Monthly Archives: March 2017

Are Corporate Shut-In’s as Vulnerable to Vitamin D Deficiency as Nursing Home Residents?

I live near a nursing home and regularly see the staff coming in and out during their shift change when I walk past. What I have not seen, despite the warm, sunny weather, are residents sitting outside in the garden, or being pushed in a wheelchair.

This is not surprising. Few nursing homes have the sufficient staff to permit taking residents outside, and so rely on visitors to do so. The residents themselves often prefer to stay inside. An elderly aunt of mine always had an excuse as to why she did not want me to take her out when I visited. I wanted to take her for a stroll in her wheelchair, but she preferred staying in.

One consequence of being a “shut-in” in a nursing home has been noted for years: a significant decrease in vitamin D levels because of the absence of exposure to sunlight.  The predictable osteoporosis, bone breakage from falls, and decreased mobility affects quality of life, making many unable to move independently, and so is linked to increased mortality. Vitamin D supplementation is strongly recommended, and shown in many studies to be effective in reducing this vitamin deficiency effects on bone strength.

But what about the staff? The nursing staff who leave the residence early in the morning, sometimes just as the sun rises, are going home to sleep. They will be back the next evening, but even though their time off is during the day? The need to rest for at least 7 hours of sleep and the necessity of managing their daily obligations leaves little time for outside exposure to sunlight. This, of course, is especially true during the short hours of daylight during the late fall and winter. Depression has a high incidence among shift workers, and their failure to be exposed to sufficient sunlight has been suggested as one possible cause.

Those who work a traditional daytime shift should not be vulnerable to vitamin D deficiency due to the absence of sunlight, but is this really true? The reality is that many are stuck in their offices from sunrise to moonrise and later. Exposure to the sun is limited to weekends and, in some employment situations, such as law associates (recent graduates from law school) priority to work supersedes any weekend plans (including going outside.) These employees could be described as ‘corporate shut-ins.’ They may be tethered to the “clock” that is tracking their billable hours, and like a galley slave chained to his oars, will not be released until their supervisor (task master) permits time off. Whatever leisure time they have is spent carrying out the essential tasks necessary for their daily life such as buying food, doing laundry, paying bills, and maybe cleaning their apartments.

As we have seen, clinicians are worried (and rightly so) about the low vitamin D levels of nursing home residents, at home elderly shut-ins, and anyone else who is unable to obtain regular exposure to sunlight.  But look in vain for concern about corporate shut-ins who don’t see the sun from Sunday to Saturday during the months of year when daylight is scarce.  According to Dr. Barbara Gilchrest, who discussed vitamin D status at a recent American Academy of Dermatology meeting in Orlando, sun and diet should be enough to supply adequate levels of this essential nutrient for most patients. But can her advice be applied to those whose exposure to sun is severely limited, and whose diet lacks vitamin D fortified foods?

In an ideal work setting, shift workers would be advised on how to eat to minimize the health problems associated with their work schedule such as obesity, high blood pressure, diabetes and depression. Taking vitamin D supplements or finding time during the day to go outside and get some sunshine might be suggested. Much of this advice, however, comes not from the workplace or health care providers, but from anecdotal reports posted on Internet sites by those who also do this type of work.

But even less advice is given to daytime employees whose work hours are long and who may go days without any time off. They will not find bottles of vitamin D on their desk, nor will their supervisors encourage them to go outside during lunch to get some sun. Indeed, they are encouraged not to leave the building. And the meals provided in these organizations so they can work late are probably not planned to ensure that they consume vitamin D fortified foods.

We know already the long-term health consequences of nursing home residents who are shut-ins and get no sun exposure. So too, we know the long-term health consequences of shift workers who rarely see the sun.

We do not yet know the long-term health consequences of the corporate shut-in, the Silicon Valley twenty-four hour programmer, the investment banker who works during Asian, European and American time zones, or the surgical resident who arrives at the hospital at 5:30 AM and leaves at midnight. They, like the nursing home resident, have too little exposure to the sun. Do we have to wait until this generation of workers ages into the nursing home before we start to worry about their vitamin D status?

Research Cites Supportive Available Upon Request.

Can Being on a Committee Make You Overeat?

The neighborhood association meeting started out benignly enough, with a non-contentious minutes read and acceptance, followed by people chitchatting as the chairperson droned on about some street maintenance issue. Someone had placed bowls of snack food on the table, along with diet and non-diet sodas, but all were ignored. About 20 minutes into the meeting an agenda item launched agitated discussions with people talking over each other and, when they couldn’t be heard, muttering to themselves. Just as suddenly hands dipped into the bowls of pretzels, chips, nuts, and crackers and cups of soda poured and gulped. Some people were talking through mouthfuls of chips as they attempted to enter the conversation and others, who were shut out, stuffed more food in their mouths.

The committee meeting was a living poster for stress-induced eating.

What was a little surprising was that the gobbling of snacks occurred in public. We tend to assume that those among us who resort often or even infrequently, to emotional overeating, do so in private. The ice cream, cookies, chicken fingers, pork rinds, or doughnuts are usually eaten alone or in the company of people who are sympathetic and supportive of the problem driving the eating.  But the behavior of this group shows that if the provocation is sufficiently strong, the eating response may be immediate, even if embarrassingly visible to others.

This is not to say that people in groups don’t overeat. Watch people at a meal listening to a speaker as they eat. Their interest in their food increases in proportion to their boredom. If a speaker notices that the members of the lunch or dinner audience are attempting to eat the crumbs of the roll from the tablecloth, it’s very clear signal that he or she ought to wrap up the talk immediately.

But people at the committee meeting were not eating out of boredom; they were eating because of stress. Each member of the committee felt that he or she had to influence the outcome of the discussion, and many were afraid that the outcome would not be to their advantage.

Were they aware of how much they were eating? If they had been asked to fill out a food diary a few hours later, would they have reported eating three handfuls of pretzels or nuts, or drinking 10 ounces of soda? Probably not.

Did the eating influence the intensity of the discussion?  The act of putting food in one’s mouth may have been somewhat calming, just as giving a whining child pieces of breakfast cereal to eat has a distracting and calming effect. And obviously chewing somewhat dry food made it hard to shout out comments without spraying a fellow committee person with bits of pretzels or chips.

The mainly carbohydrate snacks would have had a calming effect—if the meeting had gone on long enough for the food to be digested and serotonin to be made. But that would have taken at least another half an hour, and the meeting broke up before then.

Stress associated with group interaction is usually overlooked among the many triggers inducing overeating. And there are unspoken rules about eating behavior in the corporate culture that probably deem any unrestrained eating at a meeting as unprofessional even when food is available? If someone at a lunch meeting begins to munch on several chocolate chip cookies brought in with the sandwiches, others will notice and wonder at his or her lack of control. There is stress most certainly, but if it generates overeating, it is usually done afterward, in private. I once had a client whose presentation to her team was so criticized that she went to a gourmet chocolate shop in the lobby of her office building, bought five pounds of chocolate and ate it all in her office (with the door closed).

The advice I gave her might, however, be useful to those attending future meetings of committees where emotional discomfort is inevitable: Eat proactively to reduce future stress. She was to eat a small, non-fat carbohydrate, such as half a plain bagel, 30-45 minutes before going into her meetings, so that the serotonin made after she consumed the carbohydrate would be a little calming.

If my fellow neighborhood association members had followed the same advice would there have been a quieter, more restrained discussion? If they had “armed” their brain with more serotonin before the meeting, would they have ignored the snacks on the table?

But of course there is another solution to the problem of committee meeting-induced overeating: stay home.

 

How Much Vigorous Exercise Will Prevent You From Dying?

Two very busy professionals I know took some time off last Sunday to go cross-country skiing. The snow was mushy from a recent thaw, and the legs of the skiers a bit wobbly but, according to my friends, it was a vigorous workout and welcome relief from their 80-hours week of work. They had fun, but they also were doing good things for their health. Like most too busy people, fitting physical activity into the workweek is like squeezing a suitcase into an overfilled overhead bin on an airplane. Often it is impossible to do it. A forty-something year old paralegal whose commute to work on a good day takes over an hour, told me that she is lucky because her workday runs only from 8:30 to 6. After she picks her children up at their nearby after school program, drives home, gets dinner ready, does the laundry and other household chores, helps the kids with their homework, and takes a few minutes to talk to her husband…. she is ready for bed, not for a treadmill. The lawyers in the office are lucky if they leave by 9 p.m.

The weekend may be the only time when a few hours can be used for exercise. But until recently, experts have said that exercising over only two days was insufficient to have much impact on cardiovascular health and eventually longevity.  Rather, we have been told to be physically active almost everyday so that our total exercise time adds up to at least 150 minutes. And we should not assume walking to the car or commuter train station, strolling around the block with the dog, or taking out the trash meets the exercise requirement. We have to exercise with vigor: by running, climbing steps rapidly or taking a challenging aerobics class.

But now this assumption is being challenged. A recent article in JAMA Internal Medicine reported the results of an enormous study that collected information about the health and causes of death among 63,591 adults in England and Scotland from l994 to 2012.  The subjects were asked about the amount of time they exercised weekly, when during the week they did exercise, and to rate how vigorous their exercise was. All this information was self-reported rather than observed by a researcher.

The study found that people who managed to squeeze 150 minutes of vigorous weekly exercise into two weekend days, rather than over 5-7 days, seemed to have the same cardiovascular benefits as the daily workout folk. Both these groups (and a third that did less than the guidelines) all showed about a 45 decrease in mortality due to cardiovascular events compared to the group that did not exercise.

The good news from these findings is that it removes the urgency in finding time to exercise during an already overextended weekday schedule. The bad news is that it is necessary to find time to exercise in an already overextended weekend schedule. The data showing such a significant decrease in the risk of dying from a heart attack, stroke or other cardiovascular cause are too compelling to ignore. On the other hand, filling up the refrigerator, doing the laundry, spending time with the kids, parents, friends, and catching up with bills, phone calls and sleep are too compelling to ignore as well.

It is possible to extract two-and-a-half hours of time to exercise out of 48 hours of “time-off.” That is less time than it takes to watch the Oscars, Super Bowl, or an average movie including previews. And doing so does not necessarily mean playing 150 minutes of tennis or a 2½-hour bike ride or run. Any physical activity, from shoveling snow to removing rocks from a potential garden, would qualify as exercise. And the exercise does not have to be done continually. A seven-minute workout following the instructions on an App or 2 minutes of jumping rope counts toward the 150 minutes.

However, there is a problem with the exercise recommendations. What is vigorous exercise?

If you are still breathing but unable to talk or sing, if your heart rate is high and you are sweating, then you are engaging in vigorous exercise.  Straining to ride your bike up a steep hill and gasping for breath or running as fast as you can after a puppy that has just seen a squirrel and is heading for the street is vigorous exercise.  Jogging with a friend and having enough breath to talk about a television show you saw last night isn’t.

Lists of what comprises vigorous exercise are meaningless to someone who is relatively unfit. A physically well-trained individual may have to do an hour of boot camp, sprinting around a track, or bike at high speed to break a sweat. However, most of us would find any physical activity that pushes us out of our comfort zone vigorous: climbing several flights of stairs, carrying heavy bags of groceries from the car to the kitchen, walking against a strong wind, or pushing a heavily laden shopping cart across a large parking lot. And for someone who rarely moves, climbing the stairs from the cellar to the second floor a few times each day may cause rapid breathing and heart rate.

Were those 63,000 subjects in the UK all doing vigorous exercise according to the definition of exercise physiologists?  Or were some possibly a little vague about the vigor of what they were doing? Were they like some of us who, when asked about our weight and height, remove a few pounds from the former and add a few inches to the latter?  Because if they were really engaging in moderate or even light exercise, “I can still breathe and talk” exertions, then it means that cardiovascular benefits are possible for those of us who may not break a sweat in the gym.