“Exercise is good for you!”

“Exercise is good for you.”  How many times have you heard this phrase?  It has been said so often that it rivals similar health mantras in frequency such as “Eat your vegetables”, “Stop smoking!” and “Take your vitamins” (the last one hopefully I disproved the value of in an earlier post!).  Yet, we seldom ask for explanations about why these recommendations are supposed to form the foundation of our habits.  This post will review the reasons we talk about exercise and health, specifically discussing benefits that go beyond the widely known effects of lowering the rate of heart disease.  Hopefully, after reading this you will feel even more committed to your current exercise regimen or will feel encouraged to start exercising if you are not currently doing so.

To begin with, let’s define the current recommendations you will hear from doctors and health care organizations regarding the amount of exercise to do weekly.  The two most common suggestions are to get at least 150 minutes of moderate intensity activity or 75 minutes of vigorous intensity activity weekly.  Moderate intensity is considered activities that make you breathe as hard as if you were taking a brisk walk.  In fact, a brisk walk is the most common moderate intensity activity people perform.  Strenuous activity would be one that makes your heart beat faster, makes you breathe heavier and sweat more.

Now that we are on the same page about the amount of exercise recommended, let’s turn our attention to the health benefits.

#1 Cancer:   Colon cancer is the second most common cancer in men and women.  According to the National Cancer Institute, there are over 50 studies to date evaluating physical activity and colon cancer risk.  The results are consistent that people who consistently participate in physical activity reduce their risk of developing colon cancer by 30-40% compared to those who do not exercise.  This benefit applies to those of normal weight, as well as those who are overweight or obese.

Breast cancer has been studied extensively as well.  The results of over 60 studies have shown consistent decreases in breast cancer risk for all levels exercise intensity.  This protective benefit applies to premenopausal and postmenopausal women.  Equally important is that some studies suggest a survival benefit for those women with breast cancer who exercise frequently.

There are similar results showing physical activity lowering rates of endometrial cancer, possibly lung cancer (although smoking cessation remains the most important intervention to lower risk), and slowing of progression of prostate cancer in men.

#2 Sleep quality:  In the United States, 35-40% of adults have difficulty falling asleep or feeling tired during the day.  A 2011 study in the Journal of Mental Health and Physical Activity by Paul Loprinzi and Bradley Cardinal found a 65% improvement in sleep quality in people exercising moderately compared to those who were sedentary.  This finding supports the idea that exercise is a healthier option for those with insomnia compared to sleep medicines that have multiple potential side effects.

#3 Decreased falls and bone fractures:  A meta-analysis (pooling together results from multiple individual high-quality studies) published in 2014 of 22 studies that in total included over 1.2 million people was conducted by Qu, et al.  The results found a 39% and 28% reduction in hip and wrist fractures, respectively, in those who exercise consistently compared to those who do not.  Fractures of the spine (vertebral fractures) did not show any reduction with exercise.

#4 Emotional Well-Being:  Another meta-analysis of 30 prospective studies published by Mammen and Faulkner in American Journal of Preventive Medicine found 25 of the 30 showing a lower risk of developing depression in people who exercised moderately.

#5 Life expectancy:  The National Institute of Health in 2012 found a direct relationship between the amount of exercise and prolonging your life.  For people doing half the recommended level of exercise weekly, the recommended level, and twice the recommended level, the gain in years of life averaged 1.8, 3.4, and 4.2 years.  This increase applied to men, women, African-Americans, Caucasians, and the increase was even more pronounced for those with a history of heart disease or cancer.

So now you know the specifics about physical activity and your health.   Whether you are concerned about heart disease, cancer, bone health, emotional well-being, sleep or simply want to live as long as possible, exercise should be a fundamental part of your life.  Hope to see you soon on the walking trails, biking trails or in the gym!

Next week’s post:  Benefits of high-intensity interval training

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Chronic Obstructive Pulmonary Disease (COPD):  Here are the facts.

  • COPD is the third leading cause of death in America, behind vascular disease (heart attacks and strokes) and cancer
  • smoking is the main risk factor for COPD accounting for 80% of the cases but almost 20% come from exposure to occupational industrial fumes
  • the two most common forms are chronic bronchitis and emphysema
  • the American Lung Association estimates 24 million Americans are affected with COPD, many don’t even know they have it
  • cough and shortness of breath with activity are early symptoms, while shortness of breath with decreasing amount of activity, wheezing and fatigue are late symptoms

These facts, which can be found easily with a Google search, are important.  Yet, they do not give a picture of what it feels like to have COPD.  I hope the following poem (written in a style called prose poetry) will provide a few insights into the thoughts and feelings of someone who has this progressive, devastating and dangerous condition.



“You sound like my Froggie,” my granddaughter chuckled.  Froggie is the stuffed animal she won at the local carnival last summer.  If you squeeze its mid-section, a most un-frog like high-pitched wheeze escapes from its belly.  The tag says “Made in Thailand” which makes me wonder if frogs in Thailand sound different than they do here.  Regardless, my granddaughter is right.  I do sound like Froggie.

My breathless episodes come more frequently.  A few years ago walking on a humid or pollen-laden day was challenging.  Today, I wouldn’t attempt a walk on the most temperate of days.  As a kid, I spent hours playing whatever sport was in season in the park around the corner.  I never imagined a time when my body would feel like its quarterback or pitcher was maimed.  Thoughts of childhood activities, like my curiosity about Southeast Asian frogs, are simply another stab at diverting my mind from the awareness of breathing–an action unnoticed by most people despite occurring 700 times an hour.

While my musings and reminiscing sometimes succeed in creating a mental diversion, nothing is able to deflect my attention from the wheeze.  As un-frog like as it sounds coming from Froggie, it is even more unnatural, un-human, coming from me.  Not quite a whistle or a squeak, it lasts just long enough at the end of exhaling so that getting up from this soft-bottomed living room chair to get a drink from the kitchen makes me think twice about whether I am thirsty after all.

Next week’s post:  Exercise and your health

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Heroin Addiction: An equal opportunity destroyer

Heroin is the most addictive drug known.  Simply hearing the word heroin makes parents cringe, communities worry and health care policy-makers lose sleep.  It’s hard to turn on the television, radio or read a newspaper without hearing about the growing epidemic of heroin addiction.  In fact, residents of New Hampshire considered heroin to be the most important issue facing their state during this year’s Democratic and Republican primaries.  Given the widespread concern, I decided to forgo last week’s initial suggestion to discuss COPD and spend this post talking about the heroin epidemic instead.

Heroin use has increased dramatically over the last decade, affecting all demographics of society, including age, gender and socioeconomic status.  According to the National Survey on Drug Use and Health, heroin use over this time has increased in women by 100% and in men by 50%. Similarly, young adults ages 18-25 years old have seen a 109% increase in use while those over 25 years old, 58%.  For income levels less than $20,000, $20,000-50,000, and over $50,000, the increase has been 62%, 77% and 60%, respectively.

Yet, heroin is rarely used alone and the risk of addiction increases in the setting of other drug use.  Specifically, the risk increases two-fold for someone addicted to alcohol, 15-fold for cocaine, and 40-fold for opioids, which are a specific class of painkillers.  It is the association with opioids that is particularly concerning.  These pain killers, oxycodone and oxycontin, are prescribed by physicians.  Usually a person has legitimate reasons for initially taking them, such as treating pain immediately after surgery or injuries from a motor vehicle accident.  However, the medicine use sometimes continues longer than necessary and soon the “need” for the drug is about something more than pain control.  At some point, a patient’s physician may refuse to continue writing the prescriptions.  If the person is addicted, they will look for illegal ways to obtain a comparable high.  Heroin treats the same cravings as oxycodone but is only one-fifth of the “street” price.  While it is cheaper to buy, heroin raises the degree of addiction and dangers to a new level.

Heroin comes from the Opium Poppy flower, which grows in dry, warm climates such as China, Mexico, Iran, Pakistan and Afghanistan.  It does not occur naturally and must be synthesized from the sap of the flower. The sap initially is refined to morphine and then undergoes chemical treatments to form heroin.  In its purest form heroin is a white powder but, more often, it is brown, yellow or black.  Black is becoming more common and referred to as “Mexican Mud” or “Black Tar”.

Heroin is most often injected.  Within seconds it’s converted in the brain to morphine which binds to specific opioid receptors that regulate feelings of pleasure, inhibit pain and slow heart rate and breathing.  The high from heroin is almost immediate and the intensity of the high is related to the amount of drug used.  With more frequent use, the body becomes tolerant to the effects of the drug and a higher dose is required.  But, here is the catch.  The tolerance builds up more quickly in the pleasure centers of the brain than in the centers that control breathing and heart rate. Ultimately, the craving for the high can drive a person to use doses that may cause them to stop breathing completely.  This difference in tolerance may also explain why people often die of heroin overdose after a period of time free from the drug, such as being in a rehabilitation center.  Their brain has lost much of its tolerance during this hiatus but they don’t realize it.  As a result, if they relapse they use a dose similar to that which they used before becoming “clean”.  Their respiratory center is overwhelmed and they stop breathing.

Heroin overdoses are not new.  There have been high profile overdoses for the last forty years.  John Belushi, River Phoenix, Kurt Cobain, and more recently, Cory Monteith and Philip Seymour Hoffman are just some of the famous people who died using heroin or heroin mixed with other drugs.

Naloxone is a medicine that can reverse the effects of heroin quickly in the event of an overdose.  It must be given soon after a person loses consciousness.  Simply, it can save someone’s life.  Naloxone is now carried by first-responders in most major cities including EMS workers, firefighters and police.  Many cities are wrestling with the idea of providing people who abuse heroin with this antidote to prevent accidental deaths.

Unfortunately, there is no consistent national policy to address the heroin issue.  There has been a four-fold increase in heroin-related deaths in the last decade.  Sadly, without more efforts to heighten awareness on a local, state and federal level, along with efforts by the medical community to decrease opioid prescriptions, this tragic epidemic will continue and, likely, worsen.

Next week’s post:  Living with COPD, a poem

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Taking Vitamins: 30 years of exaggerated claims

As I was thinking about this week’s post, I thought I would write about the most common vitamins people are taking today.  However, it occurred to me that such an approach only represents a small portion of what I wish people to understand about the world of vitamin supplements.  The more important information to share is that, just like fad diets, fashion or music, the “in vogue” vitamins change every five or ten years.  When I was in college in the 1980’s, Linus Pauling was spearheading the belief that taking vitamin C was essential for fighting off disease and having a healthy immune system.  In the early 1990’s, when I was starting my residency in internal medicine, magnesium was the vitamin being touted as critical to increasing survival after heart attacks. In fact, every patient with a heart attack in my hospital received intravenous magnesium as part of their treatment protocol.  The late 90’s ushered in vitamin E and B-carotene (vitamin A) as the vitamin supplements “du jour”.

So what happened to these vitamin fads and why don’t we continue to talk about them today?  Well, over time we conducted multiple studies that found no or limited efficacy to taking these supplements, and in some cases actual harm.  Specifically, we found no benefit to long term vitamin C supplementation in preventing infections and a lack of benefit of magnesium in improving survival after heart attacks.  Even worse, we found B-carotene supplements increased the risk of lung cancer in smokers, while vitamin E provided no heart health protection and could provide harm in high doses.

Fast forward to the last ten years with fish oil (omega-3 fatty acids) and calcium taking center stage.  For the most part, reviewing the scientific literature found similar findings to those “invaluable” vitamins of the past.  Fish oil supplements, initially hailed as essential for good heart health, quickly became important in preventing everything from nervous system issues to eye problems.  Unfortunately, over time we have found that the preponderance of evidence shows no benefit to fish oil supplements. However, a very important distinction is that a diet including several servings a week of foods rich in fish oils is still considered healthy.  Foods rich in omega-3 fatty acids include salmon, sardines, tuna fish as well as soybeans, tofu and walnuts.

Calcium has also been a critical vitamin in the last decade touted as essential for bone health.  Yet, over the last few years two camps regarding calcium supplement safety have been developing–those who believe it is safe and still important vs. those who feel the supplements may increase the risk of heart disease.  As with most things in medicine, when two strongly opposite views are held on a question, it usually means any benefit or risk will be far less than the initial exaggerated claims. Given that we are to first do no harm, I have been recommending to my patients that they focus on getting calcium through their diets rather than supplements.  Foods that are excellent sources of calcium include low fat dairy products such as yogurt, cheese and milk, leafy green vegetables, tofu and sardines.

Once again, as with last week’s post about the lack of benefit taking multivitamins, we should be cautious about assertions that any pill is going to have a significant benefit to our overall health.  There is no substitute to a healthy well-balanced diet with lean proteins, fresh vegetables, fruit and whole grains.  Over time, this approach continues to be associated with the best health outcomes, even if it is not as exciting to discuss as this year’s latest fad diet, super-vitamin or exaggerated claims about a newly found herb from South America.

Next week’s post:  COPD:  Breathing gets tougher in a polluted world

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