Do What You Like

Many times when I bring up the topic of a regular exercise routine with patients who don’t currently exercise (or haven’t done so in a long time), they’ll ask me, “What type of exercise should I do?” Similarly, when discussing adopting a healthier diet, a patient will often ask me, “What diet should I follow?”

As we discuss in our book, there isn’t one golden approach to a healthy lifestyle. Although there are numerous health gurus out there who push their own brand of health and exclude all others (and often their way is full of “must have” nutritional supplements and videos that can cost an arm and a leg), the reality is that by following general health principles, you can improve your own health a tremendous amount, all the while doing it in a way that’s palatable to you.

There are numerous diet and exercise programs out there: Low carb, low fat, vegetarianism, paleo diets, no sugar, no white flour, gluten free, various gimmick diets centered around shakes and supplements, etc. etc. Similarly for exercise, there’s running, weight lifting, calisthenics, sports, swimming, biking, yoga, tai chi, other forms of martial arts, dance, etc. etc.

Most programs out there have something beneficial to offer. However, as human beings, we’re all unique individuals who have our likes and dislikes. For example, broccoli is a healthy vegetable. But if I told every person out there that they must include broccoli as part of a healthy diet, I would have many people who simply couldn’t follow such a diet due to their dislike of broccoli. However, if I advised people to simply include more vegetables in their diet, I would likely have more success given the fact that most people probably enjoy, or at least tolerate, some types of vegetables.

Similarly, if I told everyone that they must go on a brisk walk for 30 minutes on most days of the week (a healthy habit indeed), I will likely have several people who eagerly comply (especially if they live in a scenic area with a temperate climate). However, there are many people out there who for various reasons (they live in a bad neighborhood where it’s unsafe to walk, it’s too cold, too rainy, or too hot to walk, they dislike walking, they have chronic foot pain), won’t walk. So when people ask me what type of exercise they should take up, I simply tell them to start doing anything that they enjoy that will make them “huff and puff” a little (I do want to briefly mention that before embarking on an exercise program more intense than light walking, people at risk for heart attacks, strokes, joint pain, etc. should be cleared by their physician).

Even in the realm of smoking cessation, there are different approaches. Forcing everyone to chew nicotine gum or to wear a patch is just not realistic.

The bottom line is to make meaningful changes that you can stick to long term. I can tell you that if you don’t enjoy something, then it probably won’t last.

I know that some of you might be thinking that you enjoy smoking, don’t enjoy any fruits or vegetables, and think that the most physical kind of activity that you’ll tolerate is flipping channels on the TV or walking to the fridge. Hey, it’s a free country, and at the end of the day you can choose to treat your body the way you want. However, what I’m suggesting is finding a happy medium in which you at least adopt some healthy lifestyle measures without spending the balance of your life waking up at 4 am for a 10 mile run followed by hours of push-ups and feasting on nothing more than alfalfa sprouts, steamed asparagus and boiled chicken (unless of course, that’s what you enjoy).

- Tamir

(Image links back to source: NBC News)

Beyond alcohol – be mindful of what you drink

Many times in my career, I’ve seen people seem to ignore the amount of calories they consume through drinks. And I am not referring to alcoholic drinks (a topic on its own).

Most people are aware that sodas are bad for them and contain a lot of sugar (which they do). However, most fruit juices, as well as sweetened regular and ice tea, fruit punch and other fruit flavored beverages, lemonade, many coffee and related drinks loaded with sugar and cream, as well as many smoothies and health shakes are often loaded with calories. These excess calories are usually from sugar, and often from a particularly unhealthy type of sugar: high fructose corn syrup.

Although an orange or an apple does have some sugar, it also has fiber, which slows down the absorption of the sugar in the body. Furthermore, one serving of fruit juice will contain the sugar from several oranges or apples without any of the fiber, causing a spike in blood sugar levels. That’s why people whose blood sugar drops too low (such as diabetics who accidentally took too much insulin or who didn’t eat enough after using insulin) are told to drink orange juice or grape juice.

Energy drinks are also quite popular today, as are sports drinks. You need only look at the multiple TV commercials of a sweaty athlete gulping down a Gatorade to understand why every weekend warrior thinks that they need to go through bottles of the stuff to “replenish electrolytes” during their 90 minute softball game. Sports drinks are little more than water, sugar, and a tiny bit of salt. Average people partaking in regular exercise do not need to chug these incessantly in order to replenish salt lost during sweating; what they obtain from drinking water and following a regular healthy diet more than suffices.

You may not be aware that adding a few sugar laden beverages a day may mean >500 calories of pure sugar – enough to derail an otherwise healthy diet or trip to the gym. If you just burned several hundred calories during a brutal workout, you may have blown it by consuming a couple of sports drinks while exercising and then treating yourself to a jumbo latte with all the fixings at Starbucks.

Most servings of sodas, lemonade, ice tea, juices, sports drinks, energy drinks, and other sweetened beverages contain around 150 calories. Some fruit smoothies, and some of the large coffee drinks in commercial coffee shops, as well as “supersized” sodas and slurpees can contain double or even triple that amount of calories.

Web MD has a nice little table showing approximate calorie counts of some common drinks.

Of note, diet drinks (i.e., those containing artificial sweeteners), although having few if any calories, have also been linked to obesity and diabetes for reasons not completely understood.

In addition, all of the above sweetened drinks, as well as diet sodas and many other diet drinks containing citric acid (a common additive which gives drinks a lemony flavor) cause tooth decay, which is another reason to avoid them.

Water is probably the best way to go. Black coffee and unsweetened black or green tea are not bad for most people; indeed they may have some health benefits. Plain seltzer is probably fine as well since it’s little more than carbonated water. Adding a squeeze of lemon to water and/or seltzer can add a little flavor for those who find these drinks too “plain.”

- Tamir

What’s the deal with coffee?

There’s a misconception out there that drinking coffee is unhealthy, almost a vice to be thrown together in the same league with smoking cigarettes, boozing, and eating junk food. In fact, several patients of mine over the years were almost embarrassed to tell me that they indulge; their sheepish grin betrayed their belief that I’m somehow disappointed by their habit.

As we mention in our book, for most people, drinking coffee probably has several health benefits, including a decreased risk of liver disease, diabetes, gout, cognitive problems such as dementia, and perhaps certain cancers.

In addition, two recent studies show additional benefits. One, which was published in the American Heart Association journal, Stroke, showed a 20% decreased risk of strokes in those who drank at least one cup a day of coffee.

The second, published in the prestigious New England Journal of Medicine last December, followed roughly 400,000 people ages 51-70 for over a decade and showed that those who drank 2 or more cups a day had a 10-12% decreased risk of dying. Interestingly, for those people who smoked, the benefits were not seen. Coffee only helped former smokers or those who had never smoked.

So is there a down side to coffee? For people prone to heartburn, it’s one of the main triggers. Furthermore, in some people it increases the risk of insomnia and heart palpitations.

The bottom line is that if you currently drink coffee and feel guilty about it, then don’t – you’re likely doing your body a favor. If you don’t already drink coffee, don’t enjoy the taste, or have heartburn or palpitations when you consume it, then don’t worry about it either. Although the scales seem to be tipped towards coffee having health benefits, what you need to focus on is eating a healthy diet, not smoking, and partaking in regular exercise, which are all much more important for one’s health.

- Tamir

The Mediterranean Diet

In our book, we devote an entire chapter to diet, discussing in detail the types of foods one should eat (and avoid) in order to prevent different diseases, including heart attacks and strokes. We encourage healthy changes in eating in the hopes of mitigating some of the deleterious effects of smoking.

Of course, it goes without saying that smoking cessation is the best way to reduce the risk of smoking-related illnesses, but a healthy diet, along with exercise and stress reduction, are quite important as well. In the diet chapter, we advise eating plenty of fresh fruits and vegetables, healthy fats (such as those found in fatty fish, nuts, olive oil, and avocados), and reducing the consumption of processed carbohydrates and unhealthy fats as some of the measures a person can take to improve his or her diet.

The diet we recommend closely resembles what is known as the Mediterranean Diet, which recommends fruits and vegetables, healthy fats, and avoidance of processed carbohydrates and unhealthy fats. There have been various studies over the years showing a number of health benefits that come from adhering to such a diet.

Recently, the prestigious New England Journal of Medicine, published a well-conducted study that followed roughly 7,500 people at high risk for heart disease over approximately 5 years. It showed that those who followed such a diet had a roughly 30% lesser chance of developing a heart attack or stroke, which is on par with what many medications for heart disease can do.

In the era of fad diets, many of which are quite extreme and difficult to adhere to, the Mediterranean type diet offers a reasonable, long-term way of eating.

-Tamir

(Image links to source: sfgate)

How much is 200 calories?

Many of us who are trying to improve our diets through healthier food choices often have misconceptions about how many calories different foods contain. For example, many calorically dense foods can quickly add hundreds of calories, derailing one’s diet, whereas calorically sparse foods, such as many vegetables, can be eaten in abundance, making us full with their bulk and fiber without expanding our waistlines.

The website WiseGeek took photographs of 200 calories worth of 70 different food and drinks. As you can see, many of the vegetables and fruit can be eaten in abundance, whereas a relatively small amount of many of the junk foods that we indulge in quickly add up to 200 calories. What was fascinating was that roughly a kilo and a half of celery was calorically equivalent to a mere 35 grams of Hershey Kisses!

Obviously, there is more to weight loss than strictly caloric intake. However, I think that what this neat little project does is reinforce the fact that only a small amount of candy, pastries, etc, can quickly mess things up for us. Sometimes we mindlessly munch on different readily available snacks and candies, not realizing that despite the small size of, say, an M&M or a tortilla chip, they pack quite a lot of calories.

- Tamir

(Images link back to their source: Wisegeek.)

Sweetened and Diet Beverages Sing the Blues

As many of you may know, consumption of sugary beverages as well as soda (both regular and diet) has been linked to obesity and diabetes, among other health problems.

A recent study suggests that consumption of these beverages may increase the risk of depression as well. The researchers followed over 250,000 people for a decade (making it a pretty high quality study), and discovered that those who drank the most sugary beverages, soda, and diet soda (4+ servings daily) were 30 percent more likely to have developed depression over the duration of the study. Those that specifically consumed more diet soda, ice tea, and fruit punch had an even greater risk of being diagnosed with depression.

Conversely, coffee (4+ cups daily) seemed to have a modest protective effect, reducing the risk of depression by 10%.

I should emphasize that this study does not per se prove causation (i.e., that soda or diet soda causes depression). It is possible that people with a tendency towards depression are for some reason greater consumers of soda. However, knowing that too much sugar is harmful for many other bodily processes, and that several other studies have shed a negative light on artificial sweeteners, one has to wonder if it isn’t smarter to stick with water (with perhaps a couple of cups of java thrown in).

- Tamir

(Image links back to its source: Columbia.edu)

The potentially dangerous . . . grapefruit?

Hopefully, all of you who have been following our blog are incorporating healthy changes into your lives. Many of you know that increasing your daily intake of fresh fruits and vegetables is one of the best ways to better your health. All of that is absolutely true. However, I do have one caveat: Grapefruit.

For the average person, including grapefruit as part of a healthy, balanced diet is a good idea. These fruits contain nice amounts of vitamin C, potassium, fiber, and other beneficial substances. The problem is that grapefruit also contains a class of substances known as furanocoumarins, which may interfere with how your body breaks down many different types of medications (anything from certain blood pressure medications, cholesterol medications, heart medications, antibiotics, and psychiatric medications among others). Depending on the specific medicine, the effect may be to increase the blood level of the drug to toxic levels, or to reduce the level to one that is not effective. Not all drugs interfere with grapefruit, so many of you who take medication can feel free to indulge, but definitely run things by your doctor.

- Tamir

Keeping it simple

Famed aeronautical engineer Kelly Johnson coined the acronym K.I.S.S. – Keep it simple, stupid! Since I try not to insult others, we can keep the principle, but perhaps abbreviate the acronym to K.I.S.

People often fail when trying to effect positive changes in their lives, such as embarking on a new diet or exercise regimen, because they complicate things too much. For example, many of us, when deciding to start working out, proceed to join a gym. Instead of following a simple, straight-forward program, on advice of self styled experts or weight training magazines we adopt something along the lines of:

Day 1: 20 minutes on stationary bicycle. 20 minutes on elliptical machine. 3 sets of bench press. 3 sets of incline bench press. 3 sets of decline bench press. 3 sets of dumbbell flys. 3 sets of dips. 3 sets of standing triceps extensions. 3 sets of lying triceps extensions. 3 sets of close grip bench presses. 3 sets of dumbbell bench presses. 3 sets of crunches. 3 sets of reverse crunches. 3 sets of hanging leg raises.

Day 2: 20 minutes on treadmill. 20 minutes on stepper. 3 sets of lat pull downs. 3 sets of underhand lat pull downs. 3 sets of dumbbell rows. 3 sets of close grips machine rows. 3 sets of T-bar rows. 3 sets of dumbbell pullovers. 3 sets of back extensions. 3 sets of stiff-legged deadlifts.3 sets of barbell curls. 3 sets of alternate dumbbell curls. 3 sets of concentration curls. 3 sets of easy bar curls.

Day 3: 30 minute swim. 3 sets of leg extensions. 3 sets of leg curls. 3 sets of squats. 3 sets of leg presses. 3 sets of machine squats. 3 sets of dumbbell lunges. 3 sets of overhead barbell presses. 3 sets of dumbbell presses. 3 sets of front raises. 3 sets of lateral raises. 3 sets of cable raises.

Etc. etc.

What I’ve described isn’t an uncommon type of routine you may encounter at the gym. And you know what? If you’re a bodybuilder with many years of experience, it may not be a half bad routine. However if you’re just starting out, and have many other commitments such as job or family obligations, then working out for 2 hours a day on a regular basis is probably not going to remain a long term reality. In addition, this routine may lead to overtraining, making you so sore as to ensure that a second masochistic trip to the gym is probably not worth it.

A similar scenario often occurs with diets. No carbs. No fat. 800 calories a day. Eat only one meal a day, drink gross tasting shakes the rest of the time. How many of us can stick to such spartan eating plans? Perhaps in the short term it’s doable (although in some cases not so healthy). However, within a few weeks, those endless plates of nonfat cheese, egg white omelets and alfalfa become a monotonous if not nauseating experience.

A better approach for most beginners is to start with a simplified exercise regimen and diet.

For example, the exercise regimen could consist of:

1. 1 mile fast walk
2. 2 sets of 10 push-ups
3. 2 sets of 10 sit-ups
4. 2 sets of 10 squat thrusts
4. 3 minutes of jumping rope
5. 3 minutes of stretching

Your diet:

1. Avoid sugary foods.
2. Avoid fried foods.
3. Eat 3 more servings of fresh fruits and vegetables daily than you currently do
4. Allow yourself one off day a week.

A regimen such as the one above takes much less time to complete and is overall simpler, increasing the chances of long term adherence.

Am I saying that you can’t increase the complexity of your health & fitness routine? Absolutely not. Go wild! But do it slowly, adding small steps that you can stick with.

Another scenario that I encounter is one in which someone has a few months to get into shape – say a college student off for summer vacation. You’re done with school and are gung-ho about embarking on that lengthy and complicated diet and exercise routine you read about in the May copy of whatever fitness magazine you subscribe to (see above). You go all out during the summer and shed the excess fat. Now school is starting again. The school work piles on. You have a part time job. . . and there goes the entire routine. You don’t have 2 hours daily to spend at the gym, so you stop going. And who has time for a complicated, super restrictive diet? So a donut (or 2) with coffee is breakfast, a burger and fries or pizza on the go is lunch, and a repeat of lunch is dinner. Of course let’s not forget about the snacks! Gotta give that brain an endless supply of sugar to help it function at optimal speed so that you can ace that math midterm.

Within a few months, all that weight that was so hard to lose is piled back on (and then some). Had you followed a simple maintenance routine (again, see above), you could have kept the weight off (and your cholesterol down).

- Tamir

Tips for not overeating

I came across an interesting opinion piece which addresses how to avoid gaining weight on Thanksgiving (or for that matter any other holiday):

What I found unique about this article is that instead of offering low fat or low cal variations to Thanksgiving classics, the author addresses behaviors that affect overeating. This, to me, is a much more pragmatic and commonsense approach. The problem with simply trying to shave some calories off of your favorite dishes is that

1. They may not taste as good (or may even taste terrible). This may make your holiday less enjoyable.
2. You may still overeat. Even if that low fat pie has 25% fewer calories, if you eat piece after piece after piece, it probably doesn’t make a heck of a lot of difference that you substituted sugar free pie filling.

So this holiday season, be smart and be mindful of what behaviors and environmental triggers cause you to overeat. This will allow you to enjoy your favorite dishes without packing on the pounds.