Friday, July 25, 2014

The Heart of the Healthcare Problem


It is not excessive calorie intake but not enough exercise causing of the obesity crisis? According to a recently published paper in The American Journal of Medicine[i] this is the heart of the growing health crisis in this country. I am a little skeptical of that particular finding but that is another topic for another day. Now, before going further, can we all agree that the word ‘crisis’ is becoming overplayed?  There is crisis in the Middle East, Ukraine, on the border with Mexico and hundreds of other places and circumstances around the world. There is financial crisis on Wall Street every other day on top of local, national and international political crises. I don’t know about you, but I am getting a little tired of hearing the word “crisis.” Yes, problems exist, everybody’s got problems. Identifying problems is well and good. However, if this is the only step to be taken than nothing has changed or improved the status quo. It is time to stop focusing on the problems and start looking for solutions.
As a health and fitness professional (I label myself as such because of my education and experience, but, it is mainly because I work with people to construct positive health changes that they can learn and apply to actually living) articles like the recent one from AJM used peak my interest.  I say used to because to me this sort of thinking is becoming antiquated.  Yes, there is a major and continually growing problem of poor health in America. With an adult population that is more than 2/3 overweight and 1/3 obese there is absolutely a problem.[ii] But this is not the heart of the issue, it is troubling, but it is a symptom of underlying problem within this country and it is problem that few people, if any, are talking about.
At the heart of the health troubles facing this nation lays two fundamental concerns. The first is that the healthcare system in America is broken.  But, not in the way some would have you think. In my opinion, this brokenness has nothing to do with the cost of or method by which payment is given for health services rendered. Health care may be expensive, but then, it is not pricey if you do not need it. The underlying problem with the American health care system is precisely that it is not health care.  Nor should it be. Think about it: when do you go to the doctor? When do you need medication? When you are sick or injured and therein lay the problems.  The American health care system predominantly reacts to a problem after it exists. Perhaps it would be more accurate to call it Sick and Injury care. Do not get me wrong, I am not bashing the quality of health care in America.  I think the quality of it is outstanding.  If I have to go to the doctor, there is no better place to be. What I am suggesting is that we should take responsibility for our health seriously enough that we spend as little time in the doctor’s office as possible.
Little, if any, effort is made to address health issues from a position of proactivity and prevention. What if instead of spending billions trying to treat problems, society spent millions working to prevent the problems from happening in the first place? I will give credit where credit it is due, as a parent I can attest to the fact that the health care system does this brilliantly with childhood vaccinations. But what about with the problems that come later in life like high blood pressure and Type II diabetes? Health problems that are closely tied with being overweight or obese are behind the times when it comes to being treated in a manner that focuses on prevention or elimination of these health concerns. Oops, did you catch that? The focus should be on the prevention and/or elimination of these problems instead of simply treating symptoms. I made a suggestion that would cut the drug companies profit margins. Maybe they would find a way to make those medications and health services more affordable if the market was less demanding. It is simple economics: small supply with high demand and suddenly prices sky rocket. This is where we are now. The reverse is also true: a larger supply with little demand and prices come down in an effort to increase sales for a product or service that nobody needs. Wow, did I just figure out how a free-market, capitalistic society could fix its own health crisis?
But of course, this kind of substantive change would require action on the part of those who currently rely on this broken health care system. This is the caveat that is hard to swallow. It is not the doctor’s role to improve your health. Treat an injury or recover from an illness? Absolutely. But proactively work to keep your body healthy? Not the doctor’s responsibility. The brokenness of healthcare in America is not with the “system” or in the doctor’s training. It is in the misplaced reliance of the population to look at the health care system as being responsible for performing a duty is was never meant to.  So we come to the second part of our discussion of the cause of the health crisis in America today. Change requires action, in order for action to succeed one must exercise (pun intended) personal responsibility. One must proactively choose to improve health. It is time to do so.
It is time to move past the doom and gloom cries of alarm at the growing number of overweight and obese people in our society. Get over the fact that, as a society, our health is deteriorating. Please stop wondering what the cause is or who is to blame. Instead, let’s start looking for answers. But do not look into research studies or news headlines. My opinion is that science and research, while wonderful in its time and place, is spending too much time and effort looking at the problem instead of searching for a solution. 
However, there are those out there, people like myself, for whom healthy living is a passion born from choosing to take control. Change is hard, I know because I have lived it. If you are not familiar with my story, allow me to give a brief synopsis. I was an obese teenager, at sixteen years old I weighed 260lbs, was pre-diabetic and pre-hypertensive. I am thirty-one now and I have lost roughly 100lbs and kept it off for fifteen years. The change that has occurred in my life is why I now work in a career that allows me to help people make their own changes. I could digress into a plethora of topics regarding nutrition and exercise.  Instead, allow me to be straight-forward. My life changed because I took responsibility for my health. I chose action over inaction, responsibility over excuses, and productivity over negativity.
I made a choice. So can you. Yes, you can make that same choice. Embracing responsibility and taking action is never easy.  But, if you want to be free of a problem there is a price to be paid. Everyone pays for their health; it is just a question of when, where, and how much. A person can pay for his or her health in the doctor’s office and in the pharmacy. Or, you can pay for your health in the gym and at the grocery store. Either way, a payment for your health will be paid somewhere. Where will you spend your money?  More importantly, where will you spend your time?  More money can be made, but once time is lost, it is gone forever. I can think of a lot of things I would rather do with my time than sit around at the doctor’s office. Perhaps if we spent less time there the cost would not be such an issue. But what do I know about expensive health care? Other than my annual physical, I have not seen a doctor in the last 18 months.



[i] Ladabuam et al. Move More, Eat Less: It’s Time for Americans to Get Serious about Exercise. The American Journal of Medicine, 2014 issue 10 page 1016.

Friday, July 18, 2014

Get a Handle on Hydration

Devastating Dehydration
News flash! It is getting hot outside. The month of July is notorious for two things: heat and humidity.  Usually it is that way. Highs in the mid-80s this week are quite pleasant and not the norm for central Arkansas this time of year.  Be prepared because the heat is returning Monday.  Even with milder temperatures dehydration can still be an issue.  From the fitness enthusiasts’ perspective, dehydration centers on training.  But it often begins long before the training session starts.
Did you wake up this morning?  Odds are you did so dehydrated; before the day began your ability to function and perform has already hampered by something healthy. Something healthy is hurting your hydration? Yes, that hopefully restful night of sleep you woke up from forced you to go several hours without drinking anything. The result being deprivation in fluid levels of the body with the result being dehydration. What do you think happens to that early morning exerciser if they start to train hard in a dehydrated state? Performance will impaired but that is not all that may go wrong. Drinking plenty of water is a vital part in maintaining a healthy, safe body temperature.  Training in a state of dehydration especially in hot and humid weather, at the very least will impair performance resulting in a subpar workout. Potentially this can lead to a medical emergency such as heat stroke. To avoid these problems we need to understand how vital water is to the function of the human body.
Water represents approximate 65% of a person’s total body weight.  Hydration is important; the body can survive up 30 days without food; without water maybe a week. Death by dehydration aside, the muscle tissues are comprised of approximately 75% water. Remove the muscle fibers and cells, what is left to make the muscles work? Water. What kind of athletic performance or training is going to be accomplished if the muscles are lacking the component that makes three quarters of the muscle structure?
Dehydration happens easier than most people realize under normal circumstances.  Add in heat and humidity and suddenly most people, especially athletes and fitness enthusiasts, are living in a near constant state of dehydration. So what is the best way to determine if more water intake is necessary? If you are like most people, you drink when you feel thirsty. If this is you, you waited too long. Proper hydration should begin immediately after your morning ritual in the bathroom. Why? The color of urine is a far more accurate method of assessing hydration than simply feeling thirsty. If the urine is yellow, dark, or has a strong-smell then the body is dehydrated.  This rule applies to any time day, not just first thing in the morning. By failing to consume enough water to correct this state of dehydration a person enters a state of living voluntarily dehydrated. This can lead to cognitive performance issues as well as athletic ones.
When fluid loss is equal to 1% of bodyweight, just 2lbs on a 200lb person, internal body temperature begins to rise above normal.  This is the major health concern for those who are physically active outdoors in the heat of summer. If the dehydration continues to the point of loss of 3-5% of bodyweight (6 to 10lbs on a 200lb person), there is a high risk of cardiovascular strain and potential damage as well as a decrease in the body’s ability to regulate body temperature. This results in a faster rise of internal body temperature. If fluid loss hits the 7% mark (14lbs on a 200lb person) physical collapse and the medical emergency known as heat stroke is likely.
In the heat and humidity of a southern summer it is quite normal to sweat off two to three pounds in an hour depending upon exercise intensity.  For football players or other athletes wearing heavy pads this rate can be even faster.  This is why it is vital to weigh before and after physical activity outdoors. Try this simple test the next time you exercise outdoors. The change on the scale resulting from fluids lost because of sweating will surprise you. An accurate understanding of heat-related weight loss during exercise is important to ensure proper rehydration. For every pound of sweat lost during outdoor activity is necessary to drink one pint of water or sports drink to properly rehydrate.  But monitoring weight loss on a per workout basis is not enough.  Weekly weight change must also be monitored. If a weight loss of more than 5lbs per week happens the body has likely entered a state of chronic dehydration; more than just being dehydrated on a daily basis.

Head start to Stay Hydrated
Hydration starts 1-2 hours before exercise by drinking a minimum of sixteen ounces of water. During outdoor activity at least eight ounces of water should be consumed every thirty minutes. This should happen every fifteen to twenty minutes for people who will be outdoors for more than an hour or are practicing wearing heavy sports equipment (take note football players, parents, and moronic coaches who think water breaks are for weaklings). Whenever possible fluids should be easily accessible and consume regularly.  The body’s thirst mechanism does not function properly in a state of dehydration.  Drink even if you do not feel thirsty. Keep water in a convenient place to maximize consumption. After exercise drink one pint of water for every pound of body weight lost. Water should be the primary source of fluid intake. Remember what I said earlier about how much water contributes to bodyweight? Sports drinks are not necessary for aiding in rehydration unless physical activity will last longer than the one hour. However, sports drinks may be beneficial if it makes a person more conscious about drinking enough fluids. The risk of dehydration can be reduced by performing exercise early in the morning or later in the evening. Avoid exercising in the heat of the day.
Outside in the heat and the humidity is the most common place that dehydration can occur but it is not time that dehydration happens. It can happen indoors. Are you familiar with the space age looking sauna suits? Those things do nothing to help lose body fat. Those suits are a clothing version of hot and humid weather. Yes, you will sweat harder if you train in one.  But wearing that suit does not equate to a higher calorie burn. You are just losing water weight faster than someone not wearing a suit. The sauna suits can create a dehydration medical emergency just as effectively as hot weather.  I know because I have called ambulances for people training in those things (not a client of mine, just another gym-goer). Do not waste your time or your health on one of those. Drink up, stay hydrated and get the most health improvement out of your efforts.