10,000 Steps a Day: C’mon, Man! Is That Really Necessary?

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For perhaps 15-20 years, many health experts have recommended you walk 10,000 steps/day as important for maximizing your health and longevity. Depending on your stride length, that’s roughly 5 miles (8 km). When I walk my dogs 4 miles, it takes about 90 minutes, which is a big time commitment. Frankly, it’s often boring. But not for the dogs. So many fascinating odors!

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The good news is, you don’t need to walk the 10,000 steps in one fell swoop. Your walking around your residence and workplace throughout the day counts, too.

More good news. If you’re an older woman, maybe 4,400 steps/day is enough for a longevity benefit. In other populations studied, 6,000 to 8,000 steps/day was optimal.

I admitted a patient to the hospital a few days ago who told me her health insurer sends her a small check monthly if she meets their step goal. She’s saving them money via lower healthcare expenditures, and they’re sharing with her. I love it!

  Steve Parker, M.D.

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What Really Matters?

Only one thing really matters. That’s your relationship with Jesus Christ/God. Who was Jesus? Did he exist? Was he crucified for your eternal salvation?

Jesus is my Lord and Savior. He died for my sins. After my death, I’ll be with him in heaven forever.

  Steve Parker, M.D.

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19 Expert Weight-Loss Tips and Tricks

1.  Record-keeping is often the key to success.

2.  Accountability is another key to success. Consider documenting your program and progress on a free website such as FitDay, SparkPeople, 3FatChicks, or others. Consider blogging about your adventure on a free platform such as WordPress or Blogger, or try the newer social media sites. Such a public commitment may be just what you need to keep you motivated.

3.  Do you have a friend or spouse who wants to lose weight? Start the same program at the same time and support each other. That’s built-in accountability.

4.  If you tend to over-eat, floss and brush your teeth after you’re full. You’ll be less likely to go back for more anytime soon.

5.  Eat at least two or three meals daily. Skipping meals may lead to uncontrollable overeating later on. On the other hand, ignore the diet gurus who say you must eat every two or three hours. That’s codswallop.

6.  Eat meals at a leisurely pace, chewing and enjoying each bite thoroughly before swallowing.

7.  Plan to give yourself a specific reward for every 10 pounds (4.5 kg) of weight lost. You know what you like. Consider a weekend get-away, a trip to the beauty salon, jewelry, an evening at the theater, a professional massage, home entertainment equipment, new clothes, etc.

8.  Carefully consider when would be a good time to start your new lifestyle. It should be a period of low or usual stress. Bad times would be Thanksgiving day, Christmas/New Years’ holiday, the first day of a Caribbean cruise, and during a divorce.

9.  If you know you’ve eaten enough at a meal to satisfy your nutritional requirements yet you still feel hungry, drink a large glass of water and wait a while.

10  Limit television to a maximum of a few hours a day.

11.  Maintain a consistent eating pattern throughout the week and year.

12.  Eat breakfast routinely.

13.  Control emotional eating.

14.  Weigh frequently: daily during active weight-loss efforts and during the first two months of your maintenance-of-weight-loss phase. After that, cut back to weekly weights if you want. Daily weights will remind you how hard you worked to achieve your goal.

15.  Be aware that you might regain five or 10 pounds (2-4 kg) of fat now and then. You probably will. Don’t freak out. It’s human nature. You’re not a failure; you’re human. But draw the line and get back on the old weight-loss program for one or two months. Analyze and learn from the episode. Why did it happen? Slipping back into your old ways? Slacking off on exercise? Too many special occasion feasts or cheat days? Allowing junk food or non-essential carbs back into the house?

16.  Learn which food item is your nemesis—the food that consistently torpedoes your resolve to eat right. For example, mine is anything sweet. Remember an old ad campaign for a potato chip: “Betcha can’t eat just one!”? Well, I can’t eat just one cookie. So I don’t get started. I might eat one if it’s the last one available. Or I satisfy my sweet craving with a diet soda, small piece of dark chocolate, or sugar-free gelatin. Just as a recovering alcoholic can’t drink any alcohol, perhaps you should totally abstain from…? You know your own personal gastronomic Achilles heel. Or heels. Experiment with various strategies for vanquishing your nemesis.

17.  If you’re not losing excess weight as expected (about a pound or half a kilogram per week), you may benefit from eating just two meals a day. This will often turn on your cellular weight-loss machinery even when total calorie consumption doesn’t seem much less than usual. The two meals to eat would be breakfast and a mid-afternoon meal (call it what you wish). The key is to not eat within six hours of bedtime. Of course, this trick could cause dangerous hypoglycemia if you’re taking drugs with potential to cause low blood sugars, like insulin and sulfonylureas. If you take drugs for diabetes, talk to your dietitian or physician before instituting a semi-radical diet change like this.

18.  One of the fitness bloggers I used to follow was James Fell. He said, “If you want to lose weight you need to cook. Period.”

19.  Regular exercise is much more important for prevention of weight regain rather than for actually losing weight.

Steve Parker, M.D.

 

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Lyrica or Neurontin for Chronic Pain?

“You can take this pill, but there’s not much evidence it does any good.”

Physicians in the U.S. who prescribe opioids need a license from the Drug Enforcement Administration and it has to be renewed periodically. By the time of my next renewal, I must be able to prove to the DEA that I’ve had six (eight?) hours of approved continuing medical education on drug abuse and addiction. Because of the prescription opioid “epidemic” that reared it’s head several years ago, regulators are putting pressure on prescribers to reduce prescriptions. I’m not saying that’s a bad thing, but it can be taken too far, like expecting a patient with very recent knee or hip replacement surgery to be just fine with acetaminophen (aka paracetamol) alone. Big Pharma has convinced some prescribers to substitute opioids with Neurontin (aka gabapentin) or Lyrica (pregabalin). If not substitution, then augmentation of opioid effect at lower doses. I definitely see that in my part of the world.

Regarding that, here’s a thought-provoking article from Paul Ingraham:

One of the most notorious examples of Big Pharma living up to its reputation for evil-doing is the illegal promotion of anticonvulsant drugs like Neurontin and Lyrica for painful problems like back pain. Pfizer coughed up billions for lawsuit settlements and record-breaking fines. I think it’s safe to say that they didn’t actually pay enough to undo the damage, though…

Thanks to that horror show, and to research by Peet et al, we now know that there was a mighty 5× surge in gabapentin prescriptions in the 2000s and 2010s. That was — and continues to be — a chilling demonstration of the power of under-handed and well-funded marketing. Even as opioid prescriptions fell somewhat, gabapentin scrips rose dramatically, despite the dubious value for most of what it was being prescribed for (most kinds of pain).

  Steve Parker, M.D.

PS: Pregabalin and gabapentin are commonly used and often effective drugs for painful diabetic neuropathy in the U.S. This blog post isn’t about that neuropathic.

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Filed under Diabetes Complications

Merry Christmas, Ya’ll!

Nativity Scene

6 Comments

December 24, 2023 · 7:00 AM

Have You Heard of Dry January?

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I’ve run across a number of patients who slowly increased their alcohol consumption over months or years, not realizing it was causing or would cause problems for them. Alcohol is dangerous, lethal at times.

From a health standpoint, the generally accepted safe levels of consumption are:

  • no more than one standard drink per day for women
  • no more than two standard drinks per day for men

One drink is 5 ounces of wine, 12 ounces of beer, or 1.5 ounces of 80 proof distilled spirits (e.g., vodka, whiskey, rum, gin).

Dry January was conceived in the UK in 2012 or 2014. (A related concept is Sober October.) The idea is simply to abstain from all alcohol for the month of January. The Alcohol Change UK website can help you git ‘er done. Many folks notice that they sleep better, have more energy, lose weight, and save money. There are other potential benefits.

If you think you may have an unhealthy relationship with alcohol, check your CAGE score. It’s quick and easy.

Alternatively, if you make a commitment to a Dry January but can’t do it, you may well have a problem.

Steve Parker, M.D.

PS: Check out this video about the benefits of sobriety.

PPS: This guy quit alcohol for 30 days:

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Reduce Alzheimer’s Dementia Risk With Mediterranean Diet

Not sure where this is. Leave a comment if you recognize it.

From Queen’s University Belfast:

A Mediterranean diet of seafood, whole grains, nuts, fruit and vegetables could lower the risk of dementia by almost a quarter, according to a recent study.

Significantly the findings suggested that, even for individuals with a higher genetic predisposition to dementia, having a more Mediterranean-like diet reduced the likelihood of developing dementia.

The study which has been ongoing for the past two years, was led by Newcastle University in collaboration with colleagues from Queen’s University Belfast, University of Exeter, the University of East Anglia and the University of Edinburgh and has been published in the medical journal, BMC Medicine.

This was a large-scale project with analysis of data from over 60,000 older adults in the UK, which explored whether individuals who followed a Mediterranean-like diet had a lower risk of developing dementia than those who did not.

The research found that those with the highest level of adherence to a Mediterranean diet had a 23% reduced risk of developing dementia over a nine-year period than those with the lowest level of adherence.


Steve Parker, M.D.

H/T Jan at Low Carb Diabetic.

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Arthritis May Be a Metabolic Disturbance, Not Wear and Tear

Radical new information on osteoarthritis from Paul Ingraham:

One of the most deeply held beliefs in musculoskeletal medicine is that osteoarthritis is a “wear and tear” condition — that joints slowly crumble under the onslaught of gravity and use and abuse. This fundamentally mechanical view of arthritis directly suggests that the heavier we are, the more likely we are to have trouble in our load-bearing joints.

But that’s just not the case: osteoarthritis prevalence doubled in the 20th Century independent of age and weight (Wallace 2017).

So something else has to be going on. People got heavier on average, but not twice as heavy!

Or consider this: obese people get more osteoarthritis of the hand (Jiang 2016), but probably not because they are walking on their hands.

So … why?

This post weaves together the threads of several past posts about the biochemical foundations of seemingly “mechanical” problems, and you may recognize some pieces. But this is an all-new synthesis, anchored by some good science news you can use — practical and encouraging, which is a rare pleasure.


It’s a short read, well worth your time.

Steve Parker, M.D.

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Benefits of Eating Meat

Mucho protein, amigo

I found a review article at Animal Frontiers that makes the argument in favor of meat consumption. The authors admit little focus on the downsides of eating meat. I’ve been cutting back on my meat consumption out of sympathy for the animals. Here are some of the key points verbatim:

  • Aspects of human anatomy, digestion, and metabolism diverged from other primates, indicating evolutionary reliance on, and compatibility with, substantial meat intake. Implications of a disconnect from evolutionary dietary patterns may contribute to today’s burden of disease, increasing the risk for both nutrient deficiencies and chronic diseases.
  • Meat supplies high-quality protein and various nutrients, some of which are not always easily obtained with meat-free diets and are often already suboptimal or deficient in global populations. Removal of meat comes with implications for a broad spectrum of nutrients that need to be accounted for, whereas compensatory dietary strategies must factor in physiological and practical constraints.
  • Although meat makes up a small part (<10%) of global food mass and energy, it delivers most of the global vitamin B12 intake and plays a substantial role in the supply of other B vitamins, retinol, long-chain omega-3 fatty acids, several minerals in bioavailable forms (e.g., iron and zinc), and a variety of bioactive compounds with health-improving potential (e.g., taurine, creatine, and carnosine).
  • As a food matrix, meat is more than the sum of its individual nutrients. Moreover, within the diet matrix, it can serve as a keystone food in food-based dietary interventions to improve nutritional status, especially in regions that rely heavily on cereal staples.
  • Efforts to lower global meat intake for environmental or other reasons beyond a critical threshold may hinder progress towards reducing undernutrition and the effects this has on both physical and cognitive outcomes, and thereby stifle economic development. This is particularly a concern for populations with increased needs and in regions where current meat intake levels are low, which is not only pertinent for the Global South but also of relevance in high-income countries.

Steve Parker, M.D.

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QOTD: A Man With an Empty Stomach

A man with an empty stomach has one problem, but a man with a full stomach has a hundred.

-Anonymouse

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