Saturday, September 15, 2018

Benefits of fasting for active people goes beyond weight loss

Although intermittent fasting starting making news in 2016 and really became popular in 2017, researchers began considering the effectiveness of fasting a decade earlier.  Dr. Mark Mattson has studied in the connection between nutrition and diseases such as Alzheimers for quite a while.  He is the chief of the Laboratory of Neurosciences at the National Institute of Aging and Professor at Johns Hopkins.  His research influenced Dr. Michael Moseley, who did a BBC documentary in 2012 about the benefits of intermittent fasting.

I became more curious about Mattson after reading Kyle Boelte's May 2017 article in Outside Online entitled "What I Learned from a Year of Intermittent Fasting."  Boelte is an active man in his 30s who does not need to worry about losing weight.  However, he tried fasting to address issues that were compromising the quality of his life.  The subtitle for the article is "It won't solve all your health problems, but it might make your life a bit better."  In Nov 2017, he wrote a followup article entitled "How to Start Fasting: A beginner's guide to the burgeoning nutrition trend" that is also a good read.  It's the best introduction I've found so far for active people willing to experiment with fasting.
"I settled on the 16-hour fast, where I’d limit eating to an eight-hour window every day. As Mattson explains, the liver stores glucose (the body’s main energy source when you are regularly eating carbohydrates) for about ten to 12 hours after a meal. When you fast for more than 12 hours, your body switches from glucose metabolism to fat metabolism, which leads to a bunch of positive adaptive cellular stress responses. So, if you fast for 16 hours each day, you’re receiving the benefits of those adaptive responses without limiting your total caloric intake."

The 2014 medical journal article by Dr. Mattson referenced in Outside Online is entitled "Meal frequency and timing in health and disease."  There is a long list of references for those interested in learning more.
Proc Natl Acad Sci U S A. 2014 Nov 25; 111(47): 16647–16653. 
Published online 2014 Nov 17. doi:  10.1073/pnas.1413965111

Thursday, September 13, 2018

Reasons to avoid diet soda

The idea that diet soda is "healthy" seems to be more a function of good marketing since the 1960s than any scientific research.  The same could be said of sugar substitutes in general, but those who drink diet soda regularly probably consume far more soda than other food with the same amount of sugar substitutes.  The negative impact of drinking 1+ diet sodas per day in the U.S. is not new information.  However, the long term impact from an epidemiological standpoint is probably more obvious in 2018 than it was fifty years ago when diet drinks were still relatively new.  Coca-Cola and Pepsi were selling diet sodas by 1963.

A search on "reasons not to drink diet soda" will bring up lots of articles.  Here are a few to think about.

includes links to references - 2018

Looking for clinical trials related to diet soda can get pretty complicated.  Here's an example.  This 2015 study from the American Journal of Clinical Nutrition compared diet soda to water over a 24-week period.  It's a small study considering obese women with about 30 subjects in each group.  The soda group drank 1 soda at lunch 5 days a week.  The results was that the group drinking water at lunch lost more weight and the difference was statistically significant.  The level of insulin resistance was also measured and the water group did better.

Effects on weight loss in adults of replacing diet beverages with water during a hypoenergetic diet: a randomized, 24-wk clinical trial

It's clear that a diet soda causes just as much of an insulin spike as a regular soda.  Higher insulin levels means less chance the body switches over to burn stored fat.  That can be a key reason people who drink diet soda all day long have big waistlines and trouble staying at a healthy weight, no matter how much they restrict calorie intake and/or exercise.

The development of diabetes, kidney failure, heart failure, or osteoporosis takes years and there are many risk factors.  The research in the last 10-20 years generally supports the idea that finding an alternative to diet soda that does not include sugar substitutes is worthwhile for people interested in long term health.

When I was growing up, my family never drank soda of any kind.  Now that I am over sixty, I am rather glad I do not like soda or the taste of any sugar substitute in any type of drinks.

Science behind fasting, hunger, and daily eating habits

As I looked around for information about fasting, I came across a series of well researched videos by an American living in Tokyo in a blog called What I've Learned.  Some of the videos go together with a blog entry of the complete text.  My interest in learning more about fasting is in longevity with a high quality of life, as opposed to any need to lose more than a few pounds.

The 2018 video below is a good summary of about why someone who is fasting does not feel hungry all the time.  There are several hormones involved with eating and how the body finds fuel from food or stored fat that have only been measured relatively recently as part of medical research.  An example of of Ghrelin (hunger hormone) levels during fasting begins at the 5 min. mark.  Note that 2017 book The Obesity Code by Dr. Jason Fung is referenced.

The 2016 video about eating one meal per day includes references that demonstrate that the idea of fasting as beneficial are not particularly new.  What's actually new in the history of human beings is the concept that three meals a day are necessary for a healthy lifestyle.

Intermittent Fasting & Hunger - What the Science says, 11 min - 2018

Longevity & Why I eat once a day, 16 min - 2016

Tuesday, December 5, 2017

7-Minute Workout based on HIIT to do anywhere

Back in 2013, the NY Times wrote up a 7-Minute Workout and it proved to be quite popular.  The basic premise is that the workout uses HIIT to achieve maximum results in a short amount of time.  HIIT stands for High Intensity Interval Training and has been researched a reasonable amount in recent years.  The NY Times article was inspired by an article with the title "High-Intensity Circuit Training Using Body Weight: Maximum Results With Minimal Investment" from the Amer. College of Sports Medicine's Health and Fitness Journal.  My personal trainer suggested I give it a try during a training session about a year after I completed physical therapy for knee rehab.  After that I found a free app that makes it easy to do the workout, especially when I am traveling.  All that's needed is a little space, a towel, and an appropriate chair.

When I first started doing the 7-Minute Workout, I was in decent shape but I wasn't ready for 30 seconds for some of the exercises.  I did what I could, and then took a longer rest until it was time for the next exercise.  I felt it was more important to maintain good form than worry about the number of reps.  For instance, I started with about 8 pushups at a slow pace.  Once I got into better shape, I started doing 10-15 pushups in the 30 seconds.  When I'm in good shape, I can do 20 pushups.

Possible progression from easy to harder:
  1. Very slow, stopping before 30 sec up if needed, complete rest for 10 sec
  2. Slow and steady, continue for 30 sec, complete rest for 10 sec
  3. Normal pace for 30 sec, simpler versions for a few exercises, complete rest for 10 sec
  4. Normal pace for 30 sec, good form for all exercises, complete rest for 10 sec
  5. Normal pace for 30 sec, good form for all exercises, active rest for 10 sec
This video demonstrates the entire 7-Minute Workout.  She gives good explanations.  In this case, active rest is used instead of complete rest.  She does exercises that rely on upper body strength the easier way.  For instance pushups or the plank from her elbows.

Friday, November 24, 2017

Bone density and hyperthyroidism

An additional factor for some women, and men, to consider when thinking about bone density are thyroid hormones.  People with hyperthyroidism are at higher risk of low bone density.  People taking medication for hypothyroidism who are not being monitored often enough can end up taking too much synthetic hormone that causes them to have too much in their system.  That's a reason to check thyroid labs at least every six months, as well as pay attention to common symptoms for hyperthyroidism and hypothyroidism.

Thyroid Disease, Osteoporosis and Calcium

The good news is that once thyroid hormones are back in normal range and stable, it's possible to build up stronger bones to get back to a normal level for a given age.

A good source of information about thyroid imbalance is the latest edition of a book first published in 1999.  The Thyroid Solution by Dr. Ridha Arem, covers diagnosis and treatment for hypothyroidism and hyperthyroidism in great detail.  The third edition was published in 2017.

I was diagnosed with an over active thyroid aka hyperthyroidism in October 2016.  In my case, the source was Grave's Disease.  It took almost a year to get the correct dose for medication.  After the initial treatment, the maintenance dose is quite low.  Most of the symptoms went away within six months, but it took another few months to feel completely back to normal.

Wednesday, October 11, 2017

Five years after rupturing an ACL, still a successful coper

Hearing from other people in the midst of knee rehab recently made me think back to my knee rehab process.  My knee injury resulted in a complete ACL rupture (not a skiing accident).  Using KOOS (max 100, Knee Injury and Osteoarthritis Outcome Score) was useful for tracking the healing process.  After five years I have a different appreciation for milestones during the first year.  During rehab it was not clear how long the process would take and whether or not I would have to change my approach to skiing.  I decided to take the treatment approach based on physical therapy and improving fitness only, as opposed to scheduling ACL reconstruction surgery.
  • Month 1: crutches (injury was during 2-week international trip) and rest - June 2012
  • Month 2: formal PT, mostly no impact exercises while giving MCL strain time to heal completely, MRI confirmation that ACL completely ruptured
  • Month 3: started weekly personal training, fully functional for daily living, KOOS 86-88 (Mild or Moderate for Running, Jumping, Twisting/pivoting because avoiding those actions), second and final appointment with orthopedic surgeon
  • Month 4: continue personal training, back to indoor rock climbing, avoiding jumping and running (never liked running for exercise)
  • Month 5: final PT session included agility exercises, KOOS around 90
  • Month 6: ready for easy skiing, KOOS at 94 (Moderate for Twisting/Pivoting) 
  • Month 7: skiing at speed on small hill (Massanutten) - Jan 2013
  • Month 8: started lessons with a very experienced instructor (three Silver Clinics at Massanutten with Walter, PSIA Level 3), decided not to bother getting a brace
  • Month 9: 3-hour private lesson at Bridger (Ric Blevins, PSIA Level 3, worked with Ric the season before), skiing at Bridger and Big Sky included a few bump runs steeper than the year before
  • Month 10: skiing harder ungroomed terrain at Alta than the previous year, KOOS about 96 - Apr 2013
I had a relatively easy time making an educated decision about which treatment made sense for my ACL injury. I had an MRI and was evaluated by a orthopedic specialist about a month after injury. The collateral damage was a minor MCL strain and a small hole in the part of the meniscus that could heal fully without medical intervention. By the first time I met with the surgeon I had researched the most common treatment options was ready to discuss the options. Even though I was over 50, my orthopedic surgeon was willing to do surgery if I was interested.  At three months my surgeon supported my decision to stay a coper.  I was very careful the first six months and gave my body almost a year before considering the healing process complete. I made use of Chinese medicine (acupuncture, herbal Yunnan BaiYao) from the start.

What I’ve learned since rupturing an ACL is that there are a lot of factors to consider when deciding on treatment. Initially I thought that the level of collateral damage (meniscus, bone fracture, other ligament damage) were the most important. After reading about ACL treatment options, recent research results, and learning more about copers who ski, including skiing with several older advanced skiers who are ACL-deficient, I think the following is only the start of a list of other significant factors.
  • Health care system of the patient’s country
  • Age of patient
  • Personality of patient related to fear of further injury
  • Personality of patient related to ongoing fitness exercises
  • Type of physical activities and sports the patient enjoyed at the time of injury
The medical approaches for how to treat ACL-deficient patients continue to evolve.  The knee is complicated.  Everyone's situation is different. Regardless of what can be learned online about copers and ACLr surgery patients, it's ultimately a very personal decision that should be made in consultation with experienced medical professionals.

Importance of hips when you want to dance on the slopes

After doing ski conditioning for a while and exploring ideas online and with my personal trainer, a few exercises stand out as part of almost any routine.  Most people know that lunges and squats are useful.  One objective is to work on the glutes, which turns out to be how to have stronger hips.  Bridge exercises are a good way to strengthen hamstrings, which are important for supporting knees.  For core strength, a plank with good form is a fundamental exercise.

For this set of seven ski conditioning exercises related to hip strength, resistance bands are used to increase the difficulty.

September 2017 Denver Post - includes 4 min video of seven exercises

If someone tells you that strong quads are the basis for good skiing, show them what an orthopedic surgeon at the well known Steadman Clinic in Vail, CO has to say.

“We’re finding more and more that we think strengthening of the hip muscles is as important as anything,” said Dr. Tom Hackett, an orthopedic surgeon at the Steadman Clinic in Vail who has worked with hundreds of U.S. Ski Team athletes. “I watch people in the gym getting ready for the ski season — all they’re working on is their quads. That’s obviously important, too, but we really have found that the control over your leg that prevents knee injuries is coming from the hip. So more and more, we’re really trying to encourage our patients to work on strengthening the hips.”