23 and 1/2 hours, an important tip on being healthy

Many have written about the fallacy of miracles drugs and panaceas, observing that anything which claims to cure everything is probably bogus. This video from Mike Evans is presently making the rounds on the internet, and is a great exception to the rule that miracle cures are bogus.

This particular miracle cure:

• Reduces pain of knee arthritis by 47%
• Reduces progression to Alzheimer's and dementia by 50%
• Reduces progression to diabetes by 58%
• Reduces risk of hip fracture in postmenopausal women by 41%
• Reduces anxiety by 48%
• Reduces depression by 30% to 47%
• Reduces risk of dying by 23%

And much, much more. So what is this magic solution? Where can I get it and what does it cost? Well alas, while most Americans do not use this cheap, abundantly available intervention, it is not due to Big Pharma consipracy of suppression of this "natural" remedy, . In fact, according to the recently released 2012 Stroke and Heart Disease Update from the AHA tells us that over 60% of Americans do not get enough......

Exercise.

Watch the video for some more interesting details, but one other tidbit is where he reviews the data showing that the #1 predictor of your longevity, is cardiorespiratory fitness (ie: your ability to tolerate exercise).

AFib and endurance sport

Alex, over at Sweat Science covered some research that was announced back in August at the European Society of Cardiology (press release and abstract here). He took issue with some of the reported findings and I largely agree with his assessment. These results were presented at a scientific meeting, not published in a peer-reviewed journal, and therefore should be considered preliminary.

The authors included all arrhythmias in their research, but some of those are expected results of training, like bradycardia, while others, like atrial fibrillation, are dangerous. The abstract provides data on a couple of subtypes of arrhythmias, but not atrial fibrillation so we do not really what role it played in the outcomes. Atrial fibrillation (AFib) is a particular concern for active people because it can cause serious problems with your heart rate and some of the medicines used for it can make it harder for you to get a good athletic performance. Also, many people with AFib have to be on blood thinners like warfarin to reduce the risk of stroke, but blood thinners can be dangerous if you then get in an accident.

Hopefully some of these questions will be addressed in a full journal manuscript. As Alex points out, even if risk of AFib is increased, regular exercise has shown time and time again to extend life, so I will keep on running.

Hip strengthening exercises to avoid knee pain

Over the past few weeks, and at the direction of PT, I have been doing some simple strengthening exercises that have made a notable difference in my running. I have not had any further lateral knee pain after a run and I have been on several runs of up to four miles at a time. The specific exercises I have been doing are:

1. Straight leg raises
2. Side leg raises
3. One leg squats (or heel taps)
4. Front bends

First, straight leg raises. Lying on your back, bend one knee leaving your foot flat on the floor. Then keep the other leg straight and raise 12-18 inches off the ground. In the video, the person has their leg turned outward, which shifts the focus to one specific muscle in your quads (the vastus medialis) but you can do it without the twist to work all your quads. You can add weights (like in the video) to increase the difficulty.

Second, side leg raises are done lying on your side, in basically the same leg position with your knee bent and your heel just under your bottom. Then raise the opposite leg up, which should be exclusively using your hip abductors (the muscles on the outside of your hip). This guy is not bending his lower leg and using a band, instead of weights, to increase the resistance.

One leg squats, as noted in this video are good for strengthening, but also for improving balance. The variant of these that I did was on a step about 12-18 inches off the ground. This could be a single-step stool, or even a stair in your house. The other name, heel taps, comes from the idea that you should do these just briefly tapping your heel on the ground and then pushing up with your squatting leg. What I found very effective was the bench press benches at my gym. They have a small step at the back for a spotter and since the bench is quite heavy, it will not move with me supporting my weight on the back end of it. I can recall first trying these and watching my knee wobble all over the place but now I can do them without holding onto anything for balance and with easy control of my knee.

Last of the four I call front bends, but I gather that there are a number of names for the exercise. First, get a dumbbell, about 5-15 lbs. Hold that in front of you in one hand. Bend forward, allowing the weight in your hand to go straight down. Simultaneously, lift the leg opposite the hand with the weight, while keeping your leg straight.

Screenshot from user jasoncscs

So, these worked quite well for me, and I am excited to be out there running more. Of course, if your knee hurts, I recommend seeking professional help!

Fitness, fitness, everywhere!

I just started a new job on faculty at the University of Florida and I was sitting in my office early one morning last week when I noticed a patient walking past my door ( the IV pole in his hand was a pretty sure giveaway). I looked up to notice that he was markedly diaphoretic (“doctor-talk” for sweaty). On top of that, he was breathing pretty heavily. Now, usually when I see patients that are diaphoretic or out of breath, those are bad signs. I start thinking about serious conditions, pneumonia, heart attack, and so on. So what was going on with this guy?

Turns out, he was exercising. He was in the hospital for observation of a condition that was not life-threatening and was not keeping him from being active, so he decided to take his IV pole for some brisk walking.

“How far do you go?” I asked.

“About 30 or 40 minutes, usually about a dozen laps through the hospital.”

He is not the only example of exercise at work/in the hospital that I see. Every day, usually at lunchtime, many  people are walking laps through one of the tunnels we have that connects our different hospital buildings. The tunnel extends about a tenth of a mile, so 10 or 20 laps can get you a good low-impact workout during your lunchbreak. Someone also posted a cute sign on the exterior door to the stairs:

“Free fitness program inside”

Of course, the unfortunate thing is that the number of people taking the stairs or walking the tunnel is but a fraction of the employees here. Obviously many get exercise in other ways (I see several coworkers at the gym before work), but I see little reason to take the elevator unless you are moving a patient or transporting something heavy or cumbersome. While few people in the hospital are well enough to exercise, being up and out of bed can protect against muscle atrophy from lack of use. That said, I can count on one hand how many times I have seen patients insistent on working up a sweat while trapped in the hospital.

Non-alcoholic beer boosts health of athletes?

Another post from Lifehacker caught my attention this week. While many of us indulge in a beer or two after a good long run, new research suggests that it might actually be healthy to do so. I could not get the full article, but the abstract provides the following info. 277 healthy male marathon runners were given 1 liter of non-alcoholic wheat beer or a placebo drink daily for 3 weeks prior and 2 weeks after the Munich Marathon. Beer drinkers had lower inflammatory markers in blood tests and were three times less likely to get a upper respiratory tract infection (ie: the common cold).

Now, the blood tests you have to take with a grain of salt, since we do not really know if those lab tests of inflammation are good or bad in runners. The context of inflammation is different in a post-marathon runner than it is for a sedentary couch-dweller. It is harder to argue with a more concrete outcome like infections, but even here, it depends on how you define a cold, which the abstract does not do. Furthermore, they say that this study is placebo controlled, but how do you placebo-ify a beer? You have to ask because, if the subjects (the runners) know that they are being given the non-beer drink, and they get any idea of what the outcome is (self-reported symptoms of a cold), it could easily skew the results, even unconsciously. That, and the press release of the study conspicuously mention the brand of beer used, and the journal does not mention who the sponsor of the study was. The press release says this brand was chosen for "its popularity with marathoners" (anyone from Germany care to comment?)

Anyway, an intriguing thought, and another reason to feel okay about having a beer! (Non-alcoholic, of course...)

Yet another study linking lack of fitness to risk of heart attacks

This should probably not come as much of a surprise but researchers have published in the Journal of the American College of Cardiology, science which indicates your level of fitness is a strong indicator of your fitness and a strong predictor of future risk of heart attacks and death. In this case the researchers used a treadmill test similar to the one I took for myself recently, although they used a slightly different protocol (Balke, not Bruce). The same researchers also reported in the journal Circulation, that if you include fitness in models of risk prediction, you can be much more accurate in predicting who is at risk of having heart attacks and dying.

These research papers were also covered in the NY Times.

The Bruce Protocol

If your doctor ever suggests that you need to have a 'stress test' to check on your heart, it is very likely that you will end up on a treadmill, hooked up to many wires and tubes. Someone will be there monitoring your every heartbeat and documenting your response to the exercise.

The most commonly used protocol is called the Bruce. According to Wikipedia, it was developed by Robert Bruce, as an attempt to standardize the measurement of responses to exercise. You may be interested to know, however, that these tests usually do not require any running (most patients stop before stage 4). The speed and elevation of the treadmill follows a precise protocol, which, for Bruce, starts with walking at 1.7 miles per hour and 10% grade.

The purpose of this test, of course, is to test people who are having symptoms like chest pain and shortness of breath. Aside from that, though, it can be used as a surrogate for estimating VO2 max (maximal oxygen consumption). This, in turn, is a measure of cardiovascular fitness because it represents how much oxygen you are able to consume and transfer to your muscles to burn in aerobic exertion. The ideal way of measuring VO2 max is by directly measuring how much oxygen you inhale and exhale during exertion, but if you have access to a treadmill and can run the Bruce, there are calculations for estimating your VO2 max.

So, last month, after the marathon I figured I would give it a shot. Obviously, the first three stages or so were just a walk, an uphill walk, but nothing challenging. The next couple of stages actually were quite awkward because they are in that speed where it feels very weird to walk that fast, but it is not quite fast enough to run. By the time I got to stage 6, I was definitely running the entire time and it was very challenging. I was seriously sucking wind, but my legs were not that tired, which is the purpose of the test after all. 

While this is meant as a test of maximal exertion, clearly you have to recognize when you think you are at 99% so that someone else can shut off the treadmill. This can be hard, because you can imagine that you could always go another 5, 10, maybe 15 seconds more. When I got in sight of 24 minutes though, I figured that would be a nice even number and I was barely able to get enough air to tell someone to shut it off for me, so I figure that is pretty close to maximal. 

So, with a 24 minute run on the Bruce, my VO2 max is estimated at 75! Somehow I kind of doubt that actually, seeing as how Lance Armstrong's is reported somewhere in the 80's. Also, for the Bruce protocol programmed at my hospital, the speed and elevation are fixed after stage seven, where the true maximal test continues to increase. The calculators I found expect the true maximal test, so they are probably an overestimation.

There are some other estimates of VO2 max which do not require a treadmill:

• Cooper test: Take the distance you can run in 12 minutes (for me, about 2 miles or 3,218 meters) subtract 500 and divide by 45. This estimates my VO2 max at 60.2.
• Pedersen estimate: Take your max exertional HR (195), divide by your resting HR (55), and multiply by 15. My estimate is 53.2.

Screen-Based Entertainment and risk of death or heart attack

Cross posted from drdavemd.com

In JACC, a study was recently published which concluded that sitting in front of the TV, computer, game console, etc. is associated with higher risk of death and heart attacks. This is concerning, but not a novel finding. This study does have a couple of unique features that I wanted to write about.

The study is an observational cohort of self reported data. This means that 1) no one controlled the variable of "screen time" and subjects could watch as much or little as they wanted, 2) all the data was self-reported, ie: no one set up a timer on the TV to measure how much TV they watch, and therefore the data are limited by "recall bias" (how well can you remember just how much TV you watch?), and 3) the study is drawn from a database of previously collected data and therefore you cannot prove a causal relationship, just a correlation. So while the study has limits, this type of study design is great because it is easy and cheap to do, and can help bring up ideas about where people should do more research in the future.

One of the findings that was particularly concerning is that the researchers also had access to the subjects' report of how much exercise they did. That means they could "control" for that variable and take it into account. When they did, the risk of death or heart attack was still higher, even with regular exercise. The authors do point out that screen time is sometimes underreported, which is a limitation. One thing they failed to point out or account for is overestimation of physical exercise. Many of my patients try to find some way to say yes when I inquire about exercise, even when it seems highly unlikely that they exercise. I do not mean to imply that people are lying, just that they know what the right answer is (ie: daily exercise) and they do not want to admit that they fail to meet that standard. It is the same phenomenon that leads people to underreport alcohol use. Similarly, people also very frequently tell me that they are "quitting" smoking, or cutting back, but few have either quit or openly admit they smoke.

Another important observation about the study is that it only accounted for recreational screen time, not work screen time. The exact question from the survey was: "Thinking of weekdays, how much time on average day do you spend watching TV or another type of screen such as a computer, or video game? Please do not include any time spent in front of a screen while at school, college, or work." This seems to me a major limitation because it does not account for the 40+ weekly hours when subjects might have been computer programming or doing manual labor on a construction site, both of which would seemingly have markedly different effects on cardiovascular risk.

The other interesting data that this research group had access to was blood tests, such as c-reactive protein and cholesterol. They estimate that these account for 25% of the risk associated with screen time. This may play into my prior point that recreational screen time is only part of the equation and perhaps being immobile at work causes higher cholesterol and inflammation which then blurs the effect of recreational exercise. In any case, the risk of death and heart attacks is complex, and cannot be simply explained by sitting and watching TV or by going out running.

The study confirms prior research that recreational screen time is unhealthy and is associated with risk or cardiovascular events. Second, it suggests that exercise does not modulate this risk appreciably. This conclusion, however, does not fit with the vast majority of other studies which do show a protective effect of exercise, and I do not think that the methods used are adequate to draw this conclusion.

Additional commentary here and here.

Dog attacks, can happen to anyone

This report is a couple of weeks old, but I thought it was still worth pointing out for a public safety reminder. While I have been lucky enough to not be attacked by dogs at any point when I am out running, it really can happen to anyone, anytime. On Jan 8 of this year, Paula Radcliffe, the current women's world record holder for the marathon at 2:15:25, was reported to have been bitten by a dog while out on a training run. Reportedly the dog was being walked by an older man who lost control of the leash, permitting the dog to chase and attack Radcliffe.

Thankfully, the injury was described as being minor and Radcliffe said she has no need or desire to change her training plan, which includes targeting a fall marathon to qualify for the British Olympic team and the 2012 London Games.

Dog bites are all too common. The CDC reports 4.5 million people are bitten by dogs annually. Their website unfortunately does not really provide any significant advice on prevention or what to do if you are attacked other than to "remain still". The American Veterinary Medical Association sells a pamphlet on the subject, but it is not freely available. The AVMA does, however, offer an extensive paper on community based programs for dealing with dog attacks. One of the more extensive resources I found on the subject is over at WikiHow.com. The source material that they reference is pretty thin, so I am not sure if it is effective or recommended, but it seems like reasonable advice.

Some tips:

• While I have never been bitten, I have been chased. Just slowing to a walk and quietly moving on is usually very effective until owners can gain the dog's attention.
• Wikihow suggests a variety of methods to assert dominance without being threatening. Such as, forcefully say "no" or "go home" but do not look the dog in the eye.
• Use whatever is nearby to help shield you, sticks, your bike if you are cycling, or even just a thick sweatshirt over your arm if you are lucky enough to have one. 
• If you must strike the dog, Wikihow suggests that hitting the skull is usually not effective since they are often very thick bones, but the base of the skull (ie: the back of the neck) is most likely to get their attention and scare the dog off.

If you are bitten, definitely seek medical attention! Dog bites can be very dangerous if they become infected so make sure to see a doctor right away.

Estimating risk prior to an exercise regimen

Published online in the European Society of Cardiology is a great summary document for doctors, but potentially readable for patients, of how to get started on aerobic exercise when you have heart disease.

Firstly, they summarize a very important observation which can seem paradoxical. While exercise readily and dramatically lowers the risk of cardiovascular events, the act of going out for strenuous exercise (ie: running) TEMPORARILY slightly raises the risk. This is because patients with heart disease (silent or not) have two problems. Their hearts are a setup for lethal arrhythmias (ventricular tachycardia) and rupture of a coronary plaque (causing a heart attack). The risk of both of these is increased due to more adrenaline circulating in the blood and the greater blood flow across plaques. So while the risk of having an event DURING a run is increased, the overall risk is still very low, about 1 in 200,000 patient-hours of exercise (ie: 200,000 patients exercising for an hour each, or one person exercising for 200,000 hours, talk about a long run!) For comparison, being out of shape puts you at a 4.5 fold risk of death as compared to someone who is physically fit. Not to mention, being active may reduce your risk of diabetes, high blood pressure, and metabolic syndrome by up to 25%.

They recommend a variety of tests prior to starting exercise, such as an electrocardiogram (ECG), echocardiogram (echo), and treadmill stress testing. Each of these is meant to assess the fitness of the cardiovascular system. They also recommend examination of the lungs (pulmonary testing) and joints, since many people fail to stick with exercise due to being short of breath or knee/hip/foot/other pains. The authors also provide a handy chart for putting people into low, medium, and high risk categories based on how all the tests come out. Figure 1 from their paper shows part of why aerobic exercise is so important for cardiovascular health. Stroke volume, or the amount of blood pumped with every heartbeat, goes up dramatically with dynamic exercise (ie: running) but barely moves with isometric exercise (ie: lifting weights).

In terms of what they recommend for exercise, they note that anyone who has had a heart attack or other significant heart disease should ideally first go through a supervised program of cardiac rehab before starting exercise on their own. They recommend that for people doing exercise for "primary prevention" (ie: never had a heart attack), or only have high blood pressure (hypertension), it is fine to go ahead as long as the previously mentioned testing is normal.

So, no excuses, get out there and get started walking, running, or whatever!

Also, see this page on exercise from the medical journal Circulation which is written for patients.

RRT 94: Running for a Healthy Heart

Thanks Steve and John, I enjoyed doing the RRT with you and I hope you feel like the discussion went well.

Just a reminder...

*DISCLAIMER* All material discussed herein and on the Runner's Round Table is discussed in generalities. None of this is medical advice and you MUST seek YOUR physician's counsel prior to undertaking athletic activity, especially if you have known cardiac disease.

For those that listened, I've got some notes here on things I mentioned:

• Each increase in MET you can tolerate is associated with a 12% increase in survival. Men whose maximal exertion was < 5 METs had a 4 fold higher risk of death than men who could achieve > 10.7 METs. (Morrow Circulation 2010;121:2681)
• The average person who is active, doesn't smoke, eats fruits and veggies, and doesn't drink to excess will live an average of 12 years longer than someone who does not do any of those healthy activities. (Kvaavik Arch Int Med 2010;170(11):998)
• About 30% of your risk of death comes from your genes. (Perls, Ann Int Med 2003;139:445) Another similar estimate shows that 90% of stroke risk comes from 10 risk factors, many of which are modifiable by lifestyle or medicine. (O'Donnell et al. Lancet 2010;376:9735)
• The Government Accountability Office recently reviewed the current state of direct-to-consumer marketed genetic testing.
• Air pollution increases the risk of cardiovascular disease. (Brook et al. Circulation 2010;121:2331)

We didn't get to talk about everything I thought that people might find interesting, like:

• People with heart transplants have run marathons! A worldwide organization similar to the Olympics which helps transplant patients compete in sports. Read about athletes like Ernesto Antonio, heart transplant recipient and finisher of the Dublin Marathon.
• People who have heart conditions should get cardiac rehab, which can have an incredible impact on improving your fitness. 3-6 months of supervised activity can increase aerobic capacity (VO2) by 11-35%!

Other References:

ACC Guidelines on Secondary Prevention of Cardiovascular Disease:

http://www.ncbi.nlm.nih.gov/pubmed/16697342

AHA Guidelines on Cardiac Rehab:

http://www.ncbi/nlm.nih.gov/pubmed/15668354

http://circ.ahajournals.org/cgi/content/full/111/3/369

Join me at the table

I'll be a participant on today's episode of the Runner's Round Table at 4pm (work permitting). Visit the RRT website for more info about how to listen live, download the podcast, or join in the chatroom discussion. We will be discussing the cardiovascular benefits of running with myself, another cardiologist, and members of the Run-Net community.

Give the gift of life, but not right before a race!

I am a frequent blood donor; needles don't bother me and I like the idea of literally helping to save lives (yes, I try to do that every day at my job as well...) Shortly befre I ran the Jacksonville Marathon last December, I was "due" for a donation and the vampires are usually set up somewhere in the lobby of my hospital, so I have to walk past their curtained-off area every morning and evening. I figured though, that donating right before a race was probably and bad idea, especially if I was trying to score a BQ.

If you take the contrasting side of this, think about what athletes try to do to improve their performance. Accusations of "blood doping" are all over competitions like the Olympics and the Tour de France. Oxygen is carried by red blood cells which are full of hemoglobin, so more hemoglobin and more red blood cells equal more oxygen. The general idea is that if you can carry more oxygen, then your endurance is improved. People accomplish this legally by training at high altitude or sleeping in oxygen deprivation tents (low oxygen levels force your body to make more hemoglobin to try and carry more). They accomplish it illegally by using drugs like erythropoietin (which is a hormone your body makes, but there is a synthetic form as well).

So, it stands to reason that if you have less hemoglobin and fewer red blood cells, you will have less endurance. In this study by Birnbaum et al., ten healthy young men, donated a unit of blood and significantly decreased VO2 max by about 3 liters/min. So, if you're Steve Prefontaine (VO2 max 84.4) then a drop of 3.5% in you VO2 max might not make much difference, but for us mortals, it might mean more of a 7.5% drop. By the way, this page gives you an idea what your VO2 max might be, and depressingly demonstrates why we slow as we age.

Tha full text of the study's abstract is here:

1. J Sports Med Phys Fitness. 2006 Dec;46(4):535-9.

Effect of blood donation on maximal oxygen consumption.
Birnbaum L, Dahl T, Boone T.

Exercise Physiology Department, The College of St. Scholastica, Duluth, MN, USA.
lbirnbau@css.edu

AIM: This study determined the effect of donating one unit of blood on various
physiological parameters associated with a VO2(max) test. METHODS: Ten healthy,
male subjects (23+/-4 years, 178+/-7.6 cm, 74.4+/-12.3 kg) completed a VO2(max)
test 24 h before donating one unit of blood (~500 mL) and 24 h after donating
blood. The Bruce protocol was used to determine the subjects' VO2(max).
Physiological responses were measured at the end of the VO2(max) test. A repeated
measures ANOVA was used to determine if there were significant (P<0.05)
differences in the subjects' physiological responses between the VO2(max) before
and after blood donation. RESULTS: Significant differences were found in VO2(max)
(mean+/-SD, 3.18+/-0.74 vs 2.87+/-0.53 L.min(-1)), cardiac output (Q, 25+/-5 vs
22.5+/-3.3 L.min(-1)), stroke volume (SV, 134+/-37 vs 121+/-22 mL.beat(-1)),
delivery of oxygen (DO(2), 5+/-.87 vs 3.97+/-.68 L.min(-1)), and hemoglobin
concentration (Hb, 153+/-12 vs 135+/-16 gm.L(-1)). No significant changes were
observed for heart rate (HR); arteriovenous oxygen difference (a-vO(2) diff),
systolic blood pressure (SBP), and diastolic blood pressure (DBP). CONCLUSIONS:
These findings indicate that donating one unit of blood decreased VO2(max) due to
the decrease in Q, which resulted from the decrease in SV since HR was unchanged.
The lower VO2(max) along with the decrease in DO(2) would be expected to have a
negative effect on athletic performance.

PMID: 17119517 [PubMed - indexed for MEDLINE]

Weight Loss, tips from someone actually doing it

A long time ago in a galaxy far, far away, I used to weigh about 265 lbs. One Xmas, I was home with my parents contemplating going up to size 42 pants when I said "no". Instead of new pants, I started counting every single calorie and exercising regularly. Over the following 12-18 months, I dropped 70 pounds and weighed in at 195. Since then I have become the avid runner I am today, and the weight has stayed off.

That intro aside, I have been following Tyler's story at: 344pounds.com. He has been trying to drop from 344 lbs, and presently is down to 215 (awesome!). He recently posted 50 thoughts about weight loss. What I especially like about the list is that it is coming from someone who is ACTUALLY WORKING TO LOSE WEIGHT. Better still are his two first points, 1) read everything you can, and 2) be skeptical of everything. I could not agree more, especially when I see how many "quick, easy" fixes are out there being pimped and sold, but have no evidence of benefit beyond just getting out there and doing exercise or just eating less. There are no magic formulas!

The one thing missing from his list which I would add is: "Just do it". This is not an endorsement of Nike (one day I will get around to writing a post about Team Sweat) but it is advice on the observation that being committed is simultaneously the most important advice to accept and the hardest to employ.

What I mean is, how many people think you can eat whatever you want, never exercise, and have the perfect body? It just can't be done, we all know this in our hearts, but many people spend hundreds and thousands of dollars on gear, DVDs, books, diets, supplements, and more to find the magic answer, when the magic answer is to "just do it". Imagine, instead of spending hours shopping online for the next great fad workout video, you just went outside and went running, or cycling, or even just walking. Instead of going to GNC trying to find the bestest protein bars and shakes, you just had an apple, or a glass of water and waited until it was time for your next meal. That's why I like #18 as well. Finding an accountability partner can make the process a lot easier.

The rest of the list has some great practical advice as well. Some are psychological tactics (throw away your 'fat' clothes), but I am not sure all of them would work for me (buy clothes that are too small for you, as an encouragement). He recommends taking a multivitamin, which I cannot imagine being harmful, but don't spend a lot of money on yet another thing that sounds like a good idea but has no science behind it (also, if you eat healthy with lots of fruits/veg, you will get more than enough of all your nutrients). He recommends carbs, but I would temper the advice by saying the right carbs. In my opinion the nutritional value from same number of carb calories in bananas and a bowl of Cap'n Crunch is not the same. The mint idea is a good hack and makers all other food taste lousy for hours after a meal (I still do this sometimes).

I don't mean to say that this process is easy, I know it is not, but what is important is getting out there. Learn, but be skeptical. Because in the end, you know the answers, now you need to "just do it".