Why Losing Weight Is So Difficult

I recently came across a good article by science writer Sharon Begley that appeared in the January/February Saturday Evening Post for this year.  The piece, entitled “Lose Weight for Good!”, says that medical science is finally accepting what many of us have known all along:  that losing weight can be a complicated, difficult process, and that no two people will succeed at it in the same way.  If you don’t have time to read the whole article, at least scroll down to the “Easy Rules for a Stay-Slim Life” at the end; some of them are not what you would expect.

This started me thinking about why it took decades to get my weight down to its present, OK level (145 lb.) and to get into better shape.  There were several factors not mentioned in the article that were obstacles for me and undoubtedly are for others as well.

        1.  Thyroid Problems.  I was diagnosed with hypothyroidism as a teenager but nobody followed up on this in a systematic way until decades later.  In addition, thyroid disease was evaluated differently in the mid-twentieth century than it is today, though some medical operatives haven’t caught up with the new thinking yet.  When I look at the current report on my blood work from the lab it gives .5 to 4.90 uIU/ml as the normal range.  This is wrong:  the correct range is .4 to 2.0.  In the 1950’s and 60’s patients with readings in the 2.1 and above range were regarded as normal; today they would be treated for hypothyroidism.  Low thyroid levels are associated with slowed-down metabolism and fatigue.  Personally, I have found that if my thyroid level is too low it is impossible to lose weight no matter how little I eat or how much I exercise.  It used to be extremely frustrating when people would say that I must not be trying hard enough!

        2.  Stress.  During early adulthood I was under stress pretty much constantly.  Grad school is a high-anxiety situation for a lot of people but it is supposed to lead to a professional career.  During the 1970’s it was tough for many of us to find and keep jobs; it was as though grad school never ended.  Recent research has shown that stress is linked not only to mood disorders like depression and anxiety, but also to metabolic disorders, including obesity.  

        3.  Weak Muscles.  In gym classes in high school other students could do pull-ups; I could not.  In my twenties and thirties my muscles were so weak that I couldn’t do a single push-up.  Why was this and why didn’t anyone ever notice that a solid-looking person like me had such poor muscle tone? Here again, people with hypothyroidism can have weak muscles.  Also, my lifestyle during that period was very sedentary – I mostly sat around reading – and I probably wasn’t getting enough protein.  I wasn’t a big meat-eater and my body didn’t seem to be that good at processing the protein I did give it.   

     The good news is that all of this was totally reversible.  I now drink protein shakes and eat protein bars to get my levels to 70-100 grams per day.  I probably need at least that much because my body is unusually muscular, according to the body composition scale I use.  These days I can do forty or more push-ups, thank you Tony Horton.  So far, I can only do assisted pull-ups, but I’m working on that.  If your muscles are weak you can’t get a good workout.  If you can’t get a good workout you won’t be able to burn many calories. 

        4.  Problem Feet.  When I started doing more serious exercise in the 1990’s I began to notice little pains on the sides of my feet.  This led to my getting orthotics, a story I have told in the post “Respect the Feet.”  If I hadn’t gotten my feet fixed, I wouldn’t be able to survive the heavy-duty workouts I do today; the stress on my feet, knees, and hips would have been too much.  I often wonder how many hip and knee replacements could have been avoided if those patients had gotten their feet looked at early on.

In spite of the hassles and frustrations, getting into shape has ultimately been a process of self-discovery.  At this point I know my body very well, how far I can push it, when I should pull back.  At the age of 66, I feel more comfortable in my own skin than I ever have in my life.

It’s Not the Annual Physical, It’s the Tests

My primary care provider is a fine doctor; she is intelligent, kind, and a good listener; I enjoy talking with her when I have my annual physical each year.  What I dread are the tests, not because I mind being punctured or scanned or even having a certain amount of my time wasted, but because they sometimes force me to fend off unwanted medical interventions. 

Twelve years ago, when a previous doctor offered statins to lower my cholesterol, I said that I would try diet and exercise instead.  Diet and exercise worked, end of discussion.  A couple of years later when a bone scan revealed osteopenia (low bone density), Fosamax was pressed upon me.  I have never broken a bone and I think there is still a lot that medical science doesn’t know about bone quality so I said, “No, thanks.”  My doctor was a little offended.

The real fun started two years ago when a radiologist looking at my current mammogram thought he saw signs that might indicate cancer and recommended a biopsy.  (See the whole story in “Mammograms and the Cost Conundrum,” 8/22/2011.)  In my family cancer is almost unheard of and I am generally quite healthy so I opted for a second opinion, a move that clearly annoyed him.  The second radiologist found nothing wrong and still hasn’t.

This year the issue was heart disease, a matter I take very seriously because strokes and heart attacks are what kill most people in my family.  My PCP thought she heard a heart murmur so she sent me for an echocardiogram.  My doctor said it might be nothing:  apparently in very fit people a strong, vigorous heartbeat can sound like something wrong.  So I went for an echocardiogram.  As a side note, the technician took my blood pressure while I was sitting up talking to him.  When I saw on the screen that it was 140 over 80-something I said, “That’s much too high, let’s do it again.”  I lay quietly for a few minutes and my bp came out 118 over 63, still higher than my true number of 106/58, but at least within the normal range.  I’ve noticed a lot of medical personnel doing this:  not letting you sit quietly for a few minutes before taking your blood pressure.  Surely they know that the reading won’t be accurate; most people’s bp is higher in a doctor’s office and this just makes it worse. 

A doctor in Indianapolis read the echo and sent back a report saying that I had a “’pseudonormal’ filling pattern of the left ventricle for age (Stage 2 diastolic dysfunction).”  My PCP asked me to see a cardiologist.  My first move was to pick up a copy of the report from her office and try to learn more about what it meant.  According to several online sources, Stage 2 diastolic dysfunction is when you get shortness of breath, chest pain, and exercise intolerance.  This sounded like my father a few years before his death; it did not sound like me, with my P90X and cardio workouts.  

So I went to the cardiologist, a man widely respected for his medical expertise and his philanthropic work.  I was a little intimidated by his reputation and worried that perhaps there really was something wrong with my heart after all.  His waiting room was reassuring.  There were beautiful photographs on the wall (his work?) and a friendly receptionist.  In the examination room was his medical degree, from a university I had also attended (at the same time, it turned out).  The cardiologist was my age and a fitness buff like me.  He listened to pulses from head to foot, prodded my abs, and told me he didn’t hear a heart murmur.  Of the report he said, “I don’t know where he got this!”  Of my list of supplements he said that some of them probably weren’t doing me any good but there was nothing that would hurt me.  His recommendation:  “Don’t change a thing; just keep doing what you’re doing.” 

Need to Know: Obesity as a Threat to Our Future

On Friday evenings I often watch a program called Need to Know on public television.  This week’s episode, hosted by Scott Simon, dealt with the problem of obesity, first on the personal level, with the story of 10-year-old Carla, then on the public policy level, when Ross Hammond of the Brookings Institution was interviewed.  Carla, who lives in the South Bronx with her parents, is overweight and has been told that she is at risk for developing diabetes, an illness that runs in her family and has already killed one of her relatives.   

Children like Carla who live in low-income, predominantly minority neighborhoods have a one-out-of-two chance of developing diabetes at some point during their lifetimes, according to Dr. Alan Shapiro of the Children’s Health Fund.  Nationwide, children today have a one in three chance of getting the disease.  Correspondent and producer Sarah Schenck follows Carla as she enrolls in a health and fitness class and then proceeds to pass on what she has learned about diet and exercise to her parents.  In neighborhoods like Carla’s, sometimes called “food deserts,” nutritious food is scarce and expensive, while fast food is plentiful.  Opportunities to exercise outdoors are also limited.  Carla, a highly motivated and unusually articulate young person, seems to be making good progress toward her goals.

In the second part of the show host Scott Simon talked with Ross Hammond, a Senior Fellow at the Brookings Institution who is also on the editorial board of the journal Childhood Obesity.  As Carla’s story had illustrated, Hammond emphasizes that obesity has complex causes, including biology, the brain, and the person’s physical and social environment.  For this reason “it is very difficult to think of a single solution that will work for everyone.”  Instead, it is important to coordinate a variety of approaches to attack this urgent problem.   

According to Hammond, medical care for the overweight and obese can cost as much as 100% more than that for people of normal weight.  It is estimated that care for this group now accounts for 21% of all medical spending.  Obese patients require larger beds and special equipment in emergency rooms.  (I would add that very overweight patients in nursing homes will have the same needs over longer periods of time and that additional staff will probably be required as well:  think what it would take to turn a 400-pound patient over in bed!)  The best role for government, according to Hammond, is “helping to provide a playing field in which people can make appropriate choices and choose for themselves healthy options and have those healthy options be just as available, affordable, and convenient as unhealthy options.”  He calls obesity “a huge threat to our country.”

More Imponderables

Medical professionals generally would like people to take better care of themselves, to take more responsibility for their own health.  You can’t take responsibility unless you know the facts of the situation, yet some doctors and hospitals continue to place obstacles in the paths of patients seeking access to their own medical information.  I understand that privacy concerns necessitate the signing of a waiver and I have no objection to showing a picture ID, but even then my request is sometimes denied.  When a patient has had blood work, the actual numbers should be shown to him or her.  Some doctors provide interpretations of the tests rather the results themselves.  I remember the letters I used to get from one doctor, IN ALL CAPS, like a bulletin from the front lines.  Sharing and discussing the facts encourages cooperation between medical personnel and patients and may help to prevent erroneous diagnoses and the unnecessary treatments that result from them.

Recent discoveries in genomics have opened up new worlds of complexity in the study of the human body and made it even clearer than before that each of us is unique.  In spite of this, medical institutions in this country persist in trying to standardize treatment for all individuals in a particular category.  Medicare, which pays for my drugs, would like me to get off Premarin, which I’ve taken for more than thirty years and get on Estradiol, a newer and less tested medication.  They would also like me to swap the Synthroid I take for hypothyroidism for a generic.  (I tried a generic once before and it didn’t work the same.)  If a patient doesn’t follow orders when using a prescribed treatment, doctors call it “non-compliance.”  What should we call it when institutions want to take patients off prescribed medications that they have used successfully for years?  
   

Related Posts:  
"Please Give Me My Test Results (Not Just An Interpretation)"
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What I’m Having for Lunch: Layered Salad

This salad has a lot of variety in color and texture, as well as a mixture of sweet, spicy and nutlike flavors. 

Prep Time: 10 minutes                                                                                  Calories:  330

                                                                                                                      Protein: 26 grams

                                                                                                                      Fat: 19 grams

Ingredients 

Layered Salad

40g lettuce (a couple of good-sized handfuls)

25g kosher dill pickles, 2 or 3 small

20g grape tomatoes, 5 or 6 small

70g cooked garbanzos, 3 heaping tablespoons

1 tsp. olive oil

a squeeze of lemon juice

garlic powder

65g (2-3 oz.) chicken, cut in small pieces 

   (pulled rotisserie chicken from the store)

1 tsp. lowfat mayo

curry powder

hot sauce

salt and pepper to taste

10g roasted pumpkin seeds (a very small handful)

1.    Wash the lettuce and allow to drain while assembling the other ingredients.  I always do this even when the package says it’s pre-washed.

2.    Wash the tomatoes and cut them in two if they are large.

3.    Spread the lettuce on a plate and sprinkle the tomatoes over it.  Place the garbanzos in the center.

4.    Sprinkle the garbanzos with garlic salt, the olive oil, lemon juice, and salt and pepper, if desired.  (This is the Italian-influenced part of the salad.  In Italy people eat lots of great salads with olive oil and garlic.)

5.    In a small bowl combine the chicken, mayo, curry powder, hot sauce, salt, and pepper. 

6.    Layer chicken mixture over the garbanzos.

7.    Top lightly with roasted pumpkin seeds.

Buon appetito!

Doing P90X: My Variations

Giant Rubber Bands

I bought P90X almost three years ago but didn’t try the whole program right away.  At the time I was doing a mixed workout of strength ball training, using stability balls and weights in strength and balance exercises, plus some stretching and cardio.  I used P90X to vary the regular routine, doing one or two workouts a week.  Over many months I went through all of P90X Lean, the more cardio-oriented version of the program.  During this period of gradually working into P90X I received two important benefits:  learning Ab Ripper X and deciding that I needed to be doing at least some plyo.

This summer I decided to do P90X Classic, the basic version of the program.  The strength workout I had been doing had gotten too easy and the three sessions of intense cardio seemed to be too much.  I had already done each of the P90X workouts before so I knew what to expect.  I had also read many of the reviews of P90X on amazon.com, which can give you valuable pointers about how to fine-tune the workouts to suit your needs, as well as advice about whether you should be doing it at all.  If you haven’t exercised in years or were never in very good shape P90X is not the place to start.  But for people who want to take it to the next level it’s a truly great program.

When I first did P90X I couldn’t even finish all of the warm-up.  It had been years since I had done jumping jacks and some of the workouts include seventy or eighty of those before you even start the real exercise!  So I struggled through as many as I could and, over several months, got to the point where I could keep up with Tony Horton and the rest of the group, for that part at least.  With the five strength workouts, which are really the heart of the program, I could do most of the moves, somewhat.  One that I still can’t do is pull-ups and a couple of these routines have lots of them.  My trainer Greg Simmons introduced me to giant rubber bands which can offset part of your weight so you can do an assisted pull-up.  You hang the band from a bar, use a chair or short ladder to step into it, and voilà – pull-ups!  The strength workouts also include many variations of push-ups so I’m getting better at those.  When I was younger I couldn’t even do one push-up except the on-your-knees kind.  In the yoga routine I can’t really do the sequences with Warrior 3 and Half Moon because my balance is poor, but I keep trying anyway.  Plyo is the toughest part of P90X for me because jumping and hopping take a lot of explosive energy, but they're hard for the people in the class too.

Ab Ripper X is the shortest of the routines – 16 minutes and you can get it down to 12 if you do it on your own­ ­– and the only one you do three times a week.  Less than that doesn’t get you good enough results, as I found out by trying it.  At first I couldn’t do some of the moves; Crunchy Frog was pretty tough, as was Roll Up/V Up, and Oblique V-Ups were almost impossible.  I did 25 reps of the ones I could do and at least tried the others.  Eventually I got to the point where the whole thing was too easy so, following a tip I found online, I used ankle weights and small dumbbells for some of the exercises.  I also use knee and ankle weight for Kenpo X, the martial arts workout.

I feel that these workouts have improved my strength, especially in the shoulders, arms, and back, totally reshaped my midsection, and helped my flexibility and balance somewhat.  I haven’t lost much weight, only a couple of pounds over eight weeks.  I also find that I’m not getting enough of a cardio workout, even in Plyometrics and Kenpo X.  My metabolism is very slow, about 1100 RMR, and I’m in good shape so my heart rate gets up to around 120 and then goes right back down to below 100.  This is true even when I keep up with the group on the DVD.  After about six weeks of this, I added back a couple of half-hour sessions of cardio at the Y in order to keep up my condition in that area.

The exercises in these workouts are varied and challenging but what keeps me coming back is the ambience.  These sessions combine playfulness and hard work.  Tony Horton clowns around but also gives plenty of direction and serious advice.  I also like the fact that Beachbody didn't over-edit the tapes to remove some unintentionally funny moments, like when the handles of Sophia's bands hit Tony in the face.   It’s a comfortable atmosphere, perhaps partly because what we’re seeing is Tony working out with his friends.  Dreya Weber is the wife of P90X’s Creative Director Ned Farr; Joe Bovino and Tony are longtime friends; some of the other guys work out with Tony at the beach on Sundays.  The often-repeated motto “Do your best and forget the rest.” epitomizes the combination of effort and self-acceptance that are at the heart of this program.

Related Posts: "Room for Improvement:  the Wisdom of Tony Horton,"
                        "Ab Ripper X - Argh!,"

Statins - Whoops!

In the late 1990’s my cholesterol was high and my doctor wanted me to take a statin to lower it with the idea of reducing my risk of a heart attack.  I was uneasy about this suggestion - in the past I had been put on drugs that were later un-recommended or taken off the market entirely.  (See “Statistics and the Twenty Year Rule” and “Stilbestrol and Me.”) – so I said, “Let me try diet and exercise instead.”  That is how I got started on a long-term health and fitness project and the creation of this blog.  My cholesterol is now low enough that no doctor would recommend a statin anymore.  In the meantime, the thinking about statins is changing: for people with high cholesterol but no heart disease statins have no benefit and some worrisome risks.

Late Sunday’s “Sound Medicine” featured an interview with science writer Sharon Begley in which she reviewed the latest research in this area. There was so much good information in that short segment that I went back and located the article on which Begley’s remarks were based, “The Cholesterol Conundrum.”  Statins are one of the most widely prescribed – and most profitable – groups of drugs sold in this country.  One-quarter of American adults over 45 take a statin and sales in 2009 were $14.3 billion.  In the case of patients who already have heart disease or have had a first heart attack there is no question that these medications reduce the risk of dying, having a second heart attack, or needing heart surgery.   

But medical practice made a logical leap from this situation, called “secondary prevention,” to the notion that, in healthy people with high cholesterol, statins could prevent a first heart attack.  Unfortunately, this turns out not to be true.  Begley cites recent research indicating that 60 healthy people would have to take a statin for five years to prevent one heart attack and 268 would have to take a statin for five years to prevent one stroke, not much of a return on the financial investment.  But it gets worse.  Statins may increase blood sugar levels and raise the risk of type 2 diabetes.  This group of medications can also cause muscle weakness and a recent animal study indicates that it may make it more difficult to exercise.  In addition, statins can cause cognitive changes, such as confusion and memory loss.  Some patients believe they are getting Alzheimer’s, when it is actually the statins that have caused the symptoms.  Fortunately, these normally go away when the drug is discontinued.

Given the new information, I feel fortunate that I stayed away from statins.  If I ever do get heart disease, that will be another story.