Heat illness is also called sunstroke.  Your body normally cools itself by sweating. During hot weather, especially with high humidity, sweating just isn't enough. Your body temperature can rise to dangerous levels and you can develop a heat illness. Most heat illnesses occur from staying out in the heat too long. Exercising too much for your age and physical condition are also factors. Older adults, young children, and those who are sick or overweight are most at risk. Drinking fluids, replenishing salt and minerals, and limiting time in the heat can help.

Heat-related illnesses include:

• Heatstroke - a life-threatening illness in which body temperature may rise above 106° F in minutes; symptoms include dry skin, rapid, strong pulse and dizziness
• Heat exhaustion - an illness that can precede heatstroke; symptoms include heavy sweating, rapid breathing and a fast, weak pulse
• Heat cramps - muscle pains or spasms that happen during heavy exercise
• Heat rash - skin irritation from excessive sweating

(Centers for Disease Control and Prevention)

Overviews

• Frequently Asked Questions (FAQ) about Extreme Heat(Centers for Disease Control and Prevention).  Also available in Spanish

• Hyperthermia: Too Hot for Your Health (National Institute on Aging).  Also available in Spanish
• Extreme Heat(Federal Emergency Management Agency)

Latest News

• Relentless Heat Threatens Your Health(07/07/2010, HealthDay)
• How to Ride Out Dangerous Heat Waves(07/05/2010, HealthDay)
• Children, Elderly Need Protection from Soaring Temperatures(07/04/2010, HealthDay)
• More News on Heat Illness

Treatment

• Heat Cramps, First Aid(Logical Images)
• Heat Exhaustion, First Aid(Logical Images)
• Heatstroke, First Aid(Logical Images)

Prevention/Screening

• Extreme Heat: Tips for Preventing Heat-Related Illness(Centers for Disease Control and Prevention)
• Also available in Spanish
• Heat Exhaustion and Heatstroke(American Academy of Family Physicians)
• Also available in Spanish
• Heat Wave Safety Checklist(American Red Cross) - PDF

Specific Conditions

• Heat Injury and Heat Exhaustion(American Academy of Orthopaedic Surgeons)
• Heat Rash or Prickly Heat (Miliaria Rubra)(Logical Images)
• Heat Stress Resources for Workers(National Institute for Occupational Safety and Health)

Related Issues

• Dehydration(Mayo Foundation for Medical Education and Research)
• Heat Index(National Weather Service)
• Hot Weather and Cardiovascular Disease(American Heart Association)
• Hot-Weather Exercise: How to Keep Cool(Mayo Foundation for Medical Education and Research)

Video

• Heat Waves(Healthy Roads Media).  Also available in Spanish

Children

• Heat Rash or Prickly Heat (Miliaria Rubra)(Logical Images)
• How to Be Safe When You're in the Sun(Nemours Foundation)
• Parents' and Coaches' Guide to Dehydration and Other Heat Illnesses in Children(National Athletic Trainers' Association) - PDF

Teenagers

• Dehydration(Nemours Foundation).  Also available in Spanish
• Dehydration and Youth Sports: Curb the Risk(Mayo Foundation for Medical Education and Research)

Seniors

• Heat Stress in the Elderly(Centers for Disease Control and Prevention).  Also available in Spanish
• Hyperthermia: Too Hot for Your Health (National Institute on Aging).  Also available in Spanish
• Keep it Cool in Hot Weather (National Institutes of Health)

For more information, please contact a Lake Health Professional Librarian.

Developing Energy Pathways:  Aerobic Energy System

The oxidative system involves four methods to generate ATP:

ü      Slow glycolysis (aerobic glycolysis)

ü      Krebs cycle

ü      Electron transport chain

ü      Beta oxidation

The first method is slow glycolysis.  It comes into play when exercise is sustained for 1-3 minutes.  The break down of glucose consists of a series of enzymatic reactions.  The end result of the enzymatic reactions is ATP.  An individual glucose makes 2 pyruvate molecules and 2 ATP.  Pyruvate molecules enter into the Krebs cycle, but oxygen must be available for this to happen.  Click in this link for a clear understanding of the enzymatic reactions that convert proteins, fats, and carbohydrates into intermediate substances- How the Krebs Cycle Works.  In order for fats to enter the Krebs cycle they must go through a series of enzymatic reactions called beta oxidation.  The reactions condense free fatty acids to acetyl CoA and hydrogen. Acetyl CoA can now enter the Krebs cycle and from this state, fat metabolism continues the same course as carbohydrates.

The next and final step is for the electron transport chain to finish work started by the Krebs cycle.  The electron transport chain makes use of NADH and FADH 2 formed during glycolysis and the Krebs cycle to produce large amounts of ATP.  For a better understanding, click on this link about the Electron Transport Chain: The Movie.

In order for fat cells to enter the Kreb's cycle, the cells must go through a process called Beta oxidation.  The process starts with fatty acids or fat cells, in the form of Acyl-CoA molecules.  These molecules are broken down in mitochondria to make Acetyl-CoA, the entrance molecule for the Kreb's cycle.

Developing Energy Pathways:  Aerobic Energy System

The last energy system I’m going to discuss is the Aerobic Energy System.  When physical activity lasts longer than 2 minutes, the body begins to utilize the aerobic energy system.  This energy system consumes proteins, fats, and carbohydrate (glycogen) in order to make ATP. Development of an aerobic energy system must include various training intensities that improve the aerobic zone or target heart rate zone, which is listed as a percentage (60%- 80%) of maximum heart rate.  Energy efficient/recovery zone intensity is between 60%- 70%.  Training inside this zone improves general endurance and aerobic power.  The aerobic zone is 70- 80%, which helps advance the cardiovascular system.

Use the following as a guide for determining your intensity level:

Novice or low fitness level: 50% to 60%

Intermediate or average fitness level: 60% to 70%

Advanced or high fitness level: 75% to 80%

How to figure out your Aerobic Zone:

The easiest way to estimate your target heart rate is to use the maximal heart rate formula. Keep in mind, this formula does not take into consideration fitness level, medical conditions, or environmental factors that might affect your heart rate. Calculate your Max Heart Rate: (MHR = 220-age)

Target Heart Rate:  MHR x intensity level (from above) = THR

Example: 

220 - 32 years= 188 MHR (the fastest your heart can beat)

188 x .60= 112.8 beats per minute for intermediate fitness level

 Next blog will explain the break down of the Aerobic Energy System.

Developing Energy Pathways:  Anaerobic Lactate Energy System

The next energy system for discussion is the Anaerobic Lactate (Glycolytic) Energy System.  When the ATP-CP energy system is depleted the bodies’ only alternative is to use the stored glucose for ATP.  When glucose is broken down through anaerobic conditions, energy is produced. The breakdown of glucose produces pyruvic acid and hydronium ions.  Since oxygen is not available pyruvic acid is converted into lactic acid.  In the past, lactate or lactic acid was thought to be the cause muscle fatigue and soreness along with delayed nerve response in muscles.  However, we now understand the buildup of hydronium ions (H+) to be the cause muscle fatigue and soreness.  Researchers currently recognize lactate as a very dynamic substance. It is a key source of energy for many physical activities, it is formed by only one energy system (anaerobic lactate energy system), and will be utilized by a further energy system (aerobic energy system) in a different part of the body.  

Process of Anaerobic Lactate Energy System:

-         CP stores are depleted

-         Stored glucose is used as fuel in the absence of oxygen

-         Rapid glucose breaks down to form pyruvate acid molecules and hydronium ions

-         If oxygen is present, pyruvate acid molecules enter the mitochondrion to go through
oxidation (aerobic/ slow glycolysis) or if there is a lack of oxygen the pyruvic molecules are converted into lactic acid (anaerobic/ fast glycolysis)

-         The concentration of hydronium ions only increases if there is insufficient oxygen to the active muscles.  When this occurs the environment becomes very acidic causing muscle fatigue and soreness. 

-          During anaerobic glycolysis, the formation of 4 ATP is produced from 1 molecule of glucose.  2 ATP are used in the process, resulting in only 2 ATP molecules of energy from the process of glycolysis

The chart below provides a breakdown of how to develop your anaerobic lactate energy system.  This energy system requires high intensity and short recovery time.  

UV Safety Month is a great time to spread the message of sun, fun, and UV safety. Ultraviolet (UV) radiation is the main cause of skin cancer. UV rays can also damage your eyes. The sun releases energy (radiation) in many forms. The sunlight we see is one form. The heat we feel from the sun is another. Ultraviolet (UV) rays, a third type, are also invisible to the eye. UV rays cause sunburn. They can also damage your eyes and hurt your vision. Read More HERE.

Anyone can get skin cancer, but the risk is greatest for people with:

• White or light-colored skin with freckles
• Blond or red hair
• Blue or green eyes

You can take these steps to help prevent skin cancer:

• Stay out of the sun between 10 a.m. and 4 p.m.
• Use sunscreen with SPF 15 or higher.
• Cover up with long sleeves and a hat.
• Check your skin regularly for any changes.

Overviews

• Known Health Effects of UV(World Health Organization)
• Sun Damage(Logical Images)
• Tanning(Food and Drug Administration)
• UV Information: Understanding UVA and UVB(Skin Cancer Foundation)

Quick Guide to Healthy Living

• Protect Your Skin from the Sun

Personal Health Tools

• Skin Cancer Risk Tool
• UV Index

More Information (Health A-Z)

• Sun Protection
• Skin Cancer

Resources

• American Academy of Ophthalmology
• Centers for Disease Control and Prevention, Choose Your Cover, Skin Cancer Prevention campaign
• Centers for Disease Control and Prevention, Skin Cancer
• National Institutes of Health, National Institute on Aging, Information Center, AgePage: Skin Care and Aging
• National Institutes of Health, National Cancer Institute, Skin Cancer Home Page
• Occupational Health and Safety Administration, Protecting Yourself in the Sun
• U.S. Environmental Protection Agency, SunWise Kids School Program

Sources:          Healthfinder.gov

                        Medlineplus.gov

                        Prevent Blindness America

For more information, please contact a Lake Health Professional Librarian.

Why is my weight loss diet not causing me to lose weight?

New patients to my practice often say that they can't lose weight no matter what they do.  They chalk this up to a bad metabolism or to something that must be extremely dysfunctional about them.  Over the years, however, I'm hard pressed to remember anyone who was not able to lose weight once they began an effective diet.  No matter how impossible weight loss had seemed, it became possible once the diet was properly adjusted.  Naturally, this result assumes that the dieter follows the diet as prescribed.

Why then the frustration and why do diets seem to fail?  Here is what I've come to believe (followed by some suggestions that may help):

1. Diets Fail Because We Fail to Understand What They Are

I like to think of dieting as a completely unnatural act.  If you could revisit ancient times, you would not find any humans forcing themselves to lose weight.  Having a bit of extra fat would have conveyed a survival advantage, so why would anyone have wanted to get rid of it? Our twenty-first century bodies still behave this way.  In fact, they seem to completely ignore weight as we gain it. 

Knowing the body's propensity to correct imbalances, one would think that increasing fat would cause the appetite to shut down, or prompt the release of a cascade of hormones that would dissipate the excess. But that doesn't happen.  Perhaps the reason is this; since it was always a good thing to store extra fat, we never developed any mechanisms for aborting weight gain.

Since the body ignores our fat, how can we create weight loss?  We do it by recreating the ancient situation that would have forced the body to notice its own fat.  That situation would be a significant food shortage.  In actuality, a modern weight loss diet is simply the process of tricking the body into believing that there is a famine in the outside world.  Once the body gets the idea that there is very little food coming in, it suddenly wakes up to the presence of stored fat and starts to use it up.   This state of awakening was doubtlessly designed as a survival response hundreds of thousands of years ago.   Let's call this bodily state: "The Ancient Famine Response."

Next, let's think about what would have constituted normal eating for these same ancestors.  Since they hunted and gathered, they probably had ample food one day and very little another.  To adjust to this, human bodies developed a very flexible system for using food. If food is in short supply, the body can slow down , burn fewer calories, and be more efficient.  If we eat more, the body can speed up.   These mechanisms allowed our ancestors to stay at stable weight even when food intake fluctuated.  Let's call that the "Normal Ancient State".

Most of us start a diet with all intentions of following the rules exactly.  That works!  We lose weight because we are consistently telling the body that there is very little food coming.  We've mimicked the “Ancient Famine Response."   But we soon start to get creative.  We eat things which seem to be minor, but aren't on plan.  We eat a bit more than we should.  Or, we don't eat on some days and eat more on others.  All of these behaviors put us back into the "Normal Ancient State".  It's true that we are eating less than we did before the diet, but we are not losing. That's because food intake is intermittent and not sufficiently restrictive.  The body adjusts, lowers its burn and keeps weight stable, just as it's programmed to do.

Suggestion:  Pick a diet that you can follow to the letter.  Stay as compliant as you possibly can.  Resist the temptation to go off the diet on some days and resume on others.

2.  We Don't Have a Way to Get Calories Low Enough

In our practice, we create weight loss with a diet that has approximately 1200 calories.  Larger women and/or men may use 1500 calories or so.  This sounds simple, but it isn't.   Calorie counting is complete guesswork in the modern world.  Using packaged foods which have known caloric content can help.  Once you start eating out in restaurants, as most of us do, counting becomes impossible.   Although I do not like processed foods, dieting may be a good time to use them.  If you can construct a diet from bars, supplements, frozen diet entrees, low fat dairy products and other foods which have calories already listed,  you can be pretty sure of the number of calories you are getting.

In our program, we use three diet shakes or bars (each 160 cals) per day and have patients eat a dinner which is composed of a small piece of lean animal protein (chicken, fish, meat), a large mixed vegetable salad, a big portion of cooked green vegetables,  a piece of fruit, and a 100 cal fat free pudding.  You can work out your own plan, but knowing that you are getting the right calorie count is important.

Suggestion:  If You Aren't Losing, Check Your Calories.  Make more use of foods which have calorie labels.  Try to avoid eating out if it is scuttling your weight loss.

3. We Don't Get Our Insulin Low Enough

Insulin is a mega-important hormone for dieters because it stores fat.  It not only puts fat away into the fat cells, but it also stands guard outside the cells to make sure the fat stays put.  Only by lowering your insulin levels can you break down fat.  Imagine insulin as a jailer that keeps the prisoners trapped.  Put him to sleep and they can escape.

Insulin is made whenever we eat starch or sugar because those two things turn into blood sugar once they are absorbed.  (Insulin's other job is to control the levels of blood sugar).  Dieters have already intuited the role of insulin. What is the first thing they do when they start a diet?  They begin with salad and chicken breast.  They eliminate bread, pasta, crackers, rice and dessert.  Insulin goes to sleep and weight loss follows.  But before long, the carb addiction begins to howl.  That piece of pita doesn't have that many calories.  That rice cake is a diet thing, right?  Wrong.  This part isn't about calories.  Wake up your insulin enough and you won't lose weight.

Suggestion:  Keep starch and sugar to a bare minimum when dieting.  (This works for maintenance too!).

4. We Rely Too Much on Exercise as a Weight Loss Creator

Exercise is great.  I love it!  But alone, it will not cause weight loss (unless you are running the ultra-marathon or something).    Remember the Ancient Famine Response: unless you create a consistent state of calorie reduction, you won't lose.   In my practice I have many skilled tennis players, marathon runners, volley ball enthusiasts, and other athletes.  If exercise caused weight loss, they would not be visiting me to get off the 30 extra pounds they've accumulated.   Be especially careful with the temptation to over-exercise.  This can create hunger and entitlement (as in, "I earned that bag of M and M's").  Exercise by all means, but during weight loss, put most of your faith in calorie reduction that is consistent and calculable.

Suggestion: During weight loss, think of exercise as secondary to caloric reduction.

Remember this:  magazine covers would lead you to believe that weight loss is simple and that pretty much everyone in America is having their pounds "melt off".  This is the big lie.  Weight loss is tough and takes a tough effort.  What remains true is that the rewards for this effort are great; the endpoint incredibly worthwhile.  So keep at it and always congratulate yourself for taking on such an important and challenging task.

Depression has been found to be a significant risk factor for heart disease. So, when you are experiencing emotional pain, your heart may very well be “breaking”. The rate of depression among patients with heart disease is strikingly high, at approximately 20 to 30 percent compared to 2 percent among individuals who are not medically ill. Although many cardiac patients and, unfortunately, some of their physicians dismiss or minimize the effects of depression, it is a serious risk factor and complication for cardiac patients. Recent studies have shown that even moderate depression raised the rate of heart disease caused by obstructed coronary arteries by 60 percent and increase the rate of heart attacks by 50 percent. Although smoking, drinking, poor nutrition, and lack of exercise are important risk factors for cardiac disease, when researchers removed these factors from the equation, depression was the only remaining factor that contributed to this significant increase in heart attacks.

Unfortunately, the word depression has been overused and misused by society and therefore has lead to confusion about what it actually means. For example, it can be used to refer to mild annoyance: “I’m depressed because I can’t get tickets to the baseball game,” or to feelings that indicate major clinical depression: “There is no hope, therefore life isn’t worth living anymore”.

From a clinical standpoint, the word depression is used to describe negative emotions that can interfere with your relationships, your ability to enjoy life, and your physical health. Many people believe depression is only about feeling sad and that if they are not sad then they must not be depressed. However, you can feel irritable, anxious, or just plain disinterested with many parts of your life while suffering from depression. Many cardiac patients who are depressed admit to feeling that following their diet, taking their medication, and regularly following up with their medical appointments is not as important to them as it used to be. They appear to adopt an attitude of “Why bother?” or “What is the point?” Patients who are depressed can also experience difficulty with memory, which frequently interferes with their ability to follow the medical plans their doctors have set up for them. Therefore, one of the best things that can be done for your overall health and specifically that of your heart is to recognize signs and symptoms of depression and seek treatment.