How to live longer and enjoy yourself more

Only 19 more days until we get some blessed relief from truly deep, bipartisan, political dudgeon, the worst in many years. Even friends and family are at each other’s throat. But politicians come and go, and the truth is that America is strong enough to survive a watch with either party at the helm. So let’s talk about something that really matters – your health.

All the experts agree – there are two major knobs you can turn to improve your health, sense of wellbeing, and longevity: diet and exercise. Let’s look at physical activity first.

While some of us are already physically active from choice (exercise, competition) or necessity (work), many are not. The New York Times reports a fascinating study of Finnish identical twins who differed significantly, in later life, in exercise activity. Genetics, early life and upbringing were all similar. It was only in later life that one twin exercised and the other did not.

“It turned out that these genetically identical twins looked surprisingly different beneath the skin and skull. The sedentary twins had lower endurance capacities, higher body fat percentages, and signs of insulin resistance, signaling the onset of metabolic problems. The twins’ brains also were unalike. The active twins had significantly more grey matter than the sedentary twins, especially in areas of the brain involved in motor control and coordination.”

The Centers for Disease Control (CDC) offer the following benefits of a non-sedentary lifestyle:

• ·         Control weight
• ·         Reduce risk of cardiovascular disease
• ·         Reduce risk for type 2 diabetes and metabolic syndrome
• ·         Reduce risk of some cancers
• ·         Strengthen bones and muscles
• ·         Improve mental health and mood
• ·         Improve ability to do daily activities and prevent falls
• ·         Increase chances of living longer

Further, the amount of exercise to achieve these benefits is not extreme. The CDC recommends at least 150 minutes of moderate exercise each week (less than 25 minutes per day), and some muscle strengthening exercise at least twice per week.

Moderate exercise may include any of the following:

• ·         Walking briskly (3 miles per hour or faster, but not race-walking)
• ·         Water aerobics
• ·         Bicycling slower than 10 miles per hour
• ·         Tennis (doubles)
• ·         Ballroom dancing
• ·         General gardening

But a very easy way to incorporate more activity into your life is to embrace a more physical daily routine.

• ·         Park as far from the mall as possible and walk; eschew the closest parking space
• ·         Walk to your corner store for sundries
• ·         Shovel your driveway of moderate snowfalls
• ·         Replace your lawnmower with a non-driven walk-behind
• ·         Take the stairs whenever possible

All of this counts toward your 150 minute weekly goal.

The other major knob within your control is diet. Here are the key recommendations from the American Heart Association. Your diet should emphasize:

• ·         a variety of fruits and vegetables,
• ·         whole grains,
• ·         low-fat dairy products,
• ·         skinless poultry and fish
• ·         nuts and legumes
• ·         non-tropical vegetable oils

Ensuring that you are getting adequate dietary fiber is extremely important. One very easy rule of thumb comes from Harvard Health. When purchasing food items, quickly check the nutrition label. Locate two numbers: total carbohydrates and dietary fiber. Select the food only if dietary fiber is at least 10% of total carbohydrates. They offer this simple method: Divide the grams of carbohydrates by 10. If the grams of fiber is at least as large as the answer, the food meets the 10% standard.

Here are some examples of food you would or would not purchase based on this approach:

• ·         Whole Wheat Spaghetti – Yes
• ·         Standard (white) pasta – No

• ·         Fiber One Chewy Bars – Yes
• ·         Typical granola bar – No

• ·         Shredded wheat cereal – Yes
• ·         Any sugary cereal – No

• ·         Smartfood popcorn – Yes
• ·         Most potato chips – No

Further, you can look up the nutrition information of home-prepared foods using the web. Here is another choice that might surprise you:

• ·         Baked potato with skin on (dressed like a salad with olive oil and vinegar) - Yes
• ·         Mashed potatoes prepared with milk and butter - No

In all the foregoing is the implicit message that we must eat less meat. The healthiest peoples of the world eat meat occasionally as a treat, not a daily staple.

In conclusion, a crash diet isn’t going to help you. An unused gym membership is worthless. To be effective, you must mold for yourself a healthy lifestyle.

Exercise takes time. That is your investment, but the payoff is huge. If woven into your daily routine, it is not so difficult nor noticeable.

Here is to you and a long, healthy life. After all, we will need to last at least one more election cycle in hopes of getting better choices. 

We are not alone

Science News Magazine has been published since 1922, over ninety years. The news arm of the non-profit Society for Science and the Public educates and informs the public about current happenings in science and technology. It has covered such seminal events as the first man-made nuclear reaction, the first electronic computers, man’s first walk on the Moon, and the first jet aircraft. For some time, the editors have selected the top science story of each year.

For 2013, there were plenty of candidates. The amazing rise of miniature unmanned aerial vehicles (drones). Gene therapy advances in managing blood cancers. The ability to grow replacement organs from scratch. The Nobel prize in physics for the discovery of the Higgs boson.

But what was the top science story of 2013? Bugs.

Or more precisely, bacteria and other organisms which make up the microbiota living on and within the human body.

In a steady stream of studies and reports throughout the year, we learned more and more about our remarkable little cousins. For instance, the fact that only 10 percent of your cells are human; the other 90 percent are a mixture of bacteria, fungi, and viruses. (That microbes are so tiny and human cells relatively huge accounts for the fact that, by mass, our microbiota only amounts to a few pounds).

Scientists are even beginning to argue that we should view the human body as a superorganism defined by this mixture of human and microorganism DNA (microbiome). The advantage in doing so is that it might help us better understand the effects of diet, chemical exposure, and other factors on our health.

It is important to note that our community of microorganisms is for the most part beneficial. They help us digest food and convert it more efficiently to energy. They influence the immune system, training it to identify and fight true pathogens. They produce hormones instructing our body to store fats, and create necessary vitamins. To understand the workings of the human body without considering our microbiome is, we are finding, impossible.

Michael Pollan, in an in-depth New York Times Magazine article (“Some of My Best Friends are Germs”, May 15, 2013), details his research into this new frontier. Starting with a submission of swabs to the BioFrontiers Institute at the University of Colorado, he received a detailed report of his personal microbiome. Pollan interviews the scientists involved in the project and describes how our microbiome, unique as a fingerprint, is developed. Soon after birth, a community of microbes takes hold in the infant gut. Its composition from there is influenced by environment and, mostly, diet. In fact, the BioFrontiers scientists can identify from a person’s swab samples both where they live in the world and what is the makeup of their diet.

Researchers have observed that obesity may be encouraged by a certain mix of gut flora. And that mix of flora is a result of diet. Meat eaters have a distinct pattern of gut flora from vegetarians. Diets high in sugars and fats are quickly absorbed, denying nutrition to our little minions. They prefer diets high in fiber and complex carbohydrates; these take much longer to digest. What a surprise, then, to see that independent research into low glycemic index (GI) diets have concluded that diets high in fiber and complex carbohydrates are highly preferable for health. The microbes are the key, and they live or die by our dietary choices.

So what might this flood of human microbiome research mean? Perhaps we’ll find that our war on bacteria, with a plethora of antibiotic soaps and cleaning products, might be taking a toll on our little helpers. Certainly we need to be concerned with pathogens, but perhaps we are overdoing it.

We might find that diet books of the future will focus on cooking for our whole selves. Lightly cooked vegetables, whole grains, al dente pasta, for instance, all take longer to digest and provide the fiber that our gut bacteria thrive on. Feed them well and they will serve us well. It would be a complete change in perspective and provide a grand new toolset for managing obesity and optimizing health.

There is much research yet to do and understanding to be gained. But it is exciting that we are beginning to comprehend the owner’s guide to the whole human being.

Obamacare - Mind-numbing Complexity

"Professor Butts and the Self-Operating Napkin"

The implementation of the Patient Protection and Affordable Care Act is causing some considerable perplexity and dissension among the citizenry. But its goal is crystal clear.  According to Kathleen Sibelius, Obamacare’s primary objective is to “make coverage more secure for those who have insurance, and extend affordable coverage to the uninsured.”

This presumes that expanded insurance coverage will improve health, and well it might. But this is not a given – there are many other factors affecting the nation’s health. (Hint – obesity, alcohol, tobacco).

A secondary goal of Obamacare is to “bend the cost curve”, that is, to make health care (and hence insurance premiums) cost less than it otherwise would have. Again, this is within the realm of the possible, perhaps over a long time frame. But early experience shows 2014 insurance premiums increasing at an alarming rate, often double the cost of 2013.

A key feature of Obamacare is its complexity: a multitude of tightly interdependent moving parts. The inauspicious roll out of Healthcare.gov (termed a "debacle" by the administration) is only a symptom of the law's impenetrable convolution. 

One might make reference to Rube Goldberg, whose contraptions were fantastically complex. But in the end, they could actually be made to work. The administration is fervently hoping for such good fortune.

As well meaning as it is, Obamacare has two fundamental shortcomings:

1. Mind-numbing complexity

1. Valiant but misdirected goals

To the first point, Obamacare features a flurry of economic features intended to fund the program. These include requiring all policies to provide a broad range of “essential” services regardless of whether the policyholder wants or needs those services. For instance, young single men do not require maternity coverage but will be forced to pay for it. Older folks do not need pediatric care but are obligated to purchase it. This is not “essential” coverage at all but, rather, hidden taxes.

But Obamacare has plenty of obvious taxes, too. From a sympathetic website (www.obamacarefacts.com), here is a partial list of Obamacare taxes:

• 2.3% Tax on Medical Device Manufacturers

• 10% Tax on Indoor Tanning Services

• Blue Cross/Blue Shield Tax Hike

• Excise Tax on Charitable Hospitals which fail to comply with the requirements of Obamacare

• Tax on Brand Name Drugs

• Tax on Health Insurers

• Elimination of tax deduction for Rx drug coverage with Medicare Part D

• Employer Mandate $2000 to $3000 per employee

• Medicare Tax on Investment Income of 3.8%

• Medicare Part A Tax increase of 0.9%

• 40% Excise Tax on "Cadillac" plans

• Annual $63 fee per subscriber to fund “risk corridors”

• Medicine Cabinet Tax (OTC medicines no longer qualified as medical expenses for HSA/FSA)

• Additional Tax on HSA Distributions

• Contributions to FSAs are Reduced

• Medical Deduction Threshold tax increase

• Individual Mandate (the tax for not purchasing insurance if you can afford it)

Using static scoring, the Congressional Budget Office has projected the revenue to be garnered from these sources. But humans aren't static and behavior easily morphs. Another source of complexity and uncertainty.

This combination of mandates and complicated funding sources (not to speak of over 11,000 pages of regulations) has made the program mind-numbingly complex and led to the first of many unintended consequences (the recent cancellation of millions of “non-conforming” policies). People are perplexed, puzzled, and, perhaps, a little bit scared.

To the second point, the stated goals of Obamacare are misdirected in that what we want, what we really really want, is to directly improve the health of the American public. Obamacare assumes that insurance for all will improve general health. And it might.

But if we’re in a mandating mood, then let’s mandate that sugar and fructose and salt and unhealthy fats be removed from our diets. Require that people eat high fiber, low glycemic-index diets under threat of penalty. Demand that everyone walk 10,000 steps per day (age adjusted) or pay a sloth tax.

According to Harvard Health, the medical costs of poor diet and obesity run nearly $200 billion per year to treat diabetes, cancer, heart disease, etc.  That amount, if even partially avoided, would most assuredly “bend the cost curve”.

But we are Americans, free of spirit in our loose fitting clothes. We’d rather purchase mandated “essential” insurance coverage than have our love affair with junk food disrupted. As voters, that’s our prerogative. And who knows - it just might work.

Thin can be contagious - really!

In the old days, our moms would paint our scratches and nicks with Mercurochrome or, heaven forbid, Merthiolate, which stung like the devil. The goal was to hold the germs at bay. We had a pretty clear idea that our skin was a clear dividing line between that which is us and that which is not. And germs of all kinds were to be kept out.

But to our surprise, we are increasingly finding that some germs, species of bacteria called gut flora in particular, are not only harmless but downright beneficial.

The human digestive system contains trillions of bacteria weighing in at two to four pounds and actually outnumbering the human cells in our body. Gut flora help us process nutrients, harvest energy, create certain vitamins, and provide protection from pathogens. This symbiotic relationship is very complex, one of which we are still just scratching the surface.

Now a new study (Science, September 6) has given us a fresh sense of wonder about our tiny cousins. The surprising finding is that, not only do fat people and thin people have different species of bacteria in their guts, but those bacteria can actually influence obesity.

The study centered around a set of rare human twins, one of which was fat and the other thin. When laboratory mice received bacteria from the obese twin, they started to become fat. Mice receiving bacteria from the lean twin stayed thin. Here is the really interesting part: when the mice were comingled and bacteria in their guts were able to compete, the “thin” bacteria won the competition, infected the guts of obese mice, and kept their new hosts from gaining weight.

So far so good. But if these thin bacteria are naturally dominant, why aren’t there raging epidemics of leanness spreading across the continent?

The answer is diet. The thin bacteria were dominant when the mice were fed a low-fat, high-fiber diet. But when researchers changed that to a high-fat, low-fiber diet (more typically American ), the thin bacteria lost their dominance. They were still able to keep lean mice thin, but they were unable to establish a presence in the guts of obese mice.

The research is promising and bacterial weight therapy may be in our future. But, unfortunately, nothing that will overcome a diet of cheeseburgers and fries.

Why do we care? Because the negative effects of obesity are so severe. The CDC cites research showing that when weight increases to “overweight” or “obese,” the risk of the following conditions rises significantly:

•     Coronary heart disease
•     Type 2 diabetes
•     Cancers (endometrial, breast, and colon)
•     Hypertension (high blood pressure)
•     Dyslipidemia (for example, high total cholesterol or high levels of triglycerides)
•     Stroke
•     Liver and Gallbladder disease
•     Sleep apnea and respiratory problems
•     Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint)
•     Gynecological problems (abnormal menses, infertility)

The health effects are enormous; the impact on quality of life is tragic. And the economic impact is huge, estimated at $147 billion per year. Now that we are all in the same taxpayer-subsidized health insurance risk pool, that should make you take note.

Michelle Obama is right. As a nation, we need to begin moving to a diet which is more low-fat and high-fiber on average.In fact, if we were all to pretend we were pre-diabetic and took up a low GI (glycemic index) diet, our collective weight loss would be measured in megatons.

An apple a day, indeed, may keep the doctor away.