Health Concerns For BELIEVERS
Contemporary Issues

(Shahid Athar , M. D.)


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HEALTH MAINTENANCE THROUGH EXERCISE AND NUTRITION


The human body is a fascinating but complex machine, different from man-made machines in that it continues to grow, change shape and work 24 hours a day and still can last up to 100 years or more if well cared for.

In order to maintain growth, development and strength, the body needs good nutrition, protein for building blocks, carbohydrates for energy, and fat for fuel. Minerals and calcium build bones and vitamins act as catalysts in the complex chemical reactions. Thus good, balanced nutrition is essential for the optimum development and performance of the human body. Most of the repair work of the day's wear and tear is done when the factory is shut down during sleep.

Exercise is needed to improve circulation, to lubricate joints, to strengthen bones, to improve oxygenation to the lungs and brain, and to increase the performance of the pump (heart). Routine exercise has been shown not only to decrease cardiovascular diseases, but also to lower blood pressure, control diabetes and prevent some cancers.


(Fig. 1)

NUTRITION FOR WEIGHT MANAGEMENT



A hormone specialist is frequently asked to deal with a common medical problem affecting millions of Americans and that is weight gain. When someone is 20% over his or her ideal body weight, that person is considered to be overweight. The ideal body weight is determined according to age and height. 100 pounds of weight is allowed for the first five feet of height. For each additional inch, we can add five pounds.
(Figs. 10, 11)
Therefore, for an average build person, if he is 5 feet 10 inches tall, his ideal weight would be 150 pounds. We can add 10% for a heavy frame man and subtract 10% for a thin-frame woman. Therefore, if your ideal weight is 150 pounds and you weigh 180 pounds, it is time to get concerned because you are overweight.

WHY LOSE WEIGHT?


Obesity is a worldwide problem. In the United States, 40% of adults and 15% of all children are overweight. Unused food is stored as fat. The stored body fat is linked to heart disease, high blood pressure, diabetes, gout and arthritis. It is estimated that approximately 4 million people per year die from these diseases, and death can be directly linked to obesity as a co-existing factor.


(Fig. 2)

Those who weigh 20% more than they should, cause their heart to work double. When an overweight person walks, the force across his knee is six times over his body weight. When he runs, it is ten times over his weight. Life expectancy figures for the overweight are grim. Only 60% of overweight people reach the age of 60, as compared to 90% of slim people.

These figures increase with the degree of obesity and associated risk factors. A person who is only 20% above his ideal body weight has a 130% cardiovascular mortality or the risk of dying, while if his weight increases to 40% above his ideal body weight, the risk increases to 260%. In addition, the overweight person could be considered a cosmetic problem especially in the female sex. Also, weight gain affects people psychologically because of the cosmetic factor and the fact that they feel they are less likeable and less attractive. This causes depression and a sense of withdrawal.


WHAT CAUSES WEIGHT GAIN?




(Figs. 3 and 4)

1. Hormonal Factors: Only 10% or less of overweight people have an underactive gland which may be due to thyroid or other glands, or there may be an endocrine and metabolic problem causing them to bum their fat at a lower speed than a normal person would. Therefore, before going on a crash diet, one should see a physician to make sure he does not have a hormone imbalance.

2. Dietary Factors: 90% of obesity is caused by overeating. This problem of overeating does not occur all at once. It is a problem which begins in infancy. We have established certain myths in our society that a Gerber baby is a happy baby. This is not true. Mothers tend to make sure that their children finish everything on their plates and keep on eating as a part of good nutrition. In fact, overeating leading to obesity is a part of malnutrition rather than good nutrition. When these children grow up, they continue the habit of finishing up everything on their plates and nibbling in between.

Most people eat more than they need. A normally active person needs about 15 calories per pound of weight to be normally active and healthy. Calories are the amount of energy produced by the food of a given quali- ty. However, if someone weighs 200 lbs., that means that he is eating about 3,000 calories rather than 2,200 calories, which is what his ideal requirement would be.

It is not only the quality of the food which causes overeating, but it is the quantity of food as such. Most people who are overweight indulge in eating excessive amounts of carbohydrates. Carbohydrates come from sugar and other sweet things as well as from starches. Carbohydrates are converted into glucose in the blood. A hormone called insulin, produced in the pancreas, lowers blood sugar as it diverts glucose to channels of energy.


(Figs. 5, 6)
Some overweight people have high amounts of insulin in their blood which lowers their blood sugar too much and causes an increase in appetite. Some have a delay in secretion of insulin which causes insulin to be released after the blood sugar has reached its peak and begins to drop. This late output of insulin also causes a reactive lowering of blood sugar leading to an increase in appetite. This in turn stimulates the brain center for appetite. The person eats again, increasing the blood sugar. This unused glucose is stored as fat.

Some people have a habit of compulsive eating whether or not they are hungry. Others have a tendency to start eating whatever they can put their hands on as soon as they come home for school or work. Many housewives are overweight because they may be depressed and have nothing with which to relieve their depression except food. Eating corrects their hypoglycemia and makes them feel better. Many housewives, especially in the upper class, are not very active, and therefore they do not have the same energy loss as a normal, hardworking person.

The body's caloric balance is like a savings account. Food deposits calories in the body. The body draws out calories to meet an urgent need. If more calories are put in than drawn out, the excess calories are stored in the body in the form of fat. Moderate to average exercise will cause a balance from the energy intake and output. However, for those house-wives and others who are not very active, the energy intake will be more than the energy output, and they will thus gain weight. Television contributes to our obesity. Watching television replaces
Physiological             Social and Cultural      Individual

 1. Early Learning        Food as a: reward        1. Eating Habits
    * Hunger cramps
     in empty stomach     Punishment               2. Food Preference
    * Treatment-Food      Entertainment



2. Late Learning          Habit                     3. Lifestyle
    *"Eat it because      Ritual
      it is good for you" Vehicle for Social        4. Knowledge
    * Clean Plate Baby    Interaction
    -"Eat it because you As Indicator of Wealth     5. Financial and
      have paid for it    and Social Status         Social Status



 Fig. 6: Determinants of Eating Behavior

physical activity and leaves the mouth free to snack. Attitudes toward food and fat must be changed.

In many cultures, obesity, especially in men, is considered a sign of prosperity, which is not true. He may look better but will die younger. Many of our cultures have celebrations and festivals which start and end with food. We should realize that this is the system we have devised, rather than part of the natural order of things. Neither sweets nor salt is essential to our body in the sense that the child is bom with neither taste. We develop the taste and sustain the taste, and we also increase the taste as it suits us.

WHAT TO DO WHEN WE ARE OVERWEIGHT



In the United States, there is an upsurge of weight loss clinics as well as gimmicks ranging from the diet pill and intestinal operations to jaw wiring and refrigerators with doors telling their openers, "Shut the door, you fat-so!" However, sensible dieting and behavior modification constitute the cornerstone of treatment for overweight


(Figs. 7, 8).
First of all, the quantity of food is the most important factor. Therefore one should calculate the amount of calories he is eating to keep his weight as it is now. As shown in the previous example, if one's weight is 200 pounds, then one must be eating 15 calories per pound of weight to keep one's weight as it is. Therefore, one should consume a 3,000- calorie diet.

If one weighs 150 pounds then one should eat 15 multiplied by 150 or 2,250 calories. If one want to lose weight to below 150 pounds, then one must eat a diet consisting of 10 calories per pound of one's ideal body weight. In any case, one should eat fewer calories than allowed if one wishes to lose weight and should eat more calories than allowed if one wishes to gain weight.

At the end of the essay, a 1,000-calorie diet is given as an example. There could be personal variations in the quality of food. In general, high-energy food with sugar and starches are not advisable. The most essential part of our food is protein which comes from meat, eggs, fish, chicken and beans. The next essential part of our food is carbohydrates which come in two forms-the slow-buming starches like rice and bread and the fast-burning kind like sugar. The second kind of carbohydrates is a no-no. The rest of the calories should come from fat, after allowing for carbohydrates and protein. Preferably, unsaturated fat, like vegetable fat. should be used rather than animal fat.

After careful calculation, one should devise his diet and should try to stay on it. It is easier to lose weight than it is to keep it off. Losing weight means a temporary change in eating habits. It is a hard fact that to make the weight loss permanent, the person must make a permanent change in his eating habits as well as increase his physical activity.

Many overweight people also have a habit of not eating breakfast. This is not a healthy practice in that it leads to a feeling of hunger in the latter part of the day and leads to overeating. Therefore, a balanced breakfast will prevent overeating in the latter part of the day.

My own suggestions for sensible eating habits includes the avoidance of snacks, starches, sweets, second helpings, sweet soft drinks, fried food, fat and salt.

A protein-sparing diet includes protein without carbohydrate or fat, along with plenty of fluids and vitamins. One can stay on this experimental diet for two to four weeks before assuming a more normal pattern. One can usually lose up to five pounds a week during fasting. This diet is recommended only under supervision.

We do not approve of the use of prepared foods, especially protein diets, either in liquid form or powder form, because these diets cause potassium deficiency and can lead to adverse effects on the heart. Similarly, appetite-suppressing drugs can be harmful, resulting in loss of sleep, dry mouth, palpitations and possibly further heart problems. Nutritional behavior and exercise are the key to successful weight management.

One should eat slowly and try to enjoy the meal rather than gulping food down rapidly. One should eat from a small plate rather than a large one, and eat only what he is hungry for or less. In-between snacking again is not recommended in the daily allowance because it will add to the total amount of calories taken in.

Behavioral counseling and learning from each of our experiences are very important. This is why group treatment is used in some weight clinics with success. It is the sense of competition that motivates people to lose weight and feeling rewarded both socially and psychologically. Enclosed is an example of a 1,200-calorie diet which an overweight person can start by himself. As he loses weight, he should adjust the diet.


AEROBIC EXERCISE FOR FITNESS


Weight control is the most popular reason for beginning an exercise program. Cardiopulmonary (heart and lung) health is one of the most important benefits of any aerobic exercise. Simply speaking, aerobics is any sustained exercise that forces the heart and lungs to pump a certain amount of oxygen into the muscles. This effort increases the efficiency of the cardiopulmonary system and of the metabolism of the muscles themselves.

Not all exercises are sufficiently intense to be aerobic. An aerobic exercise that improves the condition of your heart and lungs must have three characteristics: briskness, sustained and regular. During exercise, your heart must beat at 60 percent or more of its maximum rate. It should be sustained for at least 15 to 30 minutes without interruption, and it must be repeated at least three times per week.

Sixty percent of your maximum heart rate, the lowest point at which you begin to derive aerobic benefits from exercise, is called the aerobic threshold. Some types of exercise never get you to this threshold. Doing biceps curls all day, for example, would provide no aerobic benefit because this exercise does not use enough muscle mass. The heart does not have to work hard to pump the required blood. Other sports, such as swimming, use large muscle masses but still may not push one into the aerobic threshold. Because water buoys the body, many swimmers are not working as intensely as they think.

One can find out how much to exercise by keeping track of one's heart rate. Exercise above 75 percent of the maximum heart rate may be too strenuous unless one is in excellent physical condition. Therefore, for most people, the best activity level is 60 to 75 percent of the maximum heart rate, One's maximum heart rate is usually 220 minus his age. It can be determined more accurately by a treadmill test. The following chart lists recommended target zones.

Age    Target Zone 60-75%    Average Max.
(years)   (beats per min. )    HR 100%

20          120-150               200
25          117-146               195
30          114-142               190
35          111-138               185
40          108-135               180
45          105-131               175
50          102-127               170
55          99-123                165
60          96-120                160
65          93-116                155
70          90-113                150

MONITORING THE PULSE


To monitor one's heart rate, one should take his pulse rate at rest. If running, for example, walk fast for a few seconds. Count your pulse rate for 15 seconds, and then multiply that number by four to get the number of heart beats per minute. Well-trained individuals start recovering from exercise after 15 seconds, at which point the heart rate drops dramatically.

VARIOUS ATHLETIC ACTIVITIES AND EXERCISES


According to the American Heart Association, various athletic activities and exercises can be roughly grouped into three: those which are naturally vigorous, those which are moderately vigorous, and those which are not vigorous by nature. Exercises such as cross-country skiing, running, rowing and stationary cycling are naturally vigorous enough to condition your heart and lungs.

Swimming, bicycling, racquetball, soccer, tennis and walking are moderately vigorous. They can provide beneficial effects if performed briskly. Activities such as bowling, golf, softball, volleyball and football are by nature not vigorous enough. They still have certain benefits and can be enjoyable, help improve coordination and muscle tone, and help relieve tension. However, they neither condition the heart and lungs nor bum off many calories.



The chart given below has the average calories spent per hour by a 150-pound person involved in some selected activities. (A lighter person burns fewer calories. A heavier person burns more.

Bicycling 6 mph 240 cal.
Bicycling 12 mph 410 cal.
Cross-country skiing 700 cal.
Jogging 5 mph 740 cal.
Jogging 7 mph 920 cal.
Jumping rope per hour 750 cal.
Running in place per hour 650 cal.
Running 10 mph 1,280 cal.
Swimming 25 yds. /min. for an hour 275 lbs.
Swimming 50 yds. /min. for an hour 500 cal.
Tennis-singles per hour 400 cal.
Walking 2 mph 240 cal.
Walking 3 mph 320 cal.
Walking 4- mph 440 cal.

WARMING UP AND COOLING DOWN

Regardless of the type of activity, the exercise routine should include a short warm-up and cool-down periods. A typical session would include 5 minutes of warm-up, 15 to 30 minutes of exercising in one's target heart rate, and 5 minutes of cool-down.
One should begin exercising slowly to give the body a chance to limber up and get ready for more vigorous exercise. Start at a medium pace and gradually increase it by the end of the five-minute warm-up period. With especially vigorous activity such as jumping rope, jogging or stationary cycling, begin the warm-up period with gentle stretching exercises. Some experts do not recommend any pre-exercise stretching, since the muscles and ligaments at the resting body temperature are stiff and susceptible to injury from stretching. They recommend stretching after exercise when the body is relatively wan-n.
The cooling-down period is as critical to the safety and effectiveness of your workup as the warming-up. After exercising within your target zone, gradually slow down. For example, swim more slowly or change to a more leisurely stroke. One can also cool down by changing from jumping rope to walking. This allows the body to relax gradually. Abrupt stopping can cause dizziness. If one has been exercising strenuously, waste products build up in the muscle cells. This caus6s sore muscles. The cooling-down period allows for the removal of this waste product. (Fig. 9)

ALWAYS CONSULT THE DOCTOR FIRST

Before getting involved with any vigorous activity, it is advisable to check with your doctor, particularly if you are over 40 or have a medical condition that might need special attention.


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 Fig. 11: Ideal Body Weight for Women
 Metropolitan Height-Weight Tables Desirable for Men*
 Height          Small Frame         Medium Frame              Large Frame


 5"2"            128-134             131-141                   138-150
 5"3"            130-136             133-143                   140-153
 5'4"            132-138             135-145                   142-156
 515"            134-140             137-148                   144-160
 5'6"            136-142             139-151                   146-164
 5'79'           138-145             142-154                   149-168
 5'8"            140-148             145-157                   152-172
 5'9"            142-151             148-160                   155-176
 5910"           144-154             151-163                   158-180
 51 1 1"         146-157             154-166                   161-184
 6'0"            149-160             157-170                   164-188
 6@l@9           152-164             160-174                   168-192
 6'2@l           155-168             164-178                   172-197
 6@3"            158-172             167-182                   176-202
 6'4"            162-176             171-187                   181-207



Frame size for men**
Height in 1 inch heels



5'2" to 5'3"
5'4" to 5'7"
5'8" to 5@ II"
6'0" to 6'3"
6'4"



Elbow breadth for medium frame



2 1/2" to 2 7/8"
2 5/8" to 2 7/8"
2 3/4" to 3"
2 3/4" to 3 1/8"
2 7/8" to 3 1/4"



 * Weights at ages 25 to 59 based on lowest mortality.  Weight in pounds according to frame (in indoor
 clothing weight 5 lb., shoes with I" heels).
 ** Elbow breadth is measured with the forearm upward at a 90 degree angle.  The distance between
 the outer aspects of the two prominent bones on either side of the elbow is considered to be the elbow
 breadth.  Elbow breadth less than that listed for medium frame indicates a small frame.  Elbow
 breadth greater than that listed for medium frame indicates a large frame.
 Courtesy of Metropolitan Life Insurance Company.  Reprinted with permission.
 Fig. 10: Ideal Body Weight for Men



Metropolitan Height-Weight Tables Desirable for Women*
Height      Small Frame     Medium Frame       Large Frame

4'10"       102-111         109-121            118-131
4'1 1       103-113         111-123            120-134
5'0@'       104-115         113-126            122-137
59'1"       106-118         115-129            125-140
5"2"        108-121         118-132            128-143
5"3"        111-124         121-135            131-147
5'4"        114-127         124-138            134-151
5'5"        117-130         127-141            137-155
5'6"        120-133         130-144            140-159
5'7"        123-136         133-147            143-163
5'8"        126-139         136-150            146-167
5'9"        129-142         139-153            149-170
5'10"       132-145         142-156            152-173
5'1 1       135-148         145-159            155-176
6'0"        138-151         148-162            158-179



Frame size for women**
Height in I inch heels



4'10" to 4'11"
5'0" to 5'3"
5'4" to 5'7"
5'8" to 5'11"
6'0"



Elbow breadth for medium frame



2 1/4" to 2 1/2"
2 1/4" to 2 1/2"
2 3/8" to 2 5/8"
2 3/8" to 2 5/8"
2 1/2" to 2 3/4"



 * Weights at 25 to 59 based on lowest mortality.  Weight in pounds according to frame (in indoor
 clothing weighing 3 lb., shoes with 1" heels)
 ** Elbow breadth is measured with the forearm upward at a 90 degree angle.  The distance between
 the outer aspects of the two prominent bones on either side of the elbow is considered to be the
 elbow breadth.  Elbow breadth less than that listed for medium frame indicates a small frame.
 Elbow breadth greater than that listed for medium frame indicates a large frame.
 Courtesy of Metropolitan Life Insurance Company.  Repfinted with permission.


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 Fig. 12: Calorie Guide

 FAST FOODS CALORIES                                 WHOLESOME FOOD CALORIES
 McDonald's
       Egg McMuffin                312               1 cup Yogurt            80
       Hamburger                   249               1 cup whole milk        170
       Double Hamburger            350               1 cup skim milk         80
       Cheeseburger                309               1 small apple           40
       Quarter Pounder             414               1 cup watermelon        40
       Quarter Pounder
            with cheese            521               1 small orange          40
       Big Mac                     557               1/2 small grapefruit    40
       Filet-O-Fish                406               3/4 cup strawberries    40
       French Fries                215               1 slice bread           70
       Strawberry Shake            315               1/2 cup cereal          70
 Pizza Hut
       Pizza-Cheese
            Thick Crust            1030              1 oz cheese             73
       Pizza-Thin Crust            1005              1/2 cup carrots         40
       1/2-13" thick crust           900             1/2 cup cucumbers       40
       1/2-15" thin crust          1150              1 1/2 cups pl. pop      70
 Arby s
       Junior Roast Beef           240               6 Saltine Crackers      70
       Regular Roast Beef          429               1 Baked Potato          70
       Super Roast Beef            705               1/3 cup corn            70
 Hardee s
       Hamburger                   250               1 oz slice chicken      73
       French Fries                240               1/4 c. cottage chees    70
 Burger King
       Whopper                     630               1/2 banana              40
       Fish Sandwich               744               1/2 cup applesauce      40
       Cheeseburger                305               12 grapes               40
       Chocolate Shake             365               1/2 c orange j.         40
 Kentucky Fried Chicken
       One Drumstick               220               1 slice cold cuts       73
       2-piece original dinner     595               2 Thl peanut butter     73
       3-piece original dinner     830               6 small nuts            45
 Dairy Queen
       Large Cone                  340               1/2 bagel               70
       Small Sundae                190               1/2 cup pineapple       70
       Banana Split                580               2 Thl raisins           40
       Onion Rings                 300               1 med peach             40
       Chili Dog                   330               1/2 English Muffin      70
       Ice Cream Sandwich          190               1/4 Cantaloupe          40
 Dunkin Donuts
       Plain Cake Donut            240               1/2 cup broccoli        25
       Plain Honey Dipped          260               1/2 cup cauliflower     25
       Plain Roll with Glaze       250               1/2 c. grapefruit j.    40
       Chocolate cake donut        240               1/2 c. mashed pot.      70
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 Fig. 13: Daily Meal Plan

Daily Meal Plan/1500 Calories



 Carbohydrate: 179 g             48% of total calories
 Protein: 74 g                   20% of total calories
 Fat:     54 g                   32% of total calories
 These two menus show some of the ways the exchange lists can be used to add variety to
 your meals.  Use the exchange lists to plan your own menus.



 Breakfast
 2 Starch/Bread
   (List 1)
 1 Fruit (List 4)



 1 Milk (Lost 5)

 Lunch
 2 Starch/Bread
 2 Meat (list 2)



 Sample Menu 1
 1/2 c bran flakes cereal
 I slice whole wheat toast
 1/2 banana



8 oz. skim or 1% milk



 2 slices whole wheat bread
 2 oz. lean beef



 Fruit (List 4)
 Fat (List 6)



 Dinner
 2 Starch/Bread
 3 Meat (List 2)
 1 Vegetable
 1 Fruit (List 4)
 2 Fat (List 6)



Evening Snack
 1 Starch/Bread
 1 Milk (List 5)



 1 apple
 1 Tbl. reduced-calorie
 mayonnaise or 1 tsp.
 margarine



Sample Menu 2
1 bagel (whole wheat or pumper.)



 3/4 cup mandarin oranges, drained
 and mixed with 1 cup nonfat lemon
 yogurt
 1 Tbl. cream cheese



2 Starch/Bread     2 slices whole wheat bread 2 slices rye bread
2 Meat (list 2)    2 oz. lean beef              2 oz. turkey breast
 I Vegetable (List 3) Carrot sticks and *radishes Sliced tomato, *lettuce on sandwich



 2 fresh plums
 1 Tbl. reduced-calorie
 mayonnaise



 1 small dinner roll     1 small dinner roll
 3 oz. baked chicken     1 (6") ear corn on cob
 1/2 cup cooked broccolil/2 cup green beans
 1 1/4 cup strawberries I cup cantaloupelhoneydew melon salad
 I tsp margarine         I tsp margarine for corn
 1 Tbi regular dress.    1 Tbi slivered almonds for
 *Green salad            green beans



 3 graham squares       1 oz. puffed wheat or rice cereal
 8 oz. skim or 1 % milk 8 oz skim or 1 % milk

* From List 7-Free Foods

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