February 2010

The Power of Three: Sleep, Exercise and Weight

Sleep, exercise and weight are inextricably linked together in a triad that is critically important to your health. You know about the importance of regular exercise for weight loss or weight maintenance, but you may not be aware of the importance of sleep in this relationship.

Studies have shown that people who don’t get enough sleep tend to weigh more and gain more weight over time than people who are well-rested. In the largest study, almost 70,000 women were followed over 16 years. They reported their weight every two years during the study.

At the beginning of the study, women who slept an average of five hours or less per night weighed 5.4 lbs. more than women who reported sleeping an average of seven hours per night. In addition, the women who slept less gained an additional 1.6 pounds every year over the women who slept more. That’s an extra 25.6 pounds over the course of the study.

The extra weight gain could not be explained by exercise or diet. In fact, the women who gained more weight actually ate less than their better-rested counterparts. This study could not identify what factor was responsible for the weight gain, but the authors proposed the following possibilities: sleeping less might lower the basal (baseline) metabolic rate or people who sleep less may fidget less (and burn fewer calories during the day).

Other researchers have proposed that lack of sleep causes a rise in the level of cortisol, a stress hormone, which can impact body weight. Cortisol can stimulate hunger, which can lead to overeating and weight gain. Lack of sleep is a source of physical and emotional stress. Physical stress has a long list of negative consequences to your health. Many people respond to emotional stress by eating their “comfort foods,” frequently choices that are high in fat, salt and/or sugar. This type of eating often leads to weight gain. Common sense also says that if you are staying up late every night, you are much more likely to snack during the extra hours you are awake.

In children, insufficient sleep has been identified as a causal factor in childhood obesity. Young children who stay up too late or older children who get up too early are at greater risk for obesity. You should be concerned with how much sleep your children are getting in addition to how much sleep you get each night.

Regular exercise is one way to improve your sleep. With regular exercise, you are more tired physically and more likely to go to sleep at an earlier time. You tend to have better quality sleep, as well. Regular exercise will contribute to your weight loss or maintenance, as well, by burning additional calories.

Deepening the relationship, better sleep habits help you get more from your exercise. Research has shown that elite athletes perform better with additional sleep; it stands to reason that if you are well rested, you will have a better workout. You may find that you can exercise for longer periods of time or at a higher level of exertion. You also will be more likely to keep your workout in your schedule if you are not “too tired to exercise.”

Longer periods of sleep and regular exercise have a positive effect on your body weight; but if you are overweight, your weight may negatively impact your quality of sleep. People who are overweight or obese report more disturbed sleep. In the extreme, obesity has been strongly linked to obstructive sleep apnea (OSA), periods of difficult breathing that result in sleep disruption. In extreme cases, a person may actually get less oxygen or even stop breathing for short periods, resulting in disrupted sleep. Treating OSA patients for obesity helps alleviate the occurrence of sleep apnea.

It’s clear that sleep, weight and exercise form a triad, with each component affecting the other two. So what can you do to improve your sleep in addition to regular exercise?

• Have a regular bedtime
• Keep technology (TV’s, cell phones, computers) out of your bedroom
• Use your bedroom only for sleep and romance
• Give up caffeine or at least avoid caffeine and alcohol late in the day
• Avoid napping
• Avoid a heavy meal late in the evening
• Avoid snacks high in carbohydrates late in the evening
• Keep your bedroom dark
• Use a nightlight in the bathroom to avoid turning on a bright light
• Avoid mentally stimulating activities within an hour of bedtime
• Do not exercise late in the evening
• Use a white noise machine or fan to block out incidental noises

If you are still awake 45-60 minutes after going to bed, get up and do some quiet activity like reading in another room. Return to bed when you feel drowsy.

If you routinely don’t get enough sleep, make some changes to build more time for sleep into your schedule. Once you are getting more sleep, you should see a positive impact on other aspects of your health.

Nancy Tashman, Perfectly Fit Corporate Services, Inc.
Sources:
http://www.nhlbi.nih.gov/guidelines/obesity/e_txtbk/appndx/apndx4.htm Appendix IV.
Obesity and Sleep Apnea.

Snell, Emily K. et al. "Sleep and the Body Mass Index and Overweight Status of Children and Adolescents." Child Development Vol 78, Issue 7, Jan/Feb 2007.

The Heart of the Matter:
Frequently Asked Questions about Nutrition and Heart Disease

Various studies touting the health benefits of foods and their impact on health and disease management are continuously broadcasted on the news and printed in your local paper. With so many opinions circulating, it’s difficult to know what facts you can trust. In honor of heart month, here is the recent data regarding eggs, butter vs. margarine, red wine and dark chocolate. The truth is that not everything is black and white, good or bad. Portion size, frequency and moderation all play an important role. Here’s the heart of the matter…

Will Eating Eggs Raise my Cholesterol?
Recent arguments in favor of eggs may lead you to believe that eggs may not be as bad as previously thought. According to Harvard, the only large study examining the impact of egg consumption on heart disease, (not on cholesterol levels) found no connection between the two. The same study found that diabetics who ate an egg per day were a more likely to develop heart disease than those who rarely ate eggs. According to the Mayo Clinic, “some people can consume a diet high in cholesterol without blood cholesterol levels being affected; but others need only eat a little dietary cholesterol, and their cholesterol levels soar.” Other arguments tout the health benefits of eggs as a good source of protein, some unsaturated fats, choline for memory preservation, and lutein and zeaxanthin for protection against vision loss.
The above findings do not omit the fact that chicken eggs are high in cholesterol, and diets high in cholesterol have been known to boost blood cholesterol levels. Here’s how you can still enjoy your eggs without overdosing on cholesterol:

• Stay within your daily cholesterol limits: < 300 mg per day for healthy individuals, <200mg per day for those with cardiovascular disease, diabetes, a high LDL (“bad”) cholesterol or those taking cholesterol-lowering medications. One large egg has about 213 mg cholesterol!
• If you eat a single egg, do limit cholesterol from other sources for the remainder of the day. These include fatty meats, poultry with skin, high fat dairy products and foods prepared with eggs, such as desserts.
• Omit the yolk, which contains all the cholesterol, or use pourable egg whites or yolk-free egg substitutes as sensible substitutions. Two egg whites or 1/4 cup cholesterol-free egg substitute (which is made with egg whites) can be used in place of one whole egg in a recipe that calls for eggs.

Margarine vs. Butter—Which Is Healthier?
When it comes to heart health, margarine is usually safer than butter. Margarine is made from vegetable oils, so it contains no cholesterol and is higher in healthy unsaturated fats. Butter, on the other hand, is derived from animal fat, which is high in cholesterol and saturated fat. However, some margarines are high in trans fat (hydrogenated oils), making them more dangerous than butter. Trans fats increase LDL (bad cholesterol) and decrease HDL (good cholesterol).
As a general rule, solid margarines contain higher levels of saturated and trans fats, so be sure to select soft or liquid margarines. Choose margarines that contain“0 g trans fat” and less than 2 grams saturated fat per serving on the Nutrition Facts label.  For those of you who prefer to have a little butter, consider using whipped, light, reduced-calorie or spreadable butter with vegetable oils added. Both margarine and butter are high in fat, so use both in moderation. Try adding some heart healthy olive oil to your bread or pasta instead.

Dark Chocolate a Health Food—Am I Dreaming?
Eating a small piece (1.6 ounces) dark chocolate every day is good for you. The American Heart Association reports findings that suggest a daily bar-sized serving of flavonol-rich dark chocolate might lower your blood pressure and improve insulin resistance. Chocolate contains plant flavonoids, natural antioxidants found in many foods from plants. Flavonoids help relax blood vessels, keep cholesterol from gathering in blood vessels, reduce the risk of blood clots, slow down the immune responses that lead to clogged arteries and help increase arterial blood flow.
But buyer beware; not all chocolate is created equal. Most of the flavonoids are removed when the chocolate is processed with alkali (Dutch process cocoa). To get the most from dark chocolate, choose products that are at least 70% cocoa to reap the health benefits the flavonoids provide.
While all of this evidence is attractive to chocolate lovers everywhere, the findings do not replace the need for a healthy diet, exercise or blood pressure medications prescribed by your physician. Chocolate still is loaded with calories, so be sure to restrict yourself to a bite-sized serving. Consume other flavonoid-rich foods like fruits, vegetables, black or green tea, nuts, red wine and other plant-derived foods.

Is Red Wine Really Heart-Healthy?
Many studies have linked moderate consumption of alcohol, namely red wine, with improved heart health and reduced heart disease mortality. Studies are inconclusive as to which substance in red wine is helping the heart. The flavonoids and other antioxidants in red wine such as resveratrol have been thought to help prevent heart disease by increasing levels of HDL (good) cholesterol and protecting against artery damage. Resveratrol may prevent platelets in the blood from sticking together, but a diet low in saturated and trans fat is your best defense against artery clogging fats. Flavonoids also can be found in foods such as grapes or red grape juice, as well as a diet high in fruits and vegetables. The best-known effect of alcohol is a small increase in HDL cholesterol, but regular exercise is the most effective way to raise HDL cholesterol. There is no scientific proof that drinking wine or any other alcoholic beverage can replace exercise and a healthy diet. In addition, drinking more alcohol increases such dangers as high blood pressure, obesity, stroke, suicide and accidents.
Because too much alcohol can have many harmful effects on your body, the American Heart Association cautions people not to start drinking if they do not already. If you drink wine, watch your serving size (a serving is 4 oz.) and practice moderation (1-2 drinks per day for men and 1drink per day for women). However, the American Cancer Society (ACS) recommends against alcohol for women due to the increased risk for breast cancer. Perfectly Fit Corporate Services, Inc. supports the recommendation from ACS against alcohol consumption for women.

Lisa Carr, Perfectly Fit Corporate Services, Inc.
Sources:
http://www.health.harvard.edu/press_releases/egg-nutrition
http://www.americanheart.org/presenter.jhtml?identifier=3006030
http://www.americanheart.org/presenter.jhtml?identifier=3006030
http://www.mayoclinic.com/health/cholesterol/HQ00608
http://www.americanheart.org/presenter.jhtml?identifier=3006030
http://www.mayoclinic.com/health/butter-vs-margarine/AN00835
http://my.clevelandclinic.org/heart/prevention/askdietician/margarine.aspx
http://www.webmd.com/diet/news/20040601/dark-chocolate-day-keeps-doctor-away
http://my.clevelandclinic.org/heart/prevention/askdietician/ask5_02.aspx
http://www.americanheart.org/presenter.jhtml?identifier=4422
http://www.mayoclinic.com/health/red-wine/HB00089

FDA Advisory Panel Backs Widespread Use of Statin

An FDA medical advisory panel is recommending the use of rosuvastatin (Crestor), a cholesterol-lowering drug, for treating patients with elevated levels of C-Reactive Protein (CRP), even if they have no history of heart disease or high cholesterol. According to Dr. Steven E. Nissen, chair of Cardiovascular Medicine at the Cleveland Clinic, “If the FDA accepts this recommendation, it will expand the number of Americans eligible for statin therapy by millions.”

CRP is a protein made by the liver. Levels of CRP rise in the bloodstream when there is inflammation present in the body. Patients with CRP levels of 1.0-3.0 mg/L are considered at average risk for developing cardiovascular disease. Patients with CRP levels above 3.0 mg/L are considered at high risk for developing cardiovascular disease. The FDA panel looked into the use of rosuvastatin as the result of a study reported last fall involving patients with CRP at levels of 2 mg/L or higher. This study was conducted with almost 18,000 subjects. All patients had less than 130 mg/dL LDL (considered a healthy level) but had a level of CRP of 2 mg/L or higher. Patients receiving the rosuvastatin reduced their LDL cholesterol to an average of 55 mg/dL and reduced by 44% the incidence of cardiac events including stroke or heart attack. AstraZeneca, the makers of rosuvastatin, paid for the study. It is not yet known if other statins have the same effect.

These results are dramatic and indicate one cardiovascular event will be avoided for every 25 patients treated with rosuvastatin. There were some reported side effects, the most serious of which was a slight increase in the onset of Type 2 diabetes. As a result, the panel recommended that patients taking rosuvastatin be monitored for the development of diabetes.

If the FDA accepts the recommendation of the advisory panel, testing for CRP will become standard procedure. Currently, people are not screened routinely for CRP levels. Since CRP levels increase with inflammation, those who suffer from chronic inflammatory conditions like arthritis cannot be screened with CRP. Anti-inflammatory drug like NSAIDS would also prevent evaluation of CRP levels.

The FDA is not obligated to accept the recommendations of the advisory panel, although such recommendations are generally accepted. The medical community seems to see the recommendation of the advisory panel as a welcome decision that could save lives. However, the disturbing part about this issue is a lack of discussion of lifestyle changes in the management of cardiovascular disease. Obesity is strongly linked to high levels of CRP. It also has been shown that exercise lowers levels of CRP. The benefits of cardiovascular (or aerobic) exercise and proper diet on heart health and maintaining healthy weight are well documented. To recommend that millions of people start taking a pill when regular exercise and a healthy diet might have the same effect seems irresponsible. Where does personal responsibility for health come into play? Is the medical community conceding defeat when it comes to lifestyle change?

In an era of skyrocketing health care costs, is medicating millions of people really a good trade-off to reduce the risk of a cardiovascular event? Perhaps money would be better spent in funding societal changes to promote healthy living instead of handing a windfall profit to AstraZeneca.

Nancy Tashman, Perfectly Fit Corporate Services, Inc.
Sources:
www.nlm.nih.gov/medlineplus/ency/article/003356.htm
Peck, Peggy. “FDA Panel Backs Statin for Primary Prevention.” 15 December 2009. www.medpagetoday.com

Tylenol, Other Johnson & Johnson
OTC Drugs Recalled

Johnson & Johnson has issued a recall of Tylenol and other over-the counter products including: some batches of regular and extra-strength Tylenol, children's Tylenol, eight-hour Tylenol, Tylenol arthritis, Tylenol PM, children's Motrin, Motrin IB, Benadryl Rolaids, Simply Sleep, and St. Joseph's aspirin. These products may be contaminated by a chemical used to treat the wooden pallets used to ship the products. Contaminated products may have a musty or moldy odor. For a complete list of recalled products and instructions, please visit www.mcneilproductrecall.com.

Nancy Tashman, Perfectly Fit Corporate Services, Inc.
www.fda.gov/safety/recalls/ucm195690.htm

Exercise of the Month

Pilates Push-Ups
Muscles targeted: Pectorals, Deltoids, Triceps, Core

(Click here to download the full-size PDF.)

Fresh-ipes

Chicken Stew

Save leftovers for lunch the next day.

Ingredients:
8 chicken pieces (breasts or legs)
1 cup water
2 small garlic cloves, minced
1 small onion, chopped
1 teaspoons salt
1/2 teaspoon pepper
3 medium tomatoes, chopped
1 teaspoon parsley, chopped
1/4 cup celery, finely chopped
2 medium potatoes, peeled and chopped
2 small carrots, chopped
2 bay leaves

Directions:
Remove the skin from the chicken and any extra fat. In a large skillet, combine chicken, water, garlic, onion, salt, pepper, tomatoes, and parsley. Tightly cover and cook over low heat for 25 minutes.

Add celery, potatoes, carrots, and bay leaves and continue to cook for 15 more minutes or until chicken and vegetables are tender. Remove bay leaves before serving.

Yield: 8 servings—Serving size: 1 piece of chicken. Each serving provides: Calories: 206, Total fat: 6 g,
Saturated fat: 2 g, Cholesterol: 75 mg ,Sodium: 489 mg , Calcium: 32 mg, Iron: 2 mg.

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Fudgy Chocolate Walnut Pie

All you need for chocolate bliss is a pie pan, a saucepan, a little stirring — and this fabulous recipe.

Ingredients:
Vegetable oil spray
1/2 cup reduced-fat thin chocolate wafer cookie crumbs or chocolate graham cracker crumbs (about 10 wafers or 6 graham cracker squares)
1 cup sugar
3/4 cup fat-free evaporated milk
1/2 cup light corn syrup
3 tablespoons unsweetened cocoa powder (Dutch process preferred)
3 tablespoons semisweet chocolate chips
Egg substitute equivalent to 3 eggs
2 tablespoons chopped walnuts

Cooking Instructions
Preheat oven to 350°F. Spray a 9-inch pie pan with vegetable oil spray. Using your hands, pat crumbs on bottom of pie pan. In a medium saucepan, whisk together sugar, milk, and corn syrup; cook over medium heat until sugar has dissolved, 3 to 4 minutes, whisking occasionally. Remove from heat. Whisk in cocoa powder and chocolate chips. Let mixture stand for 5 minutes, whisking occasionally to help it cool slightly. Whisk egg substitute into chocolate mixture until smooth; pour into pie pan. Sprinkle with walnuts. Place pie pan on a baking sheet. Bake for 35 to 40 minutes, or until center is set (doesn't jiggle when pie is gently shaken). Let pie cool on cooling rack for 30 minutes. Serve warm or chilled.

Cook's Tip
Use dark, slender chocolate wafer cookies as creative garnishes. Here are just a few ideas: Insert a whole wafer on top of a scoop of nonfat frozen yogurt, break wafers into irregular shapes and arrange them on a low-fat custard pie, or sprinkle crumbs over pudding made with fat-free milk.

Serves eight. Nutrition Analysis (per serving): 244 Calories. Total Fat 3.0 g: 1.0 g Saturated Fat, 0.0 g Trans Fat, 1.0 g Polyunsaturated Fat, 0.5g Monounsaturated Fat, 1 mg Cholesterol; 110 mg Sodium, 52 g Carbohydrates, 1 g Fiber, 38 g Sugar, 5 g Protein

This recipe is reprinted with permission from www.americanheart.org/presenter.jhtml?identifier=3040222 American Heart Association Low-Fat & Luscious Desserts, Copyright © 2000 by the American Heart Association. Published by Clarkson Potter/Publishers, a division of Random House, Inc.