Category Archives: Wellness

Exercise: How Much is Enough?

Are you as lazy as I am? Do the words “gym membership” fill you with terror?


I can vouch that I fit that category! And of course, I have a host of terrible excuses, even as my clinic is attached to a gym.

But I’d like to review for people just why exercise is important. One big reason is to decrease the risk of heart disease and strokes. These two diseases combined cause more deaths than any other disease — and your risk can be dramatically reduced by lifestyle choices.

Studies show that moderate exercise can decrease your risk of heart attacks and strokes by 30%. And one great finding was that brisk walking can be enough! But let’s be clear on that; a brisk walk means “out of breath, tired, and sweating”. Slowly walking the dog and chatting every ten steps after dinner, or leisurely playing 18 holes of golf, is not enough to get that heart benefit.

How many minutes is enough? The best studies show that 20-30 minutes every day is enough, or some type of out-of-breath exercise for 150 minutes a week. Easy to remember, yes?

And no, you do not need to max out your heart rate! Higher heart rates are great for weight loss, but lower heart rates help your heart. Great!

The key, of course, is finding something you love to do. Here are some ideas:

  • Dancing on the street corner every night with local Chinese (a wonderful tradition)
  • Biking to & from work or school
  • Daily Nitendo Wii Fitness exercise every morning
  • Treadmill, elliptical machine, anything for 50 minutes, three times a week at your gym

OK? I promise to exercise more if you promise as well. Your heart will thank you.

Do You Know Your BMI?



Obesity is an epidemic in many countries, and China’s diet is changing so quickly that the obesity rates here are also rapidly climbing. One popular tool to assess your own weight — and your subsequent risk category for heart disease and diabetes — is to figure out your Body Mass Index, commonly known as BMI. It’s a very simple calculation, height (meters) / weight (kg) squared.

Enter your height and weight in the above table. Your BMI score means the following:

Underweight Below 18.5
Normal 18.5 – 24.9
Overweight 25.0 – 29.9
Obesity 30.0 and Above

Doctors use this BMI number to assess a person’s risk for diseases such as heart disease and diabetes (see the table below). The BMI test does have some controversy as many feel it isn’t accurate enough, especially for very muscular persons whose BMI may be artificially high since muscle is heavier than fat (see more details here). Many doctors feel that abdominal waist circumference is more accurate to assess your obesity risks. The bottom line is that you should know either your BMI or your waist circumference risk — both is better. Your doctor should also calculate this during your annual physical checkup.

The bottom line: however imperfect the test, BMI has been validated in countless studies and can give a fairly good idea of your obesity and health risks. Plus, it’s free and you can do at home without seeing the doctor!

Classification of Overweight and Obesity by BMI, Waist Circumference, and Associated Disease Risks

Disease Risk* Relative to Normal Weight and Waist Circumference
Men 102 cm (40 in) or less
Women 88 cm (35 in) or less
Men > 102 cm (40 in)
Women > 88 cm (35 in)
Underweight < 18.5
Normal 18.5 – 24.9
Overweight 25.0 – 29.9 Increased High
Obesity 30.0 – 34.9 I High Very High
35.0 – 39.9 II Very High Very High
Extreme Obesity 40.0 + III Extremely High Extremely High

*     Disease risk for type 2 diabetes, hypertension, and CVD.
+     Increased waist circumference can also be a marker for increased risk even in persons of normal weight.

Do You Know Your Cardiovascular Age?

Heart disease is the #1 killer in most of the world. The main culprits causing heart attacks are high blood pressure, high cholesterol, obesity and diabetes. Most of these diseases are easily picked up during an annual physical with basic lab tests. But sometimes it’s very difficult for doctors to impress upon patients what the numbers mean.

Now, there’s a great free website at that inputs your basic doctor visit information (cholesterol tests results, blood pressure, weight) and shows you in a graph form your 10 year risk of heart disease. Even better, it compares you to an average risk person and also shows how you could lower your risk if you did certain things (like stopping smokng or losing 20 pounds). It also tells you your cardiovascular age — for example, a 41 year old high risk person may have a cardiovascular age of a much older, 45 year old man.

It’s an effective visual impression that hopefully will impress many people that they have many risk factors for heart disease — but they can do something about it. Check it out. Here’s a sample result below. You can click on the “full screen” icon in the lower right to get a better look.

Website of the week: CDC Travel Page

It’s the height of summer and everyone is in the middle of their traveling. I get many visits from patients asking about travel issues like, “do I need malaria pills for ___ place?” or “which vaccines do I need for ___?” Well, here’s a little secret that may save you some time: before you see the doctor, first go to the CDC Travel website and read their updated page on the country you plan to visit. This website, by the US Center for Disease Control, is the same website the doctors use, to see which vaccines are needed, as well as malaria and other issues. It also gives important information on any crucial outbreaks.

It’s a fantastic website, completely free and updated constantly. It’s a must-use, every time you travel.

By the way, try to research your travel country at least one month before visiting, to give you enough time for vaccines. Many vaccines such as japanese encephalitis are a 3 shot series that take at least 21 days.

Website of the Week: Natural Medicines Database

There is a lot of bad information on the internet regarding herbs and supplements for health. Many websites are full of self-promoting testimonials, or even direct sales advertising for their products.  It’s very difficult to find non-biased information and research results. This website, Natural Medicines Database, is a terrific source for both consumers and medical professionals. Especially useful is their free Clinical Management Series of evidence-based research on major illnesses. Much of the rest of the website requires a fee.

Low cholesterol: Fish oil vs. flax oil?

To lower cholesterol, there are a few excellent non-prescription items to use. One of the best is omega 3 fatty acids — this is naturally found in fatty fish and also in flax oil. Great! So I can get the omega 3 from the non-stinky flax, yes? Unfortunately, it seems you cannot. Recent research shows that the flax seed omega 3 does not have the same cholesterol lowering properties as fish oil. Too bad, I stocked up on flax at my last Costco run! By the way, whichever supplements you use, you need at least 1 gram a day of the omega 3 part — check your bottles. Also, it’s always best to get it naturally — by eating fatty fish at least once a week. That includes salmon, mackerel and sardines.