I’ve found myself become more comfortable talking about my chronic pain and problems revolving around fibromyalgia, but there is a part of that struggle that up until now I’ve only mentioned to one, maybe two people. And that is the chronic struggle I have with myself everyday.
Decades of research continues to demonstrate the benefits of exercise as a nondrug component of fibromyalgia management. Fibromyalgia is a chronic condition affecting more than five million American adults, mostly female. Symptoms include widespread musculoskeletal pain, profound fatigue, sleep disturbances, as well as potential cognitive impairments and depression. Research studies have investigated how people with fibromyalgia respond to traditional aerobic conditioning, strength training, and more mindful modalities such as Yoga, Pilates and tai chi.
While most people are planning for their New Year’s resolutions, many of us with multiple sclerosis are just trying to feel normal again after all the holiday activities. The problem with the holidays is that they take us out of our normal routines and create financial and emotional stress.
$750 billion is a lot of money. It is more than the GDP of many countries. And, according to a recent article published on Medical Consultants Network – it is the amount of money wasted each year by our fabulous health care system. Unimaginable as it may seem, the report from the Institute of Medicine found that the amount of money wasted (roughly 30 cents on every medical dollar) is more than the budget of Medicare ($716 billion per year).
Traditional abdominal exercises, such as sit-ups, put too much stress on a postpartum tummy and back, and are not recommended for new moms. Instead, I recommend a series of exercises developed by Shirley Sahrmann, a physical therapist who specializes in abdominal rehabilitation.
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.
In 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.
Lets take a closer look at the four primary ways you burn calories:
Purposeful exercise: This is what you burn during your workouts. This can vary considerably from day to day.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.
Here is the fate of the 1,000 excess calories the subjects ate:
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.
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
Boston-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
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.
What should I eat before I exercise?
That’s the question athletes of all ages and abilities most commonly ask when I’m presenting a sports nutrition workshop. While most people expect a simple response, such as “Eat a banana” or “Have a slice of toast,” the answer is actually complex and depends on many factors. After all, we are each an experiment of one.
The following information can help you figure out the best way to fuel your body before you exercise.
Does what you eat within 30 minutes of exercise offer performance benefits?
Your body can actually digest and use the food you eat before you exercise as long as you are exercising at a pace you can maintain for more than 30 minutes. Research also suggests that eating a snack just five minutes before moderate exercise can improve performance compared to exercising on empty. Yet, if you will be doing intense exercise—an erg test, track workout, or heavy weight lifting session, you should experiment to determine the best time to eat. You will likely feel more comfortable allowing two or three hours for your pre-exercise food to digest and empty from the stomach.
Will pre-exercise food cause heartburn or nausea?
While many people can comfortably tolerate pre-exercise food, others experience stomach distress. If the food you eat within the hour pre-exercise “talks back to you,” figure out:
What if I exercise in the early morning, before my stomach is awake?
If you drag yourself out of bed to exercise at early o’thirty, before your body and your mind are fully awake, you might not want to eat much of anything. I know of 
many rowers, runners, swimmers, and ice hockey players who eat their breakfast the night before. That is, instead of eating a bowl of cereal at 5:30 a.m., they enjoy it at 10:00 pm, before going to bed. This food helps them wake up in the morning with a normal blood glucose (blood sugar) level, and provides energy for an enjoyable and effective workout.
What if pre-exercise food contributes to diarrhea and undesired pit stops?
Food generally takes one or two days to travel through the intestinal tract. Hence, an undesired pit-stop during a long run on Sunday might relate to food that you ate the day or two before. That is, if you ate an unusually large bowl of high-fiber bran cereal on Saturday when carbo-loading for the Sunday long run, you might end up wishing you’d carbo-loaded on low-fiber corn flakes or Rice Chex. Or maybe that bean burrito on Friday night caused the problem? You can try tracking your food and fiber intake, looking for suspicious patterns.
In general, exercise speeds up intestinal motility. With time, most bodies can adjust if you train your intestines to handle pre-exercise food. For example, one runner started by nibbling on one pre-exercise pretzel, and then two, and gradually built up his tolerance to the suggested 100 to 300 calories of carbs consumed within the hour pre-exercise. He enjoyed the benefits of feeling stronger at the end of his runs.
Should I purposefully not eat before I exercise because I want to lose weight while I exercise?
One client reported she didn’t eat before she went to the gym because she was exercising to burn calories. Why would she want to add calories to her diet? Wouldn’t that defeat the main purpose of her workouts?
Think again: If you consume 100 to 300 calories before you workout, you will be able to exercise harder, at higher intensity and burn more calories than if you schlep through the session on fumes, with little enthusiasm or enjoyment. (Plus, you will not be as hungry afterwards and will be able to refrain from over-indulging.) Trust me, the plan to exercise-on-empty is hard to sustain; it is not fun. Just notice the drop-off in attendance at the gym between Jan. 1 and Feb. 1…
Food is fuel. As an athlete or a fitness exerciser, you need to fuel your body appropriately—including pre-exercise. Just as you put gas in your car before you take it for a drive, you want to put fuel in your body before you embark on a busy day. Be as nice to your body as you are to your car, please!
By eating nothing before my morning workout, won’t I burn more fat?
You may have heard you can burn more fat during low-level “fat burning exercise” if you do not eat beforehand. Yes, you might burn more fat than carbohydrates, but burning fat differs from losing body fat. You lose body fat when, at the end of your day, you have created a calorie deficit. That is, you will lose body fat (weight) if you have eaten only 1,800 calories by bedtime, even though you burned off 2,200 calories during the day. By fueling pre-exercise, you can have a better workout—and perhaps burn more calories than if you were to run on fumes.
To lose body fat, I suggest you fuel adequately by day, so you will have energy to enjoy an active lifestyle, and then lose weight at night by eating a lighter dinner. Fueling by day and dieting by night (so you lose weight when you are sleeping), is far preferable to restricting by day only to over-indulge at night due to extreme hunger.
Can training on empty enhance endurance?
Some recent research suggests that highly competitive athletes might be able to enhance their performance if they train under-fueled a few times a week. These depletion workouts can alter muscle metabolism so that the muscles are able to compete better when fully fueled.
If you want to “train low,” be sure to do your important high intensity workouts when you are well fueled. You cannot (enjoyably) exercise hard when you are running on fumes. Your performance will suffer unless you do some high quality hard workouts when you are well fueled.
From The Athlete’s Kitchen; Copyright: Nancy Clark, September 2014
Boston-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