Modifying Your Alzheimer’s Risk

One of the most feared illnesses today is Alzheimer’s disease. Aloysius Alzheimer, a German psychiatrist and neuropathologist, first described the characteristic brain changes and associated dementia more than one hundred years ago.  Despite the rapid advance of medicine and technology over the intervening century, we still know far too little about this devastating and incurable disease.

Diagnosing Alzheimer’s dementia requires expensive testing looking for particular damage due to accumulation of beta-amyloid and tau protein, which cause the signature plaques and tangles in the brain. As a result, many patients with dementia never get tested and may not get labeled with actual Alzheimer’s disease. Regardless, most dementia – 80% – is the result of Alzheimer’s.

Alzheimer’s disease can last more than a decade, starting with mild cognitive impairment (MCI) and relentlessly progressing to more difficulty solving problems, personality changes, getting lost, forgetting people or significant life events, and ultimately losing the ability to care for oneself, to toilet, to speak, to walk. Some people progress more rapidly than others. The Alzheimer’s Association website https://www.alz.org/ can be a great resource for caregivers or those wanting more information.

Unfortunately, currently available prescription medications, which may help somewhat with mental function, mood, behavior, and ability to perform activities of daily living (like bathing, dressing, eating, etc.), do little to change the course of the illness or the rate of decline. We don’t yet have a magic bullet.

Genetic factors can increase risk of dementia, but most dementia cases occur sporadically in older adults in whom multiple genes influence risk.  We cannot – yet – modify our genes. Changing our lifestyle, however, is one way to improve the odds of developing dementia, even for those with high genetic risk.  Many of the dietary and lifestyle habits and activities recommended to improve overall health (think heart disease, cancer, diabetes) may also be of some benefit with dementia.

One Mediterranean-type diet, which researchers named the MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet, focuses on foods that impact brain health: leafy green vegetables, berries, nuts, olive oil, fish, wine in moderation, and avoiding red meat.    The point is these broad dietary recommendations are not new and not exclusive to affecting Alzheimer’s risk. Let’s just call it healthy eating.

In addition, physical and mentally stimulating activities – such as reading or crossword puzzles – are important as we age. Both diet and exercise may help with Alzheimer’s risk by virtue of preventing conditions like diabetes, hypertension, and coronary artery disease that can exacerbate cognitive decline. Most older adults cannot keep up the same rigorous workout routine they might have when they were younger. But exercising at least 150 minutes a week, whether by biking, walking, swimming, gardening or doing yard work, can increase the flow of blood to the brain, improve the health of blood vessels and raises the level of HDL cholesterol, which together help protect against both cardiovascular disease and dementia.  One study found that people who engaged in more than six activities a month—including hobbies, reading, visiting friends, walking, volunteering, and attending religious services—had a 38% lower rate of developing dementia than people who did fewer activities.  Along with physical and mental activity and a healthy diet, individuals who avoid smoking tobacco have a lower dementia risk. 

There is mixed evidence about the use of fish oil supplements to improve thinking and memory in Alzheimer’s.  Given the benefit for cardiovascular health, it is reasonable for most people to take a fish oil supplement.   Vitamin D deficiency has been identified as an independent risk factor for the development of dementia of any cause, and supplementation is recommended for patients in whom deficiency is diagnosed.  Finally, no dietary supplement has been proven to be effective in boosting memory or preventing dementia. It is wise to talk to your doctor about the risks and benefits of any over-the-counter medications or supplements you are taking.

As with any recommendations, we must acknowledge that playing by the rules will not guarantee we will prevent Alzheimer’s (or any other disease, for that matter). Probably two-thirds of the risk of developing Alzheimer’s simply can’t be modified.  But adopting a healthy lifestyle with heart- and brain-healthy diet and exercise habits will lessen your chances of developing any number of chronic and life-threatening illnesses. When we all work toward that goal, our entire community is healthier. That’s worth striving for!

How to Lose Weight and Improve Health

Weight loss is always high on most people’s New Year’s resolution list. For something that is desired by so many of us, it is surprising how difficult it is to achieve and how controversial or ineffective the proposed methods are. Half of all Americans ages 20 and over say they've attempted to lose weight in the past year.  Exercising more and eating less are the two top strategies people use to try to lose weight. Yet so often we fail.

Our focus needs to shift to healthy living as opposed to weight loss alone. No single diet can be recommended for everyone, because – and you knew this already – what works for one person may not work for another.  Of all the individual diet programs out there, Weight Watchers (now called WW, to move the emphasis away from weight loss) seems to be more effective than others, at least according to US News & World Reports.  Noom is a more recent (and expensive) addition to the behavioral change and app-integrated weight loss arena. What these programs recognize is that weight loss is more than just counting calories (or, as is the case in the WW system, points). Weight loss requires behavioral change, community, and a lifestyle of eating healthier and moving more.

Though we don’t know enough about the genetics involved in weight loss and weight gain, the observation that some people have to work harder than others to stay thin or lose weight appears to be supported by scientific data. Apart from genetics, some people’s intestines are 50% longer than others. (Shorter guts absorb fewer calories.) Differences in gut microbiomes can alter how people process food.  Cooking increases digestion of food and absorption of calories.

All of this means that just counting calories is not the answer to weight loss. The old adage calories in, calories out is simply false. That’s because a calorie is not a calorie. If that were the case, a diet of donuts alone would be fine. But it turns out the rate your body absorbs calories may be as important as the amount of calories you take in. In other words, that sugary donut hits our bloodstream far faster than calories from more complex carbohydrates or from fat and protein.  And, those quickly absorbed sugars are far more likely to create body fat – and make you paradoxically hungrier in the process.

For years, the culprit of the obesity epidemic was thought to be dietary fat. Low-fat, high-carb diets were all the rage. Only recently has it come to light that sugar companies secretly funded studies designed to blame fat for making us fat. But low-fat, high-carb diets didn’t work; we kept getting fatter. For an entire polemic on the subject, check out The Case Against Sugar by Gary Taubes. It is enough to scare anyone off sugar. That is not to say that we know for certain the extent to which sugar is responsible for the obesity epidemic. Gina Kolata, writing in the New York Times, notes that a number of societal factors may have contributed to the obesity epidemic, from growing portion sizes, the popularity of restaurants and fast food, snacking, the cultural acceptance of obesity, and even the decline in smoking.  The science is not settled.

That’s not to say that you shouldn’t watch what you eat. Keeping a food diary can help you understand what and how much you are eating and the types of calories you are consuming. A study of nearly 1,700 participants showed the best predictors of weight loss were how frequently food diaries were kept and how many support sessions the participants attended. Those who kept daily food records lost twice as much weight as those who kept no records.  I wrote about my so-called Bar Code Diet many years ago and that if I couldn't scan it or enter it into my phone, I didn't put it in my mouth.  That – along with regular exercise with a group of friends, who kept me accountable – did help me lose weight and keep it off.

What can you do realistically on your own and without added expense?

1. Keep a food diary. You may not be aware of just what you consume in a given day. For the technologically savvy, phone apps like MyFitnessPal and Lose It! can be helpful. Remember, some days you may have more success than others. Just keep going.
2. Avoid high fructose corn syrup and sugary drinks, and cut your daily sugar intake significantly.  Having an occasional celebratory dessert is fine. But make it a rare and portion-controlled treat, if for no other reason than sugary foods are seductive and lead to overeating.
3. Focus on overall healthy behaviors, eating fewer processed foods, and increasing physical activity as opposed to weight loss per se. That includes avoiding smoking and excess alcohol intake as well as taking advantage of a host of other preventive, screening, and early detection programs. Weight is just a number; health is a lifestyle.
4. Be a part of a community or small group. Accountability – both for diet and exercise – is a great motivator and reinforcer. Fat shaming doesn’t work; encouragement and support does.

Emphasizing physical activity and healthy behaviors at all ages is key to reducing morbidity and improving health outcomes in communities. Far from ignoring obesity, when we emphasize a lifestyle that includes awareness and adjustment of eating habits and sets exercise goals (such as increasing walking speed, strength gains, etc.), our overall health – and the health of our community – will improve. And you know what? We will lose weight along the way.

Moving the Needle on Health in Angelina County

Back in January, I wrote about the abysmal county health rankings in Deep East Texas and the fact that Angelina County has been named the county with the highest obesity rate in Texas. Almost four out of ten of us aren't merely overweight, we are downright obese. Let’s just admit it; we’re fat. And that fatness is a major factor in the development of high blood pressure, diabetes, heart disease, and many cancers, among other illnesses. 

Obesity is a two-edged sword that is both killing us early and costing us a lot in terms of ongoing healthcare expenditures and lost productivity. Smoking is, of course, another huge factor in our high cost of healthcare and poorer health outcomes. We must do better.

The rhetoric on the national stage is all about the skyrocketing cost of health insurance and how to tweak (or get rid of) Obamacare, as if that would solve our healthcare problems. The government can’t do it for us, folks. Regardless of what happens with healthcare reform, we need to collectively get off our fat behinds and take more responsibility for our own health. We need to do this individually, yes, but we also need to work on this as a community.

I mentioned in January the groundwork being laid by the Texas Forest Country Partnership. They hosted a series of strategic planning sessions to set goals for growth across a broad spectrum of our regional economy, from forestry and tourism to manufacturing and healthcare. Part of their healthcare recommendation was to raise our county health rankings in the region.

Since then, the $1 billion Episcopal Health Foundation, whose goal is to improve the health of the 10 million people living throughout the 57-county region served by the Episcopal Diocese of Texas, hosted a community meeting in Nacogdoches specifically to deepen their relationship with organizations working to improve community health in this area. Other foundations have expressed a similar interest.

But let’s be very clear: no foundation or partnership is going to do the work for us. We all have to be involved. The amazing thing about Angelina County is the number of resources we already have, along with the incredible people behind them! These resources need to intentionally focus on both individual and community health and work in a coordinated effort to put the pieces of our health puzzle together.

Hospitals must strengthen community outreach, especially with diabetes, heart disease, stroke, and cancer education. Physicians must expand care for the indigent in our communities. It is our duty. The Angelina County & Cities Health District deserves our full support for the incredible care they already provide, but they can and must do more. That requires funding, whether from grant support, state government, or from within Angelina County. Their primary care outreach is crucial to the health of our county.

Organizations like the American Cancer Society, The Coalition, ADAC, and the Burke Center must expand outreach and education about healthy lifestyles and disease prevention, cancer screening, smoking cessation, and immunizations. Women’s Special Services at CHI St. Luke’s Health Memorial will continue to apply for grants for low income women to get breast and cervical cancer screening. 

Lufkin went smoke free years ago and is better off for it. What about other cities? Diboll? Angelina County? Texas? Our state legislators need to use that proposed bathroom bill as toilet paper and instead pass smoke free legislation, which we know will both improve the health of our communities and save taxpayer dollars.

Chamber businesses need to provide or strengthen wellness programs for their employees, encouraging healthier lifestyles, diet, exercise, and smoking cessation. Maybe if people had to climb two flights of stairs to buy their cigarettes rather than drive through a barn or stop at a convenience store, fewer people would smoke. And they’d lose weight while they were at it! Is it just as easy for us to shop for healthy foods as it is tobacco and junk food? How do we encourage and facilitate healthy eating?

Our educational institutions from elementary school through college should have comprehensive, intentional programs to promote health and exercise. It is discouraging when I see employees at both our local hospitals riding the elevator to go up one floor when taking the stairs is much more beneficial.

Active events like the Neches River Rendezvous, Pineywoods Purgatory and Relay for Life are fantastic. What other events can we organize that will involve an even larger and broader swath of people year round? Find a reason to get outside. Participate in a fun run, even if you simply walk a mile or two. A stroll around the zoo can be good exercise and lots of fun. Or, spend an hour or two hiking the trails at Kit McConnico Park. It’ll do your heart and soul good! 

City sidewalks have been a great addition in recent years. Use them! Our Parks and Recreation Department has a website with programs and classes as well. Do we have a master plan for parks and recreation activities? If not, maybe we should.

I have a dream of a coordinated community effort where healthy living concepts infuse everything we do. Will Angelina County catch the vision to join in this effort? Lifestyle changes are hard. Nothing happens overnight. Changes in community health are measured over years - decades, even. We cannot get discouraged. Slow, meaningful progress over time will make a difference.

One early step coming up is the Texas Forest Country Partnership Economic Summit November 7-8, 2017 at the Pitser Garrison Convention Center. Included in that Summit will be a Rural Healthcare Symposium. Though it will address more than just Angelina County healthcare, it will be an important venue to discuss and brainstorm together. The Texas Forest Country Partnership should continue to take the lead in bringing groups together, applying for and administering grants, and monitoring progress and effectiveness.

As we plan for a healthy new direction in Angelina County, I encourage everyone to get involved. Be prepared to work! Come up with concrete ideas that you (or your business or organization) are willing to implement. Where philanthropic support is necessary, we will approach local, regional, and national foundations for assistance.

We must become the change we want to see and move the needle on health in Angelina County out of the red zone and into the green. Who’s with me?

Resolve to Improve the Health of our Region

January is a time of resolution, and often our New Year resolutions focus on diet and exercise. My friends, we need a city, county, and region resolution to lose weight!

In July, 2016, Sabrina Perry wrote an article for HealthGrove.com – a health data analysis and visualization site – titled, The County with the Highest Obesity Rate in Every State. She repeated the American Medical Association’s contention that obesity is a disease and noted that the World Health Organization considers obesity a global epidemic. I perused the article with interest, looking for the county in Texas that got the dubious honor of being the fattest. Unfortunately, it was our very own Angelina County.

Look around and it is evident. Angelina County has the highest obesity rate in Texas, coming in at 37.5%. That means nearly 4 out of 10 of us aren’t just overweight; we are downright fat. To achieve the dubious distinction of being fat, you have to get to a body mass index (BMI) of over 30. To give you an idea what it takes to qualify as obese, consider a 5’11” male such as myself. My appropriate weight is less than 180 pounds (and probably more like 160 pounds). Any more than that and I am considered overweight. But to be considered obese – which is what 37.5% of Angelina County residents are – I would need to weigh 215 pounds or more. For me, that would be at least 35 pounds overweight, if not more. I routinely see patients with a BMI of 40 or more, which is considered extreme (or morbid) obesity. That would be a whopping 100 pounds overweight for me.

What can we do?

Dan Buettner, author and founder of bluezones.com, has been writing for years about particular geographic pockets around the world where people live longer. According to the website, “Residents of the Blue Zones live in very different parts of the world. Yet they have nine commonalities that lead to longer, healthier, happier lives.” So much of this is what has been preached to us for decades: don’t smoke, eat your vegetables and legumes, exercise, don’t overeat, and drink wine in moderation. On top of this are stress-related factors, having strong family and friend relationships, and spirituality.

It’s not just that we are obese. Our overall health is terrible. The Robert Wood Johnson Foundation ranks population health by county. In Texas, many of the lowest ranked counties are in deep East Texas. Wouldn’t it be great if Lufkin could be known not just for pump jacks and forests, but also for the health of our citizens? This can only work for communities if each of us individually works at it. We have family, friends, and lots of churches. Strengthen those relationships. And, let’s stop smoking, exercise, and eat right!

I recently participated in a set of strategic planning sessions hosted by the Texas Forest Country Partnership called Stronger Economies Together, or SET. The purpose was to set goals for growth across a broad spectrum of our regional economy, from forestry and tourism to manufacturing and healthcare. Our SET healthcare workgroup noted that we have significant work to do if we are going to impact the poor healthcare factors and outcomes the Robert Wood Johnson Foundation identified in the deep East Texas region. We set an ambitious goal simply to raise our overall health ranking from the lowest 20% to the next lowest; in other words, from poor to still below average. But we have to start somewhere.

This will require a multi-year effort working with all aspects of the healthcare and social service community to start to move the dial toward a healthier region. We can do it, but we all need to make – and keep – that that resolution for better health!

Social Media Diet for the New Year

I have resolved to start a new diet this year. Not the typical food diet, mind you – there is certainly nothing wrong with that. I am going on a social media diet.

When Facebook first came out, I signed up in order to keep up with my kids. They have long since moved on from Facebook. Instagram and especially Snap Chat are more the rage now. Meanwhile, I still troll Facebook’s News Feed several times a day looking for the occasional gem in the garbage can of posts and reposts. I guess I feel compelled to know what is going on in the lives of people I care about. Unfortunately, what most people share is not in the least what I care about.

You know exactly what I mean. I am happy to “like” a post about a significant event in someone’s life, be it a birthday, anniversary, or other meaningful milestone. But please don’t tell me about your bodily complaints, the thing your pet did that was only cute to you, or – hear me now, football fans – play by play about UT, A&M, Dallas Cowboys, or any other team. Think before you post: Is this post worthy of being eternally stored and linked to your name in the Cloud?

For every meaningful, personal post, I have to scroll through a dozen or more platitudes or opinions that only make me feel sorry for the person who wasted their time sharing such meaningless drivel. Even religious posts that may be important to you in the moment rarely have an impact on others. And I fear 2016 – with a presidential election around the corner – is going to be filled with poisonous arrows back and forth between staunch conservatives and bleeding liberals, whose posts are designed to demean and belittle their opponents (and by extension, their supporters). I want no part of that.

After my kids moved on from Facebook, Instagram became the draw. It still bothers me that every time I want to enlarge an Instagram post, my double tapping the photo (a la iPhone) I end up “liking” the photo instead. Then there is Twitter. @justinbieber has 72.4M followers, and is following 247.5K. I, on the other hand, have a measly 110 followers, most of whom I don’t know (and therefore I wonder why they follow me). To be honest, there is nothing (or no one) I follow that provides information I can’t get elsewhere, and there is nothing so urgent that a tweet would change anything I do.

Finally, there are the KTRE and Lufkin News app notifications that pop up on my phone. I tweeted KTRE at one point, saying (in 140 characters or less), “@KTREnews you send out too many alerts. I’ll give you one a day; make it a meaningful one! #wasteoftime” KTRE actually “liked” that tweet, but they still send out too many alerts.

I must admit, I made a conscious decision with both Instagram and Twitter to limit the number of people I follow. Even so, contemplating a social media diet is giving me angst. What will I miss? Who will notice if I don’t wish them Happy Birthday or “Like” their post? But that insecurity is simply pride. I know who I am and who my friends are, and I don’t need Facebook to confirm that for me.

Will I delete these apps entirely? I don’t think so. Will I restrict my viewing and posting? Absolutely. Just don’t judge me when you read this column after it is tweeted and posted on Facebook. It is a diet, after all, not total starvation.

My Bar Code Diet

In December 2013, I wrote a column about my brother's heart attack and my wakeup call to lose weight. I promised to report back on my progress. I just didn't think it would take this long!

The reason you haven't heard from me earlier is because the first several months were spent researching weight loss techniques and plans rather than actually doing anything about it. As a matter of fact, I gained an additional eight pounds while contemplating dieting, which proves that just thinking about food adds weight!

We love to talk about losing weight. Actually doing it is much harder. It takes commitment. And, we only commit to something we truly think will work. I am happy to report now that not only did I lose the weight I gained, I lost an additional eleven pounds. So, I am now 19 pounds down from my max!

How did I do it? Wait for it...

Diet and exercise! I used to joke that bulimia was better than exercise. Bad joke. I did not go that route. I opted for the simple math: calories in < calories out.

It was not as difficult as I thought it was going to be, once I made some key decisions. First, I had to stop eating hospital food. I just didn't know how many calories I was eating! More importantly, I had to track how much I was eating.

Hence, my Bar Code Diet. If I couldn't scan it into my phone, I didn't put it in my mouth, with rare exceptions. There are iPhone and android apps (like Lose It or My Fitness Pal) which will help you set a goal for weight loss. You enter your starting weight, your target weight, and how much you want to lose per week. Generally, 1-2# is typical. The apps then tells you how many calories per day you can eat and how long it will take you to get to your goal, assuming you are compliant with the diet. You scan the bar code with your smart phone and it tracks how many calories you eat. You can even track calories burned with exercise. These apps have many chain restaurant menus on file, so it is possible to eat out and still track your calories. I don’t recommend it, though, because portion sizes in restaurants are generally huge and it is hard to stop mid meal.

Every day starts with breakfast. Even if it is only a latte, you need to consume some calories (including some carbohydrates) within 30 minutes of waking up to reset your hormone and blood sugar levels.

My favorite meals to take with me are Hormel Compleats (not frozen, but need to be microwaved) or Zone bars (taste great and are easy to grab and go). And in the evening at home, often an Atkins frozen meal is quite satisfying, plus it limits carbs in the evening, which can keep you from getting hungry in the middle of the night (or from waking up starving). Of course, our metabolism slows as we age, so exercise (including some strength training) is essential. Even walking can be a great start if you haven’t done any exercise at all.

This isn’t fad dieting. It is simply counting calories. Anyone can do that nowadays. Not only did I lose nineteen pounds, I also dropped my cholesterol 40 points. I don't have acid reflux anymore. I sleep well at night. I feel better. And I know that my risk of both heart disease and cancer will be less as a result.

Heart Disease Prevention for the Holidays

My brother just had a heart attack. He had classic chest pain and immediately went to the ER. Before he could sneeze, he was transferred from his small town to a regional center for a heart catheterization, where they found a single vessel blockage. He had a stent placed and has no significant damage. He’s doing great. He’s more upset that A&M lost to LSU.

I’m the one not handling it well.

You see, my brother is only five years older than me. He exercises regularly, jogging 3 miles at a time. He’s even been to the Cooper Clinic in Dallas for all sorts of tests. Our father will be 80 years old in a few weeks, and he has not had a heart attack. Why my brother? And, to the point of my worry, why not me?

Now, I know that we all just gorged ourselves over Thanksgiving, and Christmas is right around the corner. Any talk of diet and exercise should wait until after the first of the year, right? If you are like me, it takes awhile to get psyched up for this. Habits are hard to start and easy to break. This needs to be a lifestyle decision. Mind you, I am not a stranger to exercise… I just haven’t been very friendly with him lately.

If you are like me, there are things you just don’t really want to change. I like my morning latte from Standpipe Coffee and cookies from Confections (shout outs to Ben and Dawn!), and when I travel, I often seek out nice restaurants. At 178 lb, many would say I am not overweight. The insurance industry, however, would disagree. My BMI is right at 25, the cutoff for being “overweight”. Scary word, that one, but not as frightening as “obese”, which a significant percentage of Americans are now.

Dr. Huber, my internist, would like to see me lose 10 lb or more. He told me so last year. In one ear and out the other… Actually, I did lose weight, but gained it back. I should learn to schedule my appointments at the low end of the scale.

As a cancer physician, I preach prevention and early detection every day. The facts with cancer are irrefutable: diet, exercise, and not smoking are three very important things we can do to help lessen our risk of getting cancer. Well, those three things also happen to be the key to lowering one’s risk of heart disease, which kills even more people than cancer.

We are fortunate to have access to incredible cardiac care right here in Lufkin. Truly excellent cardiologists and cardiac surgeons practice here. I would not hesitate to have my heart cath done down the hallway from my office here at Memorial if I had to. But like my cancer patients tell me, they really didn’t want to ever see me professionally, and I’d just as soon keep my relationship with my cardiology friends a social one.

I don’t want to be a “do as I say, not as I do” role model and end up on the cardiac cath table in five years. I see Dr. Huber this month to discuss what other measures – tests? medication? – I need to take for heart disease prevention.

And, I’ve decided that December is a good time to start my diet and exercise program. Yes, I’m going to enjoy Christmas! But maybe I can limit my portion sizes some and NOT go for that second (or third) slice of pecan pie! (Or that second cookie at Confections!)