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

Latest Posts

How Many Calories Do I Need? And Other Questions From The Boys & Girls Clubs Fit Family Challenge

This year’s finalists for the Boys & Girls Clubs’ Fit Family Challenge are about to be announced. I’ve had the privilege of acting as nutrition coach for the semi-finalist families, and have had fantastic interactions with them about common nutrition questions. In my continuing Q&A series, I thought I’d share some of our email conversations:

Q: How many calories do I need per day, and how many should I eat to lose weight?

I like to use this Mayo Clinic calculator to get a rough estimate of daily caloric needs.   If you enter your height, weight, age, and activity level it will tell you approximately how many calories/day you need to maintain your weight. To lose one pound a week, you need to subtract 500 calories/day from that number. So, for example if the calculator suggests that you need 2000 calories/day – you should follow a 1500 calorie/day diet to lose 1 pound a week. Studies have shown that people who drop more than 500 calories below their daily maintenance needs have a hard time sticking to their diet. You may feel weak, trembly, and irritable if you cut down too low too fast. You will have to play with the amount a little bit since the calculator is not exact – if you don’t see the scale moving when you cut out 500/day, then you have to wonder if you’re counting calories correctly or perhaps if you have to go a little bit lower still. Unfortunately, the “reward” for losing weight is that you have to permanently eat less when you are at your desired goal because there is less of you to feed!

Q: What do you think about sports drinks? Do my kids need them when running races?

As far as sports drinks are concerned, their benefits are often over-hyped and exaggerated. That being said, I believe they do have a role in hydration during endurance sports like long distance running. When you do strenuous exercise for long periods of time (over 1 hour of effort) you lose a lot of body salt and minerals (electrolytes) in your sweat. It’s important to replace certain key electrolytes so your body doesn’t become depleted and begin to cramp. This is more likely to happen to folks running very long distances, such as marathons and triathlons. However, if it’s hot during your race, you could be at risk for dehydration and electrolyte loss as well.

Regular Gatorade (made by Pepsi Co.) has water, sugar, sodium, and potassium in it. Powerade (made by Coca Cola) has water, sugar, sodium, potassium and B vitamins. Powerade has a little bit higher sugar concentration, which could be an advantage on a long run. Both are reasonable choices for hydration during a race.

The rough rule of thumb is to take in 6-12 oz of fluid for every 20 minutes of running. Water is sufficient for runs that last less than an hour. Sports drinks (or adding electrolyte gels/chomps to water) are helpful if your run will last longer than an hour. It’s better to sip the water slowly at regular intervals than to dry to gulp it all down at one time. You may feel nauseated or have a “sloshy stomach” feeling if you don’t spread out your hydration.

Sports drinks can be quite expensive – and you can easily create your own at home. The World Health Organization has a simple recipe for rehydration fluids, and I found this (probably slightly tastier) version on a blog site.

Outside of endurance sports, I don’t see a physiologic need for sports drinks (with the exception of extreme sweating in hot weather or during illness with vomiting and diarrhea) – they can add unnecessary calories to your diet.

Q: Should I cut down the amount of salt in my diet?

Not necessarily. Too little salt, as well as too much salt, have both been shown to be unhealthy. If you’re eating a lot of fast food, you’re probably getting too much salt. If you cook for yourself and focus on fruits and veggies, whole grains, and lean protein you may not need to cut back. Unless you have a kidney problem or very high blood pressure, salt is generally not dangerous for you. About 2.5g of salt/day (roughly a teaspoon full) is optimal, but for most people up to 4g/day probably won’t hurt (and at least one study suggests that heart disease risk doesn’t increase until the daily intake of salt exceeds 7g/day).

Home Remedy Of The Week: You Can Find It At The Deli Counter

A friend of mine had a bad reaction to a heart medicine, dropping her blood pressure to as low as 76/49 as a result. She was feeling understandably dizzy but didn’t want to go to the ER so she asked me if there was anything she could do at home to help raise her blood pressure. I recommended that she drink a large volume of water and take some salt tablets. She had no salt in pill form, and didn’t want to take it straight out of the shaker so asked if there was any other way to get the salt in. I asked her to describe the contents of her refrigerator and pantry, and made a mental note of what I thought had the highest salt content.

My friend thought that potato chips might do the trick, and was surprised when I told her that she had something almost ten times saltier at her disposal. Four ounces of prosciutto contained almost 2g of sodium, an entire day’s worth of salt! So she dutifully consumed the sliced meat, washing it down with about a liter of water. Two hours later she was back up to 98/66 and six hours later her blood pressure had returned to a healthy 116/83.

This was a rare case where a “high salt diet” had its benefits. In the case of ham versus hypotension, ham won… and saved my friend a costly, and unnecessary ER visit. Let’s hear it for deli meat!

The Right To Bear Salt: Is Sodium Restriction Warranted For The General Population?

Q. What is the difference between a public health expert and Il Duce?
A. Mussolini was not nearly as arrogant as a public health expert.

In prior posts, DrRich related how two major publc health efforts over the past few decades – the effort to put all of us on low-fat diets, and the effort to reduce everyone’s cholesterol levels – have amounted to massive experiments, based upon insufficiently-tested assumptions and surmises and hypotheses which the experts arrogantly (and incorrectly) determined to be fact, and which were conducted upon the entire American population without its knowledge or consent.

These public health experiments cost billions of dollars, needlessly transformed large swatches of American industry, and (at least in the case of low-fat diets) likely produced significant harm to the citizenry. Furthermore, despite such results, these misbegotten public health efforts have inured Americans to the notion that it is right and proper for government experts to determine for each of us what we must and must not eat.

DrRich now feels obligated to call his readers’ attention to yet another experiment which these same public health experts have launched, an experiment under which each of us – once again – is to become an unwitting research subject, an experiment whose results are unpredictable, but which has a realistic chance of producing harm to many of us. DrRich speaks, of course, of the new US dietary guidelines, published earlier this year, regarding sodium. Read more »

*This blog post was originally published at The Covert Rationing Blog*

Could A Low-Salt Diet Be Bad For Your Heart?

A spilled salt shaker

A paper in a recent edition of  Journal of the American Medical Association (JAMA) offers the contradictory conclusion that taking in less salt—a key goal of U.S. health and dietary recommendations—is bad for you. But before you roll your eyes and groan about flip-flops in science, know that this study isn’t the kind of work on which you or anyone should base dietary decisions.

In this study of 3,681 men and women from Belgium, Bulgaria, Italy, Poland, Romania and Russia whose health was followed for eight years, participants with the lowest sodium excretion (which is a good measure of sodium intake) were 56% more likely to have died from cardiovascular disease than those with the highest sodium excretion. Among the nearly 2,100 participants with normal blood pressure at the study’s start, sodium excretion (sodium intake) had no effect on the development of high blood pressure.

These are startling findings. If true, they would undercut major programs by the U.S. government to reduce Americans’ intake of salt—the main source of sodium—from prepared and processed foods and at home. Read more »

*This blog post was originally published at Harvard Health Blog*

How A Patient Who Asks For Salt For His Eggs Could Cost A Hospital $2.5 Million

This was a classic moment of comical clarity that only comes along once a week.  As you may or may not know, starting in 2013, The Medicare National Bank has promised to take back 1% of all  of a hospital’s total Medicare revenue (to increase in future years) if the hospital has a higher 30 day readmission rate for  congestive heart failure, acute myocardial infarction or pneumonia than an as yet undefined acceptable 30 day rate of readmission.

What does this mean?  It means if the government decides that 20% is an acceptable rate for congestive heart failure 30 day readmission, and the hospital has a readmission rate of 25%, the hospital will be told to return 1% of all Medicare revenue for the year, not just their heart failure revenue.

Let’s use some hypothetical numbers, shall we?  If a hospital generates $250 million dollars in a year on 25,000 Medicare discharge diagnosis related groups (DRGs)  but only 100 of those discharge DRGs (or $1,000,000) were heart failure in 2013, what would happen if 21 CHF patients returned for readmission  (a 21% thirty day readmission rate) within 30 days for heart failure instead of allowable 20%? The hospital would have to return 2.5 million dollars (1% of their total revenue on all Medicare admissions).
That one patient that took them from 20% to 21% will cost them 2.5 million dollars.  The hospital would generate one million dollars in CHF  revenue for the year and pay back 2.5 million dollars in penalty.  That’s a pretty hefty price to pay considering that hospital profit margins from Medicare have been negative, on average, for most of the last decade. Read more »

*This blog post was originally published at The Happy Hospitalist*

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 »