Archive for May 2009

1)    Too much Cardio exercises: Too much can trigger the release of cortisol, the body’s stress hormone that actually in the long term seems to increase a person’s visceral fat- that is, the fat surrounding major organs that is particularly dangerous for our health

2)    No weight training or not enough intense weight training: Women sometimes fear that weight lifting will make them more bulky. The truth is, a good relatively intense program is actually beneficial in developing more LEAN muscle and decreasing subcutaneous (under the skin) and visceral fat.

3)    Spot reduction of fat: There is no scientific basis in spot training to reducing fat in a certain place.  When the body needs calories for exercise, it first takes it from muscle creatinine (initial short lived burst of energy), then glycogen, the storage form of glucose in muscles, then fat from the WHOLE body.

4)    Exercise is not a priority: Many women, especially mothers have many responsibilities and sadly, when push comes to shove, exercise is dropped first. This is poor prioritization because of all the health and well-being benefits of exercise. The key is to schedule one’s days so it is most efficient, freeing up time for an exercise block, and to incorporate exercise into the daily routine.

5)    Total caloric intake is too high:  Many patients come in with no sign of weight loss despite regular exercise.  Much of the time, the culprit is a diet that is far too high in calories, specifically saturated fat and refined carbohydrates. The caloric balance is heavily weighted in favor of weight GAIN due to this pattern of eating. Many of these women say they “never eat” or they only eat one meal a day. This is a critical mistake. Ideally, you want to graze small healthy, less calorie dense snacks throughout the day as our ancestors did in hunter-gatherer societies.  This  will maintain the sensation of feeling full, reduce impulse eating of high calorie foods, and prevent insulin and other hormonal spikes that make you eat more. Studies show, despite eating more frequently, the total daily caloric intake is actually lower!

6)    Poor nutritional support: Exercise is critically important for bone health in women. Weight bearing exercise like walking or weight lifting stimulates bone development and maintains or improves bone density. However, exercise is one half of the equation. The other half if nutritional support. The osteoblasts (cells that stimulate bone growth) need calcium and vitamin D to do their jobs. All women should get at least 1500mg of dietary calcium and 400 IU of Vitamin D daily. Protein requirements work out to 0.8-1.0 mg/kg/day. Sufficient calories are also needed for optimal health, including reproductive health in women.  For example, a moderately active woman that is 140 pounds needs 2100 calories/day. 160 pounds needs 2200, and 180 pounds needs 2300 calories per day. See this link to estimate how much you need http://www.chartsgraphsdiagrams.com/HealthCharts/calorie-requirement.html

7)    Doing the same exercise every day: Women love the elliptical and walking on the treadmill. I see women less on stationary bicycles, rowing machines, or stair steppers.  Muscle confusion is a key concept in getting and maintaining fitness. Switch it up as much as possible so your body doesn’t get too efficient at doing one exercise.

8)    Cardio at too low an intensity for weight loss: Many popular magazines perpetuate the myth that low intensity cardio at 50-70% is better for burning fat and losing weight. They are only partially correct. Yes fat is primarily burned at this intensity but weight loss and weight maintenance is more dependent on burning CALORIES, not fat. Higher intensity workouts at 70-85% are much better calorie burners and thus better for weight loss.

9)    Too much, too soon: It’s great to be motivated to start an exercise program but some women ramp up too quickly, get sore, or injured, get discouraged and stop exercising. Start slow, especially if you have never exercised regularly before and ramp up a tiny amount weekly. This is much safer and more sustainable

10)    No professional input: Most people don’t have all the health information needed to safely start or improve an exercise regimen. I highly suggest seeing a sports medicine physician to clear you medically first and to develop a program that fits each individuals goals and ability.  Personal trainers are also very helpful in this process.

Bonus:  Women tend to be social creatures.  Buddy up with a partner that will help motivate you. Research shows, you will likely exercise more often, more intensely, lose more weight, and become more fit if you do so!  Women, get out there and ShapeUp!

The number of adults sleeping less than 7 hours per night has increased from 16-37% over the past 40 years. Currently 65% of all Americans are overweight or obese and this number is climbing. Is there a correlation between sleep deprivation and obesity? New research seems to suggest so!

As a sports medicine physician, about to finish my fellowship in a few months, I know first-hand the result of sleep deprivation. When I was swimming at the varsity level at Brown University, I weighed in at a trim 145 pounds with a body fat percentage of 4 percent. I am 5ft 10. Fast forward 10 years filled with sleep deprivation in medical school, residency and fellowship and despite leading a physically active life, my weight peaked at 185 pounds six months ago! That’s a gain of 40 pounds and a body mass index (BMI) of 26.5, clinically overweight. Thankfully with a more conscious effort on healthy living including plenty of sleep, I have been able to maintain a more healthy 170 pounds and 10% body fat over the last 6 months with a BMI of 24.4, within the normal range. Much of my weight gain is a direct result of sleep deprivation and stress, and my genetic predisposition to obesity- thanks mom and dad! The point I want to impress upon you is that 8 hours of regular sleep per night may be the easiest way you can lose weight and fight obesity!

There is much evidence to support this theory. The most recent study, published 5/18/09 in the Journal of Clinical Investigation looked at a specific calcium channel in cells of mice that has been found to regulate body weight maintenance and sleep. They found that mice lacking the CaV3.1 T-type calcium channel were more resistant to weight gain when fed a high fat diet. They were also able to feed normal mice a drug that blocks these channels and as a result the mice slept more and were resistant to weight gain. Lastly, obese mice were fed this drug and they reduced their body weight and fat percentage. They concluded that the gene better aligns feeding patterns and circadian rhythms which govern sleep and that drugs targeting this specific calcium channel may one day become an obesity fighting drug in humans.

There are other studies at the University of Chicago, Stanford University, and University of Wisconsin that found that sleep increases the hormone Ghrelin and decreases another hormone Leptin. Ghrelin is an appetite stimulating hormone released by the stomach. Leptin is a satiety and “fullness” hormone released by fat cells. They are essentially the Yin- Yang of appetite balance. The University of Chicago study also found that sleep deprivation caused subjects to crave high carbohydrate foods like sugary cakes and candy.  Stanford and Wisconsin studied 1,024 people ages 30 to 60 for many years and confirmed that Ghrelin and Leptin changes with sleep deprivation and also noted a correlation of sleep deprivation with higher BMI.

Researchers at Columbia University looked at government data of 6115 people and found that people who sleep two to four hours a night are 73% more likely to be obese than those who get seven to nine hours. Those who get five or more hours of sleep a night are 50% more likely to be obese than normal sleepers. Those who sleep six hours are 23% more likely to be obese. The researchers reported, those who get 10 or more hours are 11% less likely to be obese.

What’s the take home point? Not only should you aim to sleep 8 hours per night, those 8 hours should also be at the same time of night. Sleeping irregularly and less than 8 hours puts you at risk for weight gain and obesity and all the complications that come with obesity. For this reason, avoid shift work if at all possible. If you think you are suffering from a lack of sleep, difficulty falling asleep or staying asleep, talk to your family physician or health care provider. Sleep well and shape up!

References:

1) Uebele, V. et al. Antagonism of T-type calcium channels inhibits high-fat diet–induced weight gain in mice. J. Clin. Invest. doi:10.1172/JCI36954. http://www.jci.org/articles/view/36954.
2) Sleep Loss May Equal Weight Gain. http://www.usatoday.com/news/health/2004-12-06-sleep-weight-gain_x.htm
3) Spiegel, K, Tasali, E, Penev, P, Van Cauter, E. Brief communication: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med 2004; 141:846.
4) National Sleep Foundation. Sleep in America Poll, National Sleep Foundation, Washington, DC, 2002.
5) BMI calculator: http://www.nhlbisupport.com/bmi/

Once in awhile, I’ll read a study that recommends something that is pure genius in its effectiveness and simplicity. A recent Australian Study done by accredited practicing dietitian Bridget Kelly recommends putting traffic light colors, red, amber and green, on every packaged food item as a standard way for the average consumer to tell if it’s healthy or not.

Many of us try to identify the healthiness of a product in the grocery store by looking at the nutrition labels that are based on percentages of daily recommended intake values however, despite being a health professional, it  takes me 10-20 seconds to adequately tell if it’s healthy or not with this label.  The average consumer may take even longer and most likely, they don’t really look at it before purchasing. The traffic light color indicator of healthiness is a great idea since most teens and adults are conditioned to associate traffic light colors with action- ie stop, go or gun the accelerator… I mean slow down in anticipation of a red light.

Kelly and colleagues wanted to find out what kind of labeling was most acceptable and effective for consumers. They showed 790 consumers mock foods with 4 different types of labeling. Each mock food item was presented individually. Two were based on the percent of daily intake and two were variations of the traffic light method. The two traffic light methods included separate traffic light colors for the major nutrients like saturated and total fat, salt, and sugar, as well as the second way which showed a single color for overall healthiness. The study found that people were five times more likely to identify the healthy foods with a traffic color for each nutrient compared with the traditional percentage based label. They were also three times as likely to find the healthy food compared with one overall traffic color label.

So should we scrap the current labeling system altogether?In my opinion, probably not. I think the percentage based system is helpful to those consumers who are more detail obsessed when comparing two similar foods. For instance, if I were comparing two soup cans, I would likely choose the one with 16% fat over the 19% one. Unfortunately, in a color coded system, both may carry the amber color and I would have no way of determining the healthier one. So I propose a compromise. How about all three? For the shopper in a rush, a prominent single overall traffic color on the front. For the average concerned consumer, individual nutrient colors, and for the detail/health obsessed, the current percentage based label. I’m sure there is a better way so if you have a great idea, sound off in the comments below!

Reference:

1) http://www.easo.org/

What/Where:

Typically shin pain is sharp or aching pain along the medial or lateral border of your shin bone (Tibia) where the muscles attach to the bone. The pain is worse during or immediately after exercise, better with rest, and may be tender to the touch over the affected area. This pain is commonly known as “shin splints” and in the sports medicine world “Medial Tibial Stress Syndrome.”

Athletes or people most at risk include:

1) Runners 2) basketball players, 3) gymnasts or 4) tennis players, 5) dancers, 6) military recruits, 7) women (especially female athletes) especially if they have irregular or missed menstrual periods, 8 ) exercisers with sudden changes in training, 9) anyone with some sort of metabolic bone disorder like osteoporosis, 10) anyone taking a medication that affects bone mass

Why:

1) Too much too soon too frequently: You have recently increased your intensity, duration and frequency of weight bearing exercise like running and your conditioning, tendon, ligament, muscle and connective tissue strength do not match the requirements for this higher level. Muscles fatigue and transfer stress/shock directly to the bones.
2) Your shoes are old, you have run more than 300 miles with them, or they are too stiff to begin with
3) You are not resting long enough between runs therefore your muscles and bones can’t heal, strengthen and thicken.
4) You are not nutritionally supporting the healing/strengthening/thickening process.
5) You change surface ie grass to clay courts, or treadmill to sidewalk.
6) You have a biomechanical problem that may stem from an inherent asymmetry in your body (ex leg length difference) or you have developed a bunion, blister or tendon problem that affects how you put weight on your foot and causes an asymmetric gait.

Red Flags- You need to see your sports medicine physician if:

1) Hoping on one foot hurts your shin
2) Pain is on the outside/lateral aspect of your shin or tibia
3) Nothing helps the pain except rest
4) The pain is very focal (in one place) only.
5) Swelling in your feet or ankles,
6) Bruising
7) You have irregular or missed menstrual periods
8 ) Pain that occurs during normal daily activity.

If you have any of these signs see your sports medicine physician as soon as possible. You may have a stress fracture of the bone  or something else that requires aggressive diagnosis and treatment to help you return to your sport/activity as quickly as safely possible.

How to prevent:

1) Calf and Achilles tendon stretching after workouts and daily.
2) Heel walking and heel raises to strengthen your Tibialis Anterior muscle.
3) If running, replace your shoes every 300-500 miles. The mid sole breaks down and doesn’t give as much shock absorption therefore that force is transmitted up into your shins.
4) If you are just starting out with running, do not increase the distance more than 10% each week from the starting distance and frequency you set with your sports medicine physician.
5) Note: A recent study  reviewed 199 studies looking at prevention of shin splints. They concluded that there were no statistically significant methods of prevention. The only method that was borderline significant was using shock absorbing insoles. Most of the studies reviewed were flawed in their methodology or were not controlled. This doesn’t mean you shouldn’t do the above, it means that they need to do better studies to see what works.

Treatment:

1) Replace your shoes if you’ve run more than 300 miles on them. Go to a good running store or sports physician that can analyze your gait and recommend the appropriate shoe for you. This is critically important for both prevention and treatment.
2) Do a lot of Achilles tendon stretching after each workout and daily
3) Ice your shins after every workout 15-20 minutes. You may repeat this hourly if you feel as long as you have 40-45 minutes between icing periods.
4) Try shock absorbing insoles. A couple good examples include those made by Spenco and Superfeet.
5) Reduce your weekly mileage if you’re a runner
6) Reduce the intensity/speed and frequency of workouts. Try doing a “Run/walk” routine with 60 seconds of running and 90 seconds of walking to start. This gives the muscles, tendons, ligaments and bones a chance to recover, and you still get the full mileage completed.
7) Return to a softer surface for some or all of your training.
8 ) Start running in the pool since you are 5% of your body weight in the water, therefore less impact is felt on your bone and joints but will still get the cardiovascular benefits of running on land.
9) You may need to take time off from your sport. Try cross training.
10) If you have irregular or skipped menstrual periods, the underlying cause is often a caloric deficiency causing an lack of energy availability so try and eat more calories. You should see your physician to figure out why your periods are irregular.
11) Nutritional support: Make sure you are getting 1000-1500mg of dietary calcium per day (dairy, collards, spinach, fortified cereals or orange juice). In addition, you must have 400 IU of dietary Vitamin D (Salmon, tuna, mackerel, fish oil, fortified dairy or cereals). Eat about 0.8-1.0 mg/kg of good quality protein per day (lean meats, fish, tofu, milk, eggs, cheese).
12) If your symptoms do not improve with the above, you must see your sports medicine physician to rule out other causes of shin pain and to diagnose and treat a gait abnormality.

As you can see, there is much you can do to prevent and treat shin splints but remember the “red flags” and see your physician if you have any of them or you don’t improve with the modifications I discussed. I hope this helps! Get out there and shape up!

References:
1) Stress Fractures of the foot and ankle- http://orthoinfo.aaos.org/topic.cfm?topic=A00379
2) Craig, D. Medial Tibial Stress Syndrome: Evidence Based Prevention – http://www.nata.org/jat/readers/archives/43.3/attr-43-03-316.pdf. Journal of Athletic Training. 2008;43 (3):316-318

Science has long known that visceral fat, the fat surrounding your abdominal organs, aka the “beer belly”, is the worst place for you health. Fat in this location has been associated with increased rates of heart attack, stroke, diabetes, hypertension and potentially even cancer.

Beer Belly fat releases inflammatory molecules like c-reactive protein (CRP) that are released into your bloodstream, resulting in damage to your heart, blood vessels and other organs over time. This is less true with fat deposited on your hips or other parts of the body.

Now a new study from the University of Illinois, published in the American Journal of Physiology, Endocrinology and Metabolism, shows that modest exercise alone will decrease visceral fat inflammation, even without a change in diet. Mice were stuffed with a high fat diet for six weeks, then put in four different groups. These included a sedentary group, an exercise group, a low fat diet group and a a group that combined  exercise and a low fat diet.

Interestingly, the exercise alone group performed almost as well as the combination of diet and exercise group. The exercise routine comprised a  1/4 of a mile 5 days a week which upscaled to humans would be around 30-45 minutes of exercise 5 days a week- precisely the recommended exercise routine by the American College of Sports Medicine  (ACSM) and the American Heart Association (AHA).

So does this mean that as long as you are exercising regularly you can pig out at your local fast food joint? Absolutely not.  Remember that this study only looks at inflammatory levels. There are numerous published good studies that show that weight loss reduces the risk of heart disease and stroke, not to mention a reduction in diabetes and cancer, and plenty of studies that show that obesity people have higher rates of diseases along with poorer quality of life.

This study does show however that if you have difficulty controlling your diet, don’t despair and stop exercising- you can still benefit from regular modest exercise alone. Eat sensibly and exercise five times per week and you may prevent all of these illnesses from happening to you!

Source:

This study is funded by the National Institute of Health (NIH) and was published in the American Journal of Physiology, Endocrinology and Metabolism. Co-authors are V.J. Vieira, R.J. Valentine, K. Wilund, N. Antao, T. Baynard, and J.A. Woods

Via Medical News Today: http://www.medicalnewstoday.com/articles/147483.php

Here’s another great benefit to white tea- it decreases fat uptake by new fat cells as well as tells existing fat cells to breakdown and release their stored fat.

A new study published today in “Nutrition and Metabolism” reports these findings. They added a white tea extract containing polyphenols, methylxanthines and epigallocatechin-3-gallate (EGCG) to preadipocytes that eventually turn into fat cells. They measured the gene expression of transcription factors that initiate fat cell genesis.

Amazingly, the study found that the white tea extract decreased triglyceride (a type of dietary fat) uptake into new fat cells without affecting cell viability. It also stimulated existing fat cells to metabolize their fat stores. This effect was on both a genetic and protein building level.

Polyphenols and EGCG are powerful antioxidants that may prevent certain cancers and maybe even cardiovascular disease. Methylxanthines like caffeine relaxes your lung and blood vessel smooth muscles, and are also mild central nervous system and cardiac stimulants. These substances are found in other tea like green tea but they are thought to have higher concentrations in white tea. White tea is the least processed version of the tea plant Camellia sinensis from which both green tea and black tea are also derived.

Here is a great picture from the Linus Pauling Institute at Oregon State University outlining the tea processing method:

What does this mean to you? It’s hard to say if this will be a useful or safe weight loss tool and more studies need to be done in humans to evaluate this but it is reasonable to drink more white tea both for antioxidant properties and/or if you are on a weight loss program prescribed or recommended by your physician.

My wife, an avid tea drinker, is going to love these findings!

Source:

Nutrition & Metabolism 2009, 6:20
http://www.nutritionandmetabolism.com/content/6/1/20

Linus Pauling Institute http://lpi.oregonstate.edu/