An essential health resource for current and former smokers - An essential health resource for current and former smokers

Consuming too little salt: How recent research disputes current guidelines

Too little salt also isn't good

Many of the current health guidelines stress limiting the intake of salt (referred to as sodium on nutrition labels) as a means of reducing adverse health outcomes, particularly strokes and heart attacks. The current guidelines in the US recommend limiting salt intake to less than 2,300 mg of sodium a day and less than 1,500 mg in high-risk individuals.

However, recent research, including a large study published in the American Journal of Hypertension, disputes these findings.

The study authors looked at data from over two dozen studies investigating salt intake and mortality, especially from heart disease. Data included over 250,000 people, both healthy and with underlying diseases. What they found was that people who consumed the least amount of sodium (less than 2,645 mg daily) as well as the most (over 4,945 mg), had higher rates of mortality and cardiovascular disease by roughly 10-15%.

What does this mean for us? It so happens that for the most part, the saltiest foods are ones that are processed and unhealthy anyway. These include canned foods and soups, instant meals, chips, many breads, cured meats, etc. One way you can tell is by looking at the nutrition labels. Any food that has more than 150-200 mg of sodium per serving is on the high side (note that some canned soups can have up to 1,000mg!). By cutting down on processed foods, which are anyway unhealthy, you automatically reduce excess salt in your diet. After that, if you like to add a pinch of salt here and there, it’s unlikely to be a big deal.

The only caveat I have is for people with certain medical problems such as heart failure or kidney disease. They should follow the advice of their doctors and nutritionists.

- Tamir


Smoking damages sense of taste

Photo by Sarah Gordon of one of the Bloomington, Indiana brains

By now, most people know about the well-publicized harmful effects of smoking such as heart disease, cancer, and strokes. However, there are many “quality of life” problems that smokers suffer. They tend to be more short of breath. They tend to catch more respiratory infections. Their teeth tend to be yellow. They don’t tend to smell too good. They’re more prone to wrinkles.

A new study published in Chemosensory Perception shows smoking also affects how we taste food.

The authors performed taste tests on hundreds of volunteers comprised of smokers, ex-smokers, and non-smokers. The volunteers were given small amounts of salt, sugar, vinegar, and caffeine to test their ability to detect salty, sweet, sour, and bitter tastes respectively. While there were no pronounced differences between smokers and nonsmokers with respect to salty, sweet, and sour, smokers were twice as likely as non-smokers to not recognize bitter correctly (26.5% versus 13%). What was disturbing was that among ex-smokers, close to 20% still mislabeled the bitter group, suggesting that smoking might permanently damage your sense of taste. This would depend on how long and how much you’ve smoked before quitting.

So if you currently smoke and aren’t too worried about having a heart attack or cancer later in life, perhaps permanently damaging your sense of taste might be a motivator to quit. After all, I know that many of you who enjoy that morning cigarette, enjoy it with your morning coffee – precisely the type of beverage whose bitter taste gets affected by smoking.

- Tamir

(Image links to source.)


The link between waist circumference and disease

Waist circumference

In much of the medical world, obesity is defined by a calculation known as the Body Mass Index (BMI). BMI = one’s mass in kilograms divided by one’s height in meters squared. Basically, a BMI of 25 to 30 is considered overweight, 30 to 40 is obese, and 40+ is morbidly obese.

Although BMI is a decent measure of obesity, it can be misleading in many people who are either muscular with very little body fat, or in those with very little muscle mass and a pot belly. In the former category, which applies to many athletes, a person would be considered obese despite having minimal body fat due to the weight of his or her musculature. In the second group, a person would technically fall into a normal BMI range despite having a gut; this is due to them having very little muscle mass.

Therefore, a somewhat better indicator of obesity would be waist circumference. Indeed, a recent study from Mayo Clinic Proceedings shows that across a wide range of BMIs (20 to 50), both men and women with the largest waists had a significantly higher risk of dying younger mainly from heart disease, lung disorders, and cancer than those with small waists. The authors of the study pooled data on over 600,000 people from multiple studies covering an average of 9 years of follow up.

Men with a waist circumference of 43 inches or higher had an over 50% higher death rate than men with waists of under 35 inches. This translated to a life expectancy of 3 fewer years. Women with a waist circumference of 37 inches or more had 80%!! higher risk of death compared to those with a waist under 27 inches, translating to 5 fewer years of life.

We now know that it’s belly fat per se that’s linked to heart disease, diabetes, certain cancers, etc. Waist circumference is also a simple goal to reach for, and something that most people can easily grasp and visualize, unlike BMI which we equate with grade school math. Furthermore, those of you who are thin but have a pot belly still run many of the same health risks as heavier people despite having a normal BMI.

- Tamir


April 2014 Workout of the Month

Once again, here are 2 sample exercise programs – one more strenuous, one less strenuous. The workouts can be done as a stand alone program, or can be incorporated into an existing workout program. They are meant to be simple, requiring your own bodyweight or very basic equipment, but are comprehensive in that they cover most of the muscle groups and provide both strength and aerobic benefits.

Before you undergo any new exercise program with the exception of light walking, get clearance from your physician. This is especially true if you are over 35, have a family history of heart disease or sudden death at a young age, smoke, or have other medical problems such as heart disease, diabetes, high blood pressure, arthritis, back pain, neck pain, knee pain, shoulder pain, etc.

Any exercise that you are not sure how to do seek guidance from an experienced person or trainer. You can look up any exercise on YouTube, etc. If any exercise feels wrong to you or is causing sharp pain, then do not do it. If I don’t mention a specific number of repetitions, then do as many as you can comfortably without excessively straining. Try to increase the number of repetitions every week by 2. If lifting weights, increase the weight by 2-10 pounds depending on the exercise and your level of fitness.

Program #1 (more strenuous)

Days 1,3,5

  1. Kettlebell swings – 3 sets of 12-15 repetitions with one minute rest in between
  2. Kettelbell Clean and Presses – 3 sets of 8-10 repetitions with one minute rest in between
  3. Barbell Lunges – 3 sets of 20 repetitions with one minute rest in between
  4. 8 count bodybuilders – 3 sets with a minute rest in between
  5. Hill Sprints or Wind Sprints – 8 sets

Days 2,4,6

  1. Inclined Push-ups – 5 sets alternated with 5 sets of Jackknife sit-ups. No rest in between exercises
  2. Jumping Squats – 5 sets alternated with 5 sets of Pull-ups. No rest in between sets
  3. Straight Punches – 5 sets alternated with 5 sets of Straight Kicks. No rest in between
  4. Plyometric Push-ups – 3 sets alternated with 3 sets Plyometric Push-ups
  5. Wrestler’s Back Bridge – 2 sets alternated with Wrestler’s Front Bridge

Day 7 – walking or rest

Program #2 (less strenuous)

Days 1,3,5

  1. Neck Resistance Exercise (4 directions) – 2 sets with a minute rest in between
  2. Supported Bodyweight Squats – 3 sets with a minute rest in between
  3. Half Push-ups – 3 sets with a minute rest in between
  4. Calf Raises – 3 sets with a minute rest in between
  5. Overhead Arm Raises using light dumbbells – 3 sets with a minute rest in between
  6. Dumbbell Alternate Curls – 3 sets of 12 with a minute rest in between
  7. 15 minutes of brisk walking

Days 2,4,6

  1. Jumping Jacks – 5 sets with a minute rest in between
  2. Superman exercise – 2 sets with a minute rest in between
  3. Twisting Curls – 3 sets with a minute rest between
  4. Dumbbell Rows – 3 sets of 10 with a minute rest in between
  5. Dumbbell Flyes – 3 sets of 10 with a minute rest in between
  6. Knee-ups – 3 sets with a minute rest in between
  7. 15 minutes of jogging

Day 7 – walking or rest


- Tamir


Breast Cancer and Physical Activity: Recent Research

In our book and blog, we repeatedly stress the benefits of exercise and physical activity in general. Unfortunately, many people still associate working out simply with losing weight, not realizing its other multiple health benefits. What ends up happening is that people who are naturally thin or of normal weight, and can stay that way without much effort, become lax about incorporating physical activity into their lives. They figure, “I’m thin anyway, why sweat at the gym.”

It turns out that – even if they’re thin – people who don’t move are damaging their bodies. Research links lack of physical activity to a high risk of dying young, suffering a heart attack, stroke, diabetes, colon cancer, and having a weaker immune system. New evidence adds breast cancer to the growing list of diseases potentially caused by being sedentary.

Breast cancer physical activity

A recent study presented at the 2014 International Conference on Obesity questioned close to 20,000 women (average age of 56) about their physical activity levels. 13 years later, they touched base with the participants to check on their overall health. 900 of the women had died during that time. The researchers found that the women who reported the lowest level of physical activity were 40% more likely to have developed breast cancer, irrespective of weight.

Unfortunately, being obese also increased one’s chances of developing breast cancer by close to 60%. The take home message is that if you’re an obese woman, incorporating physical activity into a healthy lifestyle is essential. But even for women who are already of normal weight, resting on your laurels isn’t a great idea either. It’s increasingly apparent that there’s virtually no one on this planet who would not benefit from moving.

- Tamir

(Image links to source.)


How Can Smelling Fresh Fruit Help You Eat a Healthier Diet?

Fruit display

Sticking to a healthy diet can be difficult, so it’s good to have some aces up your sleeve.

Two new studies published in the journal Appetite show some neat little tricks you can use to help you choose healthy fare.

The first study split 115 people ages 18 to 50 into two groups. All test subjects were given some made-up purpose for being in the study. One group was told to wait in a room that was sprayed to smell like fresh fruit while the other group was told to wait in a similar room but without the fruity odor.

Afterwards, all participants were taken to another room and told to pick an appetizer, main course, and dessert from a set menu. Each course had a healthy choice and an unhealthy choice. The group that had waited in the room that smelled of fresh fruit were much more likely to choose the healthy dessert than the group from the unscented room (50% vs. 75%).

The second study looked at how food is presented. Diners at a restaurant on two different nights were offered an identical healthy meal; the only difference being how it was presented on the plate. More diners judged the meal as being tasty when the presentation was neat and appealing.

The take home message from both studies is that incorporating small changes/ideas can help you continue making healthy choices. It’s well-known that olfactory and visual stimuli affect what we eat and crave. Who hasn’t walked by a bakery, smelled the wonderful aromas, looked at the delicious baked goods in the display case, and not had a craving to run inside and buy something? By trying similar things with healthy foods (smell a fresh apple or orange before going out to eat, make your meals look vibrant and appetizing), you increase the odds of maintaining good eating habits.

- Tamir


Are e-cigarettes encouraging teenagers to smoke?

As many of you are aware, e-cigarettes are becoming more and more popular. Celebrities have been seen smoking them, and they’re touted as a cool and safe alternative to regular cigarettes.

e-cigarette image

Almost everyone would agree that if it came down to smoking a regular cigarette or an e-cigarette, the e-cigarette would probably be safer. The big controversy exists due to the idea that e-cigarettes encourage teens and young adults who never would have smoked to start using them. Once hooked on the nicotine from the e-cigarettes, many go on to smoke regular cigarettes. This is especially true since there’s an eerie similarity between how cigarettes were marketed back in the 1950s and 1960s to how companies heavily market e-cigarettes today to the young population. E-cigarettes come in different flavors, shapes, styles, etc.

A new study from JAMA Pediatrics seems to confirm the fears that e-cigarettes are acting as a bridge to regular cigarettes.

The study surveyed around 40,000 teens in 2011 and 2012, and found many disconcerting results. First of all, amongst teens who were experimental smokers, those who had ever used e-cigarettes were roughly 6 times more likely to have ever been smokers (defined as smoking >100 cigarettes) as well as over 6 times as likely to be current smokers compared to those who had not used e-cigarettes. Amongst current e-cigarette users, the rates were even higher – 7.4 times the risk of ever having smoked regular cigarettes, and close to 8 times the risk of currently smoking cigarettes. Finally, for those who were current smokers, current or past e-cigarette use made it much less likely that they would abstain from smoking over the next 30 days, 6 months, and a year (up to 90% less likely!).

The only possible positive spin was that current smokers who had ever used e-cigarettes were about 50% more likely to intend to quit over the next year. However, as the above data shows, most were unable to quit.

The bottom line is that e-cigarettes seem more and more to be a wolf in sheep’s clothing. Although “fun” and “safe” on the surface, it seems that the sum of the evidence is that they are getting young people addicted to nicotine and down the line to regular cigarettes.

- Tamir


In denial

A common reaction I see when interacting with patients is denial. Let’s use a a couple of examples from my practice to drive home the point. (Names and other identifying features have obviously been changed to protect the identities of the patients.)

Case 1:

John, a pleasant 60ish year old gentleman, has been smoking up to 4 packs of cigarettes a day for decades. He was diagnosed with emphysema (a condition in which the parts of the lungs that help absorb oxygen are basically destroyed, causing shortness of breath) a few years ago, which caused him to cut down to roughly 3 packs per day. As you can imagine, emphysema is not his only medical problem. He’s chronically short of breath, fatigued, and forever catching respiratory infections. Yet in spite of it all, he refuses to acknowledge cigarettes as the top cause of his many ailments. Instead he’ll blame stress, or his diet, or side effects of medications. Sometimes he’ll simply question why we can’t find a cause for his poor health. I’ve tried to convince him to quit several times, but he’s concerned about the possible side effects of the various smoking cessation medications (as if smoking multiple packs a day is safer than any possible side effect of a medication). At the end of the day he’ll quip, “Yeah, yeah, I know I have to quit . . . but let’s get back to what’s going on with me. Why can’t I breathe well? Why am I so tired?”

Case 2:

Stacey, a bubbly 35-year-old lady, weighs in the vicinity of 280 pounds at a height of 5 feet 2 inches. She suffers from sleep apnea (a condition in which the airway becomes blocked throughout the night, causing the breathing to transiently stop or slow down – long term this damages the heart and lungs and can cause people to feel fatigued and wake up with headaches). She also has heartburn, knee pain and shortness of breath. Her blood sugar is on the high side, as is her cholesterol and blood pressure. Both of her parents have diabetes. Yes, she discusses losing weight in a sort of abstract manner. However, even though all of her problems are related to her weight, she always seems to blame them on other factors such as stress, a poor mattress, bad shoes, eating too much spicy food, etc.

Often, people who engage in unhealthy habits such as eating too much junk or smoking will blame the negative impact these behaviors have on their health on other, at times ridiculous, factors. Maybe admitting that their unhealthy habits are contributing to their poor health means that they’ll have to face up to the difficult decision to quit smoking or change the way they eat.

If this sounds like you, then it’s high time to take a hard look at where your life is likely headed. If you’re slowly smoking or eating your way to an early grave, then it’s better to tackle these bad habits now, even though it may be uncomfortable, rather than wait for something truly bad like cancer or a heart attack to strike.

- Tamir


Another reason to quit smoking: Your kids’ carotids

Secondhand smoke exposure is a controversial subject. On the one hand, there are those who make it out to be almost as bad as smoking (I’ve even heard people who claim that it’s worse than smoking!). On the other hand, there are those, mostly from pro-smoking groups, who completely minimize any possible danger from secondhand smoke.

The truth is somewhere in between. There’s no doubt that secondhand smoke is nowhere near as harmful to one’s health as actual smoking. However, there are studies that link it to several adverse health outcomes.

A recent study published in the European Heart Journal checked the thickness of the carotid arteries (the main blood vessel supplying blood to the brain) in over 2,000 people. Thicker vessels mean that they’re more diseased with unhealthy plaque that’s clogging them; it’s also a marker for blood vessel health in the rest of the body, including the vessels that supply blood to the heart.

On average, people whose parents both smoked when they were children had blood vessels that were over 3 years older than their peers who grew up in nonsmoking homes. In homes with one parent smoker, the study authors were unable to discern a difference. Perhaps when only one parent is smoking, he or she goes outside or away from others who don’t enjoy the smoke; in contrast, when both parents are smoking they’re likely to both be sitting around the house, such that the children are inhaling more smoke.

Again, if you have children and smoke around them, you’re causing serious harm to their health. It’s already known that children of smokers suffer more asthma, respiratory and ear infections, and are at increased risk of Sudden Infant Death Syndrome. This study adds further damning evidence. So if you’re cool with what cigarettes are doing to you, then fine, continue to smoke. But at least do it in a way that isn’t harming your kids. Then again, even if you smoke away from your young ones, but end up dying at a young age because you smoked, that would devastate your family as well.

- Tamir


An Inspirational Story

Often, when we’re stuck in a rut, it can become really hard to see the possibility of change. Maybe you’re overweight and don’t see how you’ll ever shed the weight. Maybe you’ve tried to quit smoking multiple times without long-term success.

One way to be inspired and persist is through learning about others who have overcome obstacles to achieve success and happiness.

I came across the following story in the British website, DailyMail. You can read the article yourselves; summing it up in a couple of sentences won’t capture its essence. Basically, the take home messages are that as long as you’re alive, it’s never too late to improve; if you really want something, persist at it; and success ultimately comes down to you. Inspiration and support from other people can help, but ultimately, it’s up to you.

- Tamir