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Why Some People Eat Lots— But Don’t Get Fat

Some of my clients seem jealous of their teammates. “They eat twice as much as I do and they are skinny as a rail. I just smell cookies and I gain weight,” spouted one collegiate runner. She seemed miffed that she couldn’t eat as much as her peers—and she couldn’t understand why. They all ran the same mileage, did the same workouts, and were similar in body size. Life seemed so unfair!

Yes, life is unfair when it comes to weight management. Some people gain (or lose) body fat more easily than others. Unfortunately, fat gain (or loss) is not as mathematical as we would like it to be. That is, if you persistently overeat (or undereat) by 100 calories a day, in theory you will gain (or lose) 10 pounds of body fat a year. But this theory does not hold up in reality. People vary greatly in their susceptibility to gain or lose body fat in response to over- or under-eating.

muesli with fresh fruits as diet foodIn general, research has suggested when people overeat, about 85% of the excess calories get stored as fat and the rest gets lost as heat. Overfed fat cells grow in size and in number and provide a storehouse of energy. Obese people commonly have enough fat stores to last a year or more; even lean athletes have enough fat stores to fuel a month or more. Fat can be advantageous during a time of severe illness or a famine.

Burning calories

Lets take a closer look at the four primary ways you burn calories:

  1. Basal metabolic rate (BMR): BMR refers to calories burned when you are at rest and unfed, such as upon waking in the morning. Your heart, lungs, liver, and other organs use a fairly consistent amount of energy each day to keep you alive. Some athletes believe they have a slow metabolic rate that causes them to gain weight easily. Not the case. Very few people have a “slow metabolism.”
  2. Thermic effect of food: This refers to the energy needed to digest, absorb and either convert food into fuel for the muscles and organs or store the excess energy as body fat. The thermic effect of food increases ~14% with overfeeding, due to the added energy needed to process the excess food.
  3. adam-runPurposeful exercise: This is what you burn during your workouts. This can vary considerably from day to day.
  4. Non-exercise activity thermogenesis (NEAT): This refers to activities of daily living (brushing teeth, washing dishes, etc.), fidgeting, energy used to maintain posture when standing and sitting, and spontaneous muscle contractions that occur during the day apart from your purposeful exercise. People with high NEAT spontaneously putter around the house, fidget with pencils, use their hands when talking, and are animated and lively. NEAT is genetic and somewhat predictive of who stays lean throughout their lifespan. People with low NEAT are good at sitting quietly.  For example, obese people tend to sit 2.5 hours more a day than their peers and this can save them about 350 calories a day. Are they obese because they sit more? (Or do they sit more because they are obese?) Is NEAT the problem?

What happens with overeating?

To better understand why some people lose or gain weight more easily than others, Dr. James Levine PhD of the Mayo Clinic designed a study to look at the biological mechanisms that hinder fat-gain. Dr. Levine studied 16 non-obese subjects (12 males and 4 females), ranging in age from 25 to 36 years. They volunteered to eat 1,000 excess calories a day (above what they needed to maintain weight) for 8 weeks. The subjects were healthy, did not do purposeful exercise more than twice a week, and maintained a stable weight. Prior to being overfed, the researchers monitored the subjects for two weeks to learn how much food they regularly consumed to maintain their weight.

During the study, the subjects lived at their homes but ate supervised meals at the research center. The food had been carefully prepared and measured in a metabolic kitchen. The weight-gain diet was high in protein (20% of total calories) and fat (40% of calories), and low in carbohydrate (40%). The researchers accounted for almost all of the excess 1,000-calories a day. On average, ~430 of the 1,000 calories were stored and ~530 were dissipated via increased energy expenditure. The researches even measured 3 days of poop before and at the end of the study to be sure the subjects did not excrete calories during overfeeding. Only 38 calories a day got flushed down the toilet during overfeeding — 13 calories more than during normal eating.

healthy diet Depositphotos_6270042_xsHere is the fate of the 1,000 excess calories the subjects ate:

  • Energy stored as fat ranged from 60-685 calories per day
  • Energy stored as muscle ranged from 15-80 calories per day
  • Additional calories burned by organs: about 80, on average
  • Additional calories used to digest the extra food: about 135, on average
  • Additional calories burned via NEAT ranged from none to 690.

The researchers used highly accurate methods to measure changes in body fat (DXA). Some of the subjects gained 10 times more fat than others, ranging from 0.8 to 9 lbs (0.36 – 4.23 kg). The overall weight gain ranged from 3 to 12 lbs (1.4 -5.5 kg), some of which was additional muscle. NEAT explained the big variation in weight gain that occurred with the subjects in this overfeeding study. The subjects who were good fidgeters and putterers gained less.

The average increase in NEAT was 336 calories a day, but this actually ranged from burning 98 calories less than baseline to burning 690 calories more than baseline. The subject who burned the most calories strolled around the research facility (or did equivalent movement) about 15 minutes more per hour than the other subjects.

Conclusion

Despite popular belief, the ease of gaining weight is unlikely due to having a “slow metabolism.”  Most often, athletes who are easy gainers are mellow, sit calmly, and don’t fidget. This contrasts to teammates that are bouncing around the locker room. If you are the mellow-type, blame your genetics — not a slow metabolism — for your ease of weight gain. And perhaps you can be grateful you can spend less money on food because you don’t eat as much?

References
Levine J, N Eberhardt, M Jensen. Role of Nonexercise Activity Thermogenesis in Resistance to Fat Gain in Humans. Science  283:212-214, 1999.

Levine J, Vander Weg M, Hill J, Klesges R. Non-exercise activity thermogenesis: the crouching tiger hidden dragon of societal weight gain. Arterioscler Thromb 26(4):729-36, 2006.


From The Athlete’s Kitchen; Copyright: Nancy Clark, October 2014

wheatiesBoston-area sports nutritionist Nancy Clark, MS, RD offers one-on-one consults with both casual and competitive athletes. Her private practice is in Newton, MA (617-795-1875). For information about her Sports Nutrition Guidebook (2014) and food guides for runners, cyclists and soccer players, see www.nancyclarkrd.com. For online education, see www.NutritionSportsExerciseCEUs.com

Diabetes Word Cloud Concept

Fitness Professionals: November is Diabetes Awareness Month

Did you know in 1980, according to the Center for Disease Control (CDC), 5.6 million Americans had been diagnosed with diabetes? This had more than doubled by 2000, with 12 million reported cases of diabetes. If this trend were to continue, by 2020 there would be an estimated 24 million diabetics in the United States alone. However, in 2012 the American Diabetes Association (ADA) estimated that 9.3% of the population, or 29.1 million Americans, have diabetes.

Senior woman lifting fitness balloon

Movement Toward Healing: Breast cancer rehabilitation using a Pilates-based approach

Ann Marie Turo, occupational therapist, yoga and Pilates instructor and Reiki master, owns a thriving Pilates-based studio. When Turo was diagnosed with a breast cancer reoccurrence in 2002, she was devastated. Despite having limited range of motion, strength and endurance, as well as decreased ADL function, it was not recommended that she have any rehabilitation. This situation is not unusual.

After undergoing a self-described “meltdown,” she decided to take matters into her own hands. Turo designed her own rehabilitation program, which included visualization, Pilates, yoga and Reiki, along with traditional occupational therapy modalities.

Turo believes that an “integrated” approach is the best way to heal physically and psychologically from breast cancer. That is why she created Integrated Mind and Body in Boston.

Pilates is enjoying wide popularity throughout the United States as a form of exercise. It focuses on the whole person, uniting mind and body through a series of flowing movements that require both flexibility and strength. Recently, therapists have began incorporating Pilates as part of their general rehabilitation program for athletes, back injuries, hip/knee replacements and even autism.

Breast cancer survivors are starting to benefit from Pilates as well. A recent pilot study (Keays, 2007) found a modest effect in improving shoulder abduction and external rotation. However, further research is necessary to determine both the safety and efficacy of Pilates, as well as optimal exercise guidelines.

Gym woman pilates stretching sport in reformer bedThere are eight principles of Pilates: relaxation, concentration, control, centering, fluidity, precision, stamina and breathing. Joseph Pilates, who developed this movement method, believed that one must pay attention to each exercise and perform it with the utmost control to avoid injury. He believed that it is not the quantity that counts, but the quality of each repetition.

Pilates exercises initiate from the “powerhouse,” or core musculature. Therefore, every exercise is an abdominal exercise that initiates at the center and flows outward. This is in tune with developmental principles and ensures a proper base from which to perform more distal work.

Proper breathing is another cornerstone of this technique. Deep breathing is essential to activate the transverse abdominal muscles, which is why the exercises are coordinated with both inhalation and exhalation. Inhalation facilitates spinal extension and trunk stability while exhalation facilitates spinal flexion and scapular depression.

During upper extremity work there should be a sense of gliding the scapulae down the back to promote shoulder stability. Pilates can incorporate more than 500 exercises, which can be performed either on a mat or on special equipment, such as the Cadillac, Reformer and barrels. These exercises can be modified to meet the needs of patients through the use of springs to assist and mobilize the muscles, and provide resistance when patients are stronger.

Women who are diagnosed with breast cancer will have surgery, which can be followed by systemic treatment such as chemotherapy and/or hormone therapy and then, possibly, radiation. After undergoing breast cancer surgery and treatment, the body seems lost and out of control. Breast cancer survivors are faced with many issues including fatigue, loss of range of motion and strength in the affected arm, lymphedema risk, weight gain and poor posture.

Furthermore, there are psychological implications to being diagnosed with a life-threatening disease and breast removal. Pilates is one tool that can help one regain a sense of mastery and control over a body that seems foreign and lost.

How Does the Rehab Work?
Loss of range of motion and tightness in the axillary and pectoralis regions is common after breast cancer surgery, especially after axillary lymph node dissection and mastectomies. The more extensive the surgery, the greater the limitations secondary to greater tissue loss, pain and scar formation. Because many of the Pilates exercises are performed in the supine position, the neck and back can be comfortably supported. Active assisted exercises with a towel or band are used to improve mobility of the shoulder girdle while the spine is in a neutral position.

Aerobic Pilates personal trainer instructor womenPilates focuses on the scapula stabilizers including the rhomboids, latissmus dorsi, middle/lower trapezius and serratus anterior while performing active range of motion, which is different than a traditional rehabilitative approach. The use of imagery is often used to coordinate the mind and body, so one may be told to “place those wing bones in your back pocket.” Even some of the exercises can be done in side lying, which eliminates gravity, making the shoulder exercises easier to perform.

Pilates emphasizes proper alignment and posture which improves movement efficiency, opens up all the lymphatic channels and facilitates good breathing.

The risk of lymphedema, the buildup of protein-rich fluid in the chest, trunk and arms, is another concern for anyone who has received lymph node dissection and/or radiation. This is due to scarring of the lymphatic vessels that disrupts lymphatic flow, along with the loss of mobility. This can interfere with normal lymphatic or venous drainage from the arm.

Since diaphragmatic breathing is used in Pilates both to stabilize and mobilize the spine, this enhances trunk organization. Lymphatic fluid can be propelled through the body with this type of breathing, along with proximal to distal exercise. As one inhales and exhales, the pressure changes, stimulating lymphatic return. In addition, diaphragmatic breathing lowers heart rate and blood pressure, creating a relaxation response conducive to emotional healing.

Use of the deep stabilizer muscles, including the transverse rectus abdominas and multifidus, encourages pumping to the thoracic duct, the main area for lymphatic return. This in effect clears the trunk for fluid from the axillary region and pectoralis area where lymph flow may be impaired.

Once the trunk is cleared, one can exercise the arm at risk. Compression garments or bandages should be worn while exercising if at risk. Exercises should be progressed slowly and gradually to allow the lymphatic system to adjust to an increased lymphatic load.

There are usually few repetitions for each Pilates exercise, which is a natural fit for women at lymphedema risk.

Aerobics pilates women feet  with yoga ballsDealing with Fatigue
Fatigue both during and after cancer treatment is the most common side effect of the treatment. Many women feel unable to function and perform daily activities while undergoing chemotherapy or radiation treatments, and this fatigue can become overwhelming as treatments accumulate. However, many research studies have confirmed the advantages of both strength and aerobic conditioning even during treatment. Pilates offers a gentle introduction or re-introduction to regular exercise that can slowly help restore strength and endurance. One can gradually build up by performing the exercises at least twice a week. This should be combined with an aerobic conditioning program, such as walking, when able.

It is time to think about alternative approaches to meeting the needs of this population, along with individuals suffering from other chronic conditions. As one can readily see, Pilates offers many benefits to women recovering from cancer, especially since occupational therapists are well trained in the modification of such activities and exercises.

At Integrated Mind and Body, Turo works with breast cancer survivors as well as individuals who have had depression, total knee replacements and total hip replacements. She requires a signed physician’s release form, and does a full intake on clients that includes medical history, pain, postural analysis and ADL evaluation, as well as the standard occupational therapy assessments.

Clients pay out of pocket to receive Pilates and Reiki in conjunction with traditional therapy services. Turo demonstrates that therapists can balance an occupational therapy frame of reference along with other healing modalities to be successful.


Reprinted with permission from Naomi Aaronson, MA, OTR/L, CHT; Also published on Advance Healthcare Network.

Naomi Aaronson, MA, OTR/L, CHT can be reached at www.recovercisesforwellness.com.

Baby Boomers and Joint Replacement Surgery

Close to 800,000 people in the United States will have a joint replaced this year. Osteoarthritis is the main—but not the only—reason. Joint replacements have become so common that most massage therapists can expect to see clients who are in various stages of recovery from this procedure. But just because it’s common doesn’t mean it’s risk-free, and a person who has had a joint repaired has a significant chance of complications that impact bodywork choices in both the near and long-term.

Wellness Coaching & Heart Disease

Maybe The Last Heart Attack

Each year over one million Americans experience a heart attack, about one every thirty seconds. CNN produced a program recently about this that has everyone talking: Dr. Sanjay Gupta Reports: The Last Heart Attack. (watch the entire program while it’s archived here)

Following the odyssey of former President Bill Clinton and two more every-day Americans, Dr. Gupta introduces us to the work of Dr. Arthur Agatston whose method of screening for coronary calcium is considered one of the best predictors of heart disease. We’re also exposed to the work of Dr. Dean Ornish and Dr. Caldwell B. Esselstyn whose diet and lifestyle-based programs have shown recognized medical effectiveness at preventing and even reversing heart disease.

“Heart disease could be as rare as Malaria in our country if we put into practice what we already know,” says Ornish. Gupta asks “Could we see the last heart attack in America?” The program brings us excellent information about what we need to do, but hangs on the gigantic “if” in the middle of Ornish’s statement.

Doctor giving medicine to senior woman for arthritis painWhat we know is that medical check ups using the best testing methods available must be combined with successful lifestyle improvement. We know the formula. “Although people with a family history of heart disease are at higher risk, you can take steps to dramatically reduce your risk. Create an action plan to keep your heart healthy by tackling these to-dos: get active; control cholesterol; eat better; manage blood pressure; maintain a healthy weight; control blood sugar; and stop smoking.”  —The American Heart Association.

What they are recommending, is all about behavioral change.

The work of Dean Ornish has been widely accepted as medically legitimate for years, yet always qualified by mentioning that the probability of Americans adopting the lifestyle recommended is remote. Becoming a complete vegetarian, exercising regularly, practicing stress management skills and increasing social and emotional support is a tall order to say the least. Yet it works!Gupta’s report is telling us that change is possible, now we have to discover how.

Here are some suggestions for the behavioral side of preventing that potential heart attack.

1. Know about your current state of health, in detail. Don’t put off that check-up or blood-work, make a commitment to yourself to get it done.

2. Envision what you want your health to be like.


3. Ask yourself, “What has to change in my life for me to live that vision?” This creates a solid foundation for you to create the plan that you will follow to make your vision a reality.


4. Develop a wellness plan that has a series of small steps. Small steps overtime lead to large lifestyle changes.


5. Gather support for your plan. Share your vision and plan with the people you know who will be positive and encouraging.


6. Track your behavior. Avoid self-deception by writing down or entering on a phone app your progress.


7. Acknowledge and celebrate every success along the way to a better life.

For the person who has already had that first heart attack all of this information and the contents of “The Last Heart Attack” are especially important. Like David Servan-Schrieber says about cancer, there is a lot we can do about heart disease, and when we don’t let people know about the legitimate resources and information out there, we are giving them “false hopelessness.”

Diagram of healthWellness and health coaches need to know about this information as they help their clients explore their way forward towards a wellness way of living. Coaches need to insist that any client they are working with on health issues be under active medical care. Lifestyle improvement is no substitute for medical treatment. Taking on the more behaviorally demanding protocols of lifestyle improvement that Ornish and Esselstyn require may be incredibly easier and more effective with an active alliance with a wellness coach.

We know that people can be successful at improving their health if they can be successful at lifestyle change. Wellness coaching may be the bridge to span the huge gap created by the word “if”.


Reprinted with permission from the Real Balance Wellness Blog.

Michael Arloski, Ph.D., PCC is a licensed psychologist, Professional Certified Coach (ICF) and a Certified Wellness Practitioner. His work as a professional coach with Real Balance Global Wellness Services includes coaching people to achieve more of their potential in three areas: wellness coaching; leadership coaching; and mentor coaching of aspiring coaches.

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todaysdietitian-october

The Power of Blueberries

Evidence shows this fruit is jam-packed with antioxidants and phytochemicals that may help prevent and slow the progression of chronic diseases.

It’s rare to encounter a client or patient who doesn’t enjoy the taste of blueberries (Vaccinium spp). But beyond their tangy sweetness and the fact you can pop them into your mouth one by one or incorporate them into many recipes, blueberries offer a wealth of health benefits.

Blueberries are rich in antioxidants and phytochemicals that research has shown are associated with cardiovascular and cognitive health and cancer and diabetes prevention. Their popularity is on the rise in North America. And the production of fresh and processed blueberries has grown steadily by an average of 20% every two years since 2008.1 Between 2005 and 2012, North America’s blueberry fields increased 74% from 71,075 to 123,635 acres. British Colombia has the most acres in cultivation, while Michigan has been a world leader in production volumes of both fresh and processed blueberries for many decades.

Nutritional Properties and Antioxidant Composition
Dietitians have stressed the importance of incorporating low-fat, fiber-rich, and nutrient-dense foods into their clients’ and patients’ diets for decades. “Everyone should be aiming to reach their recommended amount of fruits and vegetables for optimal health, and blueberries are an easy and delicious way to help you reach your goal. Just 1/2 cup is considered one serving of fruit, and they require no slicing or peeling—plus there’s no waste,” says Joanne Tehrani, RD, communications manager for the US Highbush Blueberry Council. Blueberries are an excellent source of fiber, vitamins A and C, potassium, and folate.2 One cupful contains 14% Daily Value of fiber. Moreover, blueberries are one of the richest sources of antioxidant phytonutrients.3 Blueberries’ diverse range of phenolic compounds, such as anthocyanins, quercetin, kaempferol, myricetin, and chlorogenic acid, contributes to their overall antioxidant capacity.4,5 (Antioxidant capacity, measured by a chemical laboratory analysis technique called oxygen radical absorbance capacity is one of several methods that doesn’t account for bioavailability, distribution, and metabolism of a product’s ingredients.) “Blueberries also have a rich diversity of different anthocyanin species—like 26 different anthocyanins—whereas some other berries may feature only two or three different anthocyanin species,” says Mary Ann Lila, PhD, MS, director of the Plants for Human Health Institute and a David H. Murdock distinguished professor at North Carolina State University, who has spent 18 years studying various Vaccinium species.

Read the full article at Today’s Dietitian…

From October 2014 issue, Vol. 16 No. 10 P. 42; written by Jasenka Piljac Zegarac, PhD. Reprinted with permission.

todaysdietitian-october

Breast Cancer and Exercise

October is National Breast Cancer Awareness Month, when pink ribbons remind women to schedule their mammograms and honor those who have died from or survived breast cancer. According to the National Cancer Institute, one in eight American women (12.3%) will develop invasive breast cancer during her lifetime.