Following up on recent posts here and here, don’t miss this John E. Calfee/American.com op-ed on how recent research into heart disease treatments has not only changed medicine, but also basic science research:

How do we know where heart attacks come from? The answer lies in feedback from pharmaceutical clinical trials to basic research. Long before the stent trials began to upset received wisdom, massive trials of heart drugs had first validated previously controversial hypotheses and then upset the next generation of hypotheses. Eventually, these trials pushed basic research in unexpected directions. [. . .]
So there is a bit more to this weekís news about stents and heart attacks than meets the eye or is described in the media. We are witnessing another episode in the remarkable story of feedback from drug and device development to basic science. And we can expect more drug-tools to wreak more havoc in scientific understanding of human biology.

Read the entire piece, which is an excellent summary on how clinical research spurs development of better drugs, superior treatment and even better-focused research. Check out the new design of American.com, which has quickly developed into one of the most interesting and insightful on-line magazines.

One of my goals this year is to blog more on issues relating to nutrition and exercise, which are two of the most myth-generating subjects in American culture.
Along those lines, contrary to the information about the latest fad diets that bombards most Americans on almost a daily basis, this Sandy Szwarc post explains the reality — diets do not work, at least for most people most of the time.
Similarly, long cardio workouts are often recommended as a way to burn calories for overweight folks, most of whom look absolutely miserable doing them. As Art DeVany explains, too much cardio actually has the opposite effect — long workouts will likely make a person fatter.

Given the importance of Houston’s Texas Medical Center in the development of open heart surgery (see here and here), a couple of recent NY Times articles focusing on open heart surgery caught my attention.
First, in this article, David Schribman compares his recent open heart surgery to the heart surgery that a childhood friend endured 42 years ago.
Next, following on this earlier post, this NY Times article reports that safety concerns are increasing over the long-term risks of stents used in angioplasty procedures. New data is indicating that the sickest heart patients may actually live longer if they receive bypass surgery rather than the angioplasty, which is prompting some well-known heart surgeons and cardiologists to conclude that the pendulum has swung too far away from bypass surgery.
Finally, the Times provides this extraordinary slide show of open heart surgery. The slide show is a powerful reminder that — despite the now common nature of bypass surgery — it is still not as routine as changing a flat tire.

This earlier post made the point that a sound understanding of nutritional principles and moderate eating habits are far more likely to result in proper personal weight management than relying on the dozens of fad diets that are available to the American consumer.
Along those lines, this Sandy Szwarc post reports on some rather startling statistics relating to one such diet program:

A study on one of the largest commercial weight-loss programs was just published in the International Journal of Obesity but has been ignored by the press. Understandably, a major media campaign and flurry of press releases have not trumpeted its findings.
Researchers at four major research centers across the country followed 60,164 adults enrolled in the Jenny Craig Platinum program in 2001-2002 to evaluate how long people were able to stick with this program and how much weight they lost.
They found that a quarter dropped out the first month, 42% after 3 months, 22% after 6 months, and only 6.6% were able to stick with the program for a year.
Unlike Kirstie Alley, the weight loss among people not being paid as celebrity spokespersons was considerably less notable. For a 200 pound woman able to keep with the program an entire year, according to this study, she would have lost half a pound a week….except fewer than 7 out of 100 were able to hang in for a full year. Hardly winning endorsement for the success and palatability of the program.

Read the entire post. Research is increasingly concluding that being overweight does not equate with increased mortality risk. Rather, physical activity and fitness have a far greater impact on lowering mortality risk than one’s body mass index or waist measurements. Despite our cultural stereotypes of what ìfitî looks like, research on obese adults has shown that about half rate highly fit on maximal exercise testing, which is not much different from slender people.
Thus, there is nothing wrong with wanting to lose a few pounds, but forget about the latest fad diet. Instead, understanding nutrition and modifying eating habits over the long-term is much more likely to produce the calorie deficit that will eventually result in permanent weight loss. But if the goal is to reduce mortality risk, the better bet is simply to increase the exercise and recreation regimen, and more exercise is not necessarily better ó a couple of hours total spread over 3-5 days a week is fine.

Dr. Nortin M. Hadler is a professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill, and attending rheumatologist at the University of North Carolina Hospitals in Chapel Hill. He also sounds in this ABC News op-ed a lot like my father:

To be well is not the same as to feel well.
Being well requires some sense of invincibility. No one is spared symptoms for long.
It’s abnormal to go one year without upper respiratory symptoms or pain.
Lurking in our future are heartache and heartburn, shoulder and knee pain, headache, rashes and skipped heartbeats — not to mention bothersome fatigue, sore muscles, bowel irregularity, insomnia and so much else to challenge our sense of well-being.
Nearly all of these predicaments can go away as mysteriously as they come about. To be well requires the wherewithal to cope with these ailments for as long as that takes — and it can take weeks. [. . .]
We all need to get beyond the traditional complaint of “what’s wrong with me, Doc, that I have this symptom?” and move on to more rational discourse, such as “is there any important disease that is causing my symptom? If so, can it be treated? If not, can we discern why I can’t cope with this episode?”

Read the entire piece. And then get on with coping!

Jane Brody is the longtime New York Times fitness and nutrition writer and I have admired her writing for many years. Her column from yesterday — titled “Out of Control: A True Story of Binge Eating” — is a must-read not only because it addresses an important health problem, but also because it has a compelling personal touch:

It was 1964, I was 23 and working at my first newspaper job in Minneapolis, 1,250 miles from my New York home. My love life was in disarray, my work was boring, my boss was a misogynist. And I, having been raised to associate love and happiness with food, turned to eating for solace.
Of course, I began to gain weight and, of course, I periodically went on various diets to try to lose what Iíd gained, only to relapse and regain all Iíd lost and then some.
My many failed attempts included the Drinking Manís Diet, popular at the time, which at least enabled me to stay connected with my hard-partying colleagues.
Before long, desperation set in. When I found myself unable to stop eating once Iíd started, I resolved not to eat during the day. Then, after work and out of sight, the bingeing began.
I learned where the few all-night mom-and-pop shops were located so I could pick up the eveningís supply on my way home from work. Then I would spend the night eating nonstop, first something sweet, then something salty, then back to sweet, and so on. A half-gallon of ice cream was only the beginning. I was capable of consuming 3,000 calories at a sitting. Many mornings I awakened to find partly chewed food still in my mouth.
And, as you might expect, because I didnít purge (never even heard of it then), I got fatter and fatter until I had gained a third more than my normal body weight, even though I was physically active.
My despair was profound, and one night in the midst of a binge I became suicidal. I had lost control of my eating; it was controlling me, and I couldnít go on living that way.
Fortunately, I was still rational enough to reach out for help, and at 2 a.m. I called a psychologist I knew at his home. His willingness to see me in the morning got me through the night.

Read the entire column. Brody’s honest and forthright story of how she finally came to terms with her obsession and addressed it — abandoning diets and embracing sound nutritional principles for her life — provides a hopeful and practical guide for those who are afflicted with this disorder. It is a stark reflection of the state of nutrition in the U.S. today that most of us know someone who is currently grappling with the same problem that Brody overcame.

Sandy Szwarc makes sense while expressing skepticism about the FDA’s decision to approve an over-the-counter version of Xenical (orlistat) for sale, the first prescription weight loss drug to be available without a prescription:

Even the FTCís scientific expert panel reviewing the evidence for weight loss advertisements, . . . determined that any claims that a weight loss product will cause weight loss by blocking the absorption of fat or calories were false and fraudulent advertising. . . . [E]ven with the prescription strength Xenical, people canít malabsorb enough fat a day to lose a pound a week and there are limits beyond which significant gastrointestinal problems occur. The panelís scientific analysis stated: ìThe biological facts do not support the possibility that sufficient malabsorption of fat or calories can occur to cause substantial weight loss.î

Meanwhile, this NY Times article reports that one of the formerly most popular ways to attempt to lose weight has fallen out of favor:

[I]f current trends continue, aerobics will be as rare as, . . . those vibrating belts that were supposed to jiggle away fatty hips and gravity boots that were supposed to ó what was it they were supposed to do? For now, the popularity of aerobics is sharply down from when it was ìthe mainstay of fitness in America,î said Mike May, a spokesman for the Sporting Goods Manufacturers Association.
Itís why you may have noticed ó if you have shown up at your gym attired in your best leg warmers with a sweatshirt off one shoulder ó the lack of aerobics classes on the menu. Fewer than half of the 300 gyms and health clubs recently surveyed by IDEA offered aerobics classes, a number that is ìcontinuing to decline,î according to the summation of the report.
At its peak in the mid-í80s, an estimated 17 million to 20 million did aerobics, Mr. May said. But only five million did in 2005, according to a report by the sporting goods association. ìWe expect the 2006 numbers to be significantly lower,î Mr. May said. ìAerobics are increasingly out of favor.î
The legacy of injuries is one reason. Many of the original instructors like Mr. Blahnik wonít teach aerobics ó because they canít. ìThose hardest hit by all those aerobics were often the teachers, because they were pushing harder than anyone else and doing the classes a dozen times a week,î Dr. Metzl said. ìOur bodies just werenít meant to withstand all that pounding.î

By the way, Art DeVany has compiled this category of blog posts that explores the damaging physical effects of distance running and endurance training. More exercise does not always equate with better health.

Americans love their myths and their food, so it makes sense that some of our most active myth-making occurs in the realm of eating and nutrition.
Michael Pollan, author of “The Omnivoreís Dilemma,” (Penguin 2006) provides this excellent NY Sunday Times magazine piece in which he reviews the food and nutrition myths that have been developed and dispelled over just the past two decades in America. It’s a fascinating story, particularly how Americans’ willingness to accept the latest food or nutrition fad co-exists with a huge fast-food industry that is largely based on high-calorie processed food of dubious nutritional value.
Pollan is spot on in his observation that most Americans know just enough about nutrition to be dangerous, which is also the case with medical matters generally. Few people can accurately recount how many calories they consume in a day, and even fewer still can tell you how many calories they need to consume to lose weight or maintain their optimum weight (do you know what 200 calories looks like?). Similarly, few of those overweight folks torturing themselves on the treadmills or stationary bicycles at the local gym have a clue of how long they would need to exercise to work off the excess calories that they have consumed. Despite their tenacity, most of those overweight exercisers almost always overestimate the amount of calories expended during exercise.
As my wise father used to say: “What would you rather do? Eat one less helping of mashed potatoes? Or go ride the stationary bicycle for an hour?”
By the way, the following are a couple of terrific resources on nutrition that approach the subject from very different, but quite insightful, perspectives — Junkfood Science by nutritionist Sandy Szwarc, who exposes many food myths that are based on studies of questionable merit, and Art De Vany’s blog, where he frequently explores the physiological impact of diet, obesity and exercise.