Thursday, February 18, 2010

Consumer Alert: Aspartame

Aspartame (also known to you as Nutrasweet and little blue packets of Equal) is an artificial sweetener used in a variety of products. Most people associate it with diet soft drinks and the little packets for coffee and tea. In fact, it's in a lot of products you might not even think about (certain cereals, yogurt, etc.).

Depending on who you ask, aspartame is either perfectly safe or very dangerous. I will be upfront (as I sit here and type this while drinking a Diet Coke) and say that I don't think it is dangerous per se, although probably there are people who are sensitive to it and may react. And it's probably not good in excess, like pretty much anything else. There's even some evidence that using artificial sweeteners can actually lead to weight gain. But that's not what I'm blogging about today.

A producer of aspartame, Ajinomoto, has rebranded its product as AminoSweet. According to the website, "AminoSweet is made from two amino acids, the building blocks of protein found in many of the foods and drinks we eat every day, such as fish, meat, eggs, cheese and cereals."

I have a problem with the marketing approach here. It's misleading to imply that AminoSweet is somehow a "natural" sweetener because it's "made from two building blocks of protein just like those found naturally in many everyday foods." Is Ajinomoto trying to pull the wool over our eyes? Or do they think we are stupid? We've known for years that aspartame (or Nutrasweet or Equal) is an artificial sweetener. Key word: Artificial. As in, not found in nature.

If you avoid artificial sweeteners for any reason, be sure to read labels carefully. Shady marketing practices like this are sure to multiply as the trend of "natural" products increases.

Sunday, February 7, 2010

Congenital Heart Defect Awareness Week: Feb. 7-14

Did you know that heart abnormalities are the most common birth defect? I didn't, until a few weeks ago. A Facebook friend posted a link to the Cora's Story blog and I casually clicked over to see what it was about. Cora died suddenly in her mama's arms at just 5 days old from an undetected congenital heart defect (CHD). I can't imagine suffering such a devastating loss, and I thank my lucky stars for my kids' healthy hearts. But Cora's mother Kristine has turned her pain into a wonderful mission in her daughter's name: to raise awareness about CHD and how easily it can be detected. With Kristine and Cora's help, hopefully more CHDs will be caught and treated early, saving babies' and children's lives.

Another fact I learned from Cora is how easily many CHDs can be detected. A simple pulse oximetry test (aka "pulse ox") done 24-48 hours after birth in conjunction with a newborn exam can detect a large proportion of CHDs, with a low false-positive rate. A pulse ox test is noninvasive and very simple: the reader is typically attached to the baby's toe and determines the oxygen saturation of the blood. An abnormal reading (typically below 95) is indicative of a problem. The research on pulse ox screening bears out the effectiveness of pulse ox screening tests for newborns.*

So why hasn't pulse ox testing become routine for all newborns? As I mentioned, the test is completely non-invasive and hospitals already have the equipment. Portable pulse ox readers are also available, which means both birth center and homebirth midwives could also easily carry them. Kristine is working on Cora's behalf to get laws passed nationwide mandating a pulse ox to be done on every newborn. I applaud her efforts and admire her strength at turning her pain into an effort to save lives.

What can YOU do? Request this test for your own babies and tell the pregnant moms in your life to request it when their babies are born. Pass this information on, and tell others to pass it on too. Write your Congressman and your state representatives and tell them you want pulse ox testing to be mandatory for all newborns. You might just save a baby's life.

*More information and research:
Medscape Medical News
British Medical Journal
University of Michigan
Medical News Today

Saturday, February 6, 2010

You're Doing It All Wrong

Confession: I cringe when I see your back drooping down in a plank pose. I die a little bit inside when you do a lat pulldown behind your neck. I get a shiver up my spine as you fling your legs forward on the leg extension machine.

I see people performing ineffective exercises and executing exercises with poor form all. the. time. And every time, I am seized by the same dilemma: Do I say something, or shut my mouth and pretend I didn't notice?

I don't want anyone to get injured, that's for sure. And I want people to see the results of their efforts. Performing an exercise improperly increases the likelihood of the former and decreases the likelihood of the latter. But....

I am a trainer, but I am not your trainer. If a member hasn't asked my advice, why should I offer it unsolicited? And by barging in on someone's workout, I might make him or her uncomfortable, and in fact LESS likely to seek advice or assistance from me in the future.

Not to mention, it galls me to no end to see trainers walking up to members and telling them they "should" be doing this exercise or that one. I find that highly irresponsible. Before recommending any exercise, I need to know at least a basic exercise and health history. Otherwise, how would I know about that torn rotator cuff back in '07 or those arthritic knees? I don't want to recommend any movement that is contraindicated for a person's health condition. I also don't want to recommend something that is far beyond a person's current level of ability, leaving open the possibility of injury. As a consumer, I would be suspicious of any trainer who tries to "recruit" new clients in this manner.

What do you think? Do you want someone to correct you if you're doing something incorrectly? Or would you prefer to just do your own thing without interruption?

Tuesday, February 2, 2010

My Worst Cycle Class Ever

On Friday morning I got a desperate call from the group ex director at a gym where I'm on their instructor sub list. Could I please sub a cycle class at 10:30? I reluctantly said yes... 10:30 is Rebecca's morning nap time and I had never subbed at this particular location. The director gave me some helpful information, such as the entry code for the cycle room and how to plug my iPod into the boombox being used while the stereo is being fixed.

Right away I thought, iPod? Though I have one, I am a relic who prefers to use CDs. I know, I know, I need to step into the 21st century. But I gamely charged up my iPod and got myself and the kids ready to go.

I left myself plenty of time, so I thought, to get the kids into the childcare area and get myself set up for class. I brought the kids in and was confronted with a barrage of paperwork to fill out. I hadn't done this at the other club in the chain so I didn't realize it would be necessary. I apologized to the girl and told her the copy of my driver's license (!) would have to wait until after class.

Then I headed down the steps in search of the cycle room. I successfully used the keypad to open the little lockbox containing the key to the door. But then I had a hard time using the key in the lock, while about 10 members waited around looking at me. It didn't get better once I got inside the cycle room. There was no boombox in sight and I couldn't get the microphone to work. I ran back up the steps in search of someone, anyone, at the club who could help me. The girl at the front desk pointed me to the manager and he followed me down the stairs.

The boombox, as it turns out, was in a little locked closet nowhere near the cycle room. He got that working with my iPod, thankfully, and then started tinkering with the microphone. He couldn't get it to work either. (At least it wasn't user error!) By now we were more than 5 minutes past the start time if the class, and I'm pretty sure the members were convinced I'm an idiot.

I had to conduct class with 16 attendees by shouting at them over the music. Not the first time I've ever had to do that, mind you, but still. Then for some reason my iPod was not playing the songs in the playlist in order. The playlist was ordered correctly on the menu, but the songs came out randomly (I guess I had some kind of "shuffle" setting on?) and I had to keep flicking through the songs to do them in the right order. Not easy when I was out of breath and had sweaty fingers. The class just didn't flow.

From start to finish it was pretty much a catastrophe. I wish I could say I had some sort of "lesson" in all this, but I thought I was pretty well prepared to go into a new situation. I don't know if I'll be too anxious to go back there anytime soon though.

Friday, January 29, 2010

What Happened to Informed Consent?

I guess for some people this is old news, but this morning I read this article about medical students doing pelvic and rectal exams on patients who are under general anesthesia for surgery. These patients, in many cases, did not consent to such exams, and may not ever even know it was done to them. Apparently this issue has come up a few times over the years (see the references section of this article) without ever really being resolved. And men, this includes you too... Imagine going in for a routine knee surgery and having 4 or 5 med students practice rectal exams on you while you're out cold.

If a woman goes out to a bar and a man spikes her drink with roofies and then has sex with her while she's unconscious, is it not rape if she can't remember it? Of course it is. How is this significantly different?

Any procedure performed on a patient requires informed consent. It is a legal right and an ethical obligation. The fact that this continues to go on is abhorrent. Of course med students need to learn somehow, but this is not the way.

Studies and surveys have shown that people will, when asked, consent to med students performing such exams. There are also some programs in place that pay volunteers for undergoing examinations in order to teach med students. Both are better alternatives than simply probing people's orifices without their knowledge or consent. More importantly, performing pelvic and rectal exams with a conscious patient have the advantage of allowing the patient to give feedback (as in, "Hey that HURTS!"). The student can better learn to conduct such exams so as not to hurt the patient.

If you are having surgery or any other treatment at a university or teaching hospital, ASK if they have med students learning pelvic and rectal exams on anesthetized patients. If you are ok with simply knowing in advance, you can feel free to consent at that time. Or you can tell your attending physician you do not consent, as well as write it on your consent form that you specifically do not consent to such exams.

If you are a student doctor or nurse, please refuse to check your ethics at the hospital door. Just because "this is the way it's always been done" doesn't mean it has to continue to be done that way. Tell your resident, your attending, your supervisor, or your preceptor that you won't participate in exams of anyone who hasn't given explicit consent.

Hat tip to The Unnecesarean for the topic of this post.
Further reading here

Saturday, January 16, 2010

In Florida, A Pregnant Woman is Nothing But A Womb Pod

I encourage people to follow this case in Florida, where a woman was court-ordered to be held against her will on hospital bedrest. She was 25 weeks pregnant and having some issues in her pregnancy, so it was recommended she remain on bedrest. However, with a job and two other young children at home, she did not feel that would be possible. So the hospital sought a court order to keep her hospitalized, claiming it was in the "best interests of the fetus." Never mind what might be in the best interests of her other two children! The court order required her to submit to any and all treatments during her stay. Three days later, she had no choice but to undergo a c-section, and during the surgery it was determined that the fetus had already died. (Which, as an aside, could have easily been determined by an ultrasound rather than major abdominal surgery.)

In the past, courts have always upheld patient autonomy in making medical decisions, even for pregnant women, even when it might endanger a fetus. The Florida courts, however, have summarily stripped this woman of her constitutional rights. Fortunately, a lawyer has agreed to appeal her case pro bono, and the ACLU has (rightfully) stepped in as well.

Let this case be a warning to women everywhere: The Pregnancy Police are watching. You think it's bad that people give you the stinkeye in Starbucks when you don't order a decaf latte? Just wait til they imprison you in the hospital until delivery for it.

Friday, January 8, 2010

Are You a Disaster Waiting to Happen?

A couple of weeks ago, I came across a blog post that combines two of my main interests: Teaching group ex and birthin' babies. The analogy quoted from Mother's Intention: How Belief Shapes Birth by Kim Wildner is great:

"Heart disease is the leading cause of death in the US. 873 per 100,000 die of heart disease (CDC). (Remember, natural birth is between 6 and 14 per 100,000 in the US, depending on the population.)... Using the logic of obstetrics, all health clubs should be in hospitals and all fitness trainers should be cardiac surgeons. Any independent health club with 'lay' trainers would be 'practicing medicine without a license,' subject to prosecution. It's for your own good."

Exercise is dangerous business! Go for a workout and it could end in catastrophe! Let's not forget that Pheidippides DIED running the first marathon. But don't worry, Wildner has the solution for all of us exercisers out there:

" order to know if a problem is developing, close monitoring and 'management' is required. We will need to place straps on the muscles to measure the intensity of the workout. of course, it will be restrictive, but we need to know how hard the muscles are working to know if the heart can take it. We'll need to monitor heart rate, blood pressure, fluid output. We'll need to give an IV because with sweat excreted, you could dehydrate, and of course, we simply can't take the risk of letting you drink anything lest you need emergency surgery..."

Does any of this sound faintly ridiculous? Is your health, your life, so precarious that a workout could kill you? Is your body so defective it can't handle a natural function like physical exertion? Unless you're in a risk category- such as a heart problem, an autoimmune disease, or chronic illness- the answer is no.

So why are we so quick to believe that a mother's body can't birth her baby without all the monitoring and the technology and the machine that goes ping? Why do I keep meeting women who were told their baby was too big, their pelvis too small, their bodies just "not able to do it on its own"? I think that's just sad. It can't be true that so many women's bodies function normally in every other way... except this one. Having a baby is not an emergency or a condition from which women need to be rescued. Pregnancy and birth are not a disaster waiting to happen. But unfortunately that doesn't seem to be the prevailing attitude, least of all among most obstetricians.

I leave you with one of my favorite quotes, from midwife Ina May Gaskin:

"Remember this, for it is as true and true gets: Your body is not a lemon. You are not a machine. The Creator is not a careless mechanic... Even if it has not been your habit throughout your life so far, I recommend that you learn to think positively about your body."

Saturday, January 2, 2010

Resolution Time

For a lot of people, the new year is a time to pledge change. Some people try to break old habits and some try to create new (healthier) habits. One of the most common resolutions is to get in better shape, whether that means losing weight, exercising more, or both. Maybe you've made that resolution in the past. Maybe you made it this year.

It should come as no surprise then, that January is the busiest month of the year at gyms and health clubs. (Second is September- when kids go back to school and routines that petered out over the summer start anew.) I've watched each January as the gym fills with "New Year's Resolution People" who are gone by the time Valentine's Day rolls around. And you should know, that we as instructors and trainers, are talking about you. We love to see new faces in class, really we do. But when you start out during the month of January, we are skeptical. And truthfully, though I can't speak for all instructors, there are some of us guilty of complaining about our gym regulars getting shut out of classes by overexuberant newbies during the month of January. Sorry.

Here is where I have seen a lot of people go wrong. Let's take a hypothetical woman named Jane. Jane has made a resolution to lose weight through diet and exercise. So on January 2, she signs up at the gym and vows to go every day. I would bet my last dollar that Jane will fail.


Well, for a couple of reasons. First, Jane is likely to burn herself out quickly. I see this more with men, but women do it too. Jane literally hits the ground running, going 4, 5, 6 days in a row to the gym and pushing herself hard. And then she is overtaken by fatigue and muscle soreness... And then she thinks, "Ugh, this is why working out sucks. It makes me tired and sore." And pretty soon that gym membership is nothing more than an automatic monthly charge on her credit card. Second, Jane set herself up for failure before she even began by setting a vague goal of "losing weight" through diet and exercise.

But Jane doesn't have to be one of the New Year's Resolution People that instructors and trainers sigh about. She can do one simple thing to help herself succeed. She can set a SMART goal. SMART stands for Specific, Measurable, Attainable, Relevant, and Time-bound.

Specific- "Losing weight" or "getting in shape" are not specific goals. Losing 20 lbs. or being able to run for 30 minutes without stopping is specific.
Measurable- There should be no doubt about whether a goal has been achieved. Progress towards a goal can be measured- losing 5 lbs. out of 20, or running 10 out of 30 minutes without stopping.
Attainable- Losing 20 lbs. or training for a marathon in 2 weeks is not attainable (and even if it were, it certainly wouldn't be healthy). Be realistic when setting a goal.
Relevant- It may seem obvious, but it doesn't make sense to train for a 5k run by riding a bike. And "training" for a competitive eating event is probably not a good method of weight loss. (That's a joke people!)
Time-bound- Assigning a deadline keeps goals on track. Set both short-term or interim goals to mark progress towards a long-term goal.

For Jane, a SMART goal might be: Fit into her size 6 jeans (specific) by losing 20 lbs. (measurable) in the next 4 months (time-bound). To do this she will count calories and go to the gym 3 days a week (attainable and relevant).

Finally, my personal opinion for people who haven't been working out regularly is to start off slow. Yes, we should all work out about 5 days a week, but for those just starting out, 2-3 days a week is enough. Carve out that time and cement it into a weekly schedule, the same way meetings or appointments are scheduled. Once those couple of days become a habit, add another day, and eventually another. Trying to do it all at once can be too overwhelming and discouraging, and I think that's why a lot of people can't stick with a routine for more than a few weeks.

Have you made a resolution to get in better shape in the past? How did it work out for you? Are you resolving that this is the year you'll get fit?