Excess insulin causes a range of maladies. People have the choice of managing their insulin or not. Those who do not keep their insulin in check will probably have a dumpy shaped body, emotionally feel mediocre and have a high likelihood of developing a variety of lifestyle ailments up to and including Metabolic Syndrome leading to diabetes, obesity, heart disease and cancer. Let’s face it. This is the state of the average person’s health in America with currently 200 million (67 percent) of Americans either overweight or obese. To obtain exceptional health things must be done differently.

Fortunately, knowledge is power. With knowledge people have the option to have a beautiful body, to feel good and to have a life without lifestyle disease. Lower the amount of carbohydrates eaten and blood glucose will decrease and consequently insulin levels. However it is not that simple.

A body needs carbohydrates, and if the amount of carbohydrates in a diet is lowered, then the amount of other macronutrients must increase. There are only three macronutrients that food consists of: fat, carbohydrates and protein. Thus, if the amount of carbohydrates is lowered, then either the amount of fat and/or the amount of protein must be increased. Too much protein or too much fat is harmful as well.

According to the new guidelines from the FDA, the optimal balance is 50 percent carbohydrates, 25 percent protein and 25 percent fat.

A more important issue related to carbohydrates is that different carbohydrates have different effects on blood glucose. Some carbohydrates have a high glycemic index while others have a more moderate glycemic index. Glycemic index is a measure of the effects of carbohydrates on blood sugar levels. During digestion, carbohydrate-containing foods metabolize into glucose, a single sugar molecule that serves as the primary fuel for tissues and cells. The heart, kidneys, brain and muscles cannot function properly without adequate intake of carbohydrates.

Carbohydrates with a high glycemic index are usually refined products and mostly white: white flour, sugar, white potatoes, corn, white rice, white bread and processed foods. These so-called high GI-carbohydrates result in glucose entering the bloodstream quickly and raising the blood glucose quickly. This produces an exaggerated insulin response.

Carbohydrates with a more moderate glycemic index result in glucose entering the bloodstream more slowly and raising blood glucose more slowly. This instead produces a moderate insulin response
.

A glycemic index of more than 70 is considered high, a glycemic index between 56 and 69 is considered medium and a glycemic index 55 and less is considered low:

The following are some high glycemic index carbohydrates:

• White Rice about 87 GI

• White Bread about 75 GI

• White Potatoes about 89 GI

• Bagel: 72 GI

The following are some low glycemic index carbohydrates:

• Apple ‍about 40 GI

• Asparagus about 15 GI

• Broccoli about 15 GI

• Green Beans about 15 GI

• Sweet Potatoes: 46 GI

• Whole wheat bread (with bran): 45 GI

• Quinoa: 35 GI

• Nuts and seeds: 15GI

Source: Database of Foods’ Glycemic Indexes (www.glycemicindex.com)

A common mistake that people make is eating a lot of carbohydrates that have high glycemic indexes. As I mentioned earlier bodies need carbohydrates. However, they do not need high glycemic index carbohydrates. It is a particularly bad idea to eat high glycemic carbohydrates as part of every meal, which is unfortunately what has become the norm in America. Eggs and hash browns with OJ, steak and potatoes or fries, sandwiches, chicken and white rice are all common meals.

The combination of eating diets that are both high percentage carbohydrates and diets in which those carbohydrates have a high glycemic index can be disastrous for many people’s health. Without limiting the amount of high GI carbohydrates, people will have a very difficult time maintaining a healthy weight. The human body is an awesome, resilient machine, but there is a limit on the amount of abuse one can withstand.

Dominique Kohlenberger has a Masters Degree in Physical Therapy, is a Certified Health Coach and the owner of Healthy Longevity on Longboat Key. Email questions to dkohlenberger@lbknews.com.

MATTHEW EDLUND M.D.

Paula Deen has diabetes — for three years. Just as in the movie “Casablanca,” people are shocked! Shocked! But before demonizing Ms. Deen and her butter-filled southern recipes, let’s look at what the public should gain from this overhyped, simplified media story:

1. Diabetes — even “adult onset” type II — is highly genetic. There are people who are rail thin and are diabetic, just as there are highly obese people who are not. We are now experiencing a large sub-population with TOFI (thin outside, fat inside) where ex-models find themselves diabetic while still appearing wasp-waisted. It turns out abdominal fat around organs — a not uncommon result of models’ lifestyles — is by itself an endocrine gland. The more of it there is, the greater the tendency to diabetes and cardiovascular disease. Diabetes is increasingly epidemic in south Asia, where people are more prone even with BMIs that in the west are considered “thin.”

2. Diabetes is a systemic disease with systemic causes — it’s not just about weight. You can get diabetes from chronic pancreatitis and from the autoimmune causes that provoke type I. You can even provoke diabetes with less sleep — people who sleep less than five hours a day have 2.5 times the rate of diabetes than expected.

3. Who gets diabetes is not just about food and exercise. The same things that keep your body regenerating — how you move, eat, rest and socialize — can also decrease diabetic risk. Since most of your body is new in four weeks, most of us have the chance to direct how our body gets rebuilt. Through different ways of moving, resting, eating, socializing and dealing with stress, quite a few diabetics who change lifestyle can eliminate diabetes — sadly not possible for Type I sufferers.

4. What government, health insurers, schools and individuals should be doing is what they can to prevent diabetes — not figuring out new ways to pay for its treatment. Diabetes is a very big deal as one third of the population may become diabetic by 2030 — a strain on our economy we simply cannot handle. It’s time to get the focus where it needs to be — on health, not health care.

Health should be our national goal, a nation where people are productive, engaged, excited about remaking their bodies and using ordinary activities to regenerate themselves. That Ms. Deen joined up with Novo Nordisk to push diabetic drugs is emblematic of how health problems are dealt with in this country — let’s throw more money, drugs and technology at what ails to us, to hell with the causes.

What are we doing subsidizing high fructose corn syrup so that the only foods poor people on food stamps can afford make them fatter? Doesn’t it make more sense to not pay to create the problem in the first place? Hopefully Ms. Deen’s revamped cookbooks will be a better deal for the population as a whole, though we should remain skeptical.

5. Food is about much more than calories and protein. Ingesting individual foods means imbibing hundreds — even thousands — of different chemicals that change everything from mood to asthma, not just weight. Eating rice you may take in microRNAs that directly change cholesterol synthesis; mice fed lactobacilli are much harder to get depressed or stressed than their genetically identical siblings. And don’t forget what you eat changes the ecosystem of 100 trillion bacteria living in your gut, which so far have been linked to asthma and auto-immune diseases — and who knows what else.

Bottom line

Food is very complex and just one issue to address when responding to the national diabetes health care disaster. You are more than you eat; how you move, rest and socialize at the very least changes your risk of most systemic diseases.

Let’s hope Ms. Deen can change her lifestyle sufficiently as to manage and control diabetes — and demonstrate a way for others to avoid the problem all together.

The most logic approach when starting a weight-loss program is to go on a diet and increase your “calories out” versus your “calories in.” Consequently Jan. 1 all gyms are full and everyone tries to tighten their belt by eating less. Statistics show that 85 percent of people who go on a diet will gain their weight back within two years. Those are lousy odds! So what does really work? Here are some weight-friendly eating habits you can adopt for successful permanent weight loss:

1. Start your day off with a healthy breakfast. Breakfast starts your engine for the day, which is your metabolism. Don’t try to save up calories by skipping breakfast because you will eat twice as many calories at a later time or be tempted to eat something calorie rich and nutritionally poor.

2. Eat every two to three hours. A low-glycemic, low-fat snack around 100 calories in between meals will keep your blood sugar level and limit your cravings for sweets.

3. Eliminate simple carbs in your diet. Simple carbs or bad carbs will spike your blood sugar and wear out your pancreas leading to Type II diabetes, obesity and heart disease over time. Simple carbs are: sugar, white flour, potatoes, crackers, chips, white bread, white pasta, etc. Choose whole grains like: brown rice, oatmeal, multigrain bread (Ezekiel bread is a great choice), etc.

4. Drink plenty of water. As a rule of thumb drink half of your body weight of water in ounces. Sometimes we think we are hungry but in reality our body is dehydrated. Drinking a glass of water before a meal will fill you up and make you eat less.

5. Mindful eating. Don’t eat while talking on the phone or watching TV. Enjoy and savor every bite of your precious and nutritious meal.

6. Satisfy cravings with protein. Protein uses more calories to digest than fat or carbs. It also builds muscle and aids workout recovery. Cravings usually disappear within 15 minutes. So go for a walk, call a friend or go on your computer for 15 minutes and your craving might be history.

7. Arrange your plate. Use a nine-inch plate for lunch and dinner. Preferably blue in color since the color blue will send a signal to your brain to feel satisfied quicker. And decrease your appetite. Red and yellow scream for more food. (Notice the similarity with major fast food chains?)

8. Eat fiber. Whole grains, beans and vegetables like peppers and broccoli contain plenty of fiber, which will make you feel full.

9. Snack on carbs and protein. A healthy carb with a protein as a snack will satisfy hunger more effectively and longer than either type food alone: examples are peanut butter with apple, almonds and some dried fruit, cheese and a piece of pear, etc.

10. Exercise regularly. Start with baby steps: take a daily walk and add five minutes every week up to 60 minutes. Make it part of your daily “To Do List.” Start ballroom dancing, yoga, swimming, tennis or any form of exercise that seems like fun to you. The secret is to be able to stick with it because you just love it and it will become a habit.

11. Keep a journal. Creating a daily journal of everything you put in your mouth can give you further insight into your current behaviors and eating habits. Include your health goals and a date as to when you want to achieve them. Note the times you are eating and how you feel that particular day and include your daily exercise routine, etc. You will be amazed how much you have grown when you look back to day one.

Dominique Kohlenberger has a Masters Degree in Physical Therapy, is a Certified Health Coach and the owner of Healthy Longevity on Longboat Key. Email questions to dkohlenberger@lbknews.com.

MATTHEW EDLUND M.D.
Contributing Columnist
health@lbknews.com

Historians often view wars as ending with winners and losers. We “won” World War II — and the Germans and Japanese lost.

In most human conflicts results are less clear-cut. People don’t tend to think of the “War on Cancer,” started by President Nixon, and the “War on Terror,” begun by the second President Bush, as operating in the same mental realms. Yet both involve shifting enemies, changing allies, and strategies that often appear to succeed before they fail. Both may become more controllable once we see their broad similarities.

Here are a few common traits:

1. Terrorist individuals and groups, like cancer cells, frequently form anew. The average human DNA strand may be attacked hundreds of times an hour. A few chemical and physical assaults may lead to mutations that lead to tumors, as can changes to proteins. Yet most of the time the immune system snuffs them out.

Extremist thinking is common, and so are extremist groups. Countries like the United States and Britain have hundreds of thousands of “people of interest” to security services. Most will never plan an attack, no matter how much they talk about one. And many that are planned are stopped because enough outside individuals find out about them. They stop it themselves — as occurs in families and close-knit communities — or alert political and security personnel who do.

2. Terrorists can appear pretty much anywhere — just like cancer cells. Some human cells, particularly those involved in the fast regenerating arenas like prostate and breast, may prove more cancerous than other tissue types. However any tissue group can form tumors, though some, like bone, tend to have less of them.

Terrorist individuals and groups exist everywhere. Virtually no one expected Norway to experience the major European terrorist attack of 2011. Yet Anders Breivik showed anyplace can experience terrorism, even on a vast scale.

3. The healthier a population, the later clinical tumors start to appear; the more generally harmonious, egalitarian and open a society, the less terrorist incidents tend to occur. The Japanese smoke like fiends and often work long hours and shifts. They are also the longest-lived nation in the world. Americans stood transfixed following the Fukushima tsunami-nuclear reactor disaster. The Japanese did not riot or loot, but worked cooperatively. There are few terrorist incidents in Japan.

Civil wars like those in Afghanistan and Iraq often involve many operations of seemingly indiscriminate mass murder. Terrorism thrives in highly sectarian, unequal societies — places where people don’t live quite so long even when violent deaths are subtracted from the statistics.

4. Tumors appear and often simultaneously regress; extremist groups often appear and then dissolve. It’s now thought that innumerable tumors form a single cell or small group of cells and then either self-destruct, get killed by the immune system or are somehow “walled off.” Even much larger tumors spontaneously regress.

Data on breast cancer from Norway, discussed by H. Gilbert Welch in his book “Overdiagnosis,” only makes sense if many mammographically apparent tumors regress on their own — and do so frequently.

Many extremist groups form with violent goals. Yet often they go nowhere.

Sledge hammers, surgical strikes, containment
The Bush “War on Terror” fully got going with the invasion of Iraq. A brutal dictator and his large stock of terror weapons would be violently extinguished as democracy was established freeing tens of millions. It did not work out as planned.

In the 1950s and 1960s, new chemotherapeutic agents transformed oncology. Physicians could do more than just cut out tumors or burn them out with radiation. The new, highly toxic agents, which chemically “bombed” tumors, represented a new watershed, promoting great optimism. President Nixon stated in his State of the Union message of 1971 that he would begin a war on cancer that would be recognized as the most significant act of his administration, bringing a cure within decades. It did not work out as planned.

The “War on Terror” continues. Iraq and Afghanistan remain physically and economically devastated, with politically fragile regimes. The War on Cancer continues. Forty years on, vastly more is known about cancer formation and treatment. Yet the human survival for the most common tumors has not changed appreciably, even if earlier detection occurs.

Complexity, cancer, terrorism
Human societies are so complex many aspects of them are poorly understood. The “science” of economics may win Nobel prizes but does not prevent international financial meltdowns. What foments terrorist groups appears to involve an intricate interplay of politics, culture, ideology, social alienation, economics, family life and personality.

The human body is vastly complex. When the Human Genome project was started it was expected that we would find the “gene” for schizophrenia or the few “major genes” provoking major tumors. Instead we got a map of hundreds of genetic markers that increased the rates of common illnesses by 1-5 percent.

Complexity is the order of the day. Cancer starts through the interlocking of dozens of cellular systems and is controlled by hundreds more. A few systems may be partly understood. Others — like the immune effects of the tens of trillions of other organisms within our bodies — remain black boxes.

Similarly, police and security forces have recognized the deep interplay of culture and community, personality and social connection that gives rise to extremist groups — and to their dissension and dissolution.

When George Kennan wrote about the Soviet Union in his famous essay of 1946, he argued not for continuing military wars but for containment, a complex strategy engaging diplomacy, economics, culture and ideology, as the way to stop Stalin. When it comes to cancer, containment seems to be what the body normally does.

The complexity of the issues represented by terrorism and cancer is vast. Yet controlling each may require less than perfect understanding. The key remains information — seeing how systems form, shape and reform themselves — whether they are tumor cells or terrorist groups.

And our greatest new ally may be information science, artificial brains working in combination with our own.

The “cure” to cancer may first occur not in the biological but the information laboratory. Modeling how the different elements of immunity operate — in the brain and other organs — may be enough to contain many tumors, converting them into chronic, primarily controllable conditions.

Similar work in complex information modeling should also prove increasingly useful in the political arena. Many argued after 9/11 to treat terrorism not through “wars” that would give terrorists greater public status but through police actions. More are listening to that argument today.

And societies that are more egalitarian, open and democratic generally do suffer less from extremist acts, though extremist ideologues are tolerated within set limits.

It’s easier to prevent cancer than to treat it. Similar options should motivate political leaders in the fight against terrorism.

MATTHEW EDLUND M.D.
Contributing Columnist
health@lbknews.com

Food changes gene expression — directly. Eat a bowl of rice and you can turn off genes controlling cholesterol synthesis. Right out of the pot.

You’ve been eating genetic information — probably all your life. The data comes from China, from Lin Zhang and his group at the University of Nanjing. They started looking for microRNAs, or little pieces of ribonucleic acid that turn on and turn off the messenger RNAs that make our proteins.

Zhang’s group found more than 30 different microRNAs in blood, which were small but not expected to survive ingestion. That they survived surprised people.

Zhang’s group took microRNAs that affect cholesterol out of blood and put them into mice. They then blocked their effect with drugs. And cholesterol levels plummeted.

Eating an organism
There are a lot of chemicals inside animals. The same is true of plants. The majority of antibiotics come from plants. While remaining fixed in the ground, plants have to fight off fungi, bacteria, viruses, rickettsia, set-up barriers to being eaten or destroyed by animals, and create all the complicated machinery of life. So any time we eat a plant or animal we potentially ingest thousands of separate chemicals.

We can get some idea of the complexity of food from one extensively studied plant — tobacco.

Tobacco as model
Analyses of tobacco plants usually find about 10,000 separate chemicals. One is polonium 210. Tobacco plants pick up radioactive fallout long resident in the atmosphere and concentrate it. The end result — when you light up, you really light up. That means more lung cancers.

We should expect that “superfoods” — the organically colored foods presumably beloved by the media — possess similar complexity and influential chemicals.

Proteins and carbohydrates
Food is necessary for life. From proteins we get the stuff to make our proteins; from fats, the critical molecules for lining cells and facilitating communication. Carbohydrates are both basic materials and fundamental fuels.

Yet to simplify food into carbohydrates, proteins and fats is to miss most of what they do. It’s like knowing a closed box weights 3,000 pounds and contains iron, copper and other metals, but not knowing if it contains manhole covers, a Ferrari or a cruise missile. And that’s before you consider what happens when food hits your gut.

Consider:
1. Your gut has 100 trillion bacteria
2. Collectively they control 3.3 to 9 million separate genes — compared to your approximately 27,000.

Give lactobacilli to mice as part of their diet and they are far more resistant to stress and induced depression than those without lactobacilli. Who knows what the other hundreds of other bacteria do — they certainly affect autoimmune disease.

What do you do with food?
1. Moving after meals blocks digestion and decreases glucose and insulin peaks.
2. Eat at night and you’ll have higher glucose and blood fats.
3. People eat more with friends than when alone — unless they’re watching TV.
4. Sleep less and you crave more fat and sugar.

Biological meaning of food
Food is complicated — and that’s a good thing. Once we understand the many thousands of chemicals inside food and how they interact, we should be able to more intelligently treat or prevent illness through intelligent cuisine — as East Asian medicine has tried to do for thousands of years. With greater computer crunching power, we’ll begin to understand why some cuisines, with their many interactions and sequences of foods, like the Mediterranean diet, seem to be healthy.

Food information content
It’s time to think of food differently, as more than calories and carbs. Food changes us with its procarcinogens and RNA, the drug-like effects of its innumerable chemicals, the changes it brings to the human gut ecosystem and its many trillions of different organisms.

It makes more sense to think of food as information content. A sweet potato has dozens of different kinds of fat and proteins, but it’s also got carotenoids, antioxidants, RNAs, and chemicals that promote or decrease production of liver carcinogens.

In other words, foods are drugs, energy, structural materials, gene changers, weight makers and losers. They’re also pleasure, culture, fun and love. That’s the kind of information we can really enjoy.

MATTHEW EDLUND M.D.
Contributing Columnist
health@lbknews.com

America’s health care budget is $2.6 trillion. On its own it would rank as the fifth largest economy in the world. We’re 49th in overall mortality. How much of this vast spending goes to health prevention? A pittance. Not enough people make money on preventing illness, though plenty make money treating it. What is most cost-effective for our national health does not yet gain entrance to the health care debate.

So you’re stuck — you’re going to have to take care of yourself on your own. Fortunately, there’s a lot you can do. Let’s look at what is fast becoming the leading cause of death — cancer.

UK cancer research
Professor Max Parkin and company from Queen Mary University of London and Cancer Research UK have just published in the British Journal of Cancer a survey of cancer risks for the UK, which will be similar to those here. The good news — close to half of deadly tumors (they don’t include basal cell and squamous cell skin cancers, for example) are preventable by your actions. About 34 percent of total risk was associated with tobacco, diet, alcohol and weight.

For men, the big preventable factors were smoking, how much fruit and vegetables they ate, and how much they drank.

Tobacco was a big factor for women’s cancer risk but so was weight. The data were consistent with the U.S. National Institute of Medicine’s report on breast cancer, pointing out that weight, estrogen use post-menopause, alcohol and radiation exposure were major preventable factors. Breast cancer now hits one in eight American women.

Problems with the study
Our lives are ruled by probability. Population studies — epidemiology — try to control endless human variables with complex statistical methods. The results are inevitably not perfect, nor will they ever be.

The Cancer Research UK work by Parkin often used meta-analyses or pooled analysis of many different studies to create its risk numbers. When methodology is less than great, errors creep in.

Also overall diet was not looked at, only supposed vegetable and fruit consumption. And many factors overlap; separating effects of diet versus physical activity on weight is not easy. Plus the study left out a major focus of prevention — environmental factors.
Add on other factors not studied like foods other than fruits and vegetables or cleaner water, and prevention rates could be well north of 50 percent.

How can I prevent cancer?
The simple answer is, lots. Here are some suggestions:

1. Don’t start smoking — or do what is necessary to quit. With Chantix, nicotine patches, gums, atropine shots and cognitive behavioral therapy, smoking is preventable and treatable. Plus cigarettes and cigars are ruinously expensive, which prevents teenagers from getting started.

2. Eat a pound combined of vegetables and fruits each day. Sound difficult? It isn’t. The recommended “five daily portions of vegetables and fruits” works out to 400 grams, less than the 454 grams in a pound. Many fruits and vegetables like bananas, kale and sweet potatoes cost less than a dollar a pound. Many navel oranges weigh half a pound or more. Dried beans like pinto and lentils are cheap and easy to prepare.

3. Eat breakfast and walk after meals. Many studies demonstrate that weight control is very difficult without breakfast, which can consist of something as quick and cheap as an apple and a banana. And walking after meals immediately slows digestion plus the glucose and insulin peaks that lead to belly fat.

4. Treat alcohol as a drug. Even small amounts may increase cancer rates, as was shown in these studies. Yet small regular amounts — one drink a day — may decrease coronary artery disease.

5. Wear a hat and long sleeves outside. Melanoma is increasing rapidly and globally, and is less common when you cover skin and apply sunblock. Your skin will look younger too.

Being healthy
Being healthy is about staying healthy. Cancer scares people stiff. Much of it is preventable.

Money politics has fostered political gridlock. Don’t expect much government help on the environment, food policy or encouraging physical activity. Lobbyists even got pizza declared a vegetable for school lunches. Public health is not on the political radar, so you’ll have to do this yourself. It’s good cancer prevention and is relatively simple. And cheap. It’s nice when you can help save your money — and your life.

DOMINIQUE KOHLENBERGER
Contributing Columnist
dkohlenberger@lbknews.com

Gallup’s annual Health and Healthcare survey, where Gallup asks Americans to say how much they weigh and has every year since 2001, reported Nov. 29 that Americans are an average of 20 pounds heavier than they were 20 years ago. The average weight for an adult man is now 196 pounds and for a woman it is 160 pounds, 20 pounds more than in 1990. Each of them would prefer to weigh between 16 and 22 pounds less.

The holiday season is not helping much either. Everyone knows that being overweight is bad, and we know the physical, psychological and financial toll it takes on us and society. We also know that a 10 percent weight loss can reduce our risk for disease by 50 percent and therefore can dramatically improve our physical and psychological health with significant reductions in medications. So how can we get through this season without all this damage?

1. Focus on family and friends, not food. It’s very easy for food to become the focus at social gatherings — especially during the holidays. Cookies, stuffing, eggnog, fruitcake, cocktails, etc. But this season try to move your focus to your friends and family. Instead of double fisting cookies, sit and share holiday stories with a child or visit with a family member. Make memories not pounds.

2. Plan ahead — don’t go hungry. It is so easy to overdo it when we are hungry and walk into a dining room faced with large amounts of delicious food. It’s kind of like grocery shopping when you are hungry — you end up buying a lot more of the foods you probably wouldn’t have purchased had you not been hungry. To prevent this, try timing your meals in such a way that you have a light low glycemic snack prior to arriving to a party or prior to entertaining. This will help you focus more on friends and family and less on your hunger.

Another great idea is to drink your water. We recommend at least 64 fluid ounces per day for hydration. However, another great benefit of drinking all your water is an increased satiety or fullness. Water intake will help stave off hunger and “hold you over.” Plan on drinking a 16-ounce bottle of water during the hour before you will be eating. This will help you feel more satisfied on less food.

3. Take control; choose smaller plates and avoid family style dining. Everyone loves holiday parties. When friends and family extend the invite, accept it graciously, but let them know you are watching what you’re eating. This is perfectly acceptable to do — you would tell them if you had a food allergy, right? If you are concerned that the menu doesn’t fit your needs, offer to bring a dish or two to share. This way you’re in charge of the menu and can pack your favorite meals or a friendly veggie dish and still get to party.

Also, always opt for the smaller plates. While this can be more of a mind trick than anything else, filling up a smaller plate versus putting very small amounts on a larger plate can be very satisfying mentally. Ask for a salad plate if they are not readily provided.

4. Move before munching. This is a great time of year to take advantage of the great outdoors. Hiking, sledding, cross-country skiing, snow angels, snowmen, etc., are all great seasonal activities. Don’t let the colder temps hold you back from being active — it’s all the more important if you will be partaking of holiday parties!

If you are not a cold weather person, treat yourself to a new fitness DVD and make it a regular part of your day. Get family and friends involved for a holiday-themed workout. For example: have everyone on the Wii or Christmas Day cardio.

5. Make your own cocktails. Make an early resolution not to drink your calories. Eggnog, spirits, wine and beer are all typical holiday beverages. But you can enjoy fun, refreshing cocktails without the carbohydrates and calories. Try mixing one packet Crystal light zero calories with eight ounces of sparkling water into a 16 ounce glass, squeeze in a quarter of a lemon or lime, drop the citrus wedge into the glass, stir well and fill the glass with crushed ice. Enjoy!

Dominique Kohlenberger has a Masters Degree in Physical Therapy and is a Certified Health Coach with her practice, Healthy Longevity. She has 21 years of experience in physical therapy in the Bradenton and Sarasota area. Email questions to dkohlenberger@lbknews.com.

MATTHEW EDLUND M.D.
Contributing Columnist
health@lbknews.com

The first part of this column appeared in the Dec. 2 edition and examined the four areas pointed out by New York Times Columnist Tom Friedman that should help bring the United States back to full strength. The first two were education and infrastructure.

As was clear in Part I, many factors can help revive the American economy. They also hold many lessons for individuals.

Immigration
A lot of what has kept the United States competitive since the 1970s has been successes in technology like those from Silicon Valley, where at least 35 percent of the engineers are foreign born; a long list of our major entrepreneurs and innovators were born outside the United States. Don’t forget — Steve Jobs’ father was Syrian. Stopping that immigration flow would be an effective economic stopper.

In terms of public and private health, importing new bacteria into our guts through newer probiotics may eventually make us healthier. In the economic realm, importing new ideas and techniques is one way we will more effectively compete.

We need to recognize that a healthy economy requires a healthy population; sick people don’t work well and overtax an already supremely expensive health care system.

In our private lives, the longest surviving population in the world is Asian American women in Suffolk County, N.Y. Long lived populations seemed well served by nutritionally varied diets. Simple physical activities, like housework and walking, keep people healthier longer. What may work best is to put together food, activity, rest, social support and similar daily activities into a simple system that promotes longer life and improved individual productivity.

R&D
Knowledge is now vast, but our ignorance remains greater; this year’s Nobel physics prize was implicit recognition that physicists have been talking about a mere 4 percent of the “known” universe for the past several centuries.

To become economically competitive, new ideas and new techniques are required. Government money should be spent not just on new science and new physical technologies but also on research that queries what keeps people healthy and allows them to keep others healthy. These areas are particularly understudied in the United States as there are few immediate profit payoffs in them for our industry and business — yet.

But people can do essential “R&D” on themselves by evaluating what works for them. When they try different diets they should look at the overall effects on their wellbeing; see if certain kinds of exercise benefits their overall health; evaluate the effects of sleep and rest on their ability to enjoy life, work a job and raise a family. Accountability can work for your home life just as it does for the economy as a whole.

Regenerating the future
In the 1970s, I was a medical student at SUNY Downstate, the state medical school in Brooklyn. As the New York City government went bankrupt, city hospitals ran out of insulin and became bureaucratically chaotic; physicians and nurses were killed inside emergency rooms; in the city at large real estate prices collapsed and institutions faltered.

Look at New York City now.

The United States has been left for dead throughout our history. The Civil War ravaged us, as did corruption in its aftermath; depressions punctuated the Gilded Age, when financiers and titans of industry held sway over weak national governments, a system of crony policy-making many politicians now wish to revive; the Depression left many millions jobless and hopeless; even in the 1980s Japan was “destined” to overcome and own us and become the great new global power, as China is “destined” to do in the future.

America has always come back. We are a nation of first, second, third, fourth and future acts. It’s time again to put a crisis to good use. We will have to revamp our economy, our education and infrastructure, our immigration laws and our R&D. But we also need to recognize not everything can or should be done on a national level.

Bodies regenerate all the time — that’s how we survive. And just as in our economic life, we can control much of that process, if we know what we’re doing and decide to take control.

Not every 80-year-old is fated to become a 90-year-old. But humans rebuild and reinvent, as do countries; and this country and its people are historically young. It’s time to wake up and look at what we can do, not at what we haven’t.

MATTHEW EDLUND M.D.
Contributing Columnist
health@lbknews.com

Is America’s economy failing? Why are 45 percent of families barely making it? Is a nation with stalled growth, a corrupt and over powerful financial sector, staggering debt, political dysfunction and fighting two wars overseas while its infrastructure crumbles, able to come back?

Yes — as it always has. The capacity for regeneration is inherent in the United States of America. And the same principles that can help reinvent the American economy can be applied to rejuvenate our public and private health.

There may not be much choice. According to the CIA, the United States ranks 49th in survival among nations; we also spend approximately twice as much as our developed national counterparts, like Britain and Germany. Few businessmen would be happy selling a product that ranks 49th worldwide while costing twice as much as the competition. Yet American politicians continue to describe our health care as “the best in the world.” Perhaps it is — for some of them.

The depth of our present crises might start people to tackle unpleasant reality rather than the insistently proclaimed media dream world of beautiful lies (as in, you can fight two wars, cut taxes and magically balance the budget). New York Times Columnist Tom Friedman has written of four arenas that should help bring the United States back to full strength. Let’s briefly examine them one by one for what they can do to aid public and individual health:

Education
As American secondary students are now fighting rank in the middle of international tests, arguments for educational reform often involve copying more successful models like Finland and South Korea. Such school systems get the cream of the university graduates to become teachers. Other possible reforms call for getting rid of “bad” teachers, along with more community control of schools.

The same shift in health would be to recognize the important outcome should be health — not health care. Public health measures like sanitation, nutrition and vaccination have long dramatically outweighed the results of the most effective medical regimes in keeping people healthy. Sanitation and quarantine did far more to wipe out infectious disease than antibiotics.

To improve public health we can recognize that food policy is health policy, and that in a nation where 15 percent of people are on food stamps, paying agricultural subsidies that make obesogenic foods the cheapest is shooting yourself in the head; that food, energy and water are inextricably linked for economic survival and should so be linked in policy; and that humans are built to move; even marathon runners who sit more than six hours a day possess higher cardiovascular risk.

In individual health terms we should recognize that just like the economy, your individual body never stays still — within four weeks most of it has been regenerated — and that this regenerative capacity should be exploited to the hilt. Being healthy means staying healthy. Food, activity, rest, social support and often-unappreciated factors like sunlight and body clocks can markedly improve individual health, productivity and survival.

Infrastructure
Letting your bridges and tunnels rot while your water supply disappears into leaky old pipes is not much different from sitting around eating pizza and watching TV while your arteries clog. Economies and bodies stop working when their infrastructure fails.

We remake and regenerate ourselves quickly in order to survive, as we use up our biological structures and materials very rapidly; most of your heart is remade within three days, a process neither cars, construction companies nor computers can perform with similar speed or efficiency. Doctors should not be paid most lucratively for procedures but for effectively educating their patients for self-empowerment — and keeping them well.

When it comes to health, food matters a lot. A “healthy” diet is not the standard 21^st century American fare of fast food and starch. Activity of any kind helps keep people well and alive (fidgeting changes weight and housework can prevent breast cancer). Seemingly pointless “rest” is when much of body’s regeneration is taking place. Sleeping less than what your body needs brings less economic productivity, more cardiovascular disease and infections, and greater weight and diabetic metabolism.

Without personal rest, we do not regenerate our infrastructure, our minds nor our creative capacities.

Read next week’s edition for Part II of the “Regenerating the economy, your health.”

MATTHEW EDLUND M.D.
Contributing Columnist
health@lbknews.com

“Beer and valium, that’s how I sleep. Works every time, a perfect night’s sleep.” So said an actor friend of mine, who often had trouble “coming down” after a play and used this cocktail three or four times a week.

Yet often alcohol plus sleeping pills do not “work.” Thirty percent of American women use some kind of sleeping pill each week, but combinations are rarely remarked upon — though clinically common. Studies of them are relatively sparse, as researchers tend to look at one drug at a time.

Alcohol plus sleeping pills can kill you; it was the inadvertent cause of death of Brian Epstein, The Beatles’ manager, in 1967 and many famous and not so famous media folks since. The combination can produce horrific accidents and falls; increase the incidence of anxiety and depression; and dramatically decrease the ability to function the next day.

And then there’s Ambien (generic name zolpidem).

The sleepless paramedic
Thomas Gatz is a Chicago area paramedic who woke up in the hospital. He had arrived via the police. They found him driving eastbound in his underwear on westbound lanes in the famed penitentiary town of Joliet in July 2010. His Honda had smashed into the cars of two women, multiple fractures to the arm of one. His blood alcohol level was well above legal limits.

His defense – Ambien made him do it.

Gatz kept a bottle of vodka in a fridge close to his car keys. He remembered taking two Ambien. That’s all he recalled until waking up in the hospital.

His legal defense team explained Ambien was famous for causing sleepwalking. Their claim — Gatz took the Ambien, under its influence drank the vodka, then continued to sleepwalk into the driver’s seat of his car.

But Gatz already knew Ambien could cause him trouble. In April he had taken the drug and this time fully dressed driven into two light poles. A judge is expected to rule on Gatz’s underwear ride any day now.

Ambien, anyone?
Ambien is an exceedingly popular drug. It works by hitting one of the three benzodiazepine receptors in the brain. This does not produce sleep itself. Rather, it provokes an in-between state that allows sleep to come thereafter.

And that’s the trouble. Sleeping pills, of which the most common are the older benzodiazepines like valium (diazepam), clonazepam (klonopin), ativan (lorazepam), restoril (temazepam) and the like, hit all three of benzodiazepine receptors and still do not produce fully natural sleep. All of them can provoke sleepwalking behaviors in people so prone, but Ambien, at least by clinical report, seems to produce more sleepwalking than other pills.

Sleep and consciousness
Many folks think of sleep as a light switch. That’s why many did not understand that Michael Jackson’s use of the anesthetic propofol did not produce sleep but something very like a coma.

And you need sleep to live. Lots of the body’s rebuilding occurs during sleep, particularly for memory and learning. Use an anesthetic to “sleep” and your brain doesn’t get the chance it needs to rewire itself. You won’t make good decisions that way.

You don’t get sleep when you first take Ambien. You go to someplace in between awake and sleep. And lots of strange things can happen when you do.

Now add alcohol. The chance for strange doings goes up manifold.

Rules of the game
Sleeping pills have many distinct uses. I personally use sleeping pills, like Ambien, to overcome jet lag. Sleeping pills are highly useful in stressful times and can be used by shift workers to overcome the perpetual jet lag of their work cycle.

Yet combining depressants like booze and sleeping pills is a kind of personal roulette. You don’t know what you’ll get at the end of the day.

Sometimes you don’t get another day. I was pilloried by a blogger furious for suggesting Heath Ledger’s death had something to do with alcohol and sleeping pills. He had accepted at face value that Ledger’s “anti-anxiety agents” were somehow not sleeping pills, which is one of their major uses.

So remember:

1. Alcohol plus sleeping pills does not create normal sleep.

2. Alcohol with sleeping pills’ additive effects may set you up for sleepwalking, accidents, falls or worse.

3. If you do take a sleeping pill, get right into bed. Don’t write end of the day emails; plenty of people are now texting in the middle of the night unaware that they’re “awake.”

4. Recognize that consciousness is complicated, shifting up and down throughout the 24-hour day. Focus well, and you get a lot done — and for that you need a good night’s sleep.