Exercise largely absent from US medical school curriculum, study shows

Exercise may play a critical role in maintaining good health, but fewer than half of the physicians trained in the United States in 2013 received formal education or training on the subject, according to new research from Oregon State University.

A review of medical school curriculums showed that a majority of U.S. institutions did not offer any courses on physical activity, and when the courses were offered, they were rarely required, said Brad Cardinal, a professor of exercise and sport science in OSU’s College of Public Health and Human Sciences. That could leave doctors ill-prepared to assist patients who could benefit from exercise, said Cardinal, the study’s lead author.

“There are immense medical benefits to exercise; it can help as much as medicine to address some health concerns,” said Cardinal, who is a national expert on the benefits of physical activity. “Because exercise has medicinal as well as other benefits, I was surprised that medical schools didn’t spend more time on it.”

An article on the findings has been accepted for publication in an upcoming issue of the Journal of Physical Activity and Health. Co-authors are Eugene A. Park and MooSong Kim of OSU, and Marita K. Cardinal of Western Oregon University. The study was supported by OSU.

For the study, researchers reviewed U.S. medical schools’ websites, looking for all physical activity-related coursework. They reviewed both public and private schools, and schools of medicine and osteopathic medicine. In all, 118 of the 170 accredited schools had curriculum information available online.

Of those, 51 percent offered no physical activity related coursework, and 21 percent offered only one course. And 82 percent of the schools reviewed did not require students to take any physical activity-related courses.

Schools may be spending more time on the topic than appears in the published curriculum, but the absence of physical activity in those documents suggests exercise education is not formalized or institutionalized to the degree it ought to be, given its role in helping people stay healthy, Cardinal said.

“I’m an outsider looking in, and I was expecting to see more than what we did,” he said.

Lifestyle-related chronic illnesses such as heart disease and diabetes are among the leading causes of death and disability, and one of the most important ways to prevent such chronic diseases is through regular physical activity participation, he said.

Physicians play a significant and influential role in encouraging and assisting patients who need or are trying to get more exercise, but past research has shown that many physicians lack the education, skills or confidence to educate and counsel patients about their physical activity, Cardinal said.

“Understanding why and how to exercise, and knowing how to help people who are struggling to make it a habit, is really important,” he said.

This issue is gaining more attention nationally.The American College of Sports Medicine supports an “Exercise is Medicine” initiative, designed to encourage primary care physicians and other health care providers to include physical activity in the treatment plans of their patients.

Exercise is also a key component of the U.S. government’s “Healthy People 2020” initiative to improve health across the nation, and the National Physical Activity Plan to increase physical activity for all Americans, Cardinal said.

If medical schools do not include physical activity education in their curriculums, physicians or other health care workers may need to find other ways to educate themselves about exercise and its role in keeping people healthy, or perhaps give the nod to other professionals who can, Cardinal said.

“We really need to see something happen to address this,” he said. “How do we get it more institutionalized into medical school curriculum? This is a question researchers have been asking for 40 years now. It is about time we figured it out.”

via Exercise largely absent from US medical school curriculum, study shows — ScienceDaily.

Dr. Court’s Comments:

While I am sure exercise is emphasized to some degree in all medical curricula, it is disturbing to know that the most effective treatment (along with diet) for chronic disease prevention is not formally taught to the students who will eventually be entrusted with keeping people from getting sick. Combine this with the information that almost no nutrition is taught in medical school either, I think we may have found why our medical system is so broken. Research is very clear that disease is far easier to prevent than it is to treat once it’s developed. Prevention is with diet and exercise. My experience in practice has taught me that most medical doctors are terribly ill-equipped to recommend the right kind of diet or exercise to their patients. Some of the information being given to patients is flat out wrong. They often recommend things that make patients more likely, not less, to develop chronic disease. A scary thought, indeed.

Recommendation for vitamin D intake was miscalculated, is far too low, experts say

Researchers at UC San Diego and Creighton University have challenged the intake of vitamin D recommended by the National Academy of Sciences (NAS) Institute of Medicine (IOM), stating that their Recommended Dietary Allowance (RDA) for vitamin D underestimates the need by a factor of ten.

In a letter published last week in the journal Nutrients the scientists confirmed a calculation error noted by other investigators, by using a data set from a different population. Dr. Cedric F. Garland, Dr.P.H., adjunct professor at UC San Diego’s Department of Family Medicine and Public Health said his group was able to confirm findings published by Dr. Paul Veugelers from the University of Alberta School of Public Health that were reported last October in the same journal.

“Both these studies suggest that the IOM underestimated the requirement substantially,” said Garland. “The error has broad implications for public health regarding disease prevention and achieving the stated goal of ensuring that the whole population has enough vitamin D to maintain bone health.”

The recommended intake of vitamin D specified by the IOM is 600 IU/day through age 70 years, and 800 IU/day for older ages. “Calculations by us and other researchers have shown that these doses are only about one-tenth those needed to cut incidence of diseases related to vitamin D deficiency,” Garland explained.

Robert Heaney, M.D., of Creighton University wrote: “We call for the NAS-IOM and all public health authorities concerned with transmitting accurate nutritional information to the public to designate, as the RDA, a value of approximately 7,000 IU/day from all sources.”

“This intake is well below the upper level intake specified by IOM as safe for teens and adults, 10,000 IU/day,” Garland said. Other authors were C. Baggerly and C. French, of GrassrootsHealth, a voluntary organization in San Diego CA, and E.D. Gorham, Ph.D., of UC San Diego.

via Recommendation for vitamin D intake was miscalculated, is far too low, experts say — ScienceDaily.

Dr. Court’s Commentary – 

I’ve been recommending anywhere from 4,000-6,000IU/day of vitamin D (supplementally) to my patients for many years. This is consistent with the above recommendations that people get about 7,000IU/day from all sources. Vitamin D deficiency is a culprit in many diseases of aging, and the IOM’s recommendations were far too low. It’s good to see this becoming more well recognized.

Only one study has been done (that I can find) that actually measured how much vitamin D human beings use on a daily basis. The conclusion of that study was that humans use about 4,000-6,000IU per day (hence my recommendation). In that context, the IOM’s recommendation of 600-800IU/day becomes even more startling.

Muscle Mass Beats BMI as Longevity Predictor – Who Knew!?

I’ve written a couple of times (here and here) about my dislike of the imperfect science of body mass index. In particular, I’ve stated that it does not accurately assess the elderly because of low muscle mass. The elderly are likely to have a “healthy” BMI despite being anything but. As people age they lose weight through muscle loss. This brings their BMI down and may even bring it into what is considered an optimal range. The problem is muscle mass loss reduces strength, which increases the likelihood of falls and a reduced ability to exercise. The last point is particularly problematic.

Now new research shows that when it comes to longevity, a focus on weight loss may be misplaced. Because BMI isn’t actually a very reliable indicator of life span. A more useful measure, some physicians say, might be muscle mass. Researchers analyzed BMI and muscle mass data from more than 3,600 seniors in a long-term study. And they tracked which seniors had died, a decade later. Turns out BMI wasn’t much good at predicting chance of death.

But muscle mass was: more muscle meant better odds of survival. The study appears in The American Journal of Medicine. [Preethi Srikanthan and Arun S. Karlamangla,Muscle Mass Index as a Predictor of Longevity in Older-Adults]. For more information see here.

Critics argue that it’s nearly impossible for the elderly to build muscle. I think they are missing the point. It’s not necessarily that the elderly need to bulk up. It’s that they need to minimize muscle loss. This is done through resistance training. Anyone, yes even the elderly, can resistance train. By doing so muscle loss is minimized. This may mean you don’t fit into the BMI scale perfectly, however, it does mean you are healthier. So, here’s to weight lifting!

I’m Overweight.

Or at least you would think so if you looked at my body mass index (BMI). I have written about the very imperfect science of the BMI scale before here on my blog, but I thought it deserved to be revisited. BMI is basically a height to weight ratio that comes up with a number designed to make it easy for clinicians to decide if a person is overweight or obese. Before the BMI scale was invented it was hard to assess someone’s weight and say that it was appropriate because height is also an important factor in weight. BMI combined those two.

Calculating BMI is relatively simple. You need your weight in pounds and your height in inches. Take your weight and multiply it by 703. Take your height and multiply it by itself (height squared). Now divide the first number by the second number and you have your BMI. To see my calculations or do your own click this link. My BMI falls in the “overweight category” with a score of 26.2. However, my body fat percentage is about 18%. This is well within the acceptable range for a 33-year-old man. (And I clearly do not look overweight!)

BMI misses many things when calculating whether someone is at the proper weight.

The problem for some people, like athletes, it does not take into account muscle mass. A person that is heavily muscled will always be overweight according to the BMI. As a matter of fact, I have been considered “overweight” since college despite always being is relatively good shape. If we look at professional level athletes, most of them would be considered obese!

I understand that not everyone is an elite athlete. What about the elderly? BMI is not ideal for them either. In the United States that equates to about 43 million people. Many times an elderly person will fit nicely into the BMI by being considered “ideal weight” for their height. This can be significantly misleading. Why? In the elderly muscle mass begins to drop. It happens to all of us. However, with this drop in muscle mass comes a drop in weight. As weight is lost a person is likely to fall into the “ideal weight” category even though they should be concerned about muscle mass loss. This loss in muscle mass causes a loss in strength and stability, increasing the risk of falls and increasing the risk of osteoporosis. Another problem with muscle loss is the change in your body composition. As muscle mass is lost one’s body fat percentage increases. Body fat percentage is a great indicator of health. The lower it is (within reason) the healthier you are, generally speaking.

BMI also fails to take into account many other health factors like diet, exercise, inflammatory markers, nutrient status, stress load, chemical exposure, social well-being, mood stability, and a whole host of other things we know have a large impact on our health. However, it is still widely used as a primary assessment of one’s health. As I said, it’s an imperfect science. In my opinion, it’s so imperfect it should be eliminated.

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35 Points From A Body Transformation Contest

Recently, I entered into a 6-week body transformation challenge at the gym I belong to. It’s called KDR Fitness. Great place. It began February 10th and ended March 22nd. It was technically 41 days long. I decided to enter because I needed a kick in the butt to get back to the gym. In the previous year gym days were hard to come by. With a brand new baby and practice, my gym time was way down. To top it off, I had a neck injury that took me completely out of the gym for 3 months at the end of the year. As a consequence my body fat had increased to 21.7%. Not ideal for me. During the contest, I recorded my diet and exercised in order to lose body fat and gain lean mass. I wore a heart rate monitor for all of my workouts to calculate my calories burned and generally keep track of my workouts. Here are the things I learned:

1. I started at 21.7% body fat.
2. By the 4th week I was down to 19.4%
3. By the end of the 6th week, I was down to 18.4%
4. I gained 3.7 pounds of muscle in 6 weeks.
5. I lost 7 pounds of fat in 6 weeks.
6. I missed the gym.
7. I worked out 25 times in 41 days.
8. That’s 4 workouts per week with an occasional 5th thrown in.
9. I ate MORE food than I had been eating and was able to lose fat and gain muscle.
10. I burned 15,655 calories in 25 workouts.
11. Each workout was about 1 hour.
12. Each workout burned an average of 626.2 calories.
13. The range of calories burned was 273 all the way up to 958.
14. It is not that hard for me to avoid grain.
15. I can count on one hand how many times I ate grain in 41 days (and it’s less than the whole hand).
16. Cheat meals are important.
17. This was a typical day in terms of food intake:
    Wake Up: 6:15
    Food for the day:
    Breakfast: 6:45 – 3 eggs, mixed veggies, and cheese cooked in butter. Coffee with organic half and half.
    Snack: 10:15 – 3 large beef and veggie meatballs, carrots, celery, and hummus.
    Lunch: 12:20 – Chicken breast, mixed peppers, 1 whole avocado.
    Snack: 3:30 – Protein shake, steamed broccoli.
    Workout – 60 minutes – protein/carbohydrate workout drink
    Dinner: 6:45 – Meatloaf, steamed broccoli and cauliflower with olive oil.
    Snack: 9:15 – Greek yogurt and banana.
18. Food preparation is key.
19. Eating 6 times per day isn’t that hard IF you’re prepared.
20. Eating a lot of vegetables is fairly easy IF you’re prepared.
21. You don’t necessarily have to count calories if the quality of your food is good.
22. You can eat A LOT of food if you are working out hard and still lose weight.
23. Burpees get easier the more you do them.
24. Working out more consistently makes you want to workout more consistently.
25. Using the scale to measure your progress is a bad idea.
26. My weight changed from 190.9 to 187.6 in 6 weeks. Hardly encouraging if you’re just looking at the scale.
27. Body fat analysis is far more informative.
28. You only have time for the gym if you make time for the gym.
29. You don’t need to be in the gym 7 days/week.
30. Two busy people (my wife and I) can each take turns working out during the week and get great results.
31. You should be willing and able to do an extra workout or two from home if you need to.
32. You can turn snow blowing and shoveling your driveway into a workout quite easily.
33. Body mass index (a measure of height to weight) is a terrible health assessment tool. According to it, I am “overweight.” This is because my lean mass is high, not because I am actually overweight.
34. My basal metabolic rate (calories I burn at rest over 24 hours) increased from 1,835 to 1,870 over six weeks.
35. The area of my body that gained the most muscle (as percent growth) was my left arm.

I was on a team of three and our entire team (Bro’s before Hoho’s) did very well. The winning team will win $3,000. I’ll find out in a couple of days which of the 18 teams won the contest. That’s not the important part, but it sure would be nice!

Lesson from wearing a heart rate monitor for 24 hours

I decided to see how many calories I would burn in 24 hours by wearing my Polar heart rate monitor the entire day. I thought I had a pretty good idea just how many calories I would burn in 24 hours based on other tests, but I wanted to test two things. First, how accurate are these heart rate monitors, and second, if it proves accurate, how close was I to being correct. Based on my body fat testing (done by bioelectrical impedance) my basal metabolic rate is about 2100 calories per 24 hours. Basal metabolic rate is defined as the rate at which the body uses energy while at rest to keep vital functions going, such as breathing and keeping warm. With that knowledge in mind, I assumed day-to-day I probably burn about 2500 calories (after all, I’m not at rest ALL day). That would be on a non-workout day. However, I wanted to do this test on a day I exercised. So with all that information I calculated I would burn about 3,000 calories in 24 hours on a workout day. Here is what I learned:

My total burn was 3,238 calories in 24 hours. Not too bad. I was a little low on my assumption, but I also assumed my workout would burn 500-600 calories. It ended up burning 800 calories. That makes my estimate just about spot on.

24 hours. 3,238 calories.

Sitting is bad:

While seated and doing desk work (like I am at the moment), my heart rate touches the high 40’s but is mostly in the low 50’s range. While standing and doing miscellaneous work stuff, my heart rate is in the mid 60’s to low 70’s. This makes a huge difference and is congruent with research that shows people with sedentary jobs have higher rates of cardiovascular disease and higher mortality rates. The lesson? Get up and move.

I don’t eat enough:

In the back of my mind, I knew this. There are plenty of days where I get busy and cannot have a mid-morning or mid-afternoon snack. I need to be better about that, especially on the days I exercise. In the 24 hours I also kept track of my calories with a calorie-counting app. According to it, I consumed just over 2,500 calories. Clearly a deficit, but not necessarily a bad thing. It all depends on what you’re going for. For me, I know I do better when I at least approximate my caloric expenditure.

Heart healthy:

My average heart rate over 24 hours was just 64 beats per minute. This number is quite good. I was happy to see it. My maximum heart rate was 179 during my workout.

Burn, burn, burn:

I burn through just over 100 (somewhere between 100-110) calories an hour while awake and just under 100 calories an hour while sleeping (about 80/hour). This total excludes my exercise for the day. That is about what I expected it to be.

My heart monitor seems to be pretty accurate:

Based on the body fat testing and basal metabolic rate calculation, my heart rate monitor did a pretty good job accurately predicting calorie burn in accordance with the bioelectrical testing I did the week before.

I think the moral of the story is if you want to have the wiggle room in your diet to eat more food, you need to get up and move. I challenge anyone to try and eat 3,200 healthy calories today. It’s much harder than you think. The more you move, the more muscle you build which only adds to your ability to burn energy.

Nutrition and Health Guidelines

Last month was national nutrition month and we posted some staggering statistics on the health of the nation. Today we’d like to give you some guidelines to help improve those statistics.

It’s not enough to just change your diet. It’s important to get out and move your body too. In addition, if you are under a lot of stress either emotional or physical it can affect your health. Lack of sleep is often overlooked when people are struggling to meet their health goals. If you would like more information on how these affect you, don’t hesitate to contact Dr. Court in the office.

 

Our Paleo Thanksgiving Revisited!

Thanksgiving Dinner!

As it’s a week before the big Turkey Day 2012, I wanted to share our Thanksgiving post from last year. I hadn’t really started posting recipes regularly so some of you may have missed it. Since we will be traveling to Illinois to see my family this year I won’t be cooking, but I hope you give some of these recipes a try as they were fantastic. I’ve left my original content here and added a few new comments (in italics) and pictures to some of the recipes.

This is Dr. Carrie. Dr. Court usually writes these posts but I thought it might be interesting to switch it up. Since tomorrow is Thanksgiving I thought it might be fun to share our menu. Normally, I don’t get the opportunity to cook on the holidays as we usually travel to be with either my family or his, but this year we decided not to go anywhere. As some of you know we eat mostly meat, eggs, vegetables and low glycemic fruit which means we try not to eat a lot of grains, sugar or processed food. I guess you could say we eat a Paleolithic diet which he has posted about in the past (see Why Eat a Paleolithic Diet?). We aren’t strictly Paleo as we do include some dairy in the form of cheese, Greek yogurt, cottage cheese and for me cream in my coffee.

Now, I grew up in a fantastic Midwestern, Standard American Diet family and it is sacrilege to not have pumpkin pie and stuffing to go with your marshmallow sweet potatoes, mashed potatoes and gravy, turkey, cranberry sauce from a can and green bean casserole. So, you can see my conundrum when it comes to preparing my own Thanksgiving dinner. Do I make the traditional dinner and call it a cheat day? But then what do we do with all of those leftovers? I mean we’re only 2 people. Or do I stick to my principles and make a “healthy” meal that’s just meat and veggies and have some fruit for dessert? Boring….that’s what we eat every day! (This year I do plan to make the Brussel Sprouts and Bacon to take to my big family dinner…they’re so good they’ll never suspect it came from a Paleo cookbook!)

I did what every American does…I Googled it! I wanted to see if there were recipes for Paleo versions of traditional Thanksgiving fare. Thanks to the Crossfitters who endorse the Paleo diet there are now tons of recipes online. I was amazed at what I found including an entire Paleo menu. I am not ashamed to admit that I am using most of the recipes from the first website I came across but how could I pass up Mushroom Butter Roasted Turkey, Beef Celery, Walnut and Apple Stuffing, Cranberry Sauce and Pumpkin Pie! If you want to see the complete menu, visit PaleoDiet Lifestyle.

After one click I had most of my menu complete. I still needed a yam recipe. I turned to my favorite Paleo recipe source EverydayPaleo.com. If you receive our email newsletter, you’ve heard me rave about Sarah Fragoso’s book Everyday Paleo. I love her recipes. They are super easy and sooooo tasty! I found a recipe for Paleo Holiday Yams right away. Of course that’s not the only recipe of hers I’m using. I made one from the book called Brussel Sprouts ‘n’ Bacon a few weeks ago and wanted to have it again. I also really wanted to try a recipe she calls “meat candy” aka Sausage Stuffed Dates for an appetizer. (I made these already. I tried to resist but they kept calling my name…they are AMAZING!)

Here is our complete Thanksgiving menu (pics below):

Appetizer:

• Sausage Stuffed Dates

Dinner:

• Mushroom Butter Roasted Turkey
• Beef, Celery, Walnut and Apple Stuffing
• Paleo Holiday Yams
• Brussel Sprouts ‘n’ Bacon
• Cranberry Sauce

Dessert:

• Pumpkin Pie with coconut milk ice cream!

We’ll let you know how it all turns out. So far, so good! The Sausage Stuffed Dates are a winner but I haven’t tried anything else. I have to save something for tomorrow. We have a lot of food to eat so it’s a good thing we’re going to Turkey Torcher at KDR Fitness tomorrow morning. (I’m bummed to miss the Turkey Torcher this year. It was a blast last year and a great way to kick of Thanksgiving Day! I think there are only 2 spots left but you should contact KDR Fitness if you are local and interested in participating.)

Your family might appreciate one of these recipes at your next holiday dinner! I hope you enjoy your Thanksgiving Dinner be it Paleo or Traditional.

In the spirit of the season we are so Thankful for each and every one of our blog readers and patients. Your questions, comments and feedback are always appreciated and welcomed.

HAPPY THANKSGIVING!

Sausage Stuffed Dates

I’ve made these little gems a number of time since last Thanksgiving. They’ve become a requested appetizer for get togethers! This was the large version but you can also make a smaller one bite version that’s just as addictive! (Sausage isn’t something that we recommend you eat a lot of as it typically has a lot of preservatives, but it’s fine to have once in a while especially if you buy an organic, preservative free version.)

Mushroom Butter Roasted Turkey

While the mushrooms on this turkey turned out a little crispy it tasted fantastic! I think I left it uncovered a bit too long.

Beef, Celery, Walnut and Apple Stuffing

This stuffing was so good that I’d make it as a meal! I’m glad I revisited this post so that I can do that! The texture is close to regular stuffing but a little different. Now in my family they usually make dressing, so the texture is quite different from that but it has all the right flavors!

Paleo Holiday Yams

These were yummy and reminded me of traditional holiday yams. With on a 1/4 cup of maple syrup they were sweet! You could probably just drizzle a little on there or leave it off entirely if you wanted.

Brussel Sprouts ‘n’ Bacon

I’ve also made these a number of times since last year! They’re tasty! I’m making them for my family for Thanksgiving this year.

(P.S. I’m also making my family Paleo Breakfast Bread and Chunky Apple Muffins to have at my baby shower…don’t tell! I don’t think they ever know they taste so good!)

Cranberry Sauce

Some how I forgot to take a picture of the cranberry sauce. It was good but of all the things I made last year I would tweak this recipe a bit. It was really tart. I would maybe take the maple syrup out of the yams and add it to the Cranberry Sauce.

Paleo Pumpkin Pie

Oh, now this was a hard one. I love pumpkin pie! My family loves my pumpkin pies and my grandfather used to request my pumpkin pies at Thanksgiving. Now that’s a big deal because my grandmother was an amazing cook! So, when it came to pumpkin pie it was hard to decide if I’d try something new or stick to the traditional. I ended up trying something new and was not disappointed! It was really good. It’s a little different but all the flavor that I love was there!

I encourage you to give one or all of these recipes a try for your Thanksgiving Dinner next week.  I think you and your family will be pleasantly surprised at how delicious they are and how great you feel when you’re not loaded down with all that bread and sugar. I know we felt great last year!

The Best Weight Loss Diet Is?

New information confirms what I have been telling people for years.  A low fat diet is bad for your health and a low glycemic diet is the best diet for weight loss.  The recent study was published in the Journal of the American Medical Association.  For more information, watch the short video below.

Exercise and Vitamin D Strike Again!

The more we study exercise and vitamin D, the more benefits we find.  The great thing about that is they are both very safe treatment options.  In this video, Dr. Court discusses the recent report by the US Preventative Services Task Force that shows exercise and vitamin D are the best treatments to prevent falls in the elderly!