Your Weekly Checkup: My New Year’s Resolution — Exercise!

We are pleased to bring you “Your Weekly Checkup,” a regular online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive.

“Whenever I get the urge to exercise, I lie down until the feeling passes.” This quote, repeated often, is attributed to Paul Terry, founder of the Terrytoons animation studio. The precise source is less important than the thrust of the message: although said in jest, its impact is harmful to your health!

Despite the fact that study after study has validated the benefits of exercise, many Americans still sit all day at work, watch TV at night, and drive short distances instead of biking or walking. They do not realize that even mild exercise such as walking slowly or performing household chores like vacuuming, washing windows, or folding laundry can be beneficial. Two recent studies, one from Harvard investigators and the other from the Karolinska Institute in Stockholm, examined the exercise patterns of a large number of people, and found that the most active folks reduced their mortality by 50 to 70 percent compared with the least active, sedentary participants.

One of the most exciting recent discoveries about the benefits of exercise comes from the Liverpool John Moores University in the United Kingdom. They found that a single exercise session can offer immediate protection to the heart through a mechanism called “ischemic preconditioning.” Exposing the heart repeatedly to short episodes of inadequate blood supply (ischemia), such as might occur during strenuous exercise, protects the heart to resist a longer, more serious episode of ischemia. The investigators found that a single vigorous workout provided cardioprotection lasting 2-3 hours, while repeated exercise sessions weekly yielded even greater and longer protection. The benefits of exercise can help mitigate the negative impact of other risk factors such as diabetes, obesity, and high blood pressure.

What should you do for 2018?

  1. Pick an activity you enjoy and are likely to continue: dancing, bowling, golf, walking the dog, or playing with your children or grandchildren.
  2. Start small: maybe 10 minutes initially, and gradually increase the duration and intensity over time.
  3. Exercise with friends: If you need motivation, plan to exercise with friends at a fixed time, four or five days a week. Knowing your colleagues are waiting is more likely to keep you in the game.
  4. Write it down: maintain a diary that details what you do, and your response to it. Finding that you can exercise longer with greater ease is a superb incentive to continue to even greater heights.

Exercising enables you to take control of your own health and well-being, reduce stress, maintain mental acuity and productivity, and decrease the risk of heart disease and some forms of cancer. Make it your number one New Year’s resolution!

Your Weekly Checkup: The Four-Legged Prescription to Combat Loneliness

We are pleased to bring you “Your Weekly Checkup,” a regular online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive.

You might think living in a time of widespread social media such as Facebook, Twitter, Instagram, and LinkedIn would dispel feelings of loneliness and relegate isolation to a thing of the past. Not so, particularly in the elderly. In Britain and the United States, about one third of people older than 65 live alone, and in the United States, half of those older than 85 live alone. Studies in both countries show that 10 to 46 percent of people older than 60 are lonely. England offers a telephone hot line, The Silver Line Helpline, that receives about 10,000 calls weekly from older folks seeking contact with other people. The Brits  view loneliness as a serious public health issue deserving national attention.

Why is loneliness important? Loneliness is an aversive signal much like thirst, hunger or pain. In fact, it can now be quantified and studied on a cellular level. Neuroscientists at the Massachusetts Institute of Technology identified a region of the brain called the dorsal raphe nucleus that they believe generates feelings of loneliness, and is also associated with depression. Increasing evidence links loneliness to physical illness, functional and cognitive decline and is a risk factor for early death.

What can lonely folks do to combat these feelings? Pets, especially dogs, provide companionship that reduces loneliness, anxiety, and feelings of depression. Owning a dog can foster interaction with other people, stimulate activity (e.g., walking the dog), and lead to improved mental and physical health. Almost half of American households own at least one dog. Dog owners are more likely to exercise, have a better cholesterol profile, have lower blood pressure, be less vulnerable to the physical effects of stress, and be more likely to survive a heart attack. Pet owners, especially single person households, reduce their chances of dying from heart disease by as much as 30 percent. Just owning a dog is no substitute for regular physical activity, eating a heart-healthy diet, stopping smoking, and getting regular medical care. That said, dogs seem to be good for your heart in many ways.

Frankie, my 8 ½-year-old Doberman, named after the female protagonist in my first novel, The Black Widows, recently passed away, but brought me much joy. She and I walked many happy miles together. It’s now time for me to find her replacement. For those of you who are alone and lonely, I encourage you to do the same. Select a breed that fits your needs. Your dog may not only become your best friend, but also save your life.

Your Weekly Checkup: How Much Water Should I Drink?

We are pleased to bring you “Your Weekly Checkup,” a regular online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive.

 

We’ve all heard the admonition, “Drink eight 8-ounce glasses of water each day for optimal health,” with a further warning that it must be water — not coffee, carbonated beverages, or other fluid sources. That amount equals two quarts or half a gallon of water daily. It’s hard to trace the source of the advice, or to find credible scientific evidence to support it. How are we even to know to whom this caveat applies — sedentary older folks or normally active people working in offices and exercising several hours each week? Young or old? People living in temperate or hot climates? Healthy or sick individuals? Athletes or couch potatoes? Nevertheless, it is common to see people in every category lugging around bottles of water, sipping and slurping throughout the day as they engage in their normal activities.

That’s a lot of liquid. For what reason? Because our bodies are about 60% water, supporters claim a wide range of health benefits from drinking such large quantities of water: reductions in cancer, heart disease, constipation, fatigue, arthritis, angina, migraine, hypertension, asthma, dry cough, dry skin, acne, nosebleed, and depression; improved mental alertness and weight loss. But solid proof is lacking for most of these.

Can there be harm from drinking so much water? Probably not, except for infrequent cases of causing a low sodium concentration in the blood, ingesting pollutants in the water, or maybe a guilty conscience for non-achievers.

So, how much water is enough? It depends…

Some situations require additional fluid intake:

For the rest of us, if you rarely feel thirsty, and your urine color is normally pale yellow, you’re probably getting enough fluid. The fluid can come in any form: tap or bottled water, coffee, tea, soft drinks, milk, juices, beer (in moderation), and even in foods such as watermelon and spinach.

What advice is reasonable for healthy adults living in a temperate climate, performing mild exercise? Listen to your body! If you’re thirsty, drink. Advocates like to advance the dire threat that feeling thirsty means you’re already dehydrated. However, that alarm lacks credibility since feeling thirsty precedes actual dehydration, so there’s time to prevent it. If you’re not thirsty, there’s no need to drink, unless you fit one of the special categories mentioned above. We have enough worries in life without adding one more!

Your Weekly Checkup: Can You Be Fit and Fat?

We are pleased to bring you “Your Weekly Checkup,” a regular online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive. 

 

Like many Americans, I am overweight—not a lot, but I’d love to lose ten pounds from my pot belly. Despite exercising an hour each morning, my weight remains constant because to lose, I must combine diet with exercise, and I don’t do the former. Because I lift weights and work out on the treadmill, bike, and elliptical, I tell myself I am fat but fit.

Is that really true? Can I be overweight and not at increased risk for heart disease? A recently published study based on the electronic health records of 3.5 million British patients followed from 1995 to 2015 says no. Being overweight makes me 30% more likely to develop coronary heart disease (atherosclerosis) compared with normal weight individuals, despite the absence of other health issues. The study outcome challenges the belief that I can be metabolically healthy (no diabetes, elevated cholesterol, or high blood pressure), overweight, and not at increased risk, possibly because obesity is associated with inflammation, and the latter plays a role in the development of coronary heart disease. They conclude that there is no such thing as benign obesity. Importantly, the authors also found that normal weight individuals who had metabolic risk factors such as diabetes were also at increased risk for developing coronary heart disease, despite not being overweight.

Critics argue that the study, despite its size, has flaws and that fitness outweighs fatness, if the latter is not excessive. This is a crucial point because many people, like me, find it easier to exercise daily than to diet. A bad combination is to be sedentary and overweight. Being fit at least counteracts some of the risk of being fat.

The same study found that being too lean also has risks. Underweight individuals with no metabolic abnormalities were at higher risk for stroke than individuals who were at normal weight, overweight, or obese with no metabolic problems. The risk to underweight people with metabolic issues increases even further. Metabolic health is important regardless of weight.

So, what should you do? Lose weight, of course. If you cannot, be sure to treat metabolic abnormalities such as controlling blood pressure, reducing cholesterol, and keeping blood sugar normal. This will counter some of the risk from being overweight. And get off the couch! Run, walk, exercise any way you want. But do something!

Your Weekly Checkup: Winter Can Be Harmful to Your Health

We are pleased to bring you “Your Weekly Checkup,” a regular online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive.

 

We’ve all read that dreaded headline: “Massive heart attack kills man while shoveling snow.” Is it true? Does winter increase the risks for having a heart attack, or could the sudden stress of physical activity in a couch potato be the cause? A recent study from Sweden of more than 280,000 patients suggests that cold air temperature can trigger a heart attack. The investigators found that the number of heart attacks per day was significantly higher during subzero Celsius temperatures compared to when it was warmer.  

 But winter brings many changes in addition to temperature. The hours of sunlight diminish, which can affect a variety of body functions including mood, body temperature, sleep/wake cycles, and secretion of hormones such as serum cortisol and melatonin. For example, seasonal affective disorder (SAD) is a well-established condition characterized by depression during the winter months, and is treated by exposing patients to a light therapy box emitting 10,000 lux of light each morning to simulate an earlier sunrise. Blood pressure is higher during the winter, as is cholesterol, upper respiratory infections, and the flu. Stroke mortality peaks in January, with a trough in September.  

Interestingly, mortality is higher during the winter even in Los Angeles, where the winter temperatures remain mild. A study of over 220,000 deaths from Los Angeles County almost 20 years ago showed that the mean number of deaths was a third higher in December and January than between June and September. An increase in deaths peaked around the holiday season and then fell, raising the question of whether the stress of overeating or drinking during the holiday season, or perhaps sitting down to a turkey dinner with that disagreeable relative, might be a cause. Holiday hedonism is not the likely cause, because in Australia and New Zealand, the same winter influences on mortality occur during their winter months of June through August. In addition, sudden death also peaks in infants during the winter. 

So, what can we conclude? Heart attacks, sudden death, and total mortality all increase during winter months, impacted by cold temperatures and other influences as well, such as shorter hours of daylight. My advice is to keep warm and continue your usual activities, diet, and medications. But be alert and check with your physician if you become aware of any new symptoms indicative of a change in health status. And stay happy! It’s good for your health! 

Your Weekly Checkup: How Well Do Your Medications Mix?

We are pleased to bring you “Your Weekly Checkup,” a regular online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive. 

The young physician starts life with 20 drugs for each disease, and the old physician ends life with one drug for 20 diseases.
                                                                                                                                                         —William Osler

We live in an era of polypharmacy. Many people, particularly the elderly, ingest five or more drugs daily for a multitude of common problems such as high blood pressure, arthritis pain, depression, diabetes, and so on. Most of these drugs, when prescribed and carefully monitored by a physician, help relieve symptoms, and some are even lifesaving. However, unintended consequences can cause important side effects.

The greatest risk factor for adverse drug-related events is the number of drugs prescribed. For example, the risk of an adverse drug effect is 50 to 60 percent if four drugs are taken chronically, and almost 100 percent with eight or nine drugs.

It is critical that patients review their entire drug list, including dietary supplements, at each visit with their physician or pharmacist. Often, a physician’s role is to educate patients about what drugs not to take, and to de-prescribe drugs rather than add more. A general recommendation for the patient is to take a drug for the shortest time possible and at the lowest effective dose.

Here are a few common drugs and their side effects to watch for:

Drug-drug interactions are of significant concern. Alcohol, statins, warfarin, calcium channel blockers, and many additional drugs can affect the metabolism and/or action of other drugs, which can increase or decrease the drug’s effects. The presence of medical issues such as obesity, kidney, liver or heart disease can impact a drug’s action. When in doubt, check with your physician, and never start or stop a drug without his or her knowledge.