jonr@rmcsda.org

How would you like to bring your appetite under control?  Complex food structure is key.[1]  Accordingly, Kellogg’s Cornflakes and Rice Krispies spike blood sugar significantly more than rice or corn-on-the-cob.[2] How much more?  The glycemic index (GI) of sweet corn is just under 50, while the cornflakes are just under 80.  That’s a 30-point difference.  That’s huge!  Similarly, the glycemia index of cooked brown rice is around 50, while the GI of Kellogg’s Rice Krispies is right at 95, a 45-point spread. It’s not just the added sugar.[3] Food structure makes a major difference.  For example, compare the absorption of fat from peanuts, either peanuts eaten whole, or the same number of peanuts ground into peanut butter.  Nearly 18% of the fat in whole peanuts is not absorbed and goes out into the stool. However, only 7% of the peanut oil in peanut butter is excreted.[4]  Thus, we flush more than twice the amount of fat down the toilet when eating peanuts themselves.  What does all this have to do with improving appetite control?  We’ll see soon.

Does the physical structure of food affect carbohydrate absorption?  Yes. Absolutely. Rolled oats have a considerably lower ability to raise blood sugar (glycemic index) than instant oatmeal – same oats, but more highly processed for faster cooking.  The quick oats have smaller flakes.  As a result, the glycemic index (GI) of instant oats is 79. Whereas the GI of rolled oats is 55, nearly 25 points lower![5]  Similarly, oat flour, even more highly refined, pushed up blood sugar and insulin significantly more than quick oats.[6]  Again, how does this tie in with appetite control?  Let’s take a look at this fascinating relationship.

It turns out, when fats and/or carbohydrates are absorbed too quickly, we eat more later on.  For example, twelve obese teenage boys were fed a meal of steel-cut oats (low-glycemic), then, a meal of instant oatmeal (high-glycemic).  These young people ate 53% more calories after eating the high-GI instant oatmeal than after the low-GI steel-cut oats.[7]  High-glycemic foods make you hungrier.  You’re driven to eat more at the next meal.  If fact, after eating the instant oatmeal, the boys started snacking within one hour after that meal!  Furthermore, those who ate the low-GI steel-cut oats took in less than half the calories during a five-hour period after the meal of oats.[8] 

Clearly, high glycemic foods drive up hunger pangs.  Are quick oats the worst offender? No.  Kellogg’s Cornflakes has a glycemic index (GI) as high as 132.  Even Nabisco Shredded Wheat has a GI of 83.  Rice Krispies are at 82.[9]  These high numbers result from newer sophisticated food processing methods, such as extrusion cooking, explosion puffing, and instantization.[10] White bread also spikes the blood sugar.  As a result, after the spike in blood sugar, there is a subsequent jump in insulin, so much so, the blood sugar plummets below baseline.[11]  This sets off hunger pangs!  So, high glycemic foods feed hunger and push the appetite to be out of control.  In fact, just infusing insulin, which drops blood sugar, spikes the desire to eat, and high-calorie foods, in particular.[12]^,[13]  Therefore, low glycemic foods help one to feel fuller longer, they are significantly more satisfying, maximizing satiety.[14]

Is there another real-world example to illustrate the above?  Most definitely. Thirty-six subjects were fed either quick oats, frosted corn flakes, or water.  Then, researchers measured how much each participant ate for lunch three hours later.  Significantly, those who ate the oatmeal felt more full and less hungry three hours later, and ate over 400 calories less at the next meal.[15]  Amazingly, those who had the frosted flake breakfast ate more calories at lunch than did those who had the water only breakfast.  They were hungrier at lunch than those who fasted for breakfast!  Therefore, high glycemic foods are not satisfying.[16]  They promote overeating.  Honey Nut Cherries do the same thing.  Compared to eating oatmeal, Honey Nut Cherries brought decreased sensation of stomach fullness, reduced satisfaction, and made the subjects hungrier.  Interestingly, Quaker Oatmeal Squares had the same negative effects on appetite.[17]

Why are some foods high glycemic?  They are highly processed and have significantly less intact fiber, intact starch, and complex structure.  These are all important for slowing the digestion and absorption of fats, carbohydrates, and sugars, thus, blunting the blood sugar and insulin rise after meals, keeping satiety high and appetite under better control.[18]  Thus, processing out important nutrients from the foods results in reduced appetite control.  Therefore, if you want better control of appetite, eat food just as it comes from the hand of the Creator, with nothing added (oil, flour, sugar, and salt) and nothing taken away (fiber, complex structure, protein, phytochemicals). 

If you want to know which whole plant foods raise blood sugar the least, curbing appetite the most, visit drnewstart.com, select the “Handouts” tab, then, choose the handout “Reversing Diabetes”.  The foods listed all have glycemic indices of 40 or less on a 100 scale, much lower than all the options discussed above, including the “healthier” options, like Quaker oats and steel-cut oats.

To find out if you have any future risk for diabetes or have heart disease-promoting and cancer-promoting insulin resistance, call the Rocky Mountain Lifestyle Center at (303) 282-3676 to find out which blood tests will give you these answers.  Our physician would be happy to discuss these labs, or others your doctor has ordered, with you from the perspective of preventing problems well before they crop up. 

[1] Food Funct. 2016 Mar;7(3):1245-50.

[2] Am J Clin Nutr. 1985 Dec;42(6):1192-6.

[3] Ibid

[4] N Engl J Med. 1980 Oct 16;303(16):917-8.

[5] Diabetes Care. 2008 Dec;31(12):2281-3.

[6] Am J Physiol Gastrointest Liver Physiol. 2017;313(3):G239-G246.

[7] Pediatrics. 1999;103(3):E26.

[8] Ibid

[9] Diabetes Care. 2008 Dec;31(12):2281-3.

[10] Ibid

[11] Eur J Clin Nutr. 1991;45(10):489-499.

[12] Neurosci Biobehav Rev. 1996;20(1):133-137.

[13] J Clin Invest. 2011;121(10):4161-4169.

[14] Appetite. 2007;49(3):535-553.

[15] Ann Nutr Metab. 2015;66(2-3):93-103.

[16] Ibid

[17] J Am Coll Nutr. 2013;32(4):272-279.

[18] Ibid

By Dr. Tim Arnott — As we enter a new year, it is a time we begin to think about our life and what changes we would like to make. According to Statista’s Global Consumer Survey, 39 percent of U.S. adults will make a New Year’s resolution for 2022.[i] The top three this year in descending order are to exercise more, eat healthier, and lose weight.[ii] Given the ongoing Coronavirus pandemic, these three are well-advised.  Patients significantly overweight are at higher risk of mortality from COVID-19 infection.[iii] This higher risk may stem from a fundamental mechanism of infection.[iv] COVID utilizes the angiotensin-converting enzyme (ACE)-2 receptor for entry into our cells.

Therefore, too much of this receptor in the body can facilitate COVID entry, increasing severity.  The COVID virus has a particular attraction for lung cells. Besides the lung cells, this specialized receptor is expressed in many cell types, including fat cells, kidney cells, and heart cells.

Individuals with obesity (i.e., BMI >30) have more of these “COVID access” receptors present, which may support greater virus replication and infection. This may be one reason for worse outcomes of COVID infection in people with obesity.[v] Thus, losing weight is a reasonable approach to avoid the common severe outcomes of COVID infection.

At least one key factor distinguishes individuals who are significantly overweight and/or have diabetes from individuals without such conditions; namely, greater circulating levels of glucose (higher blood sugar levels)[vi]. This factor increases the ACE (COVID-friendly) receptor expression or activity, which in turn, may worsen the severity of COVID infection. Again, high blood glucose alone can increase the expression and enzymatic activity of ACE receptors in cells.[vii] As a result, a resolution to achieve weight loss, which will lower blood sugar, makes perfect sense at the start of 2022. The question is, how?  It’s a simple math formula–calories eaten must be fewer than calories burned.  Therefore, moving muscles more is part of the solution. Consider prayer walking first thing each morning. If you walk at a brisk pace, depending upon your weight, you could burn off 100-200 calories.[viii] That’s 500 to 1000 calories a week, assuming you walk five days a week, or 2000 to 4000 calories burned every month. Thus, your weight would drop one pound a month, 12 pounds a year.  If you want to double that, simply walk one hour at a brisk pace five days a week. Then, you’d be down 25 pounds a year. That is enough weight loss to reverse diabetes in a majority of patients who are still able to make insulin, and if 25 pounds didn’t quite reverse it, losing 50 pounds likely would.[ix] Considering that overweight and/or diabetes are associated with severe COVID disease, hospitalization, and death, this kind of weight loss could be lifesaving.

Another very powerful way to reduce blood glucose levels is to walk after every meal.  Every minute walked immediately after a meal reduces your blood glucose 1-3 points. Decreasing the amount of circulating insulin and going a long way to lose significant weight could make a lifesaving difference.

Now, having said the above, you could easily wipe out any calories burned walking just by eating more. Thus, adjusting the diet is also key to successful long-term weight loss. It’s actually a simple exercise to take in fewer calories. Cooked whole grains, beans, and legumes, and fresh or frozen fruits and vegetables are 80 percent water and about 10 percent fiber.[x] Thus, they are very low in calories, and you can actually eat more volume and still lose weight by choosing these foods.[xi] The foods rich in calories are easy to spot. They are found in packages (i.e., boxes, bags, cans) with a long list of ingredients. You don’t have to read the list–just put back on the shelf any food with more than one ingredient. Further, the only other category of food rich in calories is animal products, including meat, poultry, milk, eggs, yogurt, butter, ice cream, and cheese. Limiting such foods to 10 percent of total calories or less is money in the bank toward long-term weight loss and greater protection against COVID. Fortunately, there are great unsweetened dairy substitutes to fill in the gaps, and choosing savory beans poured over well-cooked, soft, moist whole grains with a plant-based, oil-free sauce is a great low-calorie entrée.

So, go ahead. Make those New Year’s resolutions and enjoy better protection against COVID at the same time, not to mention a lower risk of heart attack, stroke, and cancer. Now, we understand the above changes are not easy and because of that, many fail to make lasting lifestyle changes.  Understanding the increased protection against COVID and improved quality of life will help keep one motivated.  Further, having outside help also makes a difference. Rocky Mountain Lifestyle Center was established to support anyone wanting to improve health through lifestyle change, so take advantage of our MD consultations, cooking school, coaching, or health classes by calling (303) 282-3676 anytime.

In summary, God’s health remedies are so wise, they improve multiple conditions at the same time.  His whole-food, plant-based (WFPB) diet has transformed the health of thousands. No wonder He pronounced His fuel of choice for man, “Very Good”.[xii]

—Tim Arnott MD  is a Board-Certified Lifestyle Medicine physician and is the medical director of Rocky Mountain Lifestyle Center; photo by iStock

[i] http://a.msn.com/01/en-us/AASFCfW?ocid=se

[ii] Ibid

[iii] Nutr Diabetes. 2020; 10: 30.

[iv] ibid

[v] ibid

[vi] Nutr Diabetes. 2020; 10: 30.

[vii] ibid

[viii] https://caloriesburnedhq.com/

[ix] Kelly J. Foundations of Lifestyle Medicine Board Review Manual, 3rd Edition.

[x] Analysis based Food Processor software (https://esha.com/products/food-processor/)

[xi] Greger M. How Not to Diet. Flatiron Books: NY, NY, ©2019.

[xii] Genesis 1:31. The Holy Bible. NKJV.

By AdventHealth — She grew up in the country living a vegetarian lifestyle and only rarely eating meat. As a substitute, she ate a lot of cheese, eggs and processed foods. Shortly after getting married, however, she started having health issues that eventually escalated with her first pregnancy.

“At the 27-week mark in the pregnancy, the doctor ordered a glucose tolerance test. I failed the test quite significantly,” said Karene Bejarano, a registered nurse who works for a west coast hospital. “They told me I had gestational diabetes and I was going to have to see an endocrinologist and do food counseling. They said, ‘But don’t worry; it will go away. You’ll just have to be careful. If you exercise and keep yourself healthy, you’ll be just fine.’”

But after giving birth, Bejarano experienced terrible muscle weakness, intermittent blurred vision and high blood sugar levels, leading to a diagnosis of Type 1 diabetes.

“It was very disheartening, and I went through a lot of denial,” she said. “I was truly grieving a loss. I was losing my health, which is part of what all of us have the right to enjoy in life.”

Bejarano is one of six individuals who share their health transformation stories in the recently released film “PlantWise.” In the documentary, the six showcase their struggles with debilitating health conditions often caused by unhealthy food choices.

The turning point for each of them is the decision to change what they put on their plate by embracing a whole-food, plant-based diet. For Bejarano, while she couldn’t completely eliminate her medication for Type 1 diabetes (an irreversible condition), her improved lifestyle allowed her to lower the amount she needed to take.

“When I made the switch to a whole-food, plant-based lifestyle, I started experiencing significant changes rather quickly,” Bejarano recounted. “Within six months, I had lost 40 pounds. My doctor said my blood pressure was quite low and that they were going to take me off my blood pressure medication. My cholesterol was dropping too, so he said I wouldn’t need my cholesterol medication anymore. In fact, I was able to get off the majority of my medications.”

Nearly half of all Americans suffer from at least one chronic disease, which is responsible for 1.7 million deaths every year, according to a study published in the International Journal of Environmental Research and Public Health. National lifestyle medicine experts believe that exposing the results of unhealthy food choices and revealing the benefits of a whole-food, plant-based lifestyle could significantly help to slow this trend.

“A plant-based diet is the best diet available for humans. When minimally processed plant food is consumed, it can be incredibly health-promoting and even therapeutic, to the point of reversing disease,” noted George Guthrie, MD, MPH, a lifestyle medicine physician at AdventHealth who is also the author of “Eat Plants, Feel Whole,” a health transformation book. “The average American is deficient in potassium, magnesium and fiber. Those eating a whole-food, plant-based diet do not have this problem.”

“I thought I was free, but I didn’t really understand what freedom was until I changed my lifestyle,” she said.

Bejarano recalled how adopting this healthy eating approach made her feel so much more alive.

“I thought I was free, but I didn’t really understand what freedom was until I changed my lifestyle,” she said. “You have more energy, you’re more vibrant and you’re happier. When you really decide you’re going to change your lifestyle and you stand firm with that decision, it radically changes your life for the better, and you’ll never want to go back.”

The film “PlantWise” stems from AdventHealth’s desire to explore using documentary films in inpatient and outpatient settings as a catalyst to inspire patients to make lifestyle changes. It is a powerful motivational tool that can give viewers a new vision and fresh hope for their condition, and help them experience vibrant wellness through embracing a healthy lifestyle.

Speaking on the vision of the film, Todd Chobotar, editor-in-chief at AdventHealth Press and executive producer of “PlantWise,” said the film was created not only to share transformative patient stories, but also detail solutions to chronic health conditions and support physician-patient engagement.

“It is our hope that ‘PlantWise’ will positively impact people’s health when it is viewed by many audiences across the globe, including health care employees, inpatients, outpatients, medical providers, consumers, churches and other community organizations,” Chobotar noted.

“PlantWise” is a 48-minute film with subtitles available in 18 languages. Sponsored by AdventHealth, Ardmore Institute of Health, American College of Lifestyle Medicine and EatingYouAlive.org, the film features 18 leading lifestyle medicine experts from 14 specialties and disciplines.

Hans Diehl, DHSc, MPH, founder of CHIP (Complete Health Improvement Program), calls “PlantWise” “the best plant-based film out there.” And T. Colin Campbell, PhD, co-author of “The China Study,” said it’s “inspiring and meaningful. Exactly what people should see!”

To view the film as well as additional resources for free, visit PlantWiseFilm.com.

–Photo supplied.

This article was originally published on the AdventHealth website

I once talked with a lady who told me, “I have been suffering with depression for two years.” As we talked, I discovered she wasn’t always depressed. She noted that after being exposed to as little as an hour or so of sunlight on the weekends, her depression left. Why is sunlight so important? Scientists have discovered that sunlight, registered through the eyes, increases serotonin in the brain. We need serotonin to feel in a good mood and to help resolve depression. Dr. Lambert at the Baker Heart Research Institute, Melbourne, Australia, found that the amount of serotonin in the blood carried by the jugular vein to be eight times greater on a bright day than a dull day.[ 1] Its important to note that the light intensity indoors with artificial lighting is often less than that experienced outside on a dull day. Most of us spend nearly all our time inside, thus, perpetually experiencing much lower light intensity than we would if we were outside even on a dull day. As a result, our brain serotonin levels may drop significantly. Additionally, the brain appears to make significantly more serotonin in the summer compared to winter. In the summertime, the blood coming from the brain has seven times more serotonin than it has in the winter under similar conditions. Sunlight in summer is of greater intensity than in winter, and more intense light entering the eyes stimulates greater manufacture of serotonin. What does all this mean? If you have been suffering with depression and/ or lack of energy, these symptoms may improve as you increase your exposure to sunlight. If possible, get at least thirty minutes of bright sunlight first thing in the morning. Morning sunlight is most beneficial. However, even walking outside during a fifteen-minute break morning and afternoon will also help raise serotonin. Make a habit of spending more time outside every day. If you have limited time, try to go outside when the sunlight is most intense. The increase in serotonin in your brain is automatic and immediate upon exposure to sunlight. However, the serotonin your body makes today will not last until tomorrow, so you need outdoor sunlight exposure daily! On cloudy days and during winter, spend more time outside because light intensity is reduced. Be careful never to burn your skin or even to turn it pink. It is sunlight entering your eyes that raises serotonin; your skin can remain completely covered. Of course, never look directly at the sun and always follow your doctor’s recommendation about sunlight exposure. Even if you don’t suffer from depression, sunlight is essential to good health—both mental and physical. Make sure you get enough sunshine! [1]. G. W. Lambert, “Effect of Sunlight and Season on Serotonin Turnover In the Brain,” The Lancet, December 7, 2002, 36 (9348): 1840-1842.”

— Dr. Arnott’s 24 Realistic Ways to Improve Your Health by Tim Arnott

By Tim Arnott — Don’t Just wait for a prostate cancer diagnosis.  There are things you can do now to prevent it.

Did you know what you eat, drink, and do with your body is more powerful than genes your parents gave you?  Scientists estimate DNA sequences or genes explain approximately ten percent of variance in health status, but epigenetics (switches that turn genes on or off) explain about 70-90 percent of health variance.[i]  These gene switches are heavily influenced by our lifestyle.  This is good news!  In other words, if we change how we live, our DNA begins to work for us, rather than against us.

Although the epigenetic gene switches are inherited, these can be changed and modified by environmental and genetic factors.  Lifestyle, especially diet, has a major influence.  One of the epigenetic mechanisms is a process in the nucleus of the cell called methylation.  Adding methyl groups (a carbon attached to three hydrogens) to the DNA can activate or repress genes.  Eating a plant-based diet increases your ability to methylate your genes.[ii]  Methyl groups come through plant foods and B vitamins (found in whole grains). Has this theory been tested?  Yes. For example, Ornish and colleagues found intensive nutrition and lifestyle changes changed the expression of more than 500 genes.  Namely, 453 genes that tend to promote prostate cancer were downregulated (turned down) and 48 genes and tend to reduce prostate cancer risk were upregulated (turned up).  In other words, after eating a ten percent fat, whole food plant-based diet, exercising, participating in group support and stress reduction activities, these prostate cancer patients were experiencing changes at the gene level lowering risk of recurrent prostate cancer.[iii] 

There are other things men can do to lower risk of prostate cancer, let’s consider some of them. Dr. Brooks and colleagues at Duke University found men with high selenium levels were at a 76 percent lower risk of prostate cancer than were men with the lowest selenium levels.  Dr. Jacobsen of Loma Linda University found men drinking soy milk more than once a day at 70 percent lower risk of prostate cancer than men who rarely or never drank soy milk. Dr. Ahonen reported in the journal Cancer Causes and Control men with high levels of vitamin D at less than one-third the risk of prostate cancer of men with lowest levels of vitamin D in their blood. Another study reported men with the smallest waistlines and lowest insulin levels with risk of prostate cancer only 12 percent of men with largest waistlines and highest insulin levels. Dr. Giovannucci reported in the Journal of the National Cancer Institute men eating more than ten servings of tomato a week at 35 percent lower risk of prostate cancer than men who ate less than one and a half servings a week. Dr. Chan reported a study in which those men using the fewest dairy products at 34 percent lower risk of prostate cancer than men eating the most. And finally, Dr. Reichman conducted a study in which men with highest vitamin A levels had less than half the prostate cancer risk of the men with lowest vitamin A levels.

Based on these studies, the following healthy changes may help lower your risk of prostate cancer or of someone you love: use tomato puree or crushed tomato generously (tomato puree is one of the few tomato products with no added salt). Eat three Brazil nuts daily (400 mcg of selenium). Choose only 100 percent whole grains. Use soy milk instead of cow’s milk. Choose cashew or tofu-based sauces in place of cheese. Expose face, arms, legs, back or chest skin to direct sunlight approximately fifteen minutes daily between 10AM and 3PM daily, even on cloudy days. Be very careful never to burn your skin with excessive sunlight exposure! Take 1,000 IU to 2,000 IU of plant-based vitamin D3 daily, no more.  Eat generously of cruciferous vegetables. Choose orange and yellow fruits and vegetables. Finally, consult with your physician regarding annual prostate cancer screening tests and whether they are medically appropriate, namely, an annual prostate exam and/or PSA after age fifty, as these are not generally recommended for prostate cancer screening.[iv]  More specifically, there is clear evidence screening with a prostate-specific antigen (PSA) test can reduce the number of deaths from prostate cancer. However, prostate cancer is often so slow growing it would not cause any problems. For that reason, many men do not benefit from treatment for prostate cancer and may unnecessarily suffer side effects, such as long-term problems with urinary and sexual function.[v]  For this reason, it is important to follow specific age-matched cancer screening guidelines in consultation with your primary care physician or urologist.

Clearly, there are many changes one can make today that may help lower prostate cancer risk.  Now, you may say, but I’m more concerned about BPH (benign prostatic hypertrophy).  I’m getting up more than three times a night to use the bathroom.  I’m having difficulty urinating.  In order to improve this disease, we must understand the cause.  The cause of an enlarged prostate is thought to be largely due to high levels of circulating insulin.[vi],[vii]  What is the solution?  The key to improvement are foods that raise blood sugar the least and are lowest in saturated fats, especially those of animal origin, and vigorous daily physical exercise. What foods could possibly be both low glycemic (least able to raise blood sugar) and low fat (especially saturated fat)?  Low glycemic whole plant foods, such as beans, peas, lentils, garbanzos, hulled barley, whole wheat and rye berries, cooked like you would cook brown rice (soak these overnight before cooking), Northern fruits (fresh or frozen), above-ground vegetables, and spouted whole wheat breads (Ezekiel and Alvarado Street breads).  For a more detailed list, go to drnewstart.com, select “Handouts” and scroll down to the “Reverse Diabetes” handout.[viii]  Of course, some individuals may need more formal treatment measures recommended by your physician, so work closely with them and follow their recommendations.  However, medications and surgical procedures are primarily used to treat symptoms, so it makes sense to make changes to remove as much of the underlying cause of BPH as possible.

Finally, take time for Christian meditation. Start a prayer journal.  Take time to still completely still and ask the Lord to speak to your mind anything relating to your health He thinks is important and wait for a few minutes (three to seven, perhaps), and write down thoughts and impressions that come to your mind.  Use common sense, follow Biblical principles, but explore this Christian discipline.  Consider this counsel, “We must individually hear Him speaking to the heart. When every other voice is hushed, and in quietness we wait before Him, the silence of the soul makes more distinct the voice of God. He bids us, “Be still, and know that I am God.” Psalm 46:10. This is the effectual preparation for all labor for God.”[ix]

[i] Kelly J. Clayton JS. Foundations of Lifestyle Medicine, Board Review Manual, 3^rd Edition. ACLM. ©2021, p. 11.

[ii] Kelly J. Clayton JS. Foundations of Lifestyle Medicine, Board Review Manual, 3^rd Edition. ACLM. ©2021, p. 149

[iii] Ibid.

[iv] Arnott, Tim. Dr. Arnott’s 24 Realistic Ways to Improve Your Health. Pacific Press Publishing Association. Kindle Edition.

[v] https://www.mskcc.org/cancer-care/types/prostate/screening/screening-guidelines-prostate

[vi] Breyer BN. Curr Urol Rep. 2014 Dec;15(12):462.

[vii] Vikram A. Eur J Pharmacol. 2010 Sep 1;641(2-3):75-81

[viii] https://www.drnewstart.com/handouts

[ix] White, EG. The Ministry of Healing. Pacific Press Pub Assn: Mountainview, CA, © 1905, p. 58.

By Tim Arnott … Would you like an easy way to add four years to your life?  Begin prayer walking.  That’s right, walk and pray one hour each morning.  Enoch took walks with God, and God took him to heaven.

Not walking also has its consequences.  The number four reason worldwide for early death is physical inactivity.  Furthermore, the Aerobics Center Longitudinal Study revealed low cardiorespiratory fitness (not exercising) was the number one cause of preventable death from all causes. Not exercising is the cause of approximately one in ten premature deaths.  If just 25 percent of those who don’t exercise started a walking program, 1.3 million premature deaths could be averted every year.  People who exercise most live the longest, whether normal weight or overweight.  Further, prolonged sitting has been shown to cause 6.9% of all causes of early death.  Similarly, television viewing has been shown to increase all-cause mortality by approximately 50% even in those getting seven hours of exercise per week.  Clearly, we were made to be active.   

On a more positive note, exercise brings remarkable benefits.  Skeletal muscle, heart muscle, and artery and organ smooth muscle all strengthen with exercise.  Bones get stronger.  In fact, one of the keys to strong bones is strong muscles.  As a result, particularly for the elderly, exercise lowers fall risk and fracture risk, including spine fractures.  A daily walking program lowers risk of high blood pressure, heart attack, stroke, diabetes, breast and colon cancer, and depression.  This is just the beginning of the benefits. According to the 2018 Physical Activity Guidelines Advisory Committee, children age three to six improve bone health and weight status with exercise.  Children six to 17 years of age experience improved cognitive function.  Adults of all ages lower risk of bladder, endometrium, esophagus, kidney, stomach, and lung cancer.  Walking brings reduced risk of dementia, improved cognitive function, improved sleep, reduced anxiety and depression, and reduced risk of excessive weight gain.  Older adults also benefit, namely, reduced incidence of fall injuries and improved physical function. Women who are pregnant and walk have reduced risk of excessive weight gain, lower risk of gestational diabetes, and reduced postpartum depression. 

Even if you already have a preexisting medical condition, walking brings benefits.  Those with breast cancer who walk or regularly exercise have lower death rates from the cancer and all other causes.  The same is true of those with colon cancer.  Prostate cancer patients have reduced risk of prostate cancer mortality.  Those with osteoarthritis have reduced pain and improved function and quality of life.  Those with high blood pressure have reduced progression of heart and blood vessel diseases.  Their blood pressure is also less likely to increase over time.  If you have diabetes and walk regularly, you are at lower risk of death from heart attack and stroke, and hemoglobin A1c, blood pressure, cholesterol, triglycerides, and weight all improve.  Those with multiple sclerosis who exercise have improved ability to walk and better physical fitness.   Cognitive function improves in those with dementia.  Furthermore, brain function has been shown to improve with exercise in those with ADHD, schizophrenia, multiple sclerosis, Parkinson disease, and prior stroke.

Not only are the benefits of walking for those with chronic conditions, but these improvements don’t take long to materialize.  Single episodes of physical exercise improved brain executive function, including concentration, attention, ability to regulate emotions, memory, ability to plan and organize, and speed of processing.  Further, a single bout of walking lowers blood pressure, improves sleep, lowers anxiety, and improves ability to handle blood sugar, in other words, exercise improves insulin sensitivity.  In fact, one of the most important ways to control blood sugar in those with diabetes is to walk 30 to 40 minutes immediately following each large meal. 

When it comes to incorporating the benefits of exercise, one should include strength training.  Resistance training and weight lifting actually reduce injuries long-term, increase basal metabolic rate, lower fatigue, improve sleep quality, improve muscle performance, increase quality of life, endurance, bone mineral density, and reduce body fat, lower cholesterol, improve ability to lower blood sugar, decrease pain and disability in those with osteoarthritis, and reduce fatty build up in the liver.  Strength training twice a week is the general recommendation.

Let’s take a look at the impact of aerobic exercise, such as brisk walking, compared with strength training, weight lifting or using weight machines, on fitness variables.  Both aerobic exercise and resistance exercise moderately increase bone mineral density.  They are equally effective.  Both reduce percent body fat, but aerobic exercise is most effective.  While resistance training moderately increases muscle mass, aerobic exercise does not.  Resistance exercise markedly improves muscle strength versus only a mild increase with aerobic exercise.  Both forms of exercise significantly lower the insulin rise after a big dose of glucose.  This means using muscles improves the ability to respond to insulin and more easily absorb blood sugar.  Thus, the pancreas can pump out less insulin.  Both exercise forms mildly reduce fasting insulin levels and improve insulin sensitivity moderately and equally.  Aerobic exercise moderately lowers triglycerides, though resistance training has only a very mild effect. Both forms of exercise raise HDL cholesterol and equally.

With all these benefits, you may decide to start an exercise program.  When it comes to starting one, it’s important to know who needs a medical clearance from their doctor.  If one has known coronary artery disease (i.e., prior heart attack, coronary bypass or stent), type 2 diabetes, chronic kidney disease, or end stage kidney disease on dialysis, even if no symptoms (i.e., chest pain or shortness of breath), medical clearance from your physician or cardiologist is required. Furthermore, any patient with the above symptoms or others, regardless of known disease, requires medical clearance.  After clearance, light (i.e., stroll) to moderate (i.e., brisk walking) exercise only should be done to begin with.  For the first six weeks, start with 15 minutes and slowly progress to 30 minutes three to six days a week.  Brisk walking 150 minutes a week is the target exercise goal for most people. 

Do these exercise benefits translate into longer life?  Yes.  For every hour you exercise, you can expect to live that hour over again plus two or three to boot.  Those who exercise 150 minutes a week gain about 2.5 years of life.  If you walk briskly one hour daily, you can expect to live four extra years.  The maximum benefit is achieved after more than eight hours a week of moderate exercise, gaining approximately 4.5 years of extra life.  In short, the lowest risk of premature death comes to those walking briskly 60 minutes first thing every morning or each evening.  In fact, physical exercise reduces all causes of death and year of life lost in all regardless of weight.

Once your physician clears you to start an exercise program, or if you have no symptoms and no serious chronic disease, it is recommended one follow the FITT prescription.  Namely, frequency of three to six days a week, moderate intensity (i.e., able to talk, but not sing while walking), time allotment of 30 to 60 minutes per session, and type of exercise (i.e., swimming, walking, or biking, et cetera).  For adults cleared to exercise, or without need for clearance, strength training is recommended two or three nonconsecutive days per week, namely, one set of eight to twelve repetitions for each major muscle group (i.e., chest, back, shoulders, biceps, triceps, abdomen and quadriceps) at 60 to 70 percent of maximum resistance.  Maximum resistance is the weight one could successfully lift or resist with one repetition.

In summary, exercise advice is not new.  The first was given nearly 6000 years ago.  The prophet Moses recorded it in Genesis, “in the sweat of your face shall you eat bread, till you return unto the ground; for out of it were you taken: for dust you are, and unto dust shall you return.”  In other words, till our last day on earth we are told to sweat in our face.  Generating sweat requires vigorous exercise.  However, work up to this gradually and get medical clearance, described above, when indicated, but sweating exercise was a command given to mankind by our Creator, His fifth command to us, actually.  His first was a whole food plant-based diet.  Science declares this sweating exercise command, like all the others, blesses our lives immensely, namely, there is strong evidence of 14 to 35 percent lower all-cause mortality, 20 to 30 percent lower coronary heart disease risk, 17 to 31 percent reduction in type 2 diabetes, 17 to 30 percent less colon cancer, and 20 to 30 percent drop in breast cancer, to name a few benefits.  In short, it pays to exercise.  You won’t want to leave home without taking this powerful medicine.

By Tim Arnott — The average adult sleeps six hours and fifty-seven minutes. However, one in five sleep less than six hours per night. Additionally, 37 percent of young adults sleep less than seven hours a night. This proportion doubled between 1960 and 2002. There has been a significant increase in short sleep duration for all age categories from 1970 to present. Sixty million US adults have difficulty sleeping. Only 10 percent seek medical attention. The indirect costs from insomnia are estimated at $60 billion annually, including presenteeism (at work, but not productive), increased long-term disability, mistakes, errors, and accidents.

Now that we’ve looked at some sleep statistics, how much sleep do we need? The Sleep Foundation recommends seven to nine hours for adults. Recommendations vary depending on the age. It is recommended newborns sleep 14 to 17 hours, infants 12 to 15 hours, toddlers 11 to 14, preschoolers 10 to 13, school age children 9 to 11, teens 8 to 10, young adults and adults 7 to 9, and, finally, older adults 7 to 8 hours. Thus, sleep requirements and recommendations change throughout the lifespan.

We cannot get far into the subject of sleep before we need to discuss circadian physiology. Our circadian rhythm governs sleep. Our circadian internal clock is made up of central and peripheral oscillators. These tissues produce oscillating (alternating) currents that create the circadian rhythm. The central oscillators are found in the suprachiasmic nucleus (SCN) in the hypothalamus of the brain, which is the body’s main “clock”. Further, peripheral oscillators are present in every major organ, namely, kidney, liver, heart, adrenal glands, and pancreas. These facilitate synchrony and alignment between the central and peripheral clocks. The purpose of these clocks is to align physiologic functions and processes with the solar light-dark cycles for maximal efficient function.

Our circadian rhythm, and, thus, the wakefulness-sleep cycle is entrained by the day-night cycle. For example, the cortisol spike that wakes us up in the morning is regulated by our central “clock”. There are nerve pathways connecting the retina to the suprachiasmic nucleus (SCN), allowing sunlight to modify the internal oscillators or clock. Another nerve bundle runs from the SCN to the pineal gland which controls melatonin secretion, thus, allowing sunlight to adjust the melatonin levels. Specifically, melatonin secretion and timing may be changed as the melanopsin photopigment in the retina absorbs short wavelengths of light, especially blue light, stimulating neurons in the retina which are connected to our internal clock, in turn, activating it.

It’s not just light intensity and wavelength that influence our internal clock, entraining our circadian rhythm. Food can do it, mainly carbohydrates (found only in plants), the concentration of sodium, potassium, and chloride in the blood plasma, and the temperature of the surrounding environment. Furthermore, modifiers change the input the central clock receives. For example, our pupil limits the amount of light getting to the retina. Sunglasses and backlight on electronic devices change the intensity of light reaching the light-sensitive proteins in the back of the eye. These modifiers can weaken or alter the entraining process, throwing off our circadian cycle and, thereby, compromising sleep quality.

Interestingly, not everyone’s light sensitive proteins are identical. The DNA that encodes these proteins can vary in a single nucleotide of “letter”, shall we say. These differences are called Single Nucleotide Polymorphisms (SNPS), and they represent a slightly different blueprint for making our proteins. Thus, each person may make slightly different light sensitive proteins with slightly different shape and function. These proteins may have enhanced or reduced function, and this can alter the circadian clock effectiveness. For example, PER and CRY proteins are a critical part of the molecular machinery controlling the circadian rhythm in the peripheral oscillator or clock. PER and CRY proteins work against proteins “clock” and “cycle” until they break down. This process takes 24 hours. More light into the eye causes more PER protein to be made, and this is an important factor in training our internal clock. Individual variation in these proteins can change one’s ability to adjust their internal clock, which may hinder sleep quality.

With all this talk about circadian physiology and individual gene variation, what can actually be done to optimize sleep? It turns out there are multiple things we can do. Simple things. It is important to get bright intensity daylight onto our face within 30 minutes of awakening and continue this for 30 minutes. From late Fall to early Spring, one may need to use a 10,000-lux light box to simulate sunlight intensity for this purpose. One should not look at the light, but simply face it while eating, studying, or reading. Keep the light box 1 ½ to 2 feet away from the face, and, again, do not look directly at the light. Morning sunlight and/or the light box will shut off melatonin, so sixteen hours later one will get a melatonin spike, helping to put the body to sleep. One can do another 20-to-30-minute session in the late afternoon to help the body remain asleep longer, or you can simply go outside and be in bright sunlight at that time.

One of the ways the body puts itself to sleep is by cooling the core temperature and warming the extremities. Thus, if one is dehydrated, blood vessels in the arms and legs constrict, making it more difficult to transfer heat from the core. This hinders ability to fall asleep. So, stay well hydrated, but drink most water before lunch. For example, drink three glasses of warm water first thing in the morning. Then, starting an hour after breakfast, drink another glass every half hour until one hour before lunch. So, if you take three glasses at 6am, eat breakfast at 7am, then, restart water intake at 8am. You would be able to drink 6 more glasses between 8am and 11am. Thus, before your lunch at noon, you could drink your daily 8 to 10 glasses. It’s probably best to drink most of your daily water before 3pm to maximize sleep duration.

In addition to optimizing hydration, it’s easier to transfer heat from the core to the extremities as one loses weight. Thus, a whole food plant-based diet, with less than 10 percent calories from fat, especially if low glycemic, will ultimately help one shed pounds naturally, and with each pound that goes, it will be easier to transfer heat to the arms and legs, helping the body to fall asleep. Limiting sodium (salt) at dinner may help one fall asleep. Excess salt causes constriction of the blood vessels in arms and legs, again, hindering heat transfer from core to extremities.

There are other steps we can take to optimize sleep. Sleeping in a cooler room will assist the body in cooling the core temperature and wearing a pair of wool socks, over even one wool sock, may assist in transfer of heat to the extremities. Again, cooling the core and warming the extremities is a big part of being able to fall asleep. A temperature of 68 degrees in the sleeping room is recommended, but this recommendation should be individualized.

Not only is falling asleep without delay a priority, but staying asleep longer is desired because during later sleep stages REM sleep predominates. During REM sleep the amygdala gets rid of the memory of fearful events, thus, helping to extinguish fear and, thereby, reduce anxiety. If sleep is cut short, REM may be reduced, leading to increased anxiety. For the student, memories of an educational nature are consolidated during REM, thus, whatever shortens REM will also impair learning and memory.

Physical exercise also enhances sleep and memory. I can personally attest daily exercise and strength training will so fatigue the muscles sleep will come more quickly, be deeper, and one will sleep longer, so, take time to exhaust your physical body most days of the week. Every hour you exercise, you can expect to live that hour over again plus two or three to boot.

In summary, simple principles, such as drinking adequate amounts of water early in the day, taking a brisk walk toward the rising sun first thing upon awakening, getting outside again in the late afternoon and walking toward the late afternoon sun, sleeping in a cool room, wearing warm socks to bed, choosing a whole food plant-based diet, enjoying a judicious weight training program that exhausts the muscles on most days, avoiding caffeine and alcohol will all work together to improve sleep quality and quantity, which, in turn, will improve mood, reduce anxiety, and enhance memory and learning.

References:

Param Dedhia, MD, John Kelly, MD, MPH. Sleep Health Science and Interventions, Section 8, Foundations of Lifestyle Medicine Board Review Manual, 3rd Edition, © 2021 American College of Lifestyle Medicine, pp. 267-294.

Dr. Arnott is available for lifestyle consultations, at the Rocky Mountain Lifestyle Center or via telemedicine. Now is the time to optimize your immune for COVID and other chronic diseases.
Make an appointment on our website rmlc.online or call 303-282-3676.

By Tim Arnott — “And we know that all things work together for good to them that love God, to them who are the called according to his purpose.”[1]  These words, as they pertain embracing the values and purposes of Adventist Medical Evangelism Network (AMEN), came true for me on November 8, 2018.  That day the Paradise Camp Fire disaster closed forever my medical practice in Paradise, California.  We lost essentially everything but the clothes on our back.  I was unemployed for nearly six months.  Then, I received an email that was to forever change the way I practiced medicine, but let me stop and give some background to this story.

For many years the Lord graciously gave me the opportunity to participate in short-term mission projects.  I was able to participate in the first mission trip organized by Students for International Mission Service (SIMS) at Loma Linda University.  Three medical students, using ophthalmoscopes, assessed visual acuity and fitted patient with glasses that had been generously donated.  It was so gratifying to see the immediate joy of many patients when the world suddenly changed from blurry to sharp.  Optometry was the focus of those visits, but not much else.  Providing appropriate medications to treat diagnosed conditions was the focus of other early mission trips.  However, it wasn’t so satisfying to simply provide patients with medication, knowing the underlying cause of their medical condition had not been addressed.  For this reason, I decided to start providing nutrition and lifestyle education as part of my mission trip medical visits.  This practice increased patient satisfaction and my own.  Additionally, my translators were learning enough that soon they were instructing the patients in principles of healthy living without my needing to tell them anything!  Still, I sensed something was missing.  I decided on future mission trips, I would make a series of handouts I could show the translator to depict NEWSTART® principles, including trust in Divine power.  In short, I decided to teach my patients, after making a diagnosis, providing indicated medication and lifestyle education, how they could get to know Christ for themselves and how important that exercise was to their eternal destiny.  In short, I began teaching patients the practical aspects of John 17:3, namely, “And this is life eternal, that they might know thee the only true God, and Jesus Christ, whom thou hast sent.”[2]  I first included this aspect of patient care on a mission trip to Bolivia.  I was stunned at the reaction.  After instructing the translator in this gospel presentation, I watched as the translator began sharing with patients how they could get to know Jesus Christ for themselves and how this was God’s chosen method to save them eternally. To my surprise, patients began weeping!  Patient after patient had similar responses.  It was as though the Holy Spirit joined the medical visit when we shared themes of eternal import with patients.  Wow.  I was amazed, and I was hooked!  I decided, from now on, the spiritual presentation would be part of my medical visits on future mission trips.  What I didn’t realize was that decision would soon transform my medical practice back home.  Yes.  I had been praying with patients on mission trips all along, and I continued to do so, and patients greatly appreciated this, but, explaining the simple gospel to patients was new for me and so rewarding.  When I realized the practical aspects of salvation were largely unknown to the majority of patients coming to mission clinics, I was deeply moved and motivated to go on future trips just to share with patients how they can take hold of eternal life with Christ for themselves. 

It wasn’t long after the experiences above that the wild fires closed my medical practice in Paradise, and I received an invitation to serve at Guam Seventh-day Adventist Clinic.  As it turned out, a family member of an AMEN officer traveled to Guam for meetings and dropped my name.  I subsequently received the email I referred to above from the medical director, inviting me to consider coming to Guam.  We accepted this invitation, but I didn’t realize God was setting me up to take what I had learned on mission trips and incorporate it into regular medical practice. 

When I arrived on Guam, the retiring physician whose practice I was to take over remained for several months and during that time my schedule was rather light.  This allowed me to see patients for 30 minutes each visit.  It is important to mention that it took a few months to become licensed and credentialed for Guam.  I spent this time with family in Loma Linda.  During this waiting period, the Lord impressed me to make a handout[3] to share with patients.  I labeled it simply, “New Patient Handout – Guam.”[4] This became my tool to transition from sharing with patients about nutrition for healing the physical body on the front page to explaining food for saving the soul from the back page.  I was not sharing doctrines, but the simple steps found in books like Steps to Christ[5], To Know God: A Five-Day Plan[6], and It’s All About Him.[7]  Amazingly, I found patients in Guam as open to this discussion as the patients in Bolivia.  I remember a young man who came back to see me after I shared the simple gospel with him.  He went home and shared this precious message with his girlfriend who gave me a wonderful endorsement, though we had never met, simply because I had shared with her boyfriend how to get to know Christ for himself.  I recall another patient who was visibly touched during the gospel presentation and began expressing his appreciation in real time, and later after the visit ended, he came back and found me in the hall and began expressing again how thankful he was I had shared how he could get to know Jesus for himself.  After having a some of these positive encounters, the Lord then arranged for me to give a presentation to the Guam AMEN members and clinic staff.  I was a novice, but almost immediately, I was asked to share my journey and experiences.  This tells me God is passionate about His medical providers sharing with patients simple steps of how they can get to know Christ for themselves. 

Immediately following that first AMEN presentation, the Lord sent me a patient that opened my eyes.  This man was the last you would expect to have interest in spiritual things.  He was rough, crude, outspoken.  After every few words, out of his mouth came cursing and swearing.  I have had a few patients over the years I came close to reprimanding for their foul language, but I never came closer than with this patient.  Early in the visit I decided I would not be sharing the gospel steps with this patient.  I knew he’d have no interest.  I had almost decided not to pray with him.  I finally, against my better judgement, chose to offer prayer.  To my surprise, he agreed!  But what happened next, never happened before or since.  I prayed a heartfelt prayer and took in the specifics of the concerns he had expressed.  I had no sooner said, Amen, when this man literally lunged at me with outstretched arm, and taking my hand in his, began shaking it back and forth for all he was worth.  I couldn’t believe my eyes.  He was so thankful!  So appreciative.  He expressed his thanks over and over again.  He told me it was the best medical visit he had ever had. At that point, I thought the visit was over.  I was satisfied.  The Lord wasn’t!  Apparently, there was unfinished business with this patient. The Lord literally delayed my always punctual and proper medical assistant from entering the exam room to complete the patient visit.  She was so delayed, I did a double take and decided there was more God wanted me to do.  I looked around for literature and saw the book Hero of Hacksaw Ridge.[8]  I returned to the exam room and offered the book to him.  He instantly recognized the title and stated he had seen the movie.[9]  I was relieved, and thought for sure the Lord would be satisfied.  I was mistaken.  Still my usually prompt, punctual, detailed-oriented MA was nowhere to be found.  I went looking for her, but to no avail.  I did another doubletake.  Perhaps there was more the Lord had in mind for this gentleman.  I went online and found my handout “Do You Want to Have Eternal Life?”[10]  I returned the second time to the exam room and offered this handout to the patient.  I had no sooner closed the door, when, instantly, my bright, cheerful medical assistant was right there walking down the hall ready to enter the patient’s room.  I stood there amazed!  The patient I thought was hopeless.  The man who seemed so far from the kingdom of God, was closer than ever I had imagined, and God wanted me to share even more than a heartfelt prayer, and orchestrated events in the clinic to get lifesaving truth into the hands of His wayward child.  This is exciting work!  To this day, I don’t know all the Lord had in mind for that visit, but I do know God is passionate about His medical professionals sharing with patients how they can get to know Christ for themselves.

[1] Romans 8:28. The Holy Bible. Authorized King James Version. Cambridge University Press: Cambridge, England, ©1611.

[2] John 17:3. The Holy Bible. Authorized King James Version. Cambridge University Press: Cambridge, England, ©1611.

[3] https://www.drnewstart.com/handouts

[4] ibid

[5] White, E.G. Steps to Christ. Pacific Press Publishing Association: Mountainview, CA. ©1892.

[6] Venden, M. To Know God: A Five-Day Plan. Review and Herald Publishing Association: Hagerstown, MD. ©1983.

[7] Venden, L. It’s All About Him. Review and Herald Publishing Association: Hagerstown, MD. ©2004.

[8] Herndon B. Hero of Hacksaw Ridge. Remnant Publications: Coldwater, MI. ©2016.

[9] Gibson, Mel. Hacksaw Ridge. Lionsgate, 2016.

[10] https://www.drnewstart.com/handouts