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creatine (2)

The Benefits of Creatine Supplementation for Active Older Women

Loss of muscle and bone mass is arguably the greatest potential threat to vitality and independence in the aging female population. As ovarian estrogen declines during the menopausal transition, muscle and bone undergo significant changes.

Muscle mass and strength decline and loss of bone density accelerates after the onset of menopause. When these losses become severe, there is an increased risk of disabling falls and fractures and associated higher rates of medical comorbidities including high blood pressure, type 2 diabetes, depression, and cardiopulmonary disease.

Previously, in Athletic Aging, I posted about this very issue. Grip Strength as a Marker of Vitality in Mid-Life Women and Body Composition and Hormone Therapy – Truth and Tales are two articles that discuss the interplay among female reproductive hormones, muscle mass and function, body composition, and metabolism.

But it’s not just about muscles and bones! Mid-life women also struggle with sleep deprivation, brain fog, depression, and mood lability.

Today we continue this important conversation and take a deep dive into the science that explores the potential benefits of creatine supplementation in mid-life women that go beyond our muscles and bones!

How Does Creatine Work?

Creatine is a naturally occurring compound that is synthesized in the Human body by the kidneys and liver from the amino acids glycine and arginine. It is stored as phosphocreatine which supplies the energy that fuels muscle movement. Creatine is also found in animal proteins such as red meat, fish, poultry, and organ meats.

The phospho in phosphocreatine is a critical component for the production of adenosine tri-phosphate (ATP) found in tiny cell components called “mitochondria” that exist in every type of cell throughout the body. Think of the mitochondria as the “batteries” that power the cells within our tissues, and ATP as the “charge”. The “T” stands for tri -or 3 phosphates which is like 3 “bars” on your cell phone. When energy is used, ATP is converted to ADP – the “D” is for di- or 2 bars on your phone. So to recharge your phone to 3 bars (ATP), you need to plug it into the electrical outlet. Creatine serves as the source of energy to fully charge the mitochondria and replenish the stores of ATP.

What the Science Tells Us

Athletes have effectively used creatine supplementation for decades to support performance. Creatine is among the safest and most well-studied supplements in the sports industry.

Most of what we know about creatine was learned through the study of young, male athletes. Creatine has been shown to be effective in enhancing muscle strength, mass, and performance in strength-based activities. Because the aging population is particularly vulnerable to loss of muscle mass and function, attention has been turned toward investigating the potential use of creatine supplementation for preserving muscle mass and function in older individuals – particularly menopausal women.

A review of several randomized control trials and meta-analysis of studies investigating creatine supplementation in older female adults has discovered the following:

  • Women have 70-80% lower creatine stores and consume lower dietary amounts of creatine compared to men.
  • Declining estrogen levels are associated with increased inflammation and oxidative stress and may contribute to the reduction in protein synthesis and response to anabolic stimuli. Creatine supplementation has been proposed as a counter-measure to the inflammatory effects of declining estrogen.
  • Creatine supplementation with a high-dose load and maintenance of 3-5g daily in the absence of resistance training had minimal impact on muscle mass, strength, function, and bone density parameters in menopausal women.
  • Although studies have shown mixed results, the vast majority of research shows improvement of muscle strength, function, and bone density parameters with supplementation of 5g of creatine daily when combined with a consistent, long-term strength-training program of 3 months or more in menopausal women ages 50-65+.
  • There were no significant adverse effects of creatine supplementation in menopausal women across multiple studies.
  • Clinical evidence has reported positive effects of creatine supplementation on mood by restoring brain energy levels and balance. Evidence also suggests that creatine supplementation may favorably impact the dopamine and serotonin systems.
  • Creatine supplementation has consistently demonstrated improved cognitive performance and brain function, particularly in cases of sleep deprivation and mental fatigue. This is important given many mid-life women struggle with vasomotor symptoms (hot flashes) and disrupted sleep.

Summary of Recommendations for Mid-Life Women

  • Engage in a program of consistent (at least 2-3 times weekly) resistance/strength training as a permanent part of your long-term workout program.
  • Daily supplementation of creatine monohydrate may improve muscle strength, mass, function, bone density parameters, and body composition when combined with a consistent resistance/strength training regimen.
  • Dosing: Many experts agree a loading dose is not necessary. A daily dose of 5g/day (ideally in a shake, beverage, or with food) over time will achieve appropriate tissue saturation levels. *Vegetarians may require a dose of 5-10g daily.
  • Check out this podcast featuring Dr. Darren Candow, one of the leading creatine researchers for an incredibly informative review of how creatine works and the potential benefits of supplementation.
  • If you have chronic conditions involving your kidneys or liver, check with your doctor before incorporating creatine into your nutrition plan.

Article reprinted from Athletic Aging with author permission.

Dr. Carla DiGirolamo is a double Board-Certified Obstetrician/Gynecologist and Reproductive Endocrinologist who specializes in the care of reproductive age and mid-life women. Carla completed her residency training in Obstetrics and Gynecology at Brown University Medical School/Women and Infants’ Hospital and her Reproductive Endocrinology training at the Massachusetts General Hospital at Harvard Medical School. She is a North American Menopause Society (NAMS) Certified Menopause Practitioner and has been featured in multiple podcasts and speakerships at various events discussing the physiology of the hormonal changes of menopause, hormone therapy and functional fitness training.

 

References

Smith-Ryan, AE et al. Creatine Supplementation in Women’s Health: A Lifespan Perspective; Nutrients 2021, 13, 877. https://doi.org/10.3390/nu13030877Ellem

Pinheiro dos Santos, E et al. Efficacy of Creatine Supplementation Combined with Resistance Training on Muscle Strength and Muscle Mass in Older Females: A Systematic Review and Meta-Analysis; Nutrients 2021, 13, 3757. https://doi.org/10.3390/nu13113757

breakfast 3

Why is Breakfast Really That Important?

There are so many misconceptions and misinformation about nutrition. Everyone wants to believe they are eating to properly fuel their body and prevent disease. There is one clear path to learn how to separate fact from fiction when it comes to nutrition information. For some reason, many people prefer to follow the nutrition fads, instead of trying to understand how the body works.

Beer Glass Alcohol

Alcohol & Athletes: The good, the bad and the ugly

When asked, Is beer good for runners? Running legend Jim Fixx’s answer was, “Sure, if it’s the other guy drinking it!” By abstaining from alcohol, you can indeed gain an advantage over your competitor’s poor judgment. Just how bad is alcohol for athletes? Does it have any health benefits, too? Let’s look at some of the good, the bad, and the ugly regarding alcohol and athletes.

The Good

Socializing with a glass of wine, a beer, or a cocktail can add a nice touch to the end of the day for those who like to relax with an alcoholic beverage. Raising a glass to celebrate a victory is a fond tradition. But we know surprisingly little about possible health benefits of drinking in moderation because almost all studies are based on self-reported information that gets tangled up with lifestyle. Do adults who do moderate social drinking enjoy a healthier lifestyle than non- or heavy-drinkers? Does alcohol make them healthier—or do social connections make the difference? While moderate alcohol intake has been linked to reduced risk of heart disease, so has eating a healthy diet and being physically active.

The Bad

Alcohol has a negative reputation regarding athletics, be it heavy beer consumption after a hard work-out, or teams enmeshed in a culture of binge drinking. Student-athletes binge-drink more than non-athletes. Male athletes binge-drink more than female athletes. And all athletes drink more than non-athletes. The higher alcohol intake of athletes can be attributed to stress and anxiety associated with being a competitive athlete, increased muscle pain and soreness, socializing or bonding with teammates, and the belief the athlete “earned” the drink—a reward for having completed the hard effort.

The Ugly

Alcohol is the 3rd leading preventable cause of death in the US. (Tobacco is Number One. A poor diet with inactive lifestyle is Number Two.) Any level of alcohol intake can contribute to several types of cancer

How do you know if you have a drinking problem?

Moderate drinkers typically sip (not gulp) their drinks, stop drinking before they get drunk, and do not drive after drinking. Problem drinkers commonly drink to get drunk and to solve their problems. They drink at inappropriate times (such as before going to work) and may become loud/angry or silent/reclusive. People addicted to alcohol start drinking with no plan, deny drinking, hide bottles, and miss work or school because of hangovers.

Alcohol management

Despite the bad and the ugly, alcohol is an undeniable part of our sports culture. The following tips offer suggestions for helping athletes manage alcohol.

• Don’t drink excessive alcohol before an event—especially in the summer heat! Drinking too much the night before an event will hurt your performance the next day. You’ll notice a slower reaction time and reduced eye-hand coordination and balance. Research with Australian rugby players who consumed on average 9 beers post-game (with a range of <1 to 22 beers) indicates—no surprise— their high alcohol intake impaired their performance. Other studies report athletes are less able to do repeated sprints (think soccer, hockey) and jumps (volleyball, basketball). Among heat-stricken summer runners, a common denominator was booze the night before the race.

• If you are going to drink the night before or after an event, plan to also consume a proper sports meal with extra water. While excessive drinking is obviously problematic, a modest amount of alcohol consumed along with a balanced meal will unlikely have a negative impact. Yes, alcohol impairs glycogen resynthesis a bit. But in the real world of sports drinking, athletes who are heavy drinkers tend to make high fat food choices (nachos, burgers, etc.). The lack of healthful grains, fruits and veggies (carbohydrates) more significantly hinders glycogen replacement!

• First quench your post-exercise thirst with water, then enjoy alcohol, if desired. Alcohol is a diuretic; it stimulates the formation of excess urine. Whiskey and other spirits with a high alcohol content will dehydrate (not rehydrate) you. If you “must” drink spirits, ask for extra ice with the cocktail. Beer would be the better choice, given the alcohol content of beer is lower and the water content is higher. Yes, dehydrated adult athletes can rehydrate with a beer or two. Low-alcohol beer is the wiser choice, and no-alcohol beer the wisest beer choice.

• Heavy alcohol intake is not on the list of Best Recovery Practices for athletes to follow! Remember: bad things happen during exercise and good things happen during recovery. Wisely chosen recovery fluids and foods help you rehydrate, refuel, and repair your muscles. Adding alcohol to the mix slows down muscle repair, protein synthesis and adaptation processes. Yet a glass or two of wine or beer, along with plenty of water and food, is permissible.

• Alcohol is a source of calories that can quickly add up. Add in the calories in the pizza, nachos or munchies that you can easily overeat when alcohol lowers your inhibitions, and you can easily succeed in gaining body fat. Just five Heineken Light Beers add 500 calories. A goblet of wine can easily add 200 calories. Be wary of drinks that come with umbrellas! (400-800 calories/10-ounces)!

• Beware of drinks in a can, such as White Claw Surge with 8% Alcohol By Volume. (ABV). You can end up drinking more alcohol than you intended. You might want to stick with the original White Claw—hard seltzer with 5% ABV—similar to most canned beers, though some craft beers have a higher alcohol content.

• Don’t drink alcohol if you want a good night’s sleep. Alcohol might help you fall asleep faster, but it disrupts your sleep cycle. You’ll get less restorative sleep. Alcohol alters body temperature, which can affect how well you sleep. It also aggravates snoring (due to relaxed muscles and a lower breathing rate), so your bed partner becomes sleep deprived and grumpy. Plus, you’ll need to go to the bathroom more often in the middle of the night. None of this enhances athletic performance.

• If you don’t want to drink, be prepared to quickly say “No thanks” in a polite but convincing voice. If the person keeps insisting, respond again: “Î don’t want to drink today. I’d appreciate if you’d help me out.” Instead, be pleased that you will enjoy the natural high of exercise.


Nancy Clark MS RD CSSD counsels both fitness exercisers and competitive athletes in the Boston-area (Newton; 617-795-1875). Her best-selling Sports Nutrition Guidebook is a popular resource, as is her online workshop. Visit NancyClarkRD.com for more info.

healthy-eating-path

Reducing Calories May Help You Live Longer


Mounting evidence suggests that we may be able to live a longer, healthier life by strategically restricting our energy intake. For many years the scientific community has known that a surplus of energy intake results in the storage of fat, which is linked to chronic disease, and premature death. However, now emerging evidence suggests that restricting calories may be able to slow the rate in which we age. Aging can be categorized as either primary or secondary. Primary aging is considered inevitable at the date of this publishing and is the biological maturing and eventual breakdown that accompanies the years of age beyond 30.  Secondary aging comes from external influences such as obesity and lifestyle factors that cause cellular damage and is not part of the natural aging process. (2)

What is calorie restriction? Calorie restriction describes a process where one limits the amount of food they consume. The term calorie is a shortened term originating from kilocalorie and is used as a measurement of food energy. When the body has an excess of calories beyond what it needs to function it stores those calories in our body as fat. Despite the diet industry’s most sincere efforts and propaganda, studies still do not support the effectiveness of one fad diet over another for weight loss. (13) This means, weight gain, and weight loss are ultimately determined by the number of calories consumed, and the number of calories expended.

Earlier we identified obesity as contributing to secondary aging. The scientific community has established that being overweight, or obese dramatically increases your risk of cancer, heart disease, and type II diabetes, among other chronic disease, thereby reducing life expectancy. In fact, people that are 100 pounds or more overweight can expect a life expectancy that is nearly 14 years less than the national average. This is a shorter life expectancy than that of someone who is of a healthy weight and smokes cigarettes. (3, 12) A calorie reduction below what your body is expending results in weight loss, and for those who have a higher than healthy level of body fat, can expect a reduction in not just their weight but in secondary and primary aging.

There are many misconceptions of what constitutes being overweight or obese.  A person is classified as being overweight if they have a BMI (body mass index) of 25 or higher, and obese if they have a BMI of 30 or higher. BMI is calculated by dividing your weight in kilograms by your squared height in meters. BMI is likely a fair indicator if you are relatively inactive. If you are engaged in a fitness program or are an athlete, an alternative approach to determining healthy weight is by determining percentage of body fat. A healthy body fat is typically considered to be between 8-22% for men and 20-35% for women (aged 18-34).  A classification of obese may be assigned if someone has a body fat percentage of 26% or higher for men and a body fat of 39% or higher for women. (7) As always if you’re not sure where you fit into these metrics see a credentialed fitness professional or consult with your primary care provider.

It is estimated a calorie deficit of 200-500 calories daily is required to achieve healthy weight loss. Two ways to achieve this deficit are to reduce calorie consumption and increase calorie burn (expenditure). Calorie burn can be increased through additional physical activity; however, it should be cautioned that one can consume calories at a far faster rate than physical activity can burn them. As an example, it is estimated that a 180-pound man burns approximately 14 calories per minute jogging (1). As a point of reference, a single Hershey kiss contains 22 calories.  The lesson here is to use physical activity in addition to a nutritious diet, not in place of a nutritious diet.  (For more information on a nutritious diet visit choosemyplate.gov.) Give special attention to the section on vegetables, especially non-starchy vegetables as they are high in vitamins and minerals and low in calories.

For persons of a healthy weight, calorie restriction appears to offer slowed primary aging. The current school of thought is that primary aging is slowed as a result of a protective cellular reaction triggered by the calorie restriction. There is still much we do not know about the mechanisms responsible for this anti-aging phenomenon and some debate among scientists exists. However, the most common consensus among scientists is that this reaction collectively comes from activating sirtuins, increasing AMPK, impacting MTOR, and an improvement in blood sugar. (8,10,15,16,17,18) If you do not know what any of that means here’s a quick break down but don’t fret if you are not familiar with the lingo.

  • Sirtuins are responsible for DNA expression and control acetyl groups, as well as activate the mitochondrial antioxidant function. (8,16,17) Oxidative damage is believed to play a role in primary aging. Acetyl groups are important because they control the energy that proteins use during cell replication.
  • AMPK (Adenosine Monophosphate Protein-activated Kinase) detects the presence of nutrients or prolonged absence of nutrients, which then triggers the fragmentation/breakdown of damaged mitochondrial components (mitochondria are the powerhouse of the cell) that need to be rebuilt, increasing mitochondrial health and efficiency. (4,16,17)
  • MTOR (mammalian target of rapamycin), specifically TORC1 regulates protein building and cell growth. It is theorized a reduction in TORC1 and in turn a reduction of cellular division results in reduced DNA damage, and less inflammation. (11,17)
  • In terms of handling blood sugar, there are two important molecules at work. These proteins are Thioredoxin-interacting protein (TXNIP), and Thioredoxin-1. When TXNIP is stimulated by insulin (which results when we eat) cell stress resistance is reduced resulting in increased oxidative damage to DNA. It is theorized that during calorie restriction, Thioredoxin-1 increases which increases oxidative stress resistance, increases nonoxidative glucose disposal, and increases insulin sensitivity (improves use of insulin and absorption of sugar) as well as reduces damage to DNA (and thus slowed DNA aging) (10,15).

Regardless of how precisely these mechanisms work or interact what we currently believe and have pieced together is a reduction in calories likely:

  • Triggers a protective response in the body that helps:
    • Protect mitochondria from free radical damage (mitochondria are the energy makers of the cells)
    • Increases cell sensitivity to insulin and in turn increases absorption of blood sugar into the muscle
    • Induces cellular stress resistance and cell cleansing, which shuts off cell replication. Think of cell replication like a copy machine, if you do not use the original for each copy, but instead use a copy to make a copy, each time the copy gets blurrier. This is thought to also occur in our cells, therefore the less copies we make or the slower we make them the slower the aging process occurs.
  • Appears to reduce risk of age-related diseases such as heart disease, cancer, and diabetes.
  • Begins at 10%-40% reduction in calories per day (from normal)
  • Starvation is too far! You still need to get the vitamins, minerals, and nutrients required to aid your body in recovery, and immune function otherwise your efforts will be counterproductive, which can be done by increasing your consumption of non-starchy vegetables.
  • Calorie restriction can be accomplished by all types of fasting schemes. For example, fasting can take place daily for 12-16 hours, every other day, or over the weekends only. The important thing is achieving that 10%-40% reduction while still getting the proper nutrition necessary. (5)

The takeaway here is achieving and maintaining a healthy weight is the first step to a healthy lifespan and the incorporation of strategically fasting, may bring additional health and longevity. Fasting has been embedded in our culture in many ways from traditional religious observances as well in the fitness industry, but the question is what scheme and plan will work best for you. Most would agree it’s the health span (length of superior quality of life attributed to good health) more than the lifespan that’s important, and while there is currently no fountain of youth this appears to be a good place to start.

Remember, of course, to consult with your primary care provider before undergoing dietary changes.


Jeremy Kring holds a Master’s degree in Exercise Science from the California University of Pennsylvania and a Bachelor’s degree from Duquesne University. He is a college instructor where he teaches the science of exercise and personal training. He is a certified and practicing personal/fitness trainer, and got his start in the field of fitness training in the United States Marine Corps in 1998. You can visit his website at jumping-jacs.com

References

  • American Council on Exercise. (2009). Retrieved from https://acewebcontent.azureedge.net/assets/education-resources/lifestyle/fitfacts/pdfs/fitfacts/itemid_2666.pdf
  • Anstey, K., Stankov, L., & Lord, S. (1993). Primary aging, secondary aging, and intelligence. Psychology and Aging8(4), 562–570. doi: 10.1037//0882-7974.8.4.562
  • Tobacco-Related Mortality. (2018, January 17). Retrieved from https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/index.htm.
  • Cantó, C., & Auwerx, J. (2011). Calorie Restriction: Is AMPK a Key Sensor and Effector?Physiology, 26(4), 214–224. doi: 10.1152/physiol.00010.2011
  • Derous, D., Mitchell, S. E., Wang, L., Green, C. L., Wang, Y., Chen, L., … Speakman, J. R. (2017). The effects of graded levels of calorie restriction: XI. Evaluation of the main hypotheses underpinning the life extension effects of CR using the hepatic transcriptome. Aging9(7), 1770–1824. doi:10.18632/aging.101269
  • Hadad, N., Unnikrishnan, A., Jackson, J. A., Masser, D. R., Otalora, L., Stanford, D. R., … Freeman, W. M. (2018). Caloric restriction mitigates age-associated hippocampal differential CG and non-CG methylation. Neurobiology of aging67, 53–66. doi:10.1016/j.neurobiolaging.2018.03.009
  • Howley, Edward T., and Dixie L. Thompson. Fitness Professionals Handbook. Human Kinetics, 2017.
  • Imai, S. I., & Guarente, L. (2016). It takes two to tango: NAD+and sirtuins in aging/longevity control. NPJ aging and mechanisms of disease2, 16017. doi:10.1038/npjamd.2016.17
  • Jacobs, Patrick L. NSCAs Essentials of Training Special Populations. Human Kinetics, 2018.
  • Johnson, M. L., Distelmaier, K., Lanza, I. R., Irving, B. A., Robinson, M. M., Konopka, A. R., … Nair, K. S. (2016). Mechanism by Which Caloric Restriction Improves Insulin Sensitivity in Sedentary Obese Adults. Diabetes65(1), 74–84. doi:10.2337/db15-0675
  • Jossé, L., Xie, J., Proud, C. G., & Smales, C. M. (2016). mTORC1 signalling and eIF4E/4E-BP1 translation initiation factor stoichiometry influence recombinant protein productivity from GS-CHOK1 cells. Biochemical Journal, 473(24), 4651–4664. doi: 10.1042/bcj20160845
  • Kitahara CM, et al. Association between Class III Obesity (BMI of 40–59 kg/m) and Mortality: A Pooled Analysis of 20 Prospective Studies. PLOS Medicine. July 8, 2014. DOI: 10.1371/journal.pmed.1001673.
  • Kuchkuntla, A.R., Limketkai, B., Nanda, S. et al. (2018). Fad Diets Hype or Hope?. Current Nutrition Reports 7: 310. doi.org/10.1007/s13668-018-0242-1
  • Mitchell, S. E., Delville, C., Konstantopedos, P., Hurst, J., Derous, D., Green, C., … Speakman, J. R. (2015). The effects of graded levels of calorie restriction: II. Impact of short term calorie and protein restriction on circulating hormone levels, glucose homeostasis and oxidative stress in male C57BL/6 mice. Oncotarget6(27). doi: 10.18632/oncotarget.4003
  • Oberacker, T., Bajorat, J., Ziola, S., Schroeder, A., Röth, D., Kastl, L., … Krammer, P. H. (2018). Enhanced expression of thioredoxin-interacting-protein regulates oxidative DNA damage and aging. FEBS letters592(13), 2297–2307. doi:10.1002/1873-3468.13156
  • Picca, A., Pesce, V., & Lezza, A. (2017). Does eating less make you live longer and better? An update on calorie restriction. Clinical interventions in aging12, 1887–1902. doi:10.2147/CIA.S126458

(-) “When and+ accumulates, such as during scarcity of nutrients especially glucose, sirtuins are activated….”

  • Son, D. H., Park, W. J., & Lee, Y. J. (2019). Recent Advances in Anti-Aging Medicine. Korean journal of family medicine40(5), 289–296. doi:10.4082/kjfm.19.0087
  • Speakman, J.R. & Mitchell, S.E. (2011) Calorie Restriction. Molecular Aspects of Medicine, Jun:32(3):159-221. doi: 10.1016/j.mam2011.07.001

 

 

 

keto meal

The Keto Diet and Athletes

Ketosis is a metabolic state similar to starvation in which energy is provided primarily by high fat intake, adequate protein intake (1 gram/Kg lean body mass) and low carbohydrate intake. The idea is to switch your body to using fat as fuel, instead of the usual carbohydrates. The keto diet has traditionally been used for weight loss, but now some athletes have taken up the diet as well. 

How does it work? 

Carbohydrates are initially restricted to 10 grams per day (15 to 20 grams per day in adolescents and adults), with patients counseled to increase their use of high fat foods (at the expense of protein). Traditionally, the diet consists of four parts fat to one part protein and carbohydrate (i.e., a 4:1 lipid to non-lipid ratio). Total calories are restricted to 80 to 90 percent of recommended values for age (Kossoff et al., 2009).  By eating a diet like this, the body becomes very efficient at utilizing fat for energy and produces higher levels of ketones (acetoacetate, acetone, and beta-hydroxybutyrate). 

What about athletes? 

Traditionally athletes have used carbohydrate sources such as maltose, dextrose, and others.  The entire industry of sports performance supplements has been geared to maximize carbohydrate absorption (max is about 240 kcals/hour due to GI function/absorption) and items are packaged in 80-100kcal/use servings.  So what happens to performance when you athletes switch to a keto diet?

Several studies have been completed looking at the short and longer (up to 3 months) use of keto-diets on performance. The results show ketosis seems to be better suited for endurance athletes than anaerobic athletes. In one study, short-term low-carbohydrate, ketogenic diets reduced exercise performance in activities that are heavily dependent on anaerobic energy systems (wroble, et al,m 2018). In another, a  low carb/keto-adaptated group of athletes had improved exercise training, lower body fat, improved fat oxidation during exercise, and better 100km time trial (McSwiney et al., 2018).

The bottom line is more research is needed, however, depending on the athletic activity, the keto diet may either help or harm athletic performance.

Contraindications: Individuals with inborn metabolic errors should NOT use the ketogenic diet.  Individuals with a history of documented myopathy or rhabdomyolysis should complete a more in depth workup for inborn errors prior to starting a ketogenic diet due to an increased risk of catabolic crisis.


Naomi L. Albertson M.D. is Board Certified by the American Academy of Family Physicians and specializes in the non-surgical management of musculoskeletal problems, sports injuries, concussions, and the treatment of osteopenia and osteoporosis.  A graduate of Tufts University School of Medicine, Dr. Albertson’s interest in bone health, exercise physiology and maximizing performance led her to develop Dr. Ni’s OC2, a bone health and muscle strength supplement for the unique frame support needs of adults over age 35. Visit her website, boneandmuscle.com.

References

  • Kossoff, E. H., Zupec-Kania, B. A., Amark, P. E., Ballaban-Gil, K. R., Christina Bergqvist, A. G., Blackford, R., Buchhalter, J. R., Caraballo, R. H., Helen Cross, J., Dahlin, M. G., Donner, E. J., Klepper, J., Jehle, R. S., Kim, H. D., Christiana Liu, Y. M., Nation, J., Nordli, D. R., Jr, Pfeifer, H. H., Rho, J. M., Stafstrom, C. E., … International Ketogenic Diet Study Group (2009). Optimal clinical management of children receiving the ketogenic diet: recommendations of the International Ketogenic Diet Study Group. Epilepsia50(2), 304–317. https://doi.org/10.1111/j.1528-1167.2008.01765.x
  • Wroble, K. A., Trott, M. N., Schweitzer, G. G., Rahman, R. S., Kelly, P. V., & Weiss, E. P. (2019). Low-carbohydrate, ketogenic diet impairs anaerobic exercise performance in exercise-trained women and men: a randomized-sequence crossover trial. The Journal of sports medicine and physical fitness59(4), 600–607. https://doi.org/10.23736/S0022-4707.18.08318-4
  • McSwiney, F. T., Wardrop, B., Hyde, P. N., Lafountain, R. A., Volek, J. S., & Doyle, L. (2018). Keto-adaptation enhances exercise performance and body composition responses to training in endurance athletes. Metabolism: clinical and experimental81, 25–34. https://doi.org/10.1016/j.metabol.2017.10.010
woman-walking-dirt-road

Restoring Health: A Lifestyle Rx

America is in bad shape. According to the Centers of Disease Control (CDC), 60% of adults are living with one chronic disease and 40% have two or more.(1)  Astoundingly, 12% of adults are living with 5 or more chronic conditions(2) including cardiovascular disease, diabetes, obesity, coronary obstructive pulmonary disease and hypertension. A concept people need to understand is that these diseases can be prevented, managed and even reversed with lifestyle choices.

The COVID-19 pandemic has shown a bright light on how our level of health can literally be a matter of life or death. A study of thousands of patients hospitalized with the novel coronavirus in the New York City area found that 94% had one chronic disease and 88% had two or more. The most common conditions included hypertension, obesity and diabetes.(3) In May of this year, the CDC reported that people with an underlying chronic illness had six times the risk of being hospitalized and twelve times the risk for dying.(4)

Boost Health & Immunity

Now is the right time to take small steps to improve health and build immune resilience with daily lifestyle choices. While there isn’t one diet, exercise regimen, or stress-relieving technique that is good for everyone, there are principles to follow that can boost health and vitality at any age.

There is a huge misconception that our genes determine our health destiny. This simply isn’t true. The study of epigenetics shows that we have the ability to change the expression of our genes by the way we think, feel, move and eat.(5) Each of our daily decisions and choices can increase or decrease inflammation in the body, moving us towards disease or back to health.

Acute & Chronic Inflammation

Our immune system uses the ancient, biological pathway of inflammation to protect us against injury and infections.(6) When you cut your finger, immune cells are sent to kill invading bacteria and begin the process of wound healing. This is acute inflammation that goes away in days or weeks when the body is healed.

One the other hand, chronic inflammation lasts a long time, from months to years.(2) It’s basically an abnormal immune response that causes damage to cells, tissues and organs. Oxidative stress plays a big role; it occurs when more free radicals are produced within cells than the body can neutralize.(2)  As you can imagine, when more damage occurs than can be repaired, health problems crop up.

It is now widely accepted that chronic inflammation is at the root of most, if not all, chronic conditions like cardiovascular disease, diabetes, obesity, hypertension, cancer, arthritis and joint disease.(2)

Lifestyle Matters

The good news is that deliberate and healthier lifestyle choices can prevent, manage and even reverse chronic inflammatory disease, the most important cause of morbidity and mortality facing people today.(7) It’s empowering to know that if you have, or want to prevent a chronic disease, you can regain your health and vitality by choosing real whole foods, optimizing sleep, reducing stress, being social, and moving more.

You may be thinking, “How the heck can simple lifestyle decisions address the complexities of chronic conditions?”  The body has an innate ability and intelligence to heal itself. You experience it each time you cut your hand; you wash the wound, put a bandage on and don’t have to think about it.

The research also supports it and I have lived it; by utilizing the power of lifestyle medicine I was able to restore my health from the ravages of chronic Lyme disease. You just need to provide the right environment for healing. This is not an easy task, but it can be done with time, effort and a plan.

Taking Action

Changing your lifestyle habits can feel overwhelming. To help you embrace this challenge, think about this analogy, “How do you eat an elephant?  One bite at a time!”   Any healing journey begins with awareness, learning and exploration; then gradually taking action, one small step at a time.

Start today by exploring lifestyle behaviors that decrease inflammation and can put your health back on track so you can live with less pain, more energy, and greater vitality. A lifestyle prescription to restore health includes:

  • Reducing stress with deep breathing.
  • Getting good quality sleep by going to bed and rising at the same time.
  • Eating a plant-based diet rich in a rainbow of vegetables.
  • Hydrating with filtered water in the morning and during the day.
  • Nurturing relationships and engaging with positive people.
  • Moving well with good posture when performing daily activities and exercise.

Be proactive, make one hour a week to learn more by reading books, researching on PubMed.gov, listening to podcasts, attending lectures and webinars so you can find the strategies and practices that work best for you. As you begin to feel better, you will naturally be motivated to continue learning and making better lifestyle choices because healthy feels so good!

Find a Fitness or Allied Health Pro Near You

Search the free MedFit Network directory to locate a professional near you! MedFit Network maintains a free directory of fitness and allied healthcare professionals who can work with individuals with chronic disease, medical conditions or the senior population.


Cate Reade, MS, RD is a Registered Dietitian, Exercise Physiologist and Functional Medicine Practitioner candidate on a mission to improve functional mobility and health span utilizing the power of lifestyle medicine. She has been teaching, writing and prescribing healthy eating and exercise programs for over 25 years. Today, as CEO of Resistance Dynamics and inventor of the MoveMor™ Mobility Trainer, she develops exercise products and programs that target joint flexibility, strength and balance deficits to help older adults fall less and live more.

 

References

  1. https://www.cdc.gov/chronicdisease/index.htm
  2. https://www.ncbi.nlm.nih.gov/books/NBK493173/
  3. https://www.the-scientist.com/news-opinion/nearly-all-nyc-area-covid-19-hospitalizations-had-comorbidities-67476
  4. https://www.cdc.gov/mmwr/Novel_Coronavirus_Reports.html June 19, 2020
  5. https://www.nature.com/scitable/topicpage/epigenetic-influences-and-disease-895/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6345337/
  7. https://pubmed.ncbi.nlm.nih.gov/23974765/
Healthy-Lifestyle-Nutrition-Exercise-Medicine

Natural Prescription – An Alternative Approach

One of the best things we can do for our bodies is to “get out of the way”! Believe it or not, our body can actually do a great job of healing itself, or functioning quite optimally when it’s allowed to do so. The body does this by reacting to what “stresses” are put upon it and finding homeostasis through temporary changes or more permanent adaptations. Even the brain will make quick reactions to things in the form of neurotransmitters and neural firing or long term adaptations in adopting new ways of perceiving things or hard-wiring changes.

A statement capturing the above sentiment is from Goodheart (1989) on healing, “People are healed by many different kinds of healers and systems because the real healer is within. The various healing modalities are merely different ways of activating the inner healer.”

Are you of the Mechanist (Rationalist) or Vitalist (Empirical) Approach?

The standard or “orthodox” medical practice in the U.S. follows a mechanist approach, where symptoms are perceived as bad and should be minimized or suppressed through surgical or pharmaceutical means. This seems great at the surface level. If something is causing me pain or discomfort let me do something to relieve or eliminate that pain. If I am having nausea or diarrhea because of something in my gut, let me take something to stop the vomiting or diarrhea. Underlying this “quick fix” of symptom alleviation is THE PROBLEM. The body is trying to rid itself of the “problem” by expelling if forwards or backwards! There are many medical conditions for which it is okay to consider treating symptoms, and for some this is vital. However, it is preferable for this to be done in conjunction with identifying the source of the problem, so a long-term fix can be explored.

A Vitalist approach views symptoms as part of the healing process, not a problem that should be hidden. Many branches of health care use this philosophy including: chiropractors, osteopaths, naturopaths, and practitioners of Chinese or Indian medicine advocate this Vitalist approach. By suppressing the symptoms, the practitioner may actually be extending the illness or exacerbating the problem. Researchers at the University of Maryland found taking aspirin for the flu may prolong the illness up to 3 days. Acetaminophen (Tylenol) or aspirin interferes with the normal fever response that fights the infection (Burke, 2000).

Listening to the Symptoms tell you Where the Problem Lies

Rather than reducing or eliminating the symptoms, what if we tried to increase our sensitivity to it. For example, if we took antibiotics to fight a bacteria, are we enhancing the body’s immune response to this foreign agent or “giving it” something to help, much like a crutch. A quote from unknown origin:

Give a man a fish, and you feed him for a day. Teach a man to fish, and you feed him for a lifetime.

This is at the heart of the Vitalist approach. The body is great at adaptation but we have to let it “learn” to adapt- not “feed” it some drug that forces it to do something. A quote from the Nobel Prize winner, Rene Dubos, Ph.D. remarks, “Good health is a process of continuous adaptation to the myriad of microbes, irritants, pressures and problems which daily challenge man.” This is also at the heart of exercise training. You must “overload” a system in order to get an improvement in function. You literally must stress it, and let it endure that strain in order to get the adaptation. Likewise, by putting your body in destabilized environments, you will gain a better sense of balance, in order to stabilize yourself. Recent evidence has found that anti-inflammatory agents actually weaken the endurance training effect.

Fortunately, medical advances have allowed us to treat many illnesses effectively and safely, and it is always advisable to follow the advice of your doctor. Allowing your body to adapt to certain stresses can be very positive in certain scenarios, but it is important to recognize when this doesn’t come at a risk of increasing morbidity, mortality, or increasing the likelihood of illness complications.

To Drug or Not to Drug: that is the Question

No one likes being depressed. About one in 10 Americans takes some sort of antidepressant medication. It is the most commonly prescribed drug in the U.S. according to a report published in the Archives of General Psychiatry (2009). While the U.S. may not be a Prozac Nation, as popularized in 1994 by the author Elizabeth Wurtzel, the rates almost doubled from 1996 to 2005 (5.84% to 10.12%). A report in the Journal of the American Medical Association found it to work best in only severe cases of depression and exercise had similar effects in the short term treatment and better effects in long term treatment! The difficulty lies in getting someone to exercise when they are depressed. Thus, an integrated approach is often the best, and this includes psychological counseling as well .

Sometimes Less is More

A take away from this article should not be that standard medical care is bad. Far from it. Many M.D.s are very knowledgeable in areas outside of their standard practice and advocate expressive, rather than suppressive therapies. The take away should be to not rush for a drug to hide or mask your symptoms, but focus on what is the root of the cause, and take action to address this. The term iatrogenic is used for the inadvertent problem caused by a medical treatment. In fact, reports estimate it to be the third leading cause of death in the U.S. with 225,000 to 250,000 dying from iatrogenic diseases annually! While it is hard to say how many of these deaths could have been avoided, it is quite obvious that minimizing invasive treatments until they are necessary is the best plan of action.

Complementary or Integrated Medicine can possibly have the answer to a majority of the health issues presented. The MedFit Network believes those professionals are the future of health care.

Free Webinar with Dr. Mark Kelly

There are a ton of misconceptions surrounding obesity and being overweight. Join Dr. Kelly for this webinar to learn what is actually dangerous about obesity, and how to rethink and reprogram your brain and life toward fun and re-creation, not fitness.


Dr. Mark Kelly Ph.D., CSCS, FAS, CPT has been actively involved in the fitness industry spanning 30 years as a teacher of exercise physiology at academic institutions such as California State University, Fullerton, Louisiana State University, Health Science Center, Tulane University and Biola. He was an exercise physiologist for the American Council on Exercise, a corporate wellness director, boot camp company owner and master fitness trainer.