Driving yourself to the doctor.

Have you ever thought about how much time you spend in your car? On average, Americans face a 50-minute round-trip drive each day just for their jobs, and nearly thee-quarters of commuters drive alone. In suburban and metropolitan areas the commute can be much longer. Even in Aiken the average commute time is about 23 minutes. When you include driving to work, taking the kids to school, and doing errands, sitting in a car can easily account for an hour or more each day.

You can find the average commute time in your area using this really cool interactive map from WNYC.

You are probably very aware of the time you spend in the car. What you may not know is that sitting in your car can also have negative effects on your health and happiness. This is the conclusion of several studies that examined the relationship between commuting time and indicators of health. One of these studies suggests that vehicle miles traveled is a strong predictor of obesity. In another study, commuting a greater distance was associated with lower levels of physical activity and fitness as well as a higher waist circumference and blood pressure.

This makes sense because spending more time sitting in your car means you have less time to dedicate to being physically active, something we know is good for your health. Add to that the fact that driving is sedentary. There is accumulating evidence that spending more time sitting in the car, at work, or at home is a predictor of poor health, regardless of how active you are the rest of the day.

It gets worse. Many people eat in their cars during long commutes. Much of the time these “meals” consist of fast food and other prepackaged foods—not many people eat salads while they drive! Since these foods are typically of questionable nutritional quality and high in calories, this alone can contribute to obesity and poor health. The combination of inactivity and eating behind the wheel can easily shift the balance toward weight gain. Plus, eating while you drive is dangerous!

Beyond the direct impact on health through eating and activity behaviors, commuting alone in a car is a form of social isolation. Research suggests that this can lead to depression, itself an important factor leading to poor health.

The problems with long commute times are well established and easy to appreciate. Unfortunately, the solutions are not. Most people can’t move in order to have a shorter commute and relying on public transportation isn’t practical or even possible for many people, especially in our area. Replacing driving a car with active modes of transportation simply isn’t practical.

Aside from the time requirement—imagine how long a 25 minute drive would take on a bike or on foot!—our environment doesn’t adequately support active travel. Being able to walk or bike requires access to safe bike lanes and sidewalks that connect people’s homes to work, school, and other destinations. Even public transportation increases activity over driving and enhances social connections. Sadly, this infrastructure doesn’t exist in most communities, which were built to support cars, not people.

But we can take steps to undo some of the damage that so much driving can cause. Making activity at other times of the day a priority is a good start. This could include exercise at the gym, going for a walk, or even yard work or housework. When possible, replace car trips with walking or biking. Planning these activities with others can strengthen social connections as well as improve health and fitness. Finally, act as an advocate for changes in the community that will make active transportation more realistic.

More confusing food labeling, from people who should know better!

Since I am thinking about the topic of confusing food labeling this week, I wanted to share another example that I read about recently.

The Academy of Nutrition and Dietetics, formerly the American Dietetic Association, announced the first food to bear their “Kids Eat Right” label. This is a big deal, because the label is a sort of endorsement from the professional organization that represents nutritionists and dietitians. It follows that these foods would be among the healthiest choices for kids.

Unless they aren’t.

It turns out that the first food to bear this label is Kraft American Singles cheese “product.” It’s not even real cheese. Or even real food for that matter. Obviously, there is more going on here than helping consumers identify healthy foods for their kids. Hint: it involves money!

Nutritionist, professor, and author Marion Nestle provides some excellent commentary about this on her blog, Food Politics. Check it out…she is an excellent resource for all things nutrition.

When it comes to making good food choices, knowledge is power.

My Health & Fitness column in the Aiken Standard this week is about making smart food choices and how the nutrition information we are provided with can complicate that process.


Making smart decisions about what you eat is an important step in losing weight, feeling better, and preventing and treating a host of health conditions. But doing so requires that you have the knowledge to make those healthy decisions. Unfortunately, most people don’t have a good education in nutrition, forcing them to rely on information provided to them.

Some of this information comes from reputable sources and is based on research and experience. More often, though, nutrition information is provided by food manufacturers whose interests may not be consistent with providing smart recommendations. The end result is that consumers (that’s us) may not understand the information they get or know how to use it to make healthy choices.

A good example is the health claims about whole grains found on many food packages, including breakfast cereals. “A good source of whole grains,” is a common claim. Most people would reasonably interpret as a sign that the food inside is healthy, or at least is healthier than similar foods that don’t contain whole grains.

These types of claims are allowed by the FDA, but they refer only to what is in the food, not whether it is healthy or not. Many of the foods bearing this claim probably are healthy choices, but this isn’t always the case.

For example, Lucky Charms cereal contains whole grains. In fact, whole grains are the first ingredient, as the claim on the box indicates. Sounds good, right? But, when you read the Nutrition Facts panel on the side of the box you will find that the second ingredient is marshmallows! Does that sound like a healthy breakfast? (Hint: It’s not!)

Lucky_Charms package

 

This is the problem. If you are like most people, you won’t take the time to read the ingredients or the nutrition information on the back of the package. And even if you do, you may find that information to be confusing. Even if you wanted to make healthy choices, you might not have the knowledge to interpret and apply the available nutrition information.

This general lack of knowledge we have about nutrition has led to situations in which some foods are restricted or banned. Recently, the city of Berkeley, California voted to impose a tax on soda and other sugary drinks in an effort to keep people from consuming too much sugar and too many calories.

This effort, and others like it, have contributed to a vigorous debate about personal choice and freedom for people to make their own decisions about what to eat and drink. One argument against these types of restrictions is that if people have the nutrition information about soda (or any other food) they can make informed choices.

This is a nice idea, but it simply isn’t fair to expect people to make good decisions if the information isn’t available or is not easy to understand. Worse, misleading information can lead to making bad decisions.

Help may be on the way. The FDA is working on a redesigned Nutrition Facts panel that should help us make better food choices. In particular, the amount of sugar added to foods will be listed. This change alone will help identify foods that may appear to be healthy, like Lucky Charms which contain whole grains, but are actually high in added sugar. Additional changes include more realistic serving sizes and better information about fat content.

It is unclear when the updated nutrition facts panel will be implemented. In the meantime, do your best to read labels and use common sense as your guide: The addition of marshmallows does not make any food any healthier, no matter how much whole grain it contains!

Our toxic activity environment, and what you can do about it.

Last week I introduced the idea that we live in a “toxic environment,” which provides easy access to high-calorie, unhealthy, inexpensive food and promotes physical inactivity. The focus was on the toxic food environment, so now it is time to explore our toxic activity environment and how you can modify it to increase your activity, which can help you lose weight.

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The environment affects our physical activity on several levels. The built environment refers to the layout of our communities, including roads, sidewalks, availability of public transportation, where homes and businesses are located, and even the design of buildings. If you live in a mixed-use area in which there are lots of well-maintained sidewalks that connect your home to schools, parks, churches, restaurants, shops, and businesses, the built environment is likely to support more activity. In larger cities, an effective public transportation network can increase your activity.

However, many people live in areas where there aren’t sidewalks or, if there are, the distances between destinations are too far to make walking convenient. Or they live in a neighborhood that is separated by distance or geography (a busy road, perhaps) from other places they go. Even when sidewalks are present, using them may be challenging due to poor maintenance, automobile traffic, or dangerous road crossings. Even when signals for pedestrians exist, there may not be enough time to safely cross the street, a serious limitation for those with limited mobility. In many cases, the built environment can actually discourage—even prevent—physical activity.

The built environment includes indoor spaces, too. If the building you work in has clean, safe, and accessible stairs, you will be more likely to use the stairs rather than the elevator. Even the design of offices and workspaces can influence activity. If your office has a desk and a chair, it is almost guaranteed you will sit much of the day. Even the small increase in activity that comes from using a standing desk or an alternative to a traditional chair, like sitting on a stability ball, can add up during the day. Some people even have treadmill desks, so they can walk while they work!

At work and at home, technology and labor-saving devices make it easy to be inactive. At work you can communicate with coworkers by phone or email instead of walking to their office to talk. Entire groups of people can have meetings via video in which each person is seated at their own desk, even though everyone works in the same building. At home you can change the TV channel, connect with friends and family, even order dinner from the comfort of your couch. Riding lawn mowers and leaf blowers reduce the physical effort needed to do yard work and robotic vacuums allow you to sit and watch your floors get cleaned.

The good news is that you can change the way in which you interact with the toxic activity environment to increase your level of activity. You may need to drive to a store or restaurant if it is too far to walk, but you can park farther away to get a few extra steps. You can get up from your desk to talk to a coworker rather than calling or sending an email. At home you can get up off the couch during commercials or take short “screen time” breaks to move. And it is perfectly alright to leave the leaf blower in the garage and use a rake to clean up the yard.

Don’t wait until you get sick: What you can do to prevent heart disease.

I have been writing recently about heart disease, how it is diagnosed, and what you and your doctor can do to treat it. In order for your doctor to start treating you for heart disease risk factors such as high blood pressure, high cholesterol, or diabetes you need to be diagnosed with one of these conditions. This requires proactively seeing your physician for screening before you start experiencing the consequences of these conditions.

But most people don’t visit their doctor until they have symptoms, and many wait until a more serious event (a heart attack, for example) occurs to seek medical attention. By this time, the disease process has progressed and managing it becomes the goal. It is possible to prevent both the conditions that lead to heart disease as well as reduce the risk that you may have a heart attack or stroke.

Your risk of heart disease is largely determined by health-related attributes and behaviors called risk factors. Some of these risk factors cannot be changed, including age, sex, and family history. Other risk factors are modifiable, meaning you can change them to reduce your risk. These modifiable risk factors include smoking, high blood pressure, high cholesterol, diabetes, obesity, and physical inactivity.

While there are medications that can lower blood pressure and cholesterol and treat diabetes, these modifiable risk factors are best addressed by lifestyle changes. Adopting healthy habits has the potential to have a bigger effect on heart attack risk than medical management. There are three important health behaviors that, together and separately, have a powerful effect on reducing heart attack risk:

Stop smoking. There is no way around this one. Quit! Ask your doctor about prescription medications that can make quitting easier. Nicotine replacement therapy in the form of patches, gum, and lozenges can help manage cravings and are available over the counter. Ultimately, though, quitting smoking is a behavior change that takes motivation, willpower, and time. But it is worth it—your risk of heart attack can drop 50–70% within five years of quitting.

Be active everyday. The importance of physical inactivity as a risk factor for heart disease is often overlooked. But make no mistake, being active on a regular basis is one of the most important things you can do to improve your heart health. Whether you have other risk factors or not, physical activity can reduce your chance of having a heart attack. And if you do have a heart attack, your active lifestyle improves your chances of survival and returning to a normal lifestyle.

The benefits of exercise are well-established and impact heart disease risk in a multitude of ways. Physical activity helps with weight control, lowers blood pressure, improves blood lipids, and prevents and treats diabetes. Think of this as a great health “deal.” By modifying one risk factor—inactivity—you can also promote beneficial changes in four others—obesity, hypertension, high cholesterol, and diabetes. There is no other treatment, drugs included, that can have such a broad impact on heart disease risk!

Improve your diet. If you are like most Americans, your diet is too high in saturated fat, salt, and added sugar and lacking adequate whole grains, fruits and vegetables, and fiber. This type of diet is associated with obesity, high blood pressure, high cholesterol, and diabetes. All of these conditions are risk factors for heart disease, so you may literally be eating your way to a heart attack.

It turns out that adopting a healthier eating pattern is important in reducing your risk of heart disease. Saturated fat intake can lead to abnormal blood lipids and high salt intake is linked to high blood pressure. While eating sugar doesn’t cause diabetes, the type of diet described above is associated with weight gain and diabetes. Just like with physical activity, a healthy diet can lead to improvements in several other risk factors.

The potential impact of these three health behaviors is great. Even modest changes in diet and activity can lead to improvements in risk factors and reduced heart attack risk. More intensive lifestyle modification can produce even greater benefits. In one famous study, daily exercise, a low-fat vegetarian diet, and stress management actually caused regression of heart disease, meaning that the blockages in the coronary arteries were smaller following treatment. While you may not follow such a strict program, becoming more active, eating a healthier diet, and quitting smoking can go a long way to improving your heart health.

The attack of our toxic food environment. And how to fight back!

The term “toxic environment” was popularized by Kelly Brownell, an obesity and weight loss researcher, years ago to refer to conditions that promote the consumption of high-calorie, unhealthy food and encourage being physically inactive. This combination is thought to be a major factor that contributes to obesity and other chronic diseases, so understanding both aspects deserves our attention. Hy Health & Fitness column in the Aiken Standard this week  focuses on our toxic food environment. (Next week I will explore our toxic activity environment)


Fastfood One characteristic of the toxic environment is that food is available almost everywhere. Gas stations have evolved into convenience stares that happen to sell gas, tempting you as you enter to pay. Displays of candy, soda, and other snacks are present at nearly every checkout lane in nearly every store, even stores that have nothing to do with food. You can find vending machines that sell candy and soda most places you go, even hospitals and schools. Many workplaces have a common area where you can typically find a candy dish or a break room with vending machines. Even going to a meeting at work may mean sitting around a table with a plate of donuts in the center. Sure, you don’t have to buy a soda when you pay for gas or take a donut from the plate, but resisting can be difficult. The more you are around food, the more likely you are to eat it, even if you aren’t hungry. Whether your goal is to eat less food or to eat healthier food, the world we live in makes it difficult. It’s not just willpower, either. We are all susceptible to marketing, whether done by a store, restaurant, or a friend with a plate of freshly baked brownies. The power of marketing, combined with the fact that most of us don’t really understand food or nutrition, is difficult to overcome. It gets worse. It turns out that much of the food we are continually exposed to is of poor nutritional quality. Convenience foods such as candy, snacks, and drinks tend to be high in calories, mostly from added sugar and/or fat, and low in nutrients like vitamins, minerals, and fiber. Many restaurant meals, both fast food and casual dining, are similar in this way. Even prepackaged meals that you eat at home tend to be high in calories and low in healthy nutrients. So, not only are we almost always around food, much of that food is unhealthy. It also turns out that these unhealthy, calorie-dense foods come in portions that contain a shocking number of calories that can contribute to weight gain. Think about soda, for example. It used to be that you could buy a soda in a 12 oz. can or a 16 oz. bottle. Now 20 oz. bottles are common and even larger sizes are almost always an option. The same is true for candy and snacks, like chips. As portions increase, so do the calories we consume. To be fair, there isn’t necessarily anything wrong with having so many foods and drinks available to us. We don’t need to eat these foods, right? But, all too often, we do. And when the excess calories from all of this food are combined with a low level of physical activity, a “perfect storm” is created that almost always leads to weight gain. Changing our food environment is difficult, maybe even impossible. But we can change the way we interact with our environment. This includes being more mindful of what, when, and why we are eating. Being aware of internal signals like hunger and external forces like advertising and peer pressure can help us make smarter decisions within our toxic food environment.

What your doctor may do to diagnose and treat heart disease, and what YOU should do

As Heart Month draws to a close, it’s worth understanding a bit more about the tools your doctor may use to diagnose and treat heart disease or a heart attack. And, equally important, what you can (and should) do if you have a heart attack help prevent it from happening again.


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Coronary artery disease or heart disease is caused by atherosclerosis, a process which involves the accumulation of cholesterol plaques in the arteries that supply blood to the heart. These plaques can narrow the blood vessels and reduce blood and oxygen delivery to the heart, leading to symptoms like chest pain (ischemia). The plaques can also rupture and form a blood clot, blocking oxygen delivery and causing a myocardial infarction—a heart attack.

If you experience symptoms such as chest pain or have a high risk of heart disease due to family history and other risk factors, your doctor may recommend a diagnostic test. In a graded exercise test (GXT), or “stress” test, a person exercises, typically walking on a treadmill, at increasing speed and grade while heart rate, blood pressure, and heart rhythm are monitored by a doctor or exercise physiologist.

Stress_test

Changes in these variables, as well as the person’s exercise capacity, can be signs of ischemia and heart function. Often, a GXT is combined with another diagnostic technique such as nuclear imaging, which shows areas of the heart that do not receive enough blood flow, or an echocardiogram that uses ultrasound to show the heart beating and ejecting blood.

Based on the GXT results a cardiologist may recommend an angiogram, in which a catheter is inserted into an artery and threaded into the coronary arteries, dye is injected, and the coronary arteries are viewed through X-ray imaging. This allows cardiologists to actually see the extent of the narrowing in the coronary arteries.

You can been diagnosed with heart disease based on the results of an angiogram or if you had a heart attack. During the angiogram a cardiologist can perform an angioplasty in which a balloon catheter is inflated to open narrowed arteries. A mesh stent may also be placed to help keep the vessel open for longer. In other cases coronary artery bypass surgery may be indicated. Considered open heart surgery, this procedure actually bypasses narrowed sections of coronary arteries using another vessel, typically a leg vein. Both angioplasty and bypass surgery can restore adequate blood flow to the heart and treat ischemia and heart attacks.

Many people consider the treatment complete after the heart attack has ended and the angioplasty or bypass surgery is complete. The truth is that the long-term outcomes are largely based on what happens next. Traditionally, heart disease patients were told to rest and not stress their hearts, a belief that many still hold today. But exercise-based cardiac rehabilitation programs are key to improving heart health and preventing future complications.

Most cardiac rehabilitation programs include several phases. Phase I programs start in the hospital and focus on getting out of bed and performing self-care activities and some walking. Phase II cardiac rehab involves closely-monitored exercise, usually for 12 weeks following a heart attack or surgery. Phase III involves longer exercise sessions with greater independence and transitions into Phase IV, a lifelong exercise program. Education about exercise, nutrition, weight control, stress management, proper medication use, and psychosocial wellbeing are essential in all phases of cardiac rehabilitation.

The benefits of cardiac rehabilitation are well-established through research and practice. In fact, many patients credit cardiac rehabilitation with saving their lives, even if they had bypass surgery. Despite this, less than a third of patients who are eligible for cardiac rehabilitation actually attend a program.

If you or someone you know has had a heart attack or surgery, encourage them to ask their doctor about cardiac rehabilitation—it is likely to be the best way to improve quality of life and avoid future heart problems.