The Statin Scare

Many of you may have heard the recent news in regards to the FDA updating the risk profile for the common cholesterol lowering medications referred to as "statins."  As portrayed by the media, if you take this medication you are sure to end up with dementia and crippling diabetes.  Let me share my perspective on this situation.

First of all, it must be reemphasized that statin medications have unequivocally resulted in lower rates of death due to heart disease.  Even in the short time that I have been in practice I have seen far fewer patients develop heart disease, suffer heart attacks or had the need for procedures and surgery.  This certainly is not due to the population eating better and getting more exercise since obesity rates have steadily climbed higher and higher over that same time period. It is due to driving down cholesterol levels, largely from statin medications.  This has been quantified to about a 25% decrease chance of death in those who take the medication.  That is very substantial.

Now to the cautions.  I'll be the first one to say that I do not want to take one of these medications.  I put a lot of time and effort into exercising regularly and eating right so that I do not have to.  I have grandparents who had heart disease and stroke.  My father was recently put on a statin medication.  I may have to take one some day but I will do all in my power to lower my risk through non pharmaceutical means first.  If my levels raise despite my best efforts I'll have no second thoughts about trying a statin medication.

The FDA highlighted two main concerns.  The first is the "reports of memory loss."  This sounds like the medicine can cause dementia.  That is as scary a thought as having cancer.  I have dementia in my family as well and have no desire to head down that path.  What has been reported is not dementia but more of a "brain fog." Patients describe this as muddled thinking, not being as sharp.  The good news is that this is totally reversible.  It goes away when the medications is stopped.  It happens quite infrequently but I have seen it in my practice on occasion.

The second concern is for elevated blood sugar readings.  As a prescribing physician I have not seen diabetic patients have problems with their blood sugars after taking the statin medications.  I wonder if this is related to the population becoming more obese.  That would be a reason both for having elevated cholesterol levels requiring medication as well as being predisposed to developing diabetes.  It is important to understand that the lower cardiovascular risk seen in studies using statin are the most robust in the subset of patients who have diabetes.  It is currently considered to be bad practice to avoid statin drugs in diabetics whose LDL cholesterol values are over 100 mg/dl.  Dr. Amy Egan, the deputy director of safety for the FDA's metabolism and endocrinology division summed it by saying, “Clearly we think that the heart benefit of statins outweighs this small increased risk, But what this means for patients taking statins and the health care professionals prescribing them is that blood-sugar levels may need to be assessed after instituting statin therapy” (link here).


If you have concerns, by all means share those with your physician but don't stop taking your medication till you do.  These are life saving medications.  They need to be treated with care, yes.  The risks of not taking them may well be higher than the risk of stopping them.  

Harnessing Hypertension

Does having hypertension automatically consign one to taking medications for the rest of one's life?  What about all of the side effects of taking medications?  Aren't they bad for you?  Knowing the risks posed by high blood pressure (see my previous post), what can be done to keep the pressure down?  answers to these questions are not always straightforward and can only be answered correctly on an individual basis.  Let me discuss some generalities first.

It is always better to control blood pressure without medications.  Always.  It may not always be possible to lower blood pressure enough with healthy living alone, but doing so will certainly decrease the number and or the dose of medications needed to keep it under control.  There are four basic precepts to keep in mind in harnessing hypertension.

First, if you smoke you must quit.  Nothing else you do will matter much if you keep smoking.  You may have a perfectly normal blood pressure, controlled with medications but your risk of heart disease and stroke will not go down significantly if you keep smoking.  Nicotine is a vasoconstrictor.  This means that it narrows the blood vessels.  Think of your garden hose.  If you want to increase the pressure in the hose to wash off your deck you apply a device at the end of the hose that narrows it.  Every time a cigarette is smoked the blood vessels narrow for about twenty minutes.  I see this all the time in my office.  A patient will come in with a higher than normal blood pressure.  One quick sniff tells me that they likely had one last cigarette before walking in the door.  At the end of the visit, I'll recheck the blood pressure and it will have come down.  In the beginning these changes are reversible.  With time, the stress on the walls of the blood vessel cause it to become thickened.  This is like taking that garden hose and turning it into a pipe.  As there is no elasticity or give in the blood vessel wall, pressure shoots up even more.  This whole cascade is caused from cigarette smoking.  I know that it is hard.  You must quit smoking.

Second, regular cardiovascular exercise is as good as taking a medication.  The side effects are much better.  It will not give you a cough, make your ankles swell or take away your sex drive.  It will give you more energy, relieve stress and help you sleep better.  The biggest side effect from exercise is injury, of course.  Start slow and gradually build up.  Consistency is the key.  To effectively lower blood pressure some sort of exercise needs to be done at least four days of the week.  During exercise, the blood pressure will actually go up.  This is normal.  The muscles need more blood flow during exercise to provide fuel and oxygen to the muscles.  The heart responds by contracting more quickly and with a greater force.  As the heart itself gets in better shape, it pumps more efficiently.  A well conditioned athlete will have a very low heart rate and excellent blood pressure readings. This is a sign that the blood vessels are relaxed and the heart is not burdened.

If you want to avoid taking medications or limit the number that you need, make sure that the fuel you give your body is of the highest quality.  In particular, limiting the salt content in your food will help your blood pressure.  The sodium in salt causes your body to retain more water in the kidneys.  This is equivalent to turning up the knob on the garden hose.  The higher the volume in the tubes, the higher the pressure.  You must first break the habit of salting your food.  This includes tomatoes and cantaloupe.  In addition, much of the food that we eat has a lot of salt in it to begin with.  Make the effort to look at everything that you eat in a day.  Look at the labels, find out how much sodium is in all that you eat.  Your total sodium intake in a day should be less than 2000 mg.  It is easy to find a website to tell you how much salt is in common foods (here's one).  If it is in a package, a wrapper or a can, it likely has salt in it.  If it says "low fat" it likely has salt in it.  Guess what has not salt in it at all?  Fruits and vegetables.  In fact, fresh fruits and vegetables are naturally high in potassium.  When potassium is delivered to the kidney it exchanges with sodium, excreting it in the urine.   By eating fruits and vegetables you are actually getting rid of salt.  The best diet to lower your blood pressure is the DASH diet (dietary advice to stop hypertension).

Lastly, limit the toxins in your system.  Admittedly this includes nicotine and salt but those two are so important they get their own category.  In addition, alcohol can be an issue.  Up to four glasses of red wine has been shown to have a beneficial effect on cholesterol levels but not more, and not any other kind of alcohol.  No amount of beer, vodka or other forms have been shown to have any beneficial effect.  The alcohol molecule itself can have adverse effects on the heart.  Alcohol also contains sodium and "empty calories" (they don't do your body any good).  Caffeine is not as bad as nicotine but it is a stimulant.  It will artificially raise the heart rate.  The only safe way of doing this is through exercise.  Just this week I saw a patient in follow up who has dramatically reduced his blood pressure by eliminating soda, coffee and adding exercise.  Many medications can make blood pressure worse.  Anti-inflammatory medications such as Aleve (naproxen) or Advil (ibuprofen) can have a deleterious effect, especially in older individuals. ADD drugs such as Aderall and Ritalin can also raise blood pressure.  The anti-depressant Effexor also must be used with care in addition to the migraine medications like Imitrex.  Decongestants are especially bad for hypertension and should not be used.  This is just a sample.  Look on the labels of anything that you take and make sure it does not give warning in regards to high blood pressure.

In summary, I have not given any advice in this post that I have not given previously.  I have tailored it specifically to high blood pressure.  The advice remains simple, putting it into practice is difficult.  Choose on thing that you can do better and work on that.  Make a positive step in your health today.

Earning My Ice Cream

If you have read many of my posts you must wonder if we even own an ice cream scoop.  I am constantly talking about fruits and veggies.  I extoll the virtues of avoiding processed foods.  Fats and sugars?  Must stay away at all costs.  What could be worse for you than ice cream?  It is loaded with sugar and is full of fat.  I tell my patients that it is the diabetic double whammy.  My daughter, a competitive swimmer is achieving her best times ever this year.  I asked her what was going on, "did you give up ice cream?" It truly is not good for you.  All true, but...I love ice cream.  I admit it.  In fact, I must give ice cream credit for much of how I view health and nutrition.

If ever my family had any reason to celebrate, ice cream was involved.  Sporting events, good grades, giving a talk in church, all were a reason for ice cream.  Anyone ever eat the cylindrical scoops from Lucky's?  Keeping the triple decker upright was always tricky.  We could never get Mom and Dad to spring for the triple, though, that had to be from paper route money.  Ice cream never lasted more than a few days in our home.  With three boys and my father (the biggest sneak of us all), the carton never lasted long.  Now mind you, we would get in trouble if found skimming off the top.  We all thought we had mastered the art of taking a spoon and taking off only the top layer so as to avoid detection.  No obvious divots could be found.  Oh, how sneaky we were!  Sure.  I have no doubt that Mom knew exactly what we were doing.  Especially, since you could never really just take off the top layer.  Once started, the layers quickly started to add up.

As I grew older and started to buy my own food, I started talking myself into the Bill Cosby rationale of healthy eating.  Let's see, ice cream has milk.  We all need milk every day.  It has calcium.  It is good for our bones.  It must be something that I should have every night.  It would "settle my stomach."  And so for several years I ate ice cream pretty much every night.  I reasoned that it was better than being addicted to heroin.  As the waist began to expand, my energy level start to sag, I had to admit that perhaps the ice cream was not helping me out.  I decided to give it up.  That lasted until the next time it was offered to me.  Like a chain smoker I would quickly go back to a bowl every night.  As I kept trying to stop my habit but failing, I finally settled on a dietary plan that I could stick with and still have my ice cream.


I decided that instead of feeling guilty for eating ice cream, I would go back to my childhood and use it as a reward.  I decided that during the week I would eat healthy.  I would eat at least 4-5 servings of fruits and vegetables a day.  I would not eat candy, treats, dessert, soda or even my beloved....ice cream.  I decided that if I did this in conjunction with exercising at least four days during the week I could eat whatever I wanted on the week end.  In the beginning I craved the treats so badly I would get headaches, sweaty and a bit dizzy.  When the weekend would come I ate way too much.  By Sunday night I was bloated, had a headache and couldn't wait for Monday to begin so that I had a reason to regain my will power.  With time, I learned to control myself better.  I now may enjoy a bowl of ice cream (which I did while writing this post!) but since I behaved during the week, I can savor it.  I enjoy it.  I've earned it.

Measuring Bone Health

The ultimate goal of maintaining bone health is to prevent fractures.  We use a test called a bone density to help assess fracture risk.  It is a rather simple test to have done.  It requires no needles and is not painful.  It is similar to taking an x-ray but instead of taking a picture it takes a measurement.  The measurements are averaged and compared to the bones of young healthy adults.  The comparison is quantified mathematically in the form of a logarithm, called a T score.  Now before you roll your eyes and stop reading this, all you need to know is that the further you get away from zero, the worse you get.  Zero is the normal for that young healthy adult.  Osteoporosis (brittle bones) is labeled at -2.5 and osteopenia begins at -1.0.  Since it is logarithmic, -2.0 doesn't mean it is twice as bad, it means it is twenty times as bad and -3.0 is three hundred times as bad.

Ideally a bone density scan should be done on the same machine by the same technician.  There is significant variation between different types of machines.  The least accurate measurements are from the ones that look at the heel or the wrist.  Those should only be done as a quick screen and if abnormal should prompt a full evaluation with the standard scan done on the hip and spine.  The heal and wrist scans should not be used as a determinant to guide therapy.  Our bones are not uniformly thick, therefore variations in where the beam is directed can results in different values.  The technicians are trained to perform the test in the same area but if it is possible, having the same technician will lead to the most precise results.


One condition that will affect the accuracy of the test is arthritis of the spine.  In this condition, there is a build up of calcium deposits on the sides of the bone which will make the bone appear to be thicker and stronger than it really is.  In those patients who have a significant amount of arthritis, the scan should only be done on the hip.  Arthritis of the hip does not have the same problem because the measurement is not taken through the joint where the build up occurs.

It is important to understand that the number on the test is not the only determinant of your fracture risk.  A person with a nontraumatic hip fracture may have a T score of -2.2.  That would put them in the thin but not brittle group.  However, this person has already had a fracture so the future risk of additional fractures is going to be much higher.  Regardless of the T score, this person has osteoporosis.  Someone else with the same score and no history of fracture would be at a much lower risk.  Other risk factors should be considered such as whether a person is a woman who has gone through menopause, one's level of activity, whether or not a person is a smoker, one's family history is important and body size and composition.  A tool to add risk factors to one's T score to more accurately measure fracture risk is called the FRAX calculator.  This can be easily computed on line.  A score of 3% or higher is considered to be high risk and would warrant treatment.

Who should be screened for osteoporosis and how frequently does a bone density need to be repeated?  Men without risk factors are typically not screened.  Women should be screened for a baseline at menopause, repeating the test every two to five years depending on the score and their overall risk.  Those at higher risk due to medical conditions, certain medications, unprovoked fractures, etc should be screened earlier.  If in doubt, discuss this with your physician.  You should know your risk.  If you are at an above average risk for fracture, taking care of your bones now can prevent horribly painful conditions later when it will be too late to build back your bones.

Dem Bones Dem Bones

I have received a request to discuss the treatment for osteoporosis, so here are my two or three cents.  Feel free to make additional requests.  You can leave a comment on this blog or send an email to me at mpf9973@bjc.org.

During our younger years most of us take our bones for granted.  They carry us from place to place remarkably well.  They are quite resilient and only give way under a significant amount of stress.  As we get older that changes.  I have had a patient break their pelvis by nearly bending over to pick up a load of laundry.  Slips and falls can easily lead to broken hips, collar bones or arms.  The back bones can spontaneously implode on themselves like a stepped on soda can.  Not only are all these situations extremely painful, they are dangerous as well.  If an 80 year old falls and breaks a hip, there is a 50% chance that they will no longer be alive within six months.  It takes longer to heal at that age.  The immobility will predispose one to blood clots.  Pneumonia is more common.  The physical stress of the fracture may trigger a heart attack.  Muscle wasting occurs, making future falls even more likely.  This is the reason why physicians are so concerned about your bones.

Osteoblast: Bone Builder

Osteoclast: Bone Eater

The time to act is now, not after a fracture has happened.  By that time the bones are already brittle and weak.  To understand the different therapies used to improve bone strength, let me first explain bone metabolism.  One of the reasons why bone is so strong is that it is constantly being remodeled.  You can think of bones as scaffolding composed of calcium deposits.  There are two types of workers on the scaffolding, osteoblasts and osteoclasts. The osteoblast is the builder cell.  He is your brick mason, so to speak.  The osteoclast are the low paid college kids who come in and tear out the old bone that is showing signs of decay.  Think of calcium as the bricks used to build up the scaffolding.  The reason why people develop thin bones is because of an aberration in one of these three areas.  First, the youthful demolition workers may be over active.  Second, the deliberate mason builders may work too slow to match the demolition done by their younger counterparts.  Third, there may be a deficiency of material to work with (not enough calcium).  An example of the first are people given anti-inflammatory steroids such as prednisone.  This turns on the osteoclasts and bone destruction is accelerated.  Women in menopause who lack the estrogen of youth have a decrease in the activity of their osteoblasts (mason workers).  Patients with Celiac disease don't absorb calcium as well and lack the material used to make the bones.  The same is true for patients taking long term anti-acid suppressant medications or patients with vitamin D deficiency.  An overactive parathyroid gland will result in pulling calcium out of the bones and into the blood stream.  Understanding the cause of why someone's bones are thin is important so as to recommend how to counteract those effects.

The most important way to improve bone health is to be on them and be active.  There will never be a better solution than regular weight bearing exercise.  In as little as six weeks, well conditioned, young astronauts in space will begin to lose strength in their bones.  The same happens to anyone confined to bed for an illness.  Self imposed inactivity (nice way of saying "laziness") has similar effects.  When we are active and up on our feet our bones feel that pressure.  The mechanical reaction stimulates our osteoblasts to action and they get to work building more bone.  This won't do you any good if there is not adequate calcium to work with.  Calcium is mostly found in dairy products.  It is recommended that we obtain 1000-1200 mg of calcium a day.  Each serving of dairy contains approximately 300 mg of calcium.  The absorption of calcium is enhanced by the effects of vitamin D.  Vitamin D is activated by sun light.  As little as 10 minutes of sun exposure three days a week will suffice (see "Good Rays or Bad").  If you are not getting enough calcium through your diet, it is good to supplement that with a combination calcium-vit D tablet.  I recommend using 600 mg of calcium combined with 400 units of vitamin D, 1 or 2 tablets a day depending on your diet.  If you take a medication to block the acid in your stomach, using calcium citrate, which is absorbed better in an acid free environment than is calcium carbonate, which requires acid for absorption.

Regardless of what conditions affect your bones, adequate exercise, the appropriate diet and just enough sun exposure will help.  In a future post, I'll discuss how bone strength is measured and medications used to treat brittle bones.

Holi-DAYS

The holidays are upon us.  Thanksgiving is just a few days away.  This is often the beginning of hibernation for too many of my patients.  However, I do not care for bears.  We humans have no physiologic need to store fat to make it through the long dark winter.  Remember, bears do this due to a lack of access to food during the winter.  We do not have this problem.  Now, we will, like hibernating bears, grind our metabolism down to a halt if we allow ourselves to slip into a pattern of inactivity, only getting up to forage in the refrigerator.

What are good ways of staying active in the winter time?  It will likely involve exercising indoors.  If you do not have your own treadmill, exercise bike or other equipment, consider joining a gym.  Many are relatively inexpensive.  The malls are open early for those who want to walk in them.  Put on a coat and take your walk.  Don't let the winter doldrums keep you from being active.

In regards to eating habits, this is the time of year I refer to as "the danger zone."  There will be plenty of opportunities to eat the wrong types of food.  You need to make up your mind now how you are going to respond when something really tempting crosses your path.  Many of my men patients will tell me, "if she wouldn't buy/make those cookies/cakes, I wouldn't eat them."  This is a weak excuse at best.  We must be firmly responsible for the decisions we make.  Make a resolution now and stick with it.  Don't wait until the first of the year and you've put on ten extra pounds.  Watch yourselves every day.  Get on the scale daily if you need to.  Be strong.

Lastly, I fully understand that during the holidays we are going to eat food that is not healthy.  There are three simple hints that can help keep things under control.  First, earn your calories.  Get up early on Thanksgiving and go for an extra long walk.  Play football with the kids (this may have other adverse health outcomes, though).  Go to the gym and stay longer.  If you are going to eat more, burn more.  Secondly, realize that there will be far more choices than normal.  It is all right to eat from all of them if the portions are much smaller than what you would normally take at a normal meal.  If there is something that isn't your favorite, skip it.  Don't dish it up just because it is the next item in the line.  Lastly, remember that these special days are just that..."days."  They are not holi-weeks or holi-months, they are holi-DAYS. Enjoy yourself.  Taste all the goodies.  Don't fret about feeling guilty all day but when the day is over it is OVER.  Get back on track the next day.

Diabetes Prevention-Earning Your Calories

Michael Phelps at work

It should be pretty clear from the last two posts that sugar in the blood stream leads to the dangerous complications of diabetes.  Just as important as what is delivered to the blood vessels is how it leaves. The greatest source of energy demand is from the muscles.  If we don't use our muscles, they won't use up the sugar.  It is that plain and simple.  Conversely, when we actively use our muscles we turn into a blood sugar burning machine.  Well conditioned athletes use up a huge amount of sugar.  In the last Olympics, it was well documented that Michael Phelps, our gold medal, world record breaking swimmer, consumed around 9000 calories a day.  Most of those were in the form of carbohydrates.  That would put many of my diabetic patients in the hospital in a diabetic coma.  He had to consume that much to keep up with the amount of calories that his muscles were consuming due to his intense training.  However, I have witnessed many swim coaches who are over weight and at risk for diabetes.  The reason?  While they were actively training they developed a habit of heavy caloric intake which was not adequately scaled back when their training decreased.  The point is that exercise allows us to be able to eat more food.

One need not be an olympic swimmer to increase his ability to burn sugar.  Intensity matters but consistency is the key.  In the days when most of our population worked on farms, type II diabetes was not very common.  Today, where many of us work at computer screens or sitting down, the incidence is sky rocketing.  That is not a coincidence.  If you are not a construction worker or a farmer, you likely need more exercise.  I've discussed this in previous posts, but it does not matter what sort of activity you engage in as long as you are moving your muscles and getting your heart rate up.  The heart rate is an indicator that the muscles have used up their store of fuel and are calling out for a new delivery.  Whatever you choose to participate in, do it regularly.  It would be nice to be able to exercise just once a week for three hours and call it quits.  If we just ate once a week, I suppose that would work, but as long as we are putting fuel in the body, we need to keep the engine running.  I recently saw a patient in the office and I told him, "I'll make you a deal...you only have to exercise on the days that you eat."  The glimmer of hope that shone in his eyes as I started my sentence quickly turned to despair as he realized the point I was making.


I enjoy eating as much as anyone else.  I love ice cream.  I have been known to have a certain fondness for M&M's.  I realize that eating such items on a regular basis is a recipe for disaster.  Some years back to curb a nearly nightly habit of having ice cream, I put together my rules for eating.  I have followed these rules now for 15 years and I'll have to say that it has worked well for me.  During the week, I make sure and eat my five servings of fruits and vegetables a day.  I avoid all sweets, junk food, and yes, even ice cream.  On the weekends, I can eat anything I want, if and only if, I have exercised at least four days during the week.  I'll admit that in the beginning, I over did it on the weekends.  By Sunday, I would often feel bloated, lethargic and I often battled headaches.  Monday would be a relief.  I now no longer go crazy and feel much better for it.  It is nice to be able to sit down and have a milkshake without guilt.  I view it as a reward rather than a transgression.  Since I have burned it, I earned it!

How Hard to Push

It is not uncommon that I am asked about exercise.  Am I working out hard enough? How much is too much?  We have all heard of people who have gone out to exercise and had a heart attack and died. What is one to do?  How should one start and with how much intensity?

First of all, make sure that you meet with your doctor prior to starting an exercise program.  For the vast majority of people it will be quite safe to start exercising without any further testing. There are some patients who will need to make sure that there are no blockages in the heart arteries prior to beginning.  Your doctor will make that judgement.

The best way to start exercising is slowly and gradually.  It is more important to build a habit in the beginning than it is to build muscles and endurance.  The worst thing that can happen is to jump into a program aggressively and get injured.  That will just lead to discouragement, making it even harder to get back into a regular regimen. I would start just three days a week.  It may be for only 5 or 10 minutes.  Every day build it up little by little.  Ultimately, you want to be doing some sort of exercise for 45 minutes at a time, four days a week.  That is the goal.  More is even better.

The intensity with which you work out will vary depending on the activity.  In the beginning, I do not suggest that you track your heart rate.  Again, it is more important to just make the habit of exercising.  Certainly if you feel short or breath or dizzy, stop exercising and check your heart rate.  To calculate your heart rate, count the number of beats in fifteen seconds and multiply that by four.  If you feel your pulse and there are 20 beats in fifteen seconds, your heart rate is 80 beats per minute.  The maximal predicted heart rate for steady cardiovascular exercise can be calculated by subtracting your age from 220 and taking 80% of that.  If someone is 56 years old, 220-56 is 164.  My way of figuring out 80% is to take 10%, double it and subtract it again.  In this case 10% is 16, doubling it is 32; 164-32=132.  This is not a number that if surpassed will lead to immediate death.  It is just a recommendation to keep you at a steady level.  If short burst of exercise raise your heart rate above this level and do not cause dizziness, excessive shortness of breath or chest discomfort, that is acceptable.

If during exercise you start to feel any of the above mentioned symptoms, it is not time to panic.  It is time to stop and let your heart recover.  Lay down so that blood will get to your head.  Get some fluid in you.  Make sure you stay well hydrated during your work out. If you exercise for more than 30 minutes, you need to have a water bottle with you.  If you go for more than 45 minutes, you should add carbohydrates and electrolytes such as a sport drink or energy bar.  If resting for five minutes does not result in feeling better, you should get assistance.  Remember, keep moving but let's make sure to use common sense.

Make Every Step Count

"I don't have time for exercise."  I hear this all the time.  Most people, frankly, can make time to exercise.  It won't be found because there is always something that will fill a void.  Time for exercise has to be made.  I do know of some people, that truly have no time for exercise.  Some work two jobs or who care for elderly parents who are not well.  Exercising with small children is difficult also.  How is one to do it?

First, make every step count.  Go buy a pedometer (step counter).  They are rather inexpensive and can be found at most sporting good stores.  It is worn at the waist and will activate every time a step is taken.  Sufficient activity for one day is 10,000 steps.  Wear one around for a day and see how many steps you take.  See how many steps you need to make up and find ways of increasing them.  Park in a far corner of the lot wherever you go.  Take the stairs instead of the elevator.  It has been years since I have used the elevator at the hospital.  Take your dog for a walk.  Take a friend for a walk.  Take a bag lunch to work and go for a walk while you eat it.  Every step counts but you've got to take them.

What do you do during your down time?  Instead of going to a movie, go to the park.  Eat at a restaurant in an interesting area of town so that you can take a stroll afterwards.  When was the last time you have been dancing?  It is fun and burns those calories.  If you are going to sit and play a video game, then for goodness sake, get the Wii fit or one of the dance programs that makes you get up and move.  Walk over to your neighbor's house.  Go to the mall, but park on the other side.  Don't take the escalators but find the stairs.  In everything you do ask yourself, "How can I make every step count?"


Track your progress.  This will make you accountable to yourself.  Just this week I spoke with an 89 year old who told me that over the last 15 years he has biked over 40,000 miles.  This is a frail, old man.  He is not breaking any records for speed.  I have no doubt, though, that it has kept him alive.  By keeping track of your progress, you will find that you will naturally do small things to increase your activity.  If you only need to climb one flight of stairs to get to work, you may decide to go up two or three flights and then go back down to your level.  If you work on the 45th floor of a building, you may get off on the 40th floor and walk up the remaining five flights.  Make every step count.

The Buddy System

Like a group of boy scouts on a mountain adventure, to safely ascend the peak of good health it is helpful to have someone at your side.  A partner gives you a reason to show up at the gym when the alarm goes off, the air is cold and the bed is warm.  A partner helps you stay on track.  Your "buddy" may be an exercise class.  It might be a family member.  It could even be your dog who needs to talk a walk.  Being accountable to others transforms desire into resolve; good intentions into a way of life.

Staying on track with health is like walking on the straight and narrow path.  If we can't stay on it, we need to at least cross over it as often as possible.  A buddy helps to get us back on the wagon.  They will cheer for us when we are doing well, comfort us when times are hard and encourage us when we want to quit.  It can be as difficult to forge good habits as it is to break bad ones. Just as Alcoholics Anonymous uses mentors to keep a drunk dry, a mentor can also keep you going.  It has been shown that it generally takes twelve weeks of persistent effort to forge a good habit.  The hardest aspect of healthy living is to take a healthy choice and repeat it again and again and again.  It would be so much easier if we could exercise just one week out of a month and reap the same rewards.  Our bodies don't respond that way.  Consistency is the key.  I came across an article that found that Olympic level swimmers were studied as to their level of physical fitness at the peak of their exercise routine and then followed after stopping.  It only took six weeks for them to get out of shape.


A little competition never hurts either. Choosing a friend who is just a little better than you can do wonders.  Set a goal together.  Sign up for a walk or a run.  Support your favorite charity.  Buy yourself a bathing suit that is two sizes too small in the winter and pay for a summer vacation.  Upcoming weddings, reunions and other occasions can serve as goals to keep you going as well.  If you make the goal with a buddy, it will keep you going even on days when you may need to exercise on your own.  Do what works for you, but having a partner will keep healthy living a priority in your life.

Move That Body

Fifteen years ago there were two states that had obesity rates over 20%. Currently all states but two have such rates.  As a society we are getting bigger and bigger and bigger.  Much of that has to do with how and what we eat (see my previous posts) but the biggest reason in my mind is that we are getting more and more sedentary.  Most of us live in neighborhoods where it is impossible to walk to the store.  Very few of us take public transportation that would require us to walk to and from a bus stop or train station.  Most jobs are now desk jobs.  Many jobs that require physical activity have now become automated.  Even farming is not as physical as it once was.  We have machines that do most of the work for us.  When I was a child, we spent most of the day outside playing.  There are currently many children that spend all of their free time in front of either a television or computer screen.  Physical education at school has been cut back in many districts.  The combination of a diet that is full of foods requiring very little metabolism with a life style that does very little to activate our metabolism, adds up to caloric excess.  Our body is only too happy to store it away as fat and the weight comes on.

I came across an astounding statistic a few years back.  There is a group of people followed by the UCLA medical center who have lost about 100 pounds a piece and have kept it off.  The researchers were eager to try and find out what characteristics these people had in common.  They could only find two.  First, they all ate breakfast.  Second, they all exercised on average one hour per day for at least five days a week.  I'll talk about the first point in a later post but it is the second one that I want to stress.  This kind of exercise requires a complete life change and priority adjustment.  Those who try to find time to exercise, don't.  Time for exercise is not found, it is made.  It is only after exercise becomes a priority that big changes occur.  Anyone who has watched, "The Biggest Loser" can attest that the winners have all learned how to work out hard.  The ones who go home and don't keep up their routine regain weight.  Those who have changed their life for good, keep it off.

I have seen patients lose 10-20 pounds through watching their diet better but the only ones that I have seen lose 40-100 pounds are the ones who made exercise a priority.  Diet alone will fail because at a certain point of calorie restriction the body will just shut off metabolism.  Exercise is needed to keep it going.  I recently saw a 93 year old patient who is doing wonderfully well.  She remains active, her mind is sharp and is a delight to be around.  I don't think that it is any coincidence that her only complaint to me that day was that the "CURVES" in her neighborhood closed down.  When I asked if she found other ways to exercise, she slapped me on the shoulder and said, "of course!"


I know that I am not proposing anything that everyone doesn't already know.  It is not a lack of knowledge that keeps us back, it is motivation.  In the weeks to come I hope to inspire you a little more by sharing my thoughts on why exercise is so important, how it keeps us healthy, ways to begin exercising and helpful hints to keep it up and keep it going.  Tune in and keep moving!