Filed under: Op-Ed
Most people understand what it means to have high blood pressure, excess fat around the middle, a high cholesterol level, and the importance of addressing these health problems. What some may not realize is how serious the situation becomes when a person has been diagnosed with three or more such conditions in conjunction with other health issues.
This occurrence is called metabolic syndrome.
People who suffer from this combination of conditions (a reported one in four—50 million in the United States alone) have a dramatically increased risk for developing heart disease, type-2 diabetes, or a stroke. Individually, these symptoms pose a health risk, but identified together they raise the risk for cardiovascular disease.
Metabolic syndrome is characterized by a cluster of symptoms that include excess fat in the abdominal area (as measured by waist circumference), borderline or high blood pressure, high cholesterol that fosters plaque buildup in arteries, insulin resistance or glucose intolerance indicating the body can’t properly use insulin, raising blood sugar levels, and the presence of a protein in the blood, which can cause inflammation.
People with metabolic syndrome have at least three of the following risk factors:
- Excessive body fat around the waist
- Low levels of HDL ("good") cholesterol
- High levels of triglycerides (a type of blood fat)
- Elevated blood pressure
- Elevated glucose (blood sugar) levels after fasting
The complications of metabolic syndrome are serious and, if not addressed, can cause major health problems. If you are overweight and don't yet have these problems, keep in mind that the older you get, the more likely you are to develop them. Older adults can develop metabolic syndrome without being overweight, so it is important to get annual physical exams.
What can be done to prevent metabolic syndrome? If you are fall into the categories above or are overweight, one way to reduce your risk of metabolic syndrome is to incorporate healthy habits such as starting an exercise regimen. (But be sure to consult your doctor before starting a new exercise program, especially if you have not been active for a while.)
Diet is also key to reducing the risk of metabolic syndrome. By making small changes in your diet—such as decreasing the number of calories you take in per day; eating more fruits, vegetables, whole grain products, and low-fat meals, and avoiding fast/fried/fatty/oily foods—you can reduce your chances of developing metabolic syndrome.
If you would like to know more about metabolic syndrome, we recommend the following resources:
In a recent Healthy Tip, we briefly described a notable article in the June 2011 New England Journal of Medicine about long-term weight gain. The 20-year study involved more than 120,000 healthy men and woman of normal weight. All were examined at four-year intervals and were found to have gained an average of almost a pound a year. That doesn’t seem like much—unless you consider that if you’re a fit 160 pounds at age 30, you’ll have put on 20 pounds by age 50. At that point your extra weight may be compounded by diabetes, bad joints, heart disease, and perhaps even cancer—all of which are associated with obesity. So now you’re forced to find ways to lose weight.
Wouldn’t it have been better to maintain a healthy weight all along? Some of the study’s observations regarding food choices and exercise might prove helpful in maintaining your weight as you age.
The study found that some foods were significantly associated with weight gain: potato products such as potato chips and French fries, sugary beverages (sodas, for example), red meat, processed meat products, and refined grains. On the other hand, foods associated with no weight gain were vegetables, whole grains, fruits, nuts, and yogurt.
Other factors found to be associated with weight were physical activity (increase = no gain in weight); alcohol consumption (increase = weight gain); sleep habits (less than six or more than eight hours per night = weight gain); and TV habits (more TV = weight gain), a correlation that seemed partly due to more snacking (Superbowl, anyone?) and less activity.
A single change in diet or lifestyle had less effect than several together. It makes sense that if you exercise less and eat more foods associated with weight gain, you’ll gain weight more easily than if you exercise less but still eat well.
Why some foods seem to contribute to weight gain more than others is still not fully understood, but it probably has a lot to do with what makes us feel satisfied when we eat. High-calorie food and drink that go down fast and easy and quickly enter our bloodstream may not make us feel full when we consume them, so we tend to eat more of them. High-fiber foods like fruits and vegetables fill us up and are low in calories. Even high-fiber nuts, which tend to have a lot of calories, are associated with no weight gain, perhaps because they satisfy us and keep us from eating candy and cake that do cause weight gain. Yogurt is an interesting case, since there has been a lot of interest lately in probiotics (bacteria felt to contribute positively to our health). Perhaps yogurt changes the bacterial flora in a way that contributes to weight stability and loss.
The reason we discuss this study in more depth is twofold. First, it highlights the fact that Americans have a tendency to gain weight as they get older. Knowing that, we can be vigilant of what we eat and how active we are in order to help prevent this weight gain. Second, it warns us of the most common food offenders to avoid—and those to embrace—and underscores the concept that weight is a balance between the calories we consume (foods and beverages we eat) and the calories we expend (physical activity). Make sure you find the proper balance when you’re young, so you won’t be overweight—and perhaps sick—when you’re older.
What has the Human Performance Resource Center (HPRC) been doing this past year to make our Warfighters safer? A lot! HPRC has a number of missions, but the most important one—and the one that all of HPRC’s other tasks support—is to provide evidence-based information on Human Performance Optimization (HPO). HPO involves giving our Warfighters the training and information they need to effectively carry out their missions in any environment, with the resilience to avoid injury and illness and the ability to recover quickly if injured or ill. As it turns out, HPO embodies all the domains of Total Force Fitness (TFF)—physical fitness, nutrition, dietary supplements, extreme environments, family/social issues, and psychological fitness—that ADM Mullen is asking the services to embrace.
Some of the accomplishments of HPRC this year are:
- Responding to questions from the field (mostly from Warfighters and providers) at the average rate of one per day and growing. These questions cover topics such as proper hydration, dietary supplement use, sleep requirements, managing altitude sickness, how to beat heat illness, and fitness fueling. Every question answered has the potential of protecting our Warfighters from inaccurate commercial information and harmful practices and of increasing their resilience.
- Overseeing a workgroup of subject matter experts (SMEs) who developed a white paper on High-Intensity Training that helps put in perspective the information available on these popular training programs. A scientific paper will be published in the near future.
- Overseeing the workgroup of SMEs who are developing the concept of Total Force Fitness for ADM Mullen, Chairman, Joint Chiefs of Staff.
- Developing and expanding a website that is now servicing more than a thousand people a week by supplying needed information on HPO and TFF.
- Supplying “healthy tips” to entities such as the Uniformed Services publication The Pulse and the Military Times.
- Partnering with multiple organizations across the services and DoD to help collaborate and coordinate efforts in HPO/TFF.
These examples provide a good snapshot of the activity level at HPRC. The staff and volunteer SMEs are working hard to make our Warfighters safer and more resilient to both physical and mental trauma. Who could ask for a better mission?
The USDA announced on June 2, 2011, that its classic food guide Pyramid is being replaced with the easy-to-understand and interactive MyPlate. Using a “familiar mealtime visual,” MyPlate is intended to remind Americans about balancing meals with the five food groups: fruits, vegetables, grains, protein, and dairy. Based on the 2010 Dietary Guidelines, notable changes to the new guide are the inclusion of more fruits and vegetables, less grains, and the re-categorization of oils as providing “essential nutrients” but not appearing on the plate.
The result is a simple visual graphic of a balanced meal that families can use as a tool to make sure the portions of the major food groups are covered in meals. The simplicity of the graphic helps ALL family members, especially children, become more engaged in what and how much they should be eating. An interactive plate on the MyPlate website allows users to click on each section of the plate, which then displays a page for the selected food group with description, key message, and a list with pictures of single-serving sizes of some common foods in that group. These changes allow families to easily identify what a healthy, balanced meal looks like. Also featured is an Interactive Tools section that enables users to develop personalized plans and learn about specific healthy food choices. When all family members know the basics of healthy eating, mealtime can truly be a shared event.
MyPlate can also encourage family discussions about healthy foods, which can help develop good eating habits by all members of a family. For example, you can find out if there are any particular foods that family members like or dislike, and then find and offer alternatives in the specific food group of a disliked item. This will help eliminate the likelihood that someone will skip the essential healthy components of a meal. Get everyone excited and involved during mealtime! Fun meals shared as a family can promote healthy eating habits for children that they can carry into adulthood and can reinforce family bonding.
Keep in mind that MyPlate isn’t designed as strict rule to be followed—it’s perfectly fine to have dairy products directly on the plate instead of in a cup. Desserts, which are currently placed in the “Empty Calories” section, are okay when consumed in moderation in appropriate portions. You may still have to seek out other sources for how to prepare foods in healthy ways and to determine for the nutrition content of many food items. The information on MyPlate should be used as a tool to build a foundation of knowledge about food choices and help set healthy eating goals for your family. Families should take this change as an opportunity to get the entire family involved in healthy eating.
Jack3d (sometimes known as “Jacked”) is, according to the bottle, a “powerful pre-workout supplement that increases your capacity to perform.” HPRC did an extensive search for evidence-based information on Jack3d and found that all the apparently scientific literature on the product led to its promotional website, where they offer their own reviews. Anyone taking supplements should know that there have been reports about “tainted” dietary supplements containing active ingredients of FDA-approved drugs or other compounds that are not classified as dietary supplements. But there are still testimonials, blog entries, and bodybuilding forums touting the effects of Jack3d. It’s important to know exactly what is in Jack3d and that there isn’t any information on how much of each individual ingredient is in a serving.
The label of Jack3d says that it contains 4145 mg of a “Proprietary Blend” in one scoop, with 45 servings per container. In that blend are the ingredients:
- arginine alpha-ketoglutarate,
- creatine monohydrate,
- beta alanine,
- 1,3-dimethylamylamine (geranium [stem]), and
- schizandrol A,
- as well as some flavoring and color additives.
So, what does this all mean to a consumer? There have been individual studies conducted on each of the ingredients in Jack3d. Some are more effective than others for potentially enhancing athletic performance and building muscle mass. For example, creatine may increase muscle mass and enhance exercise performance during short, high-intensity repeated exercise bouts. For more information about creatine, see HPRC’s research brief. We know that 1,3-dimethylamylamine (DMAA), a chemical from the geranium plant and also synthetically made, is used in supplements promoted for weight loss, bodybuilding, and enhanced athletic performance. According to the Natural Medicines Comprehensive Database, it’s thought to have stimulant effects. Its chemical structure is similar to that of amphetamine, and it is on the World Anti-Doping Agency’s banned substance list. No scientific literature exists on the effectiveness of DMAA for weight loss, bodybuilding, or enhanced athletic performance. Caution is advised on the use of DMAA with caffeine, since both have stimulant effects and could increase the chance of increased heart rate and blood pressure.
The amount of caffeine per scoop of Jack3d has not been released, although it has been estimated that there is less than 150 mg of caffeine/scoop. Caffeine is included on the FDA’s list as a substance “generally recognized as safe.” However, the FDA has established a maximum concentration for caffeine in cola beverages: 32.4 mg per 6 oz or 71 mg per 12 oz. Other than colas, the caffeine content of food and beverages is not regulated. The label of Jack3d states: “Do not use in combination with caffeine or any stimulants from other sources whatsoever, including but not limited to, coffee, tea, soda and other dietary supplements or medications.” Caffeine seems to increase physical endurance, but it does not seem to affect activities that require high exertion over a short period of time, such as lifting.
The main issue with Jack3d is the same one that exists with many bodybuilding products on the market. There is no way to judge the interaction between the ingredients, especially when the consumer is unable to determine how much of each ingredient is in the product. This product contains multiple ingredients and, potentially, additional and potent ingredients not listed. It also could be contaminated, as has been seen with many other supplements. The FDA has put together information on tainted products promoted for bodybuilding.
It is important to mention that Jack3d comes with serious warnings on its label. As with any supplement, be educated, be advised, and consider all the unknowns before you decide whether the possible benefits are worth risking your health.
NBA superstar Shaquille O'Neal recently announced that he will retire from professional basketball after 19 seasons and four championship rings. In addition to that announcement, O'Neal announced via a YouTube video that he, like 12 million other Americans, had been diagnosed with sleep apnea.
According to his girlfriend, the seven-feet-tall, 300-plus-pounds center snored excessively during the night, and she noticed that his chest would often cease movement entirely. After participating in a Harvard University–sponsored sleep study he was diagnosed with a mild case of sleep apnea and was advised to begin wearing a CPAP (Continuous Positive Airway Pressure) mask, a respiratory ventilation therapy that assists the wearer’s breathing while asleep. O'Neal's story has a happy ending—because of the recent diagnosis and subsequent treatment, O’Neal reports that he feels more energetic and that his overall quality of life has improved. He is also happy and comfortable with the treatment. Other professional athletes suffering from sleep apnea have not been so fortunate. In 2006, Reggie White, defensive end for the Philadelphia Eagles and Green Bay Packers—one of the greatest players in football history—reportedly died from causes related to sleep apnea.
What exactly is sleep apnea? And how does it affect athletic performance? People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night and often for a minute or longer. According to the American Sleep Apnea Association, there are three types of apnea: obstructive, central, and mixed. Of the three types, obstructive sleep apnea (OSA) is the most common. Weight can contribute to sleep apnea. In 2009, a study by Sweden's Karolinska Institute showed that overweight and obese men who lost weight during a calorie-restricted diet over nine weeks had major improvements in their sleep apnea symptoms.
Other risk factors for obstructive sleep apnea include certain physical attributes, such as having a thick neck (which describes many athlete body types), deviated septum, receding chin, and enlarged tonsils or adenoids. Allergies or other medical conditions that cause nasal congestion and blockage can also contribute to sleep apnea.
Signs of sleep apnea include loud and chronic snoring, choking, snorting, or gasping during sleep, long pauses in breathing, and daytime sleepiness regardless of how much time you spend sleeping. Other common signs and symptoms of sleep apnea include waking up with a dry mouth or sore throat, morning headaches, restless or fitful sleep, insomnia or nighttime awakenings, going to the bathroom frequently during the night, waking up feeling out of breath, forgetfulness and difficulty concentrating, moodiness, irritability, or depression.
Untreated, sleep apnea can cause high blood pressure and other cardiovascular diseases, memory problems, weight gain, impotency, and headaches. Moreover, left untreated, it may be responsible for job impairment and motor vehicle crashes.
In terms of athletic/sports performance, sleep apnea is a major concern because sleep apnea causes a disruption to healthy sleep patterns, which in turn can affect physical performance. According to a 2007 Stanford University study of sleep and athletic performance, athletes who extend the amount of sleep they get and reduce their sleep debt are more likely to improve their performance. Conversely, if an athlete does not get a good night’s sleep, then the next day he/she is tired, sleepy, or irritable. In such cases, physical performance also is impaired, since there is limited energy reserve due to the lack of adequate or good-quality sleep. Sleep apnea not only has an impact on athletes—it affects the military, as well.
So what can you do if you suspect that you or your sleep partner has sleep apnea? The only way to be sure is to undergo a sleep test, which is done in a sleep lab where patients sleep in a special bedroom with electrodes and other sensors attached to various parts of the body. There, you will be monitored throughout the night to keep track of whether and how often you stop breathing, how low your O2 sat (oxygen saturation) goes, and what your brainwaves are doing while you're sleeping.
For additional resources on sleep and sleep apnea, please visit the following:
Since the beginning of Operation Enduring Freedom and Operation Iraqi Freedom, approximately two million U.S. troops have deployed. The operational tempo associated with these conflicts has led to longer and more frequent deployments with fewer rest periods in between. The inevitable stress is a challenge for military and civilian communities, even as families work hard to reintegrate their families and normal routines.
In response to these ongoing demands, the Chairman of the Joint Chiefs of Staff directed the development of the Total Force Fitness (TFF) initiative, a new Department of Defense model that focuses on the health, readiness, and performance of our Warfighters. (See the Total Force Fitness section of HPRC’s website for more information on this initiative.)
Following this initiative, a team of Joint-Service and DoD experts lead by COL Bowles of the Uniformed Services University of the Health Sciences (USUHS) came together to create a model that promotes family fitness, resilience, and optimal well-being for service members and their families. This model, which is still in development, is called The Military Family Fitness Model (MFFM).
The MFFM first examines stress-inducing demands placed on military and civilian families from sudden deployment and the return home. Then, looking to build on the resilience of the family, MFFM provides guidelines, skills, and resources for the individual, family, and community to protect against the negative effects of stress. As sources of stress increase, certain behaviors indicate the need for more support (e.g., family strife, children acting out, job instability for non-service members, family role conflict, non-supportive relationships outside the family, and/or domestic violence). With MFFM, families have individual, family, and community resources for additional support. The aim of the model is to foster a multi-level approach that strengthens family resilience and, as a result, Warfighter resilience.
Individual approaches to addressing stress include breathing exercises, yoga, mindfulness exercises, and cognitive restructuring. Family strategies include developing and maintaining strong communication skills, shared family routines, and the building of support networks. The bottom line of the MFFM is that at any point along the model, individuals, families, and communities can strengthen resilience resources to promote total family resilience and fitness.
Members of the MFFM team presented the Military Family Fitness Model at the USDA/DoD Family Resilience conference at the end of April. We encourage you to get more information on the conference presentation, read the abstract, and see the PowerPoint slides presented.
True total force fitness and overall well-being are crucial to Warfighter readiness and success, and awareness of this is now spreading like wildfire. Admiral Mullen’s Total Force Fitness Initiatives center on the importance of mind, body, family, and environment for overall Warfighter resilience.
There are numerous programs within the military designed to support and enhance Warfighter resilience – some unit specific and some branch or joint-service specific. The HPRC is in the process of gathering information on these myriad programs and highlighting those that are clearly evidence-based, that highlight the importance of mind-body integration, and that teach Warfighter-relevant skills and strategies for performance optimization.
Last week we added a section in our Total Force Fitness domain on the Comprehensive Soldier Fitness (CSF) program. We describe the program, give step-by-step information about its components, and highlight where to go for more information and program participation.
To give you a brief overview, CSF is an integrated Total Force Fitness (TFF) resilience-building program developed by the Army in collaboration with researchers in positive psychology and resilience building. CSF is designed to give Warfighters, their families, and their communities the knowledge, skills, and behaviors to “thrive in their lives” and successfully adapt to life’s challenges. Consistent with some of the components of Total Force Fitness identified by the DoD, CSF has five basic sectors: physical, social, emotional, spiritual, and family.
CSF was initially developed for the Army community, but it has now been adapted for use by the Air Force, Navy, and Marines. In addition, CSF provides training tools specifically designed for family members. Most of the training materials require AKO/DKO access, but the main exception is the family member materials, which are available for immediate download (with registration).
We hope that this new area of our website will be useful, help foster resilience in all, and provide a one-stop shop for previewing some resilience programs ongoing within the military.
Tainted dietary supplements most often occur among products typically marketed for weight loss, sexual enhancement, and bodybuilding. They can have deceptive labeling as well as undeclared, harmful ingredients. The question is: How can consumers protect themselves from these products?
The Food and Drug Administration (FDA) has recently taken some steps to help consumers look out for potentially harmful dietary supplement products. Consumers and healthcare professionals can receive notifications from the FDA by subscribing to the RSS feed. The Commissioner of Food and Drugs also sent a letter to the dietary supplement industry reminding them of their responsibility to prevent the sale of tainted products in the United States. The FDA has also made it easier to report to the FDA about tainted products.
Some of these tainted dietary supplement products contain active ingredients of FDA-approved drugs or other compounds that are not classified as dietary ingredients. These products can have serious side effects, including death. The FDA has identified roughly 300 tainted products that are not legal dietary supplements and are warning consumers about the serious side effects of these products. Consumers should be cautious of:
- Product ads that claim to “melt your fat away,” or claim that “diet and exercise [are] not required,” or products that use the words “guaranteed,” “scientific breakthrough,” or “totally safe.”
- Products that use numerous testimonials about “results seen” from using the product.
- Any product that is labeled or marketed in a foreign language. Consumers should not buy or consume these products.
- Products that are marketed as herbal alternatives to FDA-approved drugs.
- Products marketed and sold on the Internet.
There have been some recent voluntary recalls due to FDA investigations of dietary supplement products. Some of these have included weight-loss products that contained the prescription drug ingredient sibutramine. Sexual enhancement products have also been recalled for containing the undeclared drug ingredients sulfosildenafil and tadalafil. Other products marketed as supplements have been identified as containing various prescription drug ingredients.
It is important that consumers be aware that, under the Dietary Supplement Health and Education Act of 1994, companies do not need FDA approval prior to marketing such products. Thus, generally speaking, the FDA does not approve dietary supplements.
Consumers need to be savvy when they make product purchases, and when in doubt, check with a healthcare professional or registered dietitian to determine if you need a dietary supplement product and to help determine what could be a tainted product. If it looks too good to be true, chances are it is. For more information, read the “FDA’s Beware of Fraudulent ‘Dietary Supplements’.”
You may have heard time and time again that breakfast is the most important meal of the day and that eating a big breakfast could help you lose weight. One explanation for this claim is that starting the day with a big breakfast prevents food cravings and induces weight loss. Is this true? And is there scientific evidence to support this claim?
Some scientific findings suggest that consuming an energy-rich breakfast causes a person to eat less during the rest of the day. Other findings suggest that increasing the size of breakfast is linked to overall greater food intake. A WebMD article examined this conflicting evidence in light of a recent study conducted by a group of German scientists at the Else-Kroner-Fresenius Center of Nutritional Medicine, Technical University of Munich. Naturally, a study has to be well designed and executed in order for the results to hold up to scrutiny by the scientific community. In this case, which involved a large group of participants, several measures were introduced to encourage accurate record keeping and sound statistics to analyze the results.
Generally speaking, the study suggests that individuals who consume bigger breakfasts in hopes of losing weight may actually end up consuming more calories than anticipated, as they are likely to eat the same amounts of food during lunch and dinner that they would following a small breakfast. This particular finding is worth sharing because it creates awareness of this behavior and may encourage people to consciously watch what they eat for lunch and dinner if they do have a big breakfast or, alternatively, reduce the size of their breakfast. This could be a key for people in their efforts to maintain or lose weight.
All the same, we wish to remind readers that there is no magic formula when it comes to losing weight. Well, maybe there is…
Higher Caloric Expenditure + Lower Caloric Intake = Weight Loss
This is a good general formula to keep in mind in your efforts to lose or maintain your weight. So for instance, while being physically active increases your caloric expenditure, reducing a high-fat diet lowers your caloric intake. And in this instance, refraining from eating a bigger breakfast than usual could contribute to reducing your caloric intake for the day.
In short, we encourage you to eat regular, healthy meals. However, if you decide to eat a bigger-than-usual breakfast, balance it out by eating less during the rest of the day. We hope that the results of this study help you make informed decisions about the number of calories you consume for breakfast.