A state of well-being

When Jenni Prokopy, founder and editor of ChronicBabe.com, recently asked bloggers to submit stories of techniques and coping strategies for how to live well with chronic disease, she received an impressive collection.

A young woman with type 2 diabetes described the importance of having a consistent morning routine. Another blogger, who has rheumatoid arthritis, shared how she deals with winter weather that makes her symptoms worsen. A woman with lupus recounted her longing to be involved in sports when she was in high school and the solution she came up with.

In purely medical terms, each of these bloggers is sick with a chronic condition. But when it comes to living their lives, they’ve figured out how to achieve a state of well-being.

What does it mean to be healthy, anyway? Is good health merely the absence of disease, or is it something more?

Researchers have been trying to define this for many years. The questions are both intriguing and difficult to answer. Which is more important - to live long or to live well? Is obesity the main measure of health or are there other indicators that matter too? Is it possible to have a chronic condition but still be healthy? Can you be healthy after cancer, heart attack or traumatic brain injury? What makes people resilient?

Some of the most interesting studies come from the field of healthy aging. They have identified a number of things that people who age well have in common: moderation in calorie intake and alcohol consumption, daily physical activity, the ability to manage stress and weather the pain of grief, and plain old zest for living.

The propensity for disease and shortened lifespan is at least partly determined by genetics, of course. The Long Life Family Study, for instance, a multi-center project that tracks families who have multiple members with exceptionally long lives, suggests there may be phenotypes associated with extreme longevity. Compared to control groups, they and their children were less likely to have diabetes, lung disease or peripheral artery disease. Both their cognitive functioning and physical functioning were better as they aged.

But other factors besides a favorable genetic profile may be at work as well. For example, the researchers noted that the participants enrolled in the Long Life Family Study were, on average, relatively well educated and had a low incidence of smoking.

An even more fascinating study comes from China, where researchers attempted to measure whether people who achieve extreme old age are somehow more resilient than those who die sooner. What they found was that individuals who had managed to survive into their 90s, were married, enjoyed better health, had pension benefits and at least one year of schooling were more likely to become centenarians.

The study’s authors observe:

When individuals reach very advanced ages, accumulated negative conditions such as health deterioration and bereavement of loved family members represent serious challenges. Thus, nonagenarians who are more resilient may have stronger capacities and potentials for dealing successfully with these serious challenges, constraints and adversities to subsequently survive to age 100+.

Several equally interesting studies have explored the role of conscientiousness on health – and here’s where those who’ve been dealt an unfavorable hand of cards can have a positive impact on their own health. Many of these studies single out traits such as self-discipline and perseverance as important predictors for health-related behavior. A study carried out in the U.K., for instance, found that young people with diabetes (most of the youths in this particular study had type 1 diabetes) and who scored well on personality tests measuring conscientiousness, emotional stability and openness to new experiences were more likely to practice good self-care, especially when they perceived their diabetes treatment was helping them control the disease.

Can you measure well-being like you’d measure your blood pressure or pulse rate? The folks at Gallup, the well-known polling group, have given it a try, releasing their annual national well-being index earlier this week.

The state-by-state poll is based on responses to several key questions: How do you feel about your life? What do you anticipate for your life five years from now? Are you satisfied with your job? Do you laugh often? Do you feel stressed out, angry or depressed? Do you have health problems that interfere with daily life? Do you eat fruits and vegetables and get regular exercise? Do you have access to clean water? Do you have enough money for food, shelter and health care? Do you feel safe walking alone at night? Do you believe your community is becoming a better place to live?

According to the results, the national well-being index is 66.8 out of 100 possible points. The best states were in the Upper Midwest and Great Plains, and included Minnesota, North Dakota and South Dakota (Iowa and Wisconsin didn’t quite make the cut). The worst were in the South and the so-called Rust Belt.

How does this apply to individuals? Since the 1950s, Gallup has polled people around the world, in search of the universal elements of well-being that matter to people regardless of country or culture. Here’s what they identified:

- Career well-being, or liking what you do every day.

- Social well-being, including having strong relationships and love in your life.

- Financial well-being.

- Physical well-being, or having good health and energy.

- Community well-being, or feeling engaged with where you live.

Surprisingly (or not), the biggest obstacle to achieving well-being is ourselves, according to Gallup authors Tom Rath and James K. Harter. By making short-term decisions, people often override what’s in their long-term best interests, they wrote. People who reported the highest levels of well-being, on the other hand, often lived in a way that was intentional rather than impulsive or focused on instant gratification. The authors conclude, “If we can find short-term incentives that are consistent with our long-term objectives, it is much easier to make the right decisions in the moment.”

Image credits: Photos, Wikimedia Commons; logo, Troy Murphy, West Central Tribune

Something fishy

If it’s Ash Wednesday next week, it must be time for fish.

Once upon a time, eating fish during Lent was considered penitential. These days, given what’s known about the nutritional benefits of seafood, it’s more likely to be seen as something healthful.

Americans historically have consumed far more meat than fish. It’s true the United States is second only to Japan and China in the sheer quantity of fish and shellfish consumed – 4.8 billion pounds in 2009 – but figures collected by the National Oceanic and Atmospheric Administration show little change in this amount over the past five years. In fact, U.S. seafood consumption per capita actually declined from 2008 to 2009, falling from 16 pounds per person to 15.8 pounds. (In comparison, we eat more than 200 pounds of meat per capita per year.) Even shrimp, America’s top favorite, was only consumed at the rate of 4 pounds per person per year.

It’s a curious trend, in view of the evidence that has been mounting for many years that fish consumption is beneficial for health in a variety of ways, from heart function to the inner workings of the brain. All told, more than 5,000 studies carried out worldwide say the same thing: Fish is good for you.

The American Heart Association, for instance, recommends two servings a week, particularly for adults who are middle-aged and older. Regular fish consumption has been linked with a reduced risk of heart disease, heart arrhythmia and high blood pressure.

There’s more: Because fish is high in protein and relatively low in fat, fish for dinner can help with weight management and the management of diabetes. One of the latest research efforts, the Framingham Osteoporosis Study, reported this month in the American Journal of Clinical Nutrition that the polyunsatured fatty acids contained in fish may help protect against bone loss.

Another benefit is that it seems to promote healthy brain function. French researchers who administered cognitive tests to nearly 3,300 adults found that those who reported higher fish consumption also had fewer cognitive difficulties.

An intriguing study by the Rush University Medical Center and its Institute for Healthy Aging even hints that eating fish might be protective against developing Alzheimer’s disease, possibly because of the antioxidant qualities of the n-3 polyunsaturated fatty acids contained in fish.

The ingredient in seafood that seems to confer the most benefit? By now you’ve probably already guessed: It’s the omega-3 fatty acids. The body doesn’t produce these on its own, so they must be obtained from outside sources. Other foods such as walnuts, soybeans and flaxseed oil also contain omega-3, but current science suggests the richest source – and the greatest impact on health - comes from seafood.

So why don’t Americans eat more seafood? In a telephone poll carried out among 1,000 U.S. adults, the top barriers were the cost of seafood and the fact that many people don’t like how it tastes. Many of the survey participants also said it was hard to find good-quality seafood and hard to prepare it properly.

An even bigger barrier, unfortunately, is environmental. Pollution has fouled both fresh-water and saltwater ecosystems, resulting in high levels of methyl mercury, PCBs and other contaminants in some fish. Environmentalists also are concerned about the impact of commercial fishing on the wild fish population, as well as the potential for domestic fish-farming to damage surrounding waters.

But in two independent reviews of the evidence back in 2006, the Harvard School of Public Health and the Institute of Medicine concluded the benefits of regular fish consumption outweigh any health risks from contaminants. The federal government’s new food guidelines, issued earlier this year, recommend eating eight ounces a week – more than twice the amount most Americans currently consume. Women who are pregnant or nursing should avoid shark, swordfish, king mackerel, and tilefish because of the potential for unsafe levels of mercury. Pregnant and nursing mothers also should limit their consumption of white albacore tuna to no more than 6 ounces a week.

For those who catch their own fish and want to know whether it’s safe, the Minnesota Department of Health has posted its guidelines here for fish harvested from Minnesota lakes and streams.

If you want to purchase seafood that’s sustainably produced, the Blue Ocean Institute and Seafood Watch include detailed information and ratings on their websites – but be aware that the data often are conflicting or confusing.

What are some good ways to add seafood to the dinner menu? One is to gradually substitute fish or shellfish for meat - having tuna in a salad or sandwich once a week, for instance. Baked or broiled fish is the best, and most healthful, method of preparation. Although many people love fish that has been breaded and deep-fried, studies of stroke incidence in the American South have discovered that frying seems to negate some of the benefits of omega-3 and might actually contribute to a higher risk of stroke.

What about fish oil capsules? According to the Mayo Clinic, you’re better off obtaining omega-3 from the real thing vs. a supplement. But if you’re at risk of heart disease, consider talking to your doctor about whether you would benefit from a supplement.

Photos: Wikimedia Commons; Logo: Troy Murphy, West Central Tribune

A balanced life

For kids, a snow day is like a gift that falls unexpectedly from the sky: a whole day to stay home and do whatever you want.

For adults? Not so much. In fact it’s often a giant inconvenience, and thanks to the wonders of telecommuting, many people are expected to continue working from home.

“Snow day, schmo day. Get to work!” groused Time magazine in a pithy little commentary last year:

Blizzard or no blizzard, it’s business as usual for today’s wired workers. Forget building a snowman with your kids. You’ve got conference calls and e-mails to attend to. And also, since the kids are home and you must work, you’ve got some extra work to do: You’ve got to find someone to watch them.

Whatever happened to slowing down for a day or two?

The statistics about American leisure time aren’t encouraging. Workers in the United States have some of the lowest vacation benefits of any industrialized nation. Whereas time off is guaranteed in countries such as France and Finland, U.S. employers aren’t even required to offer paid vacation time.

Expedia, the travel company, has been tracking vacation trends since 2000, and its data are showing an increase in the number of Americans who have vacation time but don’t use it. Some of the key statistics from its most recent study of 1,530 working-age adults in the United States are rather enlightening:

- About one-third of those who participated in the 2009 poll didn’t take all their vacation time. About one in five also reported canceling or postponing vacation plans because of work.

- One-fourth of the respondents said they continued to check their voice mail and e-mail while they were vacationing.

- Forty percent of the women in the survey said they felt guilty about taking time off; only 29 percent of the men felt this way.

- On average, employed adults in the United States leave three unused vacation days on the table each year.

All of this appears to be a symptom of a deeper issue: an increasing struggle to achieve a balance between work and home, between fostering one’s career and nurturing the self.

One of the most compelling studies on the impact of U.S. work habits and expectations was carried out in 2005 by the Families and Work Institute. Titled “Overwork in America: When the Way We Work Becomes Too Much,” it reaches this conclusion: “For a significant group of Americans, the way we work today appears to be negatively affecting their health and effectiveness at work.”

Among the highlights from the report: Employees who reported feeling overworked were more likely to experience stress, show signs of depression and rate their health as poorer. And here’s a real clincher: Fewer than half (41 percent) of those who reported high levels of overwork said they were successful at taking good care of themselves.

What will it take to change this? It’s not clear whether there’s a universal answer. In some quarters, however, people are trying.

Dr. Patricia Lindholm, a family physician from Fergus Falls and president of the Minnesota Medical Association, has made it one of her priorities to focus on physician well-being. A task force has been formed to come up with ideas and recommendations, and back in January the MMA devoted an entire issue of its monthly magazine to physician well-being.

A survey conducted by the task force identified some of the strategies doctors use for coping: making family time a priority, taking vacations, reducing their work hours, practicing yoga or meditation, being involved in hobbies or activities outside of medicine.

Earlier this month a new national partnership was announced between the Families and Work Institute and the Society for Human Resource Management to redesign workplaces for the 21st century. Among the ingredients: job autonomy, supportive relationships with supervisors, a culture of respect and, above all, flexibility that allows workers time off so they can nurture other aspects of their lives.

It’s no accident, says Ellen Galinsky of the FWI, that many of us get our best ideas while we’re in the shower; it’s the one place where we can be alone with our thoughts. Human beings need space in which to think, she writes in the Families and Work Institute blog:

We need to give ourselves time for rest and recovery. Ask anyone who is really proficient at anything – from intellectual to artistic to physical pursuits. They need time for full engagement and time for rest and recovery, as well as time for plugging in and unplugging from technology. Yet, our images of working hard at school or at work revolve around running non-stop, squeezing more and more in.

Many workplaces can’t (or won’t) change overnight. That leaves it up to individuals to change what they can on their own. Where to start? Here’s an online self-assessment that asks, “Are you overscheduled?” and helps identify areas in need of improvement. Maybe you skimp on sleep because you’re too busy, or have stopped taking time for friendships, or find yourself overcommitted because you can’t bring yourself to say no.

More strategies and ideas can be found here and here. Among them: Build downtime into your schedule; drop activities that sap your time and energy; make small changes, such as leaving work earlier one evening a week.

Is there such a thing as the perfect balance between work and the rest of life? Probably not. Priorities shift; life changes. The ideal seems to lie somewhere between being able to accomplish things in the workplace while having enough time to enjoy the rest of life.

Photo: Wikimedia Commons. Logo: Troy Murphy, West Central Tribune

Zone of restriction

The No White Foods Diet sounds simple: Just eliminate everything white from your plate, and weight loss will follow.

Longtime dieters have probably heard of the Grapefruit Diet, a high-protein, very low calorie diet that involves a limited menu of food choices and half a grapefruit or a glass of grapefruit juice with every meal. Then of course there’s the Atkins Diet, extremely low on carbohydrates and high on proteins and fats.

What these and many other fad diets have in common is restriction. Restriction in variety, restriction in quantity, restriction in calories, restriction in food groups such as carbs, sugar or dairy.

In theory they help people lose weight and become healthier. But do they really? More to the point, can any restricted diet be sustained over the long term?

It’s not an idle question. Hundreds of thousands of Americans are looking for a better way to eat and many of them are wondering: Should they eliminate carbohydrates? Should they cut out sugar? What about going vegetarian?

But the jury is still out on many of the restrictive fad diets. Although the highly popular Atkins diet has helped countless people lose weight, it remains controversial for its high-protein, low-carb philosophy. For one thing, it limits the consumption of fruits and vegetables, which nutrition experts unanimously agree are important for a healthful diet. For another, critics are concerned that long-term pursuit of the Atkins diet may lead to heart disease and increased risk of kidney stones and gallstones.

Then there’s the restriction on carbs – no more than 40 grams a day, although the human body generally needs at least three times that much in order to function properly. Refined sugar, milk, white potatoes, white rice, and bread and pasta made with white flour are supposed to be eliminated completely and forever.

When WebMD reviewed the Atkins diet, one of the experts they spoke with was Barbara Rolls, author of “Volumetrics” and a professor at Penn State University, who had this to say:

“No one has shown, in any studies, that anything magical is going on with Atkins other than calorie restriction. The diet is very prescriptive, very restrictive, and limits half of the foods we normally eat. In the end it’s not fat, it’s not protein, it’s not carbs, it’s calories. You can lose weight on anything that helps you to eat less, but that doesn’t mean it’s good for you.”

The sad truth about many of these diets is that they ultimately fail, at least in part because many people find the restrictions too unrealistic and too difficult to live with for the long term.

I learned this firsthand a few years ago when I made a short-lived foray into veganism. Initially, the prospect of eliminating meat, fish, dairy and eggs sounded doable. But soon I found myself spending more and more time and energy planning meals and tinkering with recipes, trying to meet the vegan restrictions and still achieve some kind of nutritional balance. Besides being high-maintenance, it was monotonous beyond belief – something the proponents of restricted diets often don’t warn you about. When I began contemplating whether I needed to take a multivitamin supplement to make up for the nutrients I wasn’t getting at the dinner table, it became apparent that a vegan diet didn’t really make much sense, at least for me. I’m sure there are people who happily subsist on veganism but I’m not one of them.

Indeed, amid all the clamor about obesity and overconsumption of food, there’s an issue we seem to have missed: malnutrition.

A study from Australia that recently appeared in the Nutrition and Dietetics journal found that as many as one in three elderly hospital patients and up to 70 percent of nursing home residents are either malnourished or at risk of malnutrition. Author and researcher Karen Charlton also found that malnutrition often isn’t seen as a clinical priority and hence is underdiagnosed. She called it “the skeleton in the closet of many Australian hospitals.”

Malnutrition is more likely to be a risk for certain populations – people who have undergone bariatric surgery, for instance, or have cancer or kidney disease. For those with eating disorders, it can be deadly. And although undernourishment is far more common in developing nations where many people go hungry, it also occurs in wealthy countries, in the form both of hunger and of overconsumption of an unbalanced diet.

The National Eating Disorders Association makes several important points about what can happen when people pursue diets that are overly rigid or restrictive: For one thing, restrictive diets are often short on vital micronutrients such as calcium. For another, they can affect muscle strength, metabolism, coordination and the ability to concentrate.

Perhaps one of the best-known studies on the effects of food deprivation was carried out at the University of Minnesota from 1944 to 1945. Known as the Minnesota Starvation Experiment, it involved 36 male volunteers who were subjected to an extremely low-calorie diet, then renourished with a specially designed rehabilitation diet. Although the main purpose of the experiment was to study the effects of famine and famine recovery in the aftermath of World War II, it resulted in several other important findings as well, one of them being the psychological effects of food restriction and calorie deprivation. During the starvation phase, the subjects became extremely preoccupied with food and experienced distress, depression and social withdrawal. Physical effects that were observed included a lowering of heart and breathing rates, reduced body temperature and reduced basal metabolism.

The average American consumer is unlikely to reach these extremes. But on a lesser level, it represents some of the issues that can arise when diets become highly restrictive.

So what’s the answer? A balanced diet, defined as “getting the right types and amounts of foods and drinks to supply nutrition and energy for maintaining body cells, tissues, and organs, and for supporting normal growth and development.” It should include all the major food groups in adequate proportions.

While the food pyramid might sound trite to many people, it’s as good a place as any to start. Concerned about carbs? Instead of cutting them out completely, consider whole-grain products instead. Want to reduce your fat intake from dairy? Try low-fat or fat-free options. It can be harder for vegetarians to meet all their daily nutrition requirements but it’s entirely possible, as long as they’re including enough protein, iron, calcium, zinc and other key nutrients.

The DASH eating plan is one of the few so-called diets that seems to have stood the test of time. Short for Dietary Approaches to Stop Hypertension, it was designed to reduce blood pressure but has been found to help with lowering cholesterol, insulin resistance, weight and even neurocognitive functioning as well. It emphasizes fruits, vegetables, whole grains, low-fat or non-fat dairy, lean meats, fish, nuts and legumes, plus limited amounts of sugar. The health benefits of following the DASH diet have been well studied and mostly reinforce its positive effects. Although it has some restrictions - mainly calories and sodium – it’s not unrealistically rigid, nor does it demand that people eliminate entire categories of food from their plate.

Making dietary changes isn’t easy, period. Even with a balanced diet, it can be challenging to manage the many requirements. Extreme restrictions can make it harder than it needs to be, though. It really does come down to achieving a good balance – not too much and not too little of anything.

Food photos: Wikimedia Commons. Logo: Troy Murphy, West Central Tribune

The weeknight dinner dilemma

On the Chowhound discussion boards, there’s a lengthy, ongoing conversation about what’s for dinner. One person this past week was having Vietnamese beef salad over noodles. Someone else was making quesadillas. And quite a few people were serving leftover chili, beef stew or braised pork.

Of all the challenges involved in eating more healthfully, the dilemma of what to have for dinner on a weeknight surely ranks near the top. When the Reser’s Fine Foods blog asked readers last fall to name some of the biggest obstacles, the responses sounded familiar: Picky children. Picky spouses. Lack of time. Competing priorities. The struggle to keep the menu from becoming monotonous.

One woman wrote, “My biggest challenge is getting something healthy on the table in a reasonable amount of time – and also having the ability to multi-task while making dinner! So much to do in the evenings, with so little precious time!” For someone else, it was the difficulty of coming up with and sticking to a meal plan. “I mean, days you don’t have what you need, or want what you have, or are just too tired to try,” she wrote.

Far easier to resort to fast food or a restaurant meal that’s on the table in minutes, with a minimum of effort.

So what’s wrong with having a takeout dinner or restaurant meal every so often? Nothing, really. The real issue is when it becomes the default strategy night after night.

A few years ago a study was published that tracked 3,000 healthy young adults for 15 years. The findings were interesting and probably not all that surprising: After 15 years, those who frequented fast-food restaurants more than twice a week had gained 10 extra pounds and had a two-fold greater increase in insulin resistance, putting them at risk of type 2 diabetes.

To get an idea of what’s in those fast-food meals, here are some statistics, courtesy of the FDA: A biscuit, egg and sausage breakfast sandwich contains around 37 grams of fat. A regular-sized double hamburger contains 32 grams of fat. The recommended daily allowance: 67 grams, which means consuming even one of these menu items can use up half of your dietary fat allowance for the whole day.

Sodium is another culprit. For most people, the major source of salt intake isn’t the salt shaker; it’s processed foods that are high in sodium. But consider how hard it might be to cut back when a meat combo submarine sandwich can contain more than 1,600 milligrams of sodium, or a single large cheeseburger with bacon has 1,300 milligrams. The recommended daily allowance? For healthy people, it’s 2,300 mg per day. For those who are 51 and older, African-American or who have high blood pressure, diabetes or kidney disease, the recommendation is 1,500 mg a day or less.

Wanna get really, really specific? A couple of weeks ago, Men’s Health magazine published a list of the “20 worst foods in America.” Here’s the list, which names names, provides calorie counts and suggests dining alternatives that are more palatable.

According to multiple studies, there’s really no substitute for meals prepared in your own kitchen. When you make it yourself, you can exercise far more say over how much fat, cholesterol, salt and sugar ends up on the dinner plate. Put another way, one of the eating-related behaviors that has been shown to make a difference is how often – or how seldom – we eat out.

A study that appeared in the Preventing Chronic Disease journal a few years ago surveyed 4,300 American adults about weight loss, weight loss maintenance and eating patterns. The results indicated that those who didn’t eat at fast-food restaurants were more likely to be successful at losing weight than those who reported eating fast food twice or more a week. Because this study looked only at weight loss and weight-loss maintenance, the findings are limited. But the authors point out, “Data on consumption of foods away from home suggest that when dining out, people eat more food, higher-calorie food, or both. Therefore, dining behavior is a potentially modifiable contributor to caloric intake and weight control.”

In other words, it’s something we can change. Other studies have found similar benefits for people who need to control how much sodium and/or sugar they consume.

How to make weeknight dining less of a dilemma? Kathleen Zelman of the WebMD Weight Loss Clinic offers some of her own solutions:

My strategy for quick and easy dinners starts in the grocery store. The produce bins in my refrigerator are always full. In addition to fresh fruits and veggies, I load the refrigerator with low-fat yogurt, fat-free half-and-half (a cooking trick I learned from our “Recipe Doctor” Elaine Magee), a variety of cheeses, hummus, eggs and skim milk.

Depending on what is on sale, I stock my freezer with items such as pork and beef tenderloin, salmon, tilapia, boneless chicken breasts, and lean ground round. When I get home from the market, I divide these foods into portions for two so I can easily defrost them a few hours before dinner. Also in my freezer is a supply of whole-wheat rolls, ciabatta rolls, Lean Cuisine dinners, chicken pot stickers (I toss them into chicken broth with mushrooms and scallions to make soup), and bags of frozen veggies.

Staples in my pantry include cereals (Kashi Go Lean Crunch and Special K are our favorites), brown rice (Uncle Ben’s ready rice), whole-wheat blend pasta, canned petite diced tomatoes, Mandarin orange segments, sweet potatoes, nuts, a variety of canned beans, soup, coffee and assorted teas (my afternoon pick-me-up).

I’m one of those people who cooks on weekends for the week ahead. The down side of this is that it takes planning. The up side? Well, in the freezer right now are single-serving containers of lentil stew with turkey sausage and carrots, and a pan of pasta shells stuffed with spinach and low-fat ricotta. Another strategy that seems to work well in our household: having a repertoire of weeknight meals to fall back on that are fast, taste good and require minimal energy to make.

LiveStrong.com has several specific ideas on its website for simple weeknight dinner options, low-carb menu suggestions, diet-friendly dinners, and even several useful tips for how to plan a dinner menu (take one week at a time; vary the menu to keep it interesting; get input from the rest of the household on their likes and dislikes).

Two of the most often-cited resources: Cooking Light and Everyday Food. And when I Googled “healthy weeknight meals,” I came up with more than 400,000 websites ranging from the Food Network to Eatingwell.com.

Yes, it takes time, energy and organizational skills to come up with weeknight meals that can easily be prepared at home. But with all the resources available to help, it doesn’t have to be a continual dilemma.

Image credits: Photo, Wikimedia Commons; logo, Troy Murphy, West Central Tribune

Burned out and used up

burnout n. 1. the point at which a rocket’s fuel or oxidizer is completely burned up and the rocket enters its free-flight phase or is jettisoned; 2. damage caused by overheating; 3. a state of emotional exhaustion caused by the stresses of one’s work or responsibilities.

How do you know when you’ve arrived at personal or professional burnout? In a post from four years ago that has since become a classic, emergency-room nurse/blogger Kim McAllister describes the signs:

You feel you are “on stage” for eight solid hours playing the part of a nurse.

You smile so hard for so long your face hurts.

You resent everyone. The doctors. Your colleagues. Your manager. Your patients.

The point comes when you snap. You can’t play the role any longer.

(You don’t have a choice.)

Depression follows.

You have to take medication just to get to the point that you can put on those damn scrubs and put one foot in front of the other.

(A commercial for “ER” makes you physically sick.)

You spend the majority of your time off sleeping. Your family suffers as apathy and anhedonia infuse every aspect of your life.

You can’t quit. You’re trapped. You need the money. You have to have the benefits. You desperately look for something outside of nursing to cling to, something else you can do for a living.

But… you aren’t educated to do anything else and besides, every other job you consider just pays minimum wage and you can’t support your family.

Although she’s writing about nurses, McAllister’s words surely resonate with anyone who’s ever experienced what it’s like to be worn down, depleted, used up, fried, physically and emotionally burned out.

Burnout has always been one of the hazards of the human condition. Lately, though, it seems the pressures of contemporary life, coupled with the recession, have increased our vulnerability. Workplaces have been pared down by layoffs. People are working harder with fewer resources. Stress levels are high. The struggle to keep up with all the demands often leaves everyone feeling mentally depleted and emotionally frayed.

Psychologists first began using the term “burnout” in the 1970s, and it’s an apt one. One by one, the flames of enthusiasm, vitality and motivation are quenched, to be replaced with cynicism, withdrawal, depersonalization, emptiness and depression.

Anyone can experience burnout, but some factors seem to place people at higher risk.

Experts who study burnout have identified a number of these factors. Some are external, such as work or home environments that are disorganized, unsupportive or excessively rigid. Others are internal, such as overly high expectations of oneself. An interesting article that appeared some years ago in Psychology Today explores another perspective: that job burnout is primarily the fault of organizational dysfunction rather than people’s individual mental makeup. The author, Christina Maslach, is perhaps one of the best-known researchers in the U.S. who focuses on burnout.

Other researchers have raised additional intriguing questions, such as how e-mail, cell phones and other electronic gadgets might be contributing to burnout, and the role of cultural attitudes towards work, multi-tasking and efficiency. They’re summed up in this article that appeared in New York Magazine in 2006; it’s rather a long read but worth it.

Although burnout is often associated with stress, these two states of mind are not synonymous with each other. HelpGuide, a mental health education website, explains it this way:

Burnout may be the result of unrelenting stress, but it isn’t the same as too much stress. Stress, by and large, involves too much: too many pressures that demand too much of you physically and psychologically. Stressed people can still imagine, though, that if they can just get everything under control, they’ll feel better.

Burnout, on the other hand, is about not enough. Being burned out means feeling empty, devoid of motivation, and beyond caring. People experiencing burnout often don’t see any hope of positive change in their situations. If excessive stress is like drowning in responsibilities, burnout is being all dried up. One other difference between stress and burnout: While you’re usually aware of being under a lot of stress, you don’t always notice burnout when it happens.

If this sounds like you or someone you know, an online quiz here can help you assess whether you’re headed for burnout and perhaps are in need of some intervention. Burnout that’s ignored can lead to depression, anxiety, substance abuse and increasingly difficult relationships with family and friends.

What to do about burnout? Many organizations in the fields of mental health and human resources have information and suggestions that are available online. Here’s a sample: MayoClinic.com, LiveStrong.com, and Workplaceissues.com. What they have in common is a focus on becoming more resilient, recognizing what you can change (and what you can’t), and re-engaging with the things that matter to you in life.

Emergiblog’s Kim McAllister describes her experience with burnout as a descent into a black hole. It took some counseling and antidepressants, plus learning how to avoid overwork and take care of herself, to help her regain her passion for nursing.

For each individual, the answer to preventing burnout, or finding one’s way back from burnout, is going to be different. For McAllister, it was reconnecting with the reason she went into nursing – to take care of patients.

In a post titled, appropriately enough, “Sweeping Away the Ashes,” she writes: “Lose sight of the person and you lose sight of the profession. Lose sight of their humanity and you lose sight of your own. Lose sight of your own and you become a burnt shell. You would think that after three decades of this, I’d have figured this out by now. I guess you never stop learning.”

Image credits: Photo, Wikimedia Commons; logo, Troy Murphy, West Central Tribune.

Portion distortion

If you like iced coffee, you’ll soon be able to drink it by the quart. Last week Starbucks announced it’s adding a new size to its array of cold coffees and teas – the 31-ounce Trenta.

OK, so it’s one ounce shy of a full quart. But that’s still a lot of coffee, even for coffee lovers like me. According to the company, the Trenta (the name is Italian for “30″) will be available at all Starbucks locations by early May, just in time for the arrival of warm weather.

What’s interesting about the introduction of the Trenta is that it’s apparently driven primarily by customer demand for larger drinks. Starbucks explains:

We listened to you. You told us on My Starbucks Idea and through your purchases that you love refreshing iced coffee and tea beverages but want them in a larger size. Did you know that over 60% of our iced tea customers currently order our largest size, the 24 oz. Venti?

Now you iced coffee and tea fans can enjoy more refreshment – a Trenta offers seven more ounces than a Venti at a cost of only 50 cents more!

Can you say “Supersize me”?

From Big Gulp drinks to jumbo cookies and oversized pizzas, food portions in the United States are succumbing to the philosophy that more is, well, more. The result has been an increasingly skewed perception of what constitutes a normal portion, or what nutritionists refer to as ”portion distortion.”

To get an idea of how our notions of normal have changed over the years, consider this: Twenty years ago, the typical bagel was 3 inches in diameter. A bagel nowadays has a six-inch girth. Blueberry muffins have almost quintupled in size from 1.5 ounces to 5 ounces. This quiz from the National Heart, Lung and Blood Institute helps illustrate how far out of whack many of us are when it comes to accurately judging portion sizes and calories.

It hasn’t helped that foods are often packaged in ways that blur the difference between servings and portions – a bag of chips, for instance, that contains three servings but looks like one portion. Plates have become larger, distorting the consumer’s sense of what a full plate of normal-sized food servings should be.

The new Trenta, according to Starbucks, is not necessarily loaded with calories. Unsweetened versions of the 31-ounce iced coffee or tea will contain about 90 calories. The sugared versions are 230 calories, or so we’re told. Even so, this is a massive drink that makes the 24-ounce Venti look puny by comparison (which is the whole point, I guess). The National Post of Canada pointed out last week that at 916 milliliters, the Trenta contains the same volume as the average capacity of the adult human stomach.

When food portions continue to expand, and when the marketing emphasis is on “more” and “value,” it’s not hard to see why many people have trouble maintaining a healthy weight. Even when they think they’re making good food choices, their efforts can be undone by oversized portions that simply add up to too many calories.

There are obviously many factors – activity level, for one – that contribute to weight and weight management. But experts agree that portion control is clearly an important one. A few years ago, researchers at the University of Tennessee conducted a study designed to look at whether food packaged as a single serving could help people lose weight. They found that when study participants were given single servings of food for breakfast, they took in fewer calories than a control group that was allowed to have standard servings.

Another study that appeared a couple of years ago in the Appetite journal tracked a group of people who were randomized to receive portion-controlled snacks or standard-size snacks for two weeks. During the first week, the participants who were given calorie-controlled snacks ate less than those in the standard group. In the second week, the participants who had already received the portion-controlled snacks continued to eat less, even though they now had access to standard-size snacks. Among the researchers’ conclusions: “Initial exposure to portion-controlled packages might have increased awareness of portion size such that less was consumed when larger packages were available.”

Here’s more perspective on portion distortion, from a 2008 article in the Journal of the American Board of Family Medicine which identified oversized portions as a key eating behavior contributing to weight gain:

Portion size is closely related to restaurant and fast food consumption; the largest food portions in the United States come from restaurants and fast food establishments. Between 1977 and 1996, portion sizes and energy intake increased in the US population older than 2 years of age when considering home, restaurant and fast food sources. The greater the amount of food presented to people, the more food is consumed.

How can we correct our portion perceptions to something that’s more realistic? Here are some rules of thumb from the NHLBI (the graphic can be downloaded into a handy pocket-sized reference): A cup of salad greens is equivalent to a baseball. One cup of cereal should be the size of a fist. Half a cup of cooked rice or pasta is the same as half a baseball. Three ounces of meat, fish or poultry is the same size as a deck of cards. Two tablespoons of peanut butter are the size of a pingpong ball.

The Weight-Control Information Network of the U.S. Department of Health and Human Services offers several helpful tips:

- Use smaller plates and glasses. That way, when you fill up your plate you won’t be taking as much.

- Avoid eating out of boxes or bags. Instead, measure out an amount equal to one serving and eat from a plate or bowl.

- Eat slowly so your brain has time to get the message that you’re full.

- Buy single-serving prepackaged snacks, or divide snacks from larger bags into single servings.

- When cooking in large batches, freeze leftovers so you won’t be tempted to eat them later.

Some suggestions for dining out:

- Share your meal, order half a portion, or order an appetizer.

- Avoid large beverages.

- Ask for a portion of your meal to be boxed up when it’s served.

Is it really a good value to spend a few more cents for a larger meal? Not always, because you often end up with more food and more calories. Nutritionists suggest either sharing a super-sized meal or, if you’re eating alone, forget about the bargain and order only as much as you need.

Photo: Wikimedia Commons. Logo: Troy Murphy, West Central Tribune

Warming up to breakfast

What did you have for breakfast this morning? More to the point, did you even eat breakfast? If you’re like many people, chances are you skipped it altogether, even though this first meal of the day is supposed to be the most important.

It’s hard to get a handle on the number of those who abstain from breakfast. Various studies have tried to pin this down and come up with wildly varying estimates: 4 percent, 5.1 percent, 16 percent. One survey involving mostly poor and rural middle-school students put it at 38 percent.

Once upon a time, skipping breakfast was usually a sign of a poor or low-income household. This no longer seems to be the case as more and more families of all income levels succumb to calorie-counting and time constraints. In fact, breakfast-skipping appears to be on the rise, with many surveys finding a growing number of households where breakfast is consumed as an afterthought or not at all.

Why does breakfast matter? The majority of studies have found numerous benefits for both children and adults. Kids seem to function better in school when they’ve started their day with a good breakfast. Ditto for adults in the workplace. Researchers have noted better memory, concentration and problem-solving, and even higher energy levels among those who routinely eat breakfast compared to those who don’t.

Conversely, a study conducted in Finland noted a link between breakfast habits and overall health, with breakfast-skippers more likely to smoke, drink alcohol and be sedentary. It’s not clear which is cause and which is effect, but I think it’s safe to say that eating breakfast, in and of itself, doesn’t automatically make us healthier. The real issue is that the breakfast habit seems to be one of several markers that indicate overall health. 

An especially intriguing, and often-cited,  study suggests that eating breakfast actually helps you live longer. The Alameda County Study, which started in California back in the 1960s, surveyed nearly 7,000 people in an effort to identify lifestyles that contributed to health and longer life spans. Among the researchers’ conclusions: Eating breakfast was one of the habits consistent with better health and was a predictor of longevity. Men in the study who ate breakfast and didn’t snack appeared to cut their risk of premature death. When the findings for 60- to 94-year-olds were further analyzed, eating breakfast emerged as a positive health factor that was as important as physical activity and avoiding tobacco.

So what’s the physiology behind breakfast? The first meal of the day – breaking one’s fast – helps rev up the metabolism and stabilize blood sugar levels. It also gives the body a jolt of fuel to replenish glycogen stores that deplete during the night.

Breakfast provides an extra daily chance as well for people to consume key nutrients such as calcium, protein and fiber. According to federal statistics, children who participated in the School Breakfast Program increased their intake of calcium and vitamins and were more likely to meet the daily nutrition recommendations for their age group.

With all this evidence, why do so many people continue to skip breakfast? I confess: I used to habitually avoid breakfast. My reasons were the same as most other people’s: didn’t have time, wasn’t hungry, didn’t want the extra calories.

This last excuse – the calorie-counting – seems to be pretty common. It’s also, according to much of the research, based on a fallacy. If you skip breakfast, chances are you’ll be hungry enough to start nibbling on snacks by mid-morning or having a large meal at noon, thus canceling out whatever calories you might have avoided.

The time factor, let’s face it, is very real in many households. I work around it by often preparing breakfast-type foods ahead of time. For instance, I now make my own granola. It can easily be done the night before or on the weekend. Homemade granola is simple to mix up, requiring no fancy culinary equipment or techniques. There are plenty of recipes to be found on the Internet; the one I use most often contains dried cherries and almonds. It’s very good with a couple of spoonfuls of plain yogurt or a splash of almond milk, and best of all, it’s both filling and nutritious.

One of my favorite go-to resources for healthful morning foods is “Sunlight Cafe.” The author, Mollie Katzen, is both a chef and nutrition expert, with many suggestions for turning breakfast into a great-tasting meal. A couple of weekends ago I turned to her book for a recipe for a hot cereal of millet cooked with orange juice and pecans. The grains take half an hour to cook, which sounds lengthy, but once the cereal is in the skillet it only needs to be stirred a couple of times at the 15-minute mark, leaving you free to dry your hair, put on your makeup, feed the cat, fold laundry or whatever.

Most basic cookbooks contain at least a few recipes for breakfast foods. The Internet, aided by Google, can put thousands of breakfast menus and ideas at your fingertips. If you want to keep it simple with a single information source as your Breakfast Central, check out Mr. Breakfast.com, an online place for all things breakfast-related. (Did you know January is National Oatmeal Month? Or that “how to boil an egg” is one of the Mr. Breakfast website’s top search terms?)

If you’ve been following the news, you may have noticed a new study that came out this week in Nutrition Journal. It seems to contradict the widely held belief that eating breakfast can help people control their calorie consumption the rest of the day. The researchers found that when their 380 study participants consumed a large breakfast, they also tended to rack up more daily calories overall. Reading more closely however, the key seems to lie not in the fact they ate breakfast but in what and how much they ate. In other words, calories and portion sizes still matter – but your mother also is still right about the benefits of a nutritious, balanced breakfast.

Image credits: Top: Wikimedia Commons; bottom: HealthBeat photo by Anne Polta; Logo: Troy Murphy, West Central Tribune