Eyeworld

EW NEWS & OPINION 20 January 2017 by J.C. Noreika, MD, MBA Insights healthier oils, potential benefit is squandered. Having read this far, you may wish to consult Dr. Dariush Mozaffarian's comprehensive "Di- etary and Policy Priorities for Car- diovascular Disease, Diabetes, and Obesity" published in the January 11, 2016 issue of Circulation. It ana- lyzes the latest on fats, carbs, genet- ically modified foods, dastardly SSBs (sugar sweetened beverages), salt, vitamins and supplements (spoiler alert: unless you suffer from scurvy or pellagra, don't bother), coffee, and alcohol. He applauds personal fitness devices, stating, "many incor- porate established behavior-change strategies such as setting proximal, targeted goals; self-monitoring; feed- back; and peer support." Mozaffarian's article and a Fitbit is all you need, no resolutions required. Happy New Year and, yes, you're welcome. EW Reference 1. Jakicic JM, et al. Effect of wearable tech- nology combined with a lifestyle intervention on long-term weight loss: The IDEA random- ized clinical trial. JAMA. 2016;316:1161– 1171. 2. Khera AV, et al. Genetic Risk, Adherence to a Healthy Lifestyle, and Coronary Disease. NEJM.org. Nov. 13, 2016. Editors' note: Dr. Noreika has practiced ophthalmology since 1981 and has been a member of ASCRS for more than 35 years. Contact information Noreika: JCNMD@aol.com of Medicine provides encouragement. In an article appearing online on November 13, 2016, 2 55,685 partic- ipants in three prospective cohorts and one cross-sectional study followed over 20 years demonstrat- ed that a healthy lifestyle mitigates the genetic determinants of coro- nary heart disease (CAD) across all risk categories. Furthermore, it was found that an unhealthy lifestyle negates genetic advantage. In 1957, the journal published eminent cardiologist Paul Dudley White's presentation to the Massa- chusetts Medical Society, "Genes, the Heart, and Destiny." Since then, more than 50 genetic loci have been linked to CAD; no single gene determines heart disease. Genetics and environmental factors contrib- ute independently. Folks at highest genetic risk gain the most from lifestyle modification. DNA need not be one's destiny. What constitutes healthy nutri- tion? A moving target for decades, the science is advancing rapidly. The Mediterranean Diet seems a winner because of its felicitous effects on hypertension, glucose-insulin ho- meostasis, blood lipids and lipopro- teins, endothelial cell function, and even gut microbes. The malefactors? Tobacco, simple sugars, industrial trans fats, and refined cereals. Meats, cheeses, and eggs? Depends on whether they are consumed in addi- tion to or in place of the miscreants. Ironically, "fat free" offerings such as salad dressings and deli meats are not what they appear. By substi- tuting starches, sugars, and salt for quality of life, leverage against the Reaper? The Journal of the American Medical Association 1 published a 2-year follow-up of the IDEA (Inno- vative Approaches to Diet, Exercise, and Activity) study. The National Institutes of Health and National Heart, Lung, and Blood Institute funded it. Half of the subjects were assigned a BodyMedia FIT Core Tracker and monitored through a website. The control group was instructed to self-monitor physical activity and diet via a different web- site. Voila! Although 120 of the 471 participants were lost to follow-up, those remaining shed weight. Potentially skewing the results, the dropout rate may impute to the 300 minutes of moderate-to-vigor- ous activity prescribed each week. That's almost 45 minutes a day potentially spent "Keeping Up with the Kardashians." To the astonishment of the investigators, the self-monitoring group lost more weight than the technologically enhanced group, 5.9 vs. 3.5 kgs (13 vs 7.7 lbs for us metrically challenged). The dismay in Cupertino and other tech-in- fatuated communities must have been unnerving. Lead author John Jakicic, PhD, professor and chair, Department of Health and Physical Activity, University of Pittsburgh, questioned the study's implications. Who benefits from these devices? How to keep people using them? Do the devices better prevent weight gain or encourage weight loss? Left unasked, could success depend on a covert benchmark of obsessive compulsiveness? Mazlow's hierarchy states that physiological needs including the requirement for food are most basic. If a person dissipates critical calories by walking robustly, might his des- tination, even subliminally, feature the golden arches? Might the study's results suggest B.F. Skinner and operant conditioning? If a person infallibly documents 45 minutes of sweat-soaked activity, did he not merit those Double-Stuf Oreos? Or is it merely deterministic? It doesn't make any difference how we docu- ment since we're gonna die anyway. Aging Americans average a pound weight increase per year. This is consistent with as little as 50 su- perfluous calories per day, about four Doritos. But the New England Journal A new year, the promise of a fresh start, and all the revocable resolve to eat smarter, exercise regularly, and realize a healthier lifestyle "Now there are more overweight people in America than average-weight people. So overweight people are now average. Which means you've met your New Year's resolution." –Jay Leno N othing is more inevitable than the rite of making New Year's resolutions— except breaking them. Alexander Pope's poem, "An Essay on Man," is spot on: Hope does spring eternal. Why else get out of bed in the morning? Life can al- ways be improved, configured closer to the ideal. And what better time to start again on the path to perfection than the advent of a new year, the unblemished calendar leaf, Janus looking both backward and forward? We will eat healthily, exercise habit- ually, temper our ventral striatum's craving for refined sugar, bad fats, and nicotine. Maybe even endow the kids' college fund. TV's inescapable diet spots after the holidays are intentional. Thanks- giving dinner kicks off the festivities, and Americans can consume more than 4,500 calories at that single sit down, according to the Calorie Control Council. And the fueling continues. Americans now gorge past New Year's Day. Why get serious about energy intake when Super Bowl Sunday beckons? Hope? You received a personal fitness device for Christmas, a Fitbit Charge or a Garmin Vivosmart. If you were extra nice, you may have found an Apple Watch under the tree. Short of measuring the length of telomeres, the Apple Health app tracks enough parameters to expose how irredeemably out of shape you are. Talk about big data! Can we not expect better outcomes, a higher Pope, hope, and a better way J.C. Noreika, MD, MBA

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