How to make your health and fitness goals work for 2019

Getting fitter and healthier: It’s not all drudgery

Dear reader, 

Welcome to 2019! Here’s a new year’s salute to those earnest but not well-kept resolutions to be healthier, fitter, and happier.

While you may be enthused, or just guilt-tripped, about trying new routines for your diet, exercise, sleep, vices, and social engagement, the reasons to do so now may be more emphatic than ever.

In 2018, experts got serious indications that Americans aren’t improving their health, and, in fact, some key trend lines are going the wrong way.

Let’s all vow together to not contribute to the downtrend. Instead, we can aim for do-able steps, so that 12 months from now, our health and well-being have truly improved.

So … you have questions; we have answers! Keto, paleo, or high-carb? High-intensity interval, cross-fit, or fitness snacking? Deep dozing, routine slumber, or smart napping? Smoking (actually, no), vaping, CBDs, or a dry January?  Read on for help sorting through the choices. (Don’t forget that the colored type in the text of this newsletter indicates a hyper-link you can click on to get more information).

Troubling health metrics? Tailor these steps on diet and exercise to work for you

The year just ended brought bad news about the big trends in the health of Americans. But the good news for 2019 is that there are practical, achievable personal steps each of us can take to buck the trends and stay on the right side of good health and well-being.

First, a quick review of the bad stuff:

• The nation is posting record numbers of overdose deaths and suicides, and a life expectancy rate that’s falling in a way not seen since the great wars.
• Between 2000 and 2016, rates for five of the 12 leading causes of death in the United States increased: unintentional injuries, Alzheimer’s disease, suicide, chronic liver disease, and blood stream infections. Road deaths didn’t rise but held steady at higher numbers after sharp increases.
• After a decades-long drop, deaths from heart and blood vessel diseases have all but stalled and, of big concern, are rising among adults aged 35 to 64.
• Although the numbers of people getting cancer and dying from it declined or held stable in 2018, experts said more attention needs to be paid to rises in cancer deaths involving the liver, uterus, pancreas, mouth, and throat.

The numbers are concerning because we in the United States can safeguard health with small, sustained steps — but we often fall short of our best intentions.

The general checklist for each of us needs to include:

• Eating well and in moderation,
• Moving and exercising,
• Getting good sleep,
• Abstaining from smoking and its cousin vaping,
• Using alcohol and other intoxicants in measured fashion or not at all.
• And, since we’re social animals, we also need to stay engaged with people and with activities that give us purpose.

Healthful activities need not be dreaded. With 40 percent of American adults and 18.5 percent of children and teens struggling with excess weight, it’s a good idea for us all to sit less and move more.

Vigorous exercise is great, but even walking around a couple of times a day for 10 to 15 minutes can be beneficial, experts say. So, let’s all power down those electronic devices — kids, especially — and stroll around for face-to-face conversations, and maybe even engage in fun and games. As a certain shoe maker advises, Just do it.

By the way, what matters more, experts have found, isn’t standing up while working in the office — it’s moving around. That “standing desk” may be over-rated for its health benefit.

For competitive athletes, common sense and moderation help avoid over-use and injury. That’s especially true for young competitors. Exercise programs should boost participants’ capacities aerobically, in strength (weight-lifting), and in flexibility (stretching, even in a short work-out). Let a good sweat get you out of your head and away from your daily aggravations and obsessions. Various activities can be beneficial for increasing athletes’ socializing and human contact, with team sports a plus and individual pursuits still a reason to be around others — at the gym, pool, track, or even while walking or jogging in the neighborhood.

As for our eating habits, the New York Times reported that, despite all the studies on diets and nutrition, experts have not reached a one-size-fits-all consensus on what works best. Instead, individuals vary in their response to differing regimens, whether they’re paleo (high protein, low carbs), keto (very low carb, high fat) or high carb. The newspaper said that there’s “nothing new in the diet universe” and that losing weight — and keeping it off — can be daunting.

This has led, of course, to plentiful nonsense about eating, diet, and nutrition, including flourishing hype of unnecessary and sometimes risky diet supplements. Rigorous, meaningful, and useful medical science research can be challenging in any case. But studies in diet and nutrition have proven especially hard. This field  has been tainted by nefarious conduct by Big Pharma, Big Sugar, and other rich and influential interests.

Still, in 2018, Stanford University issued the results of a respected, $8-million, year-long study with more than 600 test subjects. Here’s the core of the published work’s key findings, reported by the New York Times:

“[P]eople who cut back on added sugar, refined grains and highly processed foods while concentrating on eating plenty of vegetables and whole foods — without worrying about counting calories or limiting portion sizes — lost significant amounts of weight over the course of a year. The strategy worked for people whether they followed diets that were mostly low in fat or mostly low in carbohydrates. And their success did not appear to be influenced by their genetics or their insulin-response to carbohydrates, a finding that casts doubt on the increasingly popular idea that different diets should be recommended to people based on their DNA makeup or on their tolerance for carbs or fat.”

As journalist Michael Pollan summarized research on healthful dieting: Eat food. Not too much. Mostly plants.

Americans can benefit by increasing their consumption of vegetables, including green, leafy varieties, and those of other colors (yes, orange and purple). These can provide important vitamins and nutrients. There are health risks and harms in excess consumption of meat and pork, and these are deeply rooted in the supply chains that bring animal-based foods from farms to homes.

Instead, eat more sustainable fish, and do so safely and wisely. You can get needed daily protein from soy and other bean products or by eating healthful whole grains and nuts. Don’t gulp down nut snacks laden in salt, sugar, or added oils. Eating walnuts, almonds, pistachios, peanuts, pecans, and other nuts can change your snacking in healthful ways and provide you with important nutrients. Nuts also are a key component, with olive oil, in the “Mediterranean diet,” which studies have shown can be a healthy option.

As you’re cutting down on salt and sugar — especially for the kids and especially from sweet drinks of all kinds — more home cooking can be an answer. It can reduce your dining on food that has been over-processed. Restaurants and fast food joints, as well as vendors of packaged and prepared meals, tend to be excessive in their use of sugar, salt, and taste-enhancing and preservative chemicals.

Cooking at home, with due time set aside to do so, can be rewarding and fun. Make the kitchen into a tasty and intriguing food-lab, sprinkling a little science into the mix. Or maybe you’d like the chance to use a galaxy of trendy gadgetry — everything from sous videdevices to Instant Pots to air fryers to food processors and induction cookers.

Control and balance the portions, and even be a little theatrical. But, we can make meals at home not just a culinary performance but a time of family gathering and exchange. Savor the dining and the time with loved ones, with gratitude to eat well and be together, sharing our lives.

This could be a part of the big work we have to do in 2019 to better our human interactions and our health.

People and purpose: Key elements in health, too

Americans hurl themselves into work, putting in longer hours on average than Germans, British, French, Italians, Canadians, or Australians. Experts say we’re harming our health, maybe even killing ourselves with how we slave away every day. Our total commute time to our jobs also is rising, with more than 14 million people in 2017 spending an hour or more traveling to work.

The Washington area is struggling with a mass transit system that is rapidly deteriorating and in need of at least a half-billion dollars in fix-ups. As the Washington Post reported of U.S. Census Bureau data about travel-to-work times:

“Among major metropolitan areas, the nation’s capital trailed only New York, where the average one-way trip to work reached 37 minutes, a full two minutes longer than a decade prior. Washington’s commute times ticked up to 34.9 minutes from 34.8 in 2016, but notably, the latest figures came in 1½ minutes longer than in 2007.”

Pile on the complications of workers and their families trying to sustain private lives, with kids’ expansive school and activity demands, and the health anxiety in modern lives may be off the charts.

If sitting in gridlock isn’t crazy-making enough already, a lack of time and the racing to get from work to school to one activity after the other — soccer, music lessons, class parties and the like — leads too many Americans to gulp down too much fast food, Uncle Sam has found. This is especially true of young adults and teens. It also may be surprising, but this is true, too: The more income diners have, the higher likelihood that they eat high-calorie, high-fat food from quick joints, with 42 percent of high-income families reporting they had fast food on a given day.

For all the frenetic rushing around that many of us pack into our lives, we’re apparently getting too much stress and too little satisfaction from our harried schedules. Americans say they’re more anxious than ever. And they feel isolated, alone, and lonely. Indeed, loneliness is becoming a major health risk, as the Wall Street Journal reported in its story headlined, “Loneliness undermines health and is linked to early mortality—and baby boomers are especially feeling the effects.” The newspaper added:

“Baby boomers are aging alone more than any generation in U.S. history, and the resulting loneliness is a looming public health threat. About one in 11 Americans age 50 and older lacks a spouse, partner or living child, census figures and other research show. That amounts to about eight million people in the U.S. without close kin, the main source of companionship in old age, and their share of the population is projected to grow.”

Americans also live in a time of stark political partisanship, when the media seem filled with stories of corruption, scandal, and natural and man-made calamities. The economy, which by many indications is doing fine, remains uneven, bumpy, and far too uncertain for too many Americans. Many of us live so paycheck-to-paycheck that the Federal Reserve reported that 40 percent of adults in one of its key surveys said they could not handle a $400 surprise expense without being forced to sell something they own or to take out a costly loan.

Too many of us self-medicate to deal with real life problems: Alcohol is an increasing health worry, and a lack of sleep is taking a toll on us, too (see below). Substance abuse, already a challenge, has with bad actions by Big Pharma, doctors, hospitals, insurers, and others exploded into the opioid crisis. Drug overdoses have become the leading killer of Americans 50 and younger. Powerful synthetic pain-killers like fentanyl and illicit drugs like heroin, yes, and cocaine and amphetamines are claiming way too many lives. Americans are succumbing not only to pain and wrongful responses to it but also to the disease of desperation and despair. In a flicker, bad and final choices get made — and even celebrities and others who may seem to have it all, much less those who don’t and struggle with their lot, take their lives. It’s tragic and it’s happening too frequently now.

As we kick off a new year, may it be possible that we carry forward even a little bit of the joy, caring, positive energy, and love from the holiday season? Our challenges will be big. But in individual health terms, the small responses can add up fast — and well.

A different approach: More relaxation, less self-punishment

Attitude may matter a lot as to how we do so, however. And the tart and insightful author and social critic Barbara Ehrenreich, 77, has intriguing thoughts on modern group-think about well-being and a punishing pursuit of it. She writes:

“Most of my educated, middle-class friends had begun to double down on their health-related efforts at the onset of middle age, if not earlier. They undertook exercise or yoga regimens; they filled their calendars with upcoming medical tests and exams; they boasted about their ‘good’ and ‘bad’ cholesterol counts, their heart rates and blood pressure. Mostly they understood  the task of aging to be self-denial, especially in the realm of diet, where one medical fad, one study or another, condemned fat and meat, carbs, gluten, dairy, or all animal-derived products. In the health-conscious mind-set that has prevailed among the world’s affluent people for about four decades now, health is indistinguishable from virtue, tasty foods are ‘sinfully delicious,’ while healthful foods may taste good enough to be advertised as ‘guilt-free’” Those seeking to compensate for a lapse undertake punitive measures like fasts, purges, or diets composed of different juices carefully sequenced throughout the day. I had a different reaction to aging: I gradually came to realize that I was old enough to die, by which I am not suggesting that each of us bears an expiration date. There is of course no fixed age at which a person ceases to be worthy of further medical investment, whether aimed at prevention or cure. …

“I decided [instead] that I was … old enough not to incur any more suffering, annoyance, or boredom in the pursuit of a longer life. I eat well, meaning I choose foods that taste good and that will stave off hunger for as long as possible, like protein, fiber, and fats. I exercise — not because it will make me live longer but because it feels good when I do. As for medical care: I will seek help for an urgent problem, but I am no longer interested in looking for problems that remain undetectable to me. Ideally, the determination of when one is old enough to die should be a personal decision, based on a judgment of the likely benefits, if any, of medical care and—just as important at a certain age—how we choose to spend the time that remains to us.”

Our quality of life matters and we need meaning, purpose, and people in our lives, not just a striving to avoid decline, she argues in her book Natural Causes. It offers some curmudgeonly, idiosyncratic, and maybe even just plain wrong arguments. But taking her call for sensible, moderate and do-able healthy living — as is advocated by many experts  — we can decide to eat better, minimizing our consumption of junk food. Pack a lunch, find a work colleague, and, weather permitting, walk somewhere close and sit outdoors for a bit for that mid-day meal. Call a friend or relative you haven’t seen for a while and suggest meeting for a brisk walk, a tennis match, a swim, or even getting a bunch of folks together for a friendly softball or touch-football game.

Get the kids to sign on so that once a month the whole family skips the chock-a-block activity schedule. Instead, suggest that the youngsters to invite a favorite single uncle, aunt, or family friend for a short hike and healthful, simple picnic. As the brief entertainment, get the kids to show relatives and friends their latest learning, whether it is that new gymnastics move or dance step or a few bars of a tune.

Made too much pasta and salad? Go up the street, knock on a friendly neighbor’s door and invite them over for tea and supper. You don’t have to go for budget-busting happy hours or fancy dinners: You surely know people, wearied by the weight of care-giving or other major issues and responsibilities, who would be delighted by an invitation for a cup of coffee and a chat. Consider the innovative approach taken by compassionate older women across the country who have joined a program to help each other out in times of need.

We’ve got work to do in the days ahead to maintain and improve ourselves, our world, and our well-being. But here’s hoping that for you and yours enjoy a healthy 2019 and count this year as among your best and most filled with joy!

In minding health p’s & q’s, don’t neglect those zzzz’s

Lose weight? Get more exercise? Cut down on the drinking and don’t smoke? Although many resolutions for improved health may seem daunting to carry out, one key way to more healthful living should sound appealing: Get more sleep.

In 2018, more evidence accumulated to support why health seekers, in minding their p’s and q’s, ought to pay attention to their zzzz’s.

The federal Centers for Disease Control and Prevention counseled:

“Not getting enough sleep is linked with many chronic diseases and conditions—such as type 2 diabetes, heart disease, obesity, and depression. … Not getting enough sleep can lead to motor vehicle crashes and mistakes at work, which cause a lot of injury and disability each year. Getting enough sleep is not a luxury—it is something people need for good health.”

It’s especially true for young people with growing bodies and developing minds, affirmed researchers in Seattle. They looked at how shifting to later school start times — as recommended by an increasing number of experts in adolescent health — might benefit teens.

Their published results show that pushing back the start of the day by an hour, to 8:45 in the morning in high schools, meant that teens who previously got an average of six hours and 50 minutes of sleep a night got seven hours and 24 minutes afterward.

Further, the New York Times reported:

“[The time] change was associated with a 4.5 percent increase in grades, although the researchers could not prove it was causal. They also found an increase in punctuality and attendance, but only in [an] economically disadvantaged school.”

Researchers at the independent, nonprofit RAND Corp., who also have advocated for later school start times for young people, have found that sleep deprivation among all Americans costs the nation more than $400 billion. That’s due to lost productivity, absenteeism, and illness and even death, as RAND researchers noted that sleep issues can contribute to higher mortality risk.

The CDC cautions that as many as a third of adults in the nation don’t get the recommended amount of sleep each night. The agency’s experts suggest that Americans’ slumber would improve if we:

• Are consistent. Go to bed at the same time each night and get up at the same time each morning, including on the weekends.
• Make sure the bedroom is quiet, dark, relaxing, and at a comfortable temperature.
• Remove electronic devices, such as TVs, computers, and smart phones, from the bedroom.
• Avoid large meals, caffeine, and alcohol just before bedtime.
• Get some exercise every day. Being physically active during the day can help us fall asleep more easily at night.

Vaping soars as health risk for the young

For parents, teachers, and public health officials, 2018 will go down as a Juul of a year. That’s bad news.

The small Juul device, which looks like a computer flash drive, became a rage among the young, as did vaping with Juul and other devices. (If you’ve been living in a cave, vaping is the practice of using e-cigarettes to catalyze commercially prepared solutions to get a high, typically from nicotine.)

Indeed, researchers said that more than 1.3 million high schoolers began using e-cigarettes in the last year, getting a wallop of addictive nicotine that can be the equivalent to smoking a pack of cigarettes. The vaping-nicotine increase was “the largest annual jump in the use of any substance, including marijuana,” seen in the 44 years that experts at the University of Michigan have monitored how kids use and abuse substances, including alcohol and drugs.

The UM data, combined with other information from the federal Centers for Disease Control and Prevention, and news reports about vaping’s soaring reach and influence among the young led to a stark announcement by U.S. Surgeon General Jerome Adams. “I am officially declaring e-cigarette use among youth an epidemic in the United States,” he said at a news conference. “Now is the time to take action. We need to protect our young people from all tobacco products, including e-cigarettes.”

Adams pledged the resources of his staff to campaign against e-cigarettes, especially Juul, and vaping.

The action follows a bungled response by the federal Food and Drug Administration and Commissioner Scott Gottlieb. The FDA delayed a planned crackdown on vaping devices and their liquid products, regulatory enforcement muscled through by the Obama Administration. Instead, Gottlieb said more study was needed to see if the benefit that e-cigarettes may have in helping adults get unhooked from tobacco cigarettes outweighed risks to youngsters with the devices’ use.

That delay, however, allowed Juul — with powerful social media and youth “influencer” campaigns — to become a smash hit among the young. The company dominates the market and has seen its value soar into the billions.

Juul also is now making even more worrisome alliances as it seeks to grow in the face of intense regulatory scrutiny.

The FDA gaffe looks worse by the minute and requires careful watching in 2019, as Big Tobacco maneuvers to buy its way into Juul and to expand its tentacles in the e-cigarette trade. This is occurring even as those same companies are hunting for opportunities in the merchandising of increasingly legal marijuana. Although it is beyond passé to automatically see marijuana as a gateway to abuse of harder and dangerous drugs, with the nation already in the throes of an opioid crisis the prospect of wider dope use by kids is not good.

Addiction experts and parents and teachers already are expressing alarm about vaping and nicotine abuse. Nicotine is highly addictive and carries its own health harms, especially for the developing brains of the young. As Juul and other e-cigarette makers have conjured a fantasy of how cool and alluring vaping can be, youthful users have responded with abandon. And experts say they’re uncertain how to reverse the nicotine addictions they’re seeing in heavy vapers.

Recent Health Care Blog Posts

Here are some recent posts on our patient safety blog that might interest you:

• To paraphrase what a one-time colleague once wrote about her bosses: Never trust Big Pharma, never trust Big Pharma, never trust Big Pharma. Here’s some of the latest evidence why: Even the industry’s so-called “white hats,” makers of supposedly less expensive and more patient-accessible “generic” drugs, now are ensnared in an ever-expanding investigation of illegal price fixing.
• When big hospitals aim to get even more giant, they do so at risk of the quality of care they offer to their patients — and they can do much damage to their brand and hard-to-repair reputations. That may be a reality that elite Johns Hopkins may be discovering.
  The Tampa Bay Times deserves credit for its detailed take-down of the “internationally renowned,” Baltimore-based medical institution for the deaths and harms suffered by child heart patients at All Children’s hospital in Florida. Johns Hopkins took it over, and, according to the newspaper, within a half dozen years made a debacle of its well-regarded pediatric heart surgery program, which worsened until youngsters were dying at a “stunning rate.”
• Facts matter, and, when amassed in a smart way, they can paint a powerful and accurate picture of reality, as is made clear with findings presented in the annual “Briefing Book” on medical malpractice from the Center for Justice and Democracy at New York Law School. As the Kentucky Supreme Court recently affirmed when it slapped down an attempt in the Bluegrass state to “reform” medical malpractice lawsuits, doctors, hospitals, nursing homes, and insurers too readily embrace and spread counter-factual notions about patients who seek in the civil justice system remedies for harms they have suffered while seeking medical services. It’s our fundamental, guaranteed right to pursue such claims, the justices affirmed — and the CJ&D experts have put together research to show that medical malpractice cases don’t happen often but are valuable in protecting the quality and safety of all patients’ care.
• Johnson & Johnson, now facing thousands of lawsuits asserting ties between its famed baby powder and patients’ cancers, has campaigned for decades to keep from wide public view information that its talc was tainted with asbestos, a naturally occurring substance and an established cause of some cancers, news media reports say.
  Reuters news service published its investigation of J&J’s long efforts to deny and downplay scientific evidence it had about asbestos in a product that has helped to create and define the company as one of the nation’s family friendly consumer product and pharmaceutical giants.
• Federal regulators have warned nursing homes nationwide to improve the quality and safety of their patient care or face consequences that operators may hasten to heed. That’s because new penalties and rewards will hit them in a place that counts — their pocketbooks. Two-thirds of the nation’s nursing homes will see a year’s worth of their Medicare funding reduced, the nonprofit, nonpartisan Kaiser Health News Service (KHN) reported, “based on how often their residents ended up back in hospitals within 30 days of leaving.”
• Profit-hungry hospitals have dived to some real lows in billing and mistreating patients. Seven New York facilities have gotten slapped down by the state attorney general for breaking the law by charging more than 200 women anywhere from $46 to $2,892 for collecting evidence that the patients may have been raped. New York Attorney General Barbara Underwood, whose office conducted a year-long investigation of the abuses of state laws aimed at protecting victims of sexual violence, said in a statement: “Survivors of sexual assault have already gone through unfathomable trauma. To then subject them to illegal bills and collection calls is unconscionable.”

Sincerely,

Patrick Malone
Patrick Malone & Associates