We are a commune of inquiring, skeptical, politically centrist, capitalist, anglophile, traditionalist New England Yankee humans, humanoids, and animals with many interests beyond and above politics. Each of us has had a high-school education (or GED), but all had ADD so didn't pay attention very well, especially the dogs. Each one of us does "try my best to be just like I am," and none of us enjoys working for others, including for Maggie, from whom we receive neither a nickel nor a dime. Freedom from nags, cranks, government, do-gooders, control-freaks and idiots is all that we ask for.
Our Recent Essays Behind the Front Page
Wednesday, April 26. 2017
A high-fat meal, or any meal, produces a temporary surge of blood lipids just as a high-sugar or high-carb meal produces a surge in blood sugar. That is normal.
The low saturated fat craze was triggered by a 1950 study by Ancel Keys, a study which is now generally accepted as fraudulent. It spurred many further studies over the years but, as yet, there is no proven causal relationship between dietary fat and cardiovascular disease. In fact, there are very high saturated fat cultures (Eskimos, Masai) with very low cardiovascular disease rates.
Does your cholesterol level matter? Other than in familial hypercholesterolemia, probably not. So why check them on your every-3 year physical exams? Medical advice is conservative, slow to change, and fearful of being wrong so too-often adopts the precautionary principle. Thus when articles like this one comes out: Popular belief that saturated fat clogs up arteries is a myth, experts say, there is always pushback like "Don't tell people that, they'll get confused."
While it is established that arterial disease is related to inflammation in arterial walls, the cause of that is elusive. The known risk factors for arterial disease seem to be smoking, overweight, diabetes, familial hyperlipidemia, and sedentary life style. Almost forgot the biggest one: age. Avoid ageing at all costs because it has a 100% mortality rate.
We are far from settled science with cardiovascular diseases. In recent years, we were advised to eat margarine not butter. Now advised to eat butter and avoid margarine. Now advised to eat olive oil. It's all a shot in the dark and it could be that diet has little or nothing at all do do with it.
Monday, April 24. 2017
It's a common affliction of the middle-aged (like Frozen Shoulder), and usually there is never an identifiable cause although weight gain seems to be one. It can be in one foot or both. Sometimes it can be easily fixed with ice and stretching but it can be a chronic problem which eventually will disappear as mysteriously and suddenly as it appeared.
The most common symptom is feeling like somebody put thumbtacks in the heel of your shoe. The problem is not your shoe (although arch supports sometimes help it). The problem is inflamed tendons.
The differential diagnosis is Achilles Tendonitis.
Besides the pain of simple walking around, Plantar pain can lead to other joint or lower back problems because of altering one's gait to minimize the foot pain.
More info from the Pain Doctor
Friday, April 21. 2017
Always be a skeptic.
Wednesday, April 5. 2017
We post here frequently about the components of general fitness and physical training goals: strength, athleticism, power, endurance, etc. The variety of exercises that we recommend are stressing and training neuro-muscular and cardiac systems.
However, while we are stressing and challenging our bodies in all of the ways needed for balanced fitness, we are also training our metabolic energy systems for higher capactiy and efficiency. There is no need to know anything about it, but it is interesting.
It's basic high school biology. Animals (and plants) use ATP as an energy source for cellular functioning. ATP is generated and regenerated in the mitochondria.
However, our resting ATP batteries store very little reserve energy so 5- 20 seconds of high intensity, maximum anaerobic effort (eg 20-second sprints and HIIT sprints, or a set of heavy deadlifts) require instant regeneration of ATP. That's our "emergency" Phosphagen System. After depleted, it takes a couple of minutes to restore itself which is why you rest between deadlift sets or walk ("active recovery") between sprints. The Phosphagen system is trained by stressing it, but it has its limits.
After 10-20 seconds of high intensity, our cells turn to splitting sugar (mainly derived from carbs unless you have a Coke before exercise) - Glycolysis - to produce more ATP. This energy system, also requiring no oxygen, can keep us going for up to 2 minutes of intense effort. Like the Phosphagen system, Glycolysis is trained by short bursts of high intensity exertions of any sort.
A body can't live long, though, without oxygen. Both of the above are anaerobic (oxygen-independent) systems and neither can be sustained for very long without rest and oxygen to restore them. Aerobic exertion (using oxygen to burn sugars and fats - the Aerobic System -) can slowly but almost endlessly produce enough energy to maintain us during less intense activity in which we maintain a pretty good oxygen balance (or at rest, for that matter). Aerobic energy systems are trained and stressed by, say, 1-hour endurance exercises which keep the heart rate continuously well-above a walking heart rate, eg continuous calisthenics, and non-sprinting exercises like swimming speedy but not sprinting laps, treadmill intervals but not HIIT intervals, jogging, and similar exercises when you can breathe uncomfortably but effectively-enough to keep going.
Can aerobic exercise count as "cardio" exercise? Sort-of, maybe. It depends on where you keep your heart rate. High-intensity, high heart-rate bursts are the best heart-stressors and if it doesn't kill you it will make it stronger. Endurance is a different matter. Is normal walking "exercise"? Basically, no. It's just basic functioning unless it's fast and over 5 miles. "Cardio" means heart rate significantly elevated above walking.
Aerobic metabolism is highly efficient, which is why it takes 3 hours on an elliptical to burn the calories (270) in one plain bagel. It is why you can not lose weight by exercising unless you are fast- hiking 8 hrs/day on minimal caloric intake for a week or two. The average sedentary person (meaning under 5-10,000 "steps" daily with no other stressful exercise) probably needs less than 2000 calories per day to maintain their status quo. Remarkably, in the USA, it is not unusual for one single cheap meal to provide that much energy. In all of human history, remarkable indeed. Caloric abundance has a downside, thus the "overweight crisis" especially among our American poor.
A balanced fitness program (resistance, calisthenics, cardio, and endurance) ends up stressing all 3 energy systems without your having to think about it at all. That is just one of the many reasons why we endorse balanced fitness exercise programs instead of a single path (such as all weights, or all aerobics).
Good summary of exercise and energy systems here.
Tuesday, March 14. 2017
Only the weak would complain. They need the clinical experience as fast as they can get it. Furthermore, they need to learn how to function under stress and without adequate sleep. Physical and mental endurance need to be learned. When a multi-car crash results in 10 victims in your ER at 3 am and you're on duty, there is no choice but to rise to the occasion. That takes practice, and it is why older doctors are wiser. They have put in the hours. They can find their second wind because they have done it many times.
Nobody in America wants a doctor who would say "I've worked my 8 hours" or "I'm too tired." Maybe they are thinking of socialized medicine or unionized medicine, because those authors seem to feel that working long and hard is something terrible instead of something wonderful. Some people are not aware than some surgical procedures can take over 10 hours to complete, and, just then, an emergency comes into the OR.
Friday, February 24. 2017
Many medical treatments do not work, or do not provide the benefits desired. This is not because of deliberate quackery. It is more because of convention and the slowness of medical practice to change. Furthermore, marginal study results frequently have validity, but so marginally that there is no important clinical use. Try explaining that in court.
One example might be the treatment of borderline hypertension, which is dubious but in the US if a doc doesn't address it he'd be looked at askance because the current consensus is to treat. Next year, it might be the opposite. Another example is coronary artery stents.
The topic discussed here: When Evidence Says No, But Doctors Say Yes - Years after research contradicts common practices, patients continue to demand them and doctors continue to deliver. The result is an epidemic of unnecessary and unhelpful treatment.
Friday, February 10. 2017
He couldn't find any problems with me. He said my body fat was down to "athlete," that my fitness and endurance were far above average for my age and markedly improved from 2 years ago, that my heart was perfect, that my physique looked excellent for my age (Daddy Belly totally gone), that I should try to gain 5 more lbs by eating more (same thing my trainer keeps bugging me about but I don't like to eat much - I like to consume just enough to stop feeling hungry). Other than that, it was "Keep doing whatever you are doing."
He had me cut my BP meds in half. He wanted me to stay on the lipitor because my triglycerides had improved dramtically even though I was on the lipitor before, and were now perfect (I don't believe in that triglyceride stuff, but I want him to be happy).
He went over the details of my exercise program and told me that it was similar to his with a balance of weights, calis, and a little cardio, about 5hrs/wk total. He is fit as hell, 55 but looks like a powerful and athletic 40. However, he has been doing his program for many years. We estimate that I lost around 8 lbs. of pudge and gained about 10 lbs. of lean muscle in 2 years.
So it's been good for me from the medical angle, but that is not why I do it. I do it to maintain Fitness for Life. Any medical bonus is welcome.
(Also, he has some interesting ideas about the traumatic arthritis in my right shoulder. Wants me to see his pal at HSS if I feel like it. Just for fun, I got a tetanus booster, a Shingles vaccine, and a Pneumonia vaccine.)
This might be inspiring - I hope so. Have readers had a similar experience?
Thursday, January 12. 2017
Friday, January 6. 2017
The half-life of medical knowledge is approximated at seven years. That means that half of what you think you know about health, illness, and medical practice today will be obsolete in seven years.
It will be replaced by new better science of which, in turn, half will be obsolete seven years later. That's how it works. Skepticism about current knowledge is always appropriate. The cholesterol panic is just the most recent, dramatic example. Big mistake. Not all docs have got the memo yet. "Never mind."
Eat those eggs and bacon and sausages like you always wanted to, and skip the darn oatmeal unless it's all you can afford. And imagine that, in seven years, Mr. Science will tell you to eat candy and Dunkin Donuts for breakfast.
Our tummies might be smarter than today's science. Who knows? I love deep-fat fried donuts (not at Dunkin) and French Toast. Doesn't everybody?
Thursday, January 5. 2017
There is a cold air diuretic effect, and also a water diuretic effect which is why all kids pee in pools.
Tuesday, December 27. 2016
A book: Getting Risk Right: Understanding the Science of Elusive Health Risks by epidemiologist Geoffrey Kabat
Sunday, December 18. 2016
Heimlich maneuver inventor Henry Heimlich dies at 96
Tuesday, December 13. 2016
For a while there, it seemed as if obesity were almost a requirement of a US President. I think Trump is the fattest President we will have had in a long time. Who was the last fat President of the US, not counting Bill Clinton whose weight varied a good deal and who now looks underfed if not ill?
I think it's a stretch to term a physical condition a "disease." We do not term physical weakness "a disease," or being "uinderweight" unless you have anorexia. Many or maybe even most fat people seem comfortable with it, and accept the trade-off of tasty carbs vs. being light on their feet.
Anyway, government money is flowing into research so now being fat is suddenly a disease needing medical treatment. In the US, the expanding "disease" label is often about money. Example: One Weight-Loss Approach Fits All? No, Not Even Close.
When human variations occur on a bell curve, you can get away with drawing the vertical line of "abnormal" wherever you want. That's where America's "obesity epidemic" came from.
An annual repost. The vast majority of people who collapse have simply fainted for some reason. Do not try CPR on somebody who is pink and breathing.
Bear in mind that the breathing component is not necessary for amateurs to do - just the rapid compression is enough.
Sunday, December 11. 2016
Sunday, November 27. 2016
As I have said before, a rigorous exercise program might not extend your life. It will definitely enhance and extend your quality of life even if you begin it at any age. Everybody knows that they ought to do it, but it's hard and it hurts and we're lazy and "busy." Plus there is that terrible part: delayed gratification. Everybody hates that. As I say, "The flesh is willing but the spirit is weak."
Our quite well-informed recommendations for general fitness and conditioning for the ordinary person who wants to achieve or maintain maximal functionality for life:
1. Nutrition: Don't be visibly overweight - it's the worst thing you can do to yourself besides being an addict, and no exercise can help being fat. Does a demanding exercise program require a specific pattern of nutrition? Yes. We have discussed that in previous posts here. With a serious exercise program, you have to keep up with the protein and fats - approx. 70-100 gms of protein/day.
Under age 35, it can take 12 months to be whipped into decent shape. Over 35-40, depending on your fitness starting point, 18-24 months. Intense sports like basketball can substitute for calisthenics. Yoga is excellent, but does not substitute for any of the above. Many men find Yoga to be quite challenging and helpful. Lots of pro football players do it. If your day job is physical, all of the above recommendations would differ.
Friday, October 28. 2016
When I discuss fitness and conditioning, I use the categories of Strength Training, Endurance Training, General Athleticism Training, and Nutritional "Training."
Naturally, different regimens address each fitness category with some specificity but with some overlap. To get stronger, you have to stress nerves and damage muscle fibers by moving weight. For endurance training, 20 mins of intense interval exercise seems to beat out longer low-intensity aerobic cardio. All categories feed into General Athleticism which is most peoples' real goal - Fitness for whatever life brings - but we address it specifically with calisthenics and by playing recreational sports and other outdoor vigorous activities.
These categories of activity use different combinations of energy systems. Animal bodies have three energy systems, each with different purposes.Just as nerve pathways can improve with stress and challenge, cellular energy systems can be bolstered with stress. When you think about it, a fair amount of stress is good for both body and soul.
Your energy systems are the Phosphagen System, the Gycolysis System, and the Aerobic Oxygen System. In a balanced Conditioning regimen of Strength, Endurance, and General, all three energy systems adapt to being stressed and, ideally, exhausted. Your body will build up those systems, over time, to meet the challenge. That is called "more energy."
For one example, the Phosphagen metabolic system can be stressed or depleted by ten heavy ball floor slams or by a 30-second full-out sprint. That system is for quick bursts of maximum power.
This site, The Three Metabolic Energy Systems, explains the basic physiology of the three energy systems with a discussion of how each is best stressed (but unfortunately that discussion only addresses things like running rather than the other exercise categories which also make specific demands on the 3 energy systems).
Friday, October 21. 2016
"A third of Americans are obese"? Really? I don't think so but I do not see very many obese people in my life.
I could think that a third might be fat, though, aka "overweight." Being overweight is a bad idea because it slows you down, damages your joints, and plays a role in some diseases such as breast cancer and heart disease. Also, it is widely viewed as unattractive and as a sign of poor impulse control in Western cultures rather than a sign of prosperity as it is in some.
Donald Trump "fat-shamed" his employee "Miss Piggy" for being "an eating machine." Mr. Trump, who is fat, was attacked for that by Mrs. Clinton - who is fat and getting fatter. As for fat-shaming, even your doctor will do that to you when you visit.
I do not view being overweight or obese as a disease. They are physical "conditions." All behavior has physiological consequences and correlates, which does not make them diseases. We over-pathologize things these days in an effort to let people off the hook for their behavior or, sometimes, in search of an insurance code. In my view, if you do not mind being fat, that's fine. Your choice as long as you accept the consequences. Being underweight frightens me more, medically.
I'll briefly discuss two physiological correlates of overweight and obesity. First, satiety. A sense of satiety is managed by chemical signals from the gut to the brain. The signals are slow to inform you that "That's sufficient." Thus fast eaters do not get the memo in time to stop. Furthermore, some people have weak signaling, or just learn to ignore the signals. Heavy-duty eaters also have expanded stomachs which are less-readily satisfied and always seem to have room for more. Recreational eating is what I call that.
I think many people seem to ignore or misinterpret all sorts of physiologic signs and signals. Also, hedonism is, by definition, fun.
My second physiologic correlate for today concerns insulin. An excess of carbs (more than you need to stay alive that day) gradually causes "insulin resistance." That is not diabetes, but just an adaptation to the amount of carbs a person consumes. It is discussed here. It explains how carbs effect energy levels and fat accumulation.
A detailed examination of Medicare's problems, with some ideas for fixing them. Excellent if you think you may someday reach Medicare age without private insurance: Medicare’s Next 50 Years: Preserving the Program for Future Retiree.
Thursday, October 13. 2016
Phizzicle phitness consists of strength, endurance, and athleticism (plus body composition). A balanced fitness program will address all aspects.
Ordinary guys often tend to emphasize the strength component because it seems more rewarding, but if you have bulging biceps to impress the girls at the beach but can not sprint a mile or a half-mile, what good are you? Fact is, biceps are not very important in functional fitness. Triceps? More useful.
Ordinary gals tend to emphasize the cardio aspect but that is just as unbalanced. That's why we always say Weights + Cardio + Calisthenics (with sports counting as calisthenics unless it is TV football).
Today, more fun info re strength-building (for men and women).
- You can gain strength without dramatic growth in visible muscle size.
- An adult body can not grow new skeletal muscle cells. However, muscle cells can develop new and larger muscle fibers within the cells you were born with.
-Usable strength can only be increased by pushing, pulling, and carrying progressively heavy resistances (eg weights). Cardio and calisthenics do not generally build strength. Running one mile vs. 10 miles is not strength - it's endurance. Distance runners are often not very strong or powerful.
- Steroids work remarkably well to increase strength and size. Do not use them - go natural.
- After an initial phase of neuromuscular adaptation, strength improvement is discouragingly slow. Few good things come easily.
- Strength, endurance, and athleticism are rapidly lost without use. The older you are, the faster they disappear. Fitness is like money: Hard to get, easy to lose.
- Strength training is the best preventative for osteoporosis and general bone health, esp for women. Cardio exercise does no good for that.
- Serious strength-building programs require a diet high in protein and fats, plus adequate carbs unless overweight. A good dose of protein immediately after a painful work-out is recommended.
- Strength building is a mind-body challenge. Very difficult and unpleasant unless you love pain and extreme effort. Most people prefer comfort - just look around at people. It's more fun with a trainer or a group so there is a relational aspect to it.
Good basic strength info: How Do Muscles Grow? The Science of Muscle Growth
For strength-building for men and women, we recommend working one's way up over months or years to being able to condense a program down to multi-muscle exercises like bench press, deadlift, barbell squat, pull-up, rows, military press/inclined bench press. Together, those will stress pretty much every functional muscle group. That is my goal - a simple, basic, efficient strength regimen.
Wednesday, October 5. 2016
- As we enter flu season, it's a good idea to take the flu vaccine around now. I can possibly save you from a few days of lost work, and if you get it at CVS they will give you a 20% discount card for all the Halloween junk and other junk you buy there that day. Flu shots do not always work, because the viruses mutate so quickly. Still, it is something to do to minimize the risk of the unpleasantness.
- The Pneumonia vaccine? Not a bad idea for high risk groups (especially very young and senior citizens)
- Tetanus? (or Tetanus-Diptheria-Pertussis) vaccine? Adults who have had their booster shot long ago probably do not need to repeat, but people caring for infants usually get an adult booster dose. Most people who have had puncture injuries or sutures in the ER have gotten a tetanus shot on a precautionary basis.
- There is a recent Shingles (Herpes zoster) vaccine too for adults.
Anyway, ask your doctor of course.
The placebo idea has a long history, back to ancient Greek medicine. However, in my experience the placebo effect, such as it is, seems most powerful in the ignorant and the suggestible. Hence the enduring popularity of quackery like naturopaths and homeopaths.
While it remains true that modern physicians often recommend treatments with marginal effects, those marginal effects are likely not imaginary.
Saturday, September 17. 2016
A review of how government food advice got it all wrong and gullible citizens ate it up. They went high-carb, low fat, no red meat, etc all to either zero effect or by getting fat. A quote:
Related, Drafter of U.S. Dietary Goals Was Bribed by Big Sugar to Demonize Fat - Newly released historical documents show
That is a major but unknown scandal. Think of all of the gullible Americans who avoided "red meat" and "animal fat" over a generation, for no reason at all.
Wednesday, September 14. 2016
The cheap and easy way to cure overweight and Type 2 diabetes. No need for a doctor to get involved because in most cases people can do it themselves.
Gary Taubes promoted this, but I was on it long before him. The physiology of it is basic and simple.
Please do not tell me that you can lose fat by exercise alone. It doesn't happen. Exercise is great, but not for fat loss although many people find that strenuous exercise reduces appetite.
Wednesday, August 31. 2016
Bone weakness is mainly seen in post-menopausal women. It is asymptomatic until a bone breaks and you face a real problem. When men have it, it tends to be at least ten years later than women, on average.
You do not need to appear frail to have bone fragility, but osteopenia is one component of what we term "frailty" - vulnerability to things breaking. While being underweight is one risk factor, being heavy is not a protection. Vit D deficiency and inactivity are other factors, along with bad habits, unlucky genes, and a life style lacking in daily resistance exertion.
Hip fractures are one of the common presentations of previously-undiagnosed bone weakness. Contrary to common belief, people do not "fall and break their hip." It is usually the opposite: their femur just fractures from weakness, causing them to fall. People with bone weakness, though, are more prone to any bone fracture anytime they fall or have an accident.
Diagnosis is usually via a routine Bone Density Scan or after a fracture.
Prevention and Treatment: Besides getting some sunshine daily (not just on your face) and taking Vit D along with a good diet, the prevention and treatment for bone weakness is strength training. The medicines for osteoporosis are problematic and often ineffective. Cardio exercises - things like walking, running, swimming, etc. are not effective in building muscle or bone strength. (It is not unusual for runners to be weak-muscled - or for weight-lifters to be unable to run a mile. Balanced fitness means strength, a little cardio, and calisthenics for athleticism but only the strength component is relevant here). Some full-body calisthenics might be helpful (eg squats, farmer's walks, push-ups, step and press) but what really helps is moving heavy weights against gravity with all the muscles you can engage for a couple of hours each week.
That works because muscle stress and muscle growth put the good kind of stress on the bones to which they are attached. This naturally stimulates bone development. Bone-ligament-muscle is a functional unit. Weight training can not damage your bones. Quite the opposite.
For strength training for post-menopausal women, I recommend working towards multi-muscle-group exertions like barbell or goblet squats, bench press, deadlifts, assisted pull-ups, military press, leg press, etc with ever-increasing resistance. The uninitiated should not do these things without an experienced and savvy trainer with some nutritional sophistication. Being overweight is no obstacle to strength training, but a low BMI is a major obstacle to strength-building and requires remediation.
Bone weakness aside, any non-casual fitness program should include strength training, some cardio, and calisthenics. In addition, a nutritional plan that supports your conditioning goals.