The Blog of Dr. Sean Preuss

I'm Back...But I'm Moving!

2021-09-23T17:03:00.002-07:00

I'm returning to blogging after four years of being away. After such a long absence, I have a LOT to say.

However, the blog is moving to my new site:

www.seanpreuss.com

Please follow me to the new site. Subscribe on the home page for weekly articles related to habits and info on how to improve your longevity, physical health, mental health, and physique.

Thanks in advance.

Dr. Sean Preuss

Strength Training and Pregnancy: The Real Risk

2017-05-22T14:37:00.002-07:00

We don't live in a world where there are usually only two options...even if it seems that way. High school graduates don't have to choose from the only two local colleges. Saying "no" to vanilla doesn't mean we're eating chocolate.

With any activity during pregnancy, a common thought is to "take it easy." The insinuation is the opposite (high-effort activity) is dangerous. This may explain why more than 60% of expectant mothers remain sedentary throughout pregnancy (1). It is possible that higher-intensity exercise could be dangerous for the mom and fetus. However, there is a third option: challenging exercise that is thoughtfully planned, beneficial, and safe.

Not only should pregnant women perform challenging exercise, but exercising is the safest way to go...for the mom and the fetus. Specifically, strength training during pregnancy is extremely valuable to both parties involved. In fact, I feel strength training should become the default for expecting mothers.

Value for the Mom

Pregnancy is a risky period for the mother. If the mother is inactive, she could gain an excess of weight and lose a large amount of muscle (1). These changes are often never corrected (1). The expecting mother also could develop gestational diabetes, which increases the risk for eventual type 2 diabetes (1,3).

So...why should expecting moms strength train?

Women who strength train during pregnancy gain less weight (1). Strength training improves or maintains posture and strengthens key muscles involved with labor (2). It's no surprise that labor strain is less for these women (2). Strength training may accelerate recovery from giving birth and is connected with a lower rate of operational births (2). Lower back pain is also much less common for expecting mothers who strength train (1).

Exercise in general reduces the risk of preeclampsia by 24% (1). However, high-intensity exercise, which is what strength training is, reduces the risk by 54% (1)! In other words, high-intensity exercise prevents one out of every two women from suffering preeclampsia.

For women who develop gestational diabetes, strength training reduces or eliminates the need for insulin (1,3). This is especially noteworthy since insulin treatments increase the risk for the newborn being undersized for at least the first few years of life (3). Weight training improves post-meal and fasting blood glucose, too (3).

Value for the New Life

Strength training during pregnancy enhances the mom's status as a benefactor for the baby (you know, in addition to the fact that she's doing the baby a solid by hosting him or her for nine months).

Babies from strength-trained moms are generally longer and have more lean mass (1). A study of five-year-olds from groups of moms who did or did not strength train also provided other possible insights (1). Offspring from trained moms were more attentive, disciplined, and showed better overall neurological development (memory, emotional development, etc.).

Safety

None of these benefits matter if strength training isn't safe for the expecting mom and fetus. Fortunately, it is. Common exercise concerns during pregnancy are trauma to the fetus, hyperthermia (elevated body temperature), and disruptions of regular blood flow to the uterus (2). Strength training does not cause any of the three to occur (1,2). Strength training, or any general high-intensity exercise, does not increase the risk of a miscarriage or any negative labor side effects (1).

My Experiences and Recommendations

I strongly feel exercise, especially strength training, should be the default for expecting moms unless informed otherwise by the personal OB/GYN. It's the safest way to go for women during pregnancy.

Based on the research and my personal experience with training pregnant women, here are a few practical recommendations:

This article, especially these recommendations, assumes the pregnancy isn't high-risk. Seek the opinion and clearance of the personal OB/GYN before proceeding with anything relating to exercise. The recommendation of the OB/GYN trumps anything shared here.
After the first trimester, avoid prone and supine positions (lying facing down or up).
After the first trimester, avoid overhead lifts. These lifts might add stress to the lower back (1) and also significantly increase blood pressure.
Breathing continuously throughout an exercise is especially critical during pregnancy. Holding one's breath increases blood pressure, and that could harm the fetus (2).
Move continuously between sets to avoid blood pooling in the veins.
Due to an increase in the hormone elastin, ligaments become more flexible during pregnancy. If the mother stretches, avoid pushing the stretch the whole way. Doing so could lead to long-term tissue damage with the more lax, damage-susceptible ligaments.
With the previous point in mind, go to a comfortable but not full range of motion on hip adduction and abduction machines in the second and third trimesters.
Due to the greater risk of potential fetus trauma and bone/ligament/tendon injury, researchers recommend avoiding lunges, back squats, and stiff-legged deadlifts (2). (I personally trained most pregnant clients on machines and cables.)
For mothers with healthy, low-risk pregnancies, I've trained them close to complete muscle fatigue with challenging weights and controlled movements on each set...into the start of the third trimester...with no ill effects. Effort is not dangerous for women in healthy pregnancies. Poor exercise choices and breath-holding are dangerous.

References

Schoenfeld, B. (2011). Resistance training during pregnancy: safe and effective program design. Strength & Conditioning Journal, 33(5), 67-75.
Pujol, T. J., Barnes, J. T., Elder, C. L., & LaFontaine, T. (2007). Resistance training during pregnancy. Strength & Conditioning Journal, 29(2), 44-46.
Brankston, G.N., Mitchell, B.F., Ryan, E.A., & Okun, N.B. (2003). Resistance exercise decreases the need for insulin in overweight women with gestational diabetes mellitus. Elsevier, 190, 188-193.

Why the Negative Leads to Positive Training Results

2017-05-11T22:52:00.000-07:00

Don't skip the opportunity to make $50 an hour to earn $20 an hour. Imagine you ran a business where you offered two services: option A, a flashy service that offers some value and helps you earn $20 an hour; and option B, a less sexy but more valuable service which you earn $50 an hour for.

The downward phase of the dip is more valuable than the upward phase.

Which service would you spend the majority of your time on? I would focus on option B...and I hope you would, too.

However, many strength training enthusiasts focus on option A. Option A is the positive, or lifting portion, of a repetition. The lifting phase of the repetition is sometimes sexy (have you seen an Instagram video of a person lifting a weight, then dropping it?). Option B is the negative, or the lowering phase of the repetition. While it is less sexy, the negative provides the majority of strength and muscle gains.

Unfortunately, many trainees avoid the negative (dropping the weight) or race through the negative. This is the exact opposite of what people should do.

Advantages of the Negative

There are a few ways to test which part of the repetition is more valuable. One way is to compare people who performed the positive AND negative to people who performed twice as many positives but NO negatives. This was tested in two studies (1,2). In both studies, the people who lifted and lowered the weight gained more muscle and strength. In one study, the group performing the full rep gained 25% more muscle than the group who only performed the positives (1). In the other study, the positive and negative group gained 73% more strength than the positive-only group (2).

To maximize your benefits on the leg press, bring the weight down slowly.

Another way to get an answer is to compare negative-only training to positive-only training. A meta-analysis (research combining the results of other studies) of 20 studies comparing the two training types determined that negative-only training leads to more strength and muscle development (3).

While both are valuable, the negative is more important than the positive for building strength and muscle.

Negative-Accentuated Repetitions

The negative offers one additional benefit: people can lower more weight than they can lift. Knowing that, you can perform "negative-accentuated repetitions," which is when extra weight is added on the negative. This can be practiced by adding more weight to the negative on each rep, just before starting to lower the weight. Another method is to use a weight 20-40% heavier than your usual training weight, but have someone help on the lifting phase. The weight would be lowered entirely by yourself.

Negative-accentuated reps, with 40% more weight on the negative, leads to more endurance and muscle growth than traditional training (4,5). Researchers also found accentuated reps increased the production of testosterone, cortisol, and growth hormone (4). Those hormone changes are generally associated with enhanced strength and muscle growth during training (4).

My Recommendations

The negative is more important. With that in mind, we should emphasize it. Here's how:

The negative should be as slow, if not slower, than the positive. If you generally lift the weight in two seconds, you should lower the weight in at least two seconds.
Ideally, I recommend you shoot for at least four seconds on the lowering phase. Slow negatives will lead you to perform less overall repetitions, but the goal is to gain strength and muscle, not perform reps. Keep that in mind.
If you have a training partner, consider negative accentuated reps. Make sure to perform at least two warm-up sets before doing this! Consider starting with a weight 20% above your usual training weight. Ask your partner to help you lift. Hold at the end of the positive, remove the assistance, and lower as slow as you can.

Don't let the Instagram videos fool you. The lowering phase is where your "gains" are coming from.

References

Hather, B.M., Tesch, P.A., Buchanon, P., & Dudley, G.A. (1991). Influence of eccentric actions on skeletal muscle adaptations to resistance training. Acta Physiologica, 143(2), 177-185.
Dudley, G.A., Tesch, P.A., Miller, B.J., & Buchanon, P. (1991). Importance of eccentric actions in performance adaptations to resistance training. Aviation, Space, and Environmental Medicine, 62(6), 543-550.
Roig, M., O’Brien, K., Kirk, G., Murray, R., McKinnon, P., Shadgan, B., & Reid, W.D. (2008). The effects of eccentric versus concentric resistance training on muscle strength and mass in healthy adults: a systematic review with meta-analysis. British Journal of Sports Medicine, 43, 556-568.
Walker, S., Hakkinen, K., Haff, G.G., Blazevich, A.J., & Newton, R.U. (2017). Acute elevations in serum hormones are attenuated after chronic training with traditional isoinertial but not accentuated eccentric loads in strength-trained men. Physiological Reports, 5, e13241, DOI: 10.14814/phy2.13241.
Walker, S., Blazevich, A.J., Haff, G.G., Tufano, J.J., Newton, R.U., & Hakkinen, K. (2016). Greater strength gains after training with accentuated eccentric than traditional isoinertial loads in already strength-trained men. Frontiers in Physiology, 7, 149.

Ab Exercises and "Ab Exercises"

2017-05-03T12:36:00.003-07:00

There are some fields where professionals aren't needed to get involved. While we need a pilot to fly a plane, we don't need a financial adviser to invest money or a doctor to buy (many) medications. While the freedom allows us to learn with first-hand experience, it can also lead to issues, such as poor returns on investments or not curing acute illnesses quickly.

Those abs likely weren't developed with leg lifts.

Exercise is another field where a professional isn't needed. While training oneself has advantages (autonomy, saving money), it also has disadvantages. Not using an exercise physiologist or personal trainer adds to the risk of using fitness practices that are ineffective or even dangerous. One of the most common examples is how people train their abs.

Most "ab exercises" provide little to no benefit for the abs. They actually train other muscles which have no connection to how we look. Also, the perceived "ab exercises" are extremely strenuous for the lower back.

What Movement Trains Ab Muscles

The main role of the rectus abdominis, or "abs," is to curl the back into a 'C' shape (lumbar flexion). The most common example of this is a crunch. The pseudo ab exercises do not cause the back to curl at all. These movements actually focus on moving at the hip (hip flexion). The muscles that perform hip flexion are referred to in general as the "hip flexors" (iliopsoas and illiacus).

The photos below show you views from the front of the body. In the first image, blue indicates the abs while the red indicates the hip flexors. Notice that the abs are on the top surface while the hip flexor muscles are deeper, being close to the spine and under layers of muscle. In other words, if you train your hip flexors, you won't change the way your midsection looks.

Crunches train the abs and can improve the appearance of the midsection. If your spine curls into a 'C' shape during an exercise, it's likely an ab exercise. Below are examples of ab exercises. Note the green line, which is intended to mimic the shape of the spine in each position.

The "C" shape of the spine indicates the abs are the main working muscles.

Notice that the upper back leaves the surface but the lower back doesn't.

The Dangers of "Ab Exercises"

Pseudo ab exercises that actually focus on the hip flexors are leg lifts, knee lifts, and sit-ups. Also, ab machines are mostly used incorrectly, with people leaning forward, which emphasizes the hip flexors. During all of these movements, the spine is mostly or completely straight. Notice the straightness of the green line in the pictures below.

This is an ab machine but used incorrectly.

Leg lifts typically involve almost no "curling" of the spine.

Sit-ups mainly work the hips flexors. Notice how straight the spine is.

What makes this common exercise error a large concern is the stress hip flexion exercises put on the lower back. Research from the lab of Dr. Stuart McGill, largely considered the leading researcher in spine biomechanics, indicates the lower part of the lumbar spine (L4/L5) experiences a large amount of force during sit-ups and leg lifts (1). Injuries, in general, occur when bones, muscles, and other tissues are given more force than they can support.

The graph below shows the results of a study looking at how much force (measured in Newtons) each exercise places on the lower lumbar spine when the exercise reaches the peak of the movement. The higher the bar goes, the greater the force placed on the spine.

Source: Axler & McGill, 1997. (1)

The pseudo ab exercises, along with twisting crunches, place large loads of force on the lower lumbar spine.

My Recommendations

The truth is all non-isometric ab exercises place at least a moderate amount of stress on the lower back (1). The smartest move for your lower back is to only perform isometric movements, such as the plank and side plank. However, isometric exercises do NOT lead to muscle growth. I care about how my abs look and I imagine you do, too. Therefore, here are my thoughts on how to minimize your risk of a back injury while maximizing what you can do to help improve how your abs look:

Unless you're an athlete who needs strong hip flexors, stop performing hip flexion exercises. Drop the sit-ups and leg lifts.
Avoid ab machines...unless you are positive you are using them correctly. Your lower back should ALWAYS remain in contact with the lower back pad on the machine. Also, you should not feel any lower back ache or weakness when properly using this machine.
Avoid twisting crunches. The lower back stress isn't worth the benefit.
Perform crunches. Use a very challenging resistance (dumbbell on your upper chest?) and increase the resistance at least every two weeks. Perform only 1-2 sets, with each set continuing until complete exhaustion. The small number of sets should minimize your risk of injury.

Reference

Axler, C.T. & McGill, S.M. (1997). Low back loads over a variety of abdominal exercises: searching for the safest abdominal challenge. Medicine and Science in Sports and Exercise, 29(6), 804-810.

My Fitness Program, Results, and Rationale: Part II

2017-04-27T16:04:00.000-07:00

This is part two of a two-part series detailing what results I'm currently seeing along with my habits and lifestyle. In part one, I shared my results: my joint health, metabolic and cardiovascular numbers, and body composition data. In this part, I share what I do and why.

A crock pot dish of tomatoes, carrots, spinach, chicken, and beef broth.

This post is for anyone who follows this blog and is curious about my personal habits/routines. Before continuing, keep in mind:

My habits and routines are not perfect - it's just what works for me at the present time.
I'm frequently adjusting and experimenting, so what I do now isn't necessarily what I did six months ago or what I'll be doing in six months from now.
As mentioned in part one, my goals are health, longevity, being satisfied with how I look, and having an above average amount of strength and muscle.

My Habits and Routines

Exercise

Using my last 30 days of logging in MyFitnessPal, I average 40.7 minutes per day of activity. Focusing on my high-intensity exercise only (no walks or hikes), I average 24.7 minutes of exercise per day.

Here's a look at my last 30 days of activity and exercise in terms of total minutes each day, and a table featuring a more comprehensive breakdown of my routine.

W = walks.

Type of Exercise	Frequency	Other Details
Strength training	5x/week	Workouts last 20-28 minutes.
Walking	1-2x/week	Walks are slow and last 30-90 minutes.
High-intensity intervals on a stationary cycle	1-2x/week	Total workout is 10-15 minutes. Warm-up/cool-down: 5 minutes total. Workout is three 30-second intervals of 90-100% effort with light pedaling in between.
Hiking	1x/month	Average hike is 3-5 hours.

I don't really consider walking to be exercise. Walking is effective for reducing blood pressure and improving insulin sensitivity (diabetes prevention), but doesn't produce physique or skeletal changes. I walk for mental clarity and sun exposure.

My current strength training routine features three days of training, followed by two days of rest. In each day of training, I perform three pairs of exercises. My workouts feature 14-18 total sets. I work until exhaustion on each set and pick weights that lead to exhaustion in 4-7 reps. My reps last around eight seconds each. I increase the weight when I'm able to perform seven reps in the first set.

Day 1 (Upper)	Day 2 (Lower/Midsection)	Day 3 (Accessory)
Lat Pulldown Incline bench press 3 sets for each	Leg Curl Hack Squat* 3 sets for each	Seated Barbell Military Press Seated Calf Raise Machine 3 sets for each
Cable Row Barbell Bench Press 3 sets for each	Deadlift with Cable Machine Leg Press Machine 3 sets for each	Standing Barbell Curls Cable Pushdown 3 sets for each
Neutral Grip Pull-ups Dumbbell Bench Press 3 sets for each	Floor Crunch (dumbbell on my chest) Back Extensions 1 set for each	Dumbbell Hammer Curls Overhead Dumbbell Triceps Extension 2 sets for each

I am removing the hack squat to eliminate unnecessary stress on my lower back. In regards to the structure of my workout program, here are some reasons why I do what I do:

Short workouts: performing long workouts almost every day leads to immune system weakness, a drop in metabolism, a lack of recovery, and added joint breakdown (1). Exercise should improve health and fitness, not damage it. Also, long "cardio" workouts can limit the strength and muscle growth benefits from strength training. However, short, high-intensity interval training could enhance strength training results, plus provide health benefits (2).
Compound exercises: in my upper and lower body training days, I focus on compound movements, which are exercises which require multiple joints to move (bench press, pull-ups, row, deadlift, leg press, etc.). These exercises train more muscles at one time. Also, compound exercises have larger effects on metabolism and stimulate a greater production of growth hormone and testosterone, which could improve muscle growth (3).
Short rest between sets: resting just one minute between sets leads to fewer reps performed in the following sets (3). However, it leads to a greater increase in blood flow (3), and leads to larger improvements in blood pressure, cholesterol, and artery functioning (4).
One set each for abs and lower back: crunches and back extensions put a fair amount of stress on the lumbar spine (lower back). Therefore, I use a very small amount of exercise with each. Also, one set of back extensions are all that's needed to improve back strength and reduce pain (5).

Eating Habits

Here's a rundown of what I eat:

Basics	Averages (my last 20 days on MyFitnessPal)
Total Calorie Intake	1,716 calories/day
Intermittent Fasting	I eat only between the hours of 12 PM and 8 PM, then fast the rest of the day. I do this 5-6 days per week.
Fat	30-40% of total calories (50-115 grams per day)
Carbohydrates	30-40% of total calories (120-200 grams per day)
Protein	25-35% of total calories (120-180 grams per day)

In each meal, I eat a protein source (usually sardines, salmon, tuna, turkey, or chicken) with fruit (orange, banana, grapes, kiwi, mango, berries, etc.) or vegetables (salad, carrots, tomatoes, sweet potatoes, etc.). Most of my meals are pan-fried, from the crock pot, or involve no cooking at all.

Besides proteins, fruits, and vegetables, I eat beans and yogurt each about twice per week. I eat a sandwich or wrap once a week. My diet includes 1-2 large meals (>1,000 calories) per week and days where I consume 2,400+ calories, which are balanced by eating less than my average amount on most days.

My drinks are almost always water and carbonated water. I drink four energy drinks per week (an area I want to improve in), and 1-2 cocktails over the weekend.

Calories. Obviously I don't eat a lot. Between this and my protein intake being less than optimal, I am not optimizing the amount of muscle I can have. I eat so few calories partly due to the fast (eating for only eight hours per day). Mainly, I eat few calories because people who eat less tend to age better and live longer (6,7).
Fasting. Fasting helps control my weight, plus it is known to improve health, especially in areas related to diabetes and heart disease (8).
Protein. People who strength train should eat, on a daily basis, at least their weight in pounds multiplied by 0.82 (9). For example: 181.4 lbs. x 0.82 = 149 grams per day. When eating very few calories, that requirement increases (10). This is an area I plan to work on more soon.

Other Health-Related Habits

Donating platelets in 2014.

Here are a few other things I do to obtain or reach my goals:

Sleep. Since February, I average about 7.5-8 hours of sleep. Sleep deprivation increases blood sugar, total calorie intake, and junk food cravings (I'll blog about this in the near future).
Self-monitoring of activity and eating: I use MyFitnessPal most days of the week to track my protein intake, overall calorie consumption, and activity (as you saw before). Monitoring increases self-awareness and leads to better control of habits (11).
Self-monitoring of weight: I weight myself every morning. While this may sound like a nightmare to you, daily weighing is shown to help reach weight goals effectively for the same reason: increasing self-awareness (11). I don't stress about small fluctuations. I hope to weigh in a specific range (178-183 lbs.). If I fall out of that range, then I pay more attention to my habits so I can work back into the range.
Platelet donations: I donate platelets through United Blood Services twice per month. Blood donations are shown to help control iron in the blood (prevent an excess of iron). I don't know if donating platelets provides health benefits, but it could.

Final Thoughts

While I do switch my workouts every few months, my total workout time doesn't change significantly - I'm not interested in spending an hour at the gym, five days per week. If I were to change anything with exercise, I would actually decrease my strength training workload. Speaking of changes, I'm planning to add a little more protein and decrease my energy drink consumption in the next two months.

Thanks for reading through this post and part one. I hope this two-part series gave you a better idea of who I am, where I'm at, and provided at least one idea for something you can add to your own health habits.

References

Preuss, S.R. (2017). When exercise is toxic. The Heart Healthy Lifestyle, retrieved from http://www.thhlblog.com/2017/03/when-exercise-is-toxic.html
Preuss, S.R. (2017). Does cardio "kill your gains?" The Heart Healthy Lifestyle, retrieved from http://www.thhlblog.com/2017/04/does-cardio-kill-your-gains.html.
Kraemer, W.J. & Ratamess, N.A. (2004). Fundamentals of resistance training: Progression and exercise prescription. Physical Fitness and Performance, 36(4), 674-688.
Tan, B. (1999). Manipulating resistance training program variables to optimize maximum strength in men: A review. Journal of Strength and Conditioning Research, 13(3), 298-304.
Preuss, S.R. (2013). The direct approach: treating lower back pain with strength. The Heart Healthy Lifestyle, retrieved from http://www.thhlblog.com/2013/02/the-direct-approach-treating-lower-back.html.
CR Society. (N.d.). Calorie restriction research moves forward! CR Society International, retrieved from http://www.crsociety.org/science/research
Buettner, D. (2010). The blue zones: Lessons for living longer from the people who've lived the longest. Washington, D.C.: National Geographic.
Preuss, S.R. (2013). The fast diet and the effectiveness of intermittent fasting. The Heart Healthy Lifestyle, retrieved from http://www.thhlblog.com/2013/03/the-fast-diet-and-effectiveness-of.html.
Lemon, P. W. (2000). Beyond the zone: protein needs of active individuals. Journal of the American College of Nutrition, 19(5), 513S-521S.
Helms, E.R., Zinn, C., Rowlands, D.S., & Brown, S.R. (2014). A systematic review of dietary protein during caloric restriction in resistance trained lean athletes: a case for higher intakes. International Journal of Sport Nutrition and Exercise Metabolism, 24, 127-138.
Robinson, D. (2015). Could you triple your weight loss? Beyond Diets, retrieved from http://www.beyonddiets.com/beyonddiets-blog/2015/4/8/could-you-triple-your-weight-loss.html.

My Fitness Program, Results, and Rationale: Part I

2017-04-25T17:57:00.000-07:00

For all of you who regularly follow this blog, I wrote this post and the next post to give you a transparent view of where I'm at (health-wise and fitness-wise), what I do, and why I do what I do. I would be a complete hypocrite and lack credibility to write about health and fitness but be in poor standing myself.

Summer of 2010 versus April, 2017

In this post, I'll share my current health status and results. In part two of this series, I'll discuss my current training routine, diet, and other lifestyle habits. If you have no interest...I don't blame you...and come back next week when I get back to general exercise and nutrition topics.

Before diving into my current health and fitness, you should know what I'm aiming to do. While I'd like to be very muscular and build my athletic skills, I don't care enough to focus on those at the expense of my primary goals. Just as it's difficult to date the woman in California while living in New York, it's difficult to train for health and longevity, maintain leanness, and maximize muscle mass. We can't have everything we want, so we have to prioritize what's most important and focus on that.

Here are my primary fitness-related goals (in order):

Health (short- and long-term) and longevity
Being satisfied with how I look naked (how's that for honesty?)
Having an above average amount of strength and muscle

My Results and Status

Here's an overview of my body composition and health with a little context on how I've fluctuated over the past few years.

Body Composition

Measurement Type	Current Measurements (taken 4/25/17)
Weight	181.4 lbs
Waist Circumference	81.8 cm (32.3 inches)
Hip Circumference	101.4 cm (40 inches)
Waist-to-Hip Ratio	80.7

4/25/2017 (no oil, no filter...just me)

For most of my adult life, I've weighed around 187-190 lbs. At my heaviest (left side of the photo at the top of this article), I weighed 201 lbs. I've maintained my current weight range (179-183 lbs.) mostly since mid-2011. (This post details how I lost the weight.)

Since I've started tracking waist and hip measurements (2014), my waist and hip have increased by one and 1.5 centimeters.

As mentioned, I care most about health and being satisfied with how I look, so I track my body composition using photos and waist-to-hip ratio (WHR). WHR is more effective than weight or body fat percentage in determining a person's risk of developing heart disease or diabetes. With a WHR of 80.7, I fall into the "excellent" or "low risk" range for men, which is below 85. My BMI is 24.6 (I'm 6' tall), which is classified in the "normal" or "healthy" weight range.

Cardiovascular and Metabolic Health

Here are snippets of my most recent measurements. I'm 33 years old (birth date: 7/19/1983).

On 4/21/2017, my total cholesterol was 134 mg/dl and my blood pressure was 107/59 mmHg.

On 3/23/16, my HDLs were 70, LDLs were 86, and my triglycerides were 41 mg/dl.

This is my last fasting blood glucose test, measured at 83 mg/dl.

I fall into healthy ranges for all measures. Healthy ranges for each are the following:

Blood pressure (me: 107/59): 80-120 (systolic)/60-80 (diastolic) mmHg
Total cholesterol (134): under 200 mg/dl
HDLs (70): the desirable level is greater than 60 mg/dl
LDLs (86): less than 100 mg/dl
Triglycerides (41): less than 150 mg/dl
Fasting blood glucose (83): 70-99 mg/dl

Joint Health

As you will see in part two of this series, I exercise regularly but not as much as many fitness professionals. One reason for this is out of concern for joint health. One four-year study showed people who exercise very frequently experience just as much joint deterioration as people who don't exercise at all (1).

I have no regular joint pain. However, I experience back stiffness and ache about two or three times per year. Also, I recently experienced left knee pain on a 12-mile hike (a one-time event). While my lower back is generally pain-free (thanks to back extensions) despite an injury in 2008, the ache usually follows exercise "experiments." Examples are trying new exercises with more loading on the spine (hack squats, deadlifts, etc.) or adding volume with exercises that put force on the spine.

Final Thoughts for Part I

One thing I want to improve on is being a little smarter in my exercise experiments; while I love experiencing what others are doing, some pursuits aren't wise for joint health. As I mentioned at the start, I want to be around for a long time and to be functional during all of those years. Some risks aren't worth the minor benefits they might provide.

In part two, I'll share what I'm currently doing with my exercise program, diet, and in other areas.

Reference

Lin, W., Alizai, H., Joseph, G. B., Srikhum, W., Nevitt, M. C., Lynch, J. A., ... & Link, T. M. (2013). Physical activity in relation to knee cartilage T2 progression measured with 3 T MRI over a period of 4 years: data from the Osteoarthritis Initiative. Osteoarthritis and Cartilage, 21(10), 1558-1566.

Eating More Meals for Metabolism and Muscle

2017-04-20T17:37:00.001-07:00

In life, there are times when the actual evidence doesn't match the narrative we believe to be true. We believe a friend is a generally moral person, but he steals money from his employer, doesn't spend time with his kids, and frequently treats people disrespectfully. Some say older adults should "take it easy," but inactive people die sooner while those who exercise intensely live longer and higher quality lives.

If the evidence doesn't match the narrative, it's probably time to reconsider the narrative.

One of the most popular narratives in nutrition is eating smaller, more frequent meals "revs up" metabolism, and the increase in metabolism leads to weight loss. However, large-population studies in the US have found that increases in eating frequency are the biggest dietary change from the late 1970s to the mid 2000s (1)...a period of time when obesity was increasing in the US.

Is it time to change this recommendation in favor of traditional eating (three meals per day)? Maybe.

Meals and Metabolism

A few well-controlled studies measured metabolism with diets featuring the same amount of daily calories, but in different amounts of meals. A month-long study of women who were obese or overweight compared eating two meals per day versus eating 3-5 (2). Sleeping metabolism and total daily calories "burned" were the same in both groups. Other studies comparing two versus seven meals, three versus six meals, and two versus three meals also found no difference in metabolic rate following the different eating frequencies (3,4,5).

After seeing all of those results, you likely won't be surprised to read that a review of meal frequency studies concluded "increasing meal frequency does not appear to significantly enhance diet-induced thermogenesis, total energy expenditure, or resting metabolic rate (6)."

For the research measuring weight loss, one study showed different meal frequencies had no effect on weight or fat loss (2). Other research showed men and women lost more weight and fat when eating one meal per day compared to when they ate three meals per day, despite eating the same amount of calories with both approaches (7).

Eating more often does not increase metabolism or enhance weight loss.

Meals and Muscle Retention

For maintaining or building muscle, some believe eating more frequently is necessary. In the research review, three out of four studies showed no difference in a measure of muscle maintenance/growth when comparing different amounts of daily meals (6). One study advised that it's more important to concern yourself with how much protein you eat, not how often you eat it (6).

Meals and Hunger

Metabolism isn't impacted by how often you eat, but hunger is. A few studies asked the participants to rate their hunger at various times during each day. People were less hungry when eating three meals per day (when compared to one, two, or six meals per day), or when eating five meals (when compared to one meal per day) (7,5,3,6).

To minimize hunger, a middle ground of about 3-5 meals seems best.

Conclusion

There's one additional important point to note that the research doesn't cover: self-control. Many people (including yours truly at times) don't consistently control portions. While eating small, frequent meals may sound easy, they may actually become frequent, moderate-to-large meals. Therefore, I think eating less often (3-4 times per day) is smarter as it limits the opportunities for a person to overeat.

The narrative of eating small, frequent meals to boost metabolism and lose weight is simply a narrative...a fictional story. It's not true. Eating small meals throughout the day does NOT increase metabolism. In fact, it may increase your hunger.

If you want to lose weight, focus on the quality of your foods, eating enough protein to maintain your muscle mass, and eating around 3-4 meals per day to satisfy your hunger while minimizing opportunities to overeat.

Also, stop people when you hear them recommending small, frequent meals to "rev-up" a person's metabolism. The evidence doesn't fit the narrative.

References

Duffey, K.J. & Popkin, B.M. (2011). Energy density, portion size, and eating occasions: contributions to increased energy intake in the United States, 1977-2006. PLoS Med, 8(6): e1001050.
Verboeket-Van de Venne, W.P. & Westerterp, K.R. (1993). Frequency of feeding, weight reduction and energy metabolism. International Journal of Obesity and Related Metabolic Disorders, 17(1), 31-36.
Verboeket-van de Venne, W.P. & Westerterp, K.R. (1991). Influence of the feeding frequency on nutrient utilization in man: consequences for energy metabolism. European Journal of Clinical Nutrition, 45(3), 161-169.
Ohkawara, K., Cornier, M.A., Kohrt, W.M., & Melanson, E.L. (2013). Effects of increased meal frequency on fat oxidation and perceived hunger. Obesity, 21(2), 336-343.
Smeets, A. J., & Westerterp-Plantenga, M. S. (2008). Acute effects on metabolism and appetite profile of one meal difference in the lower range of meal frequency. British journal of nutrition, 99(06), 1316-1321.
La Bounty, P. M., Campbell, B. I., Wilson, J., Galvan, E., Berardi, J., Kleiner, S. M., ... & Smith, A. (2011). International Society of Sports Nutrition position stand: meal frequency. Journal of the International Society of Sports Nutrition, 8(1), 4.
Stote, K. S., Baer, D. J., Spears, K., Paul, D. R., Harris, G. K., Rumpler, W. V., ... & Longo, D. L. (2007). A controlled trial of reduced meal frequency without caloric restriction in healthy, normal-weight, middle-aged adults. The American journal of clinical nutrition, 85(4), 981-988.

Is Static Stretching Necessary?

2017-04-14T09:18:00.001-07:00

"We use only 10% of our brains." It was the start of a funny and cheesy pick-up line in Wedding Crashers. It was also widely-accepted as true for decades. Is it true? No, 90% of our brain is not freeloading. Despite lacking any scientific support, many believed this was a fact.

Stretching, specifically static stretching (holding a stretch for 30 or more seconds), has been considered an essential part of exercise for a long time.. This is largely because it reduces soreness and injury risk with exercise and sports...but does it really provide those benefits? Is this an actual fact? Research largely says "no."

Soreness

Delayed Onset Muscle Soreness (DOMS) is the discomfort people feel about 24-72 hours a workout or sport, especially when starting a new activity. Stretching just before or after is commonly said to prevent or reduce DOMS. This is not true, at least based on current research. A review, published in 2006, assessed five studies measuring soreness (1). People who stretched felt no reduction in soreness at 24, 48, or 72 hours after exercise. Stretching was performed for 5-10 minutes, including holds ranging from 20 seconds to two minutes. Some people stretched before the workout; some stretched afterwards. Regardless, stretching had no effect on post-activity soreness.

Injury Risk

The evidence supporting stretching to reduce injury risk is not encouraging as well (if you're a fan of stretching). A review from 2005 looked at studies focusing on lower body stretching and various lower body injuries (strains, sprains, shin splints, etc.). The result? Stretching did not reduce injury risk.

A study of about 3,000 runners had a similar result when assigning runners to stretching or non-stretching groups for three months (3). In both groups, 16% of people suffered an injury.

A more recent research review did cite a few studies where the static stretching group suffered from fewer injuries...but there was a huge influencing factor: they all performed a warm-up activity of some kind (4). Static stretching by itself does not reduce the risk of injury.

Performance

In regards to soreness or injury risk, stretching is ineffective but not harmful. Stretching could be harmful to your workout or athletic performance. When performed beforehand, static stretching leads to an average reduction of 3-4% in a maximal vertical jump and 1-2% in sprinting speed (4). Obviously these are not huge decreases but could be significant if competing against a person with similar abilities.

When performed before strength training, static stretching reduces the amount of reps a person can lift a weight for (4, 5). Specifically, people perform an average of 8% fewer reps following static stretches (4). One study found rep totals decreased by 9-24%, with the effect increasing with heavier weights (5). This likely happens because stretching reduces the amount of muscle fibers that contract during an exercise.

Is Stretching Useful?

Before answering the question that leads this section, I have one point you should know: I have no "dog in the race." I have no personal vendetta against stretching. I am simply looking for the truth.

Is stretching necessary? Is it useful? In the previous post, I started by saying life is mostly gray, not black and white; a universal rule or answer generally doesn't work. Therefore, my answer to these questions is conditional.

Stretching is useful for increasing joint range of motion, and people in sports requiring large movements (e.g. gymnastics, track and field) should perform static stretching (4). Also, if stretching temporarily reduces pain that you feel, then I think you should stretch. For injury prevention, soreness prevention, or when you are going to strength train, I recommend avoiding static stretching.

References

Herbert, R.D. & Gabriel, M. (2006). Effects of stretching before and after exercising on muscle soreness and risk of injury: systematic review. BMJ, 325(7362), 468.
Hart, L. (2005). Effect of stretching on sport injury risk: a review. Clinical Journal of Sport Medicine, 15(2), 113.
Oddi, V. (2010). USATF Announces Results of Pre-run Stretch Study. USATF. Retrieved from http://www.usatf.org/news/view.aspx?DUID=USATF_2010_08_20_12_13_14
McHugh, M.P. & Cosgrave, C.H. (2009). To stretch or not to stretch: the role of stretching in injury prevention and performance. Scandinavian Journal of Medicine & Science in Sports, 20, 169-181.
Nelson, A.G., Kokkonen, J., & Arnall, D.A. (2005). Acute muscle stretching inhibits muscle strength endurance performance. Journal of Strength and Conditioning Research, 19, 338-343.

Does Cardio "Kill Your Gains?"

2017-04-05T14:32:00.002-07:00

Life is rarely black and white. Lying is generally "bad," but not if you lie to protect another person's information or security. Investing in the stock market is often "smart," but not if the market is at a 20-year high. Life is generally gray and conditional. In many cases, a universal rule or approach doesn't apply.

This brings me to a commonly-debated fitness topic: does performing cardio limit strength training's effects on building muscle and strength? Or, phrased in a more common way, does cardio "kill my gains?"

As you would guess after reading the first paragraph, the answer to these questions is...it depends.

Cardio and Strength Training

Generally, performing large amounts of cardiovascular exercise (walking, running, cycling, etc.) along with strength training will limit less strength and muscle growth. This was shown in a review of almost 40 studies (1). When compared to people who only strength trained, men and women who performed strength and cardio exercise added strength and muscle...but not as much.

There are many reasons for this:

Glycogen (1). Glycogen is the stored form of glucose. Glucose is the main fuel source for strength training. When cardio is performed on consecutive days, glycogen is depleted, leaving less energy for strength training. As a result, a person performing a large amount of cardio likely won't be able to lift as much weight or perform as many repetitions in strength workouts.
Overtraining (1). As mentioned in the previous post, an excess of training can be noticed in a person's strength levels. One study noted people were able to gain strength for the first several weeks when performing both types of exercise. Afterwards, strength levels decreased! Were they exercising too often to fully recover from each workout?
Muscle fibers and protein synthesis (2). Strength training and cardio training stimulate different responses in cells (larger myofibrillar proteins for hypertrophy vs. more mitochondrial content). Also, to grow muscle, muscle protein development needs to exceed muscle protein breakdown for long periods of time (weeks or months). Performing long endurance workouts interrupts the emphasis on muscle protein development by promoting a focus on protein breakdown.

However, as I mentioned in the introduction, cardio does not always limit muscle and strength development. From what I noticed, there are two conditions when cardio doesn't contradict the benefits of strength training. In fact, in these circumstances, cardio might even enhance muscle and strength!

Frequency of Training

The majority of the studies in the review focused on large amounts of training, featuring long workouts which were performed 4-6 days per week for EACH type of exercise...for a total of 8-12 workouts per week (1)!

Two studies showed cardio and strength training together can be just as effective, if not more effective (3,4). A difference with these studies was the frequency. A study from 2002 showed the combination can actually lead to more muscle growth than strength training alone. In this study, cardio and strength training were performed on the same day and for three days per week (3). A second study, published in 2009, showed almost equal gains in strength from strength training alone when compared to strength training and cycling. The participants only worked out two days per week (4).

In both cases, people rested most days of the week and did not exercise on consecutive days.

Type of Cardio Training

When cardio is performed less frequently, the type of cardio matters. Cycling, when combined with strength training, complemented strength training more effectively than walking or running on a treadmill did (4). In one case, combining cycling and strength training together improved hypertrophy, or muscle growth (3). Researchers speculate that cycling is better for strength as it mimics the joint movements of some strength training (4). It's possible that other cardiovascular exercise methods that mimic strength training movements, such as the row ergometer, could also enhance strength training results when performed less frequently.

Conclusion

Does cardio "kill your gains?" It depends, of course. If strength and hypertrophy are your main concerns, research indicates sticking to 2-3 cardio workouts per week to develop the most strength and muscle you can. Also, focus on a cardio method such as cycling or rowing that is similar to strength training movements. If you are an endurance athlete or simply enjoy daily cardio, strength training will still help you gain strength and muscle...you just won't develop to your maximal level.

References

Nader, G.A. (2006). Concurrent strength and endurance training: from molecules to man. Medicine, Science, Sports, and Exercise, 38(11), 1965-1970.
Hawley, J.A. (2009). Molecular responses to strength and endurance training: are they incompatible? Applied Physiology, Nutrition, and Metabolism, 34, 355-361.
McCarthy, J.P., Pozniak, M.A., & Agre, J.C. (2002). Neuromuscular adaptations to concurrent strength and endurance training. Medicine and Science in Sports and Exercise, 34(3), 511-519.
Gergley, J.C. (2009). Comparison of two lower-body modes of endurance training on lower-body strength development while concurrently training. Journal of Strength & Conditioning Research, 23(3), 979-987.

When Exercise is Toxic

2017-03-30T21:50:00.002-07:00

Everyone should exercise. Exercise produces mental and physical health benefits, improves how we look, and enhances our physical abilities. We all know this.

Like medications, exercise requires a certain dosage: not too little yet not too much.

Exercise is like medication: a minimal amount is generally needed to attain a specific benefit (e.g. 30 minutes of walking to lower blood pressure for a day). Also, like medication, an excess could be toxic.

More isn't always better. This is certainly the case with exercise. Our bodies do not want intense exercise every day. Research shows this in a number of areas.

Strength

When a muscle group is strength trained, it initially becomes weaker and requires roughly 72 hours to completely recover and reach a slightly stronger and larger state. If we perform another intense strength training workout before recovery is complete, there could be signs indicating a lack of recovery. For example, women were only 94% as strong when performing an intense workout just two days after their previous intense strength training session with the same muscle groups (1). Especially for those who have trained for at least a year, research reviews recommend 72 hours as the shortest possible rest periods between intense training for the same muscle group (2,3).

Weight

When our bodies experience undesired sensations, they counteract. When we're cold, we contract our muscles (shiver) to generate heat.

One study featured young men on an intense exercise program where they burned an average of 627 calories per day for 93 days (4). Expending or burning 627 calories is equivalent to me (a 180-pound male) strength training about two hours or intensely cycling for 45 minutes. While these aren't extreme for a single day, they are extreme amounts of exercise for 93 consecutive days. Did the young men's bodies resist? Yes! The researchers noticed an average metabolism decrease of eight percent. In other words, their bodies compensated for the excess of exercise by decreasing the energy needs of their organs.

A study with older women showed a similar effect: women who exercised six times per week became less active outside of their training sessions. As a result, they lost less weight than women who exercised four days per week (5). The women training four times per week actually became more active outside their workouts. Were the women who exercised six times per week exhausted due to overtraining?

Immune System

An excess of training leads to a number of immune system defects (6). In fact, extremely frequent high-intensity training leads to a suppression of the immune system. Some effects are more frequent upper respiratory tract infections and more illnesses in general. An influencing factor could be the increased risk of depression and lack of sleep that people face when performing high amounts of intense exercise.

Excessive high intensity exercise can lead to more illnesses, depression, and difficulty with sleeping.

Joint Health

Joint health is another consideration for frequent high-intensity training. While a lack of exercise increases the risk for developing osteoarthritis, being very active is also a risk factor. One study showed the people who were most active over a four-year period experienced the more joint deterioration than others who were less active or sedentary (7). Exercise should improve our bone health, not accelerate its decline.

Conclusion

Let's get one thing straight: I think you should exercise. I especially support you exercising intensely. Intense exercise, such as strength training, sprints, or a spin class, provides the anti-aging benefits we seek to lead long and high-quality lives. Exercising with near maximum effort also makes the largest contributions to how well we look on the beach and in the bedroom.

However, more isn't always better. Part of the exercise process is recovery. Recovery for the hours and days after intense exercise allows our bodies to rebuild and improve past our previous abilities and muscle size.

Exercise intensely...more than once per week and less than every day. Somewhere in the middle - about 3-5 days per week - should provide a balance of training and rest.

References

Hakkinen, K. (1995). Neuromuscular fatigue and recovery in women at different ages during heavy resistance training. Electromyography and Clinical Neurophysiology, 35(7), 403-413.
Kraemer, W.J. & Ratamess, N.A. (2004). Fundamentals of resistance training: Progression and exercise prescription. Physical Fitness and Performance, 36(4), 674-688.
Tan, B. (1999). Manipulating resistance training program variables to optimize maximum strength in men: A review. Journal of Strength and Conditioning Research, 13(3), 298-304.
Tremblay, A., Poehlman, E.T., Després, J.P., Theriault, G., Danforth, E., & Bouchard, C. (1997). Endurance training with constant energy intake in identical twins: changes over time in energy expenditure and related hormones. Metabolism, 46(5), 499-503.
Hunter, G. R., Bickel, C. S., Fisher, G., Neumeier, W., & McCarthy, J. (2013). Combined aerobic/strength training and energy expenditure in older women. Medicine and science in sports and exercise, 45(7).
MacKinnon, L.T. (2000). Overtraining effects on immunity and performance in athletes. Immunology and Cell Biology, 78, 502-509.
Lin, W., Alizai, H., Joseph, G. B., Srikhum, W., Nevitt, M. C., Lynch, J. A., ... & Link, T. M. (2013). Physical activity in relation to knee cartilage T2 progression measured with 3 T MRI over a period of 4 years: data from the Osteoarthritis Initiative. Osteoarthritis and Cartilage, 21(10), 1558-1566.

Choose Your Fitness Role Models Carefully

2015-04-17T17:46:00.002-07:00

The field of personal training started when gym patrons were asking the most fit and muscular gym goers for advice. While I'm grateful for those actions leading to the career that I've been apart of since 2001, taking the advice of such people is a real gamble. Fit people may know what works best for most people...or they can just be individual success stories with advice that isn't safe or effective for the majority.

I really understood this lesson several years ago when I had a unique opportunity: I worked as a personal trainer in a gym with a few active International Federation of Bodybuilding and Fitness (IFBB) and National Physique Committee (NPC) competitors. Out of respect, I will not mention names.

Over the 14 months that I trained clients at this location, I had many opportunities to watch these individuals with their clients. One of the figure competitors - let's call her "Patricia" - was wonderful to her clients. Patricia was very detailed when introducing clients to new exercises - the result of this was obvious with the excellent lifting techniques her clients had. Also, she worked around pre-existing client injuries and developed individualized dietary strategies with her clients who wanted nutritional help. Patricia was certainly not the only trainer I would hire out of the group but she was the best example.

Some gambles produce wins...and some don't. Another trainer was an IFBB professional and among the top 15 in several tournaments in the US and internationally. Let's call him "Ron." Ron struggled with several fundamentals of personal training. His clients generally had terrible form. Ron struggled with how to help clients with basic injuries and pain. Also, it was well-known around the gym that he took steroids, which, in my opinion, makes his training methods difficult to validate. New members were unaware of these things - I think they were consumed by his impressive physique. The same could be said for an NPC champion figure competitor at the gym: she was a poor trainer in several aspects but was able to attract clients due to her impressive physique and competition success.

To be clear, I'm not discouraging you from asking the muscular guys or the extraordinarily fit women in your gym for their thoughts. You don't need me to tell you it's wise to seek the advice of someone who's achieved what you want to achieve, whether it's bodybuilding, weight loss, or another training goal.

Examine your source with detail.

Does the person have experience coaching others or just oneself? (If yes, talk to some of those trainees)
Does the person have any formal training (certifications)?
Does the person have any formal education in the field?

By getting more information on your source, you develop a better understanding of your source's credibility. You also decrease the chances of taking advice that could lead to injury or wasted time spent with ineffective training habits.

We can never completely eliminate risk. However, a little research at the start will help you make decisions pay you back with profits.

Lean with Sardines: How Eating Omega-3 Fatty Acids Helps Weight Loss

2014-07-01T15:21:00.001-07:00

It's no secret: I love eating sardines.

Sardines pack a nutritional punch with vitamins D, B6, B12, niacin, selenium, magnesium, phosphorous, zinc, copper, manganese, and protein. I enjoy the taste as well (that has to count for something, right?).

However, one of the greatest benefits they have provided me is helping me lose 30 lbs. and sustain that loss. Yes, there's a nutrient in sardines that makes weight loss efforts more successful...and don't worry, that nutrient is NOT only found in sardines.

Omega-3 fatty acids. The nutrient many people take in fish oil pills - to decrease inflammation - actually increases beta-oxidation (the breakdown of fat to produce energy). Several studies have shown that adding omega-3 fatty acids to a diet increases the amount of weight loss, especially midsection fat.

Researchers from Iceland, Spain, and Ireland noticed this in 2007 with middle-aged, overweight to slightly obese adults [1]. The researchers used several diets that were evenly matched for calories and macronutrients (fats, carbohydrates, and protein). Here's what was different:

Group one: no seafood or supplements
Group two: ate salmon three times per week (an average of 1.3 grams of omega-3 fatty acids per day)
Group three: took fish oil capsules every day (1.5 grams of omega-3s per day).

After eight weeks, the men in the salmon and fish oil groups lost an additional two pounds of fat and several centimeters from their waists when compared to group one.

A study with diabetic women had even stronger results [2]. The experimental group took 1.8 grams per day of omega-3 fatty acids in a supplement, while the other women took a placebo.

After eight weeks, the experimental group lost 3.5 lbs. of fat compared to nothing for the women who took the placebo. What's especially intriguing is that, like the men in the previous study, the women lost mostly midsection fat.

As mentioned, thee reason why omega-3 fatty acids boost weight loss is that they increase beta-oxidation. Researchers in France noticed fat breakdown increased 22% when adding 1.8 grams of omega-3 fatty acids per day to subjects' diets [3].

If you've followed this blog for a while, you know that I struggled with my weight several years ago. I peaked at 201 lbs. To get to 174 lbs. (what I weighed this morning), I made a series of changes. One of those changes was increasing my omega-3 intake by replacing chicken, conventionally-raised beef, and eggs with salmon, sardines, and grass-fed red meat. Till this day, I continue to eat at least one of those foods every day, and I continue to stay within a five-pound weight range.

Take-Home Messages

When it comes to using omega-3 fatty acids for weight loss, there are two points you should be aware of:

Adding them should not be your entire weight loss plan - if you're interested, make them a part of the plan
You may not think the weight loss numbers in the studies are that large, but I also think the amounts of omega-3s taken weren't that significant. If you took an omega-3 supplement AND ate a fatty piece of fish during most days of the week, you're likely going to consume more than the 1.3 to 1.8 grams per day that the studies used, and you'll likely lose more weight.

This website is a great source for learning the amounts of omega-3 fatty acids in various fish. Fish aren't the only natural sources of omega-3s, but they are typically the most abundant sources.

Of course, you could skip the website and just start eating sardines. I wouldn't stop you.

Before, After, and Way After: The Story of My Sustained 30-Pound Weight Loss

2014-03-16T20:14:00.000-07:00

August of 2010 (left), March of 2012 (center), and March of 2014 (right)

About two years ago on this blog, I wrote about all of the changes I made to get from 201 to 171 lbs. In summary, I hit a lifetime peak of 201 lbs. in August of 2010. For the rest of 2010, I made obvious changes, such as eliminating junk foods. In the spring of 2011, I made major changes, increasing my intake of fruits, vegetables, and omega-3 fatty acids (sardines, salmon, anchovies, cod, etc.) while eliminating processed foods from my regular diet. In the beginning of 2012, I regularly weighed in the low 170s, as you can see in the middle picture.

On March 13, 2014, I took the picture on the right. About two years after reaching 171 lbs. for the first time since high school, I still weigh about the same. How have I sustained the loss? I used the same strategy that several of my clients have used to maintain losses ranging from 10-70 lbs.: I made lifestyle changes.

August 4, 2010 (left) and March 13, 2014 (right)

For today's post, I don't need to reference any studies to make my point. I could analyze my changes from a physiological standpoint, but I won't. The point is not scientific. It's logical. The lifestyle changes I made with my eating habits several years ago are habits I still maintain today.

Here's a one-day diet sample of my diet in January, 2012 (from a post I wrote in 2012):

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

Here's what I ate last Thursday (March 13, 2014):

5:40 AM: Can of sardines with an apple
10 AM: Eight ounces of turkey and a banana
1 PM: Salad with romaine lettuce, sliced bell peppers, sliced apple, cherry tomatoes, grilled chicken, and a house vinaigrette dressing
5 PM: Eight ounces of grass-fed beef with a broccoli slaw salad (sliced broccoli and carrots, extra virgin olive oil, and a touch of Dijon mustard)

The foods aren't exactly the same, but the principles are similar: my daily eating regimen still features 3-4 meals, 8-10 servings of fruits and vegetables, a natural protein source at every meal, and extra virgin olive oil and salt as some of the few condiments I eat. I also continue to strength train 3-4 days per week.

All people who want to lose weight and maintain it don't have to eat like I eat. I realize eating sardines for breakfast isn't exactly a popular idea. Doing what I do is certainly not the point I want you to take away from this. The real point is, if you want to make a sustainable weight loss, you must make sustainable changes to your habits.

Diets where you are eating less than 1,000 calories per day, eating only one food for several days, or where you are reliant on supplements are not sustainable. Eventually you will have to transition from those initial weight loss-inducing behaviors into another phase that you can live on.

If you are looking to lose weight, ask yourself this when considering any diet or program: can I see myself doing this in five years? If the answer is no, then the program probably isn't what you are looking are. Lifestyle changes are sustainable. Most commercially-popular diets are short-term weight loss kick-starters. I look the same way I did two years ago because I'm doing similar things. It's not science. It's logic.

Don't get on the weight loss roller coaster. Make changes you can sustain and your new weight will stick around as well.

Better Health While at Work: Move Two Minutes at a Time

2014-02-12T11:44:00.000-07:00

Let's be honest: even though you are reading this article from a health-based site, you may not be exercising regularly. This is understandable. Exercise may not be a current priority for you, or maybe it is but some short-term situations have arisen that put other demands on your time.

Regardless of the reason, you don't need time for the gym to improve your health. In fact, walking around your office periodically after lunch can help fight off diabetes and heart disease.

As I discussed in The Heart Healthy Lifestyle and an article from 2011, there are several health downfalls that come with sitting. In summary, people who regularly sit many hours per day, without getting up often, are more likely to have larger waistlines and higher post-meal blood sugar spikes. Higher post-meal blood sugar spikes are concerning because they are strongly associated the risk of developing diabetes, inflammation, and artery wall thickening [1]. Overall, the more a person sits, the higher the risk of getting heart disease and insulin resistance (a precursor for type 2 diabetes) [2].

However, if your work and hobbies revolve around you sitting, you're in luck: I'm here to help. A 2012 study showed that a two-minute walk every 20 minutes after a meal led to significant reductions in blood sugar and blood insulin [1]. Specifically, the periodic two-minute walks decreased blood sugar by 24% and insulin by 25-29% for the five hours after the meal. That change in blood sugar is enough for many to drop from a diabetic or prediabetic level to a healthy range.

Reducing insulin is also important because overproducing insulin over time can lead to the death of key pancreas cells that make insulin. Insulin is responsible for helping sugar get out of the blood. When those cells die, less insulin is produced and more sugar remains in the blood, eventually resulting in diabetes.

The study had people sit for two hours before the meal (a 763-calorie drink), then sit for five hours continuously or for five hours with the two-minute walks every 20 minutes. The study was a crossover trial, meaning the same people were used for each experiment. The researchers tested two different walking speeds (2.0 mph and 3.6-4.0 mph) for the two-minute walks, but the results were very similar for both speeds.

How Does This Apply to You?

The setup of this study is similar to the second half of the work day for many people: the participants ate a lunch-sized meal, then spent about five hours sitting. The people in this study were middle-aged, overweight or obese non-exercisers but also did not have major health problems, similar to a large chunk of the US population.

This study shows that you can lower your risk of heart disease or diabetes by taking a periodic two-minute walk after lunch. Depending on your work space, you could accomplish a two-minute walk by taking a lap around your entire office or by using a bathroom on a separate floor.

You don't need a gym or an hour to improve your health through movement. Rearranging your sitting habits is a small but significant way to improve key health measures.

Obese and Healthy

2013-12-06T14:27:00.002-07:00

The debate in the health world this week comes from the reporting of a Toronto-based research review where three doctors concluded that good health cannot be attained while obese. The main supporting factor is the finding of obese individuals being 24% more likely to have a heart problem or die over a 10-year period than those in the "healthy" weight group, with weight categories defined by body mass index (BMI).

I disagree and will state my reasons below. I think this is a very critical point and not at all a scientific discussion that has no significance in the "real world."

Opposing Arguments and My Thoughts

First of all, the weight groups were described as being "metabolically" healthy or unhealthy. This is typically defined by several factors, including blood pressure, blood sugar, cholesterol, and triglycerides. BMI is calculated by using weight and height. Classifications are shown in the chart below.

Here are the two primary arguments for obesity not being healthy (one from the researchers and one I heard from most people I discussed this with over the past few days):

The new study shows a higher risk of heart disease or death with healthy obese individuals.
Obesity wears on joints, leading to knee, lower back, and other pain.

Here are my counterpoints.

1. Decades of research show that obesity does not consistently demonstrate an increased risk of early death. The National Health and Nutrition Examination Survey (NHANES) is a study that was conducted for several four-to-six-year periods over four decades in the US. After combining all of the data, the researchers found that obese people under 60 years old were 23% less likely to die during the study period when compared to the "healthy" weight group.

2. Obesity assesses total fat, and not all fat is created equal. Inner abdominal fat leads to several negative health consequences, whereas subcutaneous fat (thighs, hips, etc.) produces many benign or healthful actions. This is illustrated by a few points.

First, waist-to-hip ratio, which is essentially a measure of where your fat is stored, is a much more effective way to determine your risk of heart disease when compared to weight. High amounts of abdominal fat often indicate that a person has or will develop diabetes, whereas thigh fat does not indicate anything about diabetes risk. Overall, people who are obese primarily due to excess hip and thigh fat are unlikely to suffer from heart disease or diabetes.

3. Lifestyle is more important than body fat for determining health. Some people are obese but maintain healthy exercise and eating habits. As I pointed out on this blog and in Chapter 3 of my book, lifestyle improvements build health whereas fat removal with no diet/exercise changes (liposuction) does not. When people lose weight while changing their eating/exercise habits, their health improves primarily due to the lifestyle changes, not the fat loss.

This point is critical to make because many people are genetically obese. In some cases, obese people have abnormally high quantities of fat cells. While you can shrink your fat cells through exercise and diet, you cannot decrease the amount of fat cells that you have. Therefore, some obese people have a limit to how lean they can get, and that limit could be in an obese state.

4. Joint pain is largely a matter of strength. I'm not going to tell you that being obese doesn't put extra stress on joints. It does. It's basic physics: when there's more mass, there's more force on the joints. However, I can tell you from experience in my personal training practice, gaining strength decreases or eliminates knee and lower back pain, regardless of weight change. This is supported by research.

Seniors with osteoarthritis in their knees felt huge reductions in pain after a few months of leg strengthening and no weight loss [1]. The same pain reduction was demonstrated in several studies where people performed only one exercise per week to strengthen their lower back. If obese individuals strength train, their knees and lower backs will likely provide little to no pain.

Final Thoughts

In summary, do I think that obesity is a threat to health? Yes...when body fat is largely located in the midsection. Otherwise, I do not think obesity is a threat to health. Universally, a poor lifestyle is a threat to health. If people - no matter what their weight categories are - regularly practice healthy lifestyle habits, then I think they will maximize longevity while avoiding joint pain, heart disease, and diabetes.

Weight and Risk of Death

2013-10-30T07:30:00.000-07:00

Weight is not the best predictor of death risk, especially when your weight does not fall into an extreme.

That was a key point during a recent talk I gave (featured in last week's post) on the value of weight and waist-to-hip ratio to serve as health and longevity assessments.

This is supported by the work of Dr. Katherine Flegal, who looked at a series of studies known as The National Health and Nutrition Examination Surveys (NHANES) [1]. Each study featured four-to-six-year samples of the United States, with each sample being representative of the whole US population in terms of sex and race percentages.

Dr. Flegal combined the data from all three study periods to find out the risk of death according to age and weight. The results are shown in the table below, with the percentages showing the likelihood of death when compared to the "healthy" group.

Weight Group	25-59 Years	60-69	70+
Very Lean	+25%	+197%	+50%
“Healthy”
Overweight	-34%	-19%	-10%
Obese	-23%	+21%	+13%
Very Obese	+25%	+130%	+12%

*Weight groups feature people who have never smoked and weights are assessed by

body mass index, or BMI.

As you see, the very lean and very obese groups have higher death rates during all age ranges. Specifically, sexagenarians who are very lean or very obese face a much greater death risk.

On the other hand, overweight individuals have lower death rates in all age groups, and the risk associated with obese individuals differs between age groups and is only 13% greater for those who are at least 70 years of age (keep in mind that BMI does not account for the differences in fat mass versus lean mass, so a portion of those in the overweight group likely fall into this group due to an above average amount of muscle and bone tissue).

What does all of this mean? When not falling into an extreme, weight is a poor way to predict how long you will live. In general, weight is a poor way to assess health. As I have discussed before, not all body fat is bad, and habits are much more important to health than size/weight.

At almost any weight, if you develop healthy habits, you will achieve health.

Weight vs. Waist: My Talk on a Simple but Valuable Health Assessment

2013-10-25T15:50:00.000-07:00

Below is a talk I recently gave in Phoenix about the ability of weight and waist-to-hip ratio (WHR) to indicate your current health status. During the talk, I discuss how weight may or may not indicate how long a person will live, how effective weight and WHR are for predicting a future heart attack or diabetes, and how to measure WHR.

Here are a few points I didn't cover or misspoke about during the talk:

During the heart attack slide, I said the researchers split the participants up into different groups based on their weight and WHR. What I meant to say was the researchers split up the data a few times, once into fifths based on weight (heaviest 20%, second heaviest 20%, etc.), and then another time into fifths based on WHR. The rates of heart disease feature the comparison of the top group versus the bottom group.
On the same slide, I placed the asterisk on the 44% difference between the heaviest and lightest weight groups because the difference basically disappeared when the researchers controlled for WHR as an interfering factor (confounding variable). In other words, a larger WHR is a major reason why the research showed heavier people had a greater risk of a heart attack.
You can measure your WHR in centimeters or inches, as long as you use the same unit of measure for both spots. I prefer centimeters because they are smaller units and are the standard measure in just about every country outside the US.

Can Strength Training Help You Sleep?

2013-10-16T15:29:00.000-07:00

About one-third of Americans sleep less than six hours per night [1]. Just a few days of sleep loss increases blood sugar, and long-term deprivation greatly increases the risk of diabetes. Due to a variety of causes, many struggle with consistently attaining at least seven hours of sleep per night. Thankfully, strength training helps...but only for some.

Research shows that strength training improves sleep quality and quantity in less than three months. My personal experiences with clients suggest that people can start sleeping better in less than two weeks. However, this doesn't happen for everyone. Some people are unaffected, and some are partially affected.

As far as why it may work for some, strength training improves growth hormone levels, and growth hormone is linked to the quantity of REM sleep. Strength training also may benefit sleep-preventing respiratory issues.

Strength Training and Sleep

Thanks to inactivity, increased sensitivity to light, elevated autonomic nervous system activity, changes in Circadian rhythm, medication side effects, hormonal changes, and illnesses, sleeping becomes increasingly more difficult with age [2]. It only makes sense that strength training is considered as a sleep aid: it does not require a lot of time, it's an intense activity that could increase fatigue at night, and inactivity is a contributor to sleep loss.

Fortunately, strength training does help, but the effects are not universal. A 1997 study lead by a Harvard researcher found that strength training was able to improve sleep quality in 40% of the group [2]. The other 60% did not digress, but also did not improve.

The study placed older adults with sleeping issues into one of two programs for 10 weeks: strength training or a health education group. The strength training group lifted highly challenging weights, involving all of the major muscle groups, for three workouts per week. The other group served as a control, focusing on health education and socializing during twice-weekly visits. The strength training program was about two-to-three-times more effective for improving sleep, which was assessed through detailed questionnaires.

A more recent study from Texas Tech University also supported strength training's benefit for sleeping, showing a 38% improvement in self-rated sleep quality after three months of training [3]. This study was performed with people who were "good sleepers" to begin with. This demonstrates that strength training can also help those who already have good sleep habits.

Both studies showed that there were no differences between genders - strength training should aid sleep quality with men and women equally.

Experiences in My Practice and Underlying Reasons

As mentioned, the 1997 study showed that a strength training program either improves sleep or has no effect. This is consistent with what I have found in my training practice. I typically find one of three scenarios occur:

Strength training improves ability to fall and stay asleep, and this happens within two or three weeks.
The trainee sleeps better on workout nights, but no differently otherwise.
No effect whatsoever.

The researchers offered no explanation for why weight training is beneficial for some, but the reason could be hormonal. Growth hormone levels are connected to REM sleep [4], and strength training increases growth hormone. In addition, many struggle to sleep due to respiratory issues and strength training may improve sleep apnea. A friend of mine is a physician with the Mayo Clinic in Scottsdale, AZ, and she has noticed her patients with sleep apnea begin to sleep better after starting intense strength training programs. Many of these patients do not lose weight, so the improvement can't be attributed to obesity changes. She now refers her sleep apnea patients to facilities with such programs.

As detailed in the 1997 study, strength training poses no detriment to sleep quality. I highly recommend those who struggle getting quality rest to start strength training. If it doesn't work, the consolation prize will be better physical appearance, more strength, and thicker bones.

*Thank you to Dr. Ben Bocchicchio, who contributed to the information presented in this post.

My Talk on the Impact of Diabetes and Lifestyle Changes

2013-10-02T08:30:00.000-07:00

I recently gave a talk in central Phoenix on why diabetes should be taken seriously and the potential for diabetes prevention through lifestyle changes. The talk is a brief summary of some key points in chapters two and three of my book, The Heart Healthy Lifestyle: The Prevention and Treatment of Type 2 Diabetes.

The video is below. The slide show was left out of the video, so I posted the nine slides under the video.

Use Waist to Hip Ratio: Weight is Overrated for Assessing Health

2013-09-25T12:13:00.002-07:00

One simple measurement indicates health status and it isn't a scale. Waist to hip ratio (WHR) is a strong predictor of heart disease risk. It is also strongly connected to risk factors for heart disease and diabetes.

Even though weight is often the focus of many weight and health-oriented programs, it is a less effective indicator of health in most cases. As I have discussed before, fat location is typically more important than fat quantity. When it comes to heart attacks, heart disease, and diabetes, this is certainly true.

WHR represents two major areas of fat storage, with one being unhealthy (waist) and the other being benign or potentially healthful (hips). As waist to hip ratio increases, so do the negative health implications. While measuring waist to hip ratio is more involved than simply stepping on the scale, it requires no more than one to two minutes (look here for directions).

Relevant Research

Not all fat is created equal. All fat cells secrete proteins that affect inflammation. Visceral fat, which is the fat around our organs, secretes proteins (adipokines) that increase inflammation [1]. Our hips feature only subcutaneous fat, which simply means "fat under the skin." Subcutaneous fat produces more anti-inflammatory proteins. It also acts as a buffer, taking accepting fats (fatty acids) traveling through blood that could have been stored as visceral fat. This buffering process also likely helps enzymes and organs which assist in controlling blood sugar.

Weight fails to distinguish where a person's fat is located. That's why it is such a poor indication of health. When eliminating the influence of WHR on weight, researchers found that weight is a weak predictor of heart disease risk [2]. However, WHR was much more accurate. When weight was eliminated as an influencing factor, the men and women with the largest WHRs were still 55 and 91% more likely to develop heart disease over a nine-year span.

Another study showed that, when split into fifths by weight, those in the heaviest weight group were 44% more likely to have a heart attack than those in the lowest group [3]. However, when divided into fifths by WHR, people with the highest ratio were 252% more likely to have a heart attack than those with the lowest ratios!

Fat location also represents a number of disease risk factors. More abdominal fat is associated with higher blood sugar following meals [4] and the presence of insulin resistance [5], a condition that precedes diabetes. Triglyceride levels in blood are also tied more to abdominal fat than total body fat [6]. On the other hand, more thigh fat is usually paired with health positives, such as lower levels of insulin in blood (a good sign for preventing diabetes) [1] and lower risks for heart disease and heart attacks [2, 3].

Final Thoughts

I'm not saying WHR ratio is perfect and for everyone. WHR, like the scale, does not distinguish lean tissue (muscle, water, bone, etc.) from fat tissue. In addition, some people aren't concerned with improved health as a goal (i.e. a 21 year-old guy looking to build muscle). If health is not a focus, then WHR is unimportant. WHR also does not distinguish between the type of fat in your midsection, whether it is surrounding organs or the benign subcutaneous kind. However, as midsection size increases, it's likely that visceral fat is increasing as well, which is why WHR is generally useful as a health measure.

WHR ratio is an accurate measure to take inbetween blood tests and doctor's visits if health is one of your primary goals. It is an effective way to predict your risk of heart disease and diabetes. Weight and many body fat tests fail to distinguish fat location, which is why they are poor methods for assessing health.

The Effects of Strength Training on Healthy Minds

2013-09-18T09:00:00.000-07:00

The health mindset in the US is often to react instead of proact. As discussed in the previous article, Alzheimer's is the fifth leading cause of death in the US and dementia as a whole affects many seniors.

Senior women at risk for dementia benefit in a number of ways from strength training. Specifically, strength training improves their associative memory, processing speed, and blood flow to various parts of the brain.

However, what does strength training offer healthy minds? Treatments are often successful for people who are ill and leave a lot of room for improvement, but give little to nothing for those of even average health. In the case of men and women who are currently mentally sharp, can strength training move them even further away from the risk of dementia?

To get an answer, let's look at two studies.

First, let's discuss women [1]. Women between 65 and 75 years old strength trained once per week (1X), twice per week (2X), or participated in a control group that did a combination of light lifting along with balance exercises (CON).

The study, conducted at the University of British Columbia, lasted a year. Each exercise session lasted an hour (including warm-ups and cool downs). The exercises were challenging, with every set performed until complete fatigue ("muscle failure") withing six to eight repetitions.

Following the training, the 1X and 2X groups improved their performance in the main cognitive assessment, the Stroop Test, by 12.6 and 10.9%, whereas the score of the women in the CON group digressed slightly. The Stroop Test measures selective attention, cognitive flexibility, and processing speed.

Cognitively healthy men were assessed before and after 24 weeks of strength training in a study at the Federal University of San Paolo [2]. These men were an average age of 68 years old. This study also featured three groups, except it looked closer at the amount of weight and not the frequency of training. The men trained with a moderate resistance (MOD), a high-intensity resistance that was performed to complete fatigue (HI), or were in a control group that featured stretching and light exercises (CON).

In terms of mental and emotional outcomes, both strength training groups improved in a number of ways, whereas the control group digressed or experienced little change. Specifically, the strength-trained men improved in tests assessing short and long-term memory, selective attention, anxiety, depression, overall mood, and self-assessed quality of life.

Underlying Mechanisms and Key Points

The researchers in the San Paolo study made two key points which may explain why strength training is effective for improving cognitive function in seniors. First, in the elderly, mood is strongly connected with cognitive function, so as mood improves, so does cognitive ability. Second, strength training improves blood flow to the brain. This extra blood provides additional oxygen and nutrients to the central nervous system, including structures that are responsible for learning and memory.

Both studies compared two strength training programs. All of the strength training programs induced positive cognitive changes. However, if you asked me to create one specific exercise protocol for seniors based exclusively on the studies above, I recommend the twice-per-week frequency and training to complete fatigue with high-intensity resistances (weights that will induce complete fatigue within eight repetitions at a normal lifting speed).

In the British Columbia study, the only women to improve in peak power were the twice-per-week group. Peak power is key for seniors, as it's the trait necessary for performing the most challenging daily tasks. In the San Paolo study, the HI men were the only group to gain lean mass (muscle, bone, etc.) from training. Since the MOD group didn't train to complete fatigue, it's impossible to say whether the added lean mass came from heavier weights, training to complete fatigue, or both. However, the combination was more successful.

The most important point to take is that strength training with a moderate to difficult resistance, even as little as once per week, will improve cognitive function in seniors aren't showing signs of dementia. In a society where we generally wait for disease or signs of disease to act, be proactive and start strength training now to maintain your mental sharpness.

The Effects of Strength Training on Dementia Risk

2013-09-11T08:30:00.000-07:00

Sometimes we're tied to the tracks when the train is coming through. There are some diseases we simply can't stop. When the warning signs are present, even the best intentions and actions can't prevent what's coming. However, similar to diabetes, dementia may not be one of those diseases. Research from the past three years indicates that strength training can reverse a strong risk factor for dementia.

These results are pertinent to health in the US. One in three US seniors have some form of dementia when passing. Over five million Americans have Alzheimer's disease, the most common form of dementia. Alzheimer's is also the sixth leading cause of death in the US.

The Specific Research Findings

Mild cognitive impairment (MCI) is a well-recognized risk factor for dementia. Researchers from the University of British Columbia said MCI "represents a critical window of opportunity for intervening and altering the trajectory of cognitive decline in seniors," [1].

The same researchers took a group of 70 to 80-year old women through a strength training program for six months. The participating women all were diagnosed with MCI after scoring low on a cognitive test. All participants also complained of memory issues as well.

The strength training program consisted of twice-weekly workouts, with each trainee performing 10 exercises, two sets each. The exercises were challenging, inducing complete exhaustion ("muscle failure") in about six to eight repetitions.

The women were scored on several cognitive tests before and after the six months of training. These tests included the Stroop Test (assessing selective attention, cognitive flexibility, and processing speed), Trail Marking Tests (speed at which a person can switch from one focused task to another), and Verbal Digit Span Tests (short-term memory). Functional MRIs were also conducted.

At the end of six months, the strength-trained women experienced the following gains:

Higher Stroop Test scores
Greater associative memory
Functional changes in three areas of the brain, meaning an increased blood flow was reaching these areas after six months

The study also included groups that participated in a relatively challenging walking routine or a mixture of stretching, relaxation, and balance exercises. Despite all three groups dedicating the same amount of time to their respective programs, strength training was the only intervention that produced cognitive improvements.

Conclusions and Other Populations

MCI is a significant predictor of dementia. However, a challenging strength training program reverses at least some of the MCI issues found in senior women. This change did not occur from the same amount of relatively fast-paced walking or a mix of low intensity activities.

What about mentally healthy populations? Treatments are always more likely to produce benefits in those who have more room to improve. In other words, a diet is more likely to produce weight loss in an obese person than a lean person.

In the next post, I will cover studies that examine the affect strength training has cognitively-healthy men and women. Until then, be good. Thanks for reading.

Heart Healthy Tweets: Cues to Action for Fighting Diabetes

2013-08-28T09:30:00.000-07:00

In health coaching, it's referred to as "the expert approach." That is, the approach where the hired professional tries to help the client only by sharing information and dictating what should be done. The client is given little, if any, autonomy. The underlying assumption is that the client simply doesn't know what should be done or can't get it done due to some flaw of will power. Essentially, the client is incomplete and the "expert" will make the client complete by sharing information. An example of this is a client stating a goal of weight loss, and the nutritionist or trainer saying to go on a low carb or low fat diet.

While this does work with some, the expert approach often fails. Knowledge is not always the missing key. There are usually other problems that need solving: lack of confidence in the recommendation working, lack of confidence in oneself to start or carry out the task, or maybe the recommendation just doesn't fit with the client for some reason. Diet studies are great illustrations of this point: adherence is generally poor even though the participants often receive educational materials and diet counseling.

This gap between science and application is why the field of health behavior exists. People often need other resources to help them start and carry out a desired action. With that in mind, I want to help those who are worried about developing or who have already developed type 2 diabetes. The Heart Healthy Lifestyle: The Prevention and Treatment of Type 2 Diabetes is a resource full of research-based ideas for fighting diabetes, success stories, and tasks to help build confidence in your ability to perform the recommended ideas. However, maybe you want more help, and that's why Heart Healthy Tweets (HHT) exist.

Heart Healthy Tweets

In many behavioral health studies, cues to action are used to serve as reminders, motivation, educational tools, and confidence builders. HHT are daily cues to action and serve those purposes. However, before discussing more about HHT, let's answer the critical question: do cues to action really work?

The Journal of Diabetes Science and Technology published an article that covered studies ranging from three to 12 months with short-message interventions for diabetics [1]. These were mostly text messages covering a variety of purposes including education, information on blood-glucose monitoring, motivation to exercise and eat well, foot-care information, and even medication reminders. Not only were the results overwhelmingly positive, but nine of 10 text message interventions led to improvements in blood sugar.

Here are some of the specific research results achieved, categorized by study length:

Three Months: A hemoglobin A1c decrease of 2.15% in individuals that started at 7.0% or greater. Also, fasting and post-meal blood sugar average decreases of 28.6 mg/dl and 78.4 mg/dl. Participants receiving texts experienced fewer hypoglycemic episodes while exercising and practicing foot care more frequently.
Four Months: Total sitting dropped by 5.9 and 5.2 hours during the weekdays and weekends.
12 Months: HbA1c decreased in the text-message group by a total of 1.32%. On the other hand, the control group— who received the standard care from medical professionals —increased 0.8%.

Having short-message reminders helped diabetics make huge strides in blood sugar, self-care, exercise frequency, and sedentary habits.

Instead of going the text message route, I took a more modern approach: Twitter. HHT provide reminders, motivational messages, and ideas for taking action based on the recommendations found in The Heart Healthy Lifestyle: The Prevention and Treatment of Type 2 Diabetes.

The tweets are published daily around 11:30 AM EST/8:30 PST. Subscribing to HHT is free. The Twitter accounts are:

@THHLbook (my account, featuring HHT as well as health articles and other thoughts)
@HeartHealthyTw (HHT only)

(For those who have not read The Heart Healthy Lifestyle, some of the Tweets may not have the same impact or make sense).

I highly recommend following HHT - it's an effective resource in the path to preventing or improving type 2 diabetes, and every resource helps.

Note: The Heart Healthy Lifestyle: The Prevention and Treatment of Type 2 Diabetes is currently only available in Kindle format on Amazon. For people who don't have a Kindle, iPad, or iPhone, download this free program to read Kindle books on your computer. The download is simple and takes less than a minute.

When Exercise Prevents Weight Loss

2013-08-21T09:30:00.000-07:00

This past Monday, I spoke with a woman who has lost over 30 lbs. but still aims to lose another 15 and hasn't lost any weight in the past few months. To lose the weight, she made significant changes to her eating habits (mainly removing processed foods and non-water beverages) and strength trained. Then she added more exercise. She now participates in group exercise classes, which combine strength training and aerobic exercise, six days per week.

After several conversations where she shared details involving her weight loss timeline, diet, and exercise, she asked for my advice. I recommended exercising LESS...am I crazy?

Frequent Exercise, Metabolism, and NEAT

Our bodies are incredible systems for maintaining homeostasis. When changes occur outside the norm, our bodies often respond with negative feedback. Simply put, negative feedback is an action taken to counter and correct a current situation. For example, when we are cold, we begin to shiver, which generates heat.

Our control system does not like to be overly cold. It also does not want to lose weight. This was demonstrated in a 93-day study with 11 pairs of identical twins at Laval University [1].

The exercise program's goal was to expend about 58,300 calories over the 93 days. It comes out to an average of about 627 calories expended per day through intentional exercise. The participants, which were men averaging 21 years of age, exercised about an hour per day to reach that goal.

At the end of the study, the participants experienced an average metabolic drop of 8% - about 150 to 250 fewer calories expended per day for a young man. Even though the subjects exercised every day and maintained just about all of their fat-free mass (muscle, bone, etc.), their bodies responded by using less fuel for basic needs.

A study at the Birmingham campus of the University of Alabama compared the effects of three exercise programs on resting metabolism and daily calorie usage. The participants were 72 women between the ages of 60 and 74 years old [2]. The groups performed strength training and aerobic exercise each once (1x1), twice (2x2), or three times (3x3) per week for 16 weeks. The strength training and aerobic workouts were the same for each group.

The results were not what you would predict: the 2x2 group was the only group to expend more total calories per day. The 3x3 group actually expended fewer calories per day, which was due to changes in NEAT.

NEAT, or non-exercise activity thermogenesis, is a measure of the energy expended for everything inbetween rest and intentional physical activity. Essentially, NEAT covers all of your low intensity activities, from tapping your fingers on a desk to swaying while you're standing. NEAT is mostly subconscious (have you noticed that some people fidget more than others?).

In the Birmingham study, NEAT increased by 57 and 200 calories per day in the 1x1 and 2x2 groups. On the other hand, the 3x3 group decreased their average NEAT by 150 calories per day (some of these finds are statistically significant, and some are trends).

Finding Your Exercise Frequency

In case you're curious, in the Birmingham study, the 2x2 group lost 4.4 pounds of fat, compared to just 1.1 lbs lost by the 3x3 group. The identical twin study did produce an average weight loss of about 12 pounds. However, there's no comparison group. It's possible that a group performing half the amount of exercise could have lost more weight. In addition, the weight loss rate was about one-tenth of a pound per hour exercised...would you exercise 10 hours to lose a pound?

As you see with both studies, large amounts of exercise can lead to negative feedback reactions within the body. Resting metabolic rate dropped with the twins who exercised roughly an hour per day for 93 days. Women exercising six days per week in the Birmingham study experienced a significant decline in NEAT, unlike the groups that exercised two and four days per week.

With exercise, sometimes less is more. Rest needs to be a regular part of your exercise routine, especially with strength training (to allow for muscle repair and growth). There are basic rules for recovery - don't train the same muscle groups on consecutive days and allow each muscle group at least 48 hours of rest following strength training. Individual response to training frequency varies as well - the researchers in the identical twin study found that the sets of twins varied in their response to training, meaning genetics plays a role in how severe frequent training will impact your metabolism.

If you're not losing weight at your desired pace but are exercising 5-7 days per week, take at least one additional day off and give yourself a few weeks to see what happens.

Reference 2 (Hasn't Published Yet)

Hunter, G. R., Bickel, C. S., Fisher, G., Neumeier, W., & McCarthy, J. (2013). Combined Aerobic/Strength Training and Energy Expenditure in Older Women. Medicine & Science in Sports & Exercise.

Publishing Day: The Heart Healthy Lifestyle is Now Available on Amazon!

2013-08-15T09:07:00.000-07:00

The Heart Healthy Lifestyle: The Prevention and Treatment of Type 2 Diabetes is now available in e-book form on Amazon!

I'm thrilled...and exhausted. I have said that I worked on the book for the past 14 months, but that is not true. Yes, I wrote it over the past 14 months. However, the research going into The Heart Healthy Lifestyle comes from the last decade. That's the time that I have spent reading studies and working with diabetic and prediabetic clients.

More importantly, I'm thrilled because the recommendations in this book are proven to work and I'm excited to see how many people can improve their lifestyles, prevent type 2 diabetes, or prevent the long-term side effects of diabetes: heart attacks, strokes, high blood pressure, nerve damage, loss of sight, kidney failure, limb amputation, premature death, etc..

The book is constructed in a different format than most health books. I am a huge advocate of autonomy, so you are given many ideas for actions you can take in your daily life. Like a buffet, you choose the options for your plate. Each lifestyle idea is provided with a minimum dosage in mind, so if you are worried about trying or sustaining the action, you have the option to start by dipping your toe in the water.

All of the recommendations are rooted in research and have been performed by my clients and/or me. While people naturally vary in the amount they respond to an individual action, it's likely that you will respond strongly (in a positive manner) to at least some of the actions I advocate.

Whether you are a long-time follower of The Heart Healthy Lifestyle (formerly Health-Actualization), a first time viewer, or somewhere in the middle, if this sounds like something that can help you or a loved one, please take a minute to order it today. It's the culmination of years of hard work and a book that provides the opportunity to help many prevent diabetes or diabetic complications through simple lifestyle adjustments.

Thank you for reading The Heart Healthy Lifestyle: The Prevention and Treatment of Type 2 Diabetes and for following. It's been a pleasure to write for you over the past five years. With all of this said, the best is yet to come.

Sean