there is no finish line...enjoy the ride...

What goes in, must come out....

There’s a plethora of information about the good food and the bad food we put into your bodies everyday, but you don’t read much about what comes out.  I came across a great article written by Jonathan M. Vapnek, MD, a urologist and the clinical associate professor of urology at Mount Sinai School of Medicine in New York City and I think you would be surprised by how much information can be gleaned from the urine you produce each day.

For example, the simple “dipstick” urine test that doctors often use to check for a urinary tract infection also can help them diagnose kidney disease, diabetes, cancer and other conditions. But there is more.

What you may not realize: If you know what to look for, you can tell a lot about your health just by being aware of the physical characteristics of your urine—such as colour, smell and frequency.

COLOUR

When you’re healthy and drinking enough water, your urine should be mainly clear or straw-coloured with just a hint of yellow. The yellow colour comes from urochrome, a pigment produced by the breakdown of a protein in red blood cells.

Urine is naturally darker in the morning because you don’t drink water while you sleep. If a colour change persists, however, it could be a problem.

For example...

Brown or dark brown. Pay attention if your urine is dark for more than a week.

What this usually means: Liver disease. The liver normally breaks down and excretes bilirubin, a pigment that’s produced by the turnover of red blood cells. Patients with liver disease accumulate bilirubin. This initially will cause jaundice, a yellowing of the skin or the whites of the eyes. As more bilirubin accumulates, it can cause the urine to become brown. A combination of dark-coloured urine and jaundice means that liver disease might be getting worse. See your doctor right away.

Dark-coloured urine also can be a side effect of some antibiotics, laxatives and muscle relaxants. Eating large amounts of fava beans, rhubarb or aloe can cause brown urine as well. In some cases, dark-coloured urine can signal kidney failure.

Red or pink. Urine that’s tinged with red or pink could simply mean that you have been eating beets. (The medical term for beet-induced urine changes is beeturia). Or it could mean that you’re urinating blood.

The amount of blood will affect the colour. If the urine resembles cabernet wine, you’re bleeding a lot…urine that’s pinkish or just slightly red contains only traces of blood. A microscopic amount of blood won’t be visible—it can be detected only with a laboratory test.

What this usually means: Blood in the urine is always a problem. Make an appointment to see your doctor. If you see blood and it also hurts when you urinate, you could have an infection—in the urethra, bladder or kidney or even a malignancy in the bladder, for example. Bleeding without pain also can indicate these conditions.

Green. Though rare, a person’s urine can turn a greenish colour.

What this usually means: Green urine can appear when you’ve consumed a chemical dye—from food colouring, for example, or from taking medications such as amitriptyline (Elavil), an antidepressant, or indomethacin (Indocin), a nonsteroidal anti-inflammatory drug. In some cases, urine with a greenish tint can signal a urinary tract infection with certain bacteria (such as pseudomonas) that affect the colour.

If your urine is greenish, increase fluid intake to see if it clears. If it doesn’t in two days, see your doctor or a urologist.

 ODOUR

If you’re healthy, your urine should be highly diluted, consisting of about 95% water, with only small amounts of dissolved chemical compounds and metabolic by-products. It typically has no—or only a faint—odour.

Of course everyone is familiar with the effect that asparagus and some other foods, such as onions or fish, have on the smell of one’s urine. This strong “rotten” smell is due to the chemical compounds in certain foods, particularly molecules that are not completely broken down by the body. The smell usually disappears within a day or so.

Some other less common urine smells include…

Ammonia-like. If your urine is concentrated, with a larger-than-normal amount of urea (a chemical compound in urine), you might smell an aroma that resembles ammonia. Or you might just notice that it has a stronger smell than usual.

What this usually means: Dehydration. The less water you drink, the higher the concentration of urea and other substances—and the stronger the smell. You can diagnose this yourself by drinking, say, one extra glass of water an hour for several hours to add water to your urine. The strong urine smell will probably disappear within a few hours. If it does not, see your doctor.

Foul-smelling. If your urine smells foul or unusual in any way for more than a few days, pay attention to the odour.

What this usually means: If it’s not caused by a food that you’ve eaten, it could signal an infection in the bladder or kidneys. Less often, it’s due to a metabolic disorder that reduces the body’s ability to fully break down foods during digestion.

Uncontrolled diabetes can cause an abnormally sweet odour, and penicillin can cause a distinctive medicinal odour.

Even if you have no other symptoms, such as pain while urinating, but your urine continues to have an unusually strong smell for more than a couple of days, talk to your doctor.

FOAMY OR BUBBLY

It’s natural to see foam in the toilet when you really have to go and have a heavy stream. But urine that’s consistently foamy or bubbly could mean that you’re losing protein.

What this usually means: Kidney disease. Large amounts of protein in the urine is one of the main signs of chronic kidney disease. See your doctor right away.

MUCUS OR CLOUDY

Mucus in urine could indicate inflammation in the urinary tract.

What this usually means: Urinary tract infection. See your doctor.

Cloudy urine also can be related to infection but often is just an indication that your urine is alkaline, which is harmless at low levels.

VOLUME AND FREQUENCY

The average adult typically urinates four to eight times in 24 hours. A change in the frequency of your urinary habits, including getting up more than twice a night to urinate, or an increase or decrease in the amount that you urinate, warrants attention.

What this usually means: An increase in the frequency of urination, along with an increase in volume, is one of the telltale signs of diabetes.

If the amount of urine seems the same but you’re urinating more often, you could have a urinary tract infection. If this is the case, you’ll probably have very strong urges to urinate even when just a small amount comes out.

Frequency of urination and/or urinary urgency in the absence of a urinary tract infection can indicate an overactive bladder.

In men, enlargement of the prostate gland can trigger urinary urgency. Patients with neurological conditions, such as multiple sclerosis, can also have this symptom. Don’t worry if there’s been a decrease in the amount or frequency of urination. You probably just need to drink more water. If this doesn’t help, see your doctor.

So a basic understanding of the physical characteristics of the pee coming out of your body can be just as important as what you're putting in your body.  That being said, I can almost guarantee that if what’s going in isn’t healthy, what’s coming out will simply confirm it.

Enjoy the Ride.....Rob

What Are You Made Of?

My regular guest blogger, Dr Les Davidson and I align on most health related topics and this week is no exception.  Of the people that actually monitor their body weight, I wonder how many understand what makes up the number on their scale, and why is it important.  That’s the topic of today’s post by Dr Les.

Besides our nation being just lazy, the obesity epidemic gripping North America may be in part due to what I call, “health illiteracy”.  So many people have preconceived ideas of what “healthy” is, but in actual fact they score very low on the health literacy scale when it comes to nutrition, diet, body weight, fitness, sleep, stress, etc., and even lower on execution.

Specifically related to Dr Les’ topic of weight, I’m experiencing this “illiteracy” first hand as I train for the hardest amateur bike race in the world this August - Haute Route.   This 7 day stage race starts in Geneva and finishes in Nice France and covers 860km through the beautiful French Alps.  But it's not the distance that makes this race so grueling; it’s the 21,000 meters (68,000 feet) of climbing over the Alps that makes is so hard.  Below is the profile of the 7 days of racing facing the 600 participants of Haute Route. 

 

Given the amount and severity of climbing involved, special attention to a rider's body weight and its composition is of primary concern to every participant.  There’s a reason why cyclists pay more attention to their weight than international super models, and it has little to do with vanity.  In fact, it has everything to do with how much power a rider can produce for every kilogram of body weight.  And the relationship between power output and weight has greater sagnificance when long, steep mountain climbs are involved.

At the beginning of January, I weighed 171lbs, but to race Haute Route, I would have to shed between 15lbs to 20lbs to increase my “power-to-weight” ratio to over 4 watts/kg.  Losing weight is just half the battle, as one must also be mindful of what type of weight that's lost.  In my case, I want to lose body fat, while maintaining or even increasing lean muscle mass. 

There’s an old saying in business, “If you can measure it, you can manage it”.  So, at the beginning of February I started measuring my body fat using skin fold calipers.  By focusing on the quality and even more importantly, the quatity of food I consumed, I now weight 156lbs.  During this time I also gained 4lbs of lean muscle, so effectively I’ve lost 19lbs of body fat since January.  Since fat occupies more volume than muscle, I’ve also lost an inch from my chest, waist and hips, so I actually appear much thinner.  Below is my progression of weight loss and muscle gain since I started recording this information in February.

And here in lies the “health illiteracy” issue.

It seems in North America you can be overweight, or even obese, and no one will ever mention that you have a serious and potentially life threatening health issue.  In fact, a recent study found that over 60% of parents with overweight children considered them to be of normal weight.  But if you’re thin, as in healthy thin, people take it upon themselves to point out that you’re too thin and don’t look healthy.  Can you imagine the reaction you would receive if you told a friend that she was overweight and didn't look healthy?  The duel standard is because of three reasons:

1. Given there are so many overweight and obese people in North America, our mental model of what constitutes a healthy weight and size has been skewed over the decades.  People of a healthy thin composition are now in the minority and look different to the majority of overweight North Americans.
2. Most people are illiterate when it comes to what a healthy size and weight should be.  Just like the majority of people no longer know what represents a healthy food portion.  As a result, the bigger is better attitude prevails.
3. Finally, weight loss is generally associated with serious illnesses such as AIDS, Cancer or Eating Disorders.  My good friend Pierre LeClair who I coach was once 250lbs.  After losing 80lbs last year, he tells me people that haven’t seen him for a while ask him if he’s sick because he looks too thin, even though he’s the healthiest he’s been in decades.

This is obviously frustrating to a guy like myself that’s uber aware of my health and fitness, but more importantly, it draws attention to the fact that so many people are “health illiterate” which has negative consequences at both individual and national levels. 

Dr Les, has done a great job of framing the issue, why it’s important to understand what you’re made of, monitoring techniques, and how to bring yourself back to a healthy and well proportioned size. 

As always with much of what I share, “knowledge is power, but action flicks the switch”. 

Enjoy the ride….Rob

 

What Are You Made Of?

by: Dr Les Davidson

What are you made of? Or stated more technically, what is your body composition? Are you a lean, mean athletic machine, or are you getting a little soft?  Every year billions (with a “b”) of dollars are spent on weight-loss endeavors in North America. Beyond the obvious — looking good at the beach — is there any reason to be concerned about the composition of your body.

As a competitive wrestler throughout high school and university, the scale was a constant companion because we were grouped according to our weight classes for competition.  I learned quickly that the quality of my weight was crucial; reducing extraneous fat became an important objective. Forty years later the challenge to maintain an optimum fat to muscle ratio is still there but my motivation is less about competing and more about remaining healthy and active. In order to do that, I need to pay close attention to my body composition.

Body composition is simply a measurement of lean body mass (bones, muscles, ligaments and organs) compared to fat mass which is referred to as adipose tissue. Technology allows us to accurately measure the amount of lean mass versus fat mass. These measurements are expressed as percentages of overall weight and knowing these percentages and what they indicate is important to your health.

A certain amount of body fat is essential to insulate our body, protect our organs from trauma, provide energy, and to assist hormone production necessary for reproduction. The amount of essential fat will vary dependent on sex and age but there are recommendations for ideal body fat percentages. The table below from the American Council on Exercise is typical fat percentages.

	Male	Female
Essential fat	3-5%	10-16%
Competitive Athletes	6-13%	14-20%
Recreational Athletes	14-18%	21-24%
Average	19-20%	25-31%
Obese	25+%	32+%

 

An equally important variable is where the fat is located; excess fat found at the waist (also known as central obesity) is associated with increased risk to our health. Our waists are thickened not just by the fat we can feel but also because excess fat accumulates around the organs (visceral adipose tissue).

Historically, we believed this fat to be an inert storage of extra energy. Medical science has now come to understand that adipose tissue is a major endocrine organ that produces hormones associated with insulin resistance and general body inflammation. The conditions associated with excess fat are often discussed as separate syndromes but in reality, they are a group of interrelated issues that cascade into ill health. Insulin resistance and inflammation leads to Metabolic Syndrome or Syndrome X — conditions associated with an elevated risk of Type Two diabetes and Cardiovascular Disease. There is also strong evidence that Metabolic Syndrome increases risk for certain Cancers. Then there is the impact that excess adipose tissue has on the musculoskeletal system with increased back pain and damage to the weight-bearing joints of the lower extremities. In my office each day I see patients impacted by being overweight. It may not cause their back, hip or knee pain but it aggravates their symptoms and limits their ability to be as active as needed to regain good health.

Determining your risk:

Body weight alone is a poor indicator of body composition as it does not differentiate between lean tissue (bones, muscles, connective tissue and organs) and body fat. There is no single ideal percentage of body fat for everyone. Estimating body composition is attempted with the body mass index using the variables of weight and height (weight divided by height squared). More accurate methods using DEXA (dual energy X-ray absorptiometry) or hydrostatic weighing (calculating what sinks (lean mass) versus what floats (fat) when the client is submerged under water) are often difficult for most individuals to access. Using calipers to measure skin folds or employing Bioimpedance are affected by the skill of the person measuring and the formulas applied, but can be easily mastered with a little practice. At our office we employ the bioimpedance method. With careful attention to patient hydration and selection of the optimum formula, we have had results that match closely to results of the DEXA scan.

Another method to stratify those who have high levels of body fat ignores the percentage of lean mass and body fat and focuses instead on the amount of belly fat. Measuring your waist circumference may be a more sensitive test because, as I mentioned, Intra-abdominal or visceral fat (regardless of overall body fat) has a particularly strong correlation with cardiovascular disease, diabetes, cancers and other life shortening diseases. There are three ways that this measurement is used to quantify risk:

1. Waist circumference, Absolute waist circumference (>102 cm in men and >88 cm in women)
2. Waist–hip ratio (the circumference of the waist divided by that of the hips of >0.9 for men and >0.85 for women)[19]
3. Waist circumference divided into height. This has been described as the index of central obesity. (0 .5 or greater is suggested as a sign of increased risk. More specifically the range for women was suggested to .47-.54 and for men as .51-.58).

Reducing the risk:

1. Diet: You cannot exercise at the same pace you can eat so it is critical to moderate your calories regardless of the protein, fat or carbohydrate content of your food or the amount you exercise. Look for food in a natural state with no “improvements” by the food industry (such as partially hydrogenated fat, preservatives or high-fructose corn syrup).
2. Exercise: Just remember we are designed to move and not doing so compromises our health. Vary the intensity and duration and include resistance activity. This challenge becomes greater as we age because hormonal shifts make building lean mass harder and layering on fat easier
3. Sleep: Sleeping too little or of a poor interrupted quality increases insulin resistance and raises cortisol the stress hormone. (See Rob’s blog, The Sleep Mistake Many of Us Make)
4. Stress reduction: Being overwhelmed or on heightened alert increases the sympathetic nervous system activity. This releases cortisol and directly increases belly fat. Moderating our moods by eating or drinking too much is often seen in response to stressful situations.

The body has tremendous recuperative powers if it is provided with the right inputs. March is Nutrition month and I would like to encourage you to think of the importance of quantity as well as quality of your food! Exercise is critical for good health but it can’t exercise your way out of a bad diet! Don’t pursue some unrealistic and media-hyped expectation for your body.  People come in all shapes and sizes but no shape is improved by an expanding layer of belly fat.

Pay more attention to what you’re made of. This will be good for your health and you just might look better on the beach this summer!

Believe ‘A Calorie is a Calorie’? Coke says it is....Think Again!

I read the following article today by Dr Robert Lustig, Professor of Pediatrics at UCSF, and President of the Institute for Responsible Nutrition. 

I’ve shared Dr Lustig’s research and information in the past and given Coca Cola’ latest slick new 2 minute ad – Coming Together on YouTube suggesting to their consumers that a Calorie is a Calorie, thereby implying that it’s the fault of the general public for the obesity epidemic because they offer reduced and low calorie options (claiming no culpability on their part) is reprehensible, but predictable.

 

Dr Lustig’s research below is certainly timely given this slick piece of marketing and something every person that cares about their health and the health of their families should know and understand. 

Let's be clear, companies like Coca Cola, PepsiCo, and others that market processed foods are no friends of yours, mine or our families when it comes to selling products that are harmful to our health and the health of our families. They care only about revenues at the expense of a healthcare system that are struggling and on life support, while giving little consideration for their customers that are addicted to their unhealthy products.

Think about your health the next time you reach for the “Real Thing”, because you're not only paying for their products, you're also paying for a dying healthcare system.

I’ve copied the full article written by Dr Lustig for your convenience below.

Enjoy the Ride....Rob

Still Believe ‘A Calorie is a Calorie’?

By Dr Robert Lustig

If you do, you fly in the face of mounting and incontrovertible evidence that some calories -- in particular, "sugar calories" -- are jeopardizing both your and your family's health. Physicians and politicians who cling to the dogma that "all calories should be treated equally" imperil our country's health care system, food supply and standing in the world for the next hundred years.

A calorie is a measurement of energy (a matter of physics), not a value judgment on where that energy goes (a matter of biochemistry). As my book Fat Chance explains, you get sick from inappropriate energy storage (in your liver and muscle), not defective energy balance (bigger love handles). Nonetheless, "a calorie is a calorie" continues to be promulgated by the food industry as their defense against their culpability for the current epidemic of obesity and chronic metabolic disease. But it is as dishonest as a three-dollar bill. Here are just four examples that refute this dogma:

1. Fiber. You eat 160 calories in almonds, but you absorb only 130. The fiber in the almonds delays absorption of calories into the bloodstream, delivering those calories to the bacteria in your intestine, which chew them up. Because a calorie is not a calorie.
2. Protein. When it comes to food, you have to put energy in to get energy out. You have to put twice as much energy in to metabolize protein as you do carbohydrate; this is called the thermic effect of food. So protein wastes more energy in its processing. Plus protein reduces hunger better than carbohydrate. Because a calorie is not a calorie.
3. Fat. All fats release nine calories per gram when burned. But omega-3 fats are heart-healthy and will save your life, while trans fats clog your arteries, leading to a heart attack. Because a calorie is not a calorie.
4. Sugar. This is the "big kahuna" of the "big lie." Sugar is not one chemical. It's two. Glucose is the energy of life. Every cell in every organism on the planet can burn glucose for energy. Glucose is mildly sweet, but not very interesting (think molasses). Fructose is an entirely different animal. Fructose is very sweet, the molecule we seek. Both burn at four calories per gram. If fructose were just like glucose, then sugar or high-fructose corn syrup (HFCS) would be just like starch. But fructose is not glucose. Because a calorie is not a calorie.

Up until now, scientists have shown that sugar is "associated" or "correlated" with various chronic metabolic diseases. For instance, the increase in sugar consumption over the past 30 years paralleled the increase in obesity, diabetes and heart disease. Areas that drink more soda (e.g., the American Southeast) experience higher prevalences of these diseases. But correlation is not causation.

Which direction do the data go? Does sugar cause obesity and metabolic disease? Or do obese people with metabolic disease drink soda? You can't tell, because you only have one point in time -- the snapshot, not the movie. In the February 27 issue of the journal PLoS One, my colleagues Dr. Sanjay Basu, Paula Yoffe, Nancy Hills and I put this issue to rest, because we now have the movie.[1]

We asked the question, "What in the world's food supply explains diabetes rates, country-by-country, over the last decade?" We melded databases from the Food and Agriculture Organization (FAOSTAT), which measures food availability, the International Diabetes Federation (IDF), which measures diabetes prevalence, the World Bank World Development Economic Indicators, and the World Health Organization Global Infobase. We assessed total calories; meat (protein); oils (fat); cereals (glucose); pulses, nuts, vegetables, roots, and tubers (fiber); fruit excluding wine (natural sugar); and sugar, sugarcrops, and sweeteners (added sugar). We controlled for poverty, urbanization, aging, and most important, obesity and physical activity.

Bottom line -- only changes in sugar availability explained changes in diabetes prevalence worldwide; nothing else mattered.

Total caloric availability was unrelated to diabetes prevalence; for every extra 150 calories per day, diabetes prevalence rose by only 0.1 percent. But if those 150 calories per day happened to be a can of soda, diabetes prevalence rose 11-fold, by 1.1 percent (and Americans on average consume the added sugar equivalent of 2.5 cans of soda per day, so that's 2.75 percent!). And this effect of sugar was exclusive of obesity; controlling for body mass index did not negate the effect. Even more important, we showed that the change in sugar availability preceded the change in diabetes (that's cause, not effect); and we showed directionality -- those countries where sugar availability rose showed increases in diabetes, while those where sugar availability fell showed decreases in diabetes. This is a very robust signal, with little noise. While epidemiology can't prove scientific causation, the data allow for objective inference. Sugar drives diabetes worldwide, and unrelated to its calories.

When you do the math, fully one-quarter of the world's diabetes is explained by sugar alone.

The food industry has contaminated the American food supply with added sugar to "sell more product" and thereby uphold their Wall Street mandate to increase profits. Of the 600,000 food items in the American grocery store, 80 percent have been spiked with added sugar; and the industry uses 56 other names for sugar on the label. They know when they add sugar, you buy more. And because you do not know you're buying it, you buy even more.

The outcome: By the year 2050, one-third of all Americans will have diabetes. Trustees of the Medicare program predict that Medicare will be broke by 2024. No health care for you. Yet just six weeks ago, Coca-Cola had the temerity to introduce its two-minute ad "Coming Together," in which they say: "All calories count" because a calorie is a calorie; if you're fat, it's your fault (they claim no culpability); and because they make non-caloric drinks, they're part of the solution. The problem is that a calorie is not a calorie; if non-caloric drinks are the solution, then by inference they're saying that caloric drinks are the problem.

Sugar in excess is a toxin, unrelated to its calories. The dose determines the poison. Like alcohol, a little sugar is fine, but a lot is not. And the food industry has put us way over our limit.

The food industry will summon their spin doctors. They will yet again argue that the statistics are wrong, the interpretation is too broad -- but they will not be able to effectively refute the science. They haven't yet, and they won't succeed now. Sunlight is the best disinfectant, and it's shining brightly on the food industry's practices. They will continue the propaganda, and try to sow the seeds of doubt. But they will be on the losing end of this battle. The UK and Australia have just this past week laid down stricter guidelines for sugar consumption. The people and scientists of the United States are onto them as well. It's just a matter of time before the politicians follow.

Robert H. Lustig, M.D., is Professor of Pediatrics at UCSF, and President of the Institute for Responsible Nutrition (responsiblefoods.org), at which the Doctors' Food Project is the first campaign. He is currently getting his Masters in Studies of Law at UC Hastings College of the Law. His YouTube lecture, "Sugar: The Bitter Truth" has been viewed over 3 million times. His book, Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity and Disease (Hudson Street Press, 2012), is in bookstores now.

Alzheimer's - don't let it steal your life

Last week my uncle died and his funeral was held on Monday.  He lived in Edinburgh Scotland, so I wasn’t that close to him as I’ve lived in Canada all my life and we’ve only met a few times.  Even still, it was a sad day when I received this news.  I was further saddened when I heard my Aunt wasn’t able to attend his funeral because she suffers from Alzheimer’s and it would have been too confusing for her.  Alzheimer’s seems to run in my family, as two other Aunts of mine, who have both since passed away, also had this disease. 

When it’s all said and done, life is nothing more than a collection of experiences and memories.  All your worldly possessions don’t add up to much when you can’t recall the life you lived.  This horrible disease robs people of their most precious asset...their mind.  For me, the most frightening consequence of aging is the possible loss of my mental faculties. Utter the phrase “Alzheimer’s disease” – especially to someone like me who’s seen three family members touched by it – and people’s expressions tend to get a bit strained.

Although Alzheimer’s can affect younger people, it’s the most common cause of memory loss among the elderly. With the first baby boomers reaching age 65 in 2012, healthcare experts are predicting that many citizens will spend their final years either suffering from Alzheimer’s or caring for loved ones who have it. 

Alzheimer’s is currently the only condition among the top ten causes of death that cannot be prevented, cured or even delayed. While death rates for other major diseases like stroke, heart disease, HIV, and several cancers – have declined in recent years or at least remaining constant, those with Alzheimer’s continue to climb at an alarming rate. Despite this grim trend, in 2011 the National Institutes of Health spent about one-tenth as much for Alzheimer’s research as it did on cancer, heart disease and HIV/AIDS. 

Given the lack of focus and funding for this mental health illness, it’s going to be a while before any meaningful treatment for Alzheimer’s is forthcoming.  Like I’ve said many times before, what you do today has a profound impact on your health in the distant future, and this doesn’t only apply to your physical health, but also your mental health.  So you might want to take care of your brain today to avoid being a statistic in the future.  I suggest the following:

1. Avoid unhealthy brain habits: Stop smoking, avoid recreational drugs and limit alcohol consumption to a maximum of one (women) or two (men) drinks daily. Smoking damages the blood vessels that feed your brain, and substance abuse including social alcohol consumption destroys neurons that simply cannot be replaced.
2. Eat a healthy diet: When planning your meals, rely heavily on vegetables, fruits, legumes, whole grains and nuts. These foods contain vitamins, minerals, antioxidants and other compounds that are essential for neurotransmitter synthesis, healthy nerves and robust circulation. Limit red meats, which can be artery-clogging and increase oily, cold water fish, which is excellent for normal brain function.
3. Exercise your body: 60 minutes of exercise daily not only protects your heart, strengthens your muscles and builds strong bones; it also helps delay the onset of dementia like no other medication. You don’t have to take up triathlons either, simple walking will do.  Walking improves balance, aerobic conditioning and cerebral blood flow.
4. Exercise your brain: A 2009 study in the journal Neurology demonstrated that people who read, write, learn a new language, do crossword puzzles, play board games or cards, play musical instruments or regularly participate in group discussions are less likely to develop dementia. The study’s authors reported that every mentally stimulating activity you undertake will delay the onset of dementia. Besides wanting to retire to the South of France where the ability to speak French is necessary, learning this language to exercise my brain is the second reason I picked up the Rosetta Stone program.  Who knows if I’ll be able to speak French fluently, maybe not, but it sure is fun learning and like physical exercise helping my heart, I know learning French is helping my brain.
5. Address your medical issues: If you have high triglycerides, high blood pressure, high lipid levels, or diabetes, or if you’re packing on more body fat than you should, see your doctor or medical provider to get these problems addressed immediately. Uncontrolled hypertension or chronically elevated blood glucose or lipid levels wreak havoc on your brain and contribute to memory loss. Studies show that people who are obese during their youth and middle age are 40% to 80% more likely to develop dementia than their healthy-weight counterparts.

More of us are living longer these days, and there’s no reason to believe you won’t be one of them. Making smart lifestyle choices right now just might keep you sharp-witted well into your twilight years.  Don’t let poor lifestyle habits today rob you of the only thing of true value in your future....your lifelong memories. 

Enjoy the Ride....Rob

Good information, Wrong interpretation

A good friend of mine once said that people can only hear the information that supports their own belief systems.  We see this all the time.  It’s why there’s polarizing opinions when it comes to topics like politics, or the existence of a God.  Regardless of the information, people will only hear what justifies the continuation of their own beliefs, even when the actual facts beg to differ.

I thought about this as I read the results of a recent study published by the British medical journal, “Heart”. This study was recently featured in articles within the Wall Street Journal and the Globe and Mail.  The study suggests that people that run too fast, for too far, for too many decades, may find themselves running to their early and ultimate “finish line”.   

My 87 year old father running in Greece

In the shadow of a national health crisis, where overweight and obese people represent the majority of the population, and citizens with chronic illnesses such as Diabetes, CODP, Cardiac Disease and various forms of Cancer are reaching epidemic proportions, I’m concerned that a health illiterate public will interpret the results of this study as an excuse NOT to exercise.  They will read the headline in the paper that says, “One Running Shoe in the Grave”.  As a result, this will fuel the belief system of many that if daily exercise isn’t good for runners, so why bother exercising at all. 

In actual fact, the study involved 52,600 subjects that were followed for three (3) decades, but what was glossed over was the fact that the runners in this group had an overall 19% lower death rate than the non-runners, and within the running group only the runners that ran longer than 40kms/week and faster than 13km/hour lost their mortality advantage. 

We’ve seen the impact of this kind of reporting from the past.  A study from a few decades ago suggested drinking a glass of red wine a day is good for your heart health.  Now we have a culture of social alcoholics who justify two to three drinks a day because it’s good for their heart health, when in fact nothing could be further from the truth.  Let's be clear, alcohol should not be part of a person's health habbits.

We live in a world where people have limited attention spans and are bombarded with catchy buy lines and punchy sound bites; the headline of this running report should have read, “Long term study suggests that life-long runners enjoy a lower death rate than non-runners”.  Just like the headline of the wine report should have said, “Study finds that consuming more than one drink a day for women and two for men, leads to negative health consequences”. 

We now have a population that takes little to no interest in their personal health until they’re told by their doctor that they have a serious, possibly life threatening chronic disease and that's the moment they decide it's time to practice positive health practices.  And the sad part is many of these situations are entirely preventable. 

How are we supposed to motivate our children to be active and make healthy life choices when they watch their parents make poor choices?  Media that report the findings of studies like this recent running study have a responsibility to be mindful of the role they play in the health of the public.  Our hospitals and long term care facilities are full of people that got there because they were inactive and made poor lifelong health choices. 

This study contains valuable information for a very small number of aging runners that push the performance envelope in their training and racing.  These runners should consider the consequences of these findings and adjust their running programs accordingly. 

Finally, I’d like to report that my father who is pictured above turns 88 next year and has been walk/joggng 8kms to 10kms every day, (or about 56+km a week) for years and only stopped racing marathons when he turned 79.  While he stills enjoys excellent health, most of his friends and family that lived a sedentary life, are either ill, immobile, or dead.  I guess he and the many seniors like him are the exceptions to this study.

Enjoy the Ride....Rob

Travel to the "Bizarro World" using your healthy "Auto-Pilot"

When it comes to health, diet and exercise I think I live in the “Bizarro World”, where everything is opposite to the normal world.  It’s a world where exercise is done every day for more than one hour, and taking an unscheduled day off is considered cruel and unusual punishment.  The reason my Bizarro World is so normal for me is because my priority and attention to my health, fitness and wellness is set on “Auto-Pilot” for more than 3 decades.  Unfortunately, the majority of North American’s have their Auto-Pilots pointing in the wrong direction.  And it’s such a mystery why so many people are surprised when they receive bad news about their health. 

In addition to exercising every day, my Bizarro World’s auto pilot also directs me to shop for food in the outside aisles of the grocery store where the real food is sold, while in the “Normal World”, people shop the inner aisles where they find unhealthy processed foods, snacks and soft drinks.  My auto pilot also prevents me from ever eating at fast food joints like McDonalds, Burger King or Wendy’s, while in the Normal World, their auto pilot directs them to frequent these unhealthy fast food joints on a regular basis, with giving little consideration for the future health outcomes.  And we wonder why our healthcare costs are so out of control.

Many months ago I wrote a Blog Post about the emerging science of “Behavioural Economics” and how making small changes in lifestyle can put you a Healthy Auto Pilot.  This past weekend’s Globe and Mail had a great article on this very topic, which I’ve copied below in its entirety for your convenience. 

Having your auto pilot pointed in the right healthy direction is so important to your long term health.  Research has found that most decisions that have a long term impact are not the result of careful deliberation, but are formed through a dysfunctional Auto Pilot that repeats the same unhealthy practices over and over again for decades.  Since most degenerative diseases are the result of years or decades of repetitive choices, it only makes sense that you adjust your auto pilot’s direction towards the Bizarro World and enjoy the associated long term health benefits.

Enjoy the Ride....Rob

Can we nudge ourselves to better health?

The Globe and Mail - October 5, 2012

Eat less, move more, stop smoking, cut down on booze. Public health campaigns have been drilling these messages into our heads for years. Even so, Canadians are failing to ditch their bad habits.

The reason, according to a growing body of research, is that we spend much of our days on autopilot. Instead of making conscious decisions each time we commute to work or buy lunch, we hop in the car, see a fast-food sign and order fries.

Automatic behaviours make life more efficient, freeing up cognitive energy for important tasks. But according to a new study published in the journal Science, our mindless choices are literally putting our health at risk.

The authors suggest that instead of just providing health information, public health initiatives should target the knee-jerk behaviours that are making us fatter and sicker.

“We now know that much of our behaviour is not driven by deliberation upon the consequences of our actions but rather, is automatic, shaped by our environments, often without awareness,” says Theresa Marteau, lead author of the study and director of the behaviour and health research unit at Cambridge University.

She and her co-authors note that subtle changes in the environment, which require little or no conscious engagement, may nudge people to make healthier choices.

For example, when elevator doors are programmed to close slowly, more people take the stairs. Cafeteria customers are more likely to choose fruits and vegetables when salad bars are easier to reach. And drinkers tend to consume less alcohol when it is served in tall, narrow glasses instead of short, wide-bottomed tumblers.

Since many behaviours that increase the risk of disease offer pleasure, Marteau says, health initiatives should take enjoyment into account. She notes that young children are more willing to consume vegetables when the packaging features cartoon characters, and more likely to eat lentil stew if it is called “teddy bears porridge.”

Much of the global burden of disease may be preventible, she adds. The World Health Organization estimates that rates of Type 2 diabetes and cardiovascular disease would be cut by 75 per cent and cancer by 40 per cent if people stopped smoking, reduced alcohol consumption, improved their diets and got more exercise.

Behaviour change is the holy grail of preventive medicine – and the subject of recent bestsellers such as The Power of Habit: Why We Do What We Do in Life and Business and Nudge: Improving Decisions About Health, Wealth, and Happiness.

The latest evidence from neuroscience, psychology and behaviour economics suggests that our actions are guided by two interacting systems: a reflective system, in which we work toward goals, aware of our motivations and actions, and an automatic system, in which we act without reflection, responding to external cues while our thoughts are elsewhere.

Automatic behaviours are often at odds with our conscious goals, Marteau and her co-authors explain. What’s more, they tend to kick in when we’re under stress or faced with a task that requires attention. In one experiment, participants asked to memorize a string of numbers were more likely to choose chocolate cake over fruit salad when forced to make the decision in the middle of the exercise. (That may explain why we grab chips from the vending machine instead of multigrain crackers when we’re working on deadline.)

Although people can consciously change their behaviour, “this requires using our scarce cognitive capacity,” which may then be deflected from the complex situations we face every day, Marteau says.

Howard Leventhal, a professor of psychology at Rutgers University, confirms that external cues may prompt healthier behaviours. But he cautions that when a person leaves the environment designed to encourage healthy choices, the approach stops working. “People don’t internalize it.”

Public health campaigns should engage the reasoning process that individuals use to embed a preventive behaviour into their daily routines, he says. For example, a person with Type 2 diabetes could make a habit of parking farther from store entrances to incorporate short walks. Ideally, he says, the patient’s new automatic behaviour would be reinforced by initiatives to create healthier environments, such as making nutritious foods more readily available.

Marteau acknowledges that a multi-pronged approach is probably the most effective way to achieve widespread behaviour change. But campaigns designed to nudge the public to adopt better habits can only go so far, she and her colleagues suggest. In an earlier report in the British Medical Journal, they argue that policy makers may need to increase regulation around such issues as junk food advertising and the glut of unhealthy products on the market, to counteract the powerful cues that trigger our unhealthy behaviours.

Smoking is one example, Marteau says. While smoking cessation treatments may be effective, she points out, “they are more successful when there are fewer places where tobacco can be bought.”

Don't "Live a Little"...learn to "Live a Lot"

Most people would be happy just to say they made it to 100 years of age and still be able to walk and remember their name. Not Frenchman, Robert Marchand. No, just making it to 100 is for pussies. This guy is setting world records on his bike. First he set the one hour cycling record in Switzerland by covering over 24 kilometres in one hour, a record that was sanctioned by cycling’s international governing body, the UCI. Now he set a second official record for a person over 100 years of age by covering 100km in a time of 4:17:27. 

I’m writing this blog post from my second home in Arizona, where I have ridden over 1500kms in the past 15 days as I begin my preparation for the next year's Haute Route race from Geneva, Switzerland to Nice France. Every time I come down here from my home in Canada, I’m always shocked at the poor health of so many Americans, by evidence of the number of obese people. Given the alarming condition of the majority North American’s (Canadian’s included), just completing a 100km ride would be a near impossibility for most, but to ride it in Mr. Marchand’s time of a little over 4 hours is only a dream.  And it's such a mystery why we have out of control healthcare costs!

As much as racing in next year’s Haute Route is a lofty goal to be sure, it’s only a small step in a much larger target and Mr. Marchand is making my ultimate goal a whole lot more difficult, because instead of going after one record when I turn 100, I now have to break two. He has set the bar higher because now in addition to breaking the one hour record, I also have to beat his 100km record.

I was having a conversation with a friend the other day about Mr. Marchand accomplishments and we were identifying the many things you have to get right in your life to accomplish what he’s doing at his age. First, he has some good genetics at work here, but good genes will only get you so far, so what are the other things, let me list just a few:

• You have to remain active all your life to be able to ride 100km at 100 years of age.
• You have to eat a nutritious diet throughout your life that consists of fruits, vegetables, leafy greens, high quality protein, healthy carbohydrates, while avoiding the foods we know are bad for us.
• Drink a healthy amount of water every day.
• Don’t smoke (that's obvious) and don’t drink an unhealthy amount of alcohol (1 drink a day for women and 2 for men)
• Get enough sleep and rest
• De-stress your life
• Keep your mind active, for without a sharp mind, you'll never be able to manage even the simple things like keeping your balance, or structure a training program to accomplish the kind of physical activities Mr Marchand is capable of.
• And finally, have a passion in your life that keeps you young. Clearly, Mr. Marchand’s passion is cycling and it’s giving him purpose, and probably one of the main reasons he’s still so active.

This represents a partial list of the most important elements necessary for a long and healthy life that many will consider somewhat restrictive or even boring. In fact, I’ve been told on a number of occasions that I should “live a little”, especially when I’m at a party and I refuse to drink the same volume of alcohol as others. My goal isn’t to “live a little”, but to “live a lot”! I’m only 56, so I have another 44 years to train and prepare for my attempt at Mr. Marchand’s records. Racing next year’s Haute Route race is considered the world’s toughest cycling sportive and is what I equate to as, "living a lot".  I certainly don't want age to be the thing that prevents me from being like Mr. Marchand.

The important thing to consider about long term health is that what you do today will affect you 20, 30, or even 40 years from now.  Most people that reach their 60's, 70's and 80's in poor health, generally achieve this state as the result of poor lifestyle choices that manifest into one of the many degenerative diseases. 

The purpose of this post is to share an inspirational story of a 100 year old man that’s “living a lot” and it proves that it’s not by accident that’s he’s capable of these amazing accomplishments. For sure, you can’t do much about your genetics, and some people are just luckier than others. I may be one of those people (I hope); given my father at the age of 87 is still very active and does his daily 10km run/walk. But there are so many more variables that you have total control over if you apply discipline and dedication to make it happen.

Remember, you don’t stop exercising because you’re old; you get old because you stop exercising.

Enjoy the ride....Rob

 

Are you Sitting Your Way to an Early Grave?

Maintaining optimal health involves many criteria to be dialled in just right to ensure you get the most out of your life.  One must consider the things that can inhibit your body from operating at its full potential, like avoiding smoking, drinking to excess, eating processed foods, etc., while ensuring we’re doing the things that are good for us as part of our daily routines, like exercise, eating a healthy diet, and getting enough sleep to mention a few.  Recent research has drawn our attention to the serious health consequences associated with sitting for hours at a time, which is common today because of the way we work and entertainment ourselves.

I wrote a blog post on this topic earlier this year, and I think it’s worth another look, because so many of us are forced into this situation because of our jobs.  This time however, Dr Les weighs into the topic and explains how sitting on our butts for hours throughout the day and into the evening, has serious health risks we should be aware of.  He has done an excellent job of pointing out the risks while providing simple solutions to remain active, even if you’re stuck for hours behind a computer.

Enjoy the Ride….Rob

 

"He who sits the most, dies the soonest"

By Dr Les Davidson

Seven characteristics differentiate the "living" from the "non- living" — cellular form with heritable genetic information with respiration, metabolism, reproduction, excretion, response to stimuli and movement.  It Is because of the profound relationship of "movement" to life that our chiropractic clinic is named Adjusted for Life.

 Most people tend to think of movement in terms of physical fitness or weight loss but movement is a fundamental ingredient of being alive. It is why our clinic’s mission is—Adding Life to Your Years. The life-sustaining benefits of movement are so critical that I remind patients that while chiropractic care won’t heal them, it will remove barriers to the body healing itself.

But what constitutes movement?

For years, experts have advised us that there is a baseline level of physical activity necessary to maintain health and wellness. Canada's Physical Activity Guideline recommends 150 minutes a week of moderate to vigorous aerobic activity. This baseline level has been shown to lower the risk of heart disease, type 2 diabetes and cancer as well as provide overall health benefits.

However, research now indicates that 150 minutes of aerobic exercise each week can't protect us from the risks associated with being inactive for the other 9,903 minutes. It’s like eating a salad for lunch and then snacking on foods laden with trans fats or smoking during the break or consuming excess alcohol when you get home from work. Common sense suggests that you can’t expect one good habit to override the other health risks.

Your body relies on movement to increase oxygen uptake, circulate blood and lymph fluids, transport food down the digestive tract and lubricate your joints. For this reason sitting needs to be considered as an independent risk factor to your health. It is a risk that is dose dependent. In other words it matters how long you sit at a time, how many days of the week you sit and cumulatively how long you have sat over the years.

Risks of sitting:

1. Metabolic syndrome with increased risk of heart disease and diabetes. An important tool to counter this risk apart from proper diet is movement. The metabolic demands of movement are quantified in units known as metabolic equivalent tasks and range from .9 MET at rest to 20+ for sprinting.  Simply increasing our MET from 1.0 to 3.0 or shifting from a sitting to a standing position changes our metabolism positively. This is why standing at work when you can is important. If you decide to be more vigorous it is important to check in with your family physician before starting any exercise program.
2. Loss of productivity because of fatigue and poor concentration. Your brain receives oxygen and proprioceptive nourishment as well as sensory information regarding balance, position and movements when you are active. In other words, if you want a healthy brain, you have to move your body. "Ninety percent of the stimulation and nutrition to the brain is generated by the movement of the spine," notes Dr. Roger Sperry, Nobel Prize recipient for brain research. Sperry said that movement of the spine acts like a windmill powering up the brain.
3. Musculoskeletal pain from short and tightened muscles. Intra-discal pressure increases by one-third from lying to standing and another one-third by sitting in a slouched sitting posture. If your joints hurt or your posture is poor, consider chiropractic. Chiropractic adjustments improve joint function which will enable you to move better and more frequently—components that are fundamental ingredients to life, health and well-being.

Over the years, I have instructed patients and corporations on correct ergonomics in the work environment. I make recommendations on how to tailor their work station to specific needs in order to lower the risk of injury from cumulative trauma. While this is important, I believe it is more important to consider harm reduction or prevention. In other words it is less important how well you sit, than how long you sit!

The first step is to find ways to limit the total time you sit followed by strategies to break up this total time into as little prolonged sitting as possible. Then consider the mechanics of how you are sitting followed by exercise recommendations to counter the imbalances that occur to the soft tissues with sitting.

This time of year, with the fall weather and the return to studies and work our risk from prolonged sitting and diminished activity increases. It is important that you consciously work to counter this in your lifestyle. Three suggestions for countering this risk are

1. Replace some of your lunchtime with exercise.

2. Plan your TV time so that you aren’t drawn into watching mind numbing hours of programming.

3. Incorporate into your day simple posture improving stretching movements such as these provided by Straighten up Alberta.

Adding life to your years.... Dr. Les

Ride to Conquer Cancer

A week ago I participated in the Ride to Conquer Cancer with seven of my work colleagues.   We joined over 1800 cyclists from across the province of Alberta as they rode over 230km over a weekend.  Collectively our team raised over $43,000, adding to the over $8,000,000 this single event raised in the fight against cancer. 

It’s said a picture is worth a thousand words, than I guess a video must be worth a million words.  Below is a short 10 minute video I produced to capture the event’s highlights.  Enjoy. 

  

My Observations:

The majority of the people riding in this event were your everyday person and I couldn’t find a single person that hasn’t somehow been personally affected by cancer, either personally or through a close friend or relative. 

I write this blog with the intent to increase the quality of life through providing readers information about diet, exercise and general healthy lifestyle choices.  During the weekend, I listened to the many stories about people that had cancer and lost the fight, and those that won the fight.  But as I listened, I found myself making a mental tally how many cases were the result of “bad cards” vs how many were because of “bad habits”.  It didn’t take long to realize the majority were the result of poor lifestyle choices.  Obviously, this is not a scientific study, but the point I’m trying to make, is that many people contract cancer because they have adopted unhealthy habits from their parents, or friends and without even knowing it they find themselves running directly towards a serious cancer event. 

Too many of these cases is simply a lack of education regarding the risk factors beyond genetics.  For example, eating a diet that’s high in acid, is a breeding ground for cancer (the typical North American diet, especially soft drinks and alcohol are very acidic), or not eating foods that are high in antioxidants, that remove free radicals that cause oxidative stress, which may lead to cancer.  In the absence of information, people will do what others do with little consideration to the consequences.

The other comment I heard over and over again during the weekend was how cancer caught the person by surprise.  Cancer is generally a disease that takes years or decades to develop to the point of crisis.  Except for the people that were given “bad cards”, cancer should never come as a surprise.  If you are overweight (BMI greater than 24.8, which is now over 55% of all Canadians), or you smoke (21% of Canadians), or you drink more than the safe limit of alcohol (one drink a day for women, two for men), or if you don’t exercise daily, etc. etc. then don’t be surprised if one day cancer knocks on your door.  The decisions you make today about your health will affect you decades from now.

Regardless of how or why a person contracts cancer, this disease affects more than that individual, and events such as the Ride to Conquer Cancer raise much needed awareness in addition to the funding needed for scientific research that hopeful brings a day when we live in a cancer free world.  Until that time comes, take it upon yourself and make healthy lifestyle choices for you and your loved ones.

Enjoy the Ride.....Rob

Prevention Is Thy Cure

I don’t talk much about my day job, but let me start off by saying, I love what I do.  I get to work in an area that aligns with my passion for health by marketing solutions that improve the quality of life by leveraging technology.  Whether it’s Personal Health Records that enable citizens to monitor their own health and wellness, and that of their loved ones, or Remote Patient Monitoring thereby empowering individuals to self monitor their condition(s) and become more aware of their own health recovery.  All the solutions I sell to government and health institutions are designed to increase health quality, while reducing overall costs. 

I’m always surprised where I get the inspiration for my blog content.  The great thing about blogging is there is no preselected topic or a schedule to maintain.  I just write when something catches my attention and aligns with the purpose and theme of my site that I think you may be interested in reading.  And today, my inspiration came while meeting a healthcare executive that’s about to embark on an impressive transformational initiative that reminded me of an article I read in the Globe and Mail at the beginning of the year.  The title of the article was “Wellness Model Emphasizes Illness Prevention”.   (I’ve also copied the article below for your convenience)

I’ve often said the majority of North Americans don’t care about their health until they’re faced with a health crisis that forces them to care.  I’m often challenge when I say this, but how can you argue the fact that 50% of Canadian’s don’t meet the minimum physical activity and healthy eating recommendations, or 55% of Canadians and over 70% of Americans are overweight or obese.  Approximately 20% of Canadians still smoke (and amazingly, male smoking is back on the rise) and alcohol consumption has increased to the point that many no longer know or choose to care what is consider unhealthy.  The Heart and Stroke Foundation published a study conducted in 2010 that an amazing 9 out of 10 Canadians are jeopardizing the quality and length of their lives by ignoring these and other risk factors that they’re in complete control of.

In Canada, over 40% of your tax dollars feed an ever ravenous healthcare system, but did you know that the use of the system you pay into is wildly disproportionate.  People with one or more of the five major chronic illnesses consume over 66% of our health services.  If Canadian’s attitudes towards their personal health and illness prevention continue, the statistics above will surely worsen (and take note, the situation in the USA is even worse).  Healthcare institutions throughout North America and around the world are continually exploring options and solutions to keep up with the demand for health services, while at the same time the people that complain most about the quality of care are the same people that take little or no interest in their lifestyle choices that directly affect their health.   

Besides being a health advocate that is concerned about the quality of health of individuals and the greater population, I’m also a businessman that is witness to a healthcare system that has the potential of either bankrupting our country if current spending trends continue, or my larger concern is that the quality of life for so many will be compromised when governments and health institutions have the difficult decision of selecting which programs are to receive funding and which ones will not because of a lack of funding. 

So the day of waiting for the crisis has arrived at our door step.  The question is what can you do about it?  The answer has been under our noises for decades.  The cure to prevent many chronic illnesses and recover our critically ill healthcare system is one in the same....PREVENTION through healthy lifestyle choices. 

I’m not sure if we’re actually seeing more marketing and media push in the area of illness prevention, or if it’s just that I have a heightened sense of awareness given my passion for the topic and the career I’ve chosen.  Regardless, there seems to be more and more information available and the article below from the Globe and Mail is just one of many examples I’ve read or seen on television. 

I’ve often said, “If you don’t take time for your health today, you will have lots of time to be sick in the future”.  I’m not so sure this statement is entirely  true, because if things go unchanged and the health of North Americans continues to deteriorate at its current rate, we will run out of money to treat the volume of people with chronic illnesses and the expanding services they demand, and you may not have as much time to be sick in the future as you once thought. 

Make your health and the health of others a lifelong priority so you can “Enjoy the Ride”....Rob

CHRONIC DISEASE

Wellness model emphasizes illness prevention

The Globe and Mail

Published Thursday, Nov. 24 2011, 2:28 PM EST

Dr. John Haggie is a strong proponent of the adage “an ounce of prevention is worth a pound of cure.”

As a surgeon practising in Gander, Nfld., he has first-hand experience with serious medical conditions that could be prevented with early intervention.

Among his examples, Dr. Haggie points to a patient who is about to lose her leg due to complications of type 2 diabetes. “This outcome could have been avoided at any number of points,” he says. “Better childhood nutrition and fitness could have prevented the obesity that led to the development of this woman’s diabetes. Better drug coverage could have improved her blood glucose management. Even something as simple as having her feet checked by a nurse, which costs about $20, could have saved this woman’s leg and tens of thousands of dollars to the health care system.”

As president of the Canadian Medical Association, Dr. Haggie is promoting a transformation of the health care system that will focus on illness prevention and health promotion. “The current acute disease model of health care is 20 years out of date. Today, the biggest burden on the system comes from largely preventable chronic diseases and their complications,” he says, noting part of the challenge in promoting health is that many highly effective interventions are based in the community, not in hospital or doctors’ offices (for example, programs to encourage youth fitness and smoking cessation initiatives). As a result, they are not funded by medicare.

“We have to convince the government to invest in primary and secondary prevention initiatives. The evidence shows that an upfront investment more than pays for itself down the road,” says Michael Cloutier, president and chief executive officer of the Canadian Diabetes Association. He notes that just a two per cent reduction in diabetes prevalence rates would result in a nine per cent reduction in direct health care costs.

Unfortunately, the tools and medications that promote health are not accessible to all Canadians. Almost two-thirds of people with diabetes report that they cannot afford to comply with their prescribed therapy to effectively manage their disease. “A lot of people have to choose between paying for their rent or for their medications. Many more – especially those in remote and lower income communities – cannot afford healthy food. The result is more diabetes-related complications, poorer quality of life for these individuals and an increasing strain on our health care system,” says Mr. Cloutier. “We need to create a standard of care for chronic disease management across Canada.”

The Canadian Medical Association is advocating for co-ordinated investments in health promotion and disease prevention that will eliminate these gaps.

“Our goal is to ensure that by the end of the end of the next Health Care Accord, Canadians will have the best health in the world,” says Dr. Haggie.

“There is no reason why we can’t do that. By emphasizing health promotion now, we will see results by 2020.”