SmokersFitness.com

An essential health resource for current and former smokers

SmokersFitness.com - An essential health resource for current and former smokers

Overweight and Obese

One of the guiding principles of our book is that all people should be treated with respect; this is especially true in the health care field where it’s not uncommon for doctors and other health care providers to look down on people who smoke. This can often backfire – as smokers who may otherwise come to their physicians to get help for tobacco cessation are now turned off from seeking medical care. (And who can blame them.)

It seems that the same holds true for overweight and obese patients (I can only imagine how bad it is for people who are both obese AND smoke).

Two recent studies published in the journal Obesity reveal some disturbing and disappointing facts regarding the physician-patient relationship for the overweight or obese patient.

The first study, which followed over 200 patients from close to 40 primary care centers, showed that physicians had less rapport with patients who were overweight or obese.

The second study followed over 20,000 patients and showed that those who were overweight were 23% more likely to shop around for doctors (doctor-shop) whereas those who were obese were 52% more likely to doctor-shop than patients of normal weight. Even worse, this resulted in 85% more trips to the emergency room for problems that could have been addressed in the doctor’s office.

It’s well known that many physicians and other healthy care providers hold negative feelings towards overweight and obese patients, blaming them for their excess weight, and assuming that they sit all day and stuff their faces with junk food.

I think it’s time for all doctors and other people taking care of patients to realize that the first step towards helping people improve their lifestyle is to treat them as an equal with respect – to listen to their take on things. If you listen, most patients who smoke or who are obese will tell you of their many struggles to quit smoking or lose weight. Furthermore, realize that if you never smoked and were always trim, then it may be hard for you to empathize.

Hopefully, medical schools will start putting on more emphasis on the proper patient-doctor relationship, and quality of care for smokers and overweight or obese patients will improve.

- Tamir

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The health benefits of nuts

With more buzz out there regarding the benefits of healthy fats, particularly the Mediterranean diet, I wanted to devote a blog to briefly summarizing the benefits of nut consumption. Before I start, I want to issue a caveat; if you’re buying nuts, it’s best to buy them raw (dry roasted is second best). Many nuts are cooked in cheap, unhealthy, processed vegetable oils and are often heavily salted, both of which can detract from their health benefits.

Nuts are healthy

Nuts, although tending to be high in calories, pack a nice nutritional punch. They contain high amount of heart healthy fats, fiber, a bit of protein, heart and bone healthy magnesium, as well as smaller amounts of several other nutrients. Nut consumption has been linked to lower rates of heart disease, and because they don’t cause blood sugar levels to spike, they can be included in the diets of diabetics – their healthy fat content can provide satiety and help to control blood sugar levels.

Some preliminary research also suggests that nuts may lower the risk of certain cancers and help with cognitive decline, although more studies need to be done to support this claim.

Nuts are best used to replace unhealthy snacks such as chips, cookies, candy, etc. When added to an existing diet without removing any unhealthy foods, excessive nut consumption may cause some weight gain.

So next time you’re looking for a healthy snack to tide you over, go nuts and grab a handful. Together with some fresh fruit, you’ll find yourself energized and full until your next meal.

- Tamir

(Image links to source: Sheknows.com)

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Not hiring smokers?

Although 29 states have laws that prevent companies from not hiring smokers just because they smoke, the other 21 states have no such laws. It’s become quite common for employers to refuse someone a job just because they smoke, and even in cases in which they’re hired, smokers are often charged higher premiums for their health insurance. In other cases a smoker will be hired, but will be given an ultimatum to quit or face being fired.

In a recent poll, close to 2/3 of Americans oppose hiring practices that disfavor smokers; nevertheless, the reality is that in an already tough economy, smokers in several states will face a harder time finding employment.

A recent study published in the journal Tobacco Control offers some justification for the position of the companies that refuse to hire smokers. The study estimated that it costs an extra $5,816 a year to hire a smoker, even when one factors in lower pension costs due to the fact that the average smoker dies younger. Some of the costs were related to extra days missed due to sickness as well as other health costs; however, unsanctioned cigarette breaks (i.e. time spent smoking when one could be working) added significantly to the overall costs as well.

Smoking businessman

This is a double economic whammy for many smokers. Cigarettes in many states are quite expensive due to high tobacco taxes (a pack costs about $10 where I live); now, in addition, smokers may find it harder to get a job.

So if you needed yet one more reason to quit . . . .

- Tamir

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Smoking, Tanning, Poor Diet… and Prematurely Aging Skin

As we discussed in our book, smoking can increase the risk of developing wrinkles. A recent study published by Andrew Mayes, a scientist working for a skin care company, shows that in addition to smoking, excessive sun tanning and a diet low in fruits and vegetables also leads to premature skin aging.

What was mind-boggling was that in people who engaged in all three of these unhealthy behaviors, the skin aged by over 10 years compared to those who didn’t smoke, didn’t excessively tan, and ate plenty of fruits and vegetables.

The study followed close to 600 women for 8 years, and asked different questions regarding skin and health habits. Using digital imaging, they were able to estimate how much someone’s skin aged over the study period.

Prematurely aging skin

So, if you aren’t too concerned about getting a heart attack or cancer, then perhaps looking much older may convince you to quit smoking, eat your fruits and veggies, and not worship the sun. Hopefully, in addition to looking good, other health benefits will follow.

- Tamir

(Image links back to source.)

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Elliptical trainer benefits

Let me preface this post by stating that I have no commercial link to any manufacturer or distributor of elliptical trainers.

Over the years, I’ve tried many different exercise machines for a cardiovascular workout: treadmills, exercise bicycles, step machines, and rowing machines. I’ve generally found treadmills and rowing machines to provide the best workouts, but recently, after purchasing an elliptical trainer, I now have a new favorite machine for several reasons:

1. Easy on the joints. I’ve found the elliptical machine to be much easier and smoother on the joints. Having participated in many sports over the years (and having gotten into several mishaps – including falling out of a two-story window onto concrete as a child), I’ve broken many bones and sustained many injuries. Although I’m by no means limited in my day-to-day activities, I do find running harder due to having broken my ankle and injured my knee years ago. I’ve gone up to 90+ minutes on the elliptical trainer without any joint pain whatsoever.

2. Less noise. The elliptical trainer is for the most part quite quiet, especially when compared to the treadmill and rowing machine.

3. Great variety in the workout. Although with the treadmill you can increase the grade and the speed, on the elliptical trainer, you can increase the grade and resistance; in terms of speed, you decide – you can go as fast as you want. In addition, you can do the motion backwards, which targets the leg and hip muscles differently.

4. Upper body workout. Unlike the treadmill, on the elliptical trainer, you can use your upper body muscles (arms, back, chest) to assist you. This provides a great all around workout. I seem to notice that with the forward motions, the pushing muscles are strained more, whereas backwards motions give the pulling muscles more of a workout.

The one caveat I have is to get a high-end machine. The very cheap ones produce jerky movements which are hard on the knees – furthermore, the upper body workout is not as good, and the grading and resistance options are quite limited. Even though a high end machine can run anywhere from $800 to a few thousand dollars, if you wait for a sale or offer to purchase the floor model you can often end up with a bargain.

Though you can of course get a great workout without the use of machines, if you’d like to use a machine at home or at a gym, a high-quality elliptical trainer can give you many benefits.

- Tamir

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There is nothing new under the sun

In the Book of Ecclesiastes, King Solomon states, “What has been is what will be, and what has been done is what will be done, and there is nothing new under the sun.” No, this blog post is not meant as a Bible lesson (I’m hardly qualified to do that). However, the more years I practice medicine, the more I realize how true this statement is.

We’re living in a very rapidly evolving society. The Internet, smart phones, advanced medical technology, instant access to information, etc. etc. are things that only a couple of generations ago would have been considered pure science fiction. We are constantly bombarded with new products, including those pertaining to the improvement of our health. Every year produces new medicines for different chronic diseases, new nutritional supplements, new fitness programs and fads.

Yet, when one pauses and reflects at the summation of human health, it still boils down to the same handful of things that have held true since the beginning of time. A healthy diet including avoidance of overeating, regular exercise plus being physically active during the day, sufficient sleep, relaxation and stress reduction, and avoiding high-risk sexual behaviors, are all still the cornerstone of living a long and healthy life. Due to the fact that we’re a “quick fix” type of society, and one that’s into the latest fads, we’re often quick to discard the wisdom and common sense that has been passed to us over thousands of years.

For example, I frequently see patients at my clinic who spend hundreds to thousands of dollars a year on the latest vitamins and supplements hawked on TV, most of which have little to no evidence to back them up; at the same time, they don’t engage in any exercise, don’t sleep enough, and often eat mediocre to poor diets.

I have patients who year after year come to me to check their sugar, cholesterol, and blood pressure. Every year some or all of them are high. Yet they continue to consume a poor diet and not move. But somehow, they feel that by “checking things out” through the many wonderful medical tests out there, they’re somehow on top of their health.

Even worse are examples of patients I’ve seen who undergo potentially harmful tests such as full body CT scans (which deliver as much radiation as >2,000 chest X-rays) to check for hidden tumors, yet continue to smoke, or those who subject their bodies to such wonderful unproven therapies as coffee enemas (I’ve had two such patients).

At the end of the day, forget all of the fancy stuff flashed in front of your face 24/7. Forget that new weight loss supplement. Forget that antioxidant pill from some distant jungle which will prevent every disease in the book. Forget that new fad diet. Stick to the basics. Exercise every day. Stay active. Eat a healthy diet. Reduce your stress levels. Quit smoking. Get a good night’s sleep. Take charge of your health through common sense, proven methods. Because at the end of the day . . . there is nothing new under the sun.

- Tamir

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Are you overweight or obese? What waist to height ratios can tell you

For many decades, the health care field has been using a measurement known as the Body Mass Index (BMI) to determine if someone is obese. This measurement is based on a person’s height and weight: specifically, BMI = weight (kilograms)/height (meters) squared. A normal BMI is 18.5 – 25. 25-30 is overweight, 30-40 is obese, and over 40 is morbidly obese. Less than 18.5 is considered underweight.

The big problem with the BMI is that it doesn’t take into account what we call body composition. For example, if I brought someone into the room who’s 5 ft 10 inches tall and weighs 210 pounds, he’d be classified as obese (BMI of 30.1). However, what if I told you that he’s a professional boxer with zero fat on his waist, and big strong arms, legs, shoulders, chest, and back muscles? Would you still consider him obese? Of course not. But the fact that he’s muscular automatically pushes him into the obese category simply because the BMI is based purely on height and weight, not factoring in how much muscle and fat a person has.

On the flip side, I am sure that you’ve seen people who have very little muscle (thin arms, thin legs, thin chest), but have a pot belly. Many of them fall into a normal BMI category.

Furthermore, BMI for many people is too abstract. That’s because we’re used to judging our own weight by the number that appears on our bathroom scale, the size of the clothes we buy, etc. 26.7 simply does not mean as much as 180 pounds, a 36 inch waist, or a size 8 dress.

For several years now, an alternate measure of obesity known as the waist to height ratio has been proposed to replace BMI. The logic behind it is that most of the illnesses that we attribute to obesity such as diabetes, heart disease, and certain cancer, have to do with how much abdominal fat we carry, i.e. our waist size rather than on our weight per se.

Waist to height ratio measurements

A waist to height ratio is also quite simple to calculate, even in one’s head. Basically, you measure your waist size by using a tape measure at the level of your navel, and divide it by your height. So for someone who has a 36 inch waist and is 72 inches tall, his waist to height measurement would be 0.5. Easy enough? Based on recent research, a person’s goal waist to height number should be 0.5 or less.

Specifically, in a study presented at the European Congress on Obesity, the researchers looked at waist to height ratios of thousands of men and women over twenty years, and came up with the following conclusions:

For men, a waist to height ratio of 0.6 led to 1.7 fewer years of life compared with those whose number was 0.5. A number of 0.7 led on average to 7.2 years of lost life, and a number of 0.8 led to 16.7 fewer years of life! For women, the numbers were 1.5, 4.8, and 9.5 fewer years of life with ratios of 0.6, 0.7, and 0.8 respectively.

These are quite impressive numbers; indeed, for the group with a waist to height ratio of 0.8 the number of years lost were the same or even exceeded that seen in heavy smokers.

So, if you’re making the effort to get into shape, don’t worry so much about the weight itself (indeed, if you’re regularly exercising you may develop larger muscles which may offset some of the weight loss); instead work on ridding yourself of that spare tire.

- Tamir

(Image links back to source: PressTV)

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Rheumatoid Arthritis and Smoking: Recent Research

As if people need yet another reason to quit smoking… as if heart attacks, strokes, emphysema, and various cancers aren’t reason enough, a recent study from the journal Arthritis Research and Therapy showed a significantly increased risk of developing rheumatoid arthritis (RA) in middle aged to older women who smoke.

What was remarkable about this study was that even light smokers (1 to 7 cigarettes a day) had over double the risk of developing RA compared to lifelong nonsmokers. Another disturbing finding was that even 15 years after quitting smoking, the risk was still about double that of a nonsmoker (although it is worth noting that the risk did slowly decrease over time; people who had quit smoking 15 years before had a 30% less chance of developing RA compared to those who quit the year before).

Hands afflicted with rheumatoid arthritis

What is RA? In RA, the immune system becomes “confused” and attacks the joints, destroying them, and causing deformity. In addition, many other parts of the body such as the heart, lungs, eyes, and blood vessels can also be damaged. Fortunately, there are effective treatments today for RA, but they involve long-term use of medications which potentially have side effects.

- Tamir

(Image credit: University of Rochester Medical Center)

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Hookah Research Results

The vast amount of research on smoking has been done on the harms of cigarettes, presumably because they’re the most common form of tobacco use and probably the most harmful. Recently, hookahs have become more popular, especially amongst college age people. In addition, in the Middle East and other parts of the world, hookahs are very popular. Some people are under the impression that hookahs are a safe alternative to cigarettes. They believe that the water filters out a lot of the harmful chemicals in hookahs and that whatever the water doesn’t get, the charcoal will get rid of.

Blue glass hookah

Unfortunately, there aren’t too many studies done on the health effects of hookahs. Although it’s generally agreed that the volume of smoke per hookah session is quite high (in fact, one 40 minute session can result in inhaling as much smoke as dozens upon dozens of cigarettes), the fact that the tobacco is not heated to as high of a temperature as in a cigarette may result in a lower amount of exposure to toxic compounds.

A recent study in Cancer Epidemiology, Biomarkers & Prevention compared the amount of nicotine and various carcinogens inhaled via hookah versus cigarettes, and found that while those who used hookahs had significantly less exposure to nicotine and certain carcinogens, levels of carbon monoxide and carcinogens such as benzene were higher. Benzene exposure for example is linked to the development of leukemia.

The study didn’t measure hard outcomes (i.e. it didn’t compare rates of cancer, heart disease, etc. between hookah users to those that smoke cigarettes). In fact, there aren’t any good, long-term head to head studies addressing this.

A 2010 review from the International Journal of Epidemiology did show that hookah smokers had more than double the risk of developing lung cancer, respiratory infections, and low birth weight babies, and 3 to 5 times the risk of having periodontal disease compared with nonsmokers. Of note, risks of throat and bladder cancers were not higher (which is the case in cigarette users).

The bottom line is that at this time, it’s unclear if hookah smoking is any better than smoking cigarettes. And even if it is, it certainly isn’t a safe habit, exposing the body to many harmful substances and increasing the risk of developing lung cancer and other diseases.

So if you do currently smoke a hookah as a safe alternative to cigarettes, quit, and take up a healthier habit (join a gym, play sports, take up gardening etc.)

- Tamir

(Image credit: Psych Central)

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Varenicline Update

Let me preface this post by stating that I have no financial or commercial ties to the manufacturer of Varenicline. This is written purely for the benefit of anyone who’s trying to quit and wants to know more about the different options out there.

Varenicline (otherwise known as Chantix in the United States and Champix in several other countries) remains one of the main medications that we use to help people quit smoking. A couple of years ago, questions were raised regarding a possible increased risk of heart attacks amongst users of Varenicline, based on a study in the Canadian Medical Journal.

Subsequently, the FDA issued a warning stating that Varenicline may be associated with a small risk of heart attacks in those who have heart disease.

In our book, I mentioned that due to the possible increased risk of heart attacks, I tended to shy away from using Varenicline in people with established heart disease.

Since then, more recent data from 2 separate studies published in the British Medical Journal,

1) Svanström et al (2012)

2) Prochaska & Hilton (2012)

did NOT show any significant association between the use of Varenicline and heart disease (although it’s worth noting that the study by Prochaska and Hilton did show a trend towards increased risk, though it didn’t reach statistical significance – which means that the small increased risk may have been due to chance). Furthermore, several people criticized the methodology of the original study condemning Varenicline.

So, where does this leave us? Varenicline probably doesn’t significantly increase the risk of heart attacks, even in those with heart disease. However, it’s impossible at this time to 100% exclude such a risk. On the other hand, MANY people who smoke will end up having a heart attack, and quitting smoking is probably the single best thing they can do to decrease their risk of having a heart attack. Therefore, if I have a smoker with heart disease who wants to quit smoking, in most cases I will probably offer other options first, but when push comes to shove, if Varenicline is the only thing that works, or if it has worked well for the patient during past quit attempts, then I have no problem offering it to them after a discussion of the risks and benefits.

One final note. In our book, I mentioned that Varenicline is associated with gastrointestinal side effects such as nausea, and that it does run a small risk of having people become depressed or even suicidal (which I haven’t yet witnessed personally, but there are such reports in the medical literature and the FDA does have an official warning regarding this issue). One other side effect which I neglected to mention in the book (due to an oversight) was the possible risk of insomnia and abnormal dreams, neither of which are per se dangerous, but are obviously quite distressing.

- Tamir

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