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Everything You Ever Wanted to Know About Losing Weight, Exercise, Stress, and Cardiovascular Risk from an Expert, Dr. Sharon Alger-Mayer. The Best Diet, How Much Exercise, the Hormone Stress Connection, the Best Phytonutrients, and the Healthiest Carbs

2010-02-24T17:39:02Z

"Why is it so hard to to maintain a healthy weight and good eating habits? It's multi-factorial. Genetics loads the gun - but the environment pulls the trigger.

We are all different genetically in our hunger and satiety cues--the rate at which we burn off calories, our dietary patterns, and the stress-causing changes in our brains."

-Dr. Sharon Alger-Mayer, Associate Professor of Medicine, Division of Clinical Nutrition, Albany Medical College, Albany NY-

"A habit cannot be tossed out the window; It must be coaxed down the stairs a step at a time."
-Mark Twain-

If you are receiving this post via email click here to get to the web version with all the links.

Would you lose weight and start to exercise if it could save you money?

Starting this year almost everyone at my place of work is getting with the Program. The diet & exercise program. If lowering cardiovascular risk, and feeling great isn't enough motivation--maybe money will work! If we want to pay 2009 rates for our health insurance in 2010 & 2011 we need to show that we are either healthy, or we are taking serious steps to get healthy.

If you have hypertension, elevated cholesterol, diabetes, asthma, are a smoker, or you are overweight (BMI above 27) you need to join a free program (including Curves or Weight Watchers) and reach the set healthy goals by November 2010 to get your rebate.

Everyone, even those of us who are already in good shape--must still participate by joining a small "team" & tracking one or more healthy behaviors:

Weight loss
Pedometer steps (and we've all received a free pedometer)
Daily exercise minutes
Cups of fruits & vegetables consumed

Yes, it feels "big-brother-ish", but you aren't forced to participate--and frankly, I don't know anyone who isn't. I've just logged in my exercise minutes, and how many fruits & vegetables I've eaten--and I have to admit, it's a great way to keep me honest--and motivated!

So, now let's bring on our diet and exercise expert--Dr. Sharon Alger-Mayer.

What's Eating You? Food, Mood, and Cardiovascular Risk

For the past weekend I've been "up to my ears" listening to a fascinating lecture by Dr. Sharon Alger-Mayer--all about how diet, exercise, stress, sleep, belly fat, and brain chemicals affect our cardiovascular risk.

The lecture title says it all: "What's Eating You? Food, Mood, and Cardiovascular Risk", Audio-Digest Foundation--Family Practice 58(8): Feb. 28, 2010. Click here

I'm going to do my best to highlight some of the "new to me" research Dr. Alger-Mayer presents. Stick with me--there's a lot to cover.

Here's a chance to benefit from the knowledge, experience, and wisdom of a top-notch specialist without making an appointment.

If I had to sum it all up in 6 key points it would be:

Eat a diet that is 750 calories less than what you need to maintain your present weight. Get a diet buddy or join a support group for the best chance of success
The type of carbohydrates you eat makes a big difference and they actually affect your insuling-signaling genes. Eat Low-Glycemic Carbs! That means foods like beans, legumes, oats, quinoa, dark rye bread, vegetables, & fruits.
Exercise often--short bouts are best, enough to burn 2800 calories a week, including 11,000 steps a day (5.5 miles), & 2 days of more intense exercise a week
Consider adding phytochemicals like (but not limited to) cocoa, green tea, resveratrol (grapes or wine), acai berries, or hops (rho-iso-alpha-acids)
Get enough sleep--at least 7.5 hours
Find a way to manage stress to reduce fat-causing hormones (like cortisol) that pack on belly fat and increase inflammation. Simplest stress reducers: Exercise and deep breathing--one deep abdominal breath, hold for count of 4, and repeat.

Who Is At Risk? Who Needs to Get With the Program? Where Do You Begin?

Lifestyle accounts for more than 50% of the deaths among middle-age women.

72% of cardiovascular mortality can be attributed to lifestyle factors.

Metabolic Syndrome is what you want to prevent--or get rid of--if you have it. If you've got a little too much belly fat, elevated blood pressure, high triglycerides, elevated blood sugar, low HDLs, and/or high triglycerides you're at risk for heart attack, stroke, and type-2 diabetes. We're talking Metabolic Syndrome--and with the right diet, exercise, stress management, and the addition of some potent phytochemicals you just might turn that ship around.

Dr. Alger-Mayer's Prototype Patient:

52 year old woman
High stress job, long hours, finds it hard to find the time to exercise
Travels for work, eat too many restaurant meals, breakfasts on bagels or pastry, drinks 2-3 glasses of wine at night to wind down
Poor quality sleep, wakes up frequently
Feeling depressed, trouble concentrating, anxious, worried about her memory, worried about her health
Insulin-resistance, high blood pressure, high cholesterol, family history of early heart attack, a history of weight issues, loses weight and puts it right back on.
5'6", 228 lbs, BMI of 37, waist circumference of 42" (>35" increases risk), elevated fasting glucose, HDLS & triglycerides are OK, LDL is elevated, C-Reative Protein (inflammation marker) is elevated at 3.4 Click here for BMI tables Click here for CRP tables & "The Inflammation Connection"
Meets criteria for Metabolic Syndrome even though none of her values are super high
She is ready to get serious about losing weight and making a change

Before getting started, here's what Dr. Alger-Mayer asks all her patients to do, because "knowledge is power".

Keep a 3 day food record of what they are eating day-to-day
Record how they are feeling--emotions & moods. What's driving their food choices
Wear a step counter for 3 days--not to change anything, but to see how active they are during the day
Keep a 7 day record of their sleep cycle
What are they doing for fun? What do they have to look forward to? What helps to diffuse their stress?

Getting Started When You're Feeling Overwhelmed - Where Do You Begin?

Dr. Alger-Mayer's typical patient is an intelligent bright woman who has struggled with this weight issue for many years.

It's not just about knowing the issues. She feels totally overwhelmed & challenged by life & finding the time & energy to make big changes is extremely difficult.

Alger-Mayer says you need to break down the process into a manageable set of goals. Here's what Ms. Typical Patient wants to know from Dr. Alger-Mayer:

Is there one diet that would be best for her particular medical risk factors?
What about exercise? She knows she has to exercise, but how much does she need to do?
Are there any nutritional supplements that would help?

Let's Talk Diet - What's the Best One?

When it comes to weight loss--it doesn't matter. According to a 2009 New England Journal of Medicine study that compared four different weight-loss diets (low vs. higher fat; low carb vs. higher carb; low protein vs. higher protein)--it just didn't make any difference. All the diets achieved weight loss, and lowered cardiovascular risk factors, decreased waist circumference, and triglycerides. The fasting insulin level dropped in all the diets except the 65% carb diet. All 4 diets were basically healthy--they emphasized adequate fiber and low-glycemic carbs, were low in cholesterol, and participants were asked to do 90 minutes of exercise a week. Most weight loss occurred in the first 6 months of this 2 year study that followed over 800 overweight adults. Final conclusion: "Reduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emhasize."
What did make a difference? The patients who attended at least 66% of the group support sessions lost the most weight--an average of 20 pounds over 2 years.
To lose weight, you need to eat 750 less calories than you would need to maintain your present weight.
Dr. Alger-Mayer emphatically points out that this study DOES NOT MEAN, that diet doesn't matter--and that you can eat whatever you want to, as long as you cut calories. High fat and simple sugars are not good for you, and will not reduce your cardiovascular risk factors.
My opinion: Go for plant-based, minimal to no added fats, low-glycemic carbs like beans, oats, legumes, fruits & vegetables, whole-grains, and minimal sugar. No worries!

A Calorie is Not Just a Calorie. Carbs Affect Our Genes. What?

Some recent landmark studies have confirmed that the kind of carbohydrates we consume actually affect the genes in our abdominal fat--which has a tremendous impact on developing or curbing Metabolic Syndrome.

The Carbohydrate/Gene Study. Here's how the the low vs high glycemic carb study played out in 2 groups of people with Metabolic Syndrome. One group was fed carbs that were high fiber low-glycemic (think oats, beans, quinoa). The others group was fed carbs that were high fiber high-glycemic (think potatoes, whole wheat bread). Both carbs had the same amount of protein and fat. The low-glycemic carb meal produced a low insulin response, and the insulin-signaling genes in the abdominal fat were actually down-regulated. But after the high-glycemic carb meal, insulin shot up, and 62 different genes that are linked to the stress response, insulin-signaling and cytokine-mediated immunity were turned on. Pretty amazing! This study prompted endocrinologist Dr. David Ludwig to write an editorial called, "Putting your genes on a diet: the molecular effects of carbohydrate."
Take away point: The kind of carbs we eat have a significant effect on the gene regulation that affects how our bodies handle insulin--and don't forget that abdominal fat is a marker for an insulin response that is out of whack. This process has nothing to do with how many calories we consume, or how much we weigh--but it has everything to do with what kind of carbs we are consuming.
The effect of whole grains vs refined grains on the risk of cardiovascular disease in Metabolic Syndrome. In this study the two groups being compared both reduced their calories by 500/a day for 12 weeks--but one group ate whole grains while the other consumed refined grains. After 12 weeks both groups had the same weight loss--but the whole grain group had lost more belly fat, and had a 38% decrease the their C-reactive protein levels (inflammation marker). The magnitude of the this C-reactive protein reduction was similar to the reduction achieved with statins.
Why do we want to eat foods that discourage belly fat--and that will down-regulate the genes in our belly fat? Belly fat is completely different from the subcutaneous fat that surrounds our bodies. It's called omentum, and it acts just like an organ, secreting its own chemicals and hormones like adipokines that produce angiotensin II, that raises blood pressure. It also secretes tumor necrosis factor, interleukin 6, and C-reactive protein which lead to high blood pressure, insulin resistance, high cholesterol and inflammation that damages our brains & blood vessels. To read more about why you want to ditch the belly fat, click here.
How do I find out which foods are low-glycemic? The University of Sydney maintains the most reliable database. Look for foods that have a glycemic index of 55 or under. Click Here for the database. Click Here for their excellent newsletter. Bottom line: you want very grainy "kibbled" least-processed breads & carbs that move slowly through your digestive system.

Why Exercise Matters If You Want to Keep Your Weight Off Forever!

The best data out there on the effect of exercise on weight loss comes from the National Weight Control Registry that was started in 1994 by Dr. James Hill and Dr. Rena Wing in Denver, Colorado. The registry tracks over 5,000 people who have successfully lost an average of 60 pounds and have successfully kept it off for 5 years or more. It aims to find out why these people are successful at keeping their weight off.

The most powerful predictor of successful long-term weight loss is movement! aka Exercise.
On average people who have successfully maintained their weight loss, burn off 2800 calories a week which is quite a lot.
The calorie burn comes mostly from walking, 11,000 steps a day (that's 5.5 miles), and a higher intensity exercise for 2 days/a week--at an average of 6 METS--which is about an hour of jogging, bicycling, tennis or aerobics. 800 calories of the 2800 were burned as high intensity exercise.
The exercise doesn't have to be in the form of long workouts--like 60-90 minutes at the gym. People who had multiple short bouts of exercise on more days lost more weight and achieved similar cardiovascular benefits.

What Nutritional Supplements Can Help with Weight Loss and Reduce My Cardiovascular Risk?

It turns out that Metabolic Syndrome is tremendously impacted by the quality of our diet. We are now beginning to understand that the phytonutrients in our food--which have nothing to do with calories or weight loss--are metabolically active, and have profound effects on our signaling systems--and work through the same kinase systems that pharmaceutical drugs work on.

These phytonutrients can affect the insulin-signaling pathways which are closely linked to the inflammatory pathways in our body.

Here are a few examples of some of these active dietary phytonutrients:

Green tea
Ginseng
Cinnamon
Resveratrol
Hops - used as the bitter flavoring for beer
Cocoa

What happens when you add phytonutrient supplements to a high quality Mediterranean Diet? Magic!!

Dr. Robert Lerman compared two groups of dieters on a super healthy Mediterranean diet high in omega-3s, low glycemic carbs, high quality proteins, and fruits and vegetables for 12 weeks. One study group was supplemented with the phytonutrient hops (rho-iso-alpha acids) and an extract of acai berries.

Here's how the groups compared after 12 weeks:

Resolution of Metabolic Syndrome: 43% of the phytochemical group vs. 22% of the diet only group
Reduction of Framingham 10-year risk scores dropped by 5.6% in the phytochemical group vs. 2.9% in the diet only group
Weight loss was the same in both groups
LDLs were reduced by 17% in the phytochemical group vs. 8.4% in the diet only group
HDLs were increased by 7% in the phytochemical group vs. 3% in the diet only group
Triglycerides dropped by 35% in the phytochemical group vs. 14% in the diet only group

Take away point: The optimum way to use phytochemicals is to consume them as part of a healthy diet in whole foods (think lots of fruits & vegetables), rather than thinking, "I'll just go the health food store & buy some rho-iso-alpha acid pills & then just keep eating my regular diet." I don't think so.

According to Alger-Mayer, diets high in saturated fat have a negative effect on those protein kinase pathways, and just may wash out the beneficial effects of these phytochemicals.

What Other Whole Food Phytochemical Supplements Does Alger-Mayer Recommend?

Resveratrol

This is the phytonutrient found in the skins and seeds of grapes and of course, in wine.

It's known to reduce cardiovascular risk by lowering blood pressure.
It improves endothelial function (the lining of blood vessels) by increasing that "magic gas" nitric oxide--which makes blood vessels flexible and improves dilation. Nitric oxide production increased 3-fold in endothelial cells that were "incubated" in red wine.
It decreases blood platelet aggregation, which means less clumping and clotting
It's known to activate cell proteins that prevent cell death in bacteria--suggesting a "possible" increase in human longevity. Who knows?

Cocoa

The Greek name for cocoa means, "Drink of the Gods". Maybe they were on to something. Epichatechin is the polyphenol in cocoa that does its magic on the cardiovascular system.

It lowers blood pressure
It reduces insulin resistance and improves platelet function
It increases nitric oxide production--that "magic gas" that improves endothelial function, and it has anti-oxidant and anti-inflammatory properties.
In a recent meta-analysis in the journal Circulation, 75 grams of dark chocolate for 3 weeks increased HDLs by 14% and decreased LDL oxidation. Lowering blood pressure took even less cocoa to do the job.
How does cocoa do all this? It's probably because it increases the availability of nitric oxide, and it also increases arginase--which prevents nitric oxide from breaking down. It's a 2-for-one!
Cocoa's best benefit? It inhibits the kind of inflammation that creates atherosclerotic plaque.
This study will give you a good reason to drink cocoa daily. One of the tests for a healthy vasculature is the ability of our blood vessels to dilate. This study looked at the dilation of arteries after drinking a high flavanoid cocoa drink, compared to a low flavonoid drink. There was a significant increase in vasodilation with the high flavonoid drink--and nitric oxide levels increased as the level of flavonoids in the cocoa increased.
Watch out! Avoid cocoa or dark chocolate that is "Dutch-Processed" or is treated with an alkali to decrease its bitterness--that destroys the flavonoids!

What Does Stress Have to Do with Diet and Weight Loss?

Plenty! Stress decreases leptin---and low levels of the hormone leptin will increase food cravings even if you aren't hungry. Stress also increases ghrelin---the hormone that keeps you eating even when you aren't hungry.

Alger-Mayer says that stress reduction is a key factor in managing our food intake--and it even plays a role in our ability to exercise.

What effect does cortisol have on weight loss?

Stress increases cortisol, which increases the likelihood of snacking--especially high calorie snacks.
It increases belly fat
Cortisol increases significantly in women who are "high stress reactors"--snacking is strongly associated with daily stressers in women who are "high stress reactors".
Cortisol-Abdominal Fat Connection. Men & women with a high waist-to-hip ratio had greater cortisol release when under stress than those with a low waist-to-hip ratio--suggesting the release of cortisol in response to stress contributes to abdominal fat. Click here for a waist-to-hip calculator & chart.
Rats fed a high-fat, high sugar diet and exposed to long-term stress had a 50% increase in visceral (belly) fat

Top ways to reduce stress

Exercise. It reduces stress, anxiety, depression, and raises dopamine--the feel good brain chemical--which may also reduce the craving for high fat, high sugar foods.
Many of Alger-Mayer's patients tell her that when they exercise they are better able to stick to their meal plan and avoid cravings. When they get knocked off track, their cravings come back.
Turns out that wheel-running in rats is a protection against stress, anxiety, and depression. It also affects their serotonin and noradrenaline (fight or flight hormone) levels, and increases their dopamine--the feel-good hormone.
Exercise is actually an antidote for high sugar intake!
How deep breathing helps reduce stress. Try the "mini"--a simple technique developed by Dr. Herbert Benson, an interventional cardiologist who founded the Mind-Body Institute at Harvard.
Within one minute of deep breathing you increase the calming parasympathetic system kicks in, the heart rate drops, blood pressure drops, and "yeah", cortisol drops, too.
Here's how to do it. Take a deep breath, expanding into the abdomen. Hold it for the count of 4, and breathe out. Repeat. Doing this simple technique when you start to feel stressed may reduce cortisol, and prevent our cells from being bathed in cortisol, increases our risk of belly fat. To learn more about Benson's technique's click here.
Figure out a step-by-step plan. Be clear & specific. When will you eat? When will you walk or exercise? How long? Find an exercise and diet buddy. Alger-Mayer recommends Spark People--an online weight-loss community to help you find a group with similar ages and goals as yours.
Get enough sleep! Less than 6.5 hours of sleep causes increased hunger, impairs glucose tolerance. Alger-Mayer suggests going to sleep 20 minutes earlier to start.
Give yourself rewards for your diet or exercise success.

What am I now going to change after my "appointment" with Dr. Sharon Alger-Mayer?

I'm definitely going to to think twice about eating any high-glycemic carbs.
I'm going to try very hard to get at least 7.5 hours of sleep.
I'm going to program the free step counter I got from my workplace--and start using it. I wonder how many steps I'm walking a day?
I'm going continue with my daily cup of cocoa.
I'm going incorporate Benson's mini's--the deep breathing technique--as needed.
And that's enough for now!

Everything You Ever Wanted to Know About Vitamin D from the Expert, Dr. Michael Holick. How Much Do We Need? Why Is It So Hard to Get Enough? What About Breast-Fed Babies? Why Is It So Important for Good Health?

2010-02-09T13:27:53Z

To read more of my "Adventures in Evidence-Based Living" visit my blog Happy Healthy Long Life

When it comes to good health, I pay very close attention to how the experts are taking care of themselves.

Dr. Michael Holick, the 62 year old Professor of Medicine, Physiology, and Biophysics at Boston University's Medical Center is probably THE world expert on Vitamin D & health--he's been studying Vitamin D for over 35 years. When Holick talks--I'm listening!

What's his personal prescription for getting enough of this liquid gold?

1. 2000 IUs of vitamin D a day.

2. 3 glasses of milk a day = 300 IUs of Vitamin D

3. 400 IUs in his daily multivitamin

4. Between supplements & milk he's getting 2700 IUs a day

5. He plays tennis & cycles outside in his free time. He always wears sunscreen on his face--but leaves his arms & legs exposed--but he lives in Boston. Sensible sun exposure on your arms & legs is the BEST way to build up your Vitamin D stores--10 minutes a day if you are fair-skinned, between the hours of 10-3, with sunscreen on your face, for 2-3 times a week. That ought to do it!

6. What's his 25-hydroxyvitamin D level? He's consistently in the 50-60 ng/mL range. Just where you'd want to be to get all the health benefits of D. 30 ng/mL is the minimum and you can go all the way up to 100 & still be on the very safe side.

So, why am I writing about Vitamin D again? There's just so much to say about it! And besides, it's closing in on November--which means if you live north of Atlanta, Georgia there is no way you can get any vitamin D from the sun. It's too high in the sky & the angle is too oblique. By the end of the winter--if you aren't taking a Vitamin D supplement you are going to be deficient! Not a good thing.

You can stand stark-naked on top of a building in Boston all day in February and get zippo Vitamin D! So take that supplement & get some Real Sun in the summer!

Why Should I Care If I'm Sufficient or Deficient in Vitamin D?

I know, it sounds like snake-oil. How can Vitamin D possibly have an effect on so many chronic diseases and conditions?

Simple--every cell and tissue in the body has a Vitamin D receptor--and all of them depend upon D for optimal health. Here's just a sampling of the bad things that can happen if you aren't getting enough.

Cardiovascular disease - increase risk of heart attack 142% if under 15 ng/mL
Cancer - if you live in a northern latitude you have a higher risk of colorectal, breast, & prostate cancers. Projected 50% risk reduction with over 1000 IUs a day. Adequate Vitamin D actually inhibits cancer cell growth.
Autoimmune Diseases
Osteoporosis/fractures - study after study shows the necessity of Vitamin D to absorb calcium & build strong bones. With sufficient Vitamin D you'll absorb 30% of the calcium in your diet. Without Vitamin D, the absorption rate drops to 10-15%. Although Dr. Holick recommends a Vitamin D level of 50 as the optimal number to prevent osteoporosis, Dr. Heike A. Bischoff-Ferrari concluded that the minimum level of vitamin D to prevent hip and nonvertebral fractures in older adults should be at 75-80 nmol/l which is the equivalent of at least 32 ng/mL. ("Optimal serum 25-hydroxyvitamin D levels for multiple health outcomes" in Sunlight, Vitamin D and Skin Cancer, edited by Jorg Reichrath, 2008)
Respiratory infections & flu - Yes, believe it! Your immune system hums with D. Cytokine & immunoglobulin production is regulated by Vitamin D. 2009 Archives of Internal Medicine article shows the higher the Vitamin D, the lower the risk of upper respiratory tract infections.
Osteomalacia - generalized & isolated bone pain - it can vanish with adequate Vitamin D
Arthritis - both rheumatoid & osteoarthritis
Multiple sclerosis -risk increases the further one gets from the equator. Studies show the risk is reduced for outdoor workers, and in people with higher levels of Vitamin D.
Schizophrenia - risk diminished in infants supplemented with D in first year of life.
Type 1 Diabetes - Finnish study showed an 80% reduction in developing Type 1 diabetes for infants receiving adequate Vitamin D supplementation.
Dementia - both vascular and Alzheimer's
Fibromyalgia is often a misdiagnosed Vitamin D deficiency causing generalized muscle aches & pains.
Type 2 diabetes. May exacerbate type 2 diabetes & impair insulin production. Obesity, associated with type 2 diabetes, prevents adequate Vitamin D absorption.

Why Are So Many of Us Vitamin D Deficient & What Gets in the Way of Absorbing Adequate Vitamin D?

We're Indoors & Wear Sunscreen. We spend most of our time indoors & when we're outside we're slathered in sunscreen, or mostly covered up with clothes. Dermatologists have been telling us to wear sunscreen & avoid the sun for almost 40 years. An SPF 15 reduces Vitamin D absorption by 95-99%
No Mid-day Sun. To get adequate Vitamin D from the sun you would have to be exposed to the sun in the peak hours of 10 am to 3 pm.
It's a Vitamin D Deficiency Epidemic! Vitamin D deficiency (a level under 30 ng/mL) is epidemic in adults over 50 (over 70% of us); 50% of children are deficient; 42% of young adults are deficient; and Vitamin D deficiency even exists in California, Florida, Arizona, and Saudi Arabia. Personally, I don't know a single friend who wasn't deficient when they were first tested.
It's an Age Thing. Age decreases the ability of the skin to make Vitamin D. A 20 year old makes 3 times more Vitamin D than a 70 year old.
Dark Skin Color. African-Americans need to be out in the sun 5-10 times longer to get enough Vitamin D. They are walking around with a natural SPF of 15. Many researchers believe that the excessively low levels of D in African Americans may be responsible for their higher rates of prostate cancer, hypertension, and diabetes. For an interesting story of skin color & Vitamin D click here
Obesity. The more you weigh, the less Vitamin D is getting into your blood stream. Obese people can only utilize 50% of their Vitamin D--because it ends up in their body fat & can't get into their blood stream. They need to get 2-3 times as much Vitamin D from the sun or supplements to bring their levels up to normal.
Kidney disease & Liver Damage. Either one will impair the body's ability to activate circulating Vitamin D.
Certain Drugs Inhibit Absorption of Vitamin D. Like anticonvulsants, bile acid sequestrants (for cholesterol), Tagamet, corticosteroids, and heparin.

How Do I Find Out What My Level of Vitamin D Is?

Ask your doctor to order a simple, low cost 25-hydroxyvitamin D test for you. It's the only way to know what your baseline is. Then follow-up a few months later if you are deficient.
For optimal health aim for Dr. Holick's goal of 50 ng/mL. Absolutely get yourself up to 30 ng/mL. You're safe up to 100 ng/ML. And it's impossible to get too much Vitamin D from the sun--the body will regulate it. With supplements you would have to take over 10,000 IUs/a day, for six months to have Vitamin D intoxication. Lifeguards wearing no sunscreen have been tested--they have super-high levels, and no intoxication.
Every 100 IUs of Vitamin D you take, you can figure it will raise your Vitamin D level by 1 point, assuming you are not obese--which necessitates increasing the level by 50% or more.
For those who are very low in Vitamin D, under physician guidance, you may need to take 50,000 IUs of Vitamin D2 (yes, D2--is now confirmed to be just as good as D3) once a week for 8 weeks, then 50,000 IUs every 2 weeks "forever" after, according to Holick.

How Much Vitamin D Can I Get Naturally From the Sun? What's Safe?

You can get your Vitamin D from the sun, from April-September if you live north of Atlanta, Georgia, and it is the best source of Vitamin D.
If you are sunbathing mid-day on Cape Cod in the summer, wearing a bathing suit, without sunscreen, and you have fair skin, you will get 10,000-20,000 IUs of Vitamin D in just 15 minutes of exposure. Do that 2-3 times a week and you'll build up a healthy storehouse.
The body is able to store the Vitamin D it gets from the sun far longer than it can store the Vitamin D it gets from supplements.
Mother Nature has designed the body to store the Vitamin D we get from the sun in our body fat, and release it when we aren't "making" any more.
Our Vitamin D levels peak in the summer--but in you are barely Vitamin D sufficient at the end of the summer (a level of 30 ng/mL) you will deplete those stores in one month. By the end of the winter, you will be severely Vitamin D deficient, unless you are taking a supplement.
Sensible sun exposure. Here's what Dr. Holick advocates. 10-15 minutes of exposure on arms & legs in the peak sun hours of 10 am - 3 pm, two or three times a week. Use a sunscreen on your face, and after 10-15 minutes get out of the sun or slather up. Overexposure can increase non-melanoma skin cancer. 10-15 minutes is not overexposure.
To get exact guidance on how long you would need to stay in the sun to get enough Vitamin D, based on where you live, your skin type, the time of day, & the time of year--take a look at Dr. Holick's book, The UV Advantage, or try Dr. James Dowd's online sun exposure calculator.
Vitamin D from the sun & depression. Although Vitamin D is known to lessen depression and boost the mood--unfortunately, only the natural kind from the sun has this effect.

What About Skin Cancer? I Thought It Was Risky to Be Out in the Sun Without Sunscreen?

The American Academy of Dermatologists is still not recommending that we go out in the sun without sunscreen for any amount of time. They are recommending we take supplements and eat fish. But remember, Dr. Holick is only recommending short sun exposure with the face protected by sunscreen, and the truth of it is--melanoma, the most dangerous of skin cancers, is usually found in the unexposed parts of the body that never see sunlight.
Interestingly, occupational sun exposure decreases the risk of malignant melanoma and lifetime sun exposure is associated with a lower risk for malignant melanoma.
The Dermatological & Cancer Societies of Australia have recently changed their position on sun exposure. Now that studies have shown that 30-50% of Australian's are Vitamin D deficient because the sunscreen campaigns have been so successful, the Aussies are rethinking "their sunscreen message". Their new message: Get sensible sun exposure. Enough to get adequate Vitamin D, not too much to increase cancer.

Any Special Recommendations for Pregnant Women & Infants?

Vitamin-D deficient infants will never attain their genetically preprogrammed bone density or height. That's one scary thought!
A Boston study looked at 40 mother-infant pairs--the moms took the recommended 400 IU/day Vitamin D in their prenatal vitamin and drank 2.3 glasses of milk a day--at birth, 76% of moms were Vitamin D deficient--81% of newborns were deficient.
All pregnant women need get 1000 IUs a day in addition to the Vitamin D in their prenatal vitamin, and an additional 200 IUs from their diet, according to Holick.
Higher Vitamin D levels decreased the likelihood of preeclampsia, and reduced the need for C-sections.
Moms who got adequate Vitamin D during pregnancy reduced the risk of wheezing disorders in their children by 61%.
Breast-feeding moms need to be vigilant that their babies are getting enough Vitamin D. The breast milk of moms who are not getting enough Vitamin D has a paltry 25 IUs of Vitamin D per liter (1 quart, 2 ounces). Not even close to the 400 IUs their babies need. It would take 4000-6400 IUs/a day for a breast-feeding mom to get enough Vitamin D into her breast milk to meet the baby's requirement of 400 IUs a day. But according to Holick, until more studies are done, "it's not something we're recommending." Hopefully, we'll be able to in the near future." In the meantime--breast-feeding moms need to make sure their babies are getting 400 IUs/a day of a Vitamin D supplement.

What Kind of Supplementation Does Dr. Holick Recommend?

1000-1500 IUs/a day for most children
1500-2000 IUs/a day for adults
All pregnant women need get 1000 IUs a day in addition to the Vitamin D in their prenatal vitamin, and an additional 200 IUs from their diet.
The American Academy of Pediatrics now recommends 400 IUs/a day for infants.
In August 2009 Dr. Holick participated in an Expert Panel convened by the Institute of Medicine to work on new recommendations for Vitamin D--in light of all the research that has come out recently. Expect new standards sometime around the Spring of 2010.

Can You Get Enough Vitamin D from Diet Alone? Not Likely!

The only food that contains Vitamin D, is oily fish, like wild (not farmed) salmon--clocking in at 500-1000 IU a serving. See a Boston University breakdown of Vitamin D for various fish here.
Cod Liver Oil is an OK source.
Some foods are fortified, but at a typical 100 IUs a serving that's about 10 glasses of milk a day.

Want to learn more?

Listen to Dr. Holick and Dr. James Dowd on the People's Pharmacy

The American Academy of Pediatrics updated Vitamin D guidelines for infants & children

The Audio-Digest Family Practice Summary of "Vitamin D: the Vital Vitamin". 57(12): Mar. 28, 2009

NPR Transcript from the Living on Earth broadcast of "Skin Color and Vitamin D"

Why Is Vitamin D My Favorite Vitamin? Let Me Count the Reasons

"Institute of Medicine Studies a Boost In Vitamin D". AMA News April 20, 2009

Gretchen Reynolds. Phys Ed. Can Vitamin D Improve Your Athletic Performance? New York Times Sept. 23, 2009

So, What About Me?

I try hard, but rarely succeed in taking 2000 IUs of D a day, plus about 400 IUs from Citracal calcium supplements, and maybe an additional 400 IUs from an occasional multivitamin or from fortified food. I'm not often out in the mid-day sun--but when I am, don't tell anyone--I'm not wearing sunscreen.

I haven't been retested in over 2 years, when it was 33 ng/mL at the end of winter. I plan to retest in January 2010.

Dinner and a Movie On a Cold Winter's Night - How About Some Meaningful Movies for Grown-Ups and a Sophisticated Mediterranean Vegetable Ragout?

2010-02-02T17:39:00Z

"We are always on the lookout for movies that "speak to our condition" (a Quaker phrase) and reveal new possibilities for our lives. We love dramas that touch on universal experiences, knock down barriers between people, and evoke our compassion. We are enriched by stories that touch our hearts and send us out of the theater rejoicing. A truly good film is not only thought-provoking and entertaining, it also leaves the viewer with a sense of what it means to live deeply and fully every day."

Frederic and Mary Ann Brussat, Film Critics

If you're receiving this via email click here to get the full web version of the post.

OK--the 2010 Oscar nominees have just been announced. So, let's talk movies!

What do you do for "an evening out" when you don't want to spend a lot of money?

Make dinner at home.
Rent a movie.
Invite some friends over to share the dinner & the movie.

The Best Movies for 2009

I "discovered" Frederic and Mary Ann Brussat many years ago when I subscribed to a quarterly magazine called, "Spirituality & Health".

Once a year the Brussat's would compile at Top 10 List of the Most Spiritually Literate Films of the Past Year. I knew I could trust their recommendations because I loved the ones on their list that I had already seen. When I took their recommendations for ones I hadn't seen, I was almost always rewarded with a winner. See what you think!

Don't be put-off by their use of the words "Spiritually Literate". These movies aren't religious or sappy. If you like movies that are intelligent--shake you up--stretch your mind--and make you look at yourself or the world a little differently, they just may become your Go-To-Movie-Critics, too.

Here's their list of the Ten Most Spiritually Literate Films of 2009. If you like what you see, scroll down on their site, and check out the blue sidebar for their favorite picks of years past.

For the Brussat's Reviews of the Latest Releases click here.

Missing from the "Most Spiritually Literate List" but well worth seeing:

It's Complicated (Meryl Streep, Steve Martin, Alec Baldwin. Later-in-life romance for the baby boomer set--sassy, touching, and a just a whole-lot-of-fun)
Pirate Radio (Philip Seymour Hoffman) In 1966, hard-partying British DJs have the time of their lives running a radio station on a ship in the North Sea, broadcasting generation-defining (but banned) music to millions. Music rocks!
Crazy Heart (Jeff Bridges) Powerful story of a washed-up alcoholic country western singer who starts to rethink his sorry life. Music rocks!
This Emotional Life. PBS documentary. Harvard psychologist and best-selling author Dr. Daniel Gilbert (Stumbling on Happiness) hosts this three-part PBS series that explores the range of human emotions and how we can strive to become more positive in our day-to-day lives. The program examines the biological basis of happiness, the role of relationships-marriage-friendships-family- and the ways in which we can cope with negative emotions. Borrow it from your public library or Netflix. My husband, my 26 year old son, and I were transfixed for 3 nights and 6 hours watching this PBS special when it aired. Trust me--if they watched this for 6 hours and loved it--it has to be good!
Blind Side (Sandra Bullock) The true inspirational story of African American Michael Oher, a homeless teen with serious learning problems from across the tracks, who is taken in by an affluent Memphis couple, enrolled in a private Christian school, and taught to play football. Michael goes on to graduate from college and play for the NFL. To read the "real" story in the New York Times, click here. It's worth it!

My Go-to-Gal For Dinner Recipes

Now for the "dinner" part of the "dinner & a movie". When it comes to healthy recipes that are original, with lots of flavor and spice, I turn to Susan Russo, at Food Blogga. My husband and I made this recipe last weekend and we LOVED IT. I took some of the leftovers to work to get a review from my "official taste testers" and they gave it a BIG THUMBS UP! Look for the recipe after the movie reviews.

Take Your Pick of the Most Thoughtful Movies for Grown-Ups in 2009

The Ten Most Spiritually Literate Films of 2009

*I've added an asterisk to movies I have personally seen & recommend. Click on the links to read the Brussat's reviews.

COMPASSION
The Messenger (Oscilloscope Laboratories) is an emotionally affecting drama about the birth of compassion in an Iraq war hero assigned to work for the Casualty Notification Office.

CONNECTIONS *HL Liked it, didn't love it
Avatar (20th Century Fox) is a visually impressive and imaginative sci-fi masterpiece replete with spiritual lessons embedded in the story of an ex-Marine who joins a tribe of indigenous people.

CONNECTIONS *HL Thumbs Up
Up in the Air (Paramount Pictures) is a bright, sassy, and savvy relevant story about home, connections, unemployment, technology, and traveling light.

ENTHUSIASM *HL Thumbs Up
Julie & Julia (Sony Pictures) is a celebration of culinary creativity that demonstrates how the spiritual practice of enthusiasm makes it possible for two women to give their best to the world.

FORGIVENESS *HL Thumbs Up
Invictus (Warner Bros.) is an astonishing and incredibly entertaining movie about the power of forgiveness, the importance of sports, the art of transformative leadership, and the reconciliation of the races.

HOPE
Amreeka (Indie PR) is an uplifting story of a Palestinian mother whose resilience and grace under pressure enable her to triumph over the various obstacles as she makes a new home for her son in America.

LOVE *HL Thumbs Up
Away We Go (Focus Features) is an incredibly original and appealing drama about the cross-continent journey of two parents-to-be seeking to deepen their relationship while also finding a new home to raise their child.

MEANING *HL Thumbs Up
A Serious Man (Focus Features) is a thought-provoking spiritual drama that honors the mystery of God, the futility of seeking answers, and the need to live as best we can in a sea of roiling troubles and uncertainties.

SHADOW
The Hurt Locker (Summit Entertainment) is a riveting Iraq war film about three members of an Army bomb dismantling squad in Baghdad.

TRANSFORMATION
Precious (Lions Gate) is an emotionally poignant drama a depiction of a degraded and abused African-American teenage girl whose life is turned around by the love and concern of an inspiring teacher.

The Ten Most Spiritually Literate
Documentaries of 2009

FAITH
Youssou N'Dour: I Bring What I Love (Shadow Distribution) is an inspiring exploration of the power of music and the soul of a big-hearted African Sufi singer who has used his exceptional talent to make a better world.

JUSTICE
Burma VG: Reporting from a Closed Country (Oscilloscope)) is a moving documentary about the courage of underground video journalists during the 2007 protests in Burma against a repressive military regime.

JUSTICE
Crude (First Run Features) is a dramatic documentary about the David vs. Goliath dimensions of the "Amazon Chernobyl" case where indigenous tribal groups are fighting the multinational corporation Chevron.

JUSTICE
The Garden (Oscilloscope) is a compelling documentary about an urban garden collective and their fight for justice in a nation where poor people are expected to keep quiet and not speak truth to power.

JUSTICE
They Killed Sister Dorothy (Junge and HBO Documentary Films) is an engrossing documentary on the life and work of Amazonian activist Sister Dorothy Stang and the trial of those involved in her murder in 2005.

KINDNESS
The Way We Get By (Gita Pullapilly) is an extraordinary documentary that celebrates the kindness of three elders who serve as troop greeters in Bangor, Maine.

PLAY

Afghan Star (Zeitgeist Films) follows the competitors in an American Idol-like TV show that reflects the volatile mix of history, religion, and pop culture in contemporary war-torn Afghanistan.

QUESTING
Unmistaken Child (Oscilloscope) is a compelling, enlightening, and emotionally absorbing documentary that follows a Tibetan Buddhist student assigned to find the reincarnation of his teacher.

SHADOW
The Cove (Lions Gate) is a thoroughly shocking documentary about the slaughter of dolphins in Taiji, Japan.

SHADOW *HL Thumbs Up
Food, Inc. (Magnolia Pictures) is a bracing and disturbing documentary about the industrialization of farming, the dangers of genetically modified foods, and the growing power of the unregulated food industry.

Ten More Spiritually Literate
Films of 2009

COMPASSION *HL Thumbs Up
The Soloist (Dreamworks Videos) is a deeply spiritual movie about the moral complexities of helping another person, opening one's heart, feeling the pain of another, and letting go of the need to fix that person.

HOSPITALITY

District 9 (Sony Pictures) is a bold and creative science fiction adventure that shows the dire consequences of hating strangers and ignoring the spiritual practice of hospitality.

IMAGINATION
Phoebe in Wonderland (Image Entertainment) is a family drama about the power of the imagination and the challenges faced by children in a world where conformity is rewarded over creativity.

IMAGINATION
Where the Wild Things Are (Warner Bros.) is a haunting, innovative, and poignant film about childhood that may have you howling with the Wild Things inside and around you.

JUSTICE
American Violet (Image Entertainment) is a courageous expose of racism as the sick and sad shadow that is still alive and well in America.

LOVE
Bright Star (Apparition) is a spellbinding story of true love between English poet John Keats and his neighbor Fanny Brawne.

LOVE *HL Liked It, Didn't Love It
(500) Days of Summer (20th Century Fox) is a fresh and appealing romantic drama brimming with heart, creativity, and panache.

MEANING
Cold Souls (Samuel Goldwyn Films) is an engrossing surreal comedy that takes an inventive look at soul, dreams, emotions, and the emptiness of a life devoid of meaning.

MEANING
The Invention of Lying (Warner Bros.) is a romantic comedy that brings us to a deeper sensitivity to the sharp edges of honesty and the ways in which deceptions can both heal and harm.

SHADOW *HL Thumbs Up

In the Loop (IFC Entertainment) is an audacious and well-written British comedy that is the wildest and funniest political satire since Wag the Dog.

What's for Dinner? The Food Blogga's Mediterranean Vegetable Stew with Olives

photo by Food Blogga

Mediterranean Vegetable Stew with Olives

Makes 6 generous servings

Note: Omit the grated cheese, and this recipe is vegan.

3 tablespoons olive oil (I made this with 1 TBS of oil--and nutritional info reflects this change)

1 yellow onion, diced

3 garlic cloves, minced

1 fennel bulb, cut into ¾-inch pieces (about 1 ½ cups)

1 eggplant, cut into ¾-inch pieces (about 3 ½ cups)

1 red bell pepper, cut into ¾-inch pieces (about 2 cups)

¼ cup dry white wine

1 (28- ounce) can crushed tomatoes

¼ cup coarsely chopped Kalamata olives

¼ cup coarsely chopped Cerignola olives (large, green Italian olives)

1 (14-ounce) can cannellini beans, drained

Zest of ½ lemon (about 1 teaspoon)

1 teaspoon fennel seeds

¼ teaspoon salt

¼ teaspoon crushed red pepper flakes

1 tablespoon finely chopped fresh rosemary (I subbed 3 TBS of basil and it worked just fine)

3 tablespoons finely chopped fresh parsley

Grated Parmesan or Reggiano-Parmigiano cheese (I omitted the cheese)

1. In a large skillet over medium-high heat, heat oil. Add onions, and sauté until just transparent, about 3 minutes. Add garlic and fennel, and cook 2 minutes. Add eggplant and peppers, and cook 3-4 minutes, or until slightly softened. Add wine, and cook 5 minutes. Add tomatoes. Reduce heat to low, and simmer for 10 minutes, or until vegetables are tender but not mushy. Add olives, cannellini beans, lemon zest, fennel seeds, salt, and crushed red pepper. Stir well, and cook until heated through, 3-4 minutes. Stir in fresh herbs.

2. Serve with crusty Italian bread, or serve atop polenta, rice, or wide pasta noodles, such as parpadelle. Garnish individual servings with desired amount of grated cheese.

NOTE: I served this on homemade polenta the 2nd night. I can't believe how easy it is to make. It was a great combo with the stew.

Recipe created by Susan Russo of Food Blogga. Makes 6 servings

Nutrition Facts

Food Blogga
Mediterranean Veg Ragout wt Olives

Serving Size: 1 serving

Amount Per Serving

Calories

184

Total Fat

4.9g

Saturated Fat

0.7g

Trans Fat

Cholesterol

0mg

Sodium

796mg

Carbohydrate

33g

Dietary Fiber

10.1g

Sugars

10.9g

Protein

7.4g

Vitamin A 55%	Vitamin C 203%
Calcium 6%	Iron 15%

Archives of Internal Medicine--Seven Good Reasons to Exercise and Increase Your Chances for Healthy Aging

2010-01-29T12:23:41Z

Exercising Ladies in their Eighties

Weight Machine Workout for Muscles and the Mind

"Exercise is better than any drug or anything else we have for aging. There's no downside. If this were a drug, it would be the safest, most effective drug in the universe."

Dr. James O. Hill, Director of the Center for Human Nutrition at the University of Colorado at Denver

Seven articles--count them! All in the January 25, 2010 issue of the Archives of Internal Medicine.

All of them saying the same thing, "Exercise works. Just do it. Whatever your age. Start now!" click here for the Table of Contents.

I must be an exercise geek, because honestly, I find this kind of news exciting, encouraging, and hopeful. It shows how we really can change our health. Sure diet is an important partner in health--but exercise has a dual, and synergistic role in the equation.

Why Exercise? What We Can Learn from Six New Studies & One Editorial?

Weight-lifting improves the brain. "Resistance Training and Executive Functions," Liu-Ambrose, Teresa et al, University of British Columbia. The Study: Women aged 65-75 who spent 1-2 hours a week on progressive strength/resistance training with dumbbells and weight machines significantly improved their cognitive function after 12 months. They improved their performance by 10.9-12.6% on the most important brain function: executive ability. They saw improvements in their decision making, their ability to resolve conflicts, and they were better able to focus on subjects without becoming distracted by competing stimuli. But alas, no improvements were seen in 2 skills: keeping numbers in their working memory, and shifting from one task to another. The strength training group's skills were measured against a control group who only did balance & toning exercises. As for the balance and toning group--their scores on executive ability deteriorated by .05%. The added bonuses found in strength-training? It counteracts the inevitable muscle loss of aging while improving bone density and strength. The Canadian group also improved their walking speed--which is a predictor of substantial reduction in mortality. Big Point: The cognitive benefit showed up after 12 months of training--but not after 6 months. Those who lifted weights 2 x a week experienced less muscle discomfort than those who lifted only once a week. No surprise! Take Away Message: Add strength-training to your exercise routine. 2 or 3 times a week is best.

Start exercising at middle-age if you want to stay healthier as you age. "Physical Activity at Midlife in Relation to Successful Survival in Women at Age 70 Years or Older," Sun, Qi et al, Harvard School of Public Health and Harvard Medical School. Click here for the article. Harvard researchers looked at the health of over 13,000 women from the well-known Nurses' Health Study who had reached 70 years of age without any physical or mental impairment. Those who had higher levels of physical activity beginning at midlife were less likely to have chronic diseases, heart surgery or any physical, cognitive or mental impairments as they aged. Take note: regular moderate-intensity (not wimpy) midlife physical activity made all the difference in the world to one's health after age seventy! Those who regularly walked at a moderate pace starting from midlife had a better chance of exceptional health than those who walked at an easy leisurely pace. Picking up the pace made a huge difference in health--the fastest walkers significantly increased their odds of successful aging over the lollygaggers! And don't despair, moderate walking improved later-life health in both lean and overweight women. But those who kept their weight down (BMI range of 18.5-22.9) and exercised more vigorously than moderate walking improved their odds the most.

Understanding METS. For women, these are the METS for 1 hour of activity: 12 for running, 8 for stair-climbing; 7 for jogging; bicycling; lap swimming; and playing tennis; 6 aerobics or calisthenics; 2.5 to 4.5 for walking, depending on the pace--easy (<2 mph) normal (2-2.9 mph) brisk (3-3.9 mph) very brisk (4 mph or more) To get over 15 METS a week you would need to walk 3.5 hrs./week at 4 mph or more. Example: 30 METS=2.5 hrs of running; 30 METS=6.6 hrs of walking at a pace of 4 mph or more

Exercise for stronger bones, a better heart, less chance of falls, and to decrease your health care costs. "Exercise Effects on Bone Mineral Density, Falls, Coronary Risk Factors, and Health Care Costs in Older Women-the Randomized Controlled Senior Fitness and Prevention (SEFIP) Study," Kemmler, Wolfgang et al, the Friedrich-Alexander University of Erlangen Nuremberg, Germany.

"Contrary to pharmaceutical agents, which are typically dedicated to specific diseases, physical exercise affects a variety of risk factors and diseases and therefore plays a vital role in general disease prevention and treatment of the elderly."

In this randomized single-blinded controlled German study, 227 women over age 65 participated in an either an 18 month group exercise program, or in a wellness program (the control group). The exercise program included 2 60-minute group exercise classes, and 2 20-minute at-home sessions--including aerobic exercise at 70%-85% maximum heart rate, balance training, isometric floor strength training for the lower body, stretching, and upper body thera-band strength training. The wellness group participated in low-intensity exercise,walking at 50%-60% maximum heart rate, very low-moderate intensity strength training, and progressive relaxation exercises. Results: Compared to the wellness group, the exercise group significantly improved their bone mineral density in both the lumbar spine & hip; their fall risk decreased with a 50% lower fracture incidence; and both groups (wellness & exercise) significantly reduced their 10-year coronary heart disease risk, mainly because both groups lowered their blood pressure. Interesting Finding: Participation and adherence was much better in the group exercise classes than with the home exercise component. Not a surprise to me at all. I prefer group exercise, hands-down. Take Away Point: Even starting after age 65, exercise has a tremendous impact on one's health--and strength training definitely improves bone density.

Moderate physical exercise reduces the risk of cognitive impairment. "Physical Activity and Incident Cognitive Impairment in Elderly Persons. The INVADE Study," Etgen, Thorleif et al, Technische Universitat Munchen, Germany. This study followed a large group of Bavarians (3,903) age 55 and older for two years. At the end of the period they compared the incidence of cognitive impairment in the group with their levels of physical activity. The researchers adjusted for all the usual vascular risk factors that might contribute to cognitive impairment. The Results: Moderate or high physical activity was associated with a reduced incidence of cognitive impairment after the 2 year follow-up. For those with no physical activity the incidence of cognitive impairment was 13.9%. In those with moderate physical activity (less than 3 x a week) the incidence of impairment was 6.7%. The high physical activity (greater or equal to 3 x a week) seniors had a 5.1% incidence of impairment. Take Away Point: Exercise can the lower the risk of cognitive impairment--and the more days the better!

Even in a nursing home exercise can improve the quality of life--but not by that much. "Effects of Exercise Programs to Prevent Decline in Health-Related Quality of Life in Highly Deconditioned Institutionalized Elderly Persons," Dechamps, Arnaud et al, Universite Victor Segalen, Bordeaux, France. This study included 160 institutionalized out-of-shape elderly (average age of 82) who were still able to understand basic motor instructions & who could move from one position to another. They were divided into 3 groups: adapted tai chi for 30 minute sessions 3x a week; a cognitive action program which is a type of exercise that is related to everyday actions--from 30-40 minutes 2x a week; and a control group which had no exercise program. Results: After 12 months, the non-exercising control group experienced a greater decline in the activities of daily living than the exercisers. Those in the exercise programs slowed their health quality decline, however, the improvements experienced by the elderly exercisers weren't considered clinically significant. Bottom Line: Although exercise programs in nursing homes can slow down health decline, expecting actual physical improvements may be too much to ask. Don't wait until your eighties to start that exercise program. You will have a much better shot if you start young--or at middle-age.

Add exercise and weight loss to the DASH Diet and you will see even greater improvements in blood pressure. "Effects of the DASH Diet Alone and in Combination with Exercise and Weight Loss on Blood Pressure and Cardiovascular Biomarkers in Men and Women with High Blood Pressure," Blumenthal, James et al, Duke University Medical School, North Carolina. The DASH Diet emphasizes moderate calorie, low fat, low sodium, whole grain foods, along with 6-12 servings of fruits & vegetables a day. Click here to learn more. The Study: 144 participants with an average age of 52, with an average blood pressure of 138/86 mm Hg, and not on any BP medication were enrolled in the study, and divided into 3 groups: 1. DASH Diet alone with counseling, 2. DASH Diet with a behavioral weight loss program & a supervised exercise program 3x a week at a level of 70%-85% heart rate, or 3. The "usual diet control" group. The study lasted 4 months. Results: The DASH diet + weight loss & exercise group did the best, of course. Their blood pressure was reduced by 16.1/9.9 mm HG. Those on the DASH diet alone reduced their blood pressure by 11.2/7.5 mm HG, and those in the "usual diet control group dropped theirs by only 3.4/3/8 mm Hg. Weight loss: The DASH Diet + exercise & weight management group lost an average of 19.1 pounds. The DASH Diet alone group lost .7 of a pound. The "usual diet group" gained 2 pounds. Cardiovascular Markers: The DASH Diet + exercise weight loss group had the greatest improvements in this area-- including less arterial stiffness as measured by pulse wave velocity, an average of 19% improvement in their aerobic capacity (VO2 max), improved baroreflex sensitivity of 33% (less stiffness in the arteries--which is an early side effect of hypertension), and decreases in the size of the left ventricle--a side effect of high blood pressure (increases in the muscle tissue that makes up the wall of the heart's main pumping chamber-the left ventricle). TAKE AWAY POINT: The DASH Diet (high in fruits & vegetables, low in salt) + weight loss + exercise is the best combination to lower blood pressure and improve cardiovascular risk factors.

Exercise--the most effective prescription out there. It's the best "drug" available to prevent dementia and insure successful aging. "Evidence Regarding the Benefits of Physical Exercise," Drs. Jeff Williamson & Marco Pahor, Institute on Aging, University of Florida. This editorial in the Archives of Internal Medicine highlights the benefits of exercise on successful healthy aging.

"It is now well established that higher quantities of physical activity have beneficial effects on numerous age-related conditions such as osteoarthritis, falls and hip fracture, cardiovascular disease, respiratory diseases, cancer, diabetes mellitus, osteoporosis, low fitness and obesity, and decreased functional capacity, all conditions that greatly increase the risk of reduced independence in late life.
Two of these studies (in the Archives of Internal Medicine) evaluated the relationship between physical exercise and decline in cognitive function, a major contributor to loss of independence and related institutionalization in elderly individuals.
Optimism in this area is sorely needed owing to the failure of promising interventions aimed at preventing cognitive decline and dementia in the recent past.

Physical inactivity is one of the strongest predictors of unsuccessful aging for older adults and is perhaps the root cause of many unnecessary and premature admissions to long-term care."

A New Role for Omega-3? Lengthening Our Telomeres--A Key Marker for Aging, Longer Life, and Health. From JAMA & UCSF.

2010-01-25T02:07:49Z

"The main result of our study is that patients with high levels of Omega-3 fish oil in the blood appear to have a slowing of the biological aging process over five years as measured by the change in telomere length. It's also the first study that shows that a dietary factor may be able to slow down telomere shortening."

-Ramin Farzaneh-Far, M.D., of the University of California at San Francisco, lead author of "Association of Marine Omega-3 Fatty Acid Levels with Telomeric Aging in Patients with Coronary Heart Disease" JAMA 2010;303(3):250-257.

This week's big medical news story appeared in JAMA and it is one more reason why you want to be sure to get your Omega-3s everyday--while lowering your intake of the Omega-6s.

We already knew that the Omega-3s were amazing.

They're anti-inflammatory and anti-clotting
They prevent age-related cognitive decline
They lower triglycerides
They lower blood pressure
They slow age-related macular degeneration
They keep blood vessels flexible
They lower depression
They decrease joint stiffness in rheumatoid and osteo-arthritis
They're necessary for fetal and infant brain development

So What Did The JAMA Heart And Soul Study Tell Us That We Didn't Already Know?

The UCSF researchers followed 608 outpatients with stable coronary artery disease for 5-8 years. At the start of the study they measured everyone's levels of Omega-3's and the length of their leukocyte telomeres--which is a marker of aging. Remember though--this was an observational study, not a gold-standard double-blind randomized controlled study.

Here's how the lead researcher Dr. Ramin Farzaneh-Far explains the results:

"The main result from our study is that patients with high levels of Omega-3's fish oil in the blood appear to have a slowing of the biological aging process over five years as measured by the change in telomere length."
"Patients with the highest levels of Omega-3 fish oils were found to display the slowest decrease in telomere length, whereas those with the lowest levels of Omega-3 fish oils in the blood had the fastest rate of telomere shortening, suggesting that these patients were aging faster than those with the higher fish oil levels in their blood."

"By measuring telomere length at two different times we are able to see the speed at which the telomeres are shortening and that gives us some indication of how rapidly the biological aging process is taking place in these patients."

What Are Telomeres And How Exactly Do They Affect The Aging Process?

PLASTIC TIPS ON SHOELACES--that's the analogy often used to describe telomeres. They are the red caps sitting on the ends of these blue chromosomes.

Just like plastic shoelace tips that keep the laces from fraying--the telomeres protect valuable genetic material needed for our cells to divide properly, and to repair worn-out cells.

They are also strong markers for aging (see the graph below and get depressed). Not only do they shorten as we age, over time the telomeres can become damaged and shorten because of inflammation, smoking, obesity, or lack of exercise.

Emmuanel Skorkalakes, of the Wistar Institue in Philadelphia, explains,

"When the telomeres become short, then you start cutting into actual chromosomes where there are genes essential for our body. To prevent the fraying DNA in all those aging cells from seeding maliganant tumors, the body turns them dormant. Your body shuts down more and more cells every day and you become old."

This week's JAMA study is just one more bit of evidence that shows how our lifestyle choices can affect telomere length--and promote healthy aging.

A 2008 twin study published in the Archives of Internal Medicine compared the telomere length of exercising twins versus couch-potato twins. After only 12 months, the telomere's of the exercising showed the equivalent of being 10 years younger than their couch-potato siblings. Click here to read about the study.
A 2008 study led by Dr. Dean Ornish followed a group of men with early prostate cancer who made these lifestyle changes: increased their fruit & vegetable consumption; limited their fat consumption to 10%; lowered their consumption of refined sugar; took vitamin supplements & fish oil; exercised for 30 minutes a day; and either meditated or did yoga for stress relief. After only 3 months, 24 out of 30 men showed significant increases in their telomerase levels. Click here to read about the study.
A number of studies have also shown how stress can accelerate telomere shrinking, especially in caregivers of chronically ill children and the spouses of Alzheimer's patients. One study even suggested that you can accelerate your biological age by as much as 17 years if you're exposed to what you perceive as high psychological stress!

All About Omega-3's. Does It Really Have To Be Fish Oil?

Yes, the JAMA study used Omega-3 fish oil, but Omega-3s really originate in green leafy plants--not in fish.

Susan Allport is a medical researcher who is an expert in "all things Omega-3". She has written a brilliant article in the September 2009 issue of Prevention, "The Vanishing Youth Nutrient" that does an excellent job of explaining why we need Omega-3s in our diet, why so many physicians equate Omega-3 with fish, and why Omega-3 is sorely lacking in our diets. Click here for the article.

We can only obtain the Omega-3s through our diet.
They are essential to the healthy development of our brains--and they are found in the highest concentrations in our most active tissues: brains, eyes, hearts, the tails of sperm.
The metabolism of every species on the planet is a function of the amount of Omega-3s in its tissues, according the Dr. Tony Hulbert of the University of Wollongong in Australia. Think: Omega-3=growth, activity, energy. Omega-6=hibernation, fat storage, belly fat. Athletes take note: high concentrations of omega-3s in muscle cells lead to improved athletic performance.
Research from the 1980s showed fish-eating populations of Greenland and Japan had the lowest rates of heart disease. That's why the Omega-3s became associated with fish--instead of with green plants. And that's why the American Heart Association recommends fish or fish oil as our main source of Omega-3s. Big Problem: Fish are not a sustainable source of Omega-3s--there are simply not enough fish in the world's oceans.
Big Point: "Omega-3s are found in the green leaves of plants. Fish are full of omega-3s because they eat phytoplankton (the microscopic green plants of the ocean) and seaweed. They are what turn sunlight into sugars, the basis of life on Earth."
You can get all your Omega-3s from green leafy vegetables, legumes, flax seeds, chia seeds (they have the highest level of any plant-click here to read more), or walnuts, highly purified fish oil supplements, or algae-sourced Omega-3 supplements.
Big Point: If you cut back on vegetable oils, processed foods, trans-fats, corn-fed meat, chicken and milk you will actually lower the amount of Omega-3s you need in your diet to balance the negative effects of the inflammatory, fat-promoting Omega-6s we are getting in our Western Diet.
The ratio of Omega 6's to 3's should be 2:1, or ideally 1:1. Currently, for most Americans, the ratio is 17:1 in favor of heart-disease-causing Omega 6's.

Why Is Our Diet So High in Omega-6s, And So Low In Healthy Omega 3's?

Omega-6 fats come from the seeds of plants. We need them--but we need far less of them than we are consuming--and we need them in just the right ratio to Omega-3s. They promote blood clotting, inflammation, and cause us to "pack on the pounds". Just like corn-fed beef. Grass-fed or plant-fed animals and humans are naturally lower in fat!
Big Point: Omega-6s and Omega-3s are in constant competition to enter our cells. Eat too many Omega-6s in the form of meat, oil, or processed food--and you'll be seriously deficient in Omega-3s. Eat less Omega-6s, and your body won't need as many Omega-3s to function properly.
Omega-3s began to disappear from our food supply when previously grass-fed animals began eating corn and soybeans, which are high in Omega-6s. The factory-farm and feedlots replaced the family farm, and grass-fed meat, milk, and eggs became history. Click here to read about King Corn's effect on our health.
With farm subsidies for corn and soybeans, companies like Archer Daniels Midland figured out how to extract oil from these and other seed plants--giving us even more Omega-6s in our diet.
The AHA and other health agencies encouraged us to use oil and margarine because they assumed these cholesterol-free oils were good for the heart. Wrong!
"Food chemists discovered that rancidity in packaged food was caused by the oxidation of some minor but pesky fats: the Omega-3s." So they removed them and extended the shelf-life of packaged food.
Fewer and fewer of us are eating enough green leafy vegetables, fish, or flax to even put a dent into the "out-of-whack" Omega-6 to Omega 3 ratio.

I highly recommend you read Susan Allport's article in Prevention, as well as her book, The Queen of Fats. She does an excellent job of explaining the good, the bad, and the ugly of the fat world.

If you need any more convincing on the wonders of Omega-3, watch Allport's brief video, The Rat Race, comparing rats fed on diets rich in Omega-3s with those fed on diets deficient in Omega-3s.

Click here if you aren't seeing the video.

It's the Start of the New Year, the Start of the New Decade, and the Start of My Sixties. Some Simple Strategies for Staying Healthy and Happy. At Least I Can Hope!

2010-01-22T22:19:05Z

Author Dan Buettner has scoured the Earth -- not for the fabled Fountain of Youth -- but for the key to a happy old age. He spent five years visiting areas of the world where people tend to live longer, healthier lives, areas he calls "Blue Zones." (See image below.)

Buettner says he has identified four things people can do that can potentially increase life expectancy:

Create an environment that encourages physical activity
Set up your kitchen in such a way that you're not overeating
Cultivate a sense of purpose
Surround yourself with the right people.

"These are long-term fixes that have been shown over and over to add not only more years of life, but better years of life."

-NPR story, "Can 'Blue Zones' Help Turn Back the Biological Clock?", June 8, 2008-

If you're reading this through via email, click here to get to the more readable web-version.

It's the start of the New Year.

It's the start of a new decade.

It's the day I turn sixty.

Look, I'm not a big-birthday-celebration-kind-of-person. They come and go and I don't even think about the years. But turning 60 is different. It's the last quarter of life, with no guarantees on what that quarter is going to look like.

Judging by my parents--that last quarter of life doesn't look so promising. Which is exactly why I've been paying attention to exercise and eating right since I turned 30.

That's when my dad had one of those massive debilitating strokes that left him unable to communicate, unable to read or fully understand speech, and eventually unable to walk or do anything. He was 69 at the time--just when he was getting ready to kick back a little, work a little less, travel, and just enjoy life. He spent 16 years living in this kind of post-stroke-limbo-state, spiraling downward.

My mom was 62 at the time, and my dad's stroke changed her life in an instant. One minute she was planning all the trips they'd finally have a chance to take--and enjoying their new role as grandparents--and in the next she was jockeying the world of wheelchairs and therapists.

With the stress of full-time care-giving, and years of no exercise or attention to diet, by 72 she had developed severe coronary artery blockages, hypertension, kidney stones, and painful spinal fractures. Then came the mini-strokes that finally added up to vascular dementia in her eighties.

And unfortunately, this scenario is all too common. "[M]ost elderly Americans - more than two-thirds of current 65-year-olds, according to a detailed 2005 projection by a team of health policy analysts -- at some point will need assistance to cope with daily living, either paid help or unpaid, at home or in a facility."

So, sixty seems kind of scary to me.

Which is exactly why I'm ready for a more "Conscious Aging" plan. We already have all the evidence we need to stay healthy. It's not about adding more years to our lives. It's all about adding more life to our years!

Just a sampling of the evidence.

The 52 country INTERHEART study was very clear. There are 9 easy-to-modify risk factors that are associated with 90% of heart disease. This was a huge study--30,000 people from every inhabited country--and the results were the same for all races, all sexes, all countries. All 9 of these risk factors are within our control--and would eliminate 90% of heart disease, regardless of one's genetics. 1. Keep lipids (cholesterol & triglycerides) down; 2. Stop smoking; 3. Prevent or control hypertension; 4. Prevent or control diabetes; 5. Reduce belly fat; 6. Find ways to control psychological and social stressors; 7. Increase fruit and vegetable consumption; 8. Moderate alcohol consumption is protective; 9. Get regular physical exercise Lancet 364:937-952, Sept. 11, 2004.
The Nurses' Health Study and Health Professionals Follow-up Study. "The largest and longest study to date, done as part of the Harvard-based Nurses' Health Study and Health Professionals Follow-up Study, included almost 110,000 men and women whose dietary habits were followed for 14 years. The higher the average daily intake of fruits and vegetables, the lower the chances of developing cardiovascular disease...[F]or every extra serving of fruits and vegetables that participants added to their diets, their risk of heart disease dropped by 4%." Harvard School of Public Health

The China Study. This is Dr. T. Colin Campbell's mammoth 2006 study on the effects of a plant-based diet on health--citing over 750 studies. The conclusion: People who ate the most-animal-based foods got the most chronic disease. People who ate the most plant-based foods were the healthiest and tended to avoid chronic disease. According to Campbell, "Good nutrition supported by exercise, clean water, and sunshine is greater than the sum of its parts. It's a biological symphony. My introduction to Dr. T. Colin Campbell

The Longevity Personality. From the Journal of the American Geriatrics Society, April 2009 comes this conclusion: Those who live the longest are more outgoing, more active, more easy-going, more empathetic, and more agreeable than those who live a normal life span. The Blue Zones calls it, "likeability".

Here's My Strategy for Staying Out-of-Trouble After Sixty

Some of these are long-time habits, and they're easy for me to follow. Some of these I don't do as regularly as I should. Some of these are new goals. But this much I do know: If I don't have a plan, if I don't do these consciously, and if I don't carve out time to make them happen--they won't.

1. Stick with 7-9 servings of fruits and vegetables a day. The Green Smoothies make it easy. I get 6 servings in a 27 ounce Klean Kanteen that I divide over breakfast and an afternoon snack. I calculated the nutritional info on my daily 27 ounce serving that includes, 2 1/2 cups kale, 8 mini-carrots, 1/2 cup pomegranate juice, 1/2 apple, 1/2 orange, 1/2 kiwi, and 3/4 cup frozen black raspberries. Check out the nutrient content for 27 ounces:

Nutrition Facts

The Healthy Librarian's
Green Smoothie-kale,blackberries,carrots,orange,kiwi,pom juice,apple

Serving Size: 1 serving

Amount Per Serving

Calories

342

Total Fat

2.2g

Saturated Fat

0.2g

Trans Fat

Cholesterol

0mg

Sodium

140mg

Carbohydrate

82.1g

Dietary Fiber

13.8g

Sugars

49.1g

Protein

8.9g

Vitamin A 729%	Vitamin C 485%
Calcium 35%	Iron 28%

Then throw in some veggie-based soup, a salad, a veggie-based dinner entree, some fruit for dessert, and I'm good to go.

This eating plan is the same as the DASH Diet (Dietary Approaches to Stop Hypertension)--guaranteed to stop hypertension. The Cache County (Utah) Study on Memory shows it also prevents cognitive decline. Dr. Amy Lanou and Michael Castleman, authors of Building Bone Vitality claim it will build and strengthen bones--because the 17 nutrients necessary to build strong bones are all found in a diet high in fruits and vegetables.

2. A balanced exercise plan. It's not just about cardio--there are 4 areas that need attention: Cardio (spinning-my fave), Weight-training, Flexibility & Balance (yoga-my fave), and Core Strength. No, you can't just walk and think you're in good shape. I'm super regular with my cardio, and not as regular with the weight training and yoga. Click here to see what my workout looks like. As for core strength--that's pretty much non-existent. And when it comes to weight-training, according to Randy Raugh, the Canyon Ranch physical therapist, and author of the excellent Prime for Life--Functional Fitness for Ageless Living--to get the maximum benefits you need to do it for 3 non-consecutive days a week--2 at the minimum. Unfortunately, I often weight train only 1 day a week. If you want to build strong bones and prevent osteoporosis, and maintain your muscle strength as you age--weight-bearing exercise for the lower body, and weight-training for the upper body is a must-do! Yoga, helps with balance, preventing future falls, and building strength. As for core strength, I'm upping my game with Dr. Stuart McGill's routine, and my birthday-present to myself is the physical therapist-designed Pelvicore exercise ball.

3. A plant-based diet with minimal added fat. I'm nearing the 2 year mark on eating plant-based, so this is the easy part. I've got this down pat. I still use a little olive oil for cooking and in salads, and very occasionally eat some seafood or dairy when eating with friends. I'm convinced. If you want to lower your cholesterol, reduce your risk for type-2 diabetes, lower your blood pressure, reduce your risk of heart disease & stroke, and reduce your belly fat--this is the way to go. Dr. David J. Jenkins of St. Michael's Hospital in Toronto is one of the pre-eminent researchers on the benefits of a plant-based, low-glycemic diet (like beans, nuts, oats,& quinoa) for improving diabetes control, lowering cholesterol, and preventing cardiovascular disease. Click here for Jenkins research. And that's not all--keeping your blood sugar stable with low glycemic plant-based foods and exercise will preserve your brain. Click here. And as for too much fat--not only is it bad for your belly--it's bad for your brain--so just ditch it Click here.

4. No time urgency. This is what keeps the Okinawans calm, relaxed, and living longer. I'm really working on this one--which goes hand-in-hand with flexibility. Things don't always go as planned--you either go-with-the-flow or get stressed and anxious. My favorite 2 words, "Oh well." Life goes better when you stay in the moment, chill, and don't worry about getting there fast. When our Christmas Day trip to New York City was aborted because of an ice storm, we checked into a hotel at noon, and enjoyed a dinner of cranberry nut mix, Larabars, Cliff Bars, and clementines. All the restaurants were closed in this Pennsylvanian town. Oh well. We had a good time, and made it to New York safe and sound the next day.

5. More Dancing, Singing, Laughing, Playing, Schmoozing, and Mahjing. What's the point of staying healthy without having fun? That's the reason we work at staying healthy. Cool fact: There's a little organ deep in the ear, called the sacculus--and it gives us a great sense of pleasure and well-being when it's stimulated. But, it can only be stimulated through singing! So, bring on the Singstar Karaoke! Click here.

6. The Supplements. I'm really bad at regularly taking supplements. I'm good at counting them out, taking them to work, and bringing them back home with me. Truth is, there are some supplements worth taking because there's no easy way to get enough of them through diet alone. Here are my favorites: Omega-3s (I use Omega-Brite), DHA, (an omega-3 for brain health), Magnesium, Citracal, Vitamin D (I'm up to 3000 IUs), Curcumin (also known as turmeric, the yellow color in curry), and Juvenon (the combo of acetyl l-carnitine & alpha lipoic acid) developed by Dr. Bruce Ames. Click here to read more about what I take, and what some prominent physicians take.

7. Eliminate the time-wasters from my day. Except for watching "The Middle" or "Glee", TV watching always leaves me bored and unsatisfied. So, why bother wasting the precious time? The same goes for my mindless internet cruising, checking in more than necessary with email, the NYT, and other favorite sites. Enough already!

8. Maximize my peak energy times of the day. Over a year ago I blogged about getting in sync with our natural energy ebb and flow throughout the day. It works--and I intend to start planning my day around them, when possible. For instance, 9-11 is the peak time for brain work-creativity-and analytical work. On days when I don't work I would usually use this time for exercise & errands. Poor use of brain time. Better to exercise between 3-6. To read more, click here: Maximize Your Energy-Match Your Tasks to Your daily Energy Levels.

9. Give a gift a day for 29 days a month. When 36 year old Cami Walker of LA learned she had multiple sclerosis, her spirits flagged. She was tired, in pain, and had the prospect of a debilitating disease ahead of her. When a holistic health educator gave her the prescription of giving 29 gifts a day for a month she thought it sounded it crazy. Nothing big (and that's the point)--something like making a supportive phone call or saving a piece of yummy cake for her husband. Of course the prescription didn't cure her, but it had a startling effect of helping her cope with her illness and gave her a more positive outlook on life. I love this idea. It's a planned regular way to just think about kindness. No big acts, just something little-done everyday. To read more, click here.

10. Cultivate my garden of friends and family. Regular phone calls, visits, dinners, outings, and celebrations. At 60 there's no time to delay any of these. It's the glue that keeps us together and makes life worth living.

11. Once You're Through Learning--You're Through. This is the philosophy of John Wooden, the 97-year-old retired UCLA basketball coach. No doubt about it, learning and sharing what I learn is my purpose in life. I'm lucky to have a job that gives me access to learning about health and medicine, and a hobby that gives me a chance to share what I learn.

12. Start Eating Less. OK, I'm ready to shed a few pounds, and I know from past experience that writing down exactly what I eat, and how much I've exercised, really works. I use something called MyFoodDiary.com and it's set up with all my favorite recipes. Unfortunately, I haven't used it in quite some time. The new year is a great time to start! To read more about this tool, click here.

For some good reasons to eat less, read: CALERIE: The NIH Calorie-Restriction Experiment. Lessons for Health, Slowing Down the Aging Process, Longevity, and Disease Prevention

Time to end this list. I've already maximized my 9-11 brain time and written this post. It's now time to make my smoothie, do some core exercises, take those supplements, answer birthday phone calls, enjoy a birthday lunch, followed by an evening out with friends who all share the same wedding anniversary--if we can just make it through our foot of snow!

I'd love to hear from anyone who is 60 or over with advice, tips, and wisdom about maximizing life in the sixties, seventies, and more.