Lesser of Two 'Evils': Fat, Sugar, Cigs

Linda Brookes, MSc


February 12, 2018

Moderate-Intensity Versus Vigorous-Intensity Exercise

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Although exercise is generally good, some people view it as a necessary evil. The US Department of Health and Human Services recommends 150 minutes per week of moderate-intensity exercise (eg, brisk walking) or 75 minutes per week of vigorous-intensity aerobic exercise (eg, running).[18] Only about 1 in 5 Americans meets these targets.[19] If the aim is to improve fitness or lower blood pressure, moderate exercise is both sufficient and more achievable, Dr Lin notes. But it's not enough if the goal is to lose weight, unless attention is also paid to diet. "It's hard for people to change two behaviors at once, so usually I tell them that if they are going to exercise, they shouldn't worry too much about dieting until they establish the exercise habit," Dr Lin advises.

However, exercise must be vigorous to lose weight, and it must be maintained to keep the weight off, he adds, noting that in the TV show The Biggest Loser, contestants regained weight when they stopped vigorous physical activity after the show ended.[20] Recent studies have suggested that moderate-intensity exercise provides greater cardiometabolic benefit than vigorous exercise.[21,22] Dr Lin believes that musculoskeletal injury is a greater risk, especially in older patients or those who suddenly begin exercising vigorously. "I always advise them to be cautious, and slowly ramp things up," he stresses.

Verdict: Vigorous exercise is better for weight loss.

Smoking Versus E-cigarettes

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Clinicians want their patients who smoke (at last count, around 38 million in total[23]) to quit. The adverse effects of conventional cigarettes are well known, but little is known about electronic cigarettes (e-cigarettes). Early opinions about e-cigarettes were negative, because they contain nicotine as well cancer-causing chemicals in the aerosol emitted.[24] Outside of the United States, this view has evolved, and e-cigarettes are now marketed in some countries as smoking cessation aids.

Recently, the United States appears to have reached a similar view on e-cigarettes.[25] As Dr Lin points out, "although the research into e-cigarettes still is fairly sparse and we are still trying to figure out the long-term effects, the consensus now is that if you are going to use one of them, choose e-cigarettes." Recognizing that the evidence supporting e-cigarettes as aids to help adults quit smoking is inconclusive,[25,26] Dr Lin believes that smokers who have tried to quit numerous other ways should try e-cigarettes. "Usually, you end up saying that they couldn't be any worse for you than what you are doing now," he admits.

The main concern about e-cigarettes is whether nonsmokers who try them, particular young people, will move on to conventional cigarettes. Many studies have indicated that the use of e-cigarettes by young people increases the odds of smoking conventional cigarettes[25] (by double, according to recent data[27]). "Most adolescents I talk to have tried e-cigarettes, and many believe that they are less harmful than conventional cigarettes," Dr Lin notes. "If it becomes a widespread trend, we could end up with a whole generation of teenagers hooked on cigarettes, and that might not have happened if they hadn't had the e-cigarette option," he warns. "When we counsel adolescents, we must take the position that they shouldn't start smoking at all," he stresses.

Verdict: E-cigarettes may be less harmful than smoking, but only in adults who already smoke.

Antimicrobial Household Cleaners Versus a Microbe-Rich Home

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One of the best ways to prevent the spread of bacterial infections in homes is to maintain a clean home, especially the kitchen, which can be contaminated with such pathogens as Escherichia coli and Salmonella.[28] Antibacterial household cleaners are routinely advertised as offering benefits over regular soap products, but experts doubt that they are actually more effective.[29] Dr Lin agrees that little evidence supports the consistent use of antibacterial products for household cleaning. "People think that 'cleaner' is healthier, but these products are not necessary," he says. "In the kitchen, follow safe food storage and preparation practices," he stresses. "Don't undercook meat and ensure that you wash vegetables with plain water, and that's all you need to do to prevent E coli and those kinds of outbreaks."

Along with perhaps being unnecessary, concerns have arisen about potential harmful effects of the long-term use of antibacterial cleaners, including the development of bacterial resistance.[30] Too much emphasis on hygiene and cleanliness in industrialized countries, resulting in reduced exposure to a range of bacteria, viruses, and other pathogens, has been linked to dysfunction of immunoregulatory mechanisms (the "hygiene hypothesis").[31] "There is something to the hygiene hypothesis. If you have a functioning immune system, you shouldn't need antimicrobial soap," Dr Lin says. A group of antimicrobial agents known as "quaternary ammonium salts" (or "quats") have been linked with harmful developmental effects, such as inhibition of mitochondrial function and impaired estrogen signaling.[32]

Verdict: Keep homes clean, but antibacterial cleaners are unnecessary.

Persuading Patients to Change

The key to getting patients to adopt healthier habits is to keep reminding them "without battering them with it," Dr Lin says. "You can end up alienating the patient. Then the patient won't do anything because the doctor always makes them feel bad," he cautions. "One day, when it seems as though the patient will never do anything, suddenly they will be willing to do it. But if you had become jaded and didn't feel like bringing it up any longer, then maybe it never would have happened," he suggests. "You have to be realistic, but not so pessimistic about the patient's inability to change that you stop giving them chances to do it," he adds.


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