Skipping Meals and Metabolism

People often miss meals because they get busy or are trying to lose weight. But how you skip meals, and the amount you eat at your next meal, can affect your overall health.

The scientific data on skipping meals has been confusing. In some studies, fasting has resulted in measurable metabolic benefits for obese people, and in animal studies, intermittent feeding and fasting reduces the incidence of diabetes and improves certain indicators of cardiovascular health. Even so, several observational studies and short-term experiments have suggested an association between meal skipping and poor health.

In recent months, two new studies may help explain how skipping meals affects health.

The most recent study, published this month in the medical journal Metabolism, looked at what happens when people skip meals but end up eating just as much as they would in a normal day when they finally do sit down to a meal. The study, conducted by diabetes researchers at the National Institute on Aging, involved healthy, normal-weight men and women in their 40s. For two months, the study subjects ate three meals a day. For another eight-week period, they skipped two meals but ate the same number of calories in one evening meal, consumed between 4 p.m. and 8 p.m.

The researchers found that skipping meals during the day and eating one large meal in the evening resulted in potentially risky metabolic changes. The meal skippers had elevated fasting glucose levels and a delayed insulin response — conditions that, if they persisted long term, could lead to diabetes.

The study was notable because it followed another study earlier this year that found that skipping meals every other day could actually improve a patient’s health. In that study, published in March in Free Radical Biology & Medicine, overweight adults with mild asthma ate normal meals one day. This was followed by a day of severely restricted eating, when they ate less than 20 percent of their normal caloric intake, or about 400 or 500 calories a day — the equivalent of about one meal. Nine out of 10 study participants were able to stick to the eating plan.

After following the alternate-day dieting pattern for two months, the dieters lost an average of 8 percent of their body weight, and their asthma-related symptoms also improved. They had lower cholesterol and triglycerides, “striking” reductions in markers of oxidative stress and increased levels of the antioxidant uric acid. Markers of inflammation were also significantly lower.

The conclusion, say the authors of the more recent meal-skipping study, is that skipping meals as part of a controlled eating plan that results in lower calorie intake can result in better health. However, skipping meals during the day and then overeating at the evening meal results in harmful metabolic changes in the body.

Tis the season

November 22, 2007, 10:33 am

The Skinny on Holiday Weight Gain

Reports of your holiday weight gain have been greatly exaggerated. Media stories often suggest that the average person gains 7 to 10 pounds between Thanksgiving and Christmas. And in surveys, people say they gain, on average, about five pounds this time of year.

But several studies now show that the average weight gain during the winter holidays is just one pound.

The news isn’t all good. Most people don’t ever lose the pound of weight they put on during the holidays, according to a report in The New England Journal of Medicine. Since the average weight gain during adulthood is about one to two pounds a year, that means much of midlife weight gain can be explained by holiday eating.

For people who are already overweight, the holiday weight news is worse. Although the average gain is only one pound, people who are already overweight tend to gain a lot more. One study found that overweight people gained five pounds or more during the holidays.

And we start packing on that extra pound of holiday weight early in life. Researchers at the University of Oklahoma studied holiday weight gain among college students during the Thanksgiving break. The students were weighed the day before Thanksgiving, then weighed again about two weeks later. The average weight gain for the 94 students was about one pound. Students who were of normal weight gained about a half a pound during the period. Students who were overweight, meaning their body mass index was 25 or more, gained about two pounds.

Holly Hull, the lead researcher on the Oklahoma study, says Thanksgiving marks the beginning of a “high risk” time for the overweight. “I think the number of people who only overeat at the Thanksgiving meal is slim to none,'’ said Dr. Hull. “The holiday season doesn’t represent one day of overeating. You have this period that extends through the new year where there’s more alcohol, more snacks, more finger foods and appetizers that are energy dense.'’

Another Reason to Choose Whole Foods

Some Food Additives Raise Hyperactivity, Study Finds

By ELISABETH ROSENTHAL

Published: September 6, 2007

Common food additives and colorings can increase hyperactive behavior in a broad range of children, a study being released today found.

It was the first time researchers conclusively and scientifically confirmed a link that had long been suspected by many parents. Numerous support groups for attention deficit hyperactivity disorder have for years recommended removing such ingredients from diets, although experts have continued to debate the evidence.

But the new, carefully controlled study shows that some artificial additives increase hyperactivity and decrease attention span in a wide range of children, not just those for whom overactivity has been diagnosed as a learning problem.

The new research, which was financed by Britain’s Food Standards Agency and published online by the British medical journal The Lancet, presents regulators with a number of issues: Should foods containing preservatives and artificial colors carry warning labels? Should some additives be prohibited entirely? Should school cafeterias remove foods with additives?

After all, the researchers note that overactivity makes learning more difficult for children.

“A mix of additives commonly found in children’s foods increases the mean level of hyperactivity,” wrote the researchers, led by Jim Stevenson, a professor of psychology at the University of Southampton. “The finding lends strong support for the case that food additives exacerbate hyperactive behaviors (inattention, impulsivity and overactivity) at least into middle childhood.”

In response to the study, the Food Standards Agency advised parents to monitor their children’s activity and, if they noted a marked change with food containing additives, to adjust their diets accordingly, eliminating artificial colors and preservatives.

But Professor Stevenson said it was premature to go further. “We’ve set up an issue that needs more exploration,” he said in a telephone interview.

In response to the study, some pediatricians cautioned that a diet without artificial colors and preservatives might cause other problems for children.

“Even if it shows some increase in hyperactivity, is it clinically significant and does it impact the child’s life?” said Dr. Thomas Spencer, a specialist in Pediatric Psychopharmacology at Massachusetts General Hospital.

“Is it powerful enough that you want to ostracize your kid? It is very socially impacting if children can’t eat the things that their friends do.”

Still, Dr. Spencer called the advice of the British food agency “sensible,” noting that some children may be “supersensitive to additives” just as some people are more sensitive to caffeine.

The Lancet study focused on a variety of food colorings and on sodium benzoate, a common preservative. The researchers note that removing this preservative from food could cause problems in itself by increasing spoilage. In the six-week trial, researchers gave a randomly selected group of several hundred 3-year-olds and of 8- and 9-year-olds drinks with additives — colors and sodium benzoate — that mimicked the mix in children’s drinks that are commercially available. The dose of additives consumed was equivalent to that in one or two servings of candy a day, the researchers said. Their diet was otherwise controlled to avoid other sources of the additives.

A control group was given an additive-free placebo drink that looked and tasted the same.

All of the children were evaluated for inattention and hyperactivity by parents, teachers (for school-age children) and through a computer test. Neither the researchers nor the subject knew which drink any of the children had consumed.

The researchers discovered that children in both age groups were significantly more hyperactive and that they had shorter attention spans if they had consumed the drink containing the additives. The study did not try to link specific consumption with specific behaviors. The study’s authors noted that other research suggested that the hyperactivity could increase in as little as an hour after artificial additives were consumed.

The Lancet study could not determine which of the additives caused the poor performances because all the children received a mix. “This was a very complicated study, and it will take an even more complicated study to figure out which components caused the effect,” Professor Stevenson said.

Zero Doesn't Mean Zero

(If you know me, you know how adamant, almost fanatical, I am about avoiding hydrogenated and partially hydrogenated oils. You've probably heard my warnings and, hopefully, have been reading food labels at my urging. If not, please read the below article. Hopefully, the recent media coverage will help convince you. For more information on hydrogenated oils and their health risks, please search my blog (label: "trans fat") or do your own online search.)

Zero Trans Fat Doesn't Always Mean Zero

By STEPHANIE NANO, Associated Press Writer

Sunday, August 19, 2007

Stroll the aisles of any grocery store and you're sure to spot labels declaring "zero grams trans fat" on the front of snack foods, cookies and crackers. But does zero really mean there's NO artery-clogging fat inside?

Maybe, maybe not.

Federal regulations allow food labels to say there's zero grams of trans fat as long as there's less than half a gram per serving. And many packages contain more than what's considered one serving.

"The problem is that often people eat a lot more than one serving," said Dr. Dariush Mozaffarian of Harvard School of Public Health. "In fact, many people eat two to three servings at a time."

Those small amounts of trans fat can add up, said Michael Jacobson of the consumer advocacy Center for Science in the Public Interest. To find out if there might be some trans fat, he said shoppers can check the list of ingredients to see if partially hydrogenated oil — the primary source of trans fat — is included.

"When it says zero grams, that means something different from no trans fat," said Jacobson. His group has urged the government to bar food producers from using any partially hydrogenated oils at all.

The Food and Drug Administration began forcing food companies to list the amount of trans fat on nutrition labels of packaged foods in January 2006. That led many companies to switch to alternative fats.

Trans fat occurs naturally in some dairy and meat products, but the main source is partially hydrogenated oils, formed when hydrogen is added to liquid vegetable oils to harden them.

Consumer groups and health officials have campaigned to get rid of trans fat because it contributes to heart disease by raising levels of LDL or bad cholesterol while lowering HDL or good cholesterol. Fast-food restaurants are switching to trans fat-free oils and New York City and Philadelphia are forcing restaurants to phase out their use of trans fat.

The American Heart Association recommends that people limit trans fats to less than 2 grams per day.

Julie Moss of the FDA's Office of Nutrition, Labeling and Dietary Supplements, said the half-gram threshold for labeling was adopted because it is difficult to measure trans fat at low levels and the same half-gram limit is used for listing saturated fat. She said the FDA would soon be doing consumer research on trans fat labeling, including whether a footnote such as "Keep your intake of trans fat as low as possible" should be added to food labels.

Robert Earl of the Grocery Manufacturers Association said any trans fat in products labeled zero trans fat is likely to be far less than the half-gram threshold. For example, he said, a little partially hydrogenated oil might be used to help seasoning stick.

"I think the industry has been extremely responsive. Most of them were ahead of the curve to either remove or reduce trans fat in most food products," he said.

Earl said shoppers should be looking at the entire food label.

Jacobson is also concerned that people are focusing too much on the trans fat content alone, and not considering other ingredients such as saturated fat, which also raises the risk of heart disease.

"The bigger problem is foods that have no labels at all," Mozaffarian said, citing food served not only at restaurants, but at bakeries, cafeterias and schools.

New York resident Diana Fiorini said she's just recently started paying attention to labels. Holding a box of microwave popcorn at a Manhattan store, she scanned the label and was happy to see that it listed zero grams trans fat.

"I look at the labels. It's still hard to stop yourself when you know you should," she said.

My Opinion: Obesity is Contagious?

Firstly, I would like to say that this is a gross misuse of the word "contagious," and to me the study seems to be anecdotal science at best.

Perhaps the article should have began: Bad habits can "spread from person to person, much like a virus, researchers are reporting today. When a person gains weight, close friends tend to gain weight, too."

Consider the following paragraphs, and how they fail to support the word choice "contagious":

There was no effect when a neighbor gained or lost weight, however, and family members had less influence than friends.

Proximity did not seem to matter: the influence of the friend remained even if the friend was hundreds of miles away. And the greatest influence of all was between mutual close friends. There, if one became obese, the odds of the other becoming obese were nearly tripled.

If "contagion" in the true sense was a concern, then wouldn't proximity matter? If only genetics were to blame, then family members would have more, not less, influence than friends. Contagion, hardly. Think instead of influence.

Our parents might have been on to something (shocking!) when they were concerned about whether or not we were hanging out with the wrong crowd. They did not want us becoming desensitized to the other teens' bad habits: smoking, drinking, &c. In the case of gaining weight, perhaps the bad habits off less fit friends that are easy to assume would be larger portion sizes, snacking, extra helpings, and tempting but unhealthy food choices. People who are friends with each other tend to share common interests which are reinforced through shared experiences. If you're trying to become healthier and spending a lot of time with an unfit friend whose favorite activities include watching a videos or playing x-box, it wouldn't be surprising if you gained weight. This influence works both ways. A client mentioned that one of the pluses of her work environment was that her coworkers are fit and like to partake in group activities such as kayaking, hiking, and sports.

So don't panic when you read the headline about obesity being contagious. If obesity was truly a matter of infection and not the result of more complicated factors, wouldn't doctors, dietitians & nutritionists, and personal trainers be the first to fall ill? If you have friends who are obese don't worry about catching obesity from them, but be open to exposing them your positive influence and healthy lifestyle choices. Fitness and health can be catchy too.

I've highlighted some parts of the article (which I've included in its entirety following this post) that are interesting.

Controversial New York Times Article On Obesity

Study Says Obesity Can Be Contagious

By GINA KOLATA

Published: July 25, 2007

Obesity can spread from person to person, much like a virus, researchers are reporting today. When a person gains weight, close friends tend to gain weight, too

Their study, published in the New England Journal of Medicine, involved a detailed analysis of a large social network of 12,067 people who had been closely followed for 32 years, from 1971 until 2003. The investigators knew who was friends with whom, as well as who was a spouse or sibling or neighbor, and they knew how much each person weighed at various times over three decades. That let them examine what happened over the years as some individuals became obese. Did their friends also become obese? Did family members or neighbors?

The answer, the researchers report, was that people were most likely to become obese when a friend became obese. That increased a person’s chances of becoming obese by 57 percent.

There was no effect when a neighbor gained or lost weight, however, and family members had less influence than friends.

Proximity did not seem to matter: the influence of the friend remained even if the friend was hundreds of miles away. And the greatest influence of all was between mutual close friends. There, if one became obese, the odds of the other becoming obese were nearly tripled.

The same effect seemed to occur for weight loss, the investigators say. But since most people were gaining, not losing, over the 32 years of the study, the result was an obesity epidemic.

Dr. Nicholas Christakis, a physician and professor of medical sociology at Harvard Medical School and a principal investigator in the new study, says one explanation is that friends affect each others’ perception of fatness. When a close friend becomes obese, obesity may not look so bad.

“You change your idea of what is an acceptable body type by looking at the people around you,” Dr. Christakis said.

The investigators say their findings can help explain why Americans have become fatter in recent years — each person who became obese was likely to drag some friends with them.

Their analysis was unique, Dr. Christakis said, because it moved beyond a simple analysis of one person and his or her social contacts, and instead examined an entire social network at once, looking at how a person’s friend’s friend’s friends, or spouse’s sibling’s friends, could have an influence on a person’s weight. The effects, Dr. Christakis said, “highlight the importance of a spreading process, a kind of social contagion, that spreads through the network.”

Of course, the investigators say, social networks are not the only factors that affect body weight. There is a strong genetic component at work as well.

Science has shown that individuals have genetically determined ranges of weights, spanning perhaps 30 or so pounds for each person. But that leaves a large role for the environment in determining whether a person’s weight is near the top of his or her range or near the bottom. As people have gotten fatter, it appears that many are edging toward the top of their ranges. The question has been why.

If the new research is correct, it may mean that something in the environment seeded what many call an obesity epidemic, leading a few people to gain weight. Then social networks let the obesity spread rapidly.

It also may mean that the way to avoid becoming fat is to avoid having fat friends.

That is not the message they meant to convey, say the study investigators, Dr. Christakis and his colleague, James Fowler, an associate professor of political science at the University of California in San Diego.

You don’t want to lose a friend who becomes obese, Dr. Christakis said. Friends are good for your overall health, he explains. So why not make friends with a thin person, he suggests, and let the thin person’s behavior influence you and your obese friend?

That answer does not satisfy obesity researchers like Kelly Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University.

“I think there’s a great risk here in blaming obese people even more for things that are caused by a terrible environment,” Dr. Brownell said.

On average, the investigators said, their rough calculations show that a person who became obese gained 17 pounds, and the newly obese person’s friend gained 5. But some gained less or did not gain weight at all, while others gained much more.

Those extra pounds were added onto the natural increases in weight that occur when people get older. What usually happened was that peoples’ weights got high enough to push them over the boundary, a body mass index of 30, that divides overweight and obese. (For example, a six-foot-tall man who went from 220 pounds to 225 would go from being overweight to obese.)

While other researchers were surprised by the findings, Dr. Christakis said the big surprise for him was that he could do the study at all. He got the idea from talk of an obesity epidemic.

“One day I said, ‘Maybe it really is an epidemic. Maybe it spreads from person to person,’ ” Dr. Christakis recalled.

It was only by chance that he discovered a way to find out. He learned that the data he needed were contained in a large federal study of heart disease, the Framingham Heart Study, that had followed the population of Framingham, Mass. for decades, keeping track of nearly every one of its participants.

The study’s records included each participant’s address and the names of family members. In order for the researchers to be sure they did not lose track of their subjects, each was asked to name a close friend who would know where they were at the time of their next exam, in roughly four years. Since much of the town and most of the subjects’ relatives were participating, the data contained all that Dr. Christakis and his colleagues needed to reconstruct the social network and follow it for 32 years.

Their research has taken obesity specialists and social scientists aback. But many say the finding is pathbreaking, and can shed new light on how and why people have gotten so fat so fast.

“It is an extraordinarily subtle and sophisticated way of getting a handle on aspects of the environment that are not normally considered,” said Dr. Rudolph Leibel, an obesity researcher at Columbia University.

Dr. Richard Suzman, who directs the office of behavioral and social research programs at the National Institute on Aging, called it “one of the most exciting studies to come out of medical sociology in decades.” The institute financed the study.

But Dr. Stephen O’Rahilly, an obesity researcher at the University of Cambridge, said the uniqueness of the Framingham data will make it hard to replicate the new findings. No other study that he knows of includes the same kinds of long-term and detailed data on social interactions.

“I don’t want to look like an old curmudgeon, but when you come upon things that inherently look a bit implausible, you raise the bar for standards of proof,” Dr. O’Rahilly says. “Good science is all about replication, but it is hard to see how science will ever replicate this.”

“Boy, is the Framingham study unique,” Dr. O'Rahilly said.

Fitness and Parenting

All Child-Play and No Workouts Make Dad an Unfit Boy

Below is an excerpt for a great article in the NYTimes, which explores how becoming a parent can affect a person's workouts and fitness routines. Click here for the whole article.

THEY count among their ranks former marathoners and Ironmen, beached surfers and scuba divers. They lay off red meat and trans fats. They stay current on annual physicals and take their medications as prescribed.

And yet, this group of the once-fit finds itself at risk of becoming unhealthy and stacking on the pounds, because of one threat to their physical fitness: children.

...

Too many Americans have an all-or-nothing mentality toward fitness, said Dr. Harvey B. Simon, an associate professor at Harvard Medical School. If they can’t find a 45-minute window to bike, they don’t substitute by strapping on a BabyBjörn and taking a stroll.

“There is a very common misconception, one that is shared by physicians as well as by the public, that exercise requires a set amount of time and a formal program,” said Dr. Simon, who has two grown daughters. “I’m fond of saying that the aerobic exercise movement inspired the few and discouraged the many.”

Heart-healthy exercise can take many forms (gardening, car washing, stair climbing) and needn’t be done in continuous chunks to be beneficial, said Dr. Simon, the author of “The No Sweat Exercise Plan.”

Having three and a half hours of exercise to lose puts the study’s participants well above the norm, said Janet Fulton, an epidemiologist in the division of nutrition and physical activity at the Centers for Disease Control. After all, three-quarters of Americans don’t meet the minimum requirement of two and a half hours a week, she said.

Still, cutting back on exercise as a new parent has hidden costs. “Reducing their activity in this critical period of time is probably not going to help their adjustment in terms of a new person in their house,” Dr. Fulton said. “The long-term stuff, the chronic-disease risk reduction, is great, but immediately, they’re not getting the mental-health benefit.”

For those parents who can’t stomach exercise, however, their children serve as a bulletproof cop-out. When single or childless people say they have no time to exercise, it can ring hollow. But a mother of three? Watch those heads nod in sympathy.

Reluctant exercisers use parenthood as “an excuse to not do it at all,” said Dana Wood, a mother and the health and beauty director for Cookie, a parenting magazine.

How Does Your Waistline Matter? Let Us Count the Ways.

NYTimes Explores Obesity



AT age 39, with diabetes and high blood pressure in her family, Linda M. was starting to worry about her weight and its health consequences. She was 5 feet 6 inches tall and weighed 170 pounds, which placed her in the overweight category, according to the standard definition. Although she was not officially obese, she said, “I realized I was not at my ideal weight.”

But Linda was in for a surprise during an appointment last fall with Dr. Judith Korner, an obesity specialist at Columbia University. Instead of weighing her, Dr. Korner whipped out a tape measure and measured her waist.

It was 35 inches, putting her in a danger zone, Dr. Korner explained. An overweight woman with a waist 35 inches or larger, or an overweight man with at least a 40-inch waist, is at increased risk for diabetes and heart disease.
“That was an education,” said Linda M., who did not want her last name revealed because of her weight. “I did not realize that my waist determined my future risk.”

Obesity specialists differ on what measurements are best.

Linda’s body mass index, or B.M.I., for example, was 27.4, far from the obesity category, which starts at 30. She would have to weigh 185 pounds to have a B.M.I. that high. (For comparison, a man who is six feet tall and weighs 221 pounds is considered obese.)

If a doctor were to use B.M.I. exclusively to evaluate Linda, the conclusion would be that her weight was not a serious health risk. She had only one risk factor for heart disease — a high level of triglycerides — and the guidelines for B.M.I. say that overweight people need two factors, like high triglycerides and a high cholesterol or blood pressure levels, to be considered at serious risk.

B.M.I. has limitations. Muscular men might have high B.M.I.’s, which make them seem fatter than they are. Old people often have deceptively low B.M.I.’s because they have lost so much muscle in the aging process.

In Linda M.’s case, adding her waist measurement to her B.M.I. indicates a high health risk, according to guidelines published by the National Heart, Lung and Blood Institute. For Dr. Korner, the test is useful in assessing if people like Linda M. — overweight but in a gray zone — face a true health risk? If her waist had been less than 35 inches, Dr. Korner would have been less concerned.

Dr. Ned Calonge, chairman of the United States Preventive Services Task Force, said the panel preferred B.M.I. measurements to determine whether people are fat enough to place their health at risk. For most adults, he explained, B.M.I. “is more feasible or has better validity than other measures.”

But, Dr. Calonge added, it is not enough to simply diagnose someone as obese. The goal should be better health.

And the problem with testing for obesity, using B.M.I. or anything else, is that the sort of counseling most patients get from their doctors has not been shown to improve health, Dr. Calonge said.

“You now have a, quote, diagnosis,” Dr. Calonge said. And there is at least fair evidence from research that intense and expensive counseling about diet and exercise can help people lose weight and improve conditions that place them at risk for heart disease. But, he added, “it is uncertain whether less intense interventions have any impact at all.”

For Madelyn Fernstrom, the director of the Health System Weight Management Center at the University of Pittsburgh Medical Center, the goal of a medical exam is not to document how fat someone is but to rule out rare metabolic conditions that might be causing the weight problem. An exam also helps to determine whether there are associated medical conditions that should be treated, like diabetes or high cholesterol or blood pressure.

As for Linda M., waist measurement made the difference.

“After that, I got myself in gear,” she said. “I tried to eat less sugar and healthier snacks; I was more conscious of what I was selecting.”

She lost 20 pounds and a couple of inches from her waist. Her triglycerides are lower, yet still a bit high. But, she says, as she sees it, with a smaller waist, “I’m out of the danger zone.”
Talk To Your Doctor:

• What is my body mass index?
• What does it tell me about my health risk?
• Does my waist size put me at higher risk for medical problems?
• Are there metabolic conditions that might be causing me to gain weight?
• Where can I go for practical advice on how to improve my diet and an exercise regimen to lose weight?

Calorie Calculator

The New York Times has a feature that lets you estimate the number of calories you need to consume to reach your goal weight.

http://www.nytimes.com/ref/health/caloriecounter.html

Relax your Way to Injury-Free

Free the Mind and Fewer Injuries May Follow

By SALLY WADYKA

Published: January 4, 2007 in NY Times

IN a high school locker room in Worthington, Ohio, Sam Maniar handed a piece of string tied to a washer to each of the field hockey players sitting around him. He told the athletes to use their minds to move the washer from side to side, and he watched as each girl’s washer started to swing.

“By thinking about moving the washer, we send a message from the brain to the nerve receptors in our fingers to move the string attached to the washer,” said Dr. Maniar, a sports psychologist. “Most people are in total amazement. I use it show the connection between our thoughts and our bodies.”

Every athlete and coach knows that harnessing one’s mind can lead to feats of coordination and finesse on the field. But what many are just learning is that taking care of an athlete’s emotional health — and managing stress in particular — can help prevent injury.

“The research is there showing that high stress levels do increase the risk of getting injured, but few lay people realize the connection,” Dr. Maniar said.

Iona MacKenzie, 35, a triathlete and adventure racer in Boulder, Colo., believes that a period of undue tension in 2001 led to her back-to-back injuries. Ms. MacKenzie had just started a highly stressful job in Vancouver, was rowing competitively and was also dealing with a long-distance relationship that was financially and emotionally draining.

“I’d been rowing for about seven or eight years completely injury free,” she said. “But during that year I fractured a rib and soon after that healed, I injured my lower back. Both are fairly common injuries for female rowers, but I don’t feel like either would have happened if my body hadn’t been so weakened by how much stress I was under.”

The American College of Sports Medicine recently issued a consensus statement — a joint effort by about a dozen sports medicine practitioners, team doctors and sports psychologists — to inform team physicians, coaches and athletic trainers about the important link between stress and injury.

“This concept is not always welcomed with open arms in the sports community where athletes are taught to be tough,” said Dr. Stanley A. Herring, chairman of the consensus statement committee, a team physician for the Seattle Seahawks and a consultant to the University of Washington’s sports medicine department. “But you can’t tough your way through mental issues.”

Stress is an omnipresent problem, and the word is used to describe situations ranging from a long wait at Starbucks to fear of a terrorist attack. So why, one may argue, isn’t every athlete collapsing to the ground?

While the research has shown a consistent connection between significant negative life events — the end of a relationship, a death in family, the loss of job, failing in school — and the increased risk of injury, the key isn’t so much the stressful event itself, but how a person handles it.

“One man’s stress is another man’s vacation,” Dr. Herring said. “Those at risk are the ones whose stress exceeds the resources they have to cope with it.”

There are several explanations for how stress leads to injuries. According to Frank M. Perna, a psychologist and associate professor at Boston University, there may be multiple causes. “Studies have shown that when you’re stressed you don’t pay enough attention to visual cues,” he said.

That, for example, could cause a football player to miss something in his peripheral vision and be blindsided and injured. Physiologically, more stress means more stress hormones flowing through your body.

Cortisol, a stress-related hormone, decreases the immune response, Dr. Perna said. “Athletes who are training hard are breaking down muscle,” he said, “and cortisol will impede the body’s ability to repair muscles, making them more likely to get injured or exacerbate a chronic injury.”

STRESS also increases muscle tension, and tense muscles are more susceptible to tearing or can throw a person off balance and affect coordination. Studies have shown that during a single school year, one in six athletes is likely to suffer an injury serious enough to miss games. Other studies have reported that high stress levels make athletes at least twice as susceptible to injury.

The key to recognizing athletes at risk, the researchers agreed, is simply bothering to probe deeper.

“When the athlete gets a preseason physical, it shouldn’t be just about the ‘physical,’ ” Dr. Herring said. “Ask about what’s going on at home, how are things with their girlfriend, do they feel overwhelmed? And if the answers are concerning, it’s an opportunity to help them out.”

Dr. Margot Putukian, director of athletic medicine at Princeton University, said, “Most coaches don’t perceive mental health as something they have to worry about.”

For coaches who don’t have a sports psychologist on call, it is still easy enough to implement some stress-management techniques. Dr. Maniar said there was no reason a coach could not learn a few relaxation tips.

The American College of Sports Medicine recommends methods such as progressive muscle relaxation, a sequence of movements to tense and release muscle groups to bring tension levels down. Visual imagery, which involves picturing certain images to create a different physical state, can also be employed.

“For example, imagining being on a beach in the warm sand is likely to produce a physical shift that makes you feel more relaxed,” said David B. Coppel, a sports psychologist in Kirkland, Wash.

And doing deep, abdominal breathing helps change shallow breathing (a symptom of stress and tension) into deeper, rhythmic breathing.

MOST high school and college teams may not be sitting down for group yoga and meditation sessions in place of practice, but a few forward-thinking coaches are already heeding the College of Sports Medicine’s recommendations.

Terri Simonetti Frost, who coaches the field hockey team at Thomas Worthington High School in Worthington, Ohio, brought Dr. Maniar in teach her players imagery techniques. He also encouraged the girls to better communicate about what was causing tension in their lives.

“Communication is our biggest technique for coping with stress,” Ms. Frost said. “If a kid seems off during practice, I’ll call her aside and we’ll talk about what’s going on in her life.”

Ms. Frost gives her players an extra day off each week — they practice only four days — to help reduce stress. She also talks to them about their study habits and what is going on in their academic schedules so that they won’t feel overwhelmed by school and sports simultaneously.

“I think on a sort of subconscious level it may play a role in keeping the players healthy,” she said.

Although it is impossible to prove cause and effect, she noted that none of her players were injured this last season, and the team was undefeated in the regular season.

The doctors who put together the College of Sports Medicine consensus statement also said that common emotional reactions to injury — like loss of identity, fear, anxiety and depression — could affect a player’s recovery.

“But people who have learned coping strategies for dealing with setbacks in life can better handle the stress of being on the sideline,” Dr. Perna said.

Stephanie Heinsons, 21, a senior at Ohio State University who competes in equestrian events, regularly practices controlled breathing and imagery to help cope not only with the stress of competition but also with everyday life. “These techniques help to calm me down and force my focus back into the present,” she said.

If she skips her relaxation techniques, she is more likely to feel anxious and tense up. “When I take a deep breath and tell myself to focus on the present, I become calm,” Ms. Heinsons said. “That helps me like magic.”

Eat Well, Breathe Easy

Nutrition: A Healthy Diet May Keep Chronic Lung Disease at Bay

By NICHOLAS BAKALAR, New York Times

Published: May 22, 2007

A diet rich in fruits, vegetables, fish, poultry and whole grain foods may offer protection against chronic lung disease, a new study suggests, in addition to the other benefits of such a regimen.

Researchers studied more than 42,000 male health professionals enrolled in a long-term study that began in 1986. All filled out food frequency questionnaires, and the scientists ranked them by how closely they followed what the authors call the “prudent” diet, or how much they stuck to a “Western” diet dominated by refined grains, cured and red meats, sweets and French fries. The study appeared online May 15 in Thorax.

After adjusting for age, smoking and other factors, the scientists found that the more strictly a person followed the prudent diet, the lower the risk of chronic obstructive pulmonary disease, or C.O.P.D., the umbrella term for chronic bronchitis and emphysema. Compared with the one-fifth of people with the highest intake of foods from the prudent diet, the one-fifth with the lowest intake were twice as likely to suffer from newly diagnosed C.O.P.D.

At the same time, the one-fifth of men who followed the Western diet most closely were more than four and a half times as likely to be diagnosed with chronic pulmonary disease as the one-fifth who ate the least from that menu.

Raphaëlle Varraso, the lead author, said that fruits, vegetables and omega-3 fatty acids probably explained the protective effect, and that red meat, cured meat and French fries actively increased the risk. Dr. Varraso was at the Harvard School of Public Health when the study was done, and is now a researcher at the National Institute for Health and Medical Research in France.

The Benefits of Interval Training

from the NYTimes, May 3, 2007 http://www.nytimes.com/2007/05/03/fashion/03Fitness.html?ei=5070&en=9e74e98f3732c066&ex=1180065600&pagewanted=all

SOME gymgoers are tortoises. They prefer to take their sweet time, leisurely pedaling or ambling along on a treadmill. Others are hares, impatiently racing through miles at high intensity.

Each approach offers similar health benefits: lower risk of heart disease, protection against Type 2 diabetes, and weight loss.

But new findings suggest that for at least one workout a week it pays to be both tortoise and hare — alternating short bursts of high-intensity exercise with easy-does-it recovery.

Weight watchers, prediabetics and those who simply want to increase their fitness all stand to gain.

This alternating fast-slow technique, called interval training, is hardly new. For decades, serious athletes have used it to improve performance.

But new evidence suggests that a workout with steep peaks and valleys can dramatically improve cardiovascular fitness and raise the body’s potential to burn fat.

Best of all, the benefits become evident in a matter of weeks.

“There’s definitely renewed interest in interval training,” said Ed Coyle, the director of the human performance laboratory at the University of Texas at Austin.

A 2005 study published in the Journal of Applied Physiology found that after just two weeks of interval training, six of the eight college-age men and women doubled their endurance, or the amount of time they could ride a bicycle at moderate intensity before exhaustion.

Eight volunteers in a control group, who did not do any interval training, showed no improvement in endurance.

Researchers at McMaster University in Hamilton, Ontario, had the exercisers sprint for 30 seconds, then either stop or pedal gently for four minutes.

Such a stark improvement in endurance after 15 minutes of intense cycling spread over two weeks was all the more surprising because the volunteers were already reasonably fit. They jogged, biked or did aerobic exercise two to three times a week.

Doing bursts of hard exercise not only improves cardiovascular fitness but also the body’s ability to burn fat, even during low- or moderate-intensity workouts, according to a study published this month, also in the Journal of Applied Physiology. Eight women in their early 20s cycled for 10 sets of four minutes of hard riding, followed by two minutes of rest. Over two weeks, they completed seven interval workouts.

After interval training, the amount of fat burned in an hour of continuous moderate cycling increased by 36 percent, said Jason L. Talanian, the lead author of the study and an exercise scientist at the University of Guelph in Ontario. Cardiovascular fitness — the ability of the heart and lungs to supply oxygen to working muscles — improved by 13 percent.

It didn’t matter how fit the subjects were before. Borderline sedentary subjects and the college athletes had similar increases in fitness and fat burning. “Even when interval training was added on top of other exercise they were doing, they still saw a significant improvement,” Mr. Talanian said.

That said, this was a small study that lacked a control group, so more research would be needed to confirm that interval training was responsible.

Interval training isn’t for everyone. “Pushing your heart rate up very high with intensive interval training can put a strain on the cardiovascular system, provoking a heart attack or stroke in people at risk,” said Walter R. Thompson, professor of exercise science at Georgia State University in Atlanta.

For anyone with heart disease or high blood pressure — or who has joint problems such as arthritis or is older than 60 — experts say to consult a doctor before starting interval training.

Still, anyone in good health might consider doing interval training once or twice a week. Joggers can alternate walking and sprints. Swimmers can complete a couple of fast laps, then four more slowly.

There is no single accepted formula for the ratio between hard work and a moderate pace or resting. In fact, many coaches recommend varying the duration of activity and rest.

But some guidelines apply. The high-intensity phase should be long and strenuous enough that a person is out of breath — typically one to four minutes of exercise at 80 to 85 percent of their maximum heart rate. Recovery periods should not last long enough for their pulse to return to its resting rate.

Also people should remember to adequately warm up before the first interval. Coaches advise that, ideally, people should not do interval work on consecutive days. More than 24 hours between such taxing sessions will allow the body to recover and help them avoid burnout.

What is so special about interval training? One advantage is that it allows exercisers to spend more time doing high-intensity activity than they could in a single sustained effort. “The rest period in interval training gives the body time to remove some of the waste products of working muscles,” said Barry A. Franklin, the director of the cardiac rehabilitation and exercise laboratories at the William Beaumont Hospital in Royal Oak, Mich.

To go hard, the body must use new muscle fibers. Once these recent recruits are trained, they are available to burn fuel even during easy-does-it workouts. “Any form of exercise that recruits new muscle fibers is going to enhance the body’s ability to metabolize carbohydrates and fat,” Dr. Coyle said.

Interval training also stimulates change in mitochondria, where fuel is converted to energy, causing them to burn fat first — even during low- and moderate-intensity workouts, Mr. Talanian said.

Improved fat burning means endurance athletes can go further before tapping into carbohydrate stores. It is also welcome news to anyone trying to lose weight or avoid gaining it.

Unfortunately, many people aren’t active enough to keep muscles healthy. At the sedentary extreme, one result can be what Dr. Coyle calls “metabolic stalling” — carbohydrates in the form of blood glucose and fat particles in the form of triglycerides sit in the blood. That, he suspects, could be a contributing factor to metabolic syndrome, the combination of obesity, insulin resistance, high cholesterol and elevated triglycerides that increases the risk of heart disease and diabetes.

By recruiting new muscle fibers and increasing the body’s ability to use fuel, interval training could potentially lower the risk of metabolic syndrome.

Interval training does amount to hard work, but the sessions can be short. Best of all, a workout that combines tortoise and hare leaves little time for boredom.