Healthy Habits Better Than Statins

You may recall a study from a few years ago about how certain healthy habits — consumption of ≥5 fruits or vegetable/day, regular exercise >12 times/month, moderate alcohol consumption, and not smoking — decreased mortality risk regardless of weight.

You may not have seen this part:

The results of this study reinforce the association between healthy lifestyle habits and decreased mortality risk regardless of baseline BMI. This finding is of great importance to both patients and health care providers, whose perceptions about BMI may lead them to believe only obese and/or overweight patients require regular counseling about lifestyle adjustments. Although the evidence suggests that patients across the BMI spectrum should adhere to a healthy lifestyle to optimize health, many patients with a normal-weight BMI may believe exercise and healthy eating, for example, are less important for them as long as they maintain a low BMI.

I’ve mentioned before that the emphasis on fat often leads thin people to assume they’re healthy.  Not necessarily — something the authors called out.

 In the pooled analysis that included all individuals in the cohort (normal weight, overweight, and obese), the adoption of each additional healthy habit decreased all-cause mortality between 29% and 85% (Table 2). To put this in perspective, statins decrease all-cause mortality by 12% in individuals at high risk for cardiovascular disease.  Given the tremendous benefits of a healthy lifestyle, policies and programs that encourage adherence to healthy lifestyles should be encouraged both locally and at a national level.

What can be done about this?  Encouraging moderate exercise & use of alcohol, abstaining from smoking, and eating more fruits and veggies.   The study authors also note that when primary care providers take the time to urge things things, it can be “effective in decreasing smoking, increasing fruit and vegetable consumption, moderating alcohol consumption, and increasing exercise frequency.”  (That’s more than they can say for weight loss.)

PS: I see references to statins a lot. They make money, despite side effects.  Not smoking? Doesn’t make money.  Exercise can make money, as can selling more fruits & vegetables — but not as much as a drug.  Hm.

Quote of The Day: On Sex

[Warning: rape]

I had a conversation with a therapy patient of mine recently that spoke volumes to the problems of living in a rape culture that no longer wants to use the dirty word rape. She told me that she and her best friend (both 19-years-old) frequently endured sex with their boyfriends that involved heavy drug use, painful and coerced anal sex, utter boredom for the women, regular transmission of STIs, no orgasms for the women, and “sex on demand” whenever their boyfriends wanted to have sex. When I asked her if she ever felt pleasure during sex, or ever wanted to feel pleasure, she said, point blank, “I thought sex was only supposed to be pleasurable for the guys, right?” Right. 

The Politics of Turning Rape into “Nonconsensual Sex” by Breanne Fahs

Y’know, romance novels are often seen as pure pulp, but they do ground readers in the idea of mutual pleasure.  It’s not the worse way to set some expectations for sex.  (OK, the “never needing lube” thing can be problem….)

I’m glad that patient is in therapy.

Oh, and anal shouldn’t hurt.

 

Milestones

So I threw this on twitter, but I’m repeating it here: I’m 48 years old & it’s been over a year since my last period.

I’m OK with the first.  I’m HAPPY about the second — and yes, it means I’m “officially” considered menopausal.  I had a few years of skipping periods in the fall & winter, then getting returning to regularity each summer.

Goodbye mood swings, goodbye cramps! Goodbye bloodstains in my pants!!

I wasn’t entirely sure I was in perimenopause, at first, despite the irregular periods.  I would sometimes feel suddenly warm and turn on a fan or ditch my cardigan, but not often.  I had problems sleeping and sometimes use ambien, but that was during some major life changes and I didn’t think much of it.  After I skipped 6 months I was pretty sure it was the start of menopause — and then I started having periods again. For a few months.  And… yeah.

Regularity?  What’s that?

I had my first period at age 10.  It’s been nearly 40 years.  I’m fine with being done.

Back from Norwescon!

As mentioned on Twitter, I was at Norwescon this weekend! One of the most delightful parts was the interview session with special guest Seanan McGuire, who is also Mira Grant.  I don’t have that to share with you, but I do have this from her book tour last fall for her book Parasite (which IS about genetically engineered parasites, and yes, it’s touched on in the video).

Minute 7 – how having a genetically engineered tapeworm could affect weight loss.

Minute 9:45 – could write a very socially-shaming book along the lines of “now that my PCOS doesn’t prevent me from losing weight, you actually think I deserve decent medical care?”

Minute 11:50 – poop transfers & your personal biome

Minute 25 – on bacteria & how antibiotics are overused

Minute 29 – on how drugs are mislegislated and miscontrolled

Minute 39:55 – on morning person encountering a night person

Minute 42 – “Do you honestly think it’s better to be dead than autistic?”

Watch and enjoy ;)

Wheezing Around the Block

One of the recent rants I moderated out of the comments included something* about how “wheezing around the block doesn’t count as exercise.”

Wheezing is a symptom of asthma, bronchitis, sinusitis, pneumonia, and other illness. Deciding that wheezing is only due to weight and only will be treated by weight loss is DANGEROUS.

I do wheeze. I have asthma. Now that  it is properly treated I can exercise without wheezing. My treatment plan is greatly helped by insurance to cover the not-available-in-generic Advair & other meds. One of my asthma triggers is exercise itself. This means I need to medicate pre-exercise. I’m also affected by things like air pollution and pollen.

If you’re fat and wheezing while walking around the block, you may need to see a doctor about your wheezing. It’s not necessarily “just being fat.” Waiting til you’re thin? A, may not help, and B, YOU COULD DIE in the meantime.

The fat haters of the world would have you believe you only wheeze if you’re fat and should lose weight to cure it. The fat accepters think that if you’re sick, you should be treated for that without having to lose weight first. I’m on the fat accepting side.

*Paraphrased to remove profanity & improve readability.

Saturday Ramblings

1am is still Saturday if you haven’t gone to bed yet, right?

Note to self: The expensive twice-daily asthma med works best if the evening dose is 12 hours after the morning dose, not 18 or 20. You carry it with you. Set an alarm on your phone & use it. Don’t just turn it off.

Kath posted about a current fat acceptance tag on twitter, if you haven’t seen it already. Also the HAES blog has a piece on activist burnout.

I started watching the first season of Mad Men on Netflix.  Is it weird that I’m describing it as “a grown-up Bewitched”?

N Things Make a Post

Thanks to This Is Thin Privilege for the shout-out.

Image from the Rudd Center Image Gallery

Image from the Rudd Center Image Gallery.
Not the blogger.

Jeanette took on the “Obese women get only an hour of exercise a year” thing.

…as did This is Thin Privilege.

…as did Marilyn Wann and many commenters on Facebook (signin needed).

On a personal note, my allergies are bothering me much less since Sunday.  Why? I spent over 3 hours Saturday doing “soak, rinse, repeat until the water is clear” on the electrostatic air filters for our furnace. Then waited about 4 hours for them to dry. Fortunately we replaced the windows in a few years back to the inside temp only went down about 10 degrees (and I set the heat UP about 5 degrees before I turned off the furnace to take out the filters).

Also on a personal note, I’m back into the swing of getting allergy shots once a week after an attack of life around November.

Tell Me Again How It’s “For My Own Good”

Lara Frater wrote about this and I wanted to boost the signal.  The Rudd Center recently came out with a study (PDF link) showing that weight stigma affects the stress hormone cortisol.

Exposure to weight-stigmatizing stimuli was associated with greater cortisol reactivity among lean and overweight women. These findings highlight the potentially harmful physiological consequences of exposure to weight stigma.

It doesn’t require being fat to have this kind of reaction, by the way. Both the lean and overweight women “were equally likely to report that they would rather not see obese individuals depicted in a stigmatizing manner in the media.”

What’s cortisol? Some highlights from Wikipedia:

Cortisol, known more formally as hydrocortisone is a steroid hormone [...] released in response to stress and a low level of blood glucocorticoids. Its primary functions are to increase blood sugar through gluconeogenesis; suppress the immune system; and aid in fat, protein and carbohydrate  metabolism.  [...] Cortisol counteracts insulin, contributes to hyperglycemia-causing hepaticgluconeogenesis and inhibits the peripheral utilization of glucose (insulin resistance). [...] Cortisol can weaken the activity of the immune system.

Being fat (“excess weight”) is considered a cause of insulin resistance.  And it appears that weight stigma increases cortisol … which increases insulin resistance.  Which is the chicken? Which is the egg?

This isn’t necessarily new.  Weight stigma  has been tied to weight gain before.  What this study highlights is one mechanism.  There may be others.  We know that fat bias prevents fat people from getting jobs, from getting raises, and from getting proper healthcare treatment.   Fat people are also often paid less and harassed more than similar-qualified people who are thin.  None of this improves health.

So when I hear people saying that fat people just need more “tough talk” to lose weight “for their own good”? No, I don’t believe them.

Health At Every Size Principles

I sometimes post about Health At Every Size®, both the concept (which is trademarked by ASDAH) and the book Health at Every Size: The Surprising Truth about Your Weight, by Linda Bacon.  So I am pleased to see that ASDAH has updated its HAES® Principles to be more inclusive of different abilities and backgrounds. Weight bias and weight discrimination is explicitly called out.  Supporting individual choices is more explicitly encouraged. A brief framing of the Health At Every Size® Approach has been added, as well, noting that health is NOT “simply the absence of physical or mental illness, limitation, or disease.”  It also states that

[H]ealth exists on a continuum that varies with time and circumstance for each individual. Health should be conceived as a resource or capacity available to all regardless of health condition or ability level, and not as an outcome or objective of living. Pursuing health is neither a moral imperative nor an individual obligation, and health status should never be used to judge, oppress, or determine the value of an individual.

I suggest you check the full statement on the ASDAH site.

 

Things I’m reading

Kath as a post at Fat Heffalump on the feedback from her recent interview by Jasmin Lill on news.com.au, Brisbane blogger speaks out against online bullies. Go Kath!

Closet Puritan has a thoughtful response to some of the conflation between “Fat people are more common in communities with a Walmart” and “Eating more processed food from Walmart makes people fat”.

This Adipose Rex has some musings on Christianity and the body:

This Advent I am thinking about how if my body is a temple of the Holy Spirit, then this flesh itself is sacred — this same substance worn by the God of the universe, and shaped into God’s image. If I really believe in the words I recite every week, the resurrection of the body, then this is not some temporary meat-costume I will abandon so my soul can flit off to an immaterial heaven, but the too too solid flesh that will dance in the hereafter.

This reminds me of The Unapologetic Fat Girl’s Guide to Exercise and Other Incendiary Acts by Hanne Blank, which I’ve been reading. From the introduction:

Exercise—by which I mean regular physical movement that puts your body through its paces—is crucially important because it is something that makes it possible for you and your body to coexist in better and more integrated ways. It builds a bridge across the mind-body split. [...E]xercise gives your body to you. [...] Most of all, it teaches you that your body is not just a sort of jar made out of meat that you lug around because it’s what you keep your brain in, but an equal and in fact quite opinionated partner in the joint production that is you.

And over on the HAES blog, there’s an interesting discussion on healthism & privilege.

Things to Read

You may have seen this poor as folk post on why poor people might not eat healthy.   There’s also a great post on why “healthy food vs junk food” infographics are inaccurate, misleading lies.

From Linda Bacon and Lucy Aphramor at the the Health At Every Size® Blog:

“Obesity-related” disease actually tracks your social status more than what size clothing you wear. In developed nations, data show, members of stigmatized groups, including those who are economically disadvantaged and people of color, are the most common victims of illnesses typically grouped under the “metabolic” umbrella. [...] With social status comes control over one’s circumstances – success at work, fostering loved ones’ well-being, being able to plan for the future, or even next week. The absence of those, no matter how punctilious our lifestyle habits, stresses our systems in disease-promoting ways. In contrast, being able to exert an influence over what matters to us is health-promoting.

And astronaut Karen Nyberg created a stuffed dinosaur in space.

Medical Equipment Size Limits

This article focuses on the weight limits of air ambulances, but it’s depressing anyway. The overall message of the piece is to lose weight (which we all know works so well! And immediately!)

Now, yes, most fat people aren’t very fat; most cutoffs are 300 or 350lbs; air ambulances appear to have lower-than-typical requirements.

But what can you do? Some ideas:

  1. Ask your local hospital about their equipment. 
  2. Ask you local doctor about their equipment.
  3. Ask local fat friends about their experiences.
  4. Research what is available and ask for it to be considered when new purchases are made.
  5. If there is an organization that fundraises for your local hospital, consider joining. 

I wouldn’t expect any of these to have an immediate effect, and some are long-term commitments.  These are also biased toward people who have the  time, money, education, and (possibly) public speaking skills to succeed.

Finally, you can move to an area with more choices.  This is definitely a long-term choice, and one that may also be impossible. But it may work for some.

Other thoughts?

You’re SORRY? Oh fuck you.

Dr. Peter Attia thinks about his former patient often, the woman who came to him in the emergency room at Johns Hopkins Hospital one night seven years ago.

She was obese and suffering from a severe complication of Type 2 diabetes, a foot ulcer, which required an urgent amputation. At the time, Dr. Attia admits, he silently judged her. If she had only taken better care of her health, maybe exercised more and eaten less, he thought to himself, this never would have happened to her.

But a few months ago, in a TED talk, Dr. Attia stepped onto a stage and offered a few words to his former patient: “I hope you can forgive me.”

WHAT THE FUCK?  Why should she forgive you?  You’re just another judgmental asshole in a nice long line of judgmental assholes.  Is it really such a stain on your self-image that someone might not worship you as the all-perfect person you want to be?  Why should she spend any pity or compassion on you?

“As a doctor, I delivered the best clinical care I could, but as a human being, I let you down,” Dr. Attia, his voice breaking, said in his talk. “You didn’t need my judgment and my contempt. You needed my empathy and compassion.”

Wow.   Just … wow.   He thinks his “judgment and contempt” did not prevent him from delivering the best clinical care?  Or is he admitting that the “best clinical care I could” might not be the best clinical care?

I still don’t see why he thinks an apology from just one doctor might MATTER at this point.  Maybe it would.  Maybe pigs would fly, I don’t know.

Apparently Attia’s now looking into research on whether “the precursors to diabetes cause obesity, and not the other way around“.  Interesting.  Did he read some genetic research on type 2 diabetes?

Dr. Attia’s insight was informed, in part, by the startling discovery a few years ago that despite paying close attention to his diet and exercising frequently, often for hours at a time, he had developed metabolic syndrome, a precursor to Type 2 diabetes. He had made all the right lifestyle choices, he thought, and yet he was overweight and on a fast track toward obesity and diabetes.

Oh for fuck’s sake.   Dr Perfect is SHOCKED, SHOCKED to discover his body is not 100% under his control at all times.  OMG, this is a REVELATION.

Sources:

NY Times article on Dr Attia, where I pulled most of the quotes from.

Dr Attia’s TED talk.

Itch, Itch, Itch

Ever use a long-handled bath brush to scrub your back?

Swap the brush for a dense sponge, and that’s basically the long-handled lotion applicator I got from Amazon. This morning I used it to put Aveeno anti-itch lotion on the itchy spot on the middle of my back. At bedtime I decided to try Benadryl cream – it’s definitely helping.

Part of me feels weird to use a lotion applicator (I can’t just reach?)  Yet bath brushes – which reach the same areas – are a bath staple. Strange what seems normal sometimes.

In the meantime, the itch is subsiding and I think I can sleep. 

Histamines in Food

A bit of background:

An allergen is something that triggers an allergy. When a person with allergic rhinitis breathes in an allergen such as pollen or dust, the body releases chemicals, including histamine. 

Histamine [...] causes dilatation of the blood vessels (flushing, rash, itching) and increased mucus production (runny nose, productive cough), and bronchoconstriction (wheezing, cough). Because histamine is contained in almost all body tissues, [...] it is able to cause a wide variety of symptoms.

So, allergies release histamines, and histamines causes the actual symptoms.

Well, I knew that it’s possible to be allergic to food.  I even knew that if you’re allergic to sulfites you should avoid wine.  But somehow I’d missed that some foods naturally contain … histamine.

There are many foods that contain histamine or cause the body to release histamine when ingested. These types of reactions are food intolerances, and are different from food allergy in that the immune system is not involved in the reaction. The symptoms, however, can be the same as a food allergy.

This also includes beer, wine and liquor.

The basic takeaway seems to be:  IF you have allergies, and your allergies are getting on your case? You might want to avoid food and drink with natural histamines.  There’s a long list here.  A couple studies linking wine (in particular) with more symptoms in allergy sufferers were discussed here.

(Those who do not have allergies are welcome to pour a glass of wine and rejoice in the comments.  Those with allergies, feel free to share other coping methods.)

Why I Think Declaring Obesity A Disease is Harmful

It’s inaccurate:

It distracts from the real issues:

It’s a win for the weight cycling industry

Unfortunately, what’s good for the weight cycling industry isn’t necessarily good for patients: 

There is a Change.org petition on this – I’ve signed, have you?

The Dose Makes The Poison

[A study], published in 2011, followed 28,800 subjects with high blood pressure aged 55 and older for 4.7 years and analyzed their sodium consumption by urinalysis. The researchers reported that the risks of heart attacks, strokes, congestive heart failure and death from heart disease increased significantly for those consuming more than 7,000 milligrams of sodium a day and for those consuming less than 3,000 milligrams of sodium a day.

Gina Kolata in the NY Times

Wow, it’s almost like the extreme might be the problem.  Sometimes “the dose makes the poison” is worth remembering.