Your U of T Health & Fitness Guide

Canadians today are bombarded with information and advice on health, exercise, fitness and dieting. But so much of it is contradictory, misleading or self-serving. We went to some of U of T’s best scientific minds for the straight goods on our bodies, our diets and the state of medicine today.

FITNESS

Forget the gym

You don’t need a gym membership to get fit. Opportunities to shape up are everywhere – if you can overcome the mental hurdles holding you back. “It’s less hard than people think to increase their physical activity participation to a level that contributes to improved health and reduced risk,” says Dr. Jack Goodman, associate professor in the Faculty of Physical Education and Health.

But it’s got to be fun, adds Dr. Mark Leith, a psychiatrist and clinical teacher. “If you can’t find the time, you’re still not seeing it as something pleasurable,” he says. “Your body wants to run. Let it happen.” While you’re at it, lose the goal-oriented mindset (and the heart-rate monitors), he says. “Exercise should bring a sense of pleasure and release.”

Start slowly, says Goodman. Get off the subway two stops early and walk. Bypass the escalators and bound up the stairs. Take the kids for a stroll after dinner.

From there, adopt a habitual activity, such as gardening or walking the dog. After that, two or three episodes a week of actual exercise won’t be so daunting. When you’re ready, you can graduate to bouts of more spirited exercise, three to five times a week, for 20 to 30 minutes. Take your time, says Goodman. “It takes months to establish a change in lifestyle.”

Warming up right

Warming up before exercise is just as important to your physical well-being as the game or exercise routine that it precedes, says new U of T football coach Steve Howlett (BA 1985 Scarborough). Warming up stimulates blood flow to the muscles, makes muscles more flexible and increases respiration rate and perspiration. What’s more, it’s not just your physical self that benefits. “Warming up may make one feel better and therefore more confident,” says Howlett, a member of the Ontario champion Varsity Blues team of 1983. “There also may be a meditative element that may bring a sort of peace, reduce anxiety and focus attention prior to performative events.”

Just make sure your warm-up matches your needs. Howlett offers a guideline of five to 10 minutes of low-intensity activity (such as jogging or biking), followed by 15 minutes or so of gentle stretching, gradually pushing the muscles beyond the normal range of motion.

DIET

Five tips for smarter eating

Studies show that 95 per cent of dieters fail to achieve their weight-loss goals. Why not bypass the diet industry’s $40 billion worth of hype and learn from the experts?

Find the balance: Weight control is a state of equilibrium between the amount you eat and the energy you expend, says Dr. Khursheed Jeejeebhoy, professor of medicine at U of T. For weight maintenance, most people require 30 to 32 calories a day per kilogram of body weight; a 70-kilo person, for example, will need approximately 2,100 calories. Even an extra 100 calories a day over that limit will pack on the pounds. The good news? Cutting out those extra 100 calories a day will take off pounds. You don’t need to slash your daily caloric intake in half and eat only cabbage and grapefruit to lose weight.

Shun your impulses: “The food industry has perfected the art of selling food in a fiercely competitive environment,” says Dr. David Jenkins of the department of nutritional sciences. Loaded with saturated fat, sugar and highly refined carbohydrates, today’s packaged foods are engineered to whet your taste buds and keep you coming back for more. To avoid overstimulating your appetite, choose satisfying but less tempting alternatives.

Ignore the fad diets: Dieters are often so anxious for a quick fix they don’t question the so-called facts. “Ask yourself, ‘how do we know it’s healthy?’” says Jeejeebhoy. “The data for that is almost non-existent.” Fad diets fail, he adds, because they don’t work with your appetite. “Unless you change your whole diet habit so you are satisfied with a lower number of calories, you are never going to lose weight.”

To feel satiated, seek out foods that offer more volume with fewer calories: Fruits and vegetables fill you up with their high water content instead of costly calories. Whole grains and fibre are useful because they make your stomach and intestines expand and make you feel more full. Some bulky low-fat foods are also slow to digest, making the “full” feeling last.

Find other passions: With today’s hectic lifestyles, many people eat out of frustration. “Their fulfilment comes from being filled with food,” says Jenkins. If your workload is too hectic, prioritize and cut it down. Bored with life? Find a new hobby or revisit an old one. Stimulate your mind, not your appetite. And don’t forget to exercise.

WORKPLACE WOES

Standing up for your health

When they think of occupational health, most people picture industrial workers falling off ladders. But even an average office contains hidden health threats.

According to Pat McKee, associate professor in the department of occupational therapy, poor posture and inactivity are the two biggest threats to workplace wellness. With fax machines, phones and the World Wide Web at our fingertips, there’s no reason to rise from our comfy swivel chairs, she says. “We need to introduce some inefficiencies to the office.” Move the printer to the other side of the room so you have to walk to it. That will give overworked muscles a break and jump-start the circulation that will flush metabolic waste products from them.

Beyond that, laments McKee, people don’t know how to use their chairs or adjust their monitors and keyboards. They pay the price in poor posture, cramped necks and repetitive-strain injuries. Ideally, she says, your eye should hit your computer monitor about a third of the way down. The screen should also be tilted so it doesn’t reflect any light-source glare. A below-the-desk keyboard tray is critical, because your forearms should be parallel with the ground to avoid unnecessary stress on your arm and shoulder muscles. (It also promotes better overall posture.)

But many workplace health concerns can’t be dealt with in isolation. If your company has a health and safety committee, says McKee, get involved. “Worker participation in shaping the environment has a major impact on working conditions.” If you toil in a less organized office, inform your supervisor of workplace problems or the need for more ergonomic furniture.

MENTAL HEALTH

Exercise your mind

Everyone knows nutrition and exercise are important to overall health, but many people are unaware of the physical benefits of spiritual practices such as prayer and meditation.

Dr. Yvonne Kason, of U of T’s department of family and community medicine, wants to get the word out about the mind’s incredible powers. A family physician and psychotherapist, Kason says studies show that tuning into a higher power can have a big impact on your health. “Meditation, prayer and yoga will help lower the heart rate, decrease your blood pressure and relax your muscles,” she says. A 2001 article in the British Medical Journal also pointed to the benefits of mantra (repeating a sound to encourage inner peace) and rosary prayer for improving cardiac functioning.

According to Kason, there is evidence indicating that prayer speeds healing and reduces complications in surgery. “We don’t have scientific biochemical brain scans proving why prayers work, why meditation improves depression,” she says. “All we can say is that clinical studies have documented that they do.”

A U of T study is also exploring the powers of the mind through mindfulness-based cognitive therapy, an approach that combines Buddhist meditation, hatha yoga poses and modern cognitive therapy. While the study is in the early stages, its participants are feeling the benefits, says grad student and co-investigator Andrew Welch of the department of occupational therapy. “On a social level and on a work level, we’ve seen some increases in their ability to function.”

Want to reap the benefits of spiritual practices? There are many different types, so take time to investigate what works for you. Once you’ve found a system, Kason advises starting with five minutes of meditation each morning and evening. Gradually increase that time to 20 minutes or more. “If people do that for a month,” she says, “they will definitely notice a difference in increased calmness, feeling of connection with a higher power, and increased ability to tap their spiritual connection as a tool for healing.”

PUSHING SCIENCE FORWARD

Medical research is long and painstaking work, but some U of T pioneers hope dreaming big could mean big breakthroughs in areas such as these:

Diabetes: If detected early enough, Type 1 diabetes is treatable. Thanks to a research group headed by Dr. Michael Dosch, a professor in the department of pediatrics, science is closer to diagnosing diabetes risk much earlier. Dosch and his team discovered a link between Type 1 diabetes and nervous system autoimmunity (diseases that attack the nervous system). Based on this link, researchers can trace early stages of diabetes through protein markers left by an autoimmune attack such as multiple sclerosis. Dosch, who is collaborating with a biotech firm to refine this detection, hopes a diagnostic tool will be ready within 18 months: “We hope to test every four- or five-year-old child.”

Spinal cord repair: University of Toronto researchers hope to solve the mystery of reversing nerve damage in paralyzing spinal cord injuries. The team, led by Molly Shoichet, associate professor of chemical engineering and applied chemistry, is investigating how to deliver regenerative molecules to a compressed spine, such as that suffered by actor Christopher Reeve. So far, the team has seen increased mobility in paralyzed rats, and proven that its delivery method is safe for human use. “Our goal is to go for gold,” says Shoichet. “We want to find a strategy that will restore complete function.”

Engineered organs: An ambitious multidisciplinary research project initiated by U of T aims to create the first engineered heart (a new organ made of living tissue, as opposed to an artificial heart of plastic or metal). The intent is to pool talent in biomedical engineering from around the world, in the first co-ordinated project of its kind. “We’re working on capillary beds; others are trying to make cardiac muscle,” says key investigator Michael Sefton of the Institute of Biomaterials and Bioengineering. “The Living Implants From Engineering [LIFE] project was created to combine everybody’s efforts.” If successful, the LIFE project could address organ shortages and lead to other organ replacement spinoffs.

Psychiatric disorders and strokes: Research into two proteins in the brain could mean new treatments for strokes and psychiatric disorders. A group led by assistantpsychiatry professor Fang Liu discovered that communication between proteins known as dopamine D1 and NMDA receptors controls cell death in the brain. Next step: decipher this link and control it. The findings also have implications for brain injuries and epilepsy, says Liu. “I’m hoping that clinically they can use this research to design drugs.”

SCIENCE

Four new U of T advances

From new glimpses into intricate cell workings to an improved vaccine for Alzheimer’s disease, U of T researchers continue to expand the frontiers of medical knowledge. Among last year’s advances:

Progress toward pain relief: Painful sensations are dramatically reduced when a particular gene is absent, researchers have found. Their discovery promises new treatments for chronic pain – a “huge, silent public health crisis,” says study co-author Dr. Michael Salter, director of the U of T Centre for the Study of Pain.

Led by graduate student Mary Cheng and post-doctoral research fellow Graham Pitcher, the researchers found that mice lacking a gene called DREAM (downstream regulatory element antagonistic modulator) were much less sensitive to pain than mice with the gene.

An improved Alzheimer’s vaccine: Hope for a safe, effective way to prevent Alzheimer’s disease was revived when researchers described a method of refining an experimental vaccine to eliminate potential side-effects.

Dr. JoAnne McLaurin and Dr. David Westaway of the department of laboratory medicine and pathobiology, along with Dr. Peter St George-Hyslop, director of the Centre for Research in Neurodegenerative Diseases, isolated the active component of the original vaccine and used this to create a refined, precisely targeted vaccine. Their report suggests the new vaccine can stimulate the immune system into fighting harmful plaque deposits in the brain – without triggering the brain inflammation seen in recent clinical trials.

Overcoming drug resistance in cancer cells: Antiangiogenesis is a promising cancer therapy that attacks tumours by cutting off their supply lines – the blood vessels that feed them oxygen and nutrients. Unfortunately, the drugs sometimes lose effectiveness, and cancer cells regrow.

Dr. Robert Kerbel, a professor in the department of medical biophysics, unravelled this conundrum by showing that cancer cells can mutate in a way that helps them survive better even when relatively oxygen-starved. The finding suggests antiangiogenic therapy may work better if combined with drugs that target cancer cells in oxygen-poor environments.

Cell workings explained: The intricate machinery that determines a cell’s internal calcium levels is now understood, thanks to Dr. Mitsu Ikura and graduate student Ivan Bosanac of Princess Margaret Hospital. Because cellular calcium levels affect brain function, the study “represents an important milestone in developing drugs that could one day combat brain diseases like epilepsy,” says Ikura, a professor of medical biophysics.

Their research describes how an important messenger molecule inside a cell acts as a “key” to unlock one of the cell’s entry ports, or receptors, allowing calcium to enter. This molecule-receptor interaction – previously a mystery – determines varying calcium levels throughout the cell.

NATURAL MEDICINE

“Natural does not equal safe”

Call a remedy “natural,” and many Canadians open their wallets. But take care, warns Heather Boon, assistant professor in the faculties of pharmacy and medicine. Many natural medicines have never been proven effective – or even harmless. “Natural does not equal safe,” she says.

What’s more, natural medications can affect the way conventional medications work. For instance, St. John’s wort, a popular herbal remedy for anxiety and depression, can cause your body to metabolize other drugs faster.

Still, judging whether the natural stuff “works” is not as straightforward as you might think. A belief in whatever you’re doing to help yourself has an influence on results, says Boon. “A cancer patient may consider an herb to work if it makes her feel better, but an oncologist may consider it effective only if it prolongs the patient’s life or shrinks the tumour. We need to be careful about making generalizations about whether something works or not.”

Before clambering aboard any natural-health bandwagon, Boon advises patients to do some research and talk to their health-care providers – both the conventional and complementary variety. He suggests asking if there’s any evidence that specific natural products are effective, and whether they have any adverse effects. Also ask whether there are people who shouldn’t use the product, and how it interacts with conventional medicines.

MODIFIED FOODS

Tampering with nature?

Strictly speaking, genetically modified organisms (GMOs) have been around forever, with our fore-farmers from way back experimenting with plant breeding to yield crops with as many desirable traits as possible. Why not? GMOs can improve the nutritional quality of food; help plants grow in unfavourable environments (such as arid fields or regions of high salinity); prevent or reduce infection by bacteria, viruses and insects; and spur remediation of contaminated soil or water.

They might even prove our salvation: GMOs offer the means to utilize farmland most efficiently and produce nutritious foods in sufficient quantity to feed a world population that could hit eight billion by 2025.

Still, many worry about tampering with nature. Concerns run the gamut from setting off food allergies to introducing poisons into the food supply. But Dan Riggs, associate professor of botany, urges confidence. “Give them a try,” says Riggs, who has been working in plant biotechnology for almost 20 years. “A number of foods, particularly processed foods, already contain GMO-derived materials. And no one has died from consuming [them]. It’s extremely unlikely that the modification of existing components most of us have consumed for years without problems is going to cause trouble just because they’re in a different food.”

MYTHS

Debunking the theories

Time to set the record straight on some common health theories:

You must drink eight glasses of water a day. Health gurus claim that drinking eight glasses of water a day keeps your body operating smoothly. Dr. Anne Kenshole of the department of medicine is waiting for proof. “My enquiries as to what promoted this have come up with a big zero,” she says. Kenshole says a Dartmouth Medical School study found no evidence as to why healthy adults living in temperate climates need to drink that much water. As an endocrinologist, she sees first-hand the damage from drinking too much H2O. “In people with heart or kidney disease, unnecessary water intake can overload the kidneys after a period of time,” says Kenshole. “It can upset the sodium and the potassium balance, all of which is determined by the kidneys.”

Calcium fortified with magnesium prevents bone loss. The health industry is cashing in on the new focus on osteoporosis in our aging population. A decade ago, pharmacies sold mostly simple, no-frill calcium supplements. Now their shelves are stacked with calcium combinations such as magnesium and zinc/boron. “The research out there is backing the use of calcium with vitamin D,” says Dr. Angela Cheung, department of medicine, “but the research isn’t really there for magnesium or the others.” If anything, she says preliminary reports indicate that magnesium might be harmful. While Cheung is currently studying positive effects of vitamin K, she advises people to stick with a proven team: calcium and vitamin D.

You can develop a resistance to antibiotics. Many people believe that the more antibiotics you take, the stronger the dose you require. Not true, says Dr. Andrew Simor, department of laboratory medicine and pathobiology. It’s the germ or bacteria itself that develops a resistance, not the body. “The germ may mutate or acquire genetic material that allows it to be resistant,” Simor explains. “Then the antibiotic is no longer effective” – and you need a different drug, not a stronger dosage. Still, Simor recommends using antibiotics only when absolutely necessary: “The overuse or misuse of antibiotics promotes antibiotic resistance in germs. And that’s not a good thing.”

White teeth equal healthy teeth. Celebrity choppers look great in pictures, but blue-white teeth are often weaker than their yellow counterparts. “The whole issue of trying to get whiter-than-white teeth is carried way out of proportion,” says Hardy Limeback of the Faculty of Dentistry. He points to the current array of whitening toothpastes that promise to get rid of ugly stains better than the average paste – a cosmetic claim that requires no confirmation from Health Canada. One thing these whitening toothpastes will do, he says, is promote gum recession through their abrasive agents if used improperly.

HEALTH

Three risks you’d never expect

You eat tofu and practise those yoga poses. You might think you’re in the clear, health-wise, but new risks keep emerging:

An unhappy marriage can affect your heart, according to U of T associate professor of psychiatry Dr. Brian Baker. His three-year study measured changes in blood pressure and heart-wall thickness in 103 married men and women with mild hypertension. People who were dissatisfied with their relationship developed a slightly thicker left ventricle – which may indicate heart strain – while those who enjoyed marital harmony showed a small decrease in left ventricle thickness (and lower blood pressure).

Driving right after the Super Bowl raises your risk of being in a collision, says Dr. Donald Redelmeier, a U of T medical professor and director of clinical epidemiology at Sunnybrook and Women’s College Health Sciences Centre. After examining U.S. data from 27 Super Bowl Sundays, Dr. Redelmeier found, on average, an extra 1,000 car crashes, 600 injuries and seven deaths during the four-hour periods after the big game. He blames driver fatigue, alcohol consumption and inattention.

If you’re planning a tropical holiday, seek health advice from a professional – or risk joining the growing number of Canadians who contract malaria. The number of imported cases of malaria, a potentially fatal illness, has soared in recent years, says Dr. Kevin Kain, professor of medicine and director of Toronto General Hospital’s Centre for Travel and Tropical Medicine. With 2.5 million Canadians visiting the Third World each year, Kain sees an urgent need to educate travellers about malaria. “We have no immunity,” he says. “We fight for our lives like a one-year-old.”

TALKING TO YOUR DOCTOR

These days many patients arrive at their physician’s office knowing more about an illness than their doctor, says Dr. Wendy Levinson, vice-chair of medicine. Surprisingly, that’s a good thing. “Studies indicate that patients who are actively involved in their care do better.”

But many people remain intimidated by the doctor-patient relationship, notes Dr. Michael Evans, assistant professor in the department of family and community medicine. To get the most from your doctor, he says, honesty and openness are key. “People say, ‘Oh my God, how can I talk about my hemorrhoids?’ But we see hemorrhoids five times a day, five days a week. What we want is what’s best for you, but for that to happen, you need to be forthright.”

Preparation is also important. Come to appointments with a list of medications and questions you want to ask, says Levinson.

“Not everyone wants the same thing from their physician,” notes Evans. “Some might want more information, some less. It’s helpful when patients say, ‘Here is what I’m going to need from you to solve this health problem.’”

ADDICTION

A matter of motivation

Here’s a revelation: most smokers want to quit. What’s more, most of them will (three-quarters of people who have ever smoked quit by the time they’re 65). “So you have to ask yourself, ‘Do I want to quit now or later?’” says Dr. Roberta Ferrence, director of the Ontario Tobacco Research Unit, part of the Centre for Health Promotion in the department of public health sciences. “Because all you’re doing is delaying the misery.”

A person who is motivated to quit has the best chance of pulling it off. But external support is crucial. Research says that people who are trying to kick the habit in a supportive environment (i.e., in a home where family members applaud the effort) enjoy the most success.

Ferrence advises quitters to keep busy, steer clear of smokers and put the money they would have spent on cigarettes aside for a big treat. Most relapses occur in the first week; about 85 per cent in the first year. “If you can go three months without a single relapse, you’re probably going to stay quit,” says Ferrence. And if quitting is becoming a drag, the Canadian Cancer Society has a helpline for support: 1(877) 513-5333.

MARIJUANA

The truth about pot

A recent Senate committee proposal to legalize marijuana has many Canadians confused. Isn’t pot supposed to be bad for you?

It all depends on the user, and on the patterns and context of use, says public health sciences assistant professor Dr. Benedikt Fischer.

To start, consider the pharmacologically active material contained within the rolling papers – tetrahydrocannabinol. A mild intoxicant that resembles alcohol, THC depresses the central nervous system, rendering users outgoing, goofy and sometimes sleepy. It affects their alertness, short-term memory and response time. In some cases, it inspires panic, paranoia and delusions. An alarming set of evidence links cannabis use with drivers involved in automobile accidents.

Beyond that are the familiar side effects of smoking: irritation to the bronchial lining, coughing, wheezing, excessive sputum, shortness of breath, risk of cancer and long-term chronic obstructive pulmonary disease, and the possibility of developing an addiction.

If you’re pregnant, forget it (kids born of pot-smoking moms may suffer cognitive problems). Ditto if you’re a schizophrenic who is controlled and functioning in society (you’re more likely to suffer a relapse) or under 15 (starting so young suggests certain social trouble and run-ins with authority).

That said, says Dr. Harold Kalant, professor emeritus in the department of pharmacology, “There’s no evidence that marijuana does any harm to people who are well-balanced, have no predisposition to major illness, use [it] moderately, and don’t do anything risky or foolish while using it.”