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Category Archives: General Health

What smoking does to our lungs – in graphic detail

All of you are aware that smoking damages most of the body, especially the lungs. An experiment loaded to the Internet by Devon Arbelo graphically depicts that damage.

On one side are a set of healthy pinkish lungs from a nonsmoker. As air is introduced, the lungs expand very nicely. On the other side are the blackened lungs from a long-time smoker. First of all, the color itself is off-putting. Secondly, you can see how poorly these lungs expand compared to the lungs from the nonsmoker.

At the bottom of the article are pictures of lungs posted by Ryan Au, a Hong Kong teacher. Again, you can see the color difference between the pink lungs from the nonsmoker compared to the brownish lungs from the smoker. What’s disturbing is that the brown lungs took on this appearance after only 60 cigarettes.

So next time you light up, form a mental image of the video clip and the photos from the above article.


A lifetime of bad choices condensed into less than two minutes

Most of us know that smoking, eating junk food, and avoiding physical activity are all bad for our health. The problem is that each individual cigarette, cookie, or hour on the couch watching TV causes very limited damage – so much so that we barely think about it.

How many of you plan to quit smoking at some future point? How many of you plan to join the gym in the near future? How many of you plan to start a healthy diet next week, after your birthday? We often have some vague future notion of cleaning up our act. However, because we don’t experience the damage being caused to our body at the present time, we often procrastinate or avoid making any changes.

Even when we do try, we often quit too soon; we only see infinitesimal benefits from one day to the next for the maximal effort that we’re exerting, and we feel discouraged. How many of you have quit the gym or returned to a junky diet because the weight loss slowed down drastically? How many of you returned to smoking because you were feeling stressed out and irritable after quitting? I know, I know. There’s always next year.

Rewind the Future

I recently came across a brilliant video entitled “Rewind the Future.” Put out by a group targeting childhood obesity, the video starts off with an obese 32 year old man in the hospital in the midst of a heart attack, and works its way back through his life, showing clips of poor choices such as eating fast food, etc all the way back to when he was a baby being fed french fries by his mother to keep him quiet.

Although the main point of this powerful presentation is to show parents how the poor food choices that they make for their kids leads them to be unhealthy adults, I believe that we can apply this video to other poor choices that we make.

Imagine for a minute, a future you lying on the operating table about to have a large cancerous mass removed from your lungs. Now rewind back through the years to different mental images of you smoking all the way back to that first cigarette.

Similarly, if poor food choices, lack of exercise, or obesity are your main issues, then you can pretty much use the imagery from the video, substituting a future you for the actor.

This video allows us to visualize the ultimate consequences of our poor habits, something that as I mentioned above, is hard to do in the here and now.

– Tamir


A Lesson from the CARDIA Study

It’s not too late . . .

Let’s face it. Most young people don’t lead such healthy lifestyles. Due to a variety of factors, they’re more likely to smoke, overindulge in unhealthy food and alcohol (think of your college days), and often don’t exercise much. The prevalence of obesity among young people has also hit all time highs in many countries.

Healthy life choice

Each of these unhealthy behaviors alone damages the body, in particular the heart. In fact, unhealthy lifestyle choices synergistically cause blockages in the main blood vessels supplying blood to the heart. Fortunately, in most cases it takes decades for significant heart disease to develop. That means that we have ample opportunity to get our acts together.

That’s exactly what the Coronary Artery Risk Development in Young Adults (CARDIA) study published in Circulation set out to prove. CARDIA study researchers followed over 3500 young adults (age 18-30) over 20 years. At baseline, fewer than 10% of the study participants were keeping all 5 healthy lifestyle behaviors mentioned above (not smoking, not drinking too much alcohol, exercising, keeping a healthy diet, and keeping a healthy weight). At the end of the study, roughly 25% of the participants added at least one healthy lifestyle factor; unfortunately 40% kept fewer.

The good news for those who did improve was that for each healthy factor that was added, the risk of calcification in the blood vessels supplying the heart (which is a good predictor of heart disease) decreased by 15%. Conversely, each decrease in healthy lifestyle behaviors increased the risk of heart disease by 17%.

The bottom line is that if you’re young, even if you haven’t been living the healthiest life until now, it isn’t too late to change things around. Even making small changes can yield great benefits. On the flip side, if you used to be slim, more active, and eat a healthier diet, but have strayed over the years, then you should realize that real damage is being done and try to turn things around.

– Tamir

(Image links to source, under this license.)


Sunbathing and mortality: Weighing different risks

Most of us have been taught to avoid the sun due to concerns over skin cancer. UV radiation from the sun can indeed cause damage to the skin, which down the line can lead to skin cancer.

Types of skin cancer

The most common skin cancers, basal and squamous cell carcinomas, are, for the most part, unlikely to kill someone. Due to their intrinsic characteristics, and due to the fact that they cause unsightly skin lesions which prompt treatment, they are unlikely to progress to a point at which they spread throughout the body and become deadly. On the other hand, melanoma, a third type of skin cancer, CAN be deadly and spread throughout the body. Furthermore, melanoma often starts as a small abnormal mole which many people can miss or pay little attention to.

But what about too little sunlight?

Lack of sunlight leads to deficiency in vitamin D. It’s quite hard to obtain vitamin D solely through diet since it isn’t found in any significant amount in most foods. Sunlight and supplements are pretty much the only way to obtain enough.

Low vitamin D levels may increase the risk of dying from heart attacks, strokes, and certain cancers, including . . . melanoma. I know this sounds odd, but it seems that sunburns/too much sun exposure increases the risk of a less aggressive form of melanoma whereas low vitamin D levels increase the risk of the more aggressive type.

A recent study published in the Journal of Internal Medicine lends further credence to the idea that some sun exposure is quite healthy. The study followed close to 30,000 women aged 25-64 for over 20 years, and found that those women who avoided the sun had approximately DOUBLE the risk of dying compared to those who had the highest sun exposure. Furthermore, with the exception of women who used tanning beds, the risk of developing melanoma or dying from it was not higher in the sun exposure group, presumably because of what I stated above that lack of sunlight (leading to low vitamin D levels) increases the risk of more aggressive types of melanoma.

The bottom line

I am NOT suggesting based on this study to go lie down on the beach all day and get burnt to a crisp. However, being deathly afraid of every little ray of sun and walking around slathered in sun tan lotion with a large brimmed hat for every short outdoor excursion seems harmful to one’s health.

There is no way for me to tell you exactly how much sun exposure is ideal. That is based on how dark your skin is and how powerful the sun’s rays are based on where you live and what time of the year and day it is. A simple way of gauging whether or not you are overdoing it is sunburn. If you are frequently getting sunburned then you are overdoing it and running the risk of skin cancer. However, if your skin gets a little color, then you probably hit the nail on the head.

One last note – in the winter in some areas of the world it is virtually impossible to have enough sun exposure to make adequate vitamin D levels. So it’s probably a good idea to take supplements. This also hold true for those of you who are never in the sun.

– Tamir


The myth of healthy obesity

There’s a prevalent misconception out there that a person can be obese and healthy. While it’s certainly true that obese people who exercise regularly, avoid smoking, and eat a healthy diet can decrease their risk of developing many different diseases, obesity in and of itself is not a healthy condition.

A recent study published in the Journal of the American College of Cardiology looked at plaque build-up in the coronary arteries (the blood vessels supplying blood to the heart) of approximately 15,000 people ages 30 to 59; they didn’t have any known health problems.

The study authors used a method known as the coronary artery calcium score in which a special scan of the chest measures the amount of calcium deposited in the coronary arteries. This directly correlates with the amount of artery-clogging plaque in the vessel and is a pretty good predictor of future risk of heart disease.

The study found that those patients who were obese had significantly more plaque in their vessels than those of normal weight, despite having no known diseases that increase the risk of heart disease (e.g. diabetes).

The take home message is that if you’re obese, then even if you’ve undertaken several healthy lifestyle changes, it’s still worth it to make the extra effort to lose excess body fat. Abdominal fat in particular is related to most of the diseases linked to obesity.

On the flip side, if you’re of normal weight, it’s still worth it to work out, quit smoking, and adopt a healthier diet since many other studies have shown that not moving, smoking, and eating poorly destroy one’s health.

– Tamir


Quick weight loss tips

I recently came across the following article, which has over a dozen quick tips to help us to lose weight. You can click on the link for the full article. Below I highlight some of the quick weight loss tips that I found most interesting.

  1. Eat with your non-dominant hand – a study in moviegoers showed that those who ate with their non-dominant hand (in most people their left hand) consumed half as much popcorn as those eating with their dominant hands.
  2. Get enough sleep – those with the least amount of sleep had increased levels of a hormone that causes hunger and decreased levels of a hormone that causes satiety
  3. Use olive oil instead of butter with bread – researchers found that those using olive oil ended up consuming less bread and calories overall. Furthermore, olive oil, especially extra virgin, is probably healthier than butter.
  4. Chew each mouthful – a Japanese study found that fast eaters on average weighed 15 ½ pounds more than people who eat slowly. When study participants were asked to chew each mouthful 15-20 times, they ended up consuming significantly fewer calories.
  5. Clench your fists for 30 seconds – this has been shown to reduce food cravings and prevent temptation to indulge.
  6. Eat in a quiet restaurant – eating in loud, noisy places causes our heart rate and blood pressure to increase which leads to us eating more and drinking more alcohol.
  7. Don’t shop hungry – people who shop hungry tend to buy too much high calorie, high sugar, high fat food.
  8. Compounds in chili peppers, cayenne pepper, jalapeno peppers, olive oil, and apple peels may help boost weight loss.



E-cigarette Poisoning

The jury is still out as to what role (if any) e-cigarettes have in smoking cessation. However, it’s clear that their use has skyrocketed in the past few years. With the increased use, a new problem has surfaced – nicotine poisoning.

E-cigarettes contain liquid nicotine, which can be ingested. (Of course inhalation can also result in poisoning.) In 2010 it was rare to have a case of nicotine poisoning from e-cigarettes. Most cases were from accidental ingestion of cigarettes by children. Today, over 40% of the cases are caused by e-cigarettes with more than half the cases occurring in children under 5. Since e-cigarettes come in different shapes and colors, they can often seem appealing to little kids.

Symptoms of nicotine poisoning include nausea, vomiting, malaise, headache, rapid heart rate, elevated blood pressure, and sweats, but in severe cases can result in seizures and even death.

So if you’re currently using e-cigarettes, especially if you have children, keep them in a secure location. Better yet, quit altogether. There’s still no good evidence that they help people quit smoking.

– 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


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