Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

A Father’s 5-Point Plan for Investing in Your Health

As fathers, one of our most important responsibilities is to be there for our children. Work and travel schedules may make it difficult to be home every night for dinner or to catch every baseball game or music performance, but taking action on a few simple things can help us invest in our health today to ensure we are around to support and guide our children as they grow.

As the survivor of a health scare a few years ago, I have made a personal commitment to a simple, five-point plan for health – and I encourage others to do the same. Here’s the plan I follow that can also help you invest in your future:

1. Know your numbers – Cholesterol, blood pressure, blood sugar. The key to good health is understanding first where you stand, and what you need to improve. For me, I love to cook so it’s about reducing the amount of salt and sugar I use to keep my numbers in check.

2. Know your history – Just as important as the lifestyle you lead is what you’ve inherited from your family. Knowing what you face genetically can go a long way in ensuring your current and future health. Share your family history with your physician who can help develop a customized health care plan that allows you to monitor and track against illnesses for which you might be disproportionately at risk due to what you’ve inherited.

3. Make balanced choices in your diet – Healthy eating isn’t about denying yourself every food you enjoy. As my doctor likes to say, you don’t have to give up everything. You never will be successful. But you do have to discipline yourself, and that’s something I have been working on as I try to manage my own weight. It’s not about going on a diet, which is based on denial, but about making responsible decisions that let you enjoy the foods and drinks you love, but in moderation. It’s tempting to eat steak and burgers – but research continues to caution against eating too much red meat. Instead of reaching for the chips, eat celery or carrot sticks instead. And instead of grabbing that cookie, reach for a peach or an apple to satisfy your sweet tooth.

4. Get moving! Get active – Most of us sit behind desks – or in traffic – for a good part of the day, so I can’t emphasize this point often enough. Physicians usually recommend at least 30 minutes of exercise, five days a week. You don’t have to be an athlete to get active – just walk, walk, walk! As president of a large, national health care organization, I log many miles traveling to our various sites. During my time on the road, I often take a personal walking tour of the many cities I visit. Walking doesn’t take fancy equipment and you don’t need to dress up or drive somewhere to do it. All you need is a sturdy pair of walking shoes, and many hotels provide maps for walking. You can even log miles and track your progress with walking partners at

5. Have a good relationship with your physician. I respect – and also really like my doctor. She is more than a physician; she is a great coach. You should have the type of relationship with your physician where you feel he or she is on your team. If you don’t feel comfortable with your physician or don’t think of her or him as a partner in your life plan for health, then it’s time to find a doctor who can support your path to total health.

According to the U.S. Surgeon General, 80 percent of premature deaths in the U.S. are caused by four preventable behaviors: lack of physical activity, poor diet, alcohol use and smoking. The five steps I’m sharing with you are simple behavioral changes that won’t take up a lot of time, and will pay off in dividends in 10, 20, even 30 years down the road. Making time to invest in your health is a commitment well worth making and every effort you contribute starting today, will pay significant dividends for years to come.

Bernard J. Tyson is president and chief operating officer of Kaiser Foundation Hospitals and Health Plan, Inc.

How To Have A Healthy Old Age: Food For Thought On Labor Day

I’ve spent the last couple of weeks making house calls to “at risk” seniors in rural South Carolina. At the rate of about 7 house calls per day, I was able to make some observations based on a respectable sample size. I was both surprised and intrigued by the living conditions I encountered, and I’m pleased to report that I have now performed my first physical exam under the careful scrutiny of a cat, rooster, and hen team (photo at left). On another house call I was offered a pygmy goat as a thank-you for my efforts, and countless good-natured folk offered me home made iced-tea and such edible delectables as fish patties and peach honey.

But what struck me the most was that certain seniors were in far better health than others their age, and that the healthier ones all had one thing in common: strict daily exercise regimens. I realize that this is not ground-breaking news (that exercise is good for us), but the stark contrast between those who exercised and those who didn’t could not have been clearer to me.

One particularly charming 85 year old man gave me a tour of his vegetable garden, and explained that he bicycled into town six days a week to give away okra (and other veggies) to church friends and town folk. Growing vegetables and giving them away was his current life’s work, and although he lived in extremely modest circumstances, what he owned was tidy and clean. He was joyful, bright, and had the physique of an athlete.

Contrast this man to another patient in his 80’s who didn’t exercise at all, and stayed inside smoking cigarettes most of the day. He was blind in one eye, nearly deaf, struggled to breathe, had sores on his skin. He was depressed, over-weight, and swollen from heart failure. I was so sad to see his condition, and the relative squalor in which he lived. Urine and smoke odor permeated the house, and I wondered how much longer he would survive.

When I arrived at another octogenarian’s home, I noted that the garage was filled with watermelons of various sizes. Upon further inquiry, the gentleman said that he had hand-picked the watermelons from a plot of land that he owns 2 miles from his house.  He brought them back to the house with a wheel barrow… and had made many trips back and forth over the past week. He was taking no medications and had a completely normal physical exam.

And so my days went – back-to-back visits with seniors who either were engaged in an active lifestyle, or who were wasting away, cooped up indoors with advancing dementia and chronic disease. I realized that no medical treatment has the power to overcome the relentless damage that inactivity, smoking, and deconditioning cause. The secret to a healthy old age lies in lifestyle choices, not pill bottles.

As we enjoy the last holiday weekend of the summer, let’s consider how important labor actually is to our mental and physical well being. You’re never too old to haul watermelons down the road, grow okra for your neighbors, or simply commit to smoking cessation and daily walks. If you do this regularly, your health will surely improve – and your quality of life will be enhanced immeasurably. In the end, adding life to years is what medicine is all about.

Your Nagging Fitness Questions Answered With Scientific Evidence

I just finished reading a great little book called, “Which Comes First, Cardio Or Weights? Fitness Myths, Training Truths, And Other Surprising Discoveries From The Science Of Exercise” by Alex Hutchinson, Ph.D. I’m very grateful to Alex for patiently sifting through over 400 research studies in a quest to answer (with evidence, not subjective opinion) some of our most nagging exercise questions.

Alex is the perfect guy to do this exercise myth-busting as he is a competitive runner, professional journalist, and has a Ph.D. in physics. His writing is crisp, uncluttered, and bears the understated humor of a Canadian. To be honest, I enjoyed his book so much that I was contemplating blogging about most of his conclusions. However, I don’t want to teeter on the edge of copyright infringement, so I’ll just provide you with some highlights from my favorite sections of the book:

1. Do compression garments help you exercise? I’ve wondered this many times as I jiggled my way down the road on a long run. I’ve always liked the theory behind tight outer-garments, that they reduce unnecessary movement during running, thus making one’s movement more efficient and reducing the bounce and drag on muscles and skin. They may also help with blood return to the heart and reduction in peripheral edema, speeding recovery from exercise. Believing the plausibility of the argument, I have indeed sprung for some rather expensive running tights.

So what does the scientific literature have to say about compression garments’ role in exercise? Apparently there is nothing conclusive yet. Small studies have shown no clear improvement in exercise economy, athletic power or endurance, or recovery from exercise. The only measurable benefits appear to have occurred in those who believed that the compression garments would help their performance. A nice reminder of the importance of the “mind-body” connection in athletic pursuits. Bottom line: if you like how you feel in compression garments, by all means wear them. But don’t expect any dramatic improvements in anything more than your jiggle factor.

2. Will sitting too long at work counteract all my fitness gains? The short answer to this question is: possibly. I was surprised to note that at least one large study found that sitting for more than six hours per day increased one’s risk of death by 18-37% regardless of how much exercise one performed in the other eighteen hours of the day. Long periods of sitting appear to be quite bad for your health, so getting up and moving around every hour or more is important if you have a sedentary job or lifestyle.

3. Does listening to music or watching TV help or hurt my workout? Listening to faster-tempo music can result in increased exercise effort (in many cases completely unconsciously), while TV-watching usually results in a reduced exercise effort. This is because watching videos requires visual attention and subtle changes in balance and movement occur to accomplish it.

4. Will stretching help me avoid injuries? As a person with limited flexibility, I found this section of the book to be quite comforting. As I have blogged previously, stretching has not been shown to reduce the risk of injury or post-exercise soreness. In fact, it can decrease power and speed for certain athletes, though it is important for those who intend to perform great feats of flexibility (such as gymnastics).

5. Should I take pain killers for post-workout soreness? Interestingly, non-steroidal anti-inflammatory drugs (NSAIDs) are not particularly effective in reducing post-exercise pain and can even interfere with muscle repair. NSAIDs block prostaglandins, which are important in collagen synthesis. While NSAIDs are useful in reducing inflammation and swelling in acute injuries (such as an ankle sprain), general muscle soreness isn’t a good reason to pop some ibuprofen.

6. Will drinking coffee help or hinder my performance? I’m one of the few people I know who doesn’t drink coffee, so I was surprised to discover that I may have been missing out on an important exercise enhancer. According to decades of research, caffeine is likely to improve your exercise performance. Studies have shown that pure caffeine (not necessarily in its coffee form) enhances sprint performance as well as endurance activities up to two hours. In 2004 the World Anti-Doping Agency removed caffeine from its list of restricted substances, so expect to see some caffeinated athletes in this summer’s Olympics.

7. What’s the best way to breathe during exercise? If you’ve ever marveled at your own panting, you’ve also probably wondered if there is a more efficient way to breathe – or at least a less embarrassing way. The answer is no. Studies have shown that people who consciously work to make their breathing less labored expend more energy and get less oxygen in the process. So, keep on breathing the way your body wants to… you’re naturally more efficient at it than you think.

I hope that these little tidbits have whet your appetite for more of Alex’s excellent insights. I have fully equipped myself with fast-paced music and a little caffeine, as I move my inflexible, jiggly, panting self down the road on another long run.

The Primal Games: My Life Outside The Comfort Zone

This weekend I accidentally stepped way outside my comfort zone. A friend of mine had invited me to compete in the Primal Games – an event that she described as a “fun time for all fitness levels with some guys dressed up as cave men.” Sounded innocent enough. And it appealed to my sense of whimsy, so I signed up without a second thought. A couple of weeks prior to the event I decided to do a little more research and discovered that this competition *might* be a bit more challenging than I had originally thought. The event website was somewhat vague, but alluded to things like “Atlas balls,” climbing over walls, obstacle trail run, military crawls, and medicine ball tosses. Hmmm. I’d never attempted to scale a wall in my life, nor was I too thrilled about the idea of hoisting around beach-ball-sized cement objects. I was getting nervous.

I soon discovered that my nervousness was more than well-founded. As I arrived at the event, the temperature was rising above 90 degrees Fahrenheit as I was greeted by shirtless male competitors (see photo above). Apparently, almost everyone at the Primal Games was on a team of some sort already, and many had prepared for the event for over a year (mostly at CrossFit gyms). As I gingerly approached the registration tent a well-muscled woman wrote a number in permanent marker on my arm and calf. I was branded and there was no turning back, so I decided to spend some time watching the other athletes warm up. I was astonished by some of their capabilities.

Take this guy for example (photo at left). He was able to hurdle the “women’s wall” that I struggled to scale and climb over. I stood there, staring aghast at the fellow like some kind of animal in headlights. I realized that I belonged on the sidelines as a spectator, not a competitor – but alas, I was in it for the duration.

The women at the event were only slightly less intimidating. Some looked like Olympic weight lifters, others were lean, mean, muscle machines. Very few were as old as I was. My fantasies of a day tossing water balloons back and forth with people in spandex and super-hero capes were fading fast.

And so the games began – three individual events arranged in heats, requiring a whole lot of “hurry up and wait.” My first challenge was a 1.5 mile trail run with obstacles. The distance seemed fairly innocuous so I took off at full tilt when they blew the air horn for my group. About a half-mile in I began passing members of the group that started ahead of mine. I wondered if I had misjudged my pace, but figured I’d deal with that later. I navigated jumping over some hay bales (no problem for a former dairy farmer), threw myself into the Army low-crawl and bolted across a boardwalk to come into the finishing stretch. And that is when I hit the wall. Literally.

I had never scaled a wall in my life and apparently there’s some technique to it. I ran up to the 6-foot obstacle, jumped up and grabbed the ledge and then hung there like some kind of limp towel. Nope, that was definitely not the right way to do it. Race officials tried to explain more successful strategies to me as I failed to scale the wall in a second embarrassing attempt. I opted for the penalty Burpees and crawled under the wall… only to face the next, slightly shorter wall. There was no way around it this time – I had to do it. A miss was a disqualification on the shorter wall.

Panting, sweating, and wearing all black in the midday sun, I somehow muscled my way over the short wall in the least elegant way known. I jogged ahead to the water slide, took a hard dive onto my chest and bolted to the finish line with no energy to spare. That performance was good enough for an 11th place finish in my age group (the “Masters women” – which hardly seemed a fair category title considering my lack of mastery of this challenge!)

The second event appeared deceptively straight forward. I had three minutes to launch 6 medicine balls backwards over a wall. But for every 7 feet closer to the wall you got, you had to do increasing numbers of penalty Burpees. I figured I’d be pretty good at this since I’m built more like a water buffalo than a gazelle, but no dice. This event was 70% technique, and figuring out how to get the ball to make the correct-shaped arc (so it cleared the wall) had a steep learning curve. Even the strongest-looking women often missed the wall because their ball ended up going straight up and down instead of backwards. I opted to get as close to the wall as possible and just “gut out” the high reps of Burpees.

I was relieved to see a familiar face in the crowd as I approached my med ball toss challenge. The owner of my home gym had arrived, video phone in hand, to memorialize my event. She was my only fan, and asked if I’d mind if she yelled out encouragements during my event. I agreed hesitantly, both nervous about the permanency of the video that was being made of my potential “flailings” and unsure if her shouts would induce panic or perseverance. Luckily for me it turned out to be the latter. And here’s the video to prove it:

The final event was a true soul-sucker. I watched some of the men compete, and they made it look easy. It was a combination of cement (aka Atlas) ball carries (up and down a field) and tire rope pulls. Again, as a “water buffalo” I figured I’d have an advantage on this one, but here is where I crumbled. As they started the timer, I ran out to the end of the tire pull rope and started dragging it towards myself, hand-over-hand. The weight of the tractor tire was startling, and it moved at about 1/5 the speed of the men’s pulls as I realized that this event was MUCH harder than it looked. I finally got the tire across the line and had to drag it back to the start. I was the slowest in my heat and could tell this wasn’t going to go well.

And then the race official pointed to the Atlas ball that I needed to pick up and put on my shoulder. I had never even touched one before. I squatted down, got my arms under it and used my quads to get it on my lap. The weight (75lbs) took my breath away. I knew there was no way I was going to be able to get this thing up and down the field and I lost heart. Somehow I managed to muscle it up to my shoulder, where it perched on my clavicle ominously. I started taking steps across the field. The weight was crushing. I marveled at the women in lanes next to me who were managing to make it down the field. Time stood still in the 95 degree heat with no shade and no relief anywhere in site.

By some miracle I got that ball all the way up and back, and made it through the next tire pull. Then back to the start again where the official instructed me to pick up the same Atlas ball and do a second lap. I felt the will drain out of my body. There was just no way I could do it. I struggled to get it on my shoulder again and made it on my third attempt but then got about 20 feet down the field and dropped the ball. I tried to get it up again but couldn’t. I tried to carry it like a baby in front of me but it broke through my arm hold. I asked the official if I could take a penalty and get a lighter ball. Nope. That was not an option. So I spent the last few minutes in a futile effort to move the ball down the field and then finally the merciful timer signaled the end of the heat. I was the only woman who couldn’t get the ball back the second time.

And it was at that point that the infamous words of Dirty Harry Callahan came to me, “A man’s gotta know his limitations.” I had certainly found mine, and the humble pie was bitter-sweet. On the one hand, I was pretty amazed that I had not given up and gone home at any of several understandable points during the day. On the other, I was keenly aware of my physical limitations – and had to bow the knee to the truly gifted athletes who won the day. Would I do this again? Hmmm. Ask me once my cuts and bruises are healed. All I can say is that other competitions seem less frightening now, and maybe that’s the best gift that the Primal Games has given me.

In the future when I’m asked to join friends for a half-marathon or similarly grueling event, all I need to ask is, “does it include Atlas balls?” And if the answer is, “no” then I’m in! Thanks to the Primal Games my comfort zone has permanently expanded. I hope you’ll join me in the zone sometime, my friends! Misery loves company, after all. 😉

P.S. The team winners of the Primal Games:

Eating Less Is More Important Than What You Eat

I was raised by a health food zealot, and have been “eating clean” for most of my life. I have been an editor of a peer-reviewed nutrition and obesity journal, a food critic, and a dairy farmer. I am passionate about food – but I am also passionate about science. And I have to tell you, that for measurable health benefits, how much you eat is more important than what you eat.

I know this is controversial, and I’m certainly not saying that we should throw out all our leafy green veggies and grilled chicken and chow down on a diet of Twinkies and beer. But what I am saying is that the relative importance of food volume versus food quality has been misrepresented. We are focusing too much on specific nutrients and not enough on total caloric intake. I’d guess that what we eat is about 10% of the obesity problem, and how much we eat is 90% of the problem, but we spend 90% of our time talking about changing and improving what we eat rather than portion control strategies.

Consider these research-based findings :

1. The CDC has determined that 90% Americans get all the nutrients they need from the food they eat. Even “crappy” US diets actually do provide the minimum nutrients needed to avoid disease and malnutrition. I know this is surprising, but vitamins and supplements are simply not needed by most people.

2. Measurable health benefits occur from weight loss as small as 5-10% of total body weight. You don’t need to be a bikini model to achieve the health benefits of weight loss. You can decrease your blood pressure, sugar, and cholesterol with modest weight losses. In my opinion, leanness under about 25% body fat (for women) is mostly an aesthetic choice, not one of medical necessity.

3. Exercise benefits are largest at minimal levels. Going from sedentary to slightly active provides a larger health benefit than all additional increments of exercise. Thirty minutes of exercise, five times a week, is the minimum bar set by the Department of Health and Human Services. Anything beyond that is still valuable, but doesn’t decrease health risks by as much.

4. It matters more to lose weight, than it matters how you do it. Head-to-head studies of one diet versus another have repeatedly shown minimal differences in health benefits between the diet groups. The benefits occur from the weight loss, not from the manner in which it was lost.

This is all good news. Americans can achieve healthier outcomes with less effort than generally believed. Regular exercise, and a calorie-controlled diet (rather than rigidly controlling the macro and micro nutrients) are all that is required to substantially reduce the risk of many costly and unpleasant diseases. If you want to further optimize your health by eating a diet rich in fruits and veggies, whole grains, low-fat dairy, healthy fats, and lean protein please do so! But better to be a normal weight than obese due to eating too much of that healthy diet.

The bottom line is that you don’t have to give up eating the things you like, you just have to eat less of them. Even Olympian Carmelita Jeter eats Hostess cup cakes occasionally. And she’s the fastest woman in the world!

P.S. This blog post was inspired by a Twitter conversation with @Judith_Graham who said that the complicated issue of what to eat was too difficult to address in 140 character exchanges. Thank you, Judith!

P.P.S. Also, I’ve been thinking a lot about well-meaning but misguided (IMO) health policy issues raised by mayor Bloomberg’s ban on Big Gulps and the AMA’s endorsement of soda taxes. Bloomberg was pointing in the right direction (the size of the soda, not the soda itself was the problem), but I don’t believe you can regulate good behavior. Education and personal responsibility are the way to go.

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »