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veg in hand

Heart Disease is Preventable and Reversible through Nutritional Intervention

Heart disease is devastating to both our health and our economy. It is the number one cause of death in the country. Cardiovascular disease (CVD) accounted for 32.1 percent of deaths in the United States in 2013 – one out of every three deaths is due to this preventable disease.1 A significant number of research studies have documented that heart disease is easily and almost completely preventable (and reversible) through a diet rich in plant produce and lower in processed foods and animal products.6-9

As the prevalence of CVD escalates, medical costs are rising rapidly. The American Heart Association has projected that by 2030, 40.5 percent of the US population will have some form of cardiovascular disease, and the direct medical costs attributed to cardiovascular diseases will triple compared to 2010 costs.2

Risk factors for heart disease are commonplace for U.S. adults:32.6 percent have hypertension, 13.1 percent have total cholesterol above 240 mg/dl,3 9.3 percent of U.S. adults have diabetes,4 and 68.5 percent of U.S. adults are overweight or obese.5 As a result, it has become considered normal in our society to have atherosclerosis, and to die from cardiovascular disease. If you eat the standard western diet that most people eat in the modern world, you will surely develop heart disease and may die from it.

Fighting heart disease: Superior nutrition versus drugs and surgery

In 2015, I published a scientific article in the American Journal of Lifestyle Medicine demonstrating, with survey data and case histories, the dramatic weight loss and cardiovascular benefits possible with a Nutritarian diet. Respondents who started out obese lost an average of over 50 pounds two years after the switch to a Nutritarian diet. After one year, in those who started out with hypertension, there was a 26 mm Hg average reduction in systolic blood pressure. In respondents who were not taking cholesterol-lowering medication, there was an average 42 mg/dl decrease in LDL cholesterol, and an average decrease in triglycerides of 79.5 mg/dl.10

The surgical interventions commonly used to treat heart disease, such as angioplasty and bypass surgery are futile. The COURAGE trial and additional studies conducted since have documented that patients undergoing those invasive procedures do not live longer or have fewer heart attacks compared to those receiving medical therapy  with modest lifestyle changes.11-12 Surgical interventions are not long-term solutions to heart disease; they merely treat a small portion of a blood vessel, while cardiovascular disease continues to progress throughout the vasculature.

Drugs that treat hypertension and elevated cholesterol carry serious risks and do not stop heart disease from progressing. Cholesterol-lowering statin drugs are known to increase the risk of diabetes, impaired muscle function, cataracts, liver dysfunction and kidney injury. 13 Each different class of blood pressure-lowering medications is associated with its own risks and side effects. ACE inhibitors commonly cause a persistent cough; diuretics are linked to increased risk of diabetes; beta blockers are associated with increased likelihood of stroke; calcium channel blockers may increase risk of heart attack and breast cancer; and ARBs are associated with increased risk of lung cancer.14-20

The risk associated with these treatments is unacceptable when there is a safe, effective alternative —smart nutrition and exercise – that can actually reverse heart disease and obliterate the need for risky and even futile medical care. Atherosclerotic plaque can be reversed, and cholesterol lowered without drugs or surgery.

Success stories (two of numerous)

Ronnie weighed over 300 pounds when he wound up needing emergency quadruple bypass surgery.  Three years later, he was back for an angioplasty and three stents, but his chest pain returned within one month of the surgery. Working with Dr. Fuhrman in the Ask the Doctor Community, Ronnie lost 140 pounds and went off all medications. He runs and plays sports and has served as an inspiration to family members who have also lost weight and begun to live healthier lives. Read his story.

Julia had three heart attacks within three months. After her fifth angioplasty, she still had constant chest pain. She was on 10 different daily medications, suffered migraines, and, at the age of 60, could not walk even one block. Today, Julia has lost 105 pounds, and now enjoys every day pleasures like exercise, gardening, and playing with her grandchildren. She went from a “cardiac cripple” to a healthy, happy woman. Read her story.

Like Ronnie and Julia, over the last 20 years hundreds of my other patients with advanced heart disease have demonstrated that dramatic reversal of advanced disease can even occur in a relatively short time.

Following the lenient recommendations of the American Heart Association and wearing a red dress pin do not form an effective strategy for protecting you or your loved ones against heart disease. Also, drugs and surgery do not cure heart disease. A health-promoting, nutrient-dense (Nutritarian) diet, that I have designed and advanced over the years (coupled with exercise) is dramatically effective and protective for preventing and reversing  high blood pressure, high cholesterol and diabetes — as well as heart disease — because it removes the primary dietary cause of heart disease, while providing the most protective and life-span promoting diet-style. For more information, check out my book, The End of Heart Disease.

Everyone needs to know that heart disease can be avoided; and those who already have heart disease deserve to know that they can reverse their disease. Conventional medical care does NOT protect against heart disease-related death. Only a Nutritarian diet can offer dramatic lifespan-enhancing benefits against both cardiovascular disease and cancer.

Originally printed on DrFuhrman.com. Reprinted with permission.


Joel Fuhrman, M.D. is a board-certified family physician, six-time New York Times bestselling author and internationally recognized expert on nutrition and natural healing, who specializes in preventing and reversing disease through nutritional methods. Dr. Fuhrman coined the term “Nutritarian” to describe his longevity-promoting, nutrient-dense, plant-rich eating style.

References

  1.  Xu J, Murphy SL, Kochanek KD, et al: Deaths: Final Data for 2013. Natl Vital Stat Rep 2016;64:1-119.
  2. Heidenreich PA, Trogdon JG, Khavjou OA, et al: Forecasting the Future of Cardiovascular Disease in the United States: A Policy Statement From the American Heart Association. Circulation 2011.
  3. Mozaffarian D, Benjamin EJ, Go AS, et al: Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation 2016;133:e38-e360.
  4. American Diabetes Association: Diabetes statistics [http://www.diabetes.org/diabetes-basics/statistics/]
  5. Ogden CL, Carroll MD, Kit BK, et al: Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA 2014;311:806-814.
  6. Ornish D, Brown SE, Scherwitz LW, et al: Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet 1990;336:129-133.
  7. Ornish D, Scherwitz LW, Billings JH, et al: Intensive lifestyle changes for reversal of coronary heart disease. JAMA 1998;280:2001-2007.
  8. Esselstyn CB, Jr.: Updating a 12-year experience with arrest and reversal therapy for coronary heart disease (an overdue requiem for palliative cardiology). Am J Cardiol 1999;84:339-341, A338.
  9. Esselstyn CB, Jr., Ellis SG, Medendorp SV, et al: A strategy to arrest and reverse coronary artery disease: a 5-year longitudinal study of a single physician’s practice. J Fam Pract 1995;41:560-568.
  10. Fuhrman J, Singer M: Improved Cardiovascular Parameter With a Nutrient-Dense, Plant-Rich Diet-Style: A Patient Survey With Illustrative Cases. Am J Lifestyle Med 2015.
  11. Boden WE, O’Rourke RA, Teo KK, et al: Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 2007;356:1503-1516.
  12. Trikalinos TA, Alsheikh-Ali AA, Tatsioni A, et al: Percutaneous coronary interventions for non-acute coronary artery disease: a quantitative 20-year synopsis and a network meta-analysis. Lancet 2009;373:911-918.
  13. Hippisley-Cox J, Coupland C: Unintended effects of statins in men and women in England and Wales: population based cohort study using the QResearch database. BMJ 2010;340:c2197.
  14. Simon SR, Black HR, Moser M, et al: Cough and ACE inhibitors. Arch Intern Med 1992;152:1698-1700.
  15. Bangalore S, Messerli FH, Kostis JB, et al: Cardiovascular protection using beta-blockers: a critical review of the evidence. J Am Coll Cardiol 2007;50:563-572.
  16. Gupta AK, Dahlof B, Dobson J, et al: Determinants of new-onset diabetes among 19,257 hypertensive patients randomized in the Anglo-Scandinavian Cardiac Outcomes Trial–Blood Pressure Lowering Arm and the relative influence of antihypertensive medication. Diabetes Care 2008;31:982-988.
  17. Wassertheil-Smoller S, Psaty B, Greenland P, et al: Association between cardiovascular outcomes and antihypertensive drug treatment in older women. JAMA 2004;292:2849-2859.
  18. Group PS, Devereaux PJ, Yang H, et al: Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet 2008;371:1839-1847.
  19. Li CI, Daling JR, Tang MT, et al: Use of Antihypertensive Medications and Breast Cancer Risk Among Women Aged 55 to 74 Years. JAMA Intern Med 2013.
  20. Sipahi I, Debanne SM, Rowland DY, et al: Angiotensin-receptor blockade and risk of cancer: meta-analysis of randomised controlled trials. Lancet Oncol 2010;11:627-636.
trainer-with-senior-woman-at-treadmill

How the Human Body Changes As It Ages

The human body undergoes a lot of changes during its lifetime. From infancy to old age, there are biochemical processes in the body that define these changes.

Some of them are visible externally, such as the greying of hair, skin becoming less supple, etc.

But beneath all of this, some processes happen to make all of this possible.

scale

Once You Lose Weight, Can You Keep It Off?

“I lost 10 pounds and vowed to keep them off, but no such luck. I’m so discouraged.”

“I reached my goal weight, then BOOM, I regained it once I stopped dieting.

“This is my 3rd time losing 40 pounds…”

If any of those stories sound familiar, you are not alone. Research suggests dieters tend to regain lost weight within five years, if not sooner. This includes many fitness exercisers and athletes who struggle to stay at a goal weight.

If you are fearful of regaining your hard-lost weight, this article will help you understand why maintaining lost weight takes effort. Paul MacLean, PhD, Professor of Medicine & Pathology at the University of Colorado School of Medicine, has carefully studied weight regain. He notes three reasons why dieters regain weight: biology, behavior, and environment.

Biology: The body has a strong biological drive to regain lost weight, as noted with increased appetite and a slowed metabolic rate. As backlash from dieting, the body learns to store fuel very efficiently as fat.

Behavior: After three to nine months, dieters tend to be less strict with their low-calorie diets; they often report they have hit a weight plateau. Despite self-reported claims they are diligently dieting (yet only maintaining weight), these dieters can become discouraged and less adherent. (Note: Diligently dieting anecdotes are hard to verify.)

Environment: We live in an obesogenic environment with easy access to ultra-processed foods, a sedentary lifestyle, and chemicals that contribute to weight gain including those found in upholstered furniture, pesticides, cosmetics, and who knows where else. Weight is far more complex than self-induced over-eating and under-exercising!

When adding on exercise, some people lose weight and some gain weight. Exercise alone does not guarantee fat loss. Exercisers who lose weight tend to keep the weight off if they stick with their exercise program. High levels of exercise are linked with greater success. That’s good news for athletes who train regularly! That said, a fine line exists between compulsive exercisers (who exercise to burn off calories) and athletes (who train to improve their performance). Fear of weight gain can impact both groups.

Questions arise:

  1. Is weight maintenance more about being compliant to a restrictive eating plan than to exercise?
  2. Do those who comply with a strict diet escape weight-regain?
  3. Are exercisers more likely to stay on their diet?
  4. Does exercise create metabolic adaptations that favor maintaining lost weight?

Research with rodents

Finding answers to these questions is hard to do in humans because of biology, behaviors, and environment. So MacLean turned to studying formerly obese rodents who had lost weight by being put “on a diet” and then were allowed to eat as desired for 8 weeks. Some weight-reduced rodents stayed sedentary while others got exercised.

  • Fancy cages accurately measured the rodents’ energy intake and energy expenditure. MacLean was able to see how many calories the rodents burned and if they preferentially burned carbohydrate, protein, or fat for fuel.
  • The exercise reduced-obese rodents ate less than the sedentary rodents and they regained less weight. Exercise seemed to curb their drive to overeat, meaning they felt less biological pressure to go off the diet. With exercise, their appetites more closely matched their energy needs.
  • Exercise promoted the burning of dietary fat for fuel. Hence, the exercised rodents converted less dietary fat into body fat. They used carbohydrate to replenish depleted glycogen stores. Note: Carbohydrate inefficiently converts into body fat. That is, converting carb (and also protein) into body fat uses ~25% of ingested calories to pay for that energy deposition. To convert dietary fat into body fat requires only ~2% of ingested calories. Given the calorie-burn of exercise plus the metabolic cost of converting carbs into body fat, the exercised rodents regained less weight.
  • The sedentary rodents ate heartily and were content to be inactive. Their bodies efficiently converted dietary fat into body fat; they used carb & protein to support their limited energy needs. They easily regained weight.

The Depressing News

When followed over time, the longer the rodents were weight-reduced, the stronger their appetites and drive to eat got. When allowed to eat as desired, they quickly regained the weight. “At least people, as compared to rodents, can be taught to change their eating behaviors to help counter those biological pressures,” noted MacLean. For example, people who have lost weight can stop buying fried foods, store snacks out of sight, limit restaurant eating, etc.

More depressing news. Most of MacLean’s data is from reduced-obese male rodents. Exercised males showed less weight regain than did exercised females. The female rodents seemed to know they needed extra energy to exercise, so they ate more and regained weight. MacLean states we need more research to understand the clear differences in the biological drive to regain weight.

A glimmer of hope

The best way to maintain weight is to not gain it in the first place. Yes, easier said than done (as stated upfront), but at least athletic people who maintain a consistent exercise program can curb weight regain. We can also change our behaviors to minimize weight regain by prioritizing sleep, curbing mindless eating, and choosing minimally processed foods.

Ideally, the sports culture will change so that athletes can focus less on weight and more on performance. It’s time to acknowledge that athletes, like dogs, come in many sizes and shapes. Some athletes are like St. Bernards, others are like Greyhounds. A starved St. Bernard does not become a Greyhound, but rather a miserable St. Bernard.

By fueling your genetic body type and focusing on how well you can perform, you can enjoy being stronger, more powerful—and likely can still meet your sports goals. When being leaner comes with a life-long sentence to Food & Exercise Jail, you might want to think again?


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.

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 Aging, 8(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.
  • CantĂł, 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. Aging, 9(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 aging, 67, 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 disease, 2, 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. Diabetes, 65(1), 74–84. doi:10.2337/db15-0675
  • JossĂ©, 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. Oncotarget, 6(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 letters, 592(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 aging, 12, 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 medicine, 40(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. Epilepsia, 50(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 fitness, 59(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 experimental, 81, 25–34. https://doi.org/10.1016/j.metabol.2017.10.010