Fat tissue is mainly composed of fat cells. Imagine multiple clusters of grapes hanging on a vine, held together by thin fibers (connective tissue) and throw in small nerves and blood vessels. Fat cells would be the juicy grapes. Fat tissue is one of the largest organs in the body. For men, it makes up 15 to 20% of body weight and for women, 20 to 25%. While most of the fat is visible, that is, close to the skin, a good amount also is present internally around various organs.

A fat cell can be seen as an energy storage tank composed of triglycerides. When there are more calories taken in then expended, triglycerides are formed and stored in the fat cell. When energy output exceeds caloric intake, triglycerides are released into the blood stream for energy consumption. This part of the equation is relatively simple and easy to comprehend.

When we look at a chubby kid or an obese adult, do they have more fat cells than a lean person or do they have larger fat cells or perhaps both? This becomes an important issue for the following reason. During early infancy, a large number of fat cells are formed only to decrease to a static number around the first birthday. Hence many infants are cherubic and so huggable. If the caretakers unknowingly overfeed the infant (and there may be genetic and other predisposing factors), additional fat cells are added and they also enlarge in size. This is the key point: the increased number of cells don’t go away, they remain the same or even multiply throughout childhood and adolescent life. The lean child, on the other hand, maintains the same cell count until adolescence when there is another growth spurt with the possibility of adding additional fat cells. For the obese child or the adolescent, with proper diet, the volume of the fat cells will shrink, but the numbers don’t change. This probably explains why, for these individuals, it is so easy to gain weight and so much effort needs to go into losing weight.

Just imagine, parents having this information. They could spare their children enormous amounts of future grief not to mention the cost our society pays for lost wages and health expenditures for many chronic diseases associated with obesity.

75% of obese children grow up to be obese whereas only 10% of lean kids grow up to be obese. Fat cells, much like many other cells in our body, have a certain life expectancy. Each year, there is an 8% turn over of fat cells. That is, about 8% die off, being replenished by newly formed 8%. This rule also applies equally to obese folks, which explains their weight maintenance.

To return to the original point, what is it about these fat cells which cause so much harm? Fat cells aren’t just warehousing triglycerides. Fat tissue happens to be an endocrine organ. That is, it manufactures hormones. Hormones, specifically coming from fat cells are called adipokines. Fat cells are active participants in regulating physiologic and pathologic processes, including immunity and inflammation. From an evolutionary biological view, fat cell turnover would have been designed as an on going peak and trough event (eat as much as you can now and store fat because you never know when you will eat again). Our body was not designed to carry a large amount of fat, all the time. The hormones coming out of our fat cells are many in number. They not only do direct damage to various tissues through their inflammatory actions but also recruit certain immune mediated cells which also cause harm. For example, insulin resistance develops causing diabetes. Diabetes in turn, affects virtually all the organ systems in the body since it alters the blood vessels which bring nourishments to every cell. We are only beginning to realize the vast array of chemicals spewing out of our fat cells, their actions on other cells, on genetics, other hormones, lipids and metabolism. That is, obesity is the cause of various endocrine and metabolic abnormalities rather than the victim of these abnormalities. Fat cells don’t just hang out, they play and they play rough because they were designed to store fat, then destroy or clean up the surrounding tissues during lean times.

Take home message: 1) please, keep your kids lean. The number of fat cells they create will never decrease throughout their life time; and 2) carrying much fat isn’t a cosmetic issue; these cells do much harm.

Eat consciously and move more.
Dr. Philip Bhark M.D., FACC

Also of interest… Dr Bhark will be blogging on www.ExpatNewsletter.net | Thailand’s Fastest Growing Community Website…

Before this large investigation, there were multiple smaller reports suggesting a negative link between coffee and heart disease given the possibility of a change in the lipid profile and blood pressure. These studies, in retrospect, have involved small numbers of people and were poorly designed. Tobacco use, previously not looked at in association with coffee consumption, turns out to be an important determinant as well. Coffee drinkers were more likely to smoke cigarettes, consume more alcohol and red meat and exercise less. They also tended to eat less fruits and vegetables and white meat. Therefore, it made sense to discover that coffee drinkers had an increased mortality over nondrinkers, both men and women. However, this large study cited above, was able to tease out the various confounders, looking specifically at coffee consumption alone. This is what they found out. There were less deaths among coffee drinkers from heart disease, respiratory disease, stroke, injuries and accidents, diabetes (especially among women), and infections. There were no differences among women regarding deaths from cancer. For men, who drank more than six cups of coffee daily, there was a slight increase in cancer related deaths.

About two-thirds of the participants drank regular coffee while the remainder drank castrated (decaffeinated) coffee. There was no mention of the type of coffee or the brewing methods nor whether milk or sugar was added. Coffee consumption varied from 1 cup daily to more than 6 cups. Women benefited more than men from coffee drinking. The benefits were also slightly dose dependent, with 4 to 5 cups being the “optimal” daily dosing.

Given the popularity of this beverage, I think this study is very helpful for many. Of course, if caffeine bothers you (extra heart beats, upset stomach, nervousness, insomnia and so on) you need to avoid the caffeine. Decaffeinated coffee, made naturally by water processing rather than industrial strength chemicals, can also offer a delicious brew with attendant health providing antioxidants such as polyphenols. There is some controversy that milk may nullify some of the beneficial effects of coffee.

It goes without saying that tea, especially green tea, is extremely beneficial for us. Two to three cups of green tea daily would also keep the doctor away.

Cheers. To your health! Dr. Philip Bhark M.D., FACC

Also of interest… Dr Bhark will be blogging on www.ExpatNewsletter.net | Thailand’s Fastest Growing Community Website…

To be fair, we wouldn’t be alive without cholesterol. It forms the foundation for all our sex hormones, is an essential unit of our cellular structure and function, forms bile and vitamin D, just to name a few. It is made endogenously (internal origin) by the liver and other organs, the amount depending on your exogenous cholesterol intake. Our current problem with food arises from too much availability rather than too little, as it was for our ancestors many millennia ago. Cholesterol production, absorption, transportation, uptake by cells, its journey back to the liver, degradation, elimination are more complicated than we wish to know or to understand. Therefore, we have taken short cuts and have labelled two primary cholesterol carriers as HDL (so called good cholesterol transporter) and LDL (aka “bad” cholesterol carrier). In fact, most of the beneficial aspects of cholesterol is carried out by LDL. The problem comes when we have excess amounts of LDL or when we do other harmful things to ourselves (such as smoking cigarettes, building up large amounts of free radicals through unhealthy foods, poor intake of vitamins and other nutrients, stress, etc.) whereby the LDL becomes oxidized or unstable, which in turn makes it easier to enter into blood vessel walls. Once inside the wall, it can attract many other agents, eventually forming a fatty plaque, known medically as atherosclerosis or more commonly in the streets as “clogging of the arteries”.

HDL has a good reputation because one of its primary role is to pick up used cholesterol particles, as a garbage collector would, and return them to the liver for excretion. Thus more HDL you have, the cleaner the streets (blood vessels). It is important to know that while an unstable LDL can leach into your blood vessel wall, by making them stable again through exercise, good nutrition and so forth, LDL can equally be removed from blood vessel walls. Thus, plaque formation is not an irreversible, one way street.

HDL, besides its clean up role, has many other salutary effects, which we are only now beginning to understand and appreciate. For example, it mitigates inflammatory response, is related to thinning of the blood, has a direct and indirect positive effect in keeping the arterial walls healthy, delays cell death, and prevents LDL oxidation.

Thus, we need to try to keep our LDL levels low and HDL levels high. The former is accomplished with a prudent diet (low in animal fat and high in fibers), with or without natural remedies for lowering cholesterol such as red yeast rice. It is equally important to raise the HDL since independent of LDL, HDL predicts cardiovascular risk events. For us living in Thailand, we have easy access to organic virgin cold pressed coconut oil which will raise the HDL. Other means include exercise, niacin (vitamin B3), weight loss, mild to moderate alcohol intake, while obesity, sedentary life style, diabetes, infections, malnutrition will lower HDL levels.
Why are all these measures necessary? There are definite correlations between LDL, HDL levels and our risk for sustaining a cardiovascular event (heart attack, stroke or some other form of vascular disease). But it isn’t simply a matter of “numbers game”. The picture gets confusing in part because there are many different subtypes of LDL and HDL particles, numbering in the hundreds. Some subtypes are thought to be particularly harmful (such as the small, densely packed LDLs) while others are quite beneficial (such as the large HDL2s). Thus many with “elevated” cholesterol levels live normal healthy lives while over half of the folks who suffer a heart attack have “normal” cholesterol profile. Besides the specific type of LDL and HDL as well as the total numbers, your risk depends on so many other factors such as hypertension, obesity, exercise routine, genetics, stress effects and so on. Risk factors are algorithmic and not additive, and therefore it makes sense to reduce them as best as we can. For those of you who have already had a significant cardiovascular event, you belong to an entirely different group. You need to do all you can to improve your HDL (keep it at 50 or above) and your LDL (less than 100). If it means having to take strong medications, I would recommend you do so since you have already demonstrated that you do have “clogged arteries”. Remember, you can reverse some of the damage done to the blood vessels walls by taking appropriate steps.

Finally, few additional points to consider. If your cholesterol is elevated and you are puzzled by it since you take exceptional care of yourself, please consider other causes of elevated cholesterol such as thyroid, liver or kidney disease, or genetics. Also, a fanatic low fat diet can have a reverse effect, sending the wrong message to your liver that you are starving, which in turn will crank up its cholesterol production. There is also a casual relationship between low cholesterol and cancer. Increasing evidence is now in, suggesting a forward link between low cholesterol and cancer formation but not the other way around. That is, cancer does not appear to be the cause of low cholesterol. This information is worth considering for several reasons. One, many of my cardiology colleagues take potent cholesterol lowering medications, despite the absence of any evidence that they have a cardiovascular disease. I think it shows poor judgement. For a healthy individual, the risk reduction by taking a lipid lowering medication long term would be about two percent. The risk of developing diabetes from taking these potent medications, especially at higher does long term, is about half a percent. Diabetes is currently classified as an equivalent to a “clogged artery”. If you do the math, it makes sense that we avoid taking cholesterol lowering meds if we are otherwise healthy and with no other significant risk factors.

To summarize, do your best to keep the “numbers” within a reasonable range as you enjoy your life. (For you compulsive, need to know folks, you can, for an extra expense, get detailed analysis of your cholesterol profile.) Work harder if you’ve already had a cardiovascular event. Remember, heart attacks are preventable! I am currently in France with my wife, visiting her family and friends. My cholesterol will undoubtedly rise for the moment but I promise to keep close tabs on it.

Have fun!
Dr. Philip Bhark M.D., FACC

The brain, similar to many organs in the body, adheres to the “use it or lose it” dictum. The brain either improves its functions or when left alone, steadily deteriorates over time. Toxins, poor circulation, high blood pressure, diabetes, infections, inflammations and the normal again process cause functional or structural deterioration. So does lack of use. The brain loves to be stimulated with activities such as playing music, problem solving, learning a new language (anyone speak Thai)? Through a process called “neuroplasticity” the brain cells, with repeated stimulation for a specific function, will grow in numbers in certain regions, enhancing performance. London cab drivers have large hippocampus (a primary memory area) due to their extensive memorization of city streets and famous landmarks; violinists have larger brain mass involving the area of brain that deals with hand movements; senior citizens who meditate regularly (45 minutes or more daily) actually add brain tissue in the area of the brain which deals with “executive functions” while non-mediators steadily lose brain tissue in the same area due to the normal “aging” process.

Some of the methods known to enhance brain health are exercise, nutrition, adequate rest/sleep, stress reduction and maintaining a good cardiovascular condition (blood pressure, cholesterol, diabetes, smoking, etc.) In my opinion, all the exercise coupled with vitamins and supplements for brain health may be inadequate if we leave out the emotional and cognitive aspects of brain function. An area that is becoming increasingly studied is the effects of meditation on brain function and structure. We have already mentioned that the brain changes structurally (that is, new brain tissues are formed). But what are the functional changes? There is good evidence that meditation calms the alarm “center” directly and indirectly, diminishing our reactivity to emotions such as fear, anger or panic. Meditation lowers heart rate and blood pressure but most importantly, reduces the amount of stress hormones by as much as half within a 24 hour period (30 minutes of practice, twice daily). Decreased stress hormone levels offer benefits that are too numerous to list. Hereʼs a small sample; clearer thinking, stable mood, and better judgement; improved cardiovascular system; stronger bones; more testosterone, progesterone and oxytocin production (hormones which improve our moods, sexual function and promote “bonding”) and this is a big one, diminished aging process.

So what is meditation? Again, we will remain within the confines of scientific scrutiny, avoiding religious rituals or any particular dogma. Meditation can simply be viewed as resting the brain, allowing it to function more coherently. This capacity is inherent in all human beings. A farmer, sitting on a rocking chair, overlooking his vast cornfields, a fisherman leaning on a palm tree, appreciating the setting sun and other pastoral scenes, offer our brain an opportunity to pause, perceive and praise. Each second, our brain is bombarded with over a million impulses, most of which go unnoticed by us. This busyness causes us to act autonomously. Forty percent of our daily activities are completely habituated. Meditation, while sitting, standing, lying, walking or even when performing mundane tasks such as washing dishes or eating, allows our brain to synchronize with many other parts of the brain rather than acting chaotically. With specific meditative practices such as concentration or open awareness, important skills such as attention and panoramic views can be developed. An example of a practical application would be, your emotions are unexpectedly “hijacked” by an insult from someone else. You can then react in a manner which will ultimately serve no useful purpose for anyone or, you may chose to put your attention to your breathing pattern or to your body and become keenly aware of the sensations you are feeling in a specific area. Remember your grandmother telling you to count to ten before reacting? Or with the practice of open awareness, you give yourself “space” to ponder what made the other person insult you. Is it really you who is being insulted or is the person simply projecting his or her unhappiness to you? It is critical to note that with such relatively minor incidence, your stress hormones can shoot up in a nanosecond, causing great bodily (brain included) harm. If you get mad at someone and then drop dead from a heart attack, who is the real killer? Of course you donʼt need to practice meditation to be a calm and loving person. But for many of us, with our brain programmed to function in a survival mode, we do need some amount of training to lead a healthy, peaceful and joyful life. I would encourage you to find a method of relaxing and enhancing your brain function that appeals to you and then give it a good try. Positive effects can be noticed (especially by those close to you) within a matter of few weeks, with long term benefits.

Take care of your brain. It is the only one you have.
Dr. Philip Bhark M.D., FACC

Sleep is one of the three main pillars of health, the other two being nutrition and exercise.

There are many forms of sleeplessness. We can have difficulty in falling asleep, in staying asleep, waking up too early or unrefreshed when waking up. Since sleep is an integral part of our lives and a major player, we may need to approach it from a fresh perspective. For some reason, early morning routines such as taking a shower, shaving, hair grooming, putting on a make up, perhaps a bit of exercise or stretching and breakfast are a fixed routine and considered not only important but essential to get prepped for the day. And yet, going to bed usually doesn’t command our attention. We get tired, lie in bed and hope to fall asleep. No ritual or preparation takes place. There is no closure for the events of the day. We are about to enter into another realm of which very little is known about. In my opinion, going to sleep requires some amount of consciousness or savoir faire. We can’t expect to have a good nights rest (unless we are teenagers) after overeating and over drinking, as an example. Many other less dramatic instances causing poor sleep are a poor sleeping environment (bed, mattress, ambient noise, lighting, electromagnetic field, etc.); “busy mind” (anxiety, depression, excitement), dehydration (this is a big one, especially in Thailand); medications, drugs and of course jet lag.
You are not alone when it comes to insomnia. In the West, the majority suffer from some form of sleeplessness. Only 35% get 8 hours of sleep. When I was teaching in Seoul a few years ago, high school students averaged five hours of sleep daily, related to parental pressures to excel in their studies. Understandably, day time fatigue was rampant.

Closer to home (senior ex-pats), we lose about 80% of deep sleep once past the age of 50. That is, our sleep pattern gets lighter and lighter, preventing us from obtaining deep restful sleep. Hence the daytime naps so prevalent for seniors. Women suffer more than men given hormonal fluctuations.

What are the consequences? About 25% of auto accidents are related to sleep deprivation. Daytime fatigue obviously impairs ones function at work (remember the United flight last year where both the pilot and the copilot fell asleep)? Insomnia is not only depressing to oneself but also kills sex drive, which can add to ones depression. In addition, there are significant health consequences. Poor sleep causes stress hormones to rise. Increased stress hormones affects virtually every organ system in the body, deleteriously.

Neuro-peptides which suppress your appetite diminishes while peptides that inhence your appetite increases, therefore the obesity associated with sleep deprivation. Learning is impaired since memory and sleep are intimately related. Your skin ages prematurely while you dumb down (not a good combination). Heart disease, stroke, diabetes, lung disease, high blood pressure and cholesterol are all associated with poor sleep. Pain can cause poor sleep but poor sleep can also diminish your pain threshold thus begetting more pain.

OK, enough of the bad news. So how much sleep do we need? For us adults, it is between 7 and 9 hours. For teenagers, between 8.5 and 9.25 hours while for the younger school children, 10 to 11 hours. I know there are folks out there who feel that life is too short to be wasted on too much sleep. I recommend that you check in with your body and find out what the optimal amount of sleep is for you (where you feel refreshed and energized).
To be complete, we must also consider causes of insomnia, other than those created by ourselves. Some of these are, sleep apnea, unfortunately ubiquitous, and primarily seen in obese individuals, restless leg syndrome, narcolepsy (neurological disorder), sleepwalking, asthma, Parkinson’s and arthritis.

How do we get good sleep? I would suggest that you enter into your sleep cycle with some amount of forethought. Tell yourself that you are moving into another dimension which requires a little preparation and proper environment. Therefore use your bed only for sleep and sex. It should not be another office space, entertainment center or a library (reading yourself to sleep may induce a habituated pattern, which means no book = no sleep). Try to clear your mind before closing your eyes. If you just watched TV news (no way it can make you happy) or an exciting movie, briefly process what you have witnessed and clear it from your mind. The more “work” you take into your sleep, the more processing your mind needs to do. It’s like your office or house. The more debris you create during the day, the more cleaning up is required at night. Proper lighting, soothing music, fragrant aroma all help. Lying on the floor on your back with legs up against the wall ( at a 90 degree angle) can be extremely relaxing, if you are agile. Rewinding your clock, that is, remembering your thoughts and feelings of the day starting from the present moment and going backward to the early evening, then to the afternoon and gradually remembering the moment you awoke that morning can unload a huge amount of psychic burden on your mind. Obviously a light snack, preferably carbohydrates (makes you drowsy) is more conducive to sleep than a heavy fatty meal. Minimize caffeine and alcohol before bedtime, if at all. Try to avoid excessive day time naps, which can easily reverse your sleep cycle. Exercising in the late afternoon or early evening also helps you rest well at night. It is to be hoped that you will realize that you have much more control over the quality of your sleep than you might have thought. It is a sacred realm that we enter. It can be a profoundly relaxing, healthy and revealing experience. In my opinion sleep medications should only be used in dire circumstances (it can easily become habit forming and prevents normal sleep cycle). Natural sleep aides such as melatonin and valerian can be considered. Finally, do not obsess about your insomnia. If you find yourself awake in the middle of the night, just enjoy the quiet, dark space. No phone, no work, there is really nothing to do. Might even spend this time making a list of things you are grateful for. Just relax and before you know it, you will drift off. Rest easy.

Wishing you health and happiness,
Dr. Philip Bhark M.D., FACC

Dan

A. Dear Dan,
I am sorry to hear about your travails. I can only imagine how painful your experience was. The fact that you continue to have multiple symptoms long after a bout of hemorrhagic dengue fever is indeed a puzzle. Most recover uneventfully within several weeks. As you probably know, immunity is not granted as a result of one or more infections. An infection can increase the chance of acquiring another contagion. The local infectious disease specialists I spoke with claim that, in the practical world, all bets are off. What the textbooks claim is simply a conceptual dogma.  Therefore, prevention is the key to good health.

Since a definitive answer to your current dilemma isn’t possible, we need to come up with an educated guess that would work for you. There are anecdotal accounts of folks developing fibromyalgia like complex after a bout of dengue fever. Others have described the onset of diffuse arthritis. Depending on your orientation, you may wish to seek help from a very experienced homeopath, an acupuncturist or an Ayurvedic practitioner. A main stream approach would be to get into a regular exercise program (a sine qua non), consider brief pharmacotherapy, reframe your current illness by means of cognitive based therapy and or some form of a spiritual practice. An ancient Chinese proverb states that water cannot be cut with a knife. Human beings cannot be divided into body parts or for that matter, the distinction between the mind and the body is arbitrary. A holistic approach using one or more of the above mentioned modalities will offer you some amount of relief.

Regarding your labile blood pressure readings, we can be more specific and hopefully more helpful. The best way to obtain an accurate reading is to get a 24 hour monitor. A single reading is inadequate. A drop in blood pressure while one is asleep (if you are not dreaming) is a good sign while its absence betrays a pathological state. The so called “white coat syndrome” (high readings in a setting of doctor’s office or hospital) may not be so benign after all. There are many people who have a “reactive vascular pattern”. That is, ones reaction to an ordinary stimulus is over exaggerated. This may account for the majority of people who have high blood pressure. Just look at the word hypertension; hyper and tense. Describes the phenomenon quite well, doesn’t it? There is a significant genetic predisposition to high blood pressure (I will discuss an emerging field of epigenetics later where we can alter the gene expression through natural means). Many are also salt sensitive. It is very important to mention that high blood pressure needs to be controlled. However, before jumping into pill taking, you have many reasonable alternatives. If your blood pressure is excessively high (say 170 over 120) chances are that you will need to initiate your treatment with pharmacology since the more natural approaches won’t be as effective. For labile hypertension aka pre-hypertension (as is yours) here are some means for your consideration. The fact that your diastolic number (the bottom number of your blood pressure reading) is disproportionately high suggests a “tense” response. Therefore, moderate exercise, reduced salt and caffeine use, relaxation techniques, massage, reduced alcohol consumption (if you drink) should work. There are many nutritional supplements and mechanical gadgets available to lower your blood pressure but I personally don’t think these are necessary if you are diligent with the former approach. Incidentally, there is a myth among Western medicine practitioners that ones blood pressure naturally rises as one gets older. This may be so in cultures where old people get fat and lazy. In cultures where older folks stop working, approach their waning years with calm and ease, continue to exercise moderately (such as walking) and maintain judicious diets, their blood pressure actually drops after retirement. So I would suggest that you use your “high blood pressure” as a message from your body to get more introspective and by using the innate wisdom of your body and mind, turn things around for a healthier and happier life.

Dr. Philip Bhark M.D., FACC

Let us first roll our eyes inwards and look more closely at our body. Our body was designed to move. We have over a hundred joints. What are joints for? It should be a no brainer. Our ancestors did not have a built in weapon such as fangs or claws. Nor did we have speed or excessive strength or ability to fly. But we had something that most animals don’t have, endurance. This unique ability allowed us to track animals for hours if not days. This allowed us to cover great distances as we foraged. If need be, we could even run for hours at a time at a slow steady speed. We had no couches to lie on and certainly no remote controls to play with. No one needs to be convinced that exercise is good for us in so many different ways. The human body speaks for itself with its form and function. So we could all agree that some amount of movement is intrinsic to who we are. The key issue again is what type of movement and how much? Couch jockeys claim that if one lives extra years from exercising, those extra years are spent on exercising, so why bother? It is to be hoped that they will also be thinking about how great it is to avoid crippling strokes, heart attacks, Alzheimer’s, diabetes, obesity, low energy, insomnia, depression, mood swings, etc.

Walking daily for two miles (3.3 km) in about 30 minutes is all most of us need to be in good shape (with all the attendant benefits). Yes, there are many guidelines on exercising but please remember, these are just that, guidelines, and therefore not chiseled in stone. For example, we all have different rates of metabolism. Thus, someone with a high metabolic rate will burn off more calories for the same amount of exercise than his/her neighbor who happens to have a lower metabolic rate. One thing you will hear me repeating until the sun rises from the West is that we each have unique composition and thus one of the major keys to happiness and health is for us to tailor our activities, nutrition, etc., to who we are (don’t compare yourself to the person next door). We also need to be able to distinguish between mental fatigue and physical fatigue. Thus when mentally exhausted, often related to stress, it would be of great benefit to exercise and burn off some of the accumulated stress hormones. On the other hand, if you are physically exhausted, yes, this would be a good time to get on the couch and enjoy your favorite program or simply take a nap. Exercising when fatigued, because your mind says you need to stick to your program can be quite harmful. And yes, exercise is not always beneficial. For you garden lovers, time spent gardening can be equally helpful. Dancers, yoga enthusiasts, Tai Chi or Chi Gong practitioners are generally quite fit. Please consider if your exercise routine before you became an ex-pat is still appropriate in this climate. For example, if you ran ten miles, six days a week in Massachusetts, doing the same during the hot season may build enough free radicals to shorten your life. While in Boston, I would see young athletes who ran while experiencing flu symptoms. Some ended up with irreversible heart disease as a result.

We are fortunate to have many choices in deciding how best to stay fit. Therefore, choose an activity that you really enjoy. Do not engage in something you dislike but think that it is “good for you”. You won’t last and there is a good chance you will get an injury. So if you are not already doing something fun on a regular basis (remember, weekend warriors are placing themselves in harms way), consider, swimming, hiking, jogging, biking, or any other activity where you are continuously moving for a period of time. For beginners, it is perfectly OK to pause while exercising, thus walk and run or alter speed while hiking, etc. It takes several months to get into shape, so there is no need to rush. Ones “aerobic capacity” is the ability of the cells in the muscles to consume the oxygen that so easily enters our body through the lungs. The muscles only produce a certain amount of energy called ATP (a combo of sugar molecule and an oxygen molecule) which is determined by our current physical activities.  Thus a non-exercising person’s muscular system will only produce the minimum amount of ATP. As this person wakes up to the importance of regular activity (and I am not talking about opening the refrigerator door) and starts to demand more ATP, the body will hear the message and act accordingly. This is what is known as the “exercise effect”. Over time, the energy production will have been reset, at a much higher level. This explains why someone in shape can perform so well without running out of gas so quickly. Simply let your body know that your demands are increasing and your body will respond accordingly.

There are many with extreme competitiveness, obsessive-compulsive disorders who pride themselves with their physical performances. Let them be. I hope they realize that this is not the key to happiness. They should also know that they often have higher levels of stress hormones than the folks who not only exercise in moderation but also carry what the Thais call “jai-dii” (a good heart).

Next time, I would love to discuss barefoot running (with the five finger shoes). If you jog regularly, please check it out. You will be impressed. Breathe in and relax.

]]> http://www.chiangmaisos.com/working-out/feed/ 0 http://www.chiangmaisos.com/chiang-mai-sos-announces-new-service/ http://www.chiangmaisos.com/chiang-mai-sos-announces-new-service/#comments Wed, 28 Dec 2011 12:05:09 +0000 cmsos http://www.chiangmaisos.com/?p=646 SOS Announces a new service: “Expression of Wish.”

A recent tragic case has highlighted the fact that Expats living here in Chiang Mai need someone to act on their behalf, sometimes urgently, in the event of their sudden death or in case of a serious life threatening accident.

More >>

Your consul can offer only a limited service, and, due to the structure of the consular system, cannot involve itself in legal matters on your behalf. Although we are not lawyers, we understand the practical and legal factors that your friends and loved ones may face in the event of your death overseas, and to this end, we would like to offer an additional service to our members at a small extra cost. We can also help you to create a Will pertaining to your assets here in Thailand, which would not be covered by any Will made in your home country.

SOS’ ‘Expression of Wish’ Service means that information you provide us with i.e next of kin contact details, instructions etc. will be held in a sealed envelope only to be opened in the event of your death or serious illness. For more information or to speak to an advisor Email: info@chiangmaisos.com / Call 0870 52 03 89

A reader asked me how to obtain Lipitor, a cholesterol lowering drug.

I have only had limited experience with local pharmacists and therefore will make the following suggestions with a caveat.

Yes, Lipitor is readily available as are many brand name medicines. However, prices vary and therefor you need to do due diligence and find a pharmacy you feel comfortable with.

Drugs manufactured in Western countries or elsewhere but under the guidance of the parent company need to meet very high standards of production. Unfortunately, this is not true for drugs coming from some of our neighboring countries. I believe that generic Thai pharmaceuticals are fine, especially if the cost of medication is a consideration. So ask your pharmacist where the drug is manufactured and by whom before making a decision. You will also notice that some brand name drugs are cheaper here than back in the West. The simple reason is that the parent company has subsidiaries in this part of the world. Cheaper brand name drug doesn’t mean that it is fake, however, fake drugs are common, especially on the Web. Fake drugs are not only ineffective but can be quite dangerous. They are usually made with highly toxic chemicals. They can look uncannily real. Therefore it is important to work with a pharmacist whom you can trust. Finally, about 80% of generic drugs are just as effective as the brand name. Therefore, when taking a generic medication, make sure that it is doing whatever it was designed to do. So for example, if you were taking a brand name drug to lower your cholesterol and then switch to a generic med and a follow up cholesterol check reveals a markedly elevated blood level for no apparent reason, it would be possible that the generic med is less efficacious. For this particular article, I will not comment on other means of lowering your cholesterol.

All the Best, Philip Bhark, M.D., FACC

Email: newsletter@chiangmaiexpatsclub.com for a chance to have your health questions published in Expat Newsletter and online at www.chiangmaisos.com/d-o-c

Dear Dr Bhark,

Following on from your very interesting talk last Saturday (@ChiangMaiExpats), may I ask you a question. 

Our daughter aged 45, suffered an unexpected ‘cardiac event’ about 18 months ago, following a period of overwork and chronic stress.   

Thankfully she fully recovered after treatment at a leading cardiac hospital in the UK.    Her own GP put her on Simvastatin 40gms, Ramipril 10gms and Congescor 2.5mgs.  Since then there has been a radical and negative change in her personality.  

Have you experienced similar personality changes with patients on statins? 

Many thanks for your guidance on this matter.

Liz Spring   

Dear Ms. Spring,

As a general rule, when someone complains of a possible drug related  side-effect, we need to give them the benefit of doubt, even if the stated side effect has not been published previously. There is always the first time. Having said that, there is also a maxim which states that when you hear hoof beats, think of horses first and zebras last. That is, the more common cause for a personality change might be explained by the fact that your daughter suffered a heart condition at a young age. At any age, a sudden cardiac event may potentially be devastating to ones psyche. This coupled with the fact that she has suffered from “chronic stress” may have placed her in a position where her coping skills may have been compromised. Cardiac rehab is highly recommended in this situation and if need be, some type of supportive therapy. A person with a known heart condition who subsequently suffers from extreme negativity or depression can potentially impair their overall prognosis.

 When one questions the possibility of an adverse drug effect, the best thing to do is to replace the possible suspect with another drug of the same class. Fortunately, there are many statins readily available. Also, change one drug at a time so that the “culprit” can readily be identified. She will be on medications for some amount of time and therefore going slow and steady is necessary.

Finally, it may be too early to mention this but for many people who have experienced a cardiac event, at some later point in life, many often state that “this is the best thing that ever happened to me”. It can truly be a life altering experience in a positive way. This possibility is always present. I wish you both good health and happiness.

Philip Bhark, M.D., FACC

Email: newsletter@chiangmaiexpatsclub.com for a chance to have your health questions published in Expat Newsletter and online at www.chiangmaisos.com/d-o-c