Health-Actualization

Two Unsynchronized Souls Radio Interview

2012-02-10T18:12:00.000-07:00

On Thursday night, February 9th, I had the honor of joining Monica Brinkman and Oana Niculae on their BlogTalkRadio show, Two Unsynchronized Souls. The show typically covers a variety of topics, including social issues, current events, and fiction writing. I was brought on the show to discuss exercise and nutrition, but we became so wrapped up in nutrition chatter that we barely discussed exercise. It was a fun experience. We laughed quite a bit, and Monica and Oana covered a lot of ground with their nutrition questions.

You can find the link to the episode here.

Thoughts on the Show

There are a few things I want to add to the interview:

I mentioned a few links during the show. They are: www.fitday.com, which is the online food journal that I use periodically. Also, www.grasslandbeef.com is the site for U.S. Wellness Meats, a great source for finding organic, grass-fed beef.
One thing I said accidentally was that short, intense training can improve blood pressure to its maximal degree. While short, high intensity exercise can improve most health measures as much, if not more than, long duration/moderate intensity exercise, blood pressure is actually not one of them. Blood pressure seems to respond best to long duration exercise, regardless of intensity (i.e. a half hour walk is more effective in lowering blood pressure than a 15 minute session of running sprints).
If you would like to see any of the studies that I refer to, feel free to ask.

Your thoughts and feedback are welcome. Enjoy!

What I Eat: The January Edition, and the Danger of Small, Frequent Meals

2012-01-28T15:38:00.002-07:00

This is the fifth installment of the What I Eat series (last May, July, August, and September). As you'll notice, my meals haven't changed that much since last September.

Wednesday

5:30 AM: Can of sardines with a sliced tomato in balsamic vinegar, and a banana
10 AM: Three over-easy eggs with an apple
1 PM: Three hard-boiled eggs and sliced fruit (pineapple, apples, and grapes)
6 PM: A large bowl of romaine lettuce, sliced tomatoes, an avocado, bacon, and chicken with red wine vinegar and olive oil

Thursday

5:30 AM: Can of sardines with a sliced tomato and carrots in balsamic vinegar
9:40 AM: A chicken breast (pan fried with butter) and an orange
2 PM: Four hard-boiled eggs with a chopped red bell pepper
9 PM: A large bowl of arugula, romaine lettuce, sliced carrots, ground meat, an avocado, olive oil, and balsamic vinegar

Friday

5:30 AM: Can of skipjack tuna with a sliced tomato in balsamic vinegar, and an apple
10 AM: Three over-easy eggs with a banana
4:30 PM: A large bowl of arugula, spinach, sliced carrots, raisins, and chicken with olive oil and balsamic vinegar. Also, a few handfuls of sunflower seeds and almonds.

You may look at my recent days above and think, "what's up with your breakfast???" It certainly doesn't sound appetizing for many people, but it's a nutritious and quick meal (I start training clients at 6:30 AM, so I'll take all the sleep that I can get). In regards to nutrition, that meal provides large amounts of vitamin A, D, B complex, calcium, phosphorous, selenium, omega-3 fatty acids, fat, and protein. The acetic acid in vinegar also helps control blood glucose, as discussed previously. The breakfast is a great fuel for the start of my day, especially considering that I don't consume caffeine and need to be focused so early in the morning.

US Obesity: Are We Eating Too Often?

I mentioned recently that NHANES population data is showing that obesity is no longer increasing in the United States [1]. From 1999 to 2008, the obesity rate has not significantly increased. The average has increased and decreased by a few percent in that time. While this is a positive sign, our obesity rate is still way too high - the 2007-2008 NHANES data states that 33.8% of the adult population is obese. While it is not significantly higher than 10 years ago, the obesity rate has skyrocketed in the decades leading up to '99. The million dollar question is: WHY???

Looking at diet, one study examined the changes since 1977 in three logical areas: energy density of food, portion sizes, and eating occasions [2]. Energy density basically means that we are consuming more calories per gram, which is accomplished by replacing protein or carbohydrates with fat. Eating occasions were considered any meal, snack, or beverage (excluding water) that did not fall within 15 minutes of a previous meal, snack, or non-water beverage. The researchers looked at data from four sets of years: 1977-78, '89-91, '94-98, and 2003-2006.

Energy density did not significantly change in any of the three follow-ups. However, portion sizes increased in two of three subsequent studies, and eating occasions increased in all three.

The study does not prove that portion sizes and eating occasions are the cause of our high obesity rate in the US; it only shows that there is a connection and they are possible causes. The meal frequency especially caught my attention as it is something that I have spent a lot of time studying.

Eating six small meals per day is commonly recommended for weight loss. The theory is that eating your daily calories in the same amount but spread over six meals will boost your metabolism. While this may seem logical, research shows that if anything is superior for fat loss and health, it is eating less frequently (read my previous posts, here and here, to see the research and my experiments with meal frequency). In addition, I think this idea is very flawed in the real world. Eating small, frequent meals is based on a simple concept: that people will eat with discipline, consuming no more than they would in three larger meals. Do you believe that the majority of people can do that? I don't, and I'm not trying to insult others - I may be one of them!

In conclusion, for weight loss or maintenance, I think most people would benefit from eating less frequently. Even if there is no physiological benefit to eating only two, three, or four meals per day, eating fewer meals will likely decrease a person's daily intake.

200th Post! ...What Have I Been Doing?

2012-01-19T15:04:00.002-07:00

19 days into 2012...hopefully you are still on your path to achieving New Year's resolutions (if you made any). If you aren't, you could always make some changes and restart the path (whose life doesn't feature adjustments on the fly?).

The last 19 days (and the weeks prior to that) have been eventful for me. I spent the last few days of 2011 and the start of 2012 on vacation in New York and Punta Cana with family (see the pictures below). After that, I moved (within Phoenix...my new apartment's balcony view is the picture at the top of the post) and have started spring classes for my masters program.

Now, to put the "health" back in Health-Actualization, here are the blog-relevant projects that I am working on:

I'm putting together a study at ASU that will look at a specific the effects of a specific strength training protocol on flow-mediated dilation (if that last term sounds foreign, check out my flow-mediated dilation posts from this past month). The study will occur over the summer or fall, and I will report the results here when finished.
We may not be getting fatter as a country! I have been looking at epidemiological studies (the NHANES data) from 1999-2008 and it has shown that there is no significant upward trend in obesity [1]. The average percentage of obesity has risen and fallen a few percent in recent years, but there is no consistent direction. Obesity in this research is based on body mass index measurements (weight in kilograms divided by height, in meters, squared), so it's certainly not perfect - very muscular people could fall into the obese category. However, the advantage of this research is that the height and weight were measured by the researchers, which makes it more reliable than height and weight data self-reported by the study subjects (people tend to report themselves as lighter and taller than they truly are...what a surprise...).
Future posts will include new information on healthy eating practices and how strength training benefits various health markers that I have not discussed before, such as inflammation.

Post 200!

As the title says, this is the 200th post of Health-Actualization. I am truly grateful to all of you who have followed my work over the past three and a half years. I enjoy sharing my thoughts and findings with you. More importantly, I have enjoyed the emails, comments, and personal connections that have come as a result of this blog. I stated in the 150th post that my best work is yet to come, and I still believe that is the case. I look forward to providing you with more information and getting to know you better over the next 200 posts. Thank you.

Artery Function and Diet: Part 2

2012-01-10T18:29:00.001-07:00

Before getting into the last post of this series about artery function, lets do a quick review:

Flow-mediated dilation (FMD) is the ability of the artery to dilate beyond it's normal size when blood flow increases. Dilation of 7% above the normal size is considered healthy, with higher being better and lower being worse.
A low FMD is a significant predictor of atherosclerosis and decreases in FMD over time indicate the progression of heart disease.
Dilation is important because it reduces the stress experienced by arterial walls when blood flow increases.

Diet, Part 2

In the previous post on FMD and diet, we looked at a study that showed a high fat meal suppresses FMD, whereas a high carb/fat-free meal had no effect [1]. However, after a deeper look, the results weren't so black and white. While saturated fat is a target of mainstream health today, the majority of the fat calories were unsaturated. Specifically, they came from various vegetable oils. These oils contain large amounts of omega-6 fatty acids (FA). Omega-6 FA, when taken in much higher quantities than omega-3 FA, lead to cardiovascular inflammation and increased risk for heart disease. Not only did the group eating a high fat meal consume a lot of omega-6-dense vegetable oils, but many of those oils were hydrogenated. Hydrogenated oils are known to increase many of the risk factors for heart disease (lowering HDLs, increasing triglycerides, etc.).

I also mentioned vitamin C is known to improve FMD [2], yet it did nothing for the high carb/no fat group in that study. I believe this happened because vitamin C was only able to attenuate for the damage caused by the high carb meal, which brings us to today's question: does a high carb meal affect artery function?

A group of Japanese researchers may have found the answer to this question. They put three groups of people through an oral glucose tolerance test, basically giving each subject 75 grams of glucose [3]. The three groups were split into individuals who had healthy blood sugar levels and insulin responses (NGT - normal glucose tolerance), people with slightly abnormal insulin responses and blood sugar (IGT - impaired glucose tolerance - these people will likely develop diabetes), and those who currently have diabetes (DM). Each subject fasted for 12 to 14 hours before the test, and measurements were taken one and two hours after receiving the glucose.

The Results

Blood glucose levels skyrocketed after the glucose meal. The NGT group went from a baseline of 91 to 154 and 114 mg/dl in one and two hours following. IGT started at 105 and jumped to 220 and 173. DM started at 128 and jumped to 240 and 242. The healthy blood glucose range is 70 to 99 mg/dl.

The FMD results are charted below:

All three groups significantly digressed one and two hours after taking the glucose. The NGT group started at a desirable 7.53% but plummeted to 4.24% and 6.35% during the following two hours (recall that 7% is the lowest "healthy" FMD). The IGT group started at 6.5%, then fell to 1.4 and 4.0% in the two hours after. The DM's baseline FMD was 4.77% (ouch!) and fell to 1.35 and 1.29 in hours one and two after the test.

As you see, a large dose of glucose can drop a healthy individual's FMD into an unhealthy range. In addition, the groups with high baseline blood sugar were slower to recover from the meal. Both the IGT and DM groups fell to FMDs of less than 2% following the meal. This means their arteries could dilate only about one-forth of the minimal healthy amount and could hardly dilate overall!!! The authors of the study speculated that the hyperglycemia increases the concentration of free radicals, which inactivates nitric oxide. Nitric oxide is the catalyst for arterial dilation.

In getting back to the question about high carb meals, it's clear that a high sugar meal raises blood sugar and is detrimental to arterial function. Fat and fiber both slow the metabolism of sugar, and in turn, blunt the spike of blood glucose. Therefore, this study indicates that having a meal dense in carbohydrates without any accompanying fat or fiber is very damaging to arterial health. This also supports my previous suggestion: the high carb, fat-free meal presented in the high fat meal study [1] was likely damaging but that damage was controlled by vitamin C or other nutrients in the meal.

Concluding the Discussion on FMD

For those of you who may have day-dreamed your way through my last few posts, I'm going to make this simple for you: here are my concluding points on how diet and exercise affect flow-mediated dilation, and therefore, how they affect your cardiovascular health:

Cardio in the traditional steady-state format (one speed for long periods of time) improves FMD, but high intensity interval training (alternating short bouts of 90-100% effort with longer bouts of light effort) can provide the same benefits in a fraction of the time.
Strength training is beneficial for arterial health in just about any unhealthy population. However, for healthy populations, the key may be how much time is spent between sets. Hustling between exercises could be the key for strength training to improve FMD.
A meal high in vegetable oils, including hydrogenated vegetable oils, can cause hours of arterial dysfunction. Vegetable oils are commonly found in fast food and processed foods.
A high amount of sugar causes a state of high blood glucose which also leads to hours of arterial dysfunction. Based on the study discussed in this post, I recommend avoiding meals rich in carbohydrates, especially in the absence of fat and fiber.
Vitamin C improves arterial function, but I don't recommend relying on it to save you from meals featuring high amounts of vegetable oils or sugar.

Happy Holidays!

2011-12-31T12:11:00.002-07:00

I hope all of you have enjoyed the holiday season so far. I have been on vacation over the past 10 days and will return shortly after the new year. The next few blogs will present some new material that I'm excited to show you.

Happy New Year! See you in 2012.

Artery Function and Diet: Part 1

2011-12-22T21:39:00.000-07:00

The last two blogs discussed what flow-mediated dilation (FMD) is and how exercise can be manipulated to improve it. Recalling that FMD is a measure of arterial health that strongly represents overall cardiovascular health, we're going to figure out if and what type of fat damages your heart health.

The High Fat Meal Study

A high fat meal was pinned against a low fat meal in looking at short term effects on FMD [1]. The high fat meal, with 45 grams of fat, led to a statistically significant decrease of FMD for two to four after the meal (recall that "statistically significant" just means that the changes did not occur due to chance). The fat-free meal essentially did not change FMD at all. You can see the results below in the chart.

In their conclusion, the authors stated that saturated fat is an independent predictor of cardiovascular disease risk. I mean, it seems pretty straight forward: this study clearly shows that fat is bad for your arteries. Why don't we just consider that conclusion a fact so you can get back to watching TV and I can get ready for my flight to New York tomorrow?

Unfortunately, it's not so straight forward. Lets look at the details. Here are the meals consumed by the groups:

High fat meal: Egg McMuffin®, Sausage McMuffin®, 2 hash brown patties, and an unspecified beverage.

Fat-free meal: Frosted Flakes®, skimmed milk, and orange juice.

Outside of the fat content for both groups and the caloric intake for the high fat group, the authors did not include any nutritional facts. I used McDonald's Meal Builder to figure out the nutritional facts for the high fat meal. Here are some of the key facts:

900 calories
440 calories from fat
45 grams of fat, including 16 grams of saturated fat
75 grams of carbs
40 grams of protein
Two milligrams of vitamin C (4% of daily value)

The fat-free meal was said to have zero grams of fat and nothing else can be determined as the quantities of each food and drink were unlisted.

It's impossible to conclude from this study that saturated fat alone leads to a short-term digression of FMD: most of the fat calories are from unsaturated fat, and fat makes up less than half of the calories - there are several other possible causes!

Lets start with the ingredients for a McDonald's hash brown: corn oil, hydrogenated soybean oil, dextrose, corn flour, and it's prepared by cooking in corn oil, hydrogenated soybean oil, and canola oil. Those oils are loaded with omega-6 fatty acids, one is hydrogenated, and they all have very low thresholds for heat (meaning they are chemically altered for the worse when heat is applied). Translation: this is a recipe for cardiovascular disaster. The buns on the breakfast sandwiches include similar oils and high fructose corn syrup, and the eggs are made with hydrogenated soybean oil as well. The entire high fat meal is a chemical disaster and bears little resemblance to a piece of organic meat cooked at home in butter or coconut oil at a low temperature.

The lack of change in the fat-free meal provides another reason for the difference in FMD changes: vitamin C content. The fat-free group ate frosted flakes along with skim milk and orange juice (a great meal...if you are five years old) - basically all simple carbohydrates. Even though a major change didn't occur, I believe that the carbohydrate/sugar content did negatively affect FMD. Vitamin C has demonstrated a strong, positive effect on FMD in previous research [2], but I believe the vitamin C in this case just attenuated for the damage of the sugar. I will discuss sugar in the next (and last) installment of the FMD series. As for now, knowing that vitamin C helps FMD, the fat-free group would have benefited significantly more from drinking a modest eight-ounce glass of orange juice (about 163% of the daily recommended amount, as opposed to the 4% consumed in the high fat group).

Final Conclusions

Here's what I think you should take from the studies presented above:

If you eat meals high in vegetable oils (think: omega-6 fatty acids), especially those with hydrogenated oils, you are likely going to decrease artery function in the short term (continued short term decreases lead to long term digression). Both vegetable oils and hydrogenated oils of all types are largely found in processed foods. If it doesn't have an ingredient label, you are safe.
Vitamin C improves arterial function. The fact that the high sugar, fat-free meal decreased slightly in the presence of vitamin C indicates to me that vitamin C can attenuate for the damage of some poor eating.
Don't eat fast food. Even the typically-healthy foods, like eggs that are offered at these restaurants are dense with unhealthy chemicals. You should not trust anything on the menu, even if the nutritional facts seem harmless.

In the next and final FMD post, I'm going to discuss the effects of simple carbohydrates on your arteries and heart health. It may change what you view as a "heart-healthy meal."

Exercise and Arterial Health: What Works?

2011-12-15T15:17:00.002-07:00

My last post discussed what flow-mediated dilation (FMD) is and why it's important. Here's a quick review:

FMD is the ability of an artery to dilate when blood flow increases. The importance of dilation is that it reduces regular stress on the arterial walls.
FMD is expressed as the percentage difference between maximum dilation and normal artery size. 7% and above is considered healthy.
FMD is a good predictor of atherosclerosis and heart attack risk. Greater dilation decreases the risk that any existing plaque in the arteries will lead to a heart attack.

In summary, FMD represents cardiovascular health status. Now that we've established it's importance, we need to figure out what helps improve it. In this post, I'm going to discuss the role of exercise.

Aerobic Exercise

Consistently, aerobic exercise (A.K.A. "cardio") improves FMD in research [1, 2]. If you participate in standard, steady state aerobic exercise (i.e. running/cycling/swimming at one speed for 20+ minutes), your arteries will likely improve in their dilation abilities. A steady state program could improve FMD in as little as two weeks [1]. Instead of presenting you with the research details on how much it has been shown to work, I'm going to take a different approach: comparing different methods of "cardio."

The steady state approach was pinned against high intensity interval training (HIIT) in one study [3]. All subjects in this six week study were young (averaging 23 years old) and healthy. The ones in the steady state group cycled at a moderate intensity for 50 minutes per day, five days per week (who has that kind of time???). The HIIT group performed sprints on a stationary cycle: an average of five 30-second sprints, three days per week. The results are charted below:

As you can see in chart B (normalized FMD), the sprint (HIIT) and endurance (steady state) groups finished with basically the same FMD. The endurance group improved more, but they also had a lower average starting FMD, which is an advantage for experiencing improvement. Basically, they both work and to a similar degree. Here's what I find to be the most important part: the endurance group exercised for 250 minutes (four hours and ten minutes) per week while the sprint group only trained for 7.5 minutes per week! The sprint group invested less than 1/33 of the time and achieved basically the same FMD improvement!!! FMD responds greatest to intensity, and intense exercise can produce significant gains with a fraction of the time investment.

Strength Training

Strength training's effects on arterial health aren't so clear: some studies show big changes, and some show little to no change. Strength training helped healthy, postmenopausal women increase their FMD only 0.8%, and that change was statistically insignificant (meaning it was possibly due to chance) [4]. However, another study led to a significant increase of 2.6% with overweight but healthy women, aged 24-44 [5].

Trials on young adults proved equally inconsistent. Strength training did not increase FMD in 23 year-old males [6], but significant improvements were achieved in a different study on young men and women (mostly men), average age of 18.5 years [7]. So what's the deal? Does strength training improve artery function? Am I just going to continue wasting your time by citing studies with opposing results?

I think there are some simple explanations for the different results, and these explanations can be used to make your own strength training a true cardiovascular workout. The major difference for the two adult women studies is the starting point: the postmenopausal women started with a very healthy FMD of 10.2%. There wasn't much room for improvement. However, the successful group started at a borderline healthy 6.3%. The 2.6% gain is a large change, but they still only ended the study at 8.9%, lower than the starting point for the postmenopausal women.

The young adults could not be explained by baseline numbers: the unsuccessful trial started at 7.6%, whereas the 18 year-olds started at 9.7%. What could be the difference??? Inter-set rest periods. The 23 year-olds took the traditional strength training approach of waiting two minutes in between sets, but the 18 year-olds were hustling with only 30 seconds in between. I will blog more on the importance of inter-set rest periods in the future, but when it comes to cardiovascular benefit, it seems that what you are doing in between sets is just as important as what you are doing during the sets. This one workout detail seems to transcend the importance of baseline health.

Bringing It All Together

Using aerobic exercise, most protocols should produce improvements in artery function. However, intense exercise can produce the same amount of gain in a fraction of the time. A few short, sprint-like efforts with your modality of choice (cycling, swimming, etc.) can produce the desired improvements in a much more efficient manner than long jogs.
All people with poor arterial dilation can benefit from strength training. However, for people with good cardiovascular health, the time spent in between exercises may dictate the extent of benefit. Based on reading the research, I believe strength training can provide the same magnitude of arterial benefit as aerobic exercise, as long as the trainee is hustling between exercises.

Flow-Mediated Dilation: A Single Measure for Assessing Heart Health

2011-12-14T15:28:00.001-07:00

Last week, I was helping a friend with his sink's poor drainage. Every time it was used, water would backup, filling the sink. His sink drained...but at an extremely slow rate.

The problem? The drain pipe was clogged. After taking off the trap (the 'U'-shaped portion of the white tube in the picture below), we discovered clumps of hair, food, and tweezers in the drain pipe (in defense of my friend, he recently purchased the house).

Fortunately, we were able to remove all of those items, put the trap back on, and restore normal drainage. However, wouldn't it be easier if the drain pipe could merely expand itself every time water was in the sink? In addition, imagine that the pipe could expand to greater widths when water was coming down faster or in greater amounts - taking off the trap to remove clumps of hair would never be necessary!

That's how your arteries work: when blood flow increases, arteries expand. When flow is faster or in greater volumes, the arteries expand even more. This ability to expand with increased blood flow is called flow-mediated dilation (FMD). Simply put, FMD is how much an artery can expand beyond it's usual size. It's typically measured by cutting off blood flow at the upper forearm for five minutes. A measure of 7% or greater is considered healthy.

The Importance of FMD

A poor FMD is a good predictor of atherosclerosis [1]. Researchers learned this by studying the FMD of arteries of people with no blockage versus individuals with mild atherosclerosis. The blockage-free group experienced a stellar dilation of 13.2%, whereas the atherosclerosis group only reached 1.8%. In other words, the clear arteries could expand greatly to meet varying amounts of blood flow, but the partially blocked arteries couldn't even expand 2% above their usual size. A different study found that when FMD decreases, it predicts increased thickness of the artery walls (a sign of increased risk for heart disease/heart attack) [2].

However, FMD doesn't just predict heart disease risk - it plays a key role. The authors of the first study stated that if partially blocked portions of the arteries could expand, "substantial reductions in (arterial) resistance could occur [1]." Less arterial resistance translates to less arterial stress and a lower risk for heart disease/heart attack.

This takes us back to the sink conversation: if your drain pipe could expand, the resistance to the water passing through would decrease and water would get to its desired destination in a reasonable amount of time. The difference between your drain pipes and arteries is in the end result: when water doesn't get through the drain pipe, it sits in your sink. When blood does not pass through a blockage in your arteries, tissues become oxygen-starved and die...and the person may die with it.

Why Do I Need to Know This?

Flow-mediated dilation is a measure that predicts and plays a role in heart disease and heart attack risk. It's a good representation of cardiovascular health. Typically my posts talk about a way to improve health or fitness. However, this post is merely a discussion on a way to measure health. In some of my upcoming posts, I'm going to discuss ways that exercise and diet affect FMD, and therefore, how they affect cardiovascular health. Stay tuned.

Changing LDL Particle Size Through Exercise

2011-11-05T16:47:00.003-07:00

One of the most commonly examined risk factors for heart disease is having "high cholesterol." Specifically, health professionals focus on the total of low density lipoprotein particles, which are also called LDLs or "bad cholesterol." However, as discussed here previously [1, 2], looking at the total number of LDL particles is a very flawed way to determine risk for heart disease - LDL particles aren't all built the same way.

LDLs come in different sizes and densities. LDLs that are smaller and more dense are more likely to be atherogenic. However, when larger and buoyant, LDLs don't carry the same connotation with high cardiovascular disease risk.

Now, if you have been tested through a vertical auto profile or NMR lipoprofile [1] and found out that your LDL particles are smaller and more dense, you're not completely out of luck - you can change your particle size through exercise.

Using Exercise to Improve LDL Particle Size

A large study called the STRRIDE trial looked at the effects of different intensities and volumes of exercise on LDL particle size in sedentary, overweight men and women over eight months [3]. Group A performed 176 minutes of low intensity exercise (walking) per week. Group B performed 117 minutes per week at a moderate to high intensity (jogging, cycling, or using an elliptical machine). Group C exercised about the same amount of weekly time as group A, but at the same intensity as group B.

As one would likely guess, group C showed the biggest improvement in changing LDLs from small and dense to large and buoyant. However, a more telling sign was that group B had a stronger effect than group A, despite exercising an hour less per week. In other words, intensity is more important for improving LDL particle size than volume of exercise.

A follow-up of the subjects in this study showed some discouraging and encouraging effects on the particle size changes [4]. The discouraging news was that five days of inactivity following the study almost completely attenuated the particle size benefits from the trial. However, before you start labeling exercise as futile, consider this: while five days of rest basically brought the exercise groups back to baseline LDL particle sizes, they were still much better off than the sedentary control group, who experienced significant digressions in particle size during the course of this study (perhaps the guy in the picture above was in the control group).

Final Thoughts

Obviously a lot of what I discuss on this blog relates to strength training (ST) as a means to improving health, but I have not read or found any research looking at its affect on LDL particle size. Therefore, I can't say that ST does or doesn't help and how to manipulate it to get the best results in this area. Going on the research discussed above, here are my recommendations:

Better results = higher intensity. If you are worried about having small, dense LDLs, I recommend using sprint-like efforts for the modality of exercise that you use, similar to a high intensity interval format (20-60 seconds of near all-out effort, with 1-4 minute light intensity intervals inbetween).
Even if your workout schedule is interrupted for a week here and there, you will still fair better by generally sticking to an exercise routine as opposed to remaining sedentary.

On a Personal Note...

Thanks to all H-A followers for your patience over the past two months. I recently saw a significant spike in personal training clientele and am working that in with my usual reading and a study that I am putting together at Arizona State University. Health-Actualization will have some ebbs and flows with my work load, but it certainly isn't going away any time soon.

Exercise, Weight Loss, and Health

2011-10-23T12:18:00.000-07:00

This may sound familiar: You see someone that you haven't seen in a few weeks/months/years. He has lost a lot of weight and looks fantastic. You ask how it happened. He then credits his new trainer, running regimen, home workout DVD, or a newly-found dedication to the gym.

What was missing is the major change in diet. His workout may be the cause that he targeted, but it's not the real cause of the change. What it comes to fat loss, diet is the major factor and the contribution of exercise has little practical significance. If you don't believe me, keep reading.

Exercise and Weight Loss

334 obese or overweight (according to BMI) subjects were split into four groups [1]. One group was a control group of people that did not exercise. The other three groups did eight months of aerobic exercise for 179 minutes per week at a moderate intensity, 114 minutes per week at a borderline high intensity, or 175 minutes at a borderline high intensity. Researchers had the subjects continue their usual eating habits. The results: The borderline high intensity group that exercised 175 minutes per week had the highest weight loss at a whopping 1.76 lbs. (.8 kg).
25 inactive senior women were split into three groups for a nine month exercise study [2]. One was a placebo group that performed stretching and exercises with resistance bands. The other two groups performed aerobic exercise for about 55 minutes per workout at a high intensity, or 65 minutes per workout at a moderate intensity. All three groups did four workouts per week. Researchers in this study also instructed the subjects to not change their diets. The moderate intensity group was the winner in this study, dropping 1% body fat. The other groups saw no change in percentage of body fat.
251 obese, type 2 diabetics were part of a 22-week study [3]. The subjects were split into four groups: a control (sedentary), a resistance training group, an aerobic training group, and a group that did the full resistance and aerobic training workouts. All groups worked out three times per week. Diet was monitored and managed by a dietitian with the goal of keeping energy intake even with estimated expenditure. The combined and aerobics-only groups tied for the highest weight loss at 4.8 lbs (2.2 kgs) more than the sedentary control group, whereas the resistance training group lost 1.5 lbs (.7 kgs) more than the control group. 4.8 lbs may sound good to you, but if an obese person hired me to help him/her lose weight and ended up with a 4.8 lb loss in five months, I'm probably going to be fired.
A 14 week resistance training study looked at 22 obese, adolescent Latino males, half doing strength training and half serving as the control group [4]. The exercise routine was twice per week and structured in a progressive model (increasing volume and weight load over time). Excluding a post workout dinner provided by the researchers, diet was unaltered. The resistance training group lost 2.9 lbs (1.3 kgs) and the control group lost about .5 lbs (.2 kgs).

Exercise, Weight Loss, and Health

If you simply looked at the information I presented so far, you might see the aforementioned studies as failures - these obese, overweight, or sedentary people who participated in exercise programs lasting several months saw little to no change in their weight. However, these programs were far from being failures. The subjects experienced significant improvements in health:

In the study of 334 subjects, a few of the groups experienced improvements in HDLs, triglycerides, and both systolic and diastolic blood pressure [1].
The study of senior women led to a noticeable increase of insulin sensitivity in the high intensity group [2]. Even the placebo group that did resistance band exercises saw improvement in the form of decreased blood glucose.
The study which featured 251 obese, type 2 diabetics led to improvements in HbA1c (blood sugar) for all three groups, and the resistance training-only group also gained 1.7 lbs. of lean mass (.8 kgs) [3].
10 out of 11 resistance training subjects in the obese, adolescent male study experienced an increase in insulin sensitivity (which will decrease the chances of developing type 2 diabetes in the future) [4]. They also gained about 8 lbs (3.7 kgs) of lean mass.

In Conclusion...

Enough with the studies! Here are the take home messages:

Exercise is not a significant contributor to weight loss. A resistance training program can limit or prevent the loss of lean tissue during weight loss [5], but the actual weight loss needs to come from diet changes.
Exercise is an effective tool for improving health in a wide variety of ways. If you don't want to adopt a healthier diet, exercise will still improve your life.
Weight and health can change independent of each other. A person is not unhealthy because he or she is overfat. Also, improving your health does not mean that your weight has to change.

Genetic Outcomes are Negotiable

2011-10-07T09:57:00.000-07:00

If your parents are diabetics, you're more likely to get diabetes. If your parents have heart disease, you're more likely to get heart disease. If your parents are obese, you are most likely to be obese. If your parents have cancer, you're more likely to get cancer.

Is the conclusion of your script already written?

No. Your fate is still very much in your hands. But don't take my word for it - just look at the research.

Altering Mortality and Disease Probabilities

A group of researchers in Sweden studied mortality rate and physical activity in more than 13,000 pairs of twins for about 30 years [1]. The pairs of twins were split into different categories based on their amounts of physical activity - you basically have two groups with one representative from each family of genetics. The results? The more active twins had 10 and 26% lower rates of all-cause and cardiovascular disease mortality. That's impressive, but not the most telling statistic.

Those researchers took a deeper look at how the results turned out for monozygotic twins (A.K.A. "identical" twins, as they come from the same sperm). The relationship between physical activity and mortality rate was even stronger: 20 and 32% lower all-cause and cardiovascular-related. Lifestyle changes produced the largest difference between those who had the closest genetic resemblance.

The Harvard Alumni Health Study also provides a good example of genetics taking a back seat to lifestyle [2]. The study followed Harvard alumni for over 26 years. One focus of the study is to examine the effects of parental cardiovascular disease and physical activity on heart disease risk. The researchers found that people who participated in a lot of physical activity AND had two parents who suffered from heart disease were over 20% less likely to get heart disease than sedentary people who had no parents with heart disease (apparently those sedentary Harvard alumni weren't so smart after all).

Changing Your Outcome

The studies I presented above are observational, so although they looked at the relationship between physical activity and mortality/disease rates, there were other unmeasured and uncontrolled factors (confounding variables) which affected the results. The more physically active people likely ate better diets, slept more, exercised more intensely, managed stress more effectively, etc.. Physical activity was a large part of the difference, but it was a collaborative effort.

While you could blame genetics for current or future problems, I suggest a different approach...actually, I implore you to take a different approach: be assertive! As you see above, your genetics aren't your death sentence. Like the people in the studies mentioned, your outcome is highly determined by your actions. Change your lifestyle to achieve your desired life.

What I Eat: The September Edition

2011-09-29T10:02:00.001-07:00

I started the What I Eat Series in May and am keeping the monthly tradition going [1, 2, 3]! As you will see below, the adjustments from my post about the 12 lb. weight loss have stuck and I continue to love both the foods and the effects [4].

Monday

7:30 AM: Three eggs scrambled with sugar plum tomatoes
10:30 AM: Large bowl of mixed greens with carrots, salmon, olive oil, and lemon juice (fresh squeezed)
1 PM: Banana
3:30 PM: A few pieces of grilled chicken with a fruit salad (pineapple, honeydew, grapes, and watermelon)
10 PM: Two cans of sardines and a kiwi

Tuesday

9 AM: Three eggs scrambled and an apple
12 PM: Large bowl of baby romaine lettuce with carrots, salmon, olive oil, lemon juice, and salt (stay tuned for more on salt!)
3 PM: Banana
8:30 PM: Salmon over spinach and topped with olive oil and balsamic vinegar

Wednesday

8:30 AM: Three hard-boiled eggs with a banana
4 PM: Organic beef jerky and a kiwi
7:00 PM: Chopped meat on baby romaine lettuce, topped with olive oil and salt

Salt Reduction vs. Effective Hypertension Approaches

Hypertension (high blood pressure) is a major risk factor for heart disease. Salt consumption is often connected with high blood pressure. My previous conclusion on salt was that it does cause a small increase in blood pressure, but that increase is not significant enough to cause normal levels to become high [5]. Speaking of which, Gerard Reaven, a researcher at Stanford University Medical Center, stated the following about salt in a research review [6]:

The fact that insulin has been shown to acutely regulate renal sodium and water metabolism in a manner that could raise blood pressure does not prove that these phenomena occur chronically or that they play a role in the etiology of hypertension.

Translation: salt's effect on blood pressure doesn't necessarily last, nor is it sure to be a cause of high blood pressure. Reaven goes on to say that patients with hypertension are "insulin resistant, hyperglycemic, and hyperinsulinemic." In most cases, hypertension is likely an effect of one or several of these other conditions. Basically, the issues are having excess blood sugar, insulin, and cells that won't take the sugar that insulin is trying to remove from the blood.

While I'm not recommending this in lieu of a doctor's advice, I believe an isolated hypertension treatment (salt reduction or blood pressure meds) is not nearly as effective as a plan to address the underlying issues of insulin and blood sugar problems. Address those root causes - lift weights, do some high intensity interval training, reduce carbs like grains and sugar - and the blood pressure will take care of itself.

Glycemic Variability: The Damaging Effects of Uncontrolled Blood Sugar

2011-09-15T12:19:00.003-07:00

Due to the current epidemic of type II diabetes, everyone knows that having sustained high blood sugar is detrimental to health. Chronic high blood sugar leads to a wealth of issues, including nerve damage, arterial damage, and loss of vision [1]. However, sustaining high blood sugar is NOT necessary for blood sugar levels to damage your health. Research suggests that extreme glycemic variability is as detrimental, if not more damaging, to health and mortality risk.

Glycemic Variability and the Research

Glycemic variability is the short term fluctuation of blood sugar. The average healthy individual experiences daily blood sugar changes within a third of his/her average level (i.e. a range of 25 mg/dL for a person with an average level of 75), but people with high glycemic variability can experience fluctuations that are greater than 50% of average levels. In a review of studies on glycemic variability [2], researchers had this to say about the magnitude of damage with high variability:

Glycemic variability seems to have more deleterious effects than sustained hyperglycemia in the development of diabetic complications...

Specifically, researchers say that large swings in blood sugar levels can have greater effects on endothelial function (ability of the blood vessels to expand or constrict to meet cardiovascular needs) and oxidative stress, which plays a large role in heart disease, plaque formation, and Alzheimer's.

What really caught my eye with glycemic variability was a study with ICU patients over a 10 year period at Stamford Hospital [3]. I could tell you about the results, but the charts below tell a much better story. Tables A and B divide the patients up in regards to whether or not they were diabetic before being admitted. The values at the bottom are average glucose levels (70-99 is desired and the rest have different degrees of elevated blood sugar). The vertical measure is percentage of mortality. The bars at each average glucose level separate individuals by coefficient of variation (A.K.A. amount of blood sugar variation, with green being the smallest and red the largest).

As you can see, the red bars are significantly higher than the others for people of healthy or slightly elevated blood sugar levels, meaning there was a strong link between mortality and high glycemic variability. Researchers found this relationship to be statistically significant "even after adjustment for severity of illness."

Interpreting the Data for Personal Application

The latter study was obviously performed on hospitalized patients, so it's unclear whether those results apply to those of us who are healthy. Ultimately, here's what I take away from the studies presented:

Just because a person generally has desired blood sugar levels, it doesn't mean that he or she is free from the effects of blood sugar-spiking foods.
This is possibly another way that strength training is cardio-protective. Having more muscle mass translates into having more storage space for glucose. This added storage space will limit the degree of blood sugar spikes from high sugar meals.
Finally, taking the last study as literal as possible, if you find yourself in the hospital for any serious illness, avoid simple carbohydrates and sugary foods like the plague! Your life may depend on it.

H-A Strength Training Recommendations

2011-09-13T22:13:00.001-07:00

Recently I have posted a blog showing and discussing my workout routine [1]. This has led to several questions regarding my recommendations for strength training (ST) and how they may be different from some things I have said on here in the past. To clear up confusion, here are the guidelines I follow with my clients and myself:

1. Sets: One set per exercise to muscular failure.
Discussion: There have been many studies comparing one set vs. multiple sets and the results generally don't show a statistically significant difference between the two [2]. For me to adapt a multiple set routine, there would have to be a difference in the results so great that it warrants a much larger time commitment. Working to failure ensures an effort intense and controls the variable of effort, allowing for a more quantifiable measure of workout performance (for progress tracking).

2. Rep Cadence: Lift and lower the weight in roughly 4-5 seconds each. More importantly, start the first inch of each direction as gradual as possible.
Discussion: Starting slowly ensures safety and minimizes momentum/maximizes muscular work. After the first inch on the positive (lifting phase), move at a speed where movement is controlled, fluid, and continuous. After the first inch on the negative, allow the weight to keep moving, but use added effort to slow down at the parts when the resistance seems to increase.

3. Weight Selection/Set Duration: Use a weight that will bring you to muscular failure in about 60-90 seconds.
Discussion: Aiming for this range should lead to using weights that are challenging from the start without being too heavy to the point where form is compromised. The equipment used makes a huge difference here: some machines (i.e. MedX) are easier to use at heavier resistances, while some equipment is best for time ranges closer to 90 seconds.

4. Frequency: 2-3 times per week for each muscle group on nonconsecutive days.
Discussion: I believe twice per week is optimal for most people. This allows for adequate recovery time after each workout session. In my experience, three times per week does work for some people on a permanent basis. Most commonly, I use it for people at the start of their routines who want to see results quicker and then cut back to twice per week when they experience short-term signs of overtraining (muscle burning during simple daily activities like walking the stairs, general fatigue, noticeable drops in ST performance). I have found that sustaining a three-times-per-week approach comes with a strong commitment to eating more calories and protein.

The one stance that I have changed over time is my view on once-weekly training. I realize this is advocated by several of my colleagues, but I no longer believe this frequency is enough for the majority of people who aren't genetically gifted for building muscle and can stand to gain from the health advantages of ST.

5. Split Routines: Train either the full body or split the body into upper and lower halves for workout days.
Discussion: I'm against the very segmented split routines that many bodybuilders use. Their workouts are created to isolate areas like the chest, shoulders, and back on different days. However, these workouts dynamically involve smaller muscle groups each day, such as the biceps, triceps, deltoids, and rotator cuff muscles. In my opinion, this is a recipe for long term injury. I do favor and often use half-body split routines for myself. These splits allow for shorter workouts and therefore allow for an increase in intensity. Split routines follow the same frequency recommended above: 2-3 times per week for each muscle group.

One note of caution with upper and lower body splits: if you are doing them on consecutive days, I advise training core muscles like the abs and lower back on the second day. They are stabilizers in just about all exercises, so exhausting them the day before another intense workout could increase injury risk.

6. Progression: Increase the resistance as frequently as possible without compromising form.
Discussion: An increase of at least five seconds in an exercise is a good indication of when to increase resistance. These increases are larger for people in the first few months of their workout routine and may be as small as 1-2.5 lbs. for experienced lifters. The frequent increases in resistance will provide continual stimulus for your body to make positive adaptations.

7. Exercises Per Workout: Do 3-6 for Half-Body Splits, 7-11 for Full Body.
Discussion: This is a topic that is highly dependent on both the individual and the workout intensity. For myself, I can not do more than nine exercises per workout, at least not with any meaningful intensity on the last few. However, I have clients who work hard and can do 10+. My usual full body workout is seven or eight.

8. Exercise Selection and Order: Mostly Compound Movements, Large to Small, Start with Your Target Half.
Discussion: Compound movements, exercises where the movement is straight as opposed to rotational, involve more joints and more muscles. Using these exercises increases the efficiency of the workout. All muscles should be trained regularly, regardless of specific target areas. However, feel free to adjust the quantity of exercises in each area to reflect those goals.

In general, work from largest to smallest muscle groups (hips, thighs, back, chest, lower legs, shoulders, abs, arms, etc.). For those targeting upper body muscles, start with upper and work in the lower body at some point.

The Damage Control Scale

2011-09-07T11:33:00.001-07:00

Ideally, when you make diet changes to improve health and body composition, they should be permanent. Now, it's normal to crave and occasionally indulge in some of those foods from your old diet, but how much is too much? Simply put, I used my scale to find out.

What I Did

I started weighing myself daily. As mentioned in my last blog, I recently lost 12 lbs and am weighing about 179 lbs now [1]. Assuming I regularly strength train, I find that my optimal physique seems to be between 178-183 lbs. As long as I fall within that range, I do not concern myself with fluctuations from the previous day - this is natural with constant changes in water mass. I live my life as usual and eat as I enjoy (typically a diet of vegetables, fish, eggs, meat, and fruit with the occasional dessert). On the morning that I find myself at or above 184, I pay close attention to my diet until returning to the desired range.

As a mesomorph, I have the ability to become fairly thin or overfat [1, 2]. This system not only allows me to enjoy my daily life without stressing over the minute details of what I eat, it also serves as a reminder that I am never "above" returning to the overfat physique that plagued me as a child and in my mid 20s. Since employing this strategy, I have exceeded 184 lbs. only once, and some minor and immediate diet improvements quickly returned me to the desired zone.

Try It for Yourself

If you are interested in using the scale as a damage control tool, here are my suggestions:

Once getting to a physique that you are happy with, weigh yourself every morning for a few days and take note of the range of fluctuation.
Come up with a weight range that you feel comfortable staying in. Make a promise to yourself that you will not stress over changes within this zone - remember: fluctuation is normal!
Determine a wake-up call weight, a weight that will prompt increased attention to your diet and lifestyle (Note: this concept is not for those who are in the first six months of a strength training routine, as these people are likely gaining several pounds of lean tissue).
Weigh yourself every morning and live your life without the concern of how many calories or carbs you are eating. Eat real foods, strength train regularly, and if you are not adhering to your diet as much as you need to, the scale will alert you.

My Self-Experiments and the Resulting 12 Pound Weight Loss

2011-09-01T13:29:00.001-07:00

I was recently inspired by Richard Nikoley's speech on self-experimentation at the Ancestral Health Symposium to share some things that have been working for me over the past several months [1]. Why should you care? Since May 1st, I have lost about 12 pounds (5.5 kgs) and I wasn't really overfat to begin with. More importantly, this fat loss has been easy. I eat as much as I desire every day. I rarely crave sugar. When I do eat sugar, my weight basically stays the same. My types and quantity of physical activity haven't changed during this weight loss (strength training and walking). In general, I feel great, have a ton of energy, and my concentration/mental focus has been at an all-time high.

What has changed? Well, before I get into what I have done differently, let me cover my bases:

I believe people are largely similar, but there is a heterogeneous aspect to humans and we have differing levels of responses to the same treatment [2]. What has worked for me may not work as strongly for you. On the other hand, you may get a more significant gain than I have.
I'll point out the major, deliberate changes that I have made, but confounding variables likely exist that I am not aware of.
There are many fitness professionals that are genetically lean and muscular. I am not one of those people. You are reading from someone who, maybe like yourself, has battled through thick and thin waist sizes. The following pictures are proof of that. Here are some heavier times during my early 20s:

A low point for me several years ago: 201 lbs (91.4 kgs).

I believe this was late 2007/early 2008. Weight: ~ 193 lbs. (86 kgs)

Before May 1st, I was leaner than the photos above, but unfortunately I don't have any photos from that time. However, here are my most recent progress photos that follow the 12 pound weight loss:

Taken at the end of July: 181 lbs. (82.3 kgs).

August 17: 178 lbs (81 kgs).

The Driving Force: Diet Changes

Fat Loss = Diet Changes. I have said it before: you can't outrun a bad diet. Here's what stayed the same in my diet: no grains, legumes, or dairy (besides cheese). Here's what did change:

Eliminated basically all processed foods. I was eating cheese, processed meats, and protein shakes on occasion before May. This, along with the elimination of a weekly dessert, led to the initial four pounds of weight loss.
After that initial weight loss came to a halt, I switched from a meat-based diet to a plant-based diet. I still eat eggs, fish, chicken, or red meat with every meal - the difference is that I switched the portion sizes. Vegetables and/or fruits now take up the majority of space on my plate. The larger portions of veggies and fruits have surprisingly left me more satiated.
Elaborating more on #2, I went from not eating fruit to eating it liberally (i.e. today I ate an apple, a banana, kiwi, and about a cup of raspberries). My carb intake has increased with this change, but my overall intake has decreased.
I substituted red meat from two of my daily meals and replaced it with fish. I'm now eating salmon, sardines, clams, mussels, and a few other fish with most of my meals. I eat burgers and steak about twice a week now, and my daily four-egg breakfast has remained the same.

#s 2-4 led to my last eight pounds of weight loss. Since then, I added my weekly dessert back in and my weight has been unfazed. My diet hasn't been difficult to maintain at all. I eat as much as I want for each meal. If you want to see examples of recent meals, check out the last segment of my What I Eat series [3].

There is an effective yet simple strategy that has helped with my weight maintenance, but that will be discussed in a separate post coming soon. I hope some of my experiments can be effective for you.

A Natural Diabetic Aid

2011-08-30T23:44:00.001-07:00

For type II diabetics who crave carbohydrates, there seems to be a natural "medicine" to help dull post-meal blood sugar spikes: vinegar. One study found that 20 grams (four teaspoons) of apple cider vinegar significantly improved blood glucose and insulin sensitivity in diabetics and insulin resistant individuals following a high carbohydrate meal [1]. You can see the results charted below (the controls were non-diabetic and insulin sensitive):

The dotted lines show those who took vinegar before meals.

Another study found that when ingested before bed, vinegar reduces waking blood glucose levels in type II diabetics [2]. The authors believe this is due to the effects of acetic acid, the active ingredient in vinegar. Acetic acid suppresses the enzyme that helps breakdown some complex carbohydrates into glucose, which could decrease the storage of glucose (glycogen) and therefore keep insulin sensitivity higher [1].

I strongly urge diabetics to avoid carbohydrate-dense foods in general. However, consuming vinegar before a high carb meal seems to blunt the harmful effects for diabetics, at least in the short term.

The Flaws of an Active Couch Potato

2011-08-26T09:54:00.001-07:00

Two hours and 30 minutes of moderate intensity aerobic activity per week OR one hour and 15 minutes of vigorous aerobic activity per week. This should be accompanied by "muscle-strengthening activities" at least twice per week [1].
Moderately intense cardio 30 minutes, five days per week, OR vigorous cardio for 20 minutes, three days per week. Strength training should be added in the form of 8-10 exercises, 8-12 reps each, twice per week [2].

What you just read are the physical activity guidelines for adults by the US Department of Health and Human Services (USDHHS) and the American College of Sports Medicine (ACSM). These guidelines are created in response to the associations that increased physical activity have with improved health in observational studies [3]. However, there are no guidelines for limiting sedentary behavior. After looking at the research, limiting long periods of sitting may be just as important to our health as getting exercise. Also, if you believe that exercising often means absolving yourself of the detriments of sedentary living, then keep reading.

Detriments of Sedentary Living

The average person spends 7-10 hours sedentary per day (this does not include sleeping) [4]. Research has found a linear relationship between quantity of sitting time with risk of death via cardiovascular disease [5]. More sitting is also linked to increased risk of insulin resistance, the precursor to diabetes [4].

"Too much sitting is distinct from too little exercise," as authors of one research review stated [5]. People who sit hours per day while still fulfilling the guidelines set forth by the USDHHS and ACSM may believe that the detriments of sitting doesn't apply to them, but research states otherwise. These people, called "Active Couch Potatoes," fare a little better than those who don't exercise and sit a lot. However, their risk for metabolic syndrome (high blood pressure, high blood sugar, etc.), death from all cause, and cardiovascular-related death are all significantly elevated [5]. One study actually showed that people who sat less than three hours per day had a lower risk of mortality than those who exercised about twice as much yet sat more than six hours per day [6].

The largest concern seems to be the effects from uninterrupted sedentary time. In one study, researchers had 168 subjects wear accelerometers, a device that detects force generated by muscle activity, for seven days [7]. The results showed that, "independent of total sedentary time, moderate to vigorous-intensity time, and mean intensity of the breaks, more interruptions in sedentary time were beneficially associated with metabolic risk variables, particularly adiposity measurements (waist circumference and body mass index), triglycerides, and 2-h fasting glucose." Subjects were also found to be sedentary 57% of the time!

Sitting is Bad, But Why?

Researchers in several studies suggested one common, underlying reason for why sedentary behavior causes such health and obesity issues: the suppression of lipoprotein lipase (LPL) [4, 5, 7]. LPL is an enzyme involved in the metabolism of triglycerides, fatty acids, and the production of HDLs (what some consider the "good cholesterol"). When LPL activity is dramatically decreased, energy usage and demands decrease, meaning the body favors storing more of its fat and glucose. As far as I have read, the best test performed on this theory was one involving rats [7]. Researchers prevented rats from their usual ambulatory movements (standing, light walking) for one day. As a result, LPL activity decreased by 90%!

Sedentary Solutions

Before I state my thoughts on the material and present a solution, be aware that these studies are observational. Even though the researchers have been thorough, there are many variables and it's possible that confounding factors could cause the issues that sedentary behavior is linked to.

In regards to sitting and its potential harmful effects, lets be clear: the major issue is not quantity of exercise time. The solution here is not to jog or cycle more during your non-sedentary time. The research is indicating that we are allowing our bodies to be idle for too long. Moving forward, we need to break up our long periods of sitting at our work desks, home offices, while watching TV, or during long commutes. As one study stated, the intensity of the break doesn't seem to matter [7]: Tap your toes, lift your knees up, walk to the water cooler every half hour - move in some way. Fidgeting is your friend in this case. Clearly, our desired state during consciousness is not sedentary.

My Workout and Weekly Activity

2011-08-23T11:27:00.005-07:00

In April of 2009, I posted videos of three exercises from my workout. Since then, I have been promising a full recording of my workout to some readers but haven't delivered. Well, better late than never...

Thanks to Andrew for recording the workout. In order, I performed the leg press, leg curl (on the Total Gym Power Tower), pull-ups (on the Total Gym), chest press, compound row, overhead press (Power Tower), and dumbbell biceps curls. I'm not sure why there were kids in the gym, but hopefully they weren't too distracting.

Something that Dr. Ben Bocchicchio has pointed out to me recently is that many trainees use the negative (lowering phase) of each rep as a break. Since then, I try to slow down at the points during the negative where the resistance increases. Overall, I don't try to hit a certain speed cadence (i.e. SuperSlow aiming for a 10 second positive and a 10 second negative). Besides the slowing down at some points during the negative, I gradually begin the positive and negative, and otherwise just focus on keeping the weight moving.

My Weekly Activity

This won't become a regular segment like What I Eat, but for those who are curious, the following is my activity for this past week:

Monday: Upper body strength training workout (about 10 minutes)
Tuesday: Lower body workout (10 minutes)
Wednesday: 20 minutes of basketball (shooting hoops by myself with very little running)
Thursday: 30 minute walk
Friday: Full body strength training workout (15 minutes)
Saturday: Rest
Sunday: 1 Hour walk

Typically, I will do 3-4 strength training workouts per week, with most of them being an upper or lower body workout only. I prefer these shorter workouts because, as with anything in life, effort and focus are inversely proportional to time. The split routine workouts are usually three to five exercises spanning about 10 minutes.

As you see, I squeeze in a walk or some hoops every few days. I'm an advocate of low level activity (similar to Mark Sisson's recommendations, but without the goal of reaching a target heart rate zone). Mainly, I use them to break up long sedentary periods, which could be critical to health as I'll explain in an upcoming post. In addition, getting some shirtless time outside helps attain some quality vitamin D.

What I Eat: The August Edition

2011-08-20T13:33:00.000-07:00

Thanks to all H-A readers for your patience over the past few weeks. It's good to be back!

I started the What I Eat series in May and posted another piece to this series in July. The August installment features a few days from this past week:

Sunday
8:30 AM: A few ounces of cheddar and blue cheese with a fruit salad (strawberries, grapes, and half of an apple), courtesy of Delta Airlines.
1 PM: Alaskan salmon and carrots topped with melted butter
3 PM: 4 eggs over-easy with a banana
7:30 PM: Alaskan salmon topped with melted butter (delicious leftovers from before) along with a handful of sugar plum tomatoes

Monday
11:30 AM: 4 eggs scrambled, an apple, and a handful of blackberries
2:30 PM: Large bowl of spinach, spring mix, tomato slices, pickle slices, sardines, olive oil, and white Italian vinegar
4 PM: A banana
6 PM: Red sockeye salmon, a handful of carrots, and a few handfuls of sunflower seeds.

Tuesday
11 AM: 4 eggs over-easy, an apple, and a handful of blackberries.
3 PM: A banana
4:30 PM: A few mussels along with a salad consisting of spinach, carrots, sugar plum tomatoes, olive oil, and balsamic vinegar.
7 PM: Four Italian sausages, diced tomatoes in balsamic vinegar, and a glass of red wine.

Organic Priorities

Is everything in my diet organic? No. I have two simple guidelines for when I go organic versus when I don't:

Edible exterior = Organic. Many fruits and vegetables with edible exteriors, such as strawberries and bell peppers, contain stronger and higher quantities of pesticides (I can't even pronounce many of the pesticides used on California strawberries). In addition, many of these foods have been dyed to look more appealing. Do I really want to put that crap in my body? No! When it comes to the non-edible exteriors, such as bananas, I decide whether or not to go for organic based on the price difference.
Higher on the Food Chain = Organic. When eating animals, I typically go for the best quality possible. Conventional meat comes from animals that were given hormone treatments, antibiotics, ate poor diets, and could have inherited other toxins from their environment and foods. Therefore, I go with wild-caught fish, certified organic and grass-fed meat, and free range eggs.

Dining out, which I do about once or twice per week, is the only exception to these rules. As I'm sure you know, few restaurants have organic options, so I bite the bullet and go with conventionally-produced foods in those instances.

Health-Actualization Hiatus

2011-08-06T16:16:00.000-07:00

Due to an unexpected death in the family, I will be in NY and probably won't check/reply to comments or add new posts for the next few weeks. Thanks for your understanding and patience.

Sean

Avoiding Bone-Headed Activities for Your Bones

2011-08-04T13:00:00.001-07:00

According to the National Osteoporosis Foundation (NOF), about 10 million people in the US have osteoporosis. The NOF says that those with the greatest risk are above 50 years of age, female (especially post-menopausal), have a family history of the condition, feature thin and small frames, and have experienced skeletal issues as adults (broken bones or decreased height) Exercise is said to make bones stronger, but what exactly do people mean by that? Are all methods of exercise smart choices for skeletal health? For the methods that do work, do they increase bone density throughout the body or just in some areas?

Improving Bone Density

Use it or lose it. That seems to be the case with bones: lack of movement accelerates the rate of loss. Studies analyzing those on bed rest and astronauts coming back from space clearly illustrate this. Being sedentary is a terrible option for your bones.

Swimming and water aerobics classes are common selections for seniors who are looking to improve bone density. Swimming is a logical choice for its lower level of impact, but that's where the skeletal benefits end. It is missing one major, positive influence: GRAVITY! Just like astronauts in space, swimming alleviates bone-compressing forces, which is likely why studies show it to have basically no effect on improving bone density or slowing down osteoporosis (read here and here).

In the short term, running and sports such as soccer and tennis can improve bone density in the lower body, specifically the hip, thigh, and heel (as shown here and here). However, they offer little to no benefit for the bones of the upper body and often lead to serious long-term injury because of their high impact natures.

In terms of reversing age-related bone density loss, strength training offers the most effective and most thorough method. Bone density in the forearm, thigh, hip, and lumbar spine has been shown to improve via studies on strength training (see here, here, and here). This occurs through two mechanisms. First, compound exercises (where several joints are involved), such as a leg press or chest press, bring about a force that causes the bones involved to bend slightly. The result of these slight bends is to increase the deposit of calcium in the bones. Second, strength training exercises increase bone density at the point where the tendon (of the muscle used) attaches to the bone. For example, your quadriceps' tendon attaches to a bump (called the "tibial tuberosity") that's a few inches below your knee cap. When you train your quads, the body responds by increasing bone density at that bump.

My Recommendations

In closing, if you're building a routine to improve bone density, this is what I suggest:

Strength train twice a week. Use compound exercises such as the leg press (pictured above), chest press, compound row, pull-ups, and overhead press. Use weights that you find challenging from the start of the exercise and that will bring you to complete fatigue in less than 90 seconds (one study found bone density to improve only when heavier weights are lifted).
If you are sedentary between strength training workouts, go for walks. Walking won't reverse the loss of bone density, but it may slow down the rate and is a low impact activity.
Finally, adjust your diet. Dr. Bill Davis recommends vitamin D, K, magnesium, and potassium salts as part of his osteoporosis treatment plan (keep in mind that osteoporosis is a lack of calcium depositing in the bone, not a lack of calcium).

The Difference Between Championship and Injury?

2011-08-03T11:27:00.002-07:00

Last week, I discussed the importance of vitamin D and how to attain it through measured doses of sun exposure. Apparently my article was too late for some NFL players. Researchers had this simple observation after testing blood levels of vitamin D and studying how much time the players missed due to injury:

...players who suffered muscle injuries had significantly lower levels.

(The bolded emphasis is mine).

The study looked at 89 players from a single team. A "normal" level of vitamin D is above 32 ng/mL. The average of the sixteen players who suffered muscle injuries was 19.9 ng/mL.

Now, these findings don't necessarily mean that a deficiency in vitamin D leads to muscular injuries during athletics. There is a strong possibility that a confounding variable exists (for example, low vitamin D levels and injuries can both be the result of players who don't take care of themselves properly through matters like diet and training). However, this NFL study, along with the vitamin D supplementation the Chicago Blackhawks received during their 2010 championship season, doesn't hurt the cause for us to make the steps necessary to attain adequate vitamin D.

For more information on attaining vitamin D, please read:

(Ugly) Plates and Pyramids

2011-07-29T14:07:00.003-07:00

As you likely know, the USDA announced its new food plate this past June to replace the pyramid concept that was used since 1992. "MyPlate" is their new attempt to educate Americans on a healthful diet. I have to be honest and say that it is an improvement (before you yell at the screen, keep reading), but it's still atrocious and financially motivated. The improvement is that vegetables have received a promotion: they were recommended as the third most important food group in the last food pyramid, but now seem to have pulled even for the top spot. Unfortunately, grains still take the cake (or plate, in this instance), with the other largest portion on the plate (do you know of anyone who thinks that grains are as healthy as vegetables?). Speaking of the last pyramid, check it out below:

Judging by the width of the vertical slices, the most important food groups are grains and dairy. Hello financial influence! Not only does "meat" (meat, fish, and eggs) occupy the second smallest spot, but it is combined with legumes! One is rich in protein, fat, omega-3 fatty acids, and several micronutrients (when chosen in its best form), while the other contains antinutrients (such as phytic acid), incomplete proteins, lectins, and are rich in carbs. How are they two of the same?

The above pyramid is the original 1992 version. I could go on and on about the flaws of the plate and the pyramids, but I would rather just tell you how it should be. The pyramid below most closely resembles my diet and recommendations:

Foods that should make up a regular diet:

Low Starch Vegetables
Meat, Fish, Eggs, and Fowl
Fruit
Nuts and Seeds
Oils (such as fish, olive, and coconut)

Foods that should be avoided as much as possible:

Processed Foods (if it has a long list of ingredients, include it here)
Sugars, Syrups, and Artificial Sweeteners
Grains of all kinds (bagels, bread, pasta, cereal, oatmeal, crackers, etc.)
Vegetable Oils (excluding olive)
Legumes (beans, peanuts, soy, etc.)

The Science on Sun Exposure, Melanoma, and Sunscreen

2011-07-26T10:53:00.005-07:00

I often sun bathe and take shirtless hikes and walks. I rarely wear sunscreen...should I be worried about melanoma? Should I wear sunscreen?

I'm the shirtless guy on the rock, enjoying some sun while hiking in the desert.

If I took the common dogma as truth, then the answer to both is clearly yes. However, dogma doesn't always hold up under research. Here are some of the studies on sun exposure, melanoma, and sunscreen:

Researchers at the University of New Mexico Cancer Research Center conducted a study that followed 528 people with melanoma for five years. They found that death was inversely related to sunburns and high intermittent sun exposure. The researchers concluded, "sun exposure is associated with increased survival from melanoma."
In a study of 130 Caucasian women, no association between melanoma and sunburns or proximity to the equator was found (except for women who had more than five sun burns before the age of 20).
Researchers who performed a meta-analysis of 18 studies studying the effects of sunscreen on melanoma concluded that "no association was seen" between the two.

Looking at these results, it's hard to conclude that sun exposure causes/worsens melanoma. That would be one less reason to fear the sun. However, why should we want to expose ourselves to the sun?

Vitamin D

UVB rays from the sun stimulate vitamin D production (when they aren't being blocked by sunscreen). Vitamin D plays a large role in the depositing of calcium in bones, which is why it is often the first supplement recommended to those with low bone density. It stabilizes blood levels of calcium and phosphorous. Higher levels of vitamin D may also help prevent pancreatic cancer and improve chances of surviving from both skin and bowel cancers. According to WebMD, deficiencies in vitamin D are associated with autoimmune diseases such as multiple sclerosis, lupus, Crohn's disease, and rheumatoid arthritis.

My Sun Strategy

Am I saying that people should just sit in the sun all day with no concerns? No, not at all. It's well-established that sun burns on pale skin cause the other, less-dangerous skin cancers (basil cell and squamous cell carcinomas). Pale skin should not be exposed to the sun for a long period of time. Instead, gradually attaining a tan by starting with small amounts of sun will provide vitamin D while avoiding sun burns and the possible cancers that come with it. Here's my approach for doing this:

Spend time in the sun without sunscreen. I start with 5-10 minutes when it's the first time in a while (I start with the least amount of time when I'm very fare or closer to the equator). Desirable vitamin D hours are usually 10 A.M. to 4 P.M..
I add 2-3 minutes each time I go out.
If I'm outside for a prolonged period of time (at the beach with friends, playing basketball, etc.), I cover up or seek shade after reaching my time limit. If neither is available, then I will use sunscreen (the only instance when I will use it).

For more on the topics discussed, check out:

"Is Sun Exposure a Major Cause of Melanoma? No," by Dermatologist Sam Schuster
"Scientists Reverse Stance on Sun and Cancer"
"Student Who 'Hated the Sun' Died of Skin Cancer, Aged Just 21"