Flab Marches On.... at What Cost?

Despite a weight loss industry that that took in $189.8 Billion in 2018, Americans continue to get fatter and fatter every year. It is a harsh word, but it is a serious problem. Harvard's T.H. Chan School of Public Health, in a recent article published in the New England Journal of Medicine, forecast that if current (2018) trends continue fully one half of the population of the US will be obese by 2030. Not overweight, obese. They they predict that 25% of Americans will be morbidly obese. That compares with 40% obesity and 18% morbid obesity in 2019.

As we debate how we as a society are going to manage runaway healthcare costs, it is time to introduce into the debate reality that many of the drivers of major chronic illness in our country are largely, if not completely, under our individual control. Mostly that we eat too much and much of what we do eat is garbage.

Losing weight is not super easy, but neither is it impossibly difficult. I say this from personal experience. It takes determination, support, knowledge and persistence. And sooner or later people are going to start asking why people who are determined, find the support they need to succeed, educate themselves and persevere are required to pay the endlessly rising sickcare costs of those who choose not to. Its a good question, and not one we can ignore forever.

Healthy Nighttime Noshes

Admit it. We all have those moments when it is nearly time to hit the sheets, but we're craving a snack before we do. Rather than reaching for ice cream or chocolate chip cookies, here are four tasty and healthy alternatives from dietician and nutritionist Janet Bond Brill. Guilt free late night enjoyment under 200 calories.

Chocolate covered banana.

Chocolate is not bad for you. Milk chocolate maybe, but there are actually numerous health benefits to consuming dark chocolate on a regular basis, provided it is only in moderation and individuals don't find themselves eating multiple dark chocolate bars every day. Combine it with the potassium-rich banana and you have a healthy treat. Slice up the banana, melt some dark chocolate  baking chips in the microwave, drizzle the chocolate over the banana and top with a spoonful of fat-free whipped topping.


Pumpkin pie Greek yogurt.

Plain Greek yogurt is an outstanding, low-fat source of protein and calcium. Pairing it with a little pumpkin puree (available canned) adds yet more protein and a generous dose of antioxidants. And what could be easier than just stirring the two together?


Bell peppers with a spicy dip.

Bell peppers are a near calorie free source of vitamins and fiber. They aren't bad just eaten by themselves. But pair some pepper slices with a zesty hummus, salsa or honey mustard (yes just mix honey and mustard) and you have a filling and tasty snack.


Cinnamon apple chips.

If its chips you are craving try thinly slicing up an apple (just leave the skin on) and coating them with cinnamon and a healthy sugar substitute like stevia. Heat a low oven (225 degrees is good), spread the apple slices out on a baking sheet covered with a sheet of baking parchment and bake for 45 minutes, flipping once about halfway through. Sweet, crunchy and high in fiber.

CBD vs Opiods

Medical marijuana has been used for years now as a treatment for chronic pain, among other things. More recently, CBD has been getting a lot of attention as the active ingredient responsible for most of marijuana's medically interesting properties. CBD (cannabidiol) is distinct from THC (tetrahydrocannabinol), which is the substance the produces marijuana's characteristic "high". CBD is also commonly extracted from hemp, which has very low concentrations of THC.

The exact mechanism by which CBD acts as an analgesic (pain reliever) is not well understood and is the subject of much research. But it is known to be a very powerful anti-inflammatory, and inflammation is at the root of many conditions responsible for producing pain. Examples would be arthritis, lupus and the swelling caused by surgery or injury.

Opiod drugs work on specific pain receptors in the brain and cause the release of dopamine, which creates a powerful state of euphoric well-being. Unfortunately, dopamine is implicated in nearly all addictions. So far as is known, CBD does not stimulate the release of dopamine. It also does not produce the sensations of dizziness or sleepiness that opioids often do.

Of course not everyone has the same experience and your mileage may differ. If you need help dealing with a painful condition, especially a chronic one, confer with your doctor to create a custom pain management plan for you. And don't overlook ibuprofen, acetaminophen or motrin as additional alternatives.

Chill, man. Chill.

Normal body temperature is 98.6 deg Fahrenheit, right?

The 98.6 standard was set in the late 1800s based on observations of many patients by attending physicians. So it is an average observation, not a clinically established standard. We actually have no idea what average human body temperatures were prior to about 1860. But we do know this, it has been slowly decreasing.

Based on over half a million observations through 2017, average body temperature for a healthy person is now 97.9 deg F.

Dr. Julie Parsonette at Standford University Medical School offers several possible explanations for the slow decline. Chronic inflammation has decreased over the last 200 years, while general overall heath has improved. Better indoor heating and cooling systems make it easier for the body to maintain and regulate its internal temperature.

Body temperature depends on weight, gender, age and time of day. What defines a fever may need to be reassessed, especially for old guys like me, who tend to run a bit cooler than our younger brethren. See? Old is cool!

Generic vs Brand Name - Is There a Difference?

I've always been a big fan of generic drugs. They have the exact same active ingredients as brand name drugs and are normally much less expensive. Of the six billion prescriptions written in the US every year (that's 18 for every man woman and child in the country), 90% are filled with generic drugs. The FDA assures us that they are as safe and effective as their brand name doppelgangers. And for most people, most of the time, for most generics, they are. Mostly.

There are four issues that you may want to consider when opting for a generic.

1. Generic drug manufacturers often have less stringent quality control processes. Generics are often much cheaper, of course, but that means much thinner profit margins for the manufacturer. Leaving them less money to spend on frills like quality control. The FDA does inspect these manufacturers now and then, and mostly they meet the GMP standard. Mostly.

2. Instant vs timed-release formulations. Forty years ago nearly all prescription drugs were "instant release", their active ingredient was released immediately into the bloodstream. By the mid-1980s, pharmaceutical companies began to market "time-release" formulations that released the active ingredient over long periods of time. This allowed people to take just one dose per day instead of needing to take more every few hours. The FDA process for approving generic drugs is based on a "maximal concentration" standard. That is, the highest concentration produced by a single dose. This will be exactly the same or better for a generic compared to its brand name equivalent. But the hour by hours level of a generic drug in the blood may be very different, potentially reducing its effectiveness and increasing side effects.

3. Foreign manufacturing. About 80% of the active ingredients used in generic drugs are now made in foreign countries, including India, China, Thailand, Mexico, Turkey and Brazil. Many generic pills are manufactured abroad in their entirety. The FDA is severely limited in its ability to oversee these manufacturers. In the US, the FDA can simply show up at your door unannounced and inspect your facilities. Abroad, the FDA must schedule their visits in advance, giving manufacturers days or even weeks to prepare. Some of the issues this has lead to include low levels of the active ingredient, contamination and falsification of test reports. Again, most foreign manufacturers are honest and reliable. Most.

4. Transportation. Within the US, the FDA sets stringent requirements for the conditions under which a drug may be shipped. Storage, temperature, packaging and so on. It does not have this authority outside of the US. So a not uncommon scenario might be an active ingredient is made in China, shipped to India to be formulated into pills, then sent to Houston by container ship, trucked to a wholesaler in Phoenix  and finally distributed to pharmacies. No one can really say how this might affect the drug when you finally take it. Mostly you will be fine. Mostly.

If you are going to use generic drugs, and your insurance company will be pressuring you to do just that, there is little you can do to protect yourself from these issues. There are not really any particular categories of generic drugs that are safer or riskier than others. If you are taking a generic drug, make sure to monitor your lab results to ensure that it is having the desired effect. Consider buying the brand name drug from a Canadian pharmacy. This is likely to be somewhat more expensive, but it is perfectly legal. Be aware of whether or not your symptoms are responding as expected. Get the name of the manufacturer of your specific drug from your pharmacist. If you have any problems, try to get the same drug from a different manufacturer.

In the US, generics are indeed much cheaper than brand name drugs, and mostly they are safe and effective. Mostly. But there is no such thing as a free lunch.

Take 1 Cup of Spinach and Call Me in the Morning

More than 2 out of 3 doctor visits result in generating a prescription for one or more drugs. Think about that. A recent study completed by Tufts University suggests that you might be better off with a prescription for a better diet. The projected benefits of "food prescriptions" were, to say the least, startling.

Over the lifetime of the study participants, the food prescription plan (with some percentage of the cost covered by Medicare and insurance) was estimated to reduce cardiovascular deaths by 620,000 vs the standard drug therapies. Along with a $100 BILLION reduction in health care costs.

Study co-author Yujin Lee says that healthy food prescriptions could be "as or more cost effective for reducing hypertension and cholesterol as many other common interventions such as preventive drug programs."

Instead of worrying about who is going to pick up the bill for our sick-care after our diet and lifestyle make us ill, maybe there should be some discussion of not getting ill in the first place. Just a thought Bernie.

Diet Wrapup - The End or the Beginning?

So my month of committing to calorie counting is over and the results are in. Once again it worked, and I ended February at 194 pounds, down 10 pounds over the four weeks. My blood pressure has dropped a bit and I am even sleeping better.

I was certainly not perfect about it. There were some days where I ate too much. But I knew I had done it, and I knew how much I had busted my goals by and was easily able to make it up over the rest of the week. The pounds did not come off evenly over the month either. The first week I lost 5 pounds. The second week only one. But at the end of the month there I was at 194.

I do not feel hungry or like I have had to deprive myself of eating things. I was not on any special "diet" at all. I just ate what I normally eat. The difference was making conscious choices about when and how much I ate, eating standard portion sizes and keeping up with the (truly moderate) exercise. I am feeling pretty happy with the results.

For now I am adjusting my goal from losing weight to maintaining where I am and not putting any more on. I would estimate that the entire process of tracking calories has been taking about 15 minutes a day so it is no burden to keep doing it.

My 50th High School reunion is in October and I am thinking it would be great to show up there weighing the same as I did when I graduated. That would cost me only another 9 pounds over the next 7 months, and right now that seems almost too easy to me. And 185 pounds would be right on the dot for a healthy weight for my height.

So why is dieting so hard for so many people? Trust me, if I can do it, anyone can. If you have been struggling, drop me a message. Maybe I can help.