Runnin' in a Winter Wonderland

I don't know where you may be reading from, but at least here in Kansas, winter has arrived. For the past few months, the weather had been toying with us, offering temperatures in the 50's. There were even a few days in the 60's. Not very winter like.

I am an Ohioan by birth, so the cold does not really bother me very much. That doesn't mean I like it. I would definitely prefer 70 and sunny every day. Add some grey clouds and snow to the cold, and you have a recipe for some dreary days.

Since the cold is on my mind today, I thought I'd write about how workouts should change due to the short days and cold weather. I know that many people who are habitual exercisers tend to take winters off, because of the cold and the holidays, and then begin working out again in the spring. Though rest is good for your body, taking off three months can be seriously damaging to your fitness level as well as potentially your waistline.

I definitely continue to work out over the winter months, and I recommend that you do the same. If you want to use the winter as something of a rest period, consider working out 3-4 days a week, and taking the other days to rest.

You may need to modify your workouts as well. It is still OK to exercise outside. In fact, I kind of like winter runs. They can be rather invigorating. Be sure to take a few precautions, however:

     1. Dress for the cold. Be sure to cover your head, fingers, and toes well. If the temperature is in the 20's or below, frostbite can set in rather quickly, even in as fast as 30 minutes. As long as you are moving and active, hypothermia is not much of an issue in the short term, but be sure to get in out of the cold as soon as you are done. Also, wear some layers, preferably of a heat retaining tech fabric. Avoid wearing too much clothing, however, as you can still overheat. You should feel a little chilly when you start, or you are wearing too many layers. Trust me, you will warm up as you go.

     2. Be careful of slipping. In the ER, I see many patients who slip on the ice. Obviously, if you are running fast, this danger is increased. Be careful, especially going down hills or on pavement. Try to keep an eye on the ground a few yards in front of you, so you can identify any slick spots before you actually hit them.  If you do slip, try to sit down on your bottom, rather than extending your hand or leading with your head.

     3. Prepare for emergencies. carry with you at least a little water, a small amount of food (like an energy bar), and your cell phone. You don't want to sprain an ankle three miles from any sort of aid, and be unable to call for help.

Follow these precautions, and you will be able to safely work out through the winter. Who knows, you may even enjoy running in the snow!

M. Jacob Ott, M.D.

All In

Now, I know that cavemen did not formally gamble. They did not have casinos and poker chips, so a blog post titled "all in" might seem a little odd in the context of either caveman style living or health education, but bear with me. I do have a point to this analogy.

In fact, it could be said that cavemen gambled much more frequently than we do nowadays. All parts of the life of a caveman were an exercise in risk. Do I run from the predator, or try to hide? Do I risk going out into the open to gather food, or wait until a better time? Do I waste precious energy chasing down the deer, or do I just go with the easily gathered vegetables?

By comparison, the risks we take with our lives in today's society are fairly mild. Driving in a car is about the riskiest activity that most of us will undertake on a daily basis, and even driving is really quite safe. In the industrialized world, unless you serve in the military or live in the worst portions of the inner city, your life is infinitely safer than that of a caveman.

Ironically, the safer we get as a society, the less willing we are to take risks. We are unwilling to risk our lives, our money, and our social standing. In fact, we have gotten to the point where few people say anything controversial or take bold action because they are afraid to risk what they have.

The practical result of fear of risk is a kind of wishy-washiness, that forces people to take halfhearted action, then give up their course of action at the first sign of resistance. No great achievement can come out of this kind of action. Only commitment and bold action can lead to great achievement.

So, how does this apply to health, you might ask? Well, just like the caveman, the quality of your health and life depend on how committed you are. If the caveman decided to give up as soon as the search for food got hard, he would quickly starve to death. If he decided that hiding from the lion was just too much trouble, he would quickly have become lunch.

In modern society, we have the opposite problem. Obtaining food is easy, far too easy in most cases. To make the situation worse, the foods that are the easiest to obtain are the the worst for us. Thus, if we don't really commit to eating the right foods and follow the easy path, the result will be poor health, obesity, and chronic disease.

Similarly, with exercise, the easiest path nowadays is to get little or no physical activity. That was not an option in the past. Cavemen had no cars, planters, harvesters, or grocery stores. The search for food and safety was all consuming and HARD. Nothing short of complete dedication would get the job done.

One thing hasn't changed after all these years: if you want optimal health and wellness, as well as to avoid obesity and chronic disease, you will have to dedicate yourself completely. Like a poker player pushing their whole pile of chips into the pot, you will have to go all in with your health and wellness efforts.

Even if you go all in, I cannot promise that you will achieve every one of your goals. If you don't go all in however, and take the type of wishy washy action that most people take, I can promise that you will not. Any difficult achievement requires both passion and commitment, and nothing worth having is easy. So if you really want something, and this goes for anything in life, not just your health, stir up your passion and commit fully to the effort. You will be amazed at the results!

M. Jacob Ott, M.D.

Choices, Choices

Many of you probably know that my day job is that of Emergency Medicine physician. I work in several busy emergency departments, and see a wide variety of patients. All of my patients have at least one thing in common: they have something wrong with them. No one comes to the emergency room when they feel great, except for the staff members. In addition, most of them are scared that what is wrong may be serious. Most people will not come to the emergency room unless they think what they have is serious. The fact of the matter is that the majority of patients that I see don't have an actual emergency, but that is irrelevant. It is the perception of an emergency that drives them in to see me.

The fact that I find most interesting in my job is that the things people worry about the most are usually the least deadly. Every year, during the winter months, I see hundreds of people in the ER for colds, coughs, bronchitis, the flu, and upper respiratory infections. I know why they come in for these problems: a cold or the flu will make you feel pretty crappy. That being said, all of these diseases are self- limited. What that means is they will go away on their own no matter what you do, and there is no medicine that we have which will make them better in any way. What I do with these patients is put them on medicine which will cover up their symptoms (almost all of which can be bought over the counter) until the disease goes away.

Now, it is true that infectious diseases used to be very deadly. In fact, Sir William Osler, one of the patriarchs of modern medicine, called pneumonia "captain of the men of death." In the days before vaccines and antibiotics, infectious diseases were the leading cause of death in all age groups. To illustrate this, here is a list of the leading causes of death in New Jersey in 1900 vs 2000:

Leading Causes of Death, New Jersey, 1900 and 2000

Rank                         1900                                                        2000
                     1 Acute lung diseases                                     1. Diseases of the heart
                     2 Consumption                                                 2. Malignant neoplasms
                     3 Diarrheal diseases of children                     3. Cerebrovascular diseases 


                     4 Adult brain and spinal diseases                 4. Chronic lower respiratory diseases


                     5 Diseases of heart and circulation               5. Diabetes mellitus
                     6 Deaths under one month of age                 6. Unintentional injuries
                     7 Contagious diseases (not TB)                    7. Influenza & pneumonia
                     8 Renal and cystic diseases                            8.  Septicemia
                     9 Brain and nervous diseases of children     9.  Nephritis, nephrotic syndrome, & nephrosis
                    10 Violent deaths                                               10. Alzheimer's
                    11 Digestive and intestinal diseases              11. HIV disease 


                    12 Cancer                                                            12. Chronic liver disease & cirrhosis
                    13 Puerperal                                                       13.  Pneumonitis due to solids & liquids
                    14 Acute rheumatism                                       14. Suicide
Here is what I find interesting about this list: in the year 1900, You have to go down to #5 on the list to find the first cause of death that is not an infection. The first four are: acute lung diseases (pneumonia), consumption (TB), Diarrheal diseases of children (almost all are bacteria or viruses), and Adult brain and spinal diseases (such as meningitis and polio). Finally, with #5, you get to a non infectious cause of death: heart disease. In the list from 2000, you have to go down to #8 to find a cause of death which IS from an infection: Septicemia (systemic blood bacterial infection, commonly called blood poisoning).
 
That's great, Jake, you may be saying, but what does this mean? I'll tell you. Infectious diseases are random. If you are exposed, you can be infected and get sick. Though lifestyle choices can make you more or less likely to get sick, they only play a limited role. The modern death list is filled with what I like to call "diseases of lifestyle." Though there are some environmental factors at play, diseases such as heart disease, cancer, cerebrovascular disease (stroke), and chronic lower respiratory diseases (such as emphysema), are largely based upon the choices we make. Having a heart attack or stroke is mainly based on what you choose to eat and whether or not you choose to exercise. The vast majority of cancers are either diet or tobacco related, and emphysema and other lower respiratory diseases are almost exclusively smoking related.
 
Thus, in the modern world, whether you get sick or not, and how well you heal is based largely upon the choices you make. Modern medicine has come up with many fancy drugs, and many fancy procedures, but other than antibiotics for infections, heart catheterizations for heart attacks, and emergency surgery for conditions such as appendicitis, these medicines and procedures don't really cure anything. Drugs for high blood pressure don't cure high blood pressure, and patients are placed on a treadmill of ever escalating doses as their body adapts to the medicine. Drugs for cholesterol are far less effective than proper diet and regular exercise in treating cholesterol problems. Drugs for heart disease and emphysema do nothing to reverse these diseases, only slow their progression somewhat.
 
Somehow we as doctors have failed in our education of patients, and this information does not reach people. I say this because I have a stream of people through the doors of my ER wanting me to rescue them from their self limited infections and the end consequences of their poor lifestyle choices, but relatively few are ever interested in how they can prevent these diseases in the first place. In America today, we want to go to the doctor, get a prescription pill, and continue to eat however we want, and neglect our responsibility to exercise.
 
The main reason I write this blog is to try and bring home this point. Proper nutrition and exercise are far better medicines than anything the drug companies can mix up in a lab. If you fuel your body properly, and exercise every day or nearly every day, you can avoid most of the diseases on the list above.
 
In the end, it all comes down to choices.

M. Jacob Ott, M.D.

New Year's Commitments

Have you ever made a New Year's resolution? Most of us have. You resolve to go to church more, talk to your family more, do more things with your friends, or quit smoking or drinking.

Perhaps the most common New Year's resolution that is made each year in America is the resolution to lose weight. After holiday face stuffing, during which people gain an average of 4 pounds a year, the guilty parties (I was one for years) resolve to lose weight and get down to an arbitrary goal weight. Full of piss and vinegar, they go to the local gym. The gym just happens to be running a big special designed to help people lose weight in the region of their wallet, and is happy to relieve them of a years worth of membership fees.

The resolutioner, let's just call him Jake, since this was me for years, goes to the gym every day for the first week. He hits the treadmill and the weight machines, and gets sore and feels like crap. Soon after, daily turns to weekly, which becomes not at all. Don't believe me? Go to your local gym this week, and notice how many people are there. Then go on February 1st, and do another count. I would be surprised if more than 60% the number of people are there. Prove me wrong, and leave a comment if you disagree!

The same happens with our diets. A friend of mine who is a reporter in New York just did a segment on the top ten diets as rated by US News and World report (I am not linking to it, because they are mostly useless. Since when can a news magazine tell you anything about losing weight). The point is that people want to hear a lot about diets this time of year. The gym phenomenon plays out in the area of diet as well. Jake goes out to diet until he weighs 180 lbs, and begins a program, such as Weight Watchers. He follows the rules very strictly... for a week or so, until the first time he messes up. Once he messes up, he feels like a failure, and the shame and self-loathing come back, along with the comfort food to bury those feelings. Before long, Jake has given up and gained another five pounds.

I know this story so well because I lived it for years. I am guessing that many of you know it as well. Fortunately, over long bitter experience, I learned how to break the cycle, and finally lose the weight for real. It's not about a gym, and it's not about a diet, although those are both necessary tools. It is all about attitude.

The reason that virtually all New Year's resolutions fail is because the focus is all wrong. Jake was never really committed to his health. All he cared about was losing a little weight so that he could feel good about himself. Thus, when his commitment was tested, as all commitments are, he gave up. If you want to lose weight and achieve optimum health, your focus must be on something deeper than just fitting into a pair of jeans, or even looking good in the mirror. These superficial ideals will never sustain the dedication required to lose a significant amount of weight.

Instead, your focus must be on something greater than yourself. Only dedicating yourself to a cause outside yourself will give you the staying power to endure through the days that you don't want to work out, and the days where it seems like cookies are everywhere, and the days that it seems that your scale is possessed by demons.

What should your focus be? Frankly, I have no idea. Mine, just so you know is my family and God. I want to be around on Earth as long as possible, to do God's work, and to help grow and lead my family. That commitment gets me through the rough patches and down days, and strengthens me when I am feeling weak.

Don't get me wrong, life is not perfect. In fact, it is brutally IMperfect. Temptation is still ever present, and for me at least, it is very strong. Having a higher cause makes my success mean more than a momentary temptation, and allows me to persevere, even if (when) I fail.

This year, instead of a New Year's resolution, I encourage you to make a New Year's commitment. Commit yourself to your health because of something other than your looks, emotions, or jeans size. Make that commitment public, and dedicate yourself to it totally. That is the only way to truly succeed.

If you do commit to your health, do me two favors: first, comment about what your greater cause is, so that I can help encourage you, and pass this blog along to your friends who might be struggling.

Good Luck!

M. Jacob Ott, M.D.

An Attitude of Gratitude

We in America are good at wanting things. We are a consumer culture. Advertisements on TV show us things to buy. Everyone is concerned with having the latest, greatest, and newest. From the time we are kids, until we are adults, we seem to want, want, want.

Today, however, is a day for giving thanks for what we have. When I was young, I saw a motivational speaker. That speaker's topic was the importance of having an attitude of gratitude. At first blush, I did not really agree with what he said. Why was it important to have gratitude for the things I already had. I always thought my focus should be on my goals, and what I wanted. How on earth are you supposed to reach your goals by focusing on what you already possess.

I have grown and changed much in the intervening years since I saw this motivational speaker. As those of you who follow my blog know, I have had many trials and life experiences which have taught me the importance of being thankful. As it turns out, being thankful is critically important to any goal you might want to achieve in the future, for several reasons:

1. It reminds you of how blessed you already are- No matter how difficult your life is, there are some important things you possess. You possess life, the most precious gift imaginable. In addition, you likely have at least one or two people who love you. When you realize how important the things you have are, the things you want aren't quite so pressing.

2. It relieves stress- Part of the stress that we experience comes from the American rat race. The rat race is an endless pursuit. You run in circles pursuing a career, a higher rung on the corporate ladder, a bigger house, a nicer car, and more money. Ceaselessly pursuing the next big thing creates a feeling of pressure. This pressure turns to anxiety, which leads to stress. People who are under significant negative stress are at higher risk for obesity, heart attack, stroke, and sudden death. Gratitude is like a flood gate which releases the stress when opened. Someone who is grateful on a daily basis is far less likely to hold on to stress.

3. It makes you more likely to get what you want- I don't have a good explanation for this based upon science and nature, but it works. I attribute it to God. If you don't believe in God, you can call it the universe, karma, or whatever you want. Reason would suggest that there is no connection between being grateful for what you have, and getting what you want, but I can tell you from my own life that it works! If you spend time daily focusing on being grateful, many of the things you want will come to you, and you will be less concerned about the things that don't.

As you sit down with your family members to your (hopefully healthy) dinner, spend a minute being thankful for all the blessings in your life. In the end, you will have much more to be grateful for!

M. Jacob Ott, M.D.

Eat the Whole Food

Better living through chemistry. DuPont used this slogan back in the 80's. The intent of the phrase is obvious: DuPont (and by extension, mankind) can top nature by producing artificial products to meet all of our needs. Better materials, better drugs, better foods, all of these things are implied by the slogan. Back in the 80's, most people really believed in it. Not DuPont, necessarily, but the idea that we could create products out of virtually nothing which could supplant similar (inferior) versions made by nature.

These days, much of the public and virtually all of the healthcare industry believe the same thing. We have synthetic medications, clothing fibers, building materials, and synthetic foods.

Synthetic foods, you ask. OK, so you might be thinking "I don't see any polyester apples out there," and you are right. We don't have completely synthetic foods, but we have something very close to it. Food companies are able to chemically separate parts of foods, and combine those parts into various other types of "food." I put food in quotes, because these products have little or no value as food. Mostly they are clever combinations of corn and soy molecules. Not the good parts, mostly the fat and sugar.

Yet these convenience foods flood our grocery stores and vending machines, and many people eat a diet which consists of almost all processed convenience foods. Often times, these foods are even marketed as being good for you. The manufacturer will note one or two of the nutrients contained in the product, and tout it as being good for you. For example, I am currently looking at a cereal box that touts "heart healthy grains," and "14 vitamins and minerals." Of course, they fail to mention that the "heart healthy grains" are combined with high fructose corn syrup, and that the "14 vitamins and minerals" were added in artificially, and do not actually belong in the food in question.

What is the problem with synthetic foods, you might ask? If we get all of the nutrients we need from them, why is that not an OK way to eat? They are easy and taste good. Well, there are really two major problems, and a host of minor problems. I will discuss the major problems here:


1. The foods are too energy dense. Processed foods concentrate the parts of food that we humans find appealing based upon our sense of taste, namely the fat, salt, and sugar. They leave out the fiber, starch, and all the "filler" which is in whole foods. This amps up the calorie density, and makes the foods far richer than they should be. Thus, you eat far more calories before your brain knows that you are full.

2. All that "filler" is pretty important. We are pretty arrogant as a species. Because we now believe in the omniscience of science, we study foods, and try and isolate the parts of food that are "good for us." We hone in on these nutrients, and study them. When we find one that shows some benefit in our studies, we start adding it to all kinds of processed goodies. We feel good about ourselves, because we think that this makes the otherwise unhealthy food healthy. Unfortunately, this is very far from the truth. In our arrogance, we forget that there might be other chemicals in the whole foods that we can't detect which contribute to the benefit we see. A classic example of this phenomenon is fiber. I'm sure you have heard that fiber prevents colon cancer. Shortly after this was discovered, synthetic fiber products appeared in large numbers on grocery shelves. Fiber was added to cereal, doughnuts, bread, and scores of other foods. People feel better, because they are able to get their 35 grams of fiber without changing their habitual diet at all. Wonderful, right?

Not so much. The colon cancer rates did not fall with this influx of fiber. In fact, they got higher! When the scientists did research as to why, they got quite a shock. Where the fiber in whole foods did lower the risk of colon cancer, the "fake fiber" in the other products did not. The same is true of most of the nutrients the USDA recommends. While vitamins are crucially important, and deficiencies of vitamins cause diseases, taking vitamins in pill form does not improve lifespan or mortality. In fact, some recent studies have shown that taking a vitamin may actually INCREASE your risk of death!

The bottom line is that we were meant to consume the whole foods, not their chemically rearranged counterparts. There are probably thousands of nutrients in the whole foods that we are unable to detect that work together to produce health benefits. That is why the Devolve eating rule #1 is:

Eat foods like they grow in nature

Wherever possible, eat the whole, unprocessed food. The closer you get to plucking it off the tree or pulling it out of the earth, the more nutritional value you will get out of it. In general, if your food was created in a lab, you will probably need to take a lot of lab created medicines to treat the diseases your created foods caused.

M. Jacob Ott, M.D.

The not so Incredible Edible (but Don't Eat it) Egg

The egg. Throughout my life, I have watched the egg swing like a pendulum in the court of public opinion. There is no food that goes from good guy to bad guy quite like these little guys.

In the 50's and 60's, athletes used to drink raw eggs to build strength. In the 70's, there was a backlash against the egg, and people were told to stop eating eggs, or cut back due to the spike in heart disease. Cholesterol in the eggs was blamed for this spike. In the 80's, eggs got a reprieve (I pulled the little slogan that I modified for this post's title from the 80's, although it has recurred in egg advertising throughout the years).

And so it goes. Every decade it seems, the egg switches from one extreme to the other. Eat it, don't eat it... Right now, it happens to be enjoying another good period. I recall Dr. Oz telling millions of unsuspecting people to eat an egg a day. I shudder to think of the devastation his advice on this point will cause.

As the court of public opinion with regards to nutrition is generally based upon expert opinion, let me explain why experts can't figure out where exactly to place the egg.

To the left is the nutrition label for the egg. One egg contains a relatively modest number of calories (around 70), and no carbohydrates. The numbers that the experts go back and forth on are the cholesterol and protein. As you can see, the egg has a lot of cholesterol (70% of what the USDA says that you need), and 6 g of protein (a pretty large amount for the small number of calories in the egg). So what is the problem?

The problem is, that in the opinion of most experts, protein is good, but is the amount of protein in the egg worth the amount of cholesterol that it contains? So experts with differing views argue back and forth.

Now for the problem with the problem: the experts are completely ignoring some very important facts. Many of them are aware of these facts, but because of various interests (financial is one, trying to appear mainstream is another), they choose not to tell the public. This puts you at some risk.

I am going to tell you the truth as I see it based upon research that has been done. I believe in this so much that I choose to follow my own advice in my diet, to tremendous result. You can choose to believe what I write, or not, but at least please read it and give it a chance. I just want to improve your health. I have no financial interest in this situation, and I don't care what the mainstream thinks about what I have to say.

Let's start with cholesterol. The USDA sets a limit of 300 milligrams of dietary cholesterol as what you should consume daily. As I already said, the egg has about 70% of that. What is this number based upon? Nothing at all. It is the consensus of a group of experts. Since all animal fat contains cholesterol, they had to pick a number that allowed for what they considered adequate amounts of animal foods in the diet. As you can imagine, this was heavily influenced by the egg, dairy, and meat industries.

Jake, you might ask, how much cholesterol does your body actually need? Great question. The answer is none. Zero. Zip. Cholesterol is a very important fat, and is found in virtually every cell of your body. Here's the rub: your body can easily make all the cholesterol you need, from other nutrients you intake. There is absolutely no need to take any in at all. On the other hand, cholesterol intake does have some other significant consequences. In multiple studies, a blood cholesterol level of greater than 200 was associated with double the heart attack risk of a level under 200. In medicine, we set the "normal" value for cholesterol at 200. This is incomplete data, however. In other studies, a cholesterol level of less than 150 was associated with a 5 times smaller risk of heart attack than a level of over 150. The cholesterol level of your average meat eater? 150-200. Your average vegetarian? 150-175. Your average vegan? 136.

Faced with these numbers, you might be wondering if all that protein is worth the risk that the cholesterol brings. Now we will deal with the protein issue.

Based upon multiple sources, including The China Study, animal protein intake has been linked to the following diseases:

Heart disease
Stroke
High Blood Pressure
Diabetes
Peripheral Vascular Disease
Colon Cancer
Prostate Cancer
Breast Cancer
Esophageal Cancer
Obesity
Osteoporosis

This list is not all inclusive, but is a good sampling. It should be enough to give you the gist. It is becoming more apparent that the protein is just as bad as the cholesterol, if not worse. To top it off, you don't really need the protein anyway. The USDA recommends that protein make up about 20% of your daily calories. That is double the 10% of daily calories recommended by the World Health Organization, and four times the 5% that multiple studies have shown are necessary for survival and muscle growth. The USDA's number is heavily influenced by experts who were taught the same fiction that you have been taught (and that I was taught in medical school), and by lobbyists for various groups who farm the animals that produce the protein.

The bottom line: the experts who tell you to eat or not eat eggs were trying to balance what they considered to be the good (protein) vs the bad (cholesterol). What they didn't tell you is that both nutrients go on the same side of the balance scale. They are both bad. Eggs are edible, but unless you happen to be a snake or a mongoose, you probably shouldn't eat them, unless you want the diseases on the list above.

M. Jacob Ott, M. D.