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Saturday, April 27, 2019

Fresh fruits and veggies usually pack the most punch nutritionally

On a Saturday morning 50 years ago tomorrow, then Surgeon General Luther Terry made a bold announcement to a roomful of reporters: cigarette smoking causes lung cancer and probably heart disease, and the government should do something about it.

Terry, himself a longtime smoker, spoke at a press conference unveiling Smoking and Health: Report of the Advisory Committee of the Surgeon General of the Public Health Service. That press conference was held on a Saturday in part to minimize the report’s effect on the stock market. After all, in 1964 smoking was common, fashionable, and done everywhere. In the U.S., tobacco was an even bigger business than it is today.

I vividly remember hearing about the Surgeon General’s report on the CBS Evening News. At the time, I was a first-year medical student. Between two-thirds and three-quarters of my fellow students were smokers. By the time we graduated, only 10% remained smokers. The report was one big reason why.

The impact of the report was augmented by our experience dissecting cadavers. The lungs of non-smokers were pink. The lungs of heavy smokers were black. That didn’t look healthy, and the surgeon general confirmed that it wasn’t.

I also remember the impression the report had on my mother, who had been smoking for many years. She wasn’t wowed by the science or the weight of the evidence. Instead, she was impressed by the fact that America’s “top doctor” was advising her, and other others like her, to stop smoking. (She didn’t follow his advice right away, but eventually did.)

Smoking-and-Health_coverThe 1964 Surgeon General’s report, and others that followed, have had a profound effect on the health of Americans, despite the tobacco industry’s concerted and continuing efforts to promote smoking. The percentage of Americans who smoke dropped from 42% in 1964 (the peak year for smoking) to 18% today. A new report in JAMA estimates that the decline in smoking prevented 8 million deaths since 1964, more than half of them among people under age 65.

But we still have a long way to go. Some 42 million Americans still smoke, although the majority want to quit. Each year, tobacco use accounts for nearly 500,000 deaths in the United States and 5 million deaths worldwide. And in the developing world, the last statistics I saw said that smoking is on the increase.

We continue to learn about the hazards of smoking and other forms of tobacco use. As CDC Director Thomas Frieden put it in a JAMA editorial, “Tobacco is, quite simply, in a league of its own in terms of the sheer numbers and varieties of ways it kills and maims people.” We also continue to learn about the addictive power of nicotine, and the difficulty of breaking an addiction to it.

The good news is that it’s possible to quit smoking. In the U.S. today, there are more former smokers than current smokers. Some people manage to quit on their own. Others are assisted by nicotine replacement coupled with some form of talk therapy. Stop-smoking medications such as varenicline (Chantix) or bupropion (Zyban) can also help.

I don’t recall hearing about any Surgeon General’s report before Dr. Terry’s 1964 report. In fact, I’m not sure at the time that I knew the U.S. had a Surgeon General. Since 1964, many Surgeon General’s reports have been issued, and many have received a lot of publicity. But probably no subsequent report has had as powerful an impact on the health of Americans.

I have many heroes. I don’t think you can overdo having heroes. Surgeon General Terry, and the epidemiological scientists who collected the evidence that he used, are near the top of my list. I’ll bet the eight million people who didn’t die young because of Dr. Terry’s message, and their loved ones, would agree. My mom began meditating decades ago, long before the mind-calming practice had entered the wider public consciousness. Today, at age 81, she still goes to a weekly meditation group and quotes Thich Nhat Hanh, a Zen Buddhist monk known for his practice of mindful meditation, or “present-focused awareness.”

Although meditation still isn’t exactly mainstream, many people practice it, hoping to stave off stress and stress-related health problems. Mindfulness meditation, in particular, has become more popular in recent years. The practice involves sitting comfortably, focusing on your breathing, and then bringing your mind’s attention to the present without drifting into concerns about the past or future. (Or, as my mom would say, “Don’t rehearse tragedies. Don’t borrow trouble.”)

But, as is true for a number of other alternative therapies, much of the evidence to support meditation’s effectiveness in promoting mental or physical health isn’t quite up to snuff. Why? First, many studies don’t include a good control treatment to compare with mindful meditation. Second, the people most likely to volunteer for a meditation study are often already sold on meditation’s benefits and so are more likely to report positive effects.

But when researchers from Johns Hopkins University in Baltimore, MD sifted through nearly 19,000 meditation studies, they found 47 trials that addressed those issues and met their criteria for well-designed studies. Their findings, published in JAMA Internal Medicine, suggest that mindful meditation can help ease psychological stresses like anxiety, depression, and pain.

Dr. Elizabeth Hoge, a psychiatrist at the Center for Anxiety and Traumatic Stress Disorders at Massachusetts General Hospital and an assistant professor of psychiatry at Harvard Medical School, says that mindfulness meditation makes perfect sense for treating anxiety. “People with anxiety have a problem dealing with distracting thoughts that have too much power,” she explains. “They can’t distinguish between a problem-solving thought and a nagging worry that has no benefit.”

“If you have unproductive worries,” says Dr. Hoge, you can train yourself to experience those thoughts completely differently. “You might think ‘I’m late, I might lose my job if I don’t get there on time, and it will be a disaster!’ Mindfulness teaches you to recognize, ‘Oh, there’s that thought again. I’ve been here before. But it’s just that—a thought, and not a part of my core self,'” says Dr. Hoge.

One of her recent studies (which was included in the JAMA Internal Medicine review) found that a mindfulness-based stress reduction program helped quell anxiety symptoms in people with generalized anxiety disorder, a condition marked by hard-to-control worries, poor sleep, and irritability. People in the control group—who also improved, but not as much as those in the meditation group—were taught general stress management techniques. All the participants received similar amounts of time, attention, and group interaction.

To get a sense of mindfulness meditation, you can try one of the guided recordings by Dr. Ronald Siegel, an assistant clinical professor of psychology at Harvard Medical School. They are available for free at www.mindfulness-solution.com.

Some people find that learning mindfulness techniques and practicing them with a group is especially helpful, says Dr. Hoge. Mindfulness-based stress reduction training, developed by Dr. Jon Kabat-Zinn at the University of Massachusetts Medical School in Worcester, MA, is now widely available in cities throughout the United States.

My mom would point you to Thich Nhat Hahn, who offers this short mindful meditation in his book Being Peace: “Breathing in, I calm my body. Breathing out, I smile. Dwelling in the present moment, I know this is a wonderful moment.” A recent article in Parade magazine caught my eye because it has lessons for us all. The article was about Olga Kotelko, a 94-year-old woman, who is a competitive runner and track star. Her age alone is impressive. The fact that she didn’t enter her first Master’s competition until she was 77—an age when many people are hanging up their sneakers—is amazing.

The article offers six lessons that anyone can learn from Ms. Kotelko’s daily life:

Swap Sudoku for sneakers: Yes, challenging brain activities can help protect memory and thinking skills. But so can exercise. And exercise has many other benefits for health.

Stay on your feet: The less you sit each day, the better. That doesn’t mean constantly walking. Try reading, writing letters, or working on a computer at a stand-up desk. If you watch TV, stand or sit and exercise.

Eat real food: Avoid processed foods and eat real ones. Fruits, vegetables, grains, chicken, even red meat sometimes.

Be a creature of (good) habit: Daily rituals are a great way to cement good habits.

Cultivate a sense of progress: We all like rewards. Being able to see improvement—in the distance you can walk or the weight you can lift—can motivate you to exercise daily and follow other good habits.

Lighten up: Stress is bad for the mind and the body. Find ways to ease stress, or nip it in the bud. Exercise is a good stress reliever, as is meditation or other form of invoking the relaxation response.

I’ll add another lesson touched on in the article: It takes a village. Kotelko works with a coach, Harold Morioka, who is himself a gifted Masters athlete. And she regularly works out with a running buddy, 76-year-old Christa Bortignon, who this year won the 2013 World Female Masters Athlete award.

Olga Kotelko can be an inspiration for anyone who wants to start exercising or to exercise more. As I have written before, you are never too old or too frail to start exercising. Getting started is probably the toughest hurdle to overcome. Too often, older or frail individuals have the wrong impression that they are past the point where exercise can do any good. In fact, it can do them a world of good.

Start out with a safe, easy program. Gradually add more and harder exercise. Who knows where you might end—possibly in an event challenging the likes of Olga Kotelko..Fresh fruits and veggies usually pack the most punch nutritionally

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