Thursday, September 29, 2011

An Honest Workout: Heart Rate Monitors

People in the statin ads often talk about how diet and exercise didn’t work for them.  I wonder whether these are the same people whose doctors are telling them that moderate exercise is enough and to “know your limits.”  Some doctors and even some trainers discourage older people from trying to do strenuous exercise, apparently motivated by fear of injury to the patient/ client or concern about liability for themselves. 

Moderate exercise never worked for me.  I spent years trying to improve my physical condition by brisk walking, swimming laps, or working out on an elliptical at a medium pace.  Nothing happened:  I didn’t lose weight or become stronger and my overall condition stayed about the same.  Eventually I concluded that these workouts were not hard enough to make a real difference.

How can you tell if you’re getting a good cardio workout?  You can’t unless you use a heart rate monitor.  If you work out on a machine that reads chest straps (and most of the newer ones do), youcan get by with just a chest strap.  If you don’t use a machine or you want more features you will need a watch to go with it.  Many of these are made by Polar Electro – USA.  I bought one on EBay about ten years ago and it still works fine.  Periodically I send it to the Polar Service Center for a new battery and they get it back to me right away.  My watch has some extra features like a log for keeping track of your workouts and a fitness test but I don’t use them much. 

The most commonly used formula for calculating maximum heart rate is to subtract your age from 220. When I first started doing serious exercise at age 54 I would go as fast as I could on the elliptical and my heart rate would never get much above 125 beats per minute or about 75% of my maximum heart rate of 166 bpm.  I think part of the problem was that at that point my muscles weren’t strong enough to do a harder workout.  After I started using a protein supplement and, later, proteolytic enzymes, the situation improved.  These days I do intervals alternating 4 minutes at 132 bpm with 3 minutes at 142 bpm, averaging around 137, just under 90% of my current maximum heart rate of 155.  On a day when I am tired or not feeling well I may not get much above 130; if I get down to 125 I will lose condition and start putting on weight

The thinking about exercise for older people may be starting to change.   The Personal section of the Wall Street Journal (6/28/2011) had an article about how some doctors are using intense interval training for patients recovering from a heart attack or cardiac surgery. 

Tuesday, September 27, 2011

Protein 1

Hamburgers, bacon and eggs, cold cuts, big juicy steaks, all are staples of the American diet.  People in the US are famous for consuming large portions of high protein food.  Perhaps this is why no doctor has ever asked me whether I was getting enough protein.  In junior high school gym class we were supposed to climb ropes.  I couldn’t do it.  I couldn’t do a single push-up either.  I tried to play tennis but the big, wooden rackets seemed too heavy.  Long fingernails were stylish in the 1950’s but mine always broke or peeled off in layers.  All of these were clues that I wasn’t getting enough protein but nobody paid much attention.

How much protein does an adult person need? Most sources I’ve looked at start at 40-50 grams per day.  Sometimes the recommendation is expressed as a ratio, .8 or .9 gram per kilo of body weight.  Men need more than women and people who work out regularly need more than sedentary types.  Protein deficiency can result in muscle weakness; if the body does not ingest enough protein it takes what it needs from the muscles.   A lack of protein can also lead to a weakened immune system.  Deficiency  can come about even when enough protein is being consumed if the body is not able to digest it properly.  (More on that in another post.)  Getting enough protein is essential for overall health but there is also some evidence that consuming more protein may reduce your risk of a heart attack, according to the web site of the Harvard School of Public Health.

When I was in my fifties I started really looking at the numbers on my annual blood work and noticing that the protein was low.  I thought about my current diet:  toast and fruit for breakfast, salad at lunch, meat and vegetables at dinner.  My rough estimate was that I was getting less than 30 grams per day, not nearly enough.  How to get more protein without eating more meat and adding too many calories and too much fat? A few years back I saw people on a TV fitness program drinking protein shakes.  These days I buy five-pound containers of chocolate whey protein at the gym.  (Soy protein is available too.) 

Chocolate Mint Protein Smoothie            makes 2 2-cup servings

¾ cup of low fat milk
2 tbsp. low fat yogurt
11/3 cups of ice cubes
2 scoops chocolate protein powder
2 small peppermint patties

Blend all ingredients until thick and creamy.

Fruit Protein Smoothie

Same as above but use vanilla protein powder, add two cups frozen fruit, ½ banana, and omit the peppermint patties.

Saturday, September 24, 2011

Making Juice: Remembering Jack LaLanne (1914-2011)

When I was a little kid my brothers and I sometimes read comic books.  The back pages included ads that promoted everything from sea monkeys to the Matachine Society, offering tantalizing glimpses into mysterious worlds beyond childhood.  Bodybuilder and fitness promoter Jack LaLanne made frequent appearances in this venue.  As I got older I used to see him on TV sometimes, demonstrating exercise routines impossible for me but simple for him.  In recent years he’s been featured, often with his wife Elaine, in ads promoting their juicers.  By emphasizing the importance of exercise and good nutrition Jack LaLanne was decades ahead of his time and I am grateful for his example.  Now that I am beginning to be old I follow three of his teachings:  lift weights, drink juice, and maintain a positive attitude.

According to the USDA’s, adults should eat 2 cups of fruit and 2-3 cups of vegetables daily.  As a practical matter, almost nobody does this.  Grocery shopping can be difficult for people with busy work schedules and children to care for.  Preparing and cooking vegetables requires time and energy that many people just don’t have.  Ten years ago I was probably better off than most.  I could usually manage a dinner with two vegetables; at lunchtime not so much.

What moved this issue to the top of my priority list was reading about a study by Qi Dai, M.D., Ph.D. of Vanderbilt,  Amy Borenstein, Ph.D., and Yougui Wu, Ph.D., from the University of South Florida and Eric Larson, M.D., Ph.D., of the Group Health Cooperative of Puget Sound.  “In a large epidemiological study, researchers found that people who drank three or more servings of fruit and vegetable juices per week had a 76 percent lower risk of developing Alzheimer's disease than those who drank juice less than once per week.”

This news had an electrifying effect on me.  My mother, an intelligent and well educated woman who taught Latin in a Boston private school, developed Alzheimer’s in her late 60’s and died at 71.  If drinking juice might improve my odds against this horrible disease I would do it.  Then I started thinking about large piles of bottles and cans being lugged in from the store and ending up with the recyclables – not so good for the environment.   So we bought a juicer, not a LaLanne (sorry, Jack) but a Breville, which has worked well for a long time. 

At first we tried lots of different recipes but we settled on two:  a fruit juice with pineapple, orange, berries, grapes, and apple and a vegetable juice with tomato, celery, cucumber, and carrots (lots of carrots).  Sometimes we put in seasonal ingredients, like cranberries in winter.  To clean, cut up and juice ingredients for two pitchers takes about 45 minutes.  Because we don’t’ peel anything but the oranges and the pineapple we soak everything in vinegar and water and then scrub and rinse it.  This is the hard part.  The easy part is having delicious fruit juice to drink at breakfast and vegetable juice at lunch or dinner.  We still usually cook two vegetables at dinner but having the juice ensures that we're getting enough overall.  The fruit and vegetable pulp left over from juicing goes into the compost pile and eventually winds up in our garden.  An additional benefit is that for someone like me who has trouble digesting fibrous foods (no kale or spaghetti squash, thanks) more nutrients are probably reaching my system.

Jack LaLanne, I raise my glass of vegetable juice to you.  Thanks for everything!  

Saturday, September 17, 2011

Should I Be Taking This? 2

  • Infections of the nose and throat may occur.
  • NASONEX may cause slow wound healing. Do not use NASONEX until your nose is healed if you have a sore in your nose, if you have surgery on your nose or if your nose has been injured.  
  • Some people may have eye problems, including glaucoma and cataracts. You should have regular eye exams.
  • NASONEX may cause immune system problems that can increase your risk of getting infections. Avoid contact with people who have infections like chickenpox or measles while using NASONEX. Tell your doctor about any signs of infection, such as fever, pain, aches, chills, feeling tired, nausea and vomiting.
  • A condition in which the adrenal glands do not make enough steroid hormones may occur. Symptoms can include tiredness, weakness, nausea, vomiting and low blood pressure.
  • Clinically proven to help provide relief for these nasal allergy symptoms
    • Congestion
    • Sneezing
    • Itchy nose
    • Runny nose
  • …caused by these seasonal
    or year-round nasal allergy triggers
    • Pollen
    • Mold
    • Pet Dander
    • Dust Mites
  • Helpful facts about NASONEX…
    • scent-free & alcohol-free
    • non-habit-forming
    • non-drowsy
    • won't keep you awake

An Unfashionable Body

When I was in junior high school I started to feel fat.  I had been an average-sized child but my body matured early. By the time I was in the sixth grade my physical self was pretty much what it is now. I was 5'51/2" tall, as I am now, and weighed about 135, an OK weight for my muscular frame.  

So why did I feel fat? I think part of it had to do with the normal physical changes that happen to girls at that age, changes that can make the body seem awkward and alien.  My podiatrist explained to me once that, because of the way a woman’s pelvic structure changes in adolescence, she basically has to learn how to walk all over again.  Part of it was that I probably had put on a few pounds because I was eating more, and probably less healthy, foods and leading a more sedentary life.  But an even more important factor – and one that I didn’t understand until years later – was being born at the wrong time.

In the 1950’s and early 1960’s the ideal young woman (they were always called “girls” then) was short, petite, and cute, think Sandra Dee.  At the time I believed that things had always been this way.  In fact, it turns out that there are fashions in bodies just as there are in clothing.  About ten years ago I read Alison Lurie’s book, The Language of Clothes, a wonderfully rich and insightful survey of personal attire and its meanings in various historical periods and regions of the US. 

According to Lurie, starting in the mid-nineteenth century, women with larger bodies were considered the ideal.  “… late Victorian and Edwardian woman was an impressive creature physically.  Height and weight above the average had...become an asset.  Authors compared their heroines to goddesses, praising their classic proportions, or described them as regal and queenly – whatever their social origins.”  The clothing of the period was designed to enhance the curves and broad shoulders of these statuesque women but did not flatter smaller or slimmer builds.  In photographs of the period larger women can look “glorious,” while the petite beauty may seem “awkward and cluttered with decoration” or even “reduced to an untidy bundle of expensive washing.”  My grandmother, who grew up during this period, could never see why anyone thought I looked fat; she and I had about the same build.  The photo above on the left shows me in 2010 when I was 63.  The one on the right shows my grandmother, Jane Miller Stotsenburg (soon to be Kromer) in 1907 at the time of her wedding; she was 19.

Friday, September 16, 2011

Ab Ripper X – Argh!

Trainer Tony Horton, creator of Ab Ripper X says, “I hate it, but I love it,” which sums it up pretty well.  Ab Ripper X is a series of 11 exercises done 25 times each.  The moves vary in intensity and in which muscles they work.  Some, like Bicycles or Pulse Ups, I could do right away; others, like Oblique V-Ups, are still hard.  Once you get the hang of it you can do the entire routine in 10-15 minutes.  When I first learned Ab Ripper X I was only using it occasionally and saw little progress.  It wasn’t until I began doing the whole series at least three times per week that I started seeing results.  After a month I could see parts of my rib cage that had been hidden for decades. 

Trying to lose fat around the middle is a frustrating business.  Fat loss tends to work from the outside in; if I go on a diet the first places I thin out are my face and my hands.  If I keep at it my lower legs and arms will start to look better.  The middle of the body, especially right around the navel, is the last to go.  I imagine that there are good biological reasons for this – the body trying to protect the major organs and all that – but it can be very annoying.  The benefit of a program like Ab Ripper X is that it changes  the normal progression so that you are lose proportionately more fat from the middle than you would otherwise do. 

With Ab Ripper X, as with all exercise programs, when it becomes easy your condition will no longer improve.  At that point you can go on line and find lots of ideas for making it harder again: holding a weight and adding ankle weights, for example.  I’m currently using 5 lb. ankle weights; we’ll see how long that lasts! 

Tuesday, September 6, 2011

“Please Give Me My Test Results (Not Just An Interpretation)”

As of 2010 I had had six doctors in six years.  Only one of those changes was my idea; here’s how it went:

1.   My doctor of 25 years retired, driven out by increasing costs for liability insurance.
2.  Doctor got a job with a corporate clinic. 
3.  Doctor got a job with the VA.  I’m not a vet.
4.  Doctor seemed to have an anger management problem.  I moved on to
5.  A great guy, but he became the hospitalist with the affiliated hospital.
6Wonderful new doctor – hope she stays around.

I’m sure my experience is not unusual and it illustrates an important point: most doctors today don’t know their patients well. 

In the TV show “House” doctors read the patient’s whole chart and sometimes even personally check their home for toxins or microbes.  In the real world none of this happens.  Medical staff rarely have time to read much of the patient’s chart.  The last time I went in for a physical the first nurse I saw asked me when I had had my last period.  I am 65 and I had a hysterectomy at 32!

Doctors who don’t know you well and don’t read much of your chart are forced to rely on test results because, apart from what they can glean in a short visit, this is all they have.  There are some problems with this approach.  First, mistakes happen.  After getting an unexpected result on a cholesterol test I asked about it and learned that the lab had misapplied the formula for calculating LDL.  A friend of mine was told, incorrectly as it turned out, that he was diabetic because of a lab error.  In such cases procedures or medication may be prescribed when they are not needed. 

Second, when interpreting test results it is important to consider the context.  Each person’s body is unique and some have idiosyncratic test results that are normal for them.  Without reading the patient’s chart in detail the doctor may not know this.  In my case the white blood cell count is sometimes low.  Doctors are concerned about this because it can indicate the presence of illness, including some serious conditions like cancer.  One of my doctors ordered a re-test and it was normal.  Without any other indications that I am ill I am going to forego any WBC re-tests in the future.

Third, having actual test results can give the patient important insights into how his or her own body is functioning.  For much of my life I have had weak muscles.  At some point I looked at my blood test results and noticed that my protein was a bit low.  My doctor was not concerned about this because at that level it was not a predictor of illness but I decided to start taking a protein supplement to get my reading up into the normal range.

Fourth, and most important, sharing actual test results promotes reciprocity and team work between doctor and patient.  It encourages the patient to be an active participant in his or her own care instead of giving all the responsibility to the doctor.  Research has shown that patients who are informed and participate in their own care have better outcomes.  So please, please give me a copy of my test results.  

Saturday, September 3, 2011

Lessons from DXA

In 2003 my doctor recommended that I get a DXA, an imaging procedure that assesses bone mineral density and is used to diagnose osteoporosis.  I was unhappy to learn that my BMD was low (osteopenia) though not yet in the osteoporosis category.  The test takes measurements from the spine and both hips.  In my case the spine was worse; the hip measurements were pretty much normal.  My height was 5’51/2”, the same as it has been since sixth grade.

The numbers for the spine were worrisome because an uncle and an aunt on my father’s side had both experienced serious back problems in old age.  My uncle had back surgery and wound up in a wheel chair for the rest of his life; my aunt just put up with the pain.   My doctor wanted to prescribe a bisphosphonate to help strengthen my bones but I said, “No, thanks.”  Instead, I started taking a lot more calcium and vitamin D and continued my cardio and weight training.  In successive tests, done every two years, the readings stayed about the same.

This year I went for another DXA and was startled to learn that my height was now 5’ even; I’d lost a half inch.  I asked to see a copy of the report, thinking that the reading on my spine would show deterioration.  Instead, the spinal reading was the best it had ever been, up 10% compared with the previous test.  The hip readings were lower but not a lot.  These results raised many questions.  How could I be losing height if my spine was actually better off than it had been?  What had caused the improvement? Why were the hip readings getting lower?

When I got home I asked my husband to measure my height:  the half inch was still gone.  So I went to Google and learned a number of things.  First, a person’s height can vary throughout the day because of gravity and physical activity.  Typically, a person will be tallest in the morning, after eight hours of no vertical pressure on the body, and shortest in the evening.  I thought about the fact that I had been doing push-ups and pull-ups in the morning before the test.  Strength training tends to make muscles tighten up, especially if you don’t stretch afterward. 

Later the same day I spent some time doing back-stretching exercises and had my husband measure me again.  The half inch was back! As to why the spine measurement had improved my best guess is the plyometric exercises I started doing a couple of years ago.  Plyo involves hopping and balancing.  Jumping jacks are an example, as is hopscotch, activities that involve impact on the body.  A study comparing young female soccer players with inactive women found that the soccer players had significantly higher bone density.

What about the lower hip numbers? Google turned up references to a recent study linking wearing a cell phone on your belt with reduced bone density in the hip (see “Bone Density and Cell Phones” above).  My trainer Greg also suggested doing more hip presses and lunges so I will.  A sample of one is not a scientific study but  it seems pretty clear that exercise can go a long way toward maintaining and improving bone density with little expense or risk of side effects. 

Friday, September 2, 2011

Should I Be Taking This?

  • Serious infections. These include TB and infections caused by viruses, fungi, or bacteria. Symptoms related to TB include a cough, low-grade fever, weight loss, or loss of body fat and muscle.
  • Nervous system problems. Signs and symptoms include numbness or tingling, problems with your vision, weakness in your arms or legs, and dizziness.
  • Heart failure (new or worsening). Symptoms include shortness of breath, swelling of your ankles or feet, and sudden weight gain.
  • Immune reactions including a lupus-like syndrome. Symptoms include chest discomfort or pain that does not go away, shortness of breath, joint pain, or rash on your cheeks or arms that gets worse in the sun.      (partial list)
We see them advertised all the time on TV, medications for conditions ranging from big time threats like stroke and heart disease to trivial issues like sparse eyelashes.  The inspiring dramatizations, featuring handsome actors and beautiful settings, are there to assure us that if we take X life will be much better.  At the end of each commercial is a list of warnings.  Do people really listen to these?

When we watch these ads, even if we listen to the warnings, we’re only getting part of the picture, the part the manufacturers want us to see.  Many of these drugs and relatively new; nobody has had the experience of taking them over a long period of time or of seeing how they will interact with foods, supplements, and other drugs that a particular patient may be taking.

Even the drug testing process that is supposed to verify the safety and effectiveness of medications may be tainted by self-interest.  The Wikipedia article on the pharmaceutical industry cites, “accusations and findings that some clinical trials conducted or funded by pharmaceutical companies may report only positive results” and drug companies’ rewarding of drug researchers who report results favorable to their products (as well as threats of lawsuits against those who raise discomfiting questions).  Studies that compare the effectiveness of various remedies (including some that may cost little or nothing) are few and far between.

Let’s be honest:  all health care is a balancing act.  Each individual decision should be based on a cost/benefit analysis relating to the patient’s situation at the time.  If I have an invasive cancer I may be willing to try almost any therapy including those that are toxic or could have dangerous interactions or side effects.  In the case of less threatening conditions I need to ask, “Is the drug with its cost and its possible risks really worth it?”

Getting back to the world of ads, I think it would make sense for the warnings to be listed at the beginning of the commercial before the viewer is seduced by the lovely photography and soothing words.  I’m going to start doing this with some examples I’ve encountered recently.

HUMIRA is a prescription medicine used alone, with methotrexate, or with certain other medicines to reduce the signs and symptoms of moderate to severe rheumatoid arthritis in adults, may prevent further damage to your bones and joints, and may help your ability to perform daily activities.