From 12/23/2003 - Lights Out

From 1/3/2004 - Doms

From 5/31/2004 - Vitamin D

From 9/12/2004 - Functional Foods for Heart Health

From 11/13/2004 - Eat Less to Live Longer?

9/2/2007

Sleep: How much is enough?

After reading an article in the September 2, 2007 Sunday Chronicle titled, “The More You Sleep, The Longer You Live,” I wanted to know how much sleep we really need and if it changes with age. This article emphasized getting enough sleep, seven to eight hours a day for most adults.(1)

Sleep needs vary from person to person, and they change throughout the lifecycle. Most adults need 7-8 hours (2,3,4) of sleep each night. Newborns, on the other hand, sleep between 16 and 18 hours a day, and children in preschool sleep between 10 and 12 hours a day. School-aged children and teens need at least 9 hours of sleep a night (2). Other studies state that infants and young children sleep an average of 16 – 20 hours per day; and people over 60 yrs of age, 6.5 hours daily (3, 4). Some people believe that adults need less sleep as they get older. But there is no evidence to show that older people can get by with less sleep than younger people. As people age, however, they often get less sleep or they tend to spend less time in the deep, restful stages of sleep. Older people are also more easily awakened.(2)

Patterns of sleep vary with age (8); it is thought that the amount of time spent in deep sleep decreases and the number of awakenings through the night and total time awake increases with age. Studies have reported more complaints regarding insomnia from older respondents (8,9), and sleep apnea may also be more prevalent in the elderly (10). However, a standard definition of what constitutes normal sleep is lacking, and community-based epidemiologic studies of sleep patterns that use similar definitions of insomnia and control for physical health, mental health, age and socioeconomic variable are scarce (9). The insomnia literature is therefore difficult to summarize to formulate precise estimates of the burden of illness (11).

I found another study that confirmed that teens need 9 to 9.5 hours of sleep to maintain optimum alertness (5). Since I have a teenager at home, this was also interesting to me. The consequences of daytime sleepiness in childhood includes the loss of inhibition of the prefrontal cortex, leading to mood swings, impulsivity, and impaired attention and concentration, and increased vulnerability to accidents, and the ability to convert short term memory into long term memory is impaired (6). These are negative consequences that I would like to try to avoid with my own teenage son.

Teens tend to sleep later and wake earlier for school resulting in significant sleep deprivation and daytime sleepiness (6). Inadequate sleep hygiene is a common pediatric sleep-wake problem. Teenagers are unable to fall asleep before 10:30 or 11pm owing to a physiological shift in the timing of release of melatonin, which usually induces sleep at around 8:30pm in preadolescence (5). Melatonin is a hormone produced by the pineal gland and is thought to be an endogenous sleep inducer (13). Delayed sleep phase syndrome typically starts in adolescence, mostly in boys. Patients habitually fall asleep before 2 or 3am and prefer to wake in the late morning or early afternoon. They show normal sleep quantity and quality when allowed to sleep freely but are very sleepy when they have to conform to more conventional sleep-wake schedules (7). This sounds like my son in his first year of high school. Lydia Dotto wrote a paper that focused on the studies of C Smith, stating that staying up all night studying for an exam might be the worst thing a student could do (12).

From these studies, I conclude that it is difficult to determine if older people can get by with only 6 hours of sleep or if physical health, mental health, and other variables simply result in older people getting less sleep (4). I also conclude that my son needs at least 9 hours of sleep, but I’ll be more understanding about how difficult that is when his school starts so early. It will help him to have good sleep hygiene (5).

1. The More You Sleep, The Longer You Live. Dr. Keith Humphreys. September 2, 2007, San Francisco Chronicle Magazine.

2. In Brief: Your Guide to Healthy Sleep. April 2006. NIH Publication No. 06-5800. http://www.nhlbi.nih.gov/health/public/sleep/healthysleepfs.pdf.

3. Wolkove N, Elkholy O, Baltzan M, and Palayew M. Sleep and aging: 1. Sleep disorders commonly found in older people. CMAJ. 2007 April 24; 176(9): 1299–1304.

4. Rajput V, Bromley SM., 1999. Chronic insomnia: a practical review. Am Fam Physician;60:1431-8.

5. Kotagal S, Pianosi P., 2006. Sleep disorders in children and adolescents. BMJ; 332:828-832.

6. Carskadon MA, Wolfson AR, Acebo C, Tzinschinsky O, Seifer R., 1998. Adolescent sleep patterns, circadian timing, and sleepiness at a transition to early school days. Sleep; 21(8):871-881.

7. Archer SN, Robilliard DL, Skene DJ, Smits M, Williams A, Arendt J, von Schantz M., 2003 Jun 15, A lenghth polymorphism in the circadian clock gene Per3 is linked to delayed sleep phase syndrome and extreme diurnal preference. Sleep: 24(4):411. cited in Carskadon MA, Wolfson AR, Acebo C, Tzinschinsky O, Seifer R., 1998. Adolescent sleep patterns, circadian timing, and sleepiness at a transition to early school days. Sleep; 21(8):871-881.

8. Hauri PJ, Esther MS. Insomnia. Mayo Clin Proc 1990;65:869-82 cited in Holbrook AM, et al. The diagnosis and management of insomnia in clinical practice: a practical evidence-based approach. CMAJ 2000;162(2):216-20.

9. National Institutes of Health Consensus Development Consensus Statement: the treatment of sleep disorders of older people. Sleep 1991;14(2):169-77 cited in Holbrook AM, et al. The diagnosis and management of insomnia in clinical practice: a practical evidence-based approach. CMAJ 2000;162(2):216-20.

10. Ancoli-Israel S, Kripke DF. Prevalent sleep problems in the aged. Biofeedback Self Regul 1991;16:349-59 cited in Holbrook AM, et al. The diagnosis and management of insomnia in clinical practice: a practical evidence-based approach. CMAJ 2000;162(2):216-20.

11. Holbrook AM, Crowther R, Lotter A, Cheng C, and King D. The diagnosis and management of insomnia in clinical practice: a practical evidence-based approach. CMAJ 2000;162(2):216-20.

12. Dotto Lydia. Sleep Stages, Memory and Learning. Can Med Assoc J. 1996;154(8):1193-96.

13. Wolkove N, Elkholy O, Baltzan M, and Palayew M. 2007. Sleep and aging: 2. Sleep disorders commonly found in older people. CMAJ. 176(10): 1449-1454.

From: 11/13/04

Eat Less to Live Longer?

     At a time when everything from sport utility vehicles to hamburgers come "supersized," the notion that less is more may seem out-of-date to some Americans. But when it comes to calories, eating fewer just might be a prescription for a longer, healthier life. Learn about the theory and research behind calorie restriction from Jenna A. Bell-Wilson, PhD, RD, LD, and assistant professor of medical dietetics at Ohio State University.

1. The Secret of Longevity?

     Researchers were fascinated to learn that the island of Okinawa in Japan is home to the highest percentage of centenarians (those aged 100 or older) in the world; 39.5 for every 100,000 people, compared to about 10 in every 100,000 Americans, according to a Newsweek article (Takayama 2003). The okinawa islanders consume a high-quality diet - mainly homegrown vegetables, tofu and seaweed; they also tend to live low-stress, active lives. Interestingly, while most Okinawans have protein and fat intakes similar to those of fellow citizens, the Okinawans' calorie levels are 20 percent lower than the Japanese national average (Heilbronn & Ravussin 2003).

2. Longevity and Calorie Restriction

     So, is eating fewer calories - without being undernourished - the answer to longevity? In animals placed on low-calorie, optimal diets, the typical signs of aging - such as declines in immune function and loss of functional capacity - slowed down (Roth, Ingram & Lane 1999).

     Unfortunately, research on the effect of calorie restriction in humans is limited.

     In the Biosphere 2 experiment, participants living in a self-contained ecological space outside of Tucson, Arizona, had to eat a low-calorie diet after experiencing problems with crop cultivation (Walford et al. 1999). Originally meant to eat 2,500 calories per day, the subjects averaged only 1,800 calories a day for the first 6 months, then switched to about 2,000 calories daily for the remaining 18 months. The diet consisted primarily of vegetables, fruits, nuts and grains and modest amounts of dairy, eggs and meat. At the end of 2 years, participants had not only lost weight but also reduced their blood pressure, blood glucose, insulin, total cholesterol, low-density lipoprotein ("bad" cholesterol) and triglyceride levels, all of which - when elevated - are linked to the development of chronic disease (Walford et al. 2002).

3. The Bottom Line

     Calorie restriction without undernutrition may turn out to be a prescription for a longer and healthier life. However, more studies are needed before conclusions can be drawn. In the meantime, you can take small steps toward healthy lifestyle changes (see "Living Long, Not Large" below).

References:

Heilbronn, L., & Ravussin, E. 2003. Calorie restriction and aging. American Journal of Clinical Nutrition, 78, 361-9.

Roth, G., Ingram, D., & Lane, M. 1999. Calorie restriction in primates. Journal of the American Geriatrics Society, 47(7), 896-903.

Takayama, H. 2003. The Okinawa way. Newsweek (January 13), 54-5.

Walford, R., et al. 1999. Physiological changes in humans subjected to severe, selective calorie restriction for 2 years in Biosphere 2. Toxicological Sciences, 52, 61-5.

Walford, R., et al. 1999. Calorie restriction in Biosphere 2. Journals of Gerontology: Series A, 57(6), B211-24.

Living Long, Not Large

Here are some strategies you can use to reduce unnecessary calorie consumption without creating nutrient deficiencies:

Reprint permission is granted to IDEA members by the copyright owner, IDEA Health & Fitness Inc. (800) 999-4332, www.ideafit.com.

From: 9/12/04

Functional Foods for Heart Health

     Did you know that cardiovascular disease (CVD) has been the leading cause of death in the United States every year since 1918? Fortunately, exercise, stress management and healthy eating can reduce the chance of getting CVD.

     Enhancing your diet with functional foods can also help. These foods have a potentially beneficial effect on health when eaten regularly at effective levels as part of a varied diet. Described below by Susan Kundrat, MS, RD, LD, a sports and wellness nutritionist and the owner of Nutrition on the Move in Urbana, Illinois, are some functional foods that can impact heart health.

1. Oats and Psyllium

     More than 40 human studies over a period of 30-plus years have documented the cholesterol-lowering benefits of oats. Instant oatmeal, rolled oats, oat bran and whole oat flour are all good sources. An effective daily intake is 3 grams (g) per day.

     The seed husk of psyllium is another soluble fiber shown to be effective in lowering blood cholesterol levels. You may be familiar with the psyllium in Metamucil^TM. To lower cholesterol, you need to consume three servings of Metamucil per day (one serving contains 3.4g of seed husk) to reach the effective daily intake of 10.2g of husk. You can also buy the husk in bulk from natural food stores and use it as a powder in juice, smoothies or cooked cereals.

2. Soy

     After reviewing a total of 43 studies, the U.S. Food and Drug Administration (FDA) concluded that an average daily intake of 17 to 31g of soy protein significantly lowers both total and LDL cholesterol. Based on these findings, the FDA determined that the effective daily intake is 25g of soy protein a day.

     Add soy to your diet gradually, to prevent indigestion, gas and bloating. Start with one serving daily and work up to two to three servings to reach 25g. Soy protein is found naturally in soy milk, tofu, tempeh, roasted soy nuts and miso. You can also find it in many processed and fortified foods, energy bars and drinks.

3. Flaxseed

     While much of the research on flaxseed has focused on its use for cancer prevention, studies are now looking at its role in CVD protection. Research indicates that the fiber in flaxseed may combine with essential fatty acids to promote heart health.

     Because flaxseed is high in fiber, it has a laxative effect and should be added to the diet gradually. Start with approximately 1 to 2 teaspoons of ground flax meal per day and work up to 2 tablespoons (1 tablespoon equals approximately 8g). Effective daily intake is 15 to 50g per day. The best way to enhance freshness and potency is to buy whole seeds and grind them in a coffee grinder (but not the one you use for coffee beans!) If you use preground seeds, refrigerate them in a tighly sealed container. Ground flaxseeds can be added to baking mixtures or smoothies, sprinkled on cereal or mixed with peanut butter or soy nut butter to make a spread.

     Other heart-healthy functional foods include nuts, purple grapes, fatty fish and cholesterol-lowering margarines. For more information, see the University of Illinois Functional Foods for Health Porgram at www.ag.uiuc.edu/ffh.

From 5/31/2004:

Do you get enough vitamin D? Did you know that the consequences of vitamin D deficiency are serious? Not having enough vitamin D may lead to chronic muscle and joint pain and osteoporosis – or even high blood pressure, colon cancer, non-Hodgkin’s lymphoma (a cancer) and multiple sclerosis.¹ According to Michael F. Holick, director of the Vitamin D, Skin and Bone Research Laboratory and Professor of Medicine, Dermatology, Physiology, and Biophysics at Boston University Medical Center, vitamin D deficiency increases the risk of bone fracture.²

That’s some scary stuff! What’s also scary is that doctors often misdiagnose this deficiency as arthritis or fibromyalgia. The bone disease that is caused by vitamin D deficiency is called osteomalacia.

Your body needs vitamin D to absorb calcium and phosphorus from the food you eat. It also helps the calcium and phosphorus get into the bones to make and lay down the bone’s internal structure. Without enough D, kids end up with rickets (bowed legs) because their bones aren’t developing properly and can’t hold up the weight of the rest of the body. In adults who don’t get enough vitamin D, the calcium is drawn from the bones (calcium is needed by the muscles to work), and isn’t put back, which causes osteoporosis. You won’t notice osteoporosis until you break a bone, but osteomalacia is painful because it can cause muscle weakness as well as bone ache and bone pain.

Are you convinced that we need to make sure we’re getting enough vitamin D? I hope so!

So, where do you get vitamin D? The best source is the sun! Yes, your body will make vitamin D when your skin is exposed to direct sunlight. You only need 10 to 15 minutes a day! That’s great, now that summer is here! Problem is… we’ve all been told that we must wear sunscreen of SPF 15 or greater to protect our skin from the “harmful” UV rays of the sun. The other problem is that from November through February, in most of the U.S. (upper 2/3), you can't make enough vitamin D from sunlight. It's also more difficult for darker skinned people to make vitamin D from sunlight.

This summer, try to catch some unfiltered rays before you put on the sunscreen. Maybe you can walk from the car to the beach and then put on the sunscreen. Remember, only 10 to 15 minutes a day is all you need. If you’re still squeamish about getting any sun, or if you have darker skin, then how much do you need and where do you get it?  The “Daily Value” is 400 IU, but the upper limit published by the Institute of Medicine is 2,000 IU. Dr. Holick, in the article in the December issue of Nutrition Action Health Letter, stated “Many experts now agree that, on average, you need 1,000 IU a day if you’re not exposed to sunlight.” You can get vitamin D in fortified milk. An 8 ounce glass only has 100 IU, so you’ll need lots of milk! A few orange juices, yogurts, margarines and hot cereals are also fortified. Fish such as halibut, catfish, tuna and salmon are also good sources. Finally, taking a supplement works, too.

1 – Health Magazine, June 2004, article: “The sunshine vitamin: why you need more”

2 – Nutrition Action Health Letter, December, 2003, article: “Soaking up the D’s”

From 1/3/2004:

Reprinted with permission from IDEA Health & Fitness, Inc.

Client Handout, IDEA Personal Trainer, January 2004

Preventing Muscle Soreness

If you have just begun a fitness program, or perhaps started up again after a long holiday break, you may have become really sore after exercising. You are probably experiencing delayed-onset muscle soreness (DOMS). Is this discomfort a necessary part of exercising? Get the scoop from two experts at the University of New Mexico, Albuquerque - Johndavid Maes and Len Kravitz, PhD.

1) What Is DOMS? DOMS is the perception of pain and discomfort following exercise that involves increased intensity; longer duration; unfamiliar movements; or eccentric muscular work, such as downhill running or plyometrics. This discomfort is a normal response, and most people experience it to some degree.

2) What Are the Causes and Symptoms of DOMS? For many years DOMS was blamed on the buildup of lactate (a metabolic by-product produced in the muscles from the breakdown of carbohydrate) after intense workouts, but recent research has demonstrated that the soreness following intense eccentric exercise is completely unrelated to lactate buildup. DOMS is actually brought about through tissue trauma caused predominantly by eccentric exercise. This type of exercise damages the muscle cell membrane, causing inflammation and leading to the formation of metabolic waste products that act as a stimulus to the nerve endings directly responsible for the sensation of pain.

   Symptoms of DOMS can include pain, muscle tenderness, stiffness, swelling and loss of strength. Pain and tenderness usually hit the high point 1 to 3 days after exercise and subside within 7 days. Stiffness and swelling can peak 3 to 4 days after exercise and generally resolve within 10 days. Strength loss typically peaks within 48 hours after exercise; full recovery can take as long as 5 days. These symptoms are not dependent on each other and do not always occur together.

3) What Can Help?  Nonsteroidal anti-inflammatory drugs (NSAIDS) - such as aspirin and ibuprofen - were long considered a way to alleviate the symptoms of DOMS, since they were thought to combat the inflammation that occurs with exercise-induced muscle damage. However, because of inconsistencies in the research on NSAIDS and the possible side effects of their use, such as gastrointestinal distress and hypertension, these drugs no longer appear to be the best choice for treating this condition. Employing physical strategies seems to be a more consistent, effective way to keep soreness at a minimum. (See "Physical Ways to Decrease Soreness" below.)

   Understanding the causes, symptoms and treatment of DOMS may help you avoid its complications - so you can keep exercising!

Physical Ways to Decrease Soreness

Try these strategies to minimize delayed-onset muscle soreness (DOMS):

This information is a service of IDEA, the leading international membership association in the health and fitness industry, www.IDEAfit.com. Copyright 2004 by IDEA Personal Trainer. Reprint permission is granted to IDEA members by the copyright owner, IDEA Health & Fitness Inc., (800) 999-4332.

From 12/23/2003:

"LIGHTS OUT"

By T.S. Wiley & Bent Formby, Ph.D.
Synopsis by Noah Hittner, article from PT on the Net

Believe it or not, we are often sick, fat, diabetic, and suffering from heart disease and cancer because we don’t sleep. The invention of the light bulb brought with it a host of chronic health concerns. In 1910 the average adult slept 9-10 hours per night for over 4,000 hours yearly. Currently we are lucky to get 7 for an average of 2,555 hours yearly. The body is punishing us for this.

Mammals are hard wired to store fat, become insulin resistant, and get high cholesterol during the longer days of summer, and then, to sleep (hibernate) or at least starve for a while, become insulin sensitive again, and drop cholesterol levels when the days are shorter (winter). This cycle was programmed into our physiology over a millennia. Electricity and the light bulb brought endless light, which the body interprets as endless summer. Now, we don’t sleep (hibernate) and we don’t starve (for carbohydrates). We are fat, and getting fatter.

Literally the later you stay up at night the more your brain will force you to seek energy for storage by eating sugar (carbs). Again, your body is thinking “endless summer before the winter.” Sugar is the only path to insulin release. (Please remember that ALL carbs that are not fiber, whether they are complex or simple, break down into sugar at the cellular level.) Insulin’s job is to store excess carbs as fat and CHOLESTEROL. Cholesterol levels increase to lower the freezing temperature of the cell membranes in preparation for the hibernation, that never comes.

Additionally, all of these late nights equate to massive “light toxicity.” This condition causes excessive paranoid, aggressive, hysterical, and urgent behavior - or STRESS. In this chronic state, blood sugar is elevated, taxing the insulin response, increasing CORTISOL levels in the blood which has powerful blood sugar mobilizing effects. Get ready for this. This means if you are not paying attention to these factors, signs, and symptoms; and you stress yourself out too much - EXERCISE CAN MAKE AND KEEP YOU FAT!!! Rather than acknowledging these facts, the traditional medical establishment has given us Mevacor, Provachol, and Lipitor... ($$$?)