders, and his own scientific studies and hours spent surreptitiously watching other diners at food courts and restaurants around the country, Kessler writes that he finally began to understand why he himself has spent his life having a hard time controlling his eating.

“Highly palatable” foods — those containing fat, sugar and salt — stimulate the brain to release dopamine, the neurotransmitter associated with the pleasure center. In time, the brain gets wired so that dopamine pathways light up at the mere suggestion of the food, such as driving past a fast-food restaurant, and the urge to eat the food grows insistent. Once the food is eaten, the brain releases opioids, which bring emotional relief. Together, dopamine and opioids create a pathway that can activate every time a person is reminded about the particular food. This happens regardless of whether the person is hungry.

Not everyone is vulnerable to “conditioned overeating” — Kessler estimates that about 15 percent of the population is not affected and says more research is needed to understand what makes them immune. But for those like me and Kessler, the key to stopping the cycle is to rewire the brain’s response to food — not easy in a culture where unhealthy food and snacks are cheap and plentiful, portions are huge and consumers are bombarded by advertising that links these foods to fun and good times, he said. Deprivation only heightens the way the brain values the food, which is why dieting doesn’t work, he said.

He concludes with a set of recommendations for breaking the conditioned responses we develop to crappy food. But this is where the book was a little disappointing. Having set up an exciting new framework for understanding our relationship to food, all Kessler offers by way of resisting junk food is a kind of Weight Watchers: be mindful about what you eat, avoid temptation, don’t give in a little lest you give in a lot, and so on. Nothing new here, and while it works, it’s hard, and harder still to sustain. Anyone who’s devoted more than a few hours to the question of controlling weight and eating has encountered and tried this advice — and chances are, they’ve failed at it.

Nonetheless, the book barrels along as a pop-sci book that clearly explains the science behind the “Insatiable American Appetite.”

EA Sports Active for Wii

I am 7 days into a 30-day Challenge using the new “game” for Wii from EA Sports:  Active. We have the Wii Fit (and this games takes advantage of the balance board that comes with Fit) and you can work up a sweat using it, but Wii Fit seems more focused on balance and Yoga stretching. It is also not as structured when it comes to putting you through a workout. So we mostly use it for the games, which the kids enjoy. EA Active, however, is not a game. It’s a little animated personal trainer in a box.

It comes with a leg strap, which holds your Wii nunchuk to moderate your lower body movements, and a resistance band, which is used a many of the exercises and makes it much more likely you’ll feel these exercises the next day. I found the band to be a little too easy to use and am using a stronger band we already had. I’m thinking of ways to velcro the Wii remote and nunchuck to my hands so I can use dumbbells instead.

A typical preset workout lasts about 30 minutes, involves a warm up, such as running in place; upper and lower body resistance exercises, such as alternating side lunges, side jumps, biceps curls and shoulder presses; and intermixes some game play like tennis, inline skating, or jump shots. It calculates the calories you burn and keeps track of your progress.

The downside is you are tied to the motion-sensing Wii remote and nunchuk. The onscreen trainer is concerned about your form doing the exercises, but can only tell you’re doing them right if you’re holding the remotes properly, and it can be a little tricky sometimes to hold the remotes AND hold the straps of the resistance band. If you’re doing the exercise right, but not holding the remotes like the TV wants you to, the onscreen trainer can get a little preachy.

For the casual fitness user, EA Active provides an adequate workout and some nice variety, and for someone that has trouble getting motivated to get off the couch, it can be a fun way to get you moving.


Vitamins Found to Curb Exercise Benefits

I read about an interesting study today in the NYTimes, published in this week’s  Proceedings of the National Academy of Sciences. Antioxidant vitamins like C and E  may block some of the beneficial effects of exercise and dieting, including the body’s sensitivity to insulin.

As summarized in the article:

…exercise makes the muscle cells metabolize glucose, by combining its carbon atoms with oxygen and extracting the energy that is released. In the process, some highly reactive oxygen molecules escape and make chemical attacks on anything in sight…These reactive oxygen compounds are known to damage the body’s tissues. The amount of oxidative damage increases with age, and according to one theory of aging it is a major cause of the body’s decline…The body has its own defense system for combating oxidative damage, but it does not always do enough. So antioxidants, which mop up the reactive oxygen compounds, may seem like a logical solution.

The researchers  at the University of Jena in Germany, tested this proposition by having young men exercise, giving half of them moderate doses of vitamins C and E and measuring sensitivity to insulin as well as indicators of the body’s natural defenses to oxidative damage.

They found that in the group taking the vitamins there was no improvement in insulin sensitivity and almost no activation of the body’s natural defense mechanism against oxidative damage.

The reason, they suggest, is that the reactive oxygen compounds, inevitable byproducts of exercise, are a natural trigger for both of these responses. The vitamins, by efficiently destroying the reactive oxygen, short-circuit the body’s natural response to exercise.

The researcher’s conclusions:

If you exercise to promote health, you shouldn’t take large amounts of antioxidants, and antioxidants in general cause certain effects that inhibit otherwise positive effects of exercise, dieting and other interventions.

It might be that reactive oxygen is beneficial in small doses, because it touches off the body’s natural defense system, but harmful in higher doses.

Red-bellied woodpecker

James took a picture of a Red-bellied Woodpecker (male) at the feeders on May 8.

Dieting in the Torture Memos

The Bush Administration apparently looked at Slim Fast and Jenny Craig diet plans to justify the calorie-restricted diets it fed prisoners who were being interrogated.

From the Huffington Post:

In a footnote to a May 10, 2005, memorandum from the Office of Legal Council, the Bush attorney general’s office argued that restricting the caloric intake of terrorist suspects to 1,000 calories a day was medically safe because people in the United States were dieting along those lines voluntarily.

“While detainees subject to dietary manipulation are obviously situated differently from individuals who voluntarily engage in commercial weight-loss programs, we note that widely available commercial weight-loss programs in the United States employ diets of 1,000 kcal/day for sustained periods of weeks or longer without requiring medical supervision,” the footnote reads. “While we do not equate commercial weight loss programs and this interrogation technique, the fact that these calorie levels are used in the weight-loss programs, in our view, is instructive in evaluating the medical safety of the interrogation technique.”

Rachel at the F-Word blog wonders what that means for those looking at such diets:

The fact that the same calorie restriction employed by commercial diet mongers is also used alongside such torture techniques as waterboarding, sleep deprivation and sexual and physical abuse is, in my view, even more telling.

© 2009 ackdoc - Greg Hinson, MD 508/325-9981 info@ackdoc.com Purchasing help RSS feed