Wednesday, October 18, 2006

Different Learning styles

On Education

A Late Start, but Not a Bad Start if the Student Is Finally Ready

By JOSEPH BERGER

Published: October 18, 2006

NORTHAMPTON, Mass.

Jamie Nolan brushed off high school. Like many teenagers, she thought she knew more than her parents and teachers, and spent the time when she should have been in class hanging out with what she now laughingly calls the artistic crowd — the kids with pierced tongues and green hair who didn’t actually produce very much art. Six months before graduation, she dropped out and, while living at home, in Larchmont, N.Y., spent the next six years buffing Porsches and Mercedes-Benzes for a car dealership and delivering them to their owners. Sometimes, she imagined the cars were hers, even though she ultimately realized she would never own one by working such jobs.

“I said to myself, this is all I’m going to be doing forever if I don’t do something with my life,” she recalled.

Ms. Nolan is now 28, a long-limbed, wheat-haired young woman with hopeful grayish blue eyes who retains something of the teenage rebel in the Yankee cap she slaps on backward. This onetime dropout is a senior at Smith College, bicycling around a campus gussied up in the gold and russet colors of a dazzling New England autumn, a place whose alumnae include Barbara Bush, Nancy Reagan, Gloria Steinem and Betty Friedan.

MS. NOLAN is a breathing, pulsing rebuff to parents who despair when their children meander off course and can’t seem to find themselves, those who don’t follow the classic trajectory of graduation by 22 and a high-paying job by 30. Such parents, she advises from her hard-earned experience, should realize that people follow starkly different arcs and timetables, so parents should “never give up on your kid.”

“Just because your child can’t focus on their future when you want them to doesn’t mean they can’t far surpass your expectations when they really do focus,” she said.

When Ms. Nolan was ready to focus, there were places willing to offer her a second chance. After she got her high school equivalency diploma, Westchester Community College, a 30-minute drive from home, let her show off her gifts as a student and her leadership talents as head of the student government.

Then Smith took her into its Ada Comstock Scholars Program, an admission avenue that seems to escape the notice of families who think of Seven Sisters or other selective schools as exclusively for the elite 18-to-22 set. The 31-year-old program, like similar ones at Mount Holyoke and Wellesley, has long recognized that people flower at different paces and that the vagaries of life can trip up even the most fastidious wish lists.

There are 200 Ada Comstock students — one of every 13 Smith students — ranging in age from their early 20’s into their 60’s. They have all kinds of reasons for having stumbled off the well-trod paths of life. Some, like Rita McCoubrey, 23, of Santa Ana, Calif., had babies in high school; others, like Ellie Crews, 53, of Seattle, married husbands who insisted that their careers came first, and so they raised children into adulthood.

Many colleges, like Columbia University’s School of General Studies and Harvard’s Extension School, have programs for such late-bloomers. But seldom are such students as fully integrated into the campus’s lifeblood as they are at Smith.

There, the Adas, as they call themselves, take classes and live in dorms with all the other students as well as write for the newspaper, sing in the choir and row for the crew. There are some differences: Adas can take fewer courses per semester and are given more time to graduate.

The program took 52 percent of its applicants last year, and if this class is the same as others, more than 90 percent of them will graduate.

“The faculty loves having Adas in class,” said Erika Laquer, the dean who runs the program. “They’re really motivated. They know exactly why they’re there. And they have personal development issues worked out.”

Because the students are older, Ms. Laquer has more than a few times had to fit chemotherapy into the schedules of those who have had breast cancer. The discouragement that defeated the Adas earlier in life sometimes rears up, so Ms. Laquer must remind them: “You can do it. That’s why we admitted you.” She has noticed another difference from younger students: “The Adas typically want to go to bed a lot earlier.”

Ms. Nolan’s story is one that should console parents of drifting youngsters. A firefighter’s daughter whose parents divorced when she was 8, she described herself as “the kind of the kid who knew everything and talked back.”

“The school counselor, the principal and especially my mother went through hell with me,” she said. While the job at the car dealership was leaving her empty, she kept her eye on a friend attending Sarah Lawrence. “I said to myself: ‘Why can’t I be doing the same thing. Why is driving somebody else’s Porsche around all I’m worth?’ ”

AT Westchester Community, she discovered her inner egghead and attained a 3.7 average. With luck, she figured, she might enter a state college. “I didn’t have a great deal of confidence in myself,” she said.

But she was accepted as a transfer student by Georgetown and the University of Virginia, with a full scholarship, as well as by Smith, where her scholarship virtually covered her bill. “When I got the full scholarship to Georgetown and U. Va., I cried,” she said. “I kept turning to my mother with the acceptance letters, freaking out and thinking this was a mistake. I actually called Georgetown and asked them if they made a mistake. It was the fact that I went from an absolute zero.”

Smith has been far from a cakewalk; she’s often up until 5 in the morning to get her reading done. “I look at this as an extreme sport and I’ve got to do it,” she said. “I love learning. I’m like a sponge. I’m like the nerdy kid in high school who wanted to learn everything.” With her working-class roots at a campus that draws more than a few bluebloods, she has sometimes felt “like I was on another planet.” But she determined that she was not going to “turn myself into a person obsessed with classism.”

Her tables have been turned, yes, but only because she is now ready to be a serious student, one who is even boring in on a career in law.

“If I had gone straight from high school to college, I would have flunked out and that would have been the end of it,” she said. “Because the person I was back then is not the person I am today.”

E-mail: joeberg@nytimes.com

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lifestsyle medicine

Prospects

When Advice on Diabetes Is Sound, but Ignored

By GINA KOLATA

Published: October 17, 2006

Ask any diabetes specialist whether people can protect themselves from Type 2 diabetes through diet and exercise and the answer will be a resounding yes. It has been shown three times, in studies in three countries, one of them the United States.

Ray Bartkus

Complete Coverage: Diabetes »

Weight loss and exercise can do more than just stave off diabetes, diabetes specialists will tell you. They can result in lower blood pressure, lower levels of cholesterol, less sleep apnea, more vigor and, in general, a better life.

But if you ask how likely it is that people at high risk of diabetes will follow the advice to diet and exercise, or about using a drug instead, you will get a different sort of answer.

It is a classic conundrum in medicine: if doctors know that patients can help themselves without taking drugs, but they also know that patients are not likely to follow this advice, what should they do?

Should diabetes specialists even bother to advise patients to try helping themselves through diet and exercise first, before prescribing drugs?

A large federal study, completed several years ago, seemed to make a compelling case that they should. A third of its 3,234 participants were assigned to a low-fat, low-calorie diet and told to exercise for 150 minutes a week. The others were given a placebo or were given metformin, a diabetes drug available as an inexpensive generic.

After an average of three years, just 14.1 percent of those in the diet and exercise group had developed diabetes. In contrast, 28.9 percent of participants taking the placebo had diabetes, and 21.7 percent of those taking metformin.

But the diet and exercise program was nothing like what an ordinary person might expect. The participants got extensive individual counseling and group support, at a cost of $1,356 a person the first year and $672 in each subsequent year. Even so, they shed only about 12 pounds after four years, or 4 percent of their initial weight. Most were continuing with their exercise program, though. If a large health plan decided to offer the same program for its members at risk for diabetes, the plan’s price for every member would rise by 1 percent, said Dr. David Eddy, the medical director of Archimedes Inc., a health care consulting company. Over 30 years, 61 percent of the people at risk would develop diabetes, as compared with 72 percent if no such program were instituted.

Last month, another study showed that a newer diabetes drug, rosiglitazone, might be more effective than either metformin or diet and exercise. Over three years, it reduced the risk of developing diabetes by 60 percent in people with elevated blood sugar levels.

Both drugs are relatively safe. Patients may lose about five pounds if they take metformin; other than that its major side effect is gastrointestinal disturbances, like a sense of fullness or soft bowel movements. Patients may gain about five pounds with rosiglitazone, about half of which is from fluid retention. That increases the risk of heart failure in people with heart disease.

But with the drugs’ effectiveness in preventing diabetes, maybe, some specialists say, doctors will soon view blood sugar as they do blood pressure or cholesterol. As soon as they spot an abnormally high level, they will whip out their prescription pads.

Already, health authorities have ventured along that path. International treatment guidelines once said that the first step for patients with full spectrum Type 2 diabetes was to exercise and lose weight. Only after patients had tried that and utterly failed were doctors to prescribe drugs.

As of August, however, the guidelines have changed.

“We recommend starting patients on metformin immediately,” said Dr. David M. Nathan, who directs the diabetes center at Massachusetts General Hospital and is a member of the group that formulated the new guidelines. “Don’t start with lifestyle alone, even for newly diagnosed people. Most end up failing the lifestyle recommendations.”

He added: “What classically happened was that the patients would take three months and try to diet. It wouldn’t work. Then they joined a health club. It didn’t work. Then they take another three months and try some more. By the time they were on effective therapy, they had had diabetes for years and years.”

In developing the new guidelines, the group reasoned that the consequences of untreated diabetes — which can include heart attacks, strokes, kidney failure, blindness and amputations — are too dire to allow high blood sugar levels to persist.

But that does not necessarily mean that drugs should be the first choice for people with so-called prediabetes, who have elevated blood sugar levels but have not yet developed the disease.

Or so says Rena Wing, a professor of psychiatry and human behavior at Brown University Medical School. Dr. Wing helped develop the diet and exercise program for the federal study of prediabetes.

Drugs, she said, should be a last resort for people with prediabetes. The answer to the problem of poor compliance with diet and exercise programs is to develop better ways of encouraging people to follow them, she said.

“If you have a problem that can be solved with a lifestyle change, you have to work on how to do that, how to bring it to people,” Dr. Wing said. “We have to change the system.”

For example, she said, there could be lists of effective programs for weight loss and exercise so doctors would stop telling patients to simply “lose weight” and say instead, “Join this program.”

Yet, if people know that a drug can solve their problem, how much incentive is there to change their diet and exercise patterns?

“The behaviorists say that if you have a medication available, you can hang up the idea that the patients will try lifestyle,” Dr. Nathan said.

Still, he said, “as a realist, it seems to me that the truth is that whatever your thoughts are on the importance of self-control and willpower and profligacy, and that we shouldn’t be such pigs, that we should exercise more, the truth is that we are what we are.”

Dr. Nathan added, “We have recognized that although lifestyle can be miraculously effective, it often isn’t, because people won’t change.”

Next Article in Health (3 of 14) »

Saturday, October 14, 2006

Bicycling Around the World

Multimedia

Slide Show

Outdoors

On the Road for 4 Years and 25,000 Miles

Scott Stoll, taking a break from riding in Lesotho, Africa, said his bicycle trip around the world took him through 50 countries and 6 continents.

By SCOTT STOLL

Published: October 14, 2006

In a sense, cycling around the world was easy. I bought a steel mountain bike (which I had to weld back together six times), put a repair kit, tent, sleeping bag, stove, water filter, sunscreen, clothes and peanut butter in the panniers, and had the determination to keep the pedals spinning for 4 years, 25,752 miles, 50 countries and 6 continents.

In another sense, cycling around the world was such a monumental task that I was at risk of being lost in fear for years and never actually beginning. I thought there was a likelihood that I would be run over, get sick or injured, be robbed or mugged or thrown in prison. (Actually, all those things happened.)

In retrospect, the first step I took was the unintentional sabotaging of my droll life. All in one week, my girlfriend dumped me, I was fired from my job as an art director and my best friend eloped, leaving me without rent money. After some self-pity, and self-medicating with cheap beer and bad sitcoms, I asked myself what I would do if I could do absolutely anything.

From that, the notion of cycling around the world grew like a virus, and the following year I tested myself by riding across the United States from border to border and coast to coast. The year after that 6,200-mile warmup, my friend Dennis Snader, whose path I crossed in the Grand Tetons, asked if I was serious when I said I wanted to bicycle around the world. “Of course, I’m serious,” I said with bravado.

“I’m going to do it, and I invite you to join me,” he said. “If you don’t want to come, I will find someone else.” The figurative and literal wheels were set in motion. We discovered that by crisscrossing the Equator (the seasons are in opposition), we could follow a perpetual summer around the world. As far as planning the rest of our trip, including visas and expenses, Dennis made the prophetic remark: “One wrong turn and everything will change. I don’t see the point of planning.”

We had a general idea of where we were going — following a coin toss or a pretty line on a nearly useless map — but at any one moment, we were essentially lost. But being lost can be very beneficial. When I experienced my first case of altitude sickness, I went down the wrong side of a mountain in Mexico and found myself surrounded by millions of monarch butterflies weighing down the pine trees like a heavy snow. I experienced the reality (as opposed to the concept) of the cliché, life is a journey, not a destination. It was the moments of happiness that I was searching for, not a notch on my seat post.

The reason I travel is to break out of my comfy, humdrum life, where I have a tendency to think I know it all. But I also have a tendency to be an overenthusiastic fool. For example, when I needed to cross a crocodile-infested river in Nepal, there was no bridge, just a man offering to ferry me across in a dugout canoe. There was not enough room for my bike and me. He volunteered to take my bike over and come back for me, but I was skeptical of that plan.

He assured me there were no crocodiles in that part of the river, so I swam across, next to the canoe — until I was swept downstream by the frigid current.

After Dennis, my safety blanket, retired in Turkey, I learned a lesson in perseverance on my ride up Mount Everest to a base camp in Tibet, an elevation of more than three miles. At this height, there is half the oxygen in the atmosphere as there is at sea level, which caused a burning sensation throughout my body. The physical discomfort was offset by the thrill of climbing more than half of Everest, feeling the high altitude and the burning sun and hearing the icy wind roar down the mountain.

The most important lesson I learned was that people around the world — despite appearance, education, culture, language — are essentially the same. We have fears and joys and dreams.

In Peru, some shepherds found me cold and shivering in my tent and invited me to breakfast in their cozy mud hut. All they had was dried potato soup and coca tea. They gave me all their food just to hear my story. Moments like these were the highlight of my trip.

Every day for years, people worried me by saying I was crazy. Eventually, I decided that anyone who has the courage to break his cultural mold and follow a dream needs to be a little crazy. And, in my case, have a desire to see the world from the seat of my bike.

Wednesday, October 11, 2006

Diet common sense

Seduced by Snacks? No, Not You

By KIM SEVERSON

Published: October 11, 2006

Ithaca, N.Y.

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Bill Wingell for The New York Times

Weight Watcher Prof. Brian Wansink observes participants in an eating behavior study through a one-way window at a Cornell lab.

Test Kitchen Tricks (October 11, 2006)

Readers’ Opinions

Forum: Fitness and Nutrition

Bill Wingell for The New York Times

A study of mindless eating links big bowls to bigger portions.

PEOPLE almost always think they are too smart for Prof. Brian Wansink’s quirky experiments in the psychology of overindulgence.

When it comes to the slippery issues of snacking and portion control, no one thinks he or she is the schmo who digs deep into the snack bowl without thinking, or orders dessert just because a restaurant plays a certain kind of music.

“To a person, people will swear they aren’t influenced by the size of a package or how much variety there is on a buffet or the fancy name on a can of beans, but they are,” Dr. Wansink said. “Every time.”

He has the data to prove it. Dr. Wansink, who holds a doctorate in marketing from Stanford University and directs the Cornell University Food and Brand Lab, probably knows more about why we put things in our mouths than anybody else. His experiments examine the cues that make us eat the way we do. The size of an ice cream scoop, the way something is packaged and whom we sit next to all influence how much we eat. His research doesn’t pave a clear path out of the obesity epidemic, but it does show the significant effect one’s eating environment has on slow and steady weight gain.

In an eight-seat lab designed to look like a cozy kitchen, Dr. Wansink offers free lunches in exchange for hard data. He opened the lab at Cornell in April, after he moved it from the University of Illinois at Urbana-Champaign, where he spent eight years conducting experiments in cafeterias, grocery stores and movie theaters. Dr. Wansink presents his work to dieticians, food executives and medical professionals. They use it to get people to eat differently.

His research on how package size accelerates consumption led, in a roundabout way, to the popular 100-calorie bags of versions of Wheat Thins and Oreos, which are promoted for weight management. Although food companies have long used packaging and marketing techniques to get people to buy more food, Dr. Wansink predicts companies will increasingly use some of his research to help people eat less or eat better, even if it means not selling as much food. He reasons that companies will make up the difference by charging more for new packaging that might slow down consumption or that put seemingly healthful twists on existing brands. And they get to wear a halo for appearing to do their part to prevent obesity.

To his mind, the 65 percent of Americans who are overweight or obese got that way, in part, because they didn’t realize how much they were eating.

“We don’t have any idea what the normal amount to eat is, so we look around for clues or signals,” he said. “When all you see is that big portions of food cost less than small ones, it can be confusing.”

Although people think they make 15 food decisions a day on average, his research shows the number is well over 200. Some are obvious, some are subtle. The bigger the plate, the larger the spoon, the deeper the bag, the more we eat. But sometimes we decide how much to eat based on how much the person next to us is eating, sometimes moderating our intake by more than 20 percent up or down to match our dining companion.

Much of his work is outlined in the book “Mindless Eating: Why We Eat More Than We Think” (Bantam), which will be published on Tuesday. The book is his fourth over all, but his first directed at a general audience. It is peppered with his goofy, appealing Midwestern humor and practical diet tips. But the most fascinating material is directly from his studies on university campuses and in test kitchens for institutions like the United States Army.

An appalling example of our mindless approach to eating involved an experiment with tubs of five-day-old popcorn. Moviegoers in a Chicago suburb were given free stale popcorn, some in medium-size buckets, some in large buckets. What was left in the buckets was weighed at the end of the movie. The people with larger buckets ate 53 percent more than people with smaller buckets. And people didn’t eat the popcorn because they liked it, he said. They were driven by hidden persuaders: the distraction of the movie, the sound of other people eating popcorn and the Pavlovian popcorn trigger that is activated when we step into a movie theater.

Dr. Wansink is particularly proud of his bottomless soup bowl, which he and some undergraduates devised with insulated tubing, plastic dinnerware and a pot of hot tomato soup rigged to keep the bowl about half full. The idea was to test which would make people stop eating: visual cues, or a feeling of fullness.

People using normal soup bowls ate about nine ounces. The typical bottomless soup bowl diner ate 15 ounces. Some of those ate more than a quart, and didn’t stop until the 20-minute experiment was over. When asked to estimate how many calories they had consumed, both groups thought they had eaten about the same amount, and 113 fewer calories on average than they actually had.

Last week in his lab seven people were finishing lunch while watching a big-screen TV. Cartoons on the TV served as a distraction so participants would not be influenced by what and how much those nearby ate.

Because he does not take money from food companies and is a newcomer at the university, the lab runs on the cheap. The menus, like the one on this day, are often built from Beefaroni, applesauce, M&M’s and Chex Mix: simple, inexpensive food that subjects are familiar with and that can be easily manipulated.

He prefers to experiment on graduate students or office workers, whom he sometimes lures with the promise of a drawing for an iPod. “It’s easy to find undergraduates to participate, but with the guys nothing makes sense because they all eat like animals,” he said.

On this day he is testing how much people eat depending on whether they have exercised. Over the past several weeks they have sent subjects, some who have exercised and some who have not, through an unlimited buffet line. By measuring the difference between how much and what people eat depending on whether they have exercised, Dr. Wansink hopes to prove that even moderate exercise makes us think we are entitled to many more calories than we actually burned.

“Geez Louise, you can’t believe how much people eat to overcompensate,” he said.

Those kinds of things — intuitive bits we know about food but think we are either immune to or don’t think about — are the spine of “Mindless Eating.” In it he outlines an eating plan based on simple awareness. Employ a few tricks and you can take in 100 to 300 fewer calories a day. At the end of a year you could be 10 to 30 pounds lighter.

For example, sit next to the person you think will be the slowest eater when you go to a restaurant, and be the last one to start eating. Plate high-calorie foods in the kitchen but serve vegetables family style. Never eat directly from a package. Wrap tempting food in foil so you don’t see it. At a buffet put only two items on your plate at a time.

His dieting methods aren’t as fast as the Atkins plan or even Weight Watchers, and have little to do with matters that consume nutrition researchers or even culinarians. Dr. Wansink is not that guy. Although he has studied to be a sommelier and keeps a mental list of his 100 best meals, he drinks vats of Diet Coke and will inhale a box of Burger King Cini-mini rolls with no apologies. He doesn’t think that his work will solve the obesity problem, but it’s a start.

“It’s like a big pyramid,” he said. “The people at 30,000 feet can look down and say we need a wholesale change in our food system, in school lunches, in the way we farm.” At the bottom of the pyramid, he said, are the nutritionists and the diet fanatics who think the problem will be solved by examining every nutrient and calorie.

Dr. Wansink does his research for the person in the middle, the guy on the sofa who can appreciate a good meal, whether it is from Le Bernardin or Le Burger King.

“Will being more mindful about how we eat make everyone 100 pounds lighter next year?” he said. “No, but it might make them 10 pounds lighter.”

And the best part, he promises, is that you won’t even notice.

Next Article in Dining & Wine (2 of 17) »

Tuesday, October 10, 2006

Friends make us healthier

Essay

Friends for Life: An Emerging Biology of Emotional Healing

By DANIEL GOLEMAN

Published: October 10, 2006

A dear friend has been battling cancer for a decade or more. Through a grinding mix of chemotherapy, radiation and all the other necessary indignities of oncology, he has lived on, despite dire prognoses to the contrary.

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Ward Schumaker

My friend was the sort of college professor students remember fondly: not just inspiring in class but taking a genuine interest in them — in their studies, their progress through life, their fears and hopes. A wide circle of former students count themselves among his lifelong friends; he and his wife have always welcomed a steady stream of visitors to their home.

Though no one could ever prove it, I suspect that one of many ingredients in his longevity has been this flow of people who love him.

Research on the link between relationships and physical health has established that people with rich personal networks — who are married, have close family and friends, are active in social and religious groups — recover more quickly from disease and live longer. But now the emerging field of social neuroscience, the study of how people's brains entrain as they interact, adds a missing piece to that data.

The most significant finding was the discovery of "mirror neurons," a widely dispersed class of brain cells that operate like neural WiFi. Mirror neurons track the emotional flow, movement and even intentions of the person we are with, and replicate this sensed state in our own brain by stirring in our brain the same areas active in the other person.

Mirror neurons offer a neural mechanism that explains emotional contagion, the tendency of one person to catch the feelings of another, particularly if strongly expressed. This brain-to-brain link may also account for feelings of rapport, which research finds depend in part on extremely rapid synchronization of people's posture, vocal pacing and movements as they interact. In short, these brain cells seem to allow the interpersonal orchestration of shifts in physiology.

Such coordination of emotions, cardiovascular reactions or brain states between two people has been studied in mothers with their infants, marital partners arguing and even among people in meetings. Reviewing decades of such data, Lisa M. Diamond and Lisa G. Aspinwall, psychologists at the University of Utah, offer the infelicitous term "a mutually regulating psychobiological unit" to describe the merging of two discrete physiologies into a connected circuit. To the degree that this occurs, Dr. Diamond and Dr. Aspinwall argue, emotional closeness allows the biology of one person to influence that of the other.

John T. Cacioppo, director of the Center for Cognitive and Social Neuroscience at the University of Chicago, makes a parallel proposal: the emotional status of our main relationships has a significant impact on our overall pattern of cardiovascular and neuroendocrine activity. This radically expands the scope of biology and neuroscience from focusing on a single body or brain to looking at the interplay between two at a time. In short, my hostility bumps up your blood pressure , your nurturing love lowers mine. Potentially, we are each other's biological enemies or allies.

Even remotely suggesting health benefits from these interconnections will, no doubt, raise hackles in medical circles. No one can claim solid data showing a medically significant effect from the intermingling of physiologies.

At the same time, there is now no doubt that this same connectivity can offer a biologically grounded emotional solace. Physical suffering aside, a healing presence can relieve emotional suffering. A case in point is a functional magnetic resonance imaging study of women awaiting an electric shock. When the women endured their apprehension alone, activity in neural regions that incite stress hormones and anxiety was heightened. As James A. Coan reported last year in an article in Psychophysiology, when a stranger held the subject's hand as she waited, she found little relief. When her husband held her hand, she not only felt calm, but her brain circuitry quieted, revealing the biology of emotional rescue.

But as all too many people with severe chronic diseases know, loved ones can disappear, leaving them to bear their difficulties in lonely isolation. Social rejection activates the very zones of the brain that generate, among other things, the sting of physical pain. Matthew D. Lieberman and Naomi Eisenberg of U.C.L.A. (writing in a chapter in "Social Neuroscience: People Thinking About People," M.I.T. Press, 2005) have proposed that the brain's pain centers may have taken on a hypersensitivity to social banishment because exclusion was a death sentence in human prehistory. They note that in many languages the words that describe a "broken heart" from rejection borrow the lexicon of physical hurt.

So when the people who care about a patient fail to show up, it may be a double blow: the pain of rejection and the deprivation of the benefits of loving contact. Sheldon Cohen, a psychologist at Carnegie-Mellon University who studies the effects of personal connections on health, emphasizes that a hospital patient's family and friends help just by visiting, whether or not they quite know what to say.

My friend has reached that point where doctors see nothing else to try. On my last visit, he and his wife told me that he was starting hospice care.

One challenge, he told me, will be channeling the river of people who want to visit into the narrow range of hours in a week when he still has the energy to engage them.

As he said this, I felt myself tearing up, and responded: "You know, at least it's better to have this problem. So many people go through this all alone."

He was silent for a moment, thoughtful. Then he answered softly, "You're right."

Daniel Goleman is the author of "Social Intelligence: The New Science of Human Relationships."

Monday, October 09, 2006

Body Fat & Losing it

BODY FAT: HARD FACTS ABOUT SOFT TISSUE

by M. Doug McGuff, M.D.

Fat is an amazing tissue. It has ensured survival of our species through two ice ages and never ending drought and famine. A mere pound of fat stores an astounding 3,500 Calories for delayed use at any time in the future. As dormant tissue, there is almost no metabolic cost for keeping it on the body. As a members of the human species we all owe our existence to fat. Even more amazing than fat's capabilities are the number of misconceptions surrounding this specialized body tissue.

Probably the biggest misconception regarding fat is the idea that it is unhealthy. Actually, fat is probably the main reason we are even here in the first place. Throughout human history, the ready availability of food was the exception rather than the rule. Our ability to eat when food was available and to store excess caloric energy for future use allowed us to survive when food was not available. Fat storage is the sign of good health, it signals that metabolic resources are abundant and the organism is healthy. An extreme overabundance of bodyfat places stresses on the body and can be unhealthy. However, the degree of leanness (or lack of bodyfat) that is currently in vogue is probably just as unhealthy for up to 80% of the population. Unhealthy levels of bodyfat have been increasing every decade. It seems that an adaptation that has allowed us to survive through history is now killing us in modern times.

Ask almost anyone why modern man is becoming more obese and you will get a similar answer from just about everyone. Most people believe that the labor-saving technologies of modern life have made us more sedentary, and we are much less physically active than our predecessors. Since physical activity burns calories, and we are less physically active than we once were, we are unable to burn off the calories like we used to. This argument seems logical, but the argument is incorrect for 2 basic reasons. First, physical activity burns much less calories than we have been lead to believe (we will discuss this in detail later in this chapter). Suffice to say that to survive we must be able to use our energy efficiently lest we starve to death in the process of hunting and gathering food. Secondly, our ancestors were not as physically active as we think they were. The work of anthropologists who observe primitive peoples in various regions of the globe show that a primitive hunter/gatherer lifestyle is much less physically active than that of modern man. In Australia, aborigines alternate between the modern world and traditional aboriginal life. While in their more primitive mode, these aborigines are noted to be much less active. So, despite popular opinions to the contrary, it does not appear that increased activity is the solution to modern obesity.

The real problem with modern obesity is food abundance. If I were to give you a jumbo industrial role of toilet paper and allowed you to hold it while I unraveled it, we wound end up with a very long strand of toilet paper. If I tore off the last square of toilet paper and gave you the entire rest of the strand, we could use your long strand of toilet paper to represent the length of human history where starvation was a real day to day threat. The single square in my hand would represent the length of human history where starvation was not much of a threat. Not since the end of the Great Depression and World War II has starvation not been a real possibility. We have about 150,000 generations where efficient fat storage was essential for survival, and 3-4 generations where efficient fat storage can lead to obesity. The problem is not that we are inactive, the problem is that calories are so readily available to be consumed. An hour of jogging will burn only about 150 calories above your basal metabolic rate, but it only takes about 30 seconds to eat 150 calories of cookies. We judge the value of our meals on the size of the portions we are given. When we go out to eat, we want to leave full. Studies show that there are about 1,000 Calories between being satisfied and feeling full. Even more frightening is that there are between 2,000 and 3,000 calories between feeling full and feeling stuffed. If you go out to an all-you-can-eat food bar and leave feeling stuffed, you may have consumed as many as 4,000 unneeded calories. When this happens we typically go out for a jog the next day to "burn off those calories". But to burn off that many calories would require you to jog continously for 27 hours. The problem is not that we don't burn enough calories, it's that we put too many calories down our neck.

Leptin: the genetics of fat storage

As anyone with a bodyfat problem knows, there seems to be a strong setpoint for how much body fat a particular individual has. This setpoint is controlled by a gene called the ob gene that produces a protein called Leptin. Leptin is a strong suppressor of appetitie and food intake. As your bodyfat rises, more leptin is produced and your appetite declines so that your bodyfat stabilizes. If your body fat falls, your leptin production declines and your appetite is disinhibited. It seems that we inherit a bodyfat setpoint that is most effecient for our environment and the environment of our ancestors.

Why exercise doesn't burn many calories

Go to the health club and climb on a stair stepper or treadmill. Program the machine by plugging in your weight, select your speed or program and begin your workout. As you plod along on the apparatus you are driven along by the ever-increasing number on the screen that indicates the number of calories that you have burned. Eventually you go long enough to burn 300 calories and you are left with a feeling of accomplishment. Now, as you wipe the sweat from your brow and catch your breath, let me ask you a question. Why did the machine ask you to program in your weight? If you answered to calculate how many calories you burn you are right. What you most likely failed to consider is the main reason it needs your weight is to calculate your basal metabolic rate. The average male will maintain his weight on about 3200 calories a day. That is about 140 calories an hour at rest. So the 300 calories burned are not calories burned above your basal metabolic rate, they are calories burned including your basal metabolic rate. So for your time on the treadmill, you burned about 160 calories above your baseline. If you eat just 3 cookies, you have completely undone about an hour's worth of work. Think about it...if we were so metabolically inefficient as to burn 300 calories at the rate the exercise equipment says you do, would we ever have survived as a species. The calories burned hunting and gathering would have caused us to die of starvation before we could ever have found anything to eat. At that rate of calorie burn, we would barely have enough metabolic economy to survive a trip to the grocery store. Most people have accepted blindly the information displayed on exercise equipment and as such have turned exercise into a form of guilt absolution. Have dessert (600 calories of pie) and feel guilty? Just go to the health club and work on the stepper until 600 calories tick by on the screen. Other than the fact that this simply seems pathetic, it also just doesn't work.

Let us assume that you have the determination and time to do such a workout 7 days a week. If we take the 300 calories burned and subtract out your basal metabolic rate of 140 calories, we are left with 160 calories burned. There are 3,500 calories in a pound of fat. If your appetite is not spurned by the exercise (as it commonly is) and you keep a stable calorie intake, it would take you 21.875 days to burn off a pound of fat with the extra activity. This is assuming that no other variables are present. Unfortunately there is a big variable that almost no-one accounts for...muscle loss. In order to exercise long enough to reach the 300 calorie mark on the stepper or treadmill, you have to perform low intensity steady state activity. Steady state activity does not place much demand on the muscles, that is why it can be carried out for so long. Rather than demanding use of a large percentage of your muscle fibers, you are actually using a small percentage of your weakest, slow-twitch fibers over and over. When you perform this type of exercise your body can adapt by actually losing muscle. Since you use such a small percentage of your muscle mass to do the work, additional muscle is perceived as dead weight, useless and burdensome. If a person persisted in 7 day a week steady state training the could easily lose about 5 pounds of muscle tissue. Muscle tissue is the most metabolically expensive tissue we have; it takes between 50 and 100 calories a day just to keep a pound of muscle alive. Lets assume the lower number of 50 calories a day. If you lose 5 pounds of muscle over time as you perform your calorie burning exercise that will result in a loss of 250 calories per day that would be used to keep that muscle alive. The 160 calories you burned would probably now be more like 100 burned because with practice, your running or climbing economy improves and requires less effort (most of the perceived conditioning in steady state activity is actually the exercise getting easier not because of improved cardiovascular condition, but because of improved economy of motion. This is why if you take a runner and have him perform another steady state activity such as cycling he will be gasping for air. Indeed, runners who train on treadmills in the Winter notice a large decrease in perceived condition when they hit the road in the Spring). So now if we do the math we will find that you burned about 100 calories above your baseline per day, but we must subtract out 250 calories due to muscle loss. For all your effort you are now 150 calories in the wrong direction. Furthermore, the stress hormones that result from such overtraining also stimulate fat storage. Anyone who has attempted such a program of weight loss can confirm...you will end up feeling washed out, moody, and (worst of all) fatter. The truth is this: you cannot use physical activity to negate excess caloric intake.

Muscle: the real key to burning calories

Remember when you were a teenager and could eat everything in sight and not get fat? Somewhere in your 30's things changed. Now it seems like just looking at food can make you fat. What happened?

The main difference for most people is that they have less muscle in adulthood than they had in their late teens and early twenties. As we age there is a natural tendency to lose muscle and we also are less vigorous in our physical activity, which results in further muscle loss. This loss of muscle tissue results in a decreasing metabolic rate. Lose 5 pounds of muscle and your calories burned per 24 hours decreases by about 250 calories. While this may not sound like much, it adds up. If you continue to eat like you did when you were younger, you will gain a pound of fat in about 14 days. Over a 20 week period you will gain 10 pounds.

The key to getting rid of accumulated body fat is to get back your youthful metabolism by getting back your muscle. You have probably heard people say that "muscle has memory". Well, this is one popular saying that is actually true. With a proper exercise stimulus that dormant muscle can be reclaimed. When you get back the muscle that requires 250 calories a day to keep alive, what used to be an insidious weight-gain problem will become an insidious weight-loss technique. As you become stronger you will have a natural tendency to partake of more vigorous activities. This situation will allow you to lose weight with less attention paid to calorie counting and food selection. The more reasonable your diet can be, the greater your chance to stick with it. As you ride this spiral of success, you may be able to eat more like you did as a teenager. Putting just 5 pounds of calorie burning muscle on your body can really turn things around for you.

Proper exercise and discriminant weight loss

SuperSlow inventor Ken Hutchins was the first person to ever explain the idea of discriminant weight loss to me. He told me to picture the human body as a corporation that is run by a board of directors. He told me to assume that a body operating on a calorie deficit is like a corporation running at a budget deficit. Each of the body tissues could represent a different department within that corporation. He then presented two scenarios. In the first scenario there is a budget deficit and no department has any unusual demands. In this scenario layoffs can occur in all departments. So your body lays off some fat, some muscle, some bone and connective tissue, as well as nervous tissue . Your corporation (or body) becomes a smaller version of its former self. In the second scenario, there is a large demand placed on the muscle department. In this scenario, no layoffs can occur in the muscle department. Indeed, more muscle has to be hired on. This results in a larger layoff in the fat department. We cannot produce cutbacks in the bone or connective tissue department because we need their support because muscle is not helpful unless it is attached to strong bone by strong connective tissue. This means more fat has to be let go. We cannot lay off any nervous tissue, because our new muscle is useless unless it is innervated by new nervous tissue. This means more fat has to be let go. Under this scenario, all weight loss is shunted toward fat loss. In this scenario, your corporation (body) takes on a dramatic shape change. You have added a modest amount of shape-improving muscle and jettisoned a large amount of shape-ruining fat.

Don't put that in your mouth

It should now be evident to you that the easiest way to create the calorie deficit you need to lose bodyfat is to simply avoid putting the extra calories in your mouth in the first place. Even a very modest calorie reduction of 150 calories will result in significant fat loss over time. In the long run, the self-discipline required is much easier to produce than the effort of running on a treadmill for an hour every day (which is a losing proposition anyway). A calorie intake deficit of 500 calories a day is still fairly easy to achieve, and if you have added some muscle to your body the shape change you can produce in 6-12 weeks can be amazing. Initially, you may have to be very compulsive about counting calories, but within a few weeks you will probably learn to manage simply by controlling the portion size of the foods you eat.

Superhydration

Ellington Darden, PhD (Author and former Research Director for Nautilus Sports/Medical Industries) came up with this concept. The food calories that you count are actually Kilocalories or Calories. A Calorie is the amount of heat energy required to raise the temperature of a liter of water by one degree celsius. The calories that you count are actually just units of heat-energy.

Dr. Darden developed a program of drinking large volumes of ice-cold water throughout the day. The ice water that goes into your system has to be warmed to body temperature. Thus a liter of water at 1 degree celsius that ultimate leaves your body at 37 degrees celsius and thus requires 36 calories of heat energy. If you manage to consume 5 liters of water per day this results in roughly 180 extra calories burned.
According to Dr. Darden, superhydration helps fat loss in another way. If you are well hydrated most of your body's waste products can be eliminated through the kidneys. When you are underhydrated much of this burden is assumed by the liver. One of the liver's main functions is the processing of stored bodyfat for use as energy. If your liver is occupied processing waste products it is less efficient at mobilizing bodyfat. Superhydration not only burns calories, it allows your liver to be more efficient at mobilizing fat off of your body.

Plenty of Sleep

Dr. Darden also discovered that plenty of sleep was essential to fat loss. In his research he noted that subjects who were sleep deprived did not lose fat as easily as those who were well rested. It seems that calorie restriction is fairly stressful to the body and any further stressors can result in a protective slowing of the metabolism. My own theory is that a calorie restriction sends a biological signal of starvation and decreased sleep sends a signal that the organism is having to stay up to search for food, or it has to be vigilant because its environment is unsafe. These are probably powerful biological signals that cause a protective slowing of the metabolism.

Simple Dietary Guidelines and Recommended Diets

There are literally thousands of diet books out there. Many of these books make extraordinary claims or involve complex regimines that cannot be carried out long term. By far the best diet books written are those by Ellington Darden, PhD. His books are no-nonsense and have precise regimines that are easy to follow. Most importantly, his diets easily adapt into lifelong eating habits that will keep you lean. Some of Dr. Darden's best books include Soft Steps to a Hard Body, Living Longer Stronger, and A Flat Stomach A.S.A.P. Protein Power by Dr's. Michael and Mary Dan Eades is well written and makes a compelling argument for control of carbohydrate intake. Many of my clients have found that producing a calorie deficit on this program is easier for them than many other diets. The bottom line is that you will need to devise a system of reducing calorie intake that seems to work for you.

My own dietary guidelines for people are actually quite simple. It involves looking at your hand. You have five fingers that represent five meals to eat in a day (3 meals and 2 snacks). The serving size of any food you choose should be either the size of your palm or able to fit in the palm of your hand. Meals can have 4 servings from any categorie of food. Snacks have 2 servings. Your five fingers also represent the 5 liters of water you should drink over the course of the day. If you follow these guidelines you will limit your portion sizes so that you should be able to produce weight loss without excessive attention to detail. If you want a more detailed way of portioning your intake, I also suggest the "Food Mover" sold by Richard Simmons on his informercial (although I do not recommend his aerobics-based exercise program that comes with it).

The Bottom Line

The bottom line for fat loss is as follows: 1) Build some calorie burning muscle through proper exercise. 2) Create a modest calorie deficit through dietary restraint. 3) Superhydration. 4) Get some extra sleep. 5) Avoid overactivity or steady-state activities that are popularly thought to "burn calories". If you have the discipline, these simple steps will prove successful beyond your expectations.

Time Capsule

September song

Back-to-school day came again, and with it an urgent question: Why does it take the memory of a Hello Kitty lunchbox to make you realize that life is not a drill?

By Gary Kamiya

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Oct. 10, 2006 | My daughter, Celeste, started fifth grade a month ago, and my stepson, Zachary, started his senior year of high school. For me, these annual back-to-school days are a more pointed reminder of the passage of time than birthdays, New Year's Eve or any of our society's other rituals of commemoration. I don't really feel the changes in my own life from birthday to birthday, and the change of the calendar year rarely inspires much reflection. But fourth to fifth grade? That's going from the Permian to the Triassic. You go to bed and your kids are fungal life forms; you wake up and they're reading Faulkner.

As a parent, you have a ringside seat to watch these transformations. That isn't true with your own life. As a grown-up, filing experiences away before you even have them, very little feels new anymore, and the hands of the clock spin around faster and faster. Your life slips away, with no promontories from which to observe it. Time fades you, washes out your colors, and maybe the fading itself, like the anesthetizing bite of a vampire bat, prevents you from noticing it.

But you do notice your children. They change so fast that even your tired old eyes can't miss it. And on these ceremonial occasions, like back-to-school day, images of all the other back-to-school days before them flash before your eyes. Your children get smaller and less argumentative with each one, their lunch bags get gaudier and gaudier. And remembering, you feel the finality of time. You realize that their old selves are gone and won't come back. And that you'd better enjoy the ride because it's a one-way line.

I recently witnessed a time-lapse version of this in my backyard, after we adopted two hatchling ducks from a county fair. Their growth was a science fiction-esque, almost frightening process: They went from balls of fluff that could fit in your hand to full-grown birds in a little over a month. If you blinked, you missed their entire development. Very strange.

And even stranger is that it takes the memory of a Hello Kitty lunchbox to make you realize that life is not a drill.

In his famous essay "The Sense of an Ending," the British literary critic Frank Kermode drew a distinction between the two Greek words for time: "kronos," which is the mere tick-tock of ordinary life, clock time, just "one damn thing after another," and "kairos," which is special or crisis time, transfigured time, time with the tragic dimension restored. He argues that Christianity, the central Western myth about time, instills that dimension; so does great literature.

So, in their own way, do children. They uncannily double your experiences, like an overtone or an octave note. You see yourself in your kids, but in a very strange way. Watching your children is like watching yourself through a window. You simultaneously live your life and observe it. This leads to a peculiar phenomenon: You frequently remember the experiences you have with your kids at the same time you're having them.

Why spend money on cumbersome volumes of Proust when you've got bundles of lost time conveniently located right in your own home?

A random example. I was walking back along the Embarcadero, the promenade along San Francisco's waterfront, from a Giants game with Zachary a few years ago. He was probably 11 or 12. He took my hand as we crossed the street, as he always did, and we kept holding hands after we crossed, when it suddenly entered my mind that this might be the last time we would ever do this.

Which, basically, it was.

So I enjoyed the moment, and at some point he let go of my hand. And I let go of the thought, which fluttered off like a butterfly and disappeared, and we walked up Jackson Street to our house.

The poignancy tap with kids is always open; you could drown in it. Luckily, unless you're a really melancholy or self-involved person, you don't. Because if you look at change and see only loss, you've taken yourself out of the game. The beyond-life perspective may create a tragic sense of time, but the tragic sense of time doesn't get the kids to school in the morning. For that, you need an alarm clock. Proust would probably have been a really bad parent.

Kids are an extremely irritating miracle. So parents are constantly tacking back and forth between the far shore, a place of sublime light and Turneresque shadow, and the near, a plastic wasteland adorned with broken Happy Meal toys. Hence the peculiar expression, simultaneously blissed out and pissed off, to be observed on the faces of so many parents.

Actually, if the unpleasant truth be known, we spend a lot more time on the near shore. Parenting isn't about compromise or negotiation. It's about complete and total collapse, cutting and running, the craven abandonment of all ideals and all pride. We're talking about letting the terrorists win, going home and having a drink.

It's hard to believe that George W. Bush was ever a parent. You want to transform the Middle East? Would you settle for a shwarma that's not too covered with flies? Of course, God speaks to Bush, so he has an advantage as an authority figure. I stopped believing in the voice of God when Celeste discovered the Disney Channel.

But chances are her demonic pact to worship Allie and AJ will eventually transmogrify into a love for Sarah Vaughan or Jimi Hendrix, like her older brother's. The far shore isn't -- and shouldn't be -- always in sight, but you see it often enough to steer by it.

So I watch them getting ready for their first morning of school. Celeste in her nice new skirt and top from Target, a little nervous but trying to be brave. Zachary a veteran, his painful freshman and sophomore years long behind him, already deeply immersed in subjects I didn't study until I was long out of college.

Is this the little 4-year-old who seized my leg and wouldn't let go, that moment in the kitchen so many years ago when I realized he had come to trust this strange man who had come into his life? Is this the little girl I carried in my arms for so long?

The river flows on, the same and not the same.

I take the keys and open the door. We don't want to be late on the first day of school, or of the rest of our lives.

More Play For Kids

Doctors Urge More Playtime for Children

By LINDSEY TANNER

The Associated Press
Monday, October 9, 2006; 1:13 AM

CHICAGO -- Here's some soothing medicine for stressed-out parents and overscheduled kids: The American Academy of Pediatrics says what children really need for healthy development is more good, old-fashioned playtime.

Many parents load their children's schedules with get-smart videos, enrichment activities and lots of classes in a drive to help them excel. The efforts often begin as early as infancy.

Spontaneous, free play _ whether it's chasing butterflies, playing with "true toys" like blocks and dolls, or just romping on the floor with mom and dad _ often is sacrificed in the shuffle, a new academy report says.

Jennifer Gervasio has a 5-year-old son and 3-year-old daughter involved in preschool three mornings weekly, plus T-ball and ballet for each one day a week. That's a light schedule compared to her kids' friends, and Gervasio said her son in particular has trouble finding buddies who are free to come over and just play.

"There's just such a huge variety of things you can do for your kids if you have the resources, you almost feel why not," said Gervasio, of Wilmette, Ill. "There is a part of me that would worry if I don't sign my son up for some of these things, will he not be on par with the other kids."

For now, she says, she resists the pressure, instead allowing her kids plenty of time for looking for bugs, romping at the beach and other play activities they love to do.

"I truly believe that they're better off when they can just do their own thing," Gervasio said.

Numerous studies have shown that unstructured play has many benefits. It can help children become creative, discover their own passions, develop problem-solving skills, relate to others and adjust to school settings, the academy report says.

"Perhaps above all, play is a simple joy that is a cherished part of childhood," says the report, prepared by two academy committees for release Monday at the group's annual meeting in Atlanta.

A lack of spontaneous playtime can create stress for children and parents alike. If it occurs because young children are plopped in front of get-smart videos or older children lose school recess time, it can increase risks for obesity. It may even contribute to depression for many children, the report says.

Social pressures and marketing pitches about creating "super children" contribute to a lack of playtime for many families. But so does living in low-income, violence-prone neighborhoods where safe places to play are scarce, the report says.

It says enrichment tools and organized activities can be beneficial but should not be viewed as a requirement for creating successful children. Above all, they must be balanced with plenty of free play time, the report says.

"In the current environment where so many parents feel pressure to be super parents, I believe this message is an important one," said Dr. Kenneth Ginsburg, the report's lead author and a pediatrician at The Children's Hospital of Philadelphia.

Noted pediatrician and author Dr. T. Berry Brazelton praised the academy's report.

"I hope it will have some effect," Brazelton said.

Children overscheduled with structured activities "are missing the chance they have to dream, to fantasize, to make their own world work the way they want it. That to me is a very important part of childhood," Brazelton said.

___

On the Net:

American Academy of Pediatrics: http://www.aap.org/

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