FOR SOME ATHLETES, “NO PAIN, NO GAIN” IS THEIR PERSONAL MANTRA. HOWEVER, TOO MUCH PAIN MAY MEAN NO GAIN IF THERE ARE PROBLEMS WITH EXCESSIVE inflammation, and possibly less than optimal repair of muscle, joint and bone tissue. In such cases, prevention is definitely superior to treatment; and the best prevention may be avoiding workout routines that brutalize your body to the extent that you are incapacitated, eating a healthy diet that provides adequate protein and other macro-nutrients, and using dietary supplements to support the maintenance and repair of tissues from muscles, joints and bones; and that also may help reduce excessive inflammation. Following is a discussion of such dietary supplements.

Calcium and Vitamin D
Calcium’s role in supporting the maintenance and repair of healthy bone is well established and does not require further elucidation here. Likewise, vitamin D has a long-established role in facilitating calcium absorption; and research indicates that vitamin D supplementation can help to prevent bone loss^1,2.

SierraSil^TM
SierraSil is a naturally-occurring mineral composite found only in the high Sierra Mountains. Research has demonstrated that SierraSil suppresses cartilage degradation and inflammation.³ In an unpublished double-blind, placebo-controlled study SierraSil was evaluated in patients with osteoarthritis. Results indicated that with doses of 2000 or 3000 mg, SierraSil improved joint flexibility and quality of life.⁴ A previous unpublished pilot study on SierraSil in osteoarthritis patients demonstrated similar results.⁵ SierraSil has a patent pending for supporting joint mobility, flexibility and active lifestyles.

Paractin^TM
Spasov et al⁶ has reported that standardized extracts of Andrographis paniculata have been investigated in a number of studies, showing significant reduction of major symptoms of common cold and other upper respiratory tract infections. Paractin^TM is a patented, standardized extract of Andrographis paniculata which has been shown in preliminary research to stimulate immune response at low doses and to reduce inflammation high doses.^7,8,9 It does this by invigorating the activation of Peroxisome Proliferator-Activated Receptor gamma (PPARΥ), which in turn inhibits inflammatory chemicals in the body such as NFkappaB interferon gamma (IFNΥ), and Interleukin 2 (IL-2). By supplementing the body’s ability to naturally activate PPARΥ, Paractin^TM helps promote healthy inflammation response while maintaining normal cellular structure and activity in the joints, bones, and throughout the body.

Glucosamine Sulfate
According to the book, The Arthritis Cure, there are three requirements to keep cartilage healthy: water for lubrication and nourishment, proteoglycans to attract and hold the water, and collagen to keep the proteoglycans in place. Proteoglycans are large molecules made of protein and sugar. They trap water like a sponge and make cartilage resilient.¹⁰ Glucosamine sulfate figures into healthy cartilage since it is a major building block of the water-loving proteoglycans. In addition, glucosamine sulfate's very presence stimulates the production of more proteoglycans. The fact that glucosamine sulfate increases the synthesis of these key elements of cartilage means that it actually helps repair damaged or eroded cartilage.¹¹ In fact, for many years glucosamine sulfate has been successfully used in the therapy of osteoarthritis, and has met all standards of an efficient and well tolerated drug (albeit a natural drug). This has been demonstrated by experimental as well as clinical studies, in which glucosamine sulfate led to long-lasting pain reduction and functional improvement.¹²

Chondroitin Sulfate
Chondroitin sulfate is the perfect complement to glucosamine sulfate since chondroitin acts like a liquid magnet, attracting fluid into the proteoglycans. This fluid acts as a shock absorber and also brings nutrients with it into the cartilage. Perhaps of greater significance than its fluid-enhancing properties, chondroitin sulfate protects existing cartilage from premature breakdown by inhibiting certain cartilage-chewing enzymes. Furthermore, like glucosamine, chondroitin stimulates the production of proteoglycans and collagen that are needed for healthy new cartilage. As a matter of fact, chondroitin works synergistically with glucosamine.

Plant Based Enzymes
Research has shown that certain plant-based (fungal) enzymes were shown to have powerful effects on protein digestion at the University of Rhode Island. Specifically, 300 to 500 mg of these fungal enzymes successfully released 62,000 mg of free form amino acids from protein (in the form of beef steak)¡Xthat's 42 percent more amino acids than stomach acid and enzymes alone, without fungal enzymes. Furthermore, in the laboratory fungal enzymes release branched chain amino acids from beef steak at up to 200 percent the rate of stomach acid and enzymes alone. This is particularly important since branched chain amino acids (BCAA) make up at least 35 percent of key muscle proteins. The results of this research clearly demonstrate that these enzymes cause amino acids in protein to become more bioavailable. This can help to rebuild and repair muscle tissue.

References:

1. Dawson-Hughes B, et al. Ann Intern Med 1991;115:505–12.
2. Dawson-Hughes B, et al. Am J Clin Nutr 1995; 61:1140–45.
3. Miller MJS, Ahmed S, Bobrowski P, Haqqi TM. Suppression of Human Cartilage Degradation and Chondrocyte Activation by a Unique Mineral Supplement (SierraSil™) and a Cat’s Claw Etract, Vincaria®. JANA 2004; 7(2):32–39.
4. Raut V, Gala J, Dhumale R. A double-blind randomized placebo-controlled study to compare two doses of a mineral supplement and a herbo-mineral combination in alleviating the symptoms of osteoarthritis of the knee. (unpublished)
5. A pilot study to test the safety and efficacy of the mineral supplement SierraSil™ in osteoarthritis of the knee. (unpublished)
6. Spasov AA, Ostrovskij OV, Chernikov MV, Wikman G. Comparative Controlled Study of Andrographis paniculata Fixed Combination, Kan Jang® and an Echinacea Preparation as Adjuvant, in the Treatment of Uncomplicated Respiratory Disease in Children. Phytother Res 2004; 18:47–53.
7. Paractin useful for the treatment of autoimmune diseases, and alzeimer disease by activation of PPAR- Receptor. Juan L. Hancke. Instituto de Farmacologia, Universidad Austral de Chile, Valdivia Chile. Paractin interferes with T cell activation and reduces Experimental Autoimmune Encephalomyelitis in the Mouse. Iruretagoyena MI, Tobar JA, Gonzalez PA, Sepulveda SE, Figueroa CA, Burgos RA, Hancke JL, Kalergis AM. Uniersidad Austral de Chile. Journal of Pharmacology & Exp Therapeutics, August 26 2004.
8. Paractin interferes DNA binding of NF-kB in HL-60/Neutrophils cells. María A. Hidalgo, Alex Romero, Jaime Figueroa, Patricia Cortés, Ilona I. Concha, Juan L. Hancke, & Rafael A. Burgos. Uniersidad Austral de Chile.
9. Theodosakis, J., et al, The Arthritis Cure, (1997) St. Martin’s Press: New York, 203 pgs.
10. Theodosakis, J., ibid.
11. Anonymous, Fortschr Med Suppl (1998) 183:1–12.
12. Theodosakis, J., ibid.

As we shed more clothes during the summer, one of the body’s most valuable assets is exposed: muscle. Having toned muscles is much more than a vanity issue. Turns out those who have more muscle stand to be healthier in the long run. Mounting research suggests that the amount of muscle on your frame is a leading indicator of health and longevity, with one recent study suggesting that the amount of lean muscle mass outperforms the body mass index (BMI) in determining health and mortality risk.¹

Most people over age 30 will likely notice that maintaining a fit physique becomes a more challenging endeavor with each decade of life. In our teens and 20s, there is a relative equilibrium in the rate at which our body builds and breaks down muscle. However, once we hit age 30 we slowly start to lose muscle.² By the time that milestone 50th birthday happens, we start to lose between one and two percent of muscle per year.³ And after the age of 70, muscle loss ranges from 13 to 24 percent per decade.⁴

This age-related muscle loss is known as sarcopenia and it can be likened to the process that occurs in the bones, known as osteoporosis. However, unlike osteoporosis, there are no pharmaceutical treatments that can combat muscle loss.

Keeping your muscles healthy as you age not only keeps you healthier, but it will also benefit your bones, help stabilize blood sugar, improve your endurance and allow you to enjoy a better quality of life as you age.

Here Are Seven Summer Strengthening Secrets To Improve Your Muscle Health:

1. Go Easy on Cardio: Cardiovascular exercises such as walking, cycling, and swimming, are great for the heart and mind but overdoing it doesn’t allow time for muscle recovery and regeneration and it can take time away from strengthening exercises, which are also needed. If resistance training is not part of your routine, the muscle loss that occurs daily from natural muscle protein turnover will not give the muscle the opportunity to rebuild. Resistance exercises will give you the greatest benefit for your muscles, boosting muscle protein synthesis; the process by which your body builds new muscle.⁶

2. Start Stretching: Stretching may seem boring, but spending a few minutes stretching before and after workouts offers significant benefits for your muscles. Stretching before a workout helps to increase blood flow to the muscles and after a workout, it helps speed recovery, increase range of motion and makes room for muscle fibers to grow.

3. Eat Frequently and After Workouts: Sporadic eating is almost as bad as not eating at all. Going for more than three hours without food can throw your body into starvation mode. This causes your metabolism to slow down and your body to hold onto fat to meet future caloric needs in the event that you skip another meal. Refueling after workouts is also important as this helps start the recovery process, replenishing lost glycogen (your muscles’ energy stores) and providing the nutrients your body needs in order to repair muscle and grow more of it.

4. Switch Up Your Routine: Doing the same exercises over and over is not only boring but it can limit your ability to build muscle. To encourage new muscle growth switch up your workout routine, try new exercises and gradually increase the number of weights you use. The muscles want to be challenged, or they will become stagnant. Adding some variety to your workouts will improve your gains and enjoyment.

5. Pump up the Protein: Since muscles are made from protein, it is important to ensure your body has adequate amounts of this key dietary nutrient. The recommended daily allowance (RDA) for protein is 0.8 grams per kilogram of body weight. However, a growing body of evidence suggests that the RDA is inadequate for older adults because it does not take into account physiologic changes that occur with aging and the fact that older adults need about 67 percent more protein per meal to stimulate muscle protein synthesis⁷ and support good health, promote recovery from illnesses and maintain functionality. Recent studies suggest that 25–30 grams of a high-quality protein per meal is necessary to reach the threshold for maximal stimulation of muscle protein synthesis in older adults.⁸

6. Add Amino Acids: Studies suggest that supplementing with a particular blend of essential amino acids, called Rejuvenate, can help prevent muscle loss and rebuild lost muscle. This patented formula was found to increase muscle protein synthesis by 57 percent with noticeable muscle mass improvement within 30 days.¹⁰ Rejuvenate is backed by 25 peer-reviewed published studies demonstrating its safety and efficacy. Rejuvenate can be mixed with water or incorporated into your morning smoothie or favorite beverage. Each serving contains only five calories, is low in fat and sugar, and free of dairy and gluten.

7. Get More/Better Sleep:During sleep our body is in a state of repairing and rebuilding. Critical muscle-building chemicals such as growth hormone are produced and muscle protein synthesis occurs, as long as protein is consumed prior to sleep. Studies suggest that poor sleep quality and short sleep duration is associated with an increased risk for muscle mass reduction.¹¹ If you are getting less than six hours of sleep a day you are limiting your body’s ability to naturally produce crucial muscle-building chemicals like growth hormone.

References:

1. Lee DH, Keum N, Hu FB, et al. Predicted lean body mass, fat mass, and all cause and cause specific mortality in men: prospective US cohort study. BMJ 2018; 362: k2575.
2. Keller K and Engelhardt H. Strength and muscle mass loss with aging process. Age and strength loss. Muscles Ligaments Tendons J 2013 Oct-Dec; 3(4): 346—350.
3. Hughes V, Frontera W, Roubenoff W, et al. Longitudinal changes in body composition in older men and women: role of body weight change and physical activity. American Journal of Clinical Nutrition 2002 Aug;76(2):473—81.
4. Filippin L, Teixeira V, da Silva M, et al. Sarcopenia: a predictor of mortality and the need for early diagnosis and intervention. Aging Clinical and Experimental Research 2015 Jun;27(3):249—54.
5. Vigelso A, Gram M, Wiuff C, et al. Six weeks 'aerobic retraining after two weeks' immobilization restores leg lean mass and aerobic capacity but does not fully rehabilitate leg strength in young and older men. J Rehabil Med. 2015. Accessed online, June 24, 2019. https://www.medicaljournals.se/jrm/content/html/10.2340/16501977—1961
6. Tipton KD and Wolfe R. Exercise, protein metabolism, and muscle growth. Int J Sport Nutr Exerc Metab 2001 Mar;11(1):109—32.
7. Moore DR, Churchward-Venne TA, Witard O et al. Protein ingestion to stimulate myofibrillar protein synthesis requires greater relative protein intakes in healthy older versus younger men. J Gerontol A Biol Med Sci 2015 Jan;70(1):57—62.
8. Deer RR and Volpi E. Protein Intake and Muscle Function in Older Adults. Curr Opin Clin Nutr Metab Care. 2015 May; 18(3): 248—253.
9. Snijders T, Trommelen J, Kouw IW et al. The Impact of Pre-sleep Protein Ingestion on the Skeletal Muscle Adaptive Response to Exercise in Humans: An Update. Front. Nutr., 06 March 2019. Accessed online June 24, 2019. https://doi.org/10.3389/fnut.2019.00017
10. Church DD, Fernando AA , Wolfe RR. Improved Muscle Protein Syntheses with 3.6g of Free Form Essential Amino Acid Ingestion in the Elderly. JiSSN, (Abstract) June 2019.
11. Chen Y, Cui Y, Wu Z. Relationship between sleep and muscular strength among Chinese university students: a cross-sectional study. J Musculoskelet Neuronal Interact 2017 Dec; 17(4): 327—33.

Outside of those of Indian heritage and athletes, most Americans have never heard of shilajit, which is unfortunate in that it is quite useful as a dietary supplement. Reasonable claims are that it improves the uptake of other nutrients, supports energy production without being a stimulant, enhances mitochondrial function, exerts anti-inflammatory properties, and supports the actions of coenzyme Q-10 (CoQ10). It is generally classified as an adaptogen. At one time, there were serious pharmaceutical efforts to harness shilajit to produce an orally-available insulin for diabetics.

Shilajit typically is a blackish brown rock exudate that contains fulvic and humic acids (up to 85 percent of the total weight) along with a number of non-humic components, including local plant metabolites. Other names include "mineral pitch" and "moomio." Revered in the Indian Ayurvedic tradition, it is a complex organo-mineral substance that can be found exuding from rock fissures in the mountains of Asia.¹ Most often found in the Himalayan foothills at altitudes between 1000–5000 meters, it is a substance revered in for its wealth of health-promoting properties. Consider the word "shilajit" itself—a Sanskrit term that has been variously translated as "rock-invincible," "winner of rock," or "conqueror of mountains and destroyer of weakness." Many sources claim to offer shilajit, but there are huge differences in quality. Raw shilajit must be carefully selected and properly processed before it is suitable for human consumption by modern standards. To start, the source material should be analyzed to ensure low levels of heavy metals (such as mercury, lead, and cadmium). Then the raw material must be treated to neutralize naturally present reactive oxygen species and fungal contaminants.^2,3 Most research has focused on two sets of molecules found in shilajit: fulvic acids and dibenzo-á-pyrones (DBPs).

THE COMPONENTS OF SHILAJIT

Shilajit consists of a humus "core" that is in common with soil-sediment humus. Humic acids can be further broken down into fulvic acids and dibenzo-α-pyrones (DBPs), with a partial structure of the shilajit humus core involving oxygenated dibenzo-α-pyrones.^4,5 Different sources of humic acids and different sources/forms of shilajit overlap to a large degree in components but can differ markedly in actual ratios of components. Shilajit humus consists of organic matter (60–80 percent), mineral matter (20–40 percent) and ~5 percent trace elements.

ANTI-INFLAMMATORY AND GROWTH BENEFITS OF HUMIC SUBSTANCES
A recent review of humic substances notes that these can be anti-inflammatory through a variety of mechanisms. Animal studies have demonstrated the suppression of delayed type hypersensitivity and contact hypersensitivity. Human studies have shown a reduction in C-reactive protein levels of patients suffering from osteoarthritis of the knee and the wheel and flare reaction of patients suffering from hay fever. The anti-inflammatory action of one of the humates tested involves the inhibition of the release of inflammatory-related cytokines, adhesion molecule, oxidants and components of the complement system. This same review provides safety data on properly manufactured humic and fulvic acids. Potassium humate according to this source is safe in humans at up to a daily dosage of 1 gram/kilogram bodyweight, whereas fulvic acid is safe in humans up to a much lower daily dosage of 1.8 grams total per adult.⁶ It is not advisable to test these dose limits with commercial products—follow the manufacturer's directions and start conservatively.

Large animal studies have been carried out using humic sources such as leonardite and lignite in weaned piglets and a complex of humic and fulvic acids in cattle.^7,8 These studies were positive in terms of better weaning and improved rates of growth. The latter finding is in line with the commonly proposed benefits of humic acids for digestion and nutrient utilization.

IMMUNOMODULATORY SUPPORT
Animal studies into the effects of shilajit, humic and fulvic acids support benefits to immune function. One rat study showed that humic acid and fulvic acid supplementation resulted in strong humoral immune stimulation. The impact on thyroid activity needs to be further studied.⁹ Shilajit has been shown to activate phagocytosis and cytokine release, to stimulate osteoblastic differentiation of mesenchymal stem cells to induce the proliferation of lymphocytes in the thymus.¹⁰

ADAPTOGENIC BENEFITS AND DIBENZO-α-PYRONES (DBPS)
A 2014 review of shilajit's safety and efficacy notes that "animal and human data support its use as a 'revitalizer', enhancing physical performance and relieving fatigue with enhanced production of ATP. Key constituents in shilajit responsible for these effects appear to be dibenzo-α-pyrones and fulvic acid and their derivatives."¹¹ At least some of these benefits are linked to improvements in mitochondrial function.¹²

The effects of shilajit are often described as "boosting energy levels and supporting endurance." Shilajit seems to do just that by increasing tissue concentrations of CoQ10 (and protecting ubiquinol levels) in the body and supporting efficiency in the mitochondrial electron-transport chain. CoQ10 has two primary roles in the body: 1) as a critical mitochondrial electron shuttle in the production of the body's energy currency, ATP and 2) as a lipid-soluble antioxidant that protects the body from reactive oxygen species (ROS) and helps regenerate other antioxidants like vitamin C, vitamin E, and lipoic acid. When our mitochondria begin to deteriorate and lose efficiency, a process that is often in lock-step with aging, less energy, and more ROS are generated. This leads to mitochondrial damage and decreased levels of total CoQ10, but especially the active-antioxidant form ubiquinol. That's where shilajit comes in.

Dibenzo-α-pyrones found in shilajit seem to be at least partly responsible for augmenting and protecting total CoQ10 levels and facilitating mitochondrial efficiency and durability.¹³ For instance, when one shilajit DBP (3,8- dihydroxydibenzo-α-pyrone [3,8-(OH)2-DBP]) was co-administered with CoQ10 in rats, CoQ10 levels in the heart and liver were elevated to a greater extent than when CoQ10 was given alone. In the lab dish, shilajit DBPs also protect ubiquinol from degradation in various conditions.¹⁴ Processed shilajit was also found to attenuate decreases in CoQ10 and ATP levels when given before exercise in mice.¹⁵ It seems that the "destroyer of weakness" appellation may not be mere hyperbole.

FULVIC ACID FUNCTIONS
The fulvic acid constituents of shilajit also appear to play a critical role.¹⁶ Evidence suggests that fulvic acids can both increase the GI absorption of a wide-range of constituents and support their transport into deep tissues.^17,18 And fulvic acids might be said to "lubricate" electron transfer during energy production.^19,20,21 These characteristics likely undergird the adaptogenic effects ascribed to shilajit and make it useful in the face of both physical and mental stress.²²*

As an example, consider the range of stress endured when traveling to high-altitudes: extremely low humidity, decreased atmospheric pressure, severe cold, high wind velocity, and intense solar radiation exposure. Shilajit assists the body in coping with such conditions and supports physical and mental fitness by supporting energy reserves. In fact, a pilot human study using 200 mg/day in non-athletes for 15 days found improvements in various energy markers: total ATP, ATP/ADP ratio and total adenine nucleotides (TAN).²³ Whether one is faced with a literal or figurative mountain, shilajit seems to be helpful in surmounting it.

SAFETY
Shilajit, humic and fulvic acids always must be carefully screened and prepared so as to avoid contamination with lead and other heavy metals or organic contaminants. This is a serious enough issue that the Canadian health authorities have raised it directly with regard to imported shilajit. Similarly, there are differing degrees of maximum tolerable and safe dosages among these three items. Distributors of dietary supplements must be aware of these differences and maximal tolerate intakes.

Shilajit has tested as quite safe at an intake of 100 mg/kilogram body weight daily for six weeks.²⁴ A clinical trial in men 200 mg daily for 90 days (dose determined from Ayurvedic recommendations) failed to note any clinically significant toxicological symptoms.²⁵ A larger dose of 2 grams shilajit (6.61 percent fulvic acid) daily for 45 days in humans aged 16–30 years likewise did not note any significant toxicological signs in serum.²⁶

Endnotes

1. Islam A, et al. Biotransformation of 3-hydroxydibenzo-α-pyrone and aminoacyl conjugates by Aspergillus niger isolated from native Shilajit. Electronic J Biotechnol. 2008; 11(3): 1.10.
2. Meena H, et al. Shilajit: A panacea for high-altitude problems. Int J Ayurveda Res. 2010 Jan.Mar; 1(1): 37.40. doi:10.4103/0974-7788.59942.
3. Ghosal S, et al. The Need for Formulation of Shilajit by Its Isolated Active Constants. Phytotherapy Research, 5: 211-216, 1991.
4. Ghosal S, Lal J, Singh SK. The core structure of shilajit humus. Soil Biology and Biochemistry. 1991; 23,7: 673.80.
5. Ghosal S, Reddy JP, Lal VK. Shilajit I: chemical constituents. J Pharm Sci. 1976 May;65(5):772.3.
6. van Rensburg CE. The Anti-inflammatory Properties of Humic Substances: A Mini Review. Phytother Res. 2015 Jun;29(6):791.5
7. Trckova M, Lorencova A, Babak V, Neca J, Ciganek M. The effect of leonardite and lignite on the health of weaned piglets. Res Vet Sci. 2018 Jun 12;119:134.142.
8. Cusack PM. Effects of a dietary complex of humic and fulvic acids (FeedMAX 15) on the health and production of feedlot cattle destined for the Australian domestic market. Aust Vet J. 2008 Jan-Feb;86(1-2):46.9.
9. Vucskits AV, Hullar I, Bersenyi A, Andrasofszky E, Kulcsar M, Szabo J. Effect of fulvic and humic acids on performance, immune response and thyroid function in rats. J Anim Physiol Anim Nutr (Berl). 2010 Dec;94(6):721.8.
10. Schepetkin IA, Xie G, Jutila MA, Quinn MT. Complement-fixing activity of fulvic acid from Shilajit and other natural sources. Phytother Res. 2009 Mar;23(3):373.84.
11. Stohs SJ. Safety and efficacy of shilajit (mumie, moomiyo). Phytother Res. 2014 Apr;28(4):475.9.
12. Surapaneni DK, Adapa SR, Preeti K, Teja GR, Veeraragavan M, Krishnamurthy S. Shilajit attenuates behavioral symptoms of chronic fatigue syndrome by modulating the hypothalamic-pituitary-adrenal axis and mitochondrial bioenergetics in rats. J Ethnopharmacol. 2012 Aug 30;143(1):91.9.
13. Ghosal S, et al. Mitochondria-targeted antioxidants. US 2008/0031862, 2007.
14. Bhattacharyya S, Pal D, Banerjee D, et al. Shilajit dibenzo-ƒ¿-pyrones: Mitochondria targeted antioxidants. Pharmacologyonline. 2009; 2:690.8.
15. Bhattacharyya S, Pal D, Gupta AK, Ganguly P, et al. Beneficial effect of processed shilajit on swimming exercise induced impaired energy status of mice. Pharmacologyonline. 2009;1:817.25.
16. Piotrowska D, et al. The research on antioxidative properties of TO.PA Peat Preparation and its fractions. Acta Pol Pharm. 2000 Nov;57 Suppl:127.9.
17. Bucci LR. Selected herbals and human exercise performance. Am Socii for Clin Nutr. 2000;72:624S.6.
18. Shenyuan Yuan, et al. "Application of Fulvic acid and its derivatives in the fields of agriculture and medicine." 1st ed 1993.
19. Klapper L, et al. Fulvic acid oxidation state detection using fluorescence spectroscopy. Environ Sci Technol. 2002 Jul 15;36(14):3170.5.
20. Royer RA, et al. Enhancement of biological reduction of hematite by electron shuttling and Fe(II) complexation. Environ Sci Technol. 2002 May 1;36(9):1939.46.
21. Visser SA. Effect of humic substances on mitochondrial respiration and oxidative phosphorylation. Sci Total Environ. 1987 Apr;62: 347.54.
22. Schepetkin IA, et al. Complement-fixing activity of fulvic acid from Shilajit and other natural sources. Phytother Res. 2009 Mar;23(3):373.84.
23. WD McArdle, HJ Katch & VL Katch. (2000) "Essentials of Exercise Physiology." Lippincott, Williams and Wilkins Publication, 2nd Edition, Philadelphia, PA.
24. Park JS, Kim GY, Han K. The spermatogenic and ovogenic effects of chronically administered Shilajit to rats. J Ethnopharmacol. 2006 Oct 11;107(3):349.53.
25. Biswas TK, Pandit S, Mondal S, Biswas SK, Jana U, Ghosh T, Tripathi PC, Debnath PK, Auddy RG, Auddy B. Clinical evaluation of spermatogenic activity of processed Shilajit in oligospermia. Andrologia. 2010 Feb;42(1):48.56.
26. Sharma P, Jha J, Shrinivas V, Dwivedi LK, Suresh P, Sinha M. Shilajit: evalution of its effects on blood chemistry of normal human subjects. Anc Sci Life. 2003 Oct;23(2):114.9.

Almost two years ago, this magazine ran an article entitled

"Supplements Target Ketogenesis and Metabolic Flexibility for Sports and Health."¹ (June 2016) Last month there was a review of the state of caloric restriction / fasting and ketogenic diets today. However, many readers have little interest in either caloric restriction or ketogenic diets as lifestyle choices. Both of these approaches are difficult to follow even if being utilized for specific health purposes. Nevertheless, their basic principles have application to general health and to athletics. The foremost impediment to taking advantage of these approaches was laid out in the 2016 article.

A major problem in achieving keto-adaptation by diet alone is that most individuals who have been raised on Western-style diets can take six months or more to make the shift and this shift becomes ever more difficult as we age. Studies examining the role of carbohydrates in the metabolism with roughly 30 year old males in good physical condition have revealed, for instance, that even transitioning from a high glycemic index diet to a low glycemic index diet while maintaining the same ratio of carbohydrate, fat and protein can take more than four weeks. Shifting to fatty acid metabolism for energy can be difficult.

For most of us, the issue is whether a moderate change in diet accompanied by a judicious utilization of special foods and dietary supplements can achieve the goals usually associated with caloric restriction, fasting and ketogenic diets. Fortunately, the answer for the preponderance of readers is "yes." Both for anti-aging purposes and for athletics, metabolic flexibility likely can be achieved through approaches within the reach of almost everyone. The goal is not to be ketogenic all the time, but to be able to metabolize ketones and free fatty acids routinely and easily. For a nice introduction to the distinction, readers might visit the blog entitled "Ketogenesis, Measuring Ketones, and Burning Fat vs Being in Ketosis."²

The Diet

Previously in these pages, it was noted that consuming too little protein presents issues, but, likewise, too much protein in the diet, meaning above roughly 30 percent of calories, defeats a major goal of caloric restriction, which is to not just reduce circulating insulin, but also to avoid elevating insulin-like growth factor-1 (IGF-1). Although those not trained in nutrition seldom realize this, protein sources can be used for gluconeogenesis, which is to say, to produce glucose from, non-carbohydrate sources. It is not just consuming too little fat and too much carbohydrate or too much of these two together with too little protein that defeat the aims of an anti-aging diet.

The recent Prospective Urban Rural Epidemiology (PURE) study followed 135,335 adults in eighteen countries for over seven years with respect to morbidity and mortality in terms of cardiovascular disease, strokes and non-cardiovascular disease mortality as correlated with the effects of nutrients.³ In an interview, Dr. Mashid Dehghan, the lead author, reported that Participants were categorized into quintiles of nutrient intake (carbohydrate, fats, and protein) based on percentage of energy provided by nutrients. We assessed the associations between consumption of carbohydrate, total fat, and each type of fat with cardiovascular disease and total mortality.

As noted by the researchers, their results flatly contradict decades of nutritional advice: High carbohydrate intake was associated with higher risk of total mortality, whereas total fat and individual types of fat were related to lower total mortality. Total fat and types of fat were not associated with cardiovascular disease, myocardial infarction, or cardiovascular disease mortality, whereas saturated fat had an inverse association with stroke. Global dietary guidelines should be reconsidered in light of these findings.

In the PURE study, those who consumed at least 35 percent of their calories from fat were 23 percent less likely to die than those who consumed only 10 percent or less as fat. According to PURE findings, the higher the fat intake, the less the chance of stroke. Those who consumed 77 percent of their calories as carbohydrates were 28 percent more likely to die than those who consumed less than 46 percent as carbohydrates. The conclusion of the study? "In a nutshell, a healthy diet based on the PURE results would be rich in fruits, beans, seeds, vegetables, and fats, include dollops of whole grains, and be low in refined carbohydrates and sugars."

The observant reader who takes the time to look at the PURE study's findings will quickly realize that the traditional reliance on "markers" such as blood LDL-cholesterol levels—markers long used to argue against the inclusion saturated fats any large amount of fats in general in the diet as well to promote carbohydrate consumption— does not correspond well with the actual endpoints of morbidity and mortality. This does not mean that the PURE diet needs to be ketogenic. To quote from the TotalHealth 2016 article, As admitted by Ben Greenfield, a serious triathlete who was tested with regard to the ergogenic benefits of a ketogenic diet, "after the study at University of Connecticut, I personally quit messing around with ketosis and returned to what I considered to be a more sane macronutrient intake of 50-60% fat, 20- 30% protein, 10-30% carbohydrate."⁴

As a practical matter, a more normal diet with supplements might look like this:
The diet should not be high in simple sugars, fructose or refined carbohydrates. For non-athletes and those looking primarily to increase metabolic flexibility, the diet should resemble a modified Sears Diet, meaning approximately 20 - 30 percent protein, 30 - 40 percent carbohydrate and 30 - 40 percent fat. For athletes and individuals who seriously want to initiate and maintain a fat-adapted diet, Ben Greenfield's suggestion is more in order: "50-60% fat, 20-30% protein, 10-30% carbohydrate."

Those who want to achieve most of the benefits of a ketogenic diet without undergoing the grueling restrictions normally involved (limitations not just on carbohydrate intake, which are extreme, but also on protein intake) should consider the fact that ketone bodies supply 2–6 percent of the body's energy requirements after an overnight fast (no eating at bedtime) with the higher figure reflecting a longer period without eating. After three days of fasting, 30–40 percent of energy needs are met by endogenously produced ketones. Such facts, again, lead to at least two possibilities aside from caloric restricted and ketogenic diets. First, will consuming exogenous ketones as esters or salts provide the same benefits as special diets? Second, is there a role for dietary supplements in delivering these benefits?

Ketones (Acetoacetate and β-hydroxybutyrate) Esters and Salts?

The new kid on the block in anti-aging and sports supplements is oral ketones, including a ketone ester (D-beta-hydroxybutyrate and D 1,3-butanediol) sports drink and ketone salts, typically beta-hydroxybutyrate bound to calcium, magnesium, potassium or sodium. A limited body of research indicates that such supplements may improve very long-duration endurance performance, but relatively little is known about their impact on short-duration and high-intensity workouts. Likewise, it is unclear that supplementation with ketones delivers the same benefits as adaptation to a ketogenic diet.

As one can learn from a variety of sources, "ketone bodies are three water-soluble molecules that are produced by the liver from fatty acids during periods of low food intake (fasting), carbohydrate restrictive diets, starvation and prolonged intense exercise… These ketone bodies are readily picked up by the extra-hepatic [outside the liver] tissues, and converted into acetyl-CoA which then enters the citric acid cycle and is oxidized in the mitochondria for energy. In the brain, ketone bodies are also used to make acetyl-CoA into long-chain fatty acids."⁵

In the liver, metabolism of fatty acids for energy, as opposed to ketone bodies, works in conjunction with a normal pattern of activity in the mitochondria, including the citric acid cycle. Ketone bodies are formed when there is not enough glucose from either carbohydrates, including glycogen, or the breakdown of protein to fuel the cycle. Technically, the supply of oxaloacetate is exhausted, at which point the liver produces and exports ketone bodies to tissues that can metabolize ketones fully. In starvation and under very low carbohydrate intake accompanied by restrained protein intake, ketone bodies supply up to 50 percent of the energy requirements for most body tissues and up to 70 percent of the energy required by the brain. The blog mentioned above provides a nice diagram of the cellular steps involved in ketone formation. The author also helpfully points out:

As I have written about eight hundred times in other posts, you do not need to be generating high levels of ketones to be metabolizing fat. The body does not operate in a binary system where the two choices are:

(1) Maintain deep ketosis …or…
(2) Become obese

Just because you're not in ketosis doesn't mean you're somehow not metabolizing fat so that the only other possible destination for it is to be stored.⁶

Ketone esters and salts can be ingested in an attempt to mimic a ketogenic state and work by elevating blood ketone levels to force the burning fat as fuel while interfering with certain other glycogen-related metabolic pathways. Whether supplements are the equivalent of a ketogenic diet in terms of benefits has been tested in humans only to a limited extent. In animal trials, they are not entirely equivalent and this appears also to be the case in humans. Let's start first with the animal experiments. The positive finding is that a 28-day administration of five ketone supplements on blood glucose, ketones, and lipids in male Sprague– Dawley rats caused a rapid and sustained elevation of beta-hydroxybutyrate and a reduction of blood glucose.⁷ No doubt, this represented a shift in the energy source to make use of the ingested ketones.

However, in a comparative trial of a ketogenic diet, ketone supplementation and control diet examining both control and chronic stress conditions, results differed with the intervention. Chronic experiments showed that under control conditions, only the ketogenic diet resulted in pronounced metabolic alterations and improved performance in the novel object recognition test and only the ketogenic diet prevented stress-induced deficits at the end of the trial and improved certain other aspects of performance. The advantage was to the ketogenic diet rather than supplementation in the areas of blood glucose, insulin and overall fat metabolism.⁸ Ketone supplements in animal models do indeed provide benefits, but not at the level of diet-induced endogenous production.

Thanks to recently published clinical trials, in the area of human athletic performance there now is evidence as to the limitations of ketone supplements. In one study, ten healthy adult males with similar athletic abilities and body mass indices fasted and then consumed either beta-hydroxybutyrate ketone salts or a matched placebo in a randomized order followed by a cycling time trial. Power output on the day participants consumed ketone salts was seven percent lower than on the day they consumed the placebo. As observed by study co-author Jonathan Little, assistant professor in University of British Columbia's (UBC) Okanagan's School of Health and Exercise Sciences, "Elevated blood ketones seem to inhibit the body's use of glycogen, the stored form of glucose, and favours burning fat instead."^9,10 A previous study utilizing ketone esters (573 mg/kg athlete body weight) in conjunction with carbohydrate consumption had positive findings of better performance in cycling to exhaustion trials.¹¹

The authors of both studies seem to agree that the ingestion of ketones leads to nutritional ketosis that alters the hierarchy of fuel substrate usage during exercise and it is clear that as the intensity of exercise increases, the demand for carbohydrate as an energy source increases. The ketone salt trial tested shorter and higher intensity training versus the longer period tested in the ketone ester trial, hence these were not entirely apple-to-apple trials. In addition, the ketone ester trial tested roughly 30 grams of ketone ester taken in conjunction with carbohydrate leading to significant benefit versus carbohydrate alone. However, bicycle ergometer time trial performance was only approximately two percent greater using the ketone ester plus carbohydrate versus carbohydrate alone "representing a modest increase in physical capacity in these highly trained athletes, despite significant changes in muscular metabolism." This finding, once again, indicates the difficulty of fully substituting ketones for glycogen-dependent aspects of muscle performance.

The latest studies continue the trend from above. Ingested ketones, for instance, as esters, impaired performance in elite cyclists in ˜31 kilometer laboratory-based time trials on a cycling ergometer programmed to simulate the 2017 World Road Cycling Championships course.¹² Achieving overall fat / keto adaptation via dietary means is more successful. Nevertheless, aside from the difficulty in following such diets, keto adaptation to a low carbohydrate, high fat diet requires time. Three weeks clearly is not sufficient even in highly trained athletes such as elite endurance walkers.¹³ Ten weeks in trained athletes appears to be on the margin, improving feelings of wellbeing, but not performance.¹⁴ At least insofar as attested in published trials, a full 12 weeks or more of adaptation is required even in the relatively young (20 subjects, 33 ± 11 years) and vigorous to achieve superior endurance results in comparison to a high carbohydrate diet.¹⁵

The above findings lead this author to the observation that although ketone ester-induced ketosis may increase metabolic flexibility during exercise by reducing glycolysis and increasing muscle fat oxidation, the benefits during shorter time periods and/or higher VO2/max demands are either not great or actually negative. Metabolic flexibility in the ester trial, such as it was, required the coingestion of carbohydrate. Without the co-ingestion of carbohydrate, as demonstrated in the other ketone trials (both salt and ester), there was a significant inhibition of the ability to access glycogen stores for energy upon demand.

Metabolic Fitness Supplements

Before looking at individual supplements, it is important

to understand that nutrients that aid metabolic fitness generally fulfill a number of requirements, among them the following:

• It is helpful to support fat metabolism directly such as through improved transport of fatty acids into the mitochondria for oxidation.
• Insulin sensitivity must be improved and maintained and insulin levels kept low.
• The release of fatty acids from fat cells likely is less important than is dis-inhibiting fatty acid metabolism. The first is accomplished with caffeine, yet often with a downside such as increased cortisol levels, hence alternatives to caffeine and other similar stimulants are needed.
• Inclusion of substances that actively promote fatty acid oxidation is important to help kick-start the body's ability to metabolize fats.
• Excessive gluconeogenesis by the liver (creation of glucose from glycogen in response to the release of glucagon) should be inhibited to promote fatty acid oxidation as the alternative.
• With diets that are heavy in alcohol and fat, potential "reverse" effects must be prevented.

The sources of useful supplements are not generic and this should be kept in mind because different production methods lead to different products with different results. The following discussion reviews key nutrients that fulfill one or more of the above requirements.

Potassium-Magnesium Hydroxycitrate
Very few athletes are aware of the benefits of (–)-hydroxycitric acid (HCA) for sports despite some impressive findings in terms of greater endurance and faster recovery plus reduced inflammation. This is because early trials—there were several large ones—failed to produce benefits for reasons that, in retrospect, are obvious. First, calcium HCA and calcium-containing HCA salts exhibit very poor uptake and poor results in comparative trials.^16,17,18 To this should be added the "food effect," meaning the finding that consuming food within 30 minutes of ingesting HCA typically reduces uptake by approximately 60 percent. HCA salts under normal delivery never exhibit more than lackluster bioavailability, hence any reduction of that already modest uptake into the system leads to extremely poor results. A third factor is that even seemingly nearly identical HCA salts (as tested by standard high performance liquid chromatography / HPLC) produced by slightly differing production techniques can exhibit up to 10-fold differences in bioavailability.¹⁹ Notably lacking in the research literature is any attempt to determine cellular uptake, an issue separate from bioavailability. Published research simply assumes that all uptake issues can be reduced to bioavailability, meaning blood levels, an assumption proven to be invalid with a number of nutritional substances, such as coenzyme Q10.

One way around these uptake problems with HCA is by means of a special liquid delivery. HCA salts normally are not stable in ready-to-drink formats and break apart to yield what is known as a lactone. The HCA lactone leads to good uptake—bioavailability—but little or no benefits because the molecule exhibits the wrong shape.²⁰ A recently issued US patent describes a method that not only stabilizes HCA salts in liquid, but also dramatically improves their bioavailability and physiologic efficacy.²¹

Properly produced and delivered HCA can lead to striking improvements in early fat utilization for energy, glycogen sparing and increases in endurance. This is in part because HCA helps to control the muscle's selection of fuels, an experimental finding from twenty years ago.²² More recently, using mice as the model, HCA ingestion for 13 days was found to increase fat oxidation and improve endurance exercise time to fatigue by 43 percent compared to a placebo.²³ Chronic HCA ingestion alters fuel selection rather than the simple release of fat from stores as is true of lipolysis per se, i.e., the mechanism for HCA is not the same as with caffeine, capsaicin, etc. Second, the combination of HCA plus L-carnitine improves glycogen status in liver and various muscle tissues versus placebo in exercised-trained rodents. Readers will recall that glycogen-related issues bulk large in the performance failings of ketogenic diets and ketone supplements.

What about HCA ingestion in humans? Similar positive endurance results were found by the same laboratory both with untrained men and women and with trained athletes as found in the animal tests. The following trial was conducted in trained athletes leading to significant improvements in endurance:

Subjects [n = 6] were administered … HCA or placebo as a control (CON) for 5 d, after each time performing cycle ergometer exercise at 60% VO2max for 60min followed by 80% VO2max until exhaustion.²⁴

Under the conditions of the trial, time to exhaustion at 80 percent VO2max went from approximately six minutes to approximately 8.5 minutes, which is a remarkable level of improvement. Lactate levels were lower. In evaluating the results, it must be observed that the earlier animal trials indicated that there is a greater shift in metabolism if the ingestion period lasts longer. But note clearly: the HCA salt used in these trials was a pure synthesized trisodium hydroxycitrate, not the usual HCA available as a dietary supplement.²⁵

Another benefit from HCA is as much as a 100 percent improvement in glycogen repletion in muscle after exercise when a post-workout snack is consumed.²⁶

Mango Leaf Extract and Caffeic Acid Enhance HCA's Ability to Improve Fat Metabolism

An issue that almost always is ignored with HCA is that under conditions of accelerated use of fat for energy, such as during fasting or ketogenic diets, there is a cycle that can undermine the compoundfs effects on fat metabolism by activating inside cells the substance acetyl-CoA carboxylase.²⁷ Two compounds that help to prevent this and actually improve fatty acid oxidation are caffeic acid and mangiferin (a constituent of mango leaf).

Caffeic acid is interesting for a number of reasons. For current purposes, it has been shown to improve the ability to metabolize fats for energy and also to promote the ability of glucose to enter cells, i.e., it is insulin sensitizing. In terms of HCA, caffeic acid helps block the actions of acetyl-CoA carboxylase.²⁸ This means that it helps to block the impact of high alcohol intake and high fat intake or fasting on HCA, thus allowing HCA to perform the function of disinhibiting fatty acid metabolism via β-oxidation as mentioned above.

Mangiferin, the primary active component in mango leaf extract, is even more significant than is caffeic acid. With regard to HCA, mangiferin, like caffeic acid, inhibits acetyl- CoA carboxylase. However, matters do not stop there. In various in vitro and animal trials, mangiferin increased fatty acid oxidation. A major finding is that the compound does the same, and safely, in human beings. Overweight patients with hyperlipidemia (serum triglyceride ≥ 1.70 mmol/L, and total cholesterol ≥ 5.2 mmol/L) were included in a double-blind randomized controlled trial. Participants were randomly allocated to groups, either receiving mangiferin (150 mg/day) or an identical placebo for 12 weeks. As reported in the published study,²⁹

A total of 97 participants completed the trial. Compared with the placebo control, mangiferin supplementation significantly decreased the serum levels of triglycerides and FFAs, and insulin resistance index. Mangiferin supplementation also significantly increased the serum levels of mangiferin, high-density lipoprotein cholesterol, L-carnitine, β-hydroxybutyrate, and acetoacetate, and increased lipoprotein lipase activity.

The increase in β-hydroxybutyrate and acetoacetate as well as lipoprotein lipase activity is a clear indication that mangiferin improves the availability of stored fats and promotes the oxidation of these fats for the production of energy as they became available.

Asparagine, Malate and Aspartates for Energy and Endurance

Some of the best supplements for health and sports have, as it were, slipped under the radar over the years. We tend to be attracted to whatever is "new" to the point of overlooking that these new items often are not actually novel, just older concepts dressed up in new terminology. A good example of this is the great fanfare given to the recent "discoveries" involving nicotinamide riboside. (Caloric Restriction, Fasting and Nicotinamide Riboside TotalHealth Feb 2015)³⁰ Proffered benefits include anti-aging effects, better energy metabolism and endurance.³¹ Strikingly, both the mechanisms involved and the benefits, upon closer examination, look remarkably similar to the benefits associated with what is known as the malate-aspartate shuttle. The anti-aging benefits, for instance, are similar to those associated with the Chinese herb rock lotus, which activates the enzyme (malate dehydrogenase) linked with this shuttle. (Uncovering the Longevity Secrets of the ROCK LOTUS TotalHealth April 2010)³²

For the hard science minded, the malate/aspartate shuttle is a principal mechanism for the movement of reducing equivalents from the cytoplasm to the mitochondria. In other words, this mechanism keeps energy as electrons flowing from the cytoplasm of the cell into the mitochondria and supports the production of adenosine triphosphate (ATP), the basic energy unit of the body. Ketones can play a similar role. As expressed in a recent paper, "cellular energy production depends on the metabolic coenzyme nicotinamide adenine dinucleotide (NAD), a marker for mitochondrial and cellular health. Furthermore, NAD activates downstream signaling pathways (such as the sirtuin enzymes) associated with major benefits such as longevity and reduced inflammation... [a ketogenic diet] will increase the NAD+/NADH ratio."³³ (NAD exists in oxidized and reduced forms, NAD+ and NADH.) This process is exactly what the recent discoveries regarding nicotinamide riboside are about. The shuttle also is involved in replenishing oxaloacetate, which was mentioned above with regard to ketogenesis and the Krebs/Citric Acid Cycle. Part of the role of oxaloacetate is shown in the diagram.

Now it just so happens that malic and aspartic acid (the "salts" are termed malate and aspartate) are components of this movement of energy. Malate, aspartate and the compound asparagine are known as oxaloacetate precursors. Many athletes use citrulline malate to help promote performance and reduce fatigue thinking that it is the citrulline that is active although, in fact, it is the malate. For instance, in an animal trial a month of supplementation with L-malate increased swimming time endurance by between 26.1 and 28.5 percent.³⁴ The researchers observed the activities of cytosolic and mitochondrial malate dehydrogenase were significantly elevated in the L-malate-treated group compared with the control group.

As pointed out in the TotalHealth article on the rock lotus, the malate dehydrogenase enzyme takes a period of time to be increased in the cell. A number of acute trials of, for instance, aspartates in athletes, compounds that affect the same shuttle mechanism, failed, but this should have been expected due to basic physiology and one wonders why those researchers even bothered. Under conditions of moderate exertion, supplementation with asparagine and aspartate plus L-carnitine increased time to exhaustion by approximately 40 percent.³⁵ In another animal trial, this time with intense exercise and only the two amino acids, the supplemented group showed higher exercise time, lower blood lactate concentration and a decreased the rate of glycogen degradation compared to control leading to the conclusion that "supplementation may increase the contribution of oxidative metabolism in energy production and delay fatigue during exercise performed above the AT [anaerobic threshold]."³⁶

To be sure, there are skeptics regarding magnesium—potassium aspartates for use as ergogenic aids.³⁷ However, the proposed mechanisms of action until recently have been wrong, the time frame for supplementation (acute rather than chronic), the amounts supplemented, etc., typically have been quite wide of the mark. The key mechanism of action involves the shuttle and oxaloacetate. Interestingly, this mechanism also promotes the proper metabolism of that great enemy of athletes, lactic acid. Lactic acid actually can be converted back into an energy source during exercise. As Ben Greenfield explains things in a wonderful post,³⁸ A significant rate limiting step of converting lactic acid into glucose is the conversion of the molecule Nicotinamide Adenine Dinucleotide (NAD) into Nicotinamide Adenine Dinucleotide Hydrogenase (NADH). So what does this have to do with oxaloacetate? In studies, acute oxaloacetate exposure enhances resistance to fatigue by increasing NAD to NADH conversion and allowing lactic acid to get recycled and converted to glucose at a much higher rate.³⁹

Oxaloacetate is notoriously unstable and difficult to supplement orally. A mixture of its precursors (aspartate salts, asparagine and a malate source) plus an activator of the malate dehydrogenase enzyme (rock lotus) supplemented over a period of time (three to four weeks) is a better way to achieve desired benefits. Finally, another benefit of a mixture of malate and aspartate is that the malate-aspartate shuttle plays a role in the regeneration of L-arginine and the production of nitric oxide.⁴⁰

Conclusions
Move over, NO (nitric oxide) supplements! Altering muscle fuel selection and increasing the anaerobic threshold are the hallmarks of metabolic flexibility in sports. Greater utilization of stored fatty acids for fuel, reduced lactate accumulation and better recycling, enhanced glycogen stores and an elevation of VO2max before the body's limited stores are called upon without an impairment of carbohydrate utilization is an ideal situation. It is not clear that fulfilling this goal demands artificially elevating blood ketone bodies, either through diet or supplements. Instead, maximizing the efficiency of energy pathways that make use of stored fatty acids and the malate-aspartate shuttle would seem to be not just sufficient, but preferred. Chronic HCA ingestion alters muscle fuel selection and improves glycogen stores, especially in conjunction with L-carnitine. Caffeic acid enhances these actions, as does mangiferin from mango leaf in ways that have been demonstrated in humans to augment the metabolism of both fatty acids and carbohydrates leading to elevated energy production. The malate-aspartate shuttle and the enzyme malate dehydrogenase support oxaloacetate recycling and the efficient operation of the citric acid cycle to sustain fatty acid oxidation and the reconversion of lactic acid to glucose for use as fuel by the muscles. Surely a clincher for this approach is that it promises health and anti-aging benefits, not just improvements in athletic performance.

Endnotes

1. Supplements Target Ketogenisis and Metabolic Flexibility TotalHealth Magazine
2. Measuring Ketones
3. Dehghan M, Mente A, Zhang X, Swaminathan S, Li W, Mohan V, Iqbal R, Kumar R, Wentzel-Viljoen E, Rosengren A, Amma LI, Avezum A, Chifamba J, Diaz R, Khatib R, Lear S, Lopez-Jaramillo P, Liu X, Gupta R, Mohammadifard N, Gao N, Oguz A, Ramli AS, Seron P, Sun Y, Szuba A, Tsolekile L, Wielgosz A, Yusuf R, Hussein Yusufali A, Teo KK, Rangarajan S, Dagenais G, Bangdiwala SI, Islam S, Anand SS, Yusuf S; Prospective Urban Rural Epidemiology (PURE) study investigators. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet. 2017 Nov 4;390(10107):2050–62.
4. How To Get Into Ketosis
5. Ketone_Bodies
6. Measuring Keytones
7. Kesl SL, Poff AM, Ward NP, Fiorelli TN, Ari C, Van Putten AJ, Sherwood JW, Arnold P, D'Agostino DP. Effects of exogenous ketone supplementation on blood ketone, glucose, triglyceride, and lipoprotein levels in Sprague-Dawley rats. Nutr Metab (Lond). 2016 Feb 4;13:9.
8. Brownlow ML, Jung SH, Moore RJ, Bechmann N, Jankord R. Nutritional Ketosis Affects Metabolism and Behavior in Sprague-Dawley Rats in Both Control and Chronic Stress Environments. Front Mol Neurosci. 2017 May 15;10:129.
9. Ketone sports supplements: Good for athletic performance or not?
10. O'Malley T, Myette-Cote E, Durrer C, Little JP. Nutritional ketone salts increase fat oxidation but impair high-intensity exercise performance in healthy adult males. Appl Physiol Nutr Metab. 2017 Oct;42(10):1031–5.
11. Cox PJ, Kirk T, Ashmore T, Willerton K, Evans R, Smith A, Murray AJ, Stubbs B, West J, McLure SW, King MT, Dodd MS, Holloway C, Neubauer S, Drawer S, Veech RL, Griffin JL, Clarke K. Nutritional Ketosis Alters Fuel Preference and Thereby Endurance Performance in Athletes. Cell Metab. 2016 Aug 9;24(2):256–68.
12. Leckey JJ, Ross ML, Quod M, Hawley JA, Burke LM. Ketone Diester Ingestion Impairs Time-Trial Performance in Professional Cyclists. Front Physiol. 2017 Oct 23;8:806.
13. Burke LM, Ross ML, Garvican-Lewis LA, Welvaert M, Heikura IA, Forbes SG, Mirtschin JG, Cato LE, Strobel N, Sharma AP, Hawley JA. Low carbohydrate, high fat diet impairs exercise economy and negates the performance benefit from intensified training in elite race walkers. J Physiol. 2017 May 1;595(9):2785–2807.
14. Zinn C, Wood M, Williden M, Chatterton S, Maunder E. Ketogenic diet benefits body composition and well-being but not performance in a pilot case study of New Zealand endurance athletes. J Int Soc Sports Nutr. 2017 Jul 12;14:22.
15. McSwiney FT, Wardrop B, Hyde PN, Lafountain RA, Volek JS, Doyle L. Keto-adaptation enhances exercise performance and body composition responses to training in endurance athletes. Metabolism. 2017 Dec 2. pii: S0026-0495(17)30328-1.
16. Louter-van de Haar J, Wielinga PY, Scheurink AJ, Nieuwenhuizen AG. Comparison of the effects of three different (–)-hydroxycitric acid preparations on food intake in rats. Nutr Metab (Lond). 2005 Sep 13;2(1):23.
17. Clouatre, D., Talpur, N., Talpur, F., Echard, B., Preuss, H. Comparing metabolic and inflammatory parameters among rats consuming different forms of hydroxycitrate. Journal of the American College of Nutrition 2005;24:429 Abstract.
18. Clouatre D, Preus HG. Potassium Magnesium Hydroxycitrate at Physiologic Levels Influences Various Metabolic Parameters and Inflammation in Rats. Current Topics in Nutraceutical Research 2008;6(4): 201–10.
19. Analytical report, Chemical Analysis of HCA in Rabbit Serum Samples, Bálint Analitika, LTD., Budapest, Hungary (2005)
20. Lowenstein JM, Brunengraber H. Hydroxycitrate. Methods Enzymol. 1981;72:486-97.
21. United States Patent 9,789,076 Bolus Dose of Hydroxycitric Acid with Glycerol
22. Saha AK, Vavvas D, Kurowski TG, Apazidis A, Witters LA, Shafrir E, Ruderman NB. Malonyl-CoA regulation in skeletal muscle: its link to cell citrate and the glucose-fatty acid cycle. Am J Physiol. 1997 Apr;272(4 Pt 1):E641-8.
23. Ishihara K, Oyaizu S, Onuki K, Lim K, Fushiki T. Chronic (-)-hydroxycitrate administration spares carbohydrate utilization and promotes lipid oxidation during exercise in mice. J Nutr. 2000 Dec;130(12):2990–5.
24. Lim K, Ryu S, Ohishi Y, Watanabe I, Tomi H, Suh H, Lee WK, Kwon T. Short-term (-)-hydroxycitrate ingestion increases fat oxidation during exercise in athletes. J Nutr Sci Vitaminol (Tokyo). 2002 Apr;48(2):128-33.
25. Lim K, Ryu S, Suh H, Ishihara K, Fushiki T. (-)-Hydroxycitrate ingestion and endurance exercise performance. J Nutr Sci Vitaminol (Tokyo). 2005 Feb;51(1):1-7.
26. Cheng IS, Huang SW, Lu HC, Wu CL, Chu YC, Lee SD, Huang CY, Kuo CH. Oral hydroxycitrate supplementation enhances glycogen synthesis in exercised human skeletal muscle. Br J Nutr. 2012 Apr;107(7):1048-55.
27. Triscari J, Sullivan AC. Comparative effects of (--)-hydroxycitrate and (+)-allo-hydroxycitrate on acetyl CoA carboxylase and fatty acid and cholesterol synthesis in vivo. Lipids. 1977 Apr;12(4):357-63.
28. Tsuda S, Egawa T, Ma X, Oshima R, Kurogi E, Hayashi T. Coffee polyphenol caffeic acid but not chlorogenic acid increases 5'AMP-activated protein kinase and insulin-independent glucose transport in rat skeletal muscle. J Nutr Biochem. 2012 Nov;23(11):1403-9.
29. Na L, Zhang Q, Jiang S, Du S, Zhang W, Li Y, Sun C, Niu Y. Mangiferin supplementation improves serum lipid profiles in overweight patients with hyperlipidemia: a double-blind randomized controlled trial. Sci Rep. 2015 May 19;5:10344.
30. Caloric Restriction Fasting and Nicotinamide Riboside TotalHealth Magazine
31. Dellinger RW, Santos SR, Morris M, Evans M, Alminana D, Guarente L, Marcotulli E. Repeat dose NRPT (nicotinamide riboside and pterostilbene) increases NAD+ levels in humans safely and sustainably: a randomized, double-blind, placebo-controlled study. NPJ Aging Mech Dis. 2017 Nov 24;3:17.
32. Uncovering the Longevity Secrets of the ROCK LOTUS TotalHealth Magazine
33. Elamin M, Ruskin DN, Masino SA, Sacchetti P. Ketone-Based Metabolic Therapy: Is Increased NAD+ a Primary Mechanism? Front Mol Neurosci. 2017 Nov 14;10:377.
34. Wu JL, Wu QP, Huang JM, Chen R, Cai M, Tan JB. Effects of L-malate on physical stamina and activities of enzymes related to the malateaspartate shuttle in liver of mice. Physiol Res. 2007;56(2):213–20.
35. Lancha AH Jr, Recco MB, Abdalla DS, Curi R. Effect of aspartate, asparagine, and carnitine supplementation in the diet on metabolism of skeletal muscle during a moderate exercise. Physiol Behav. 1995 Feb;57(2):367–71.
36. Marquezi ML, Roschel HA, dos Santa Costa A, Sawada LA, Lancha AH Jr. Affect of aspartate and asparagine supplementation on fatigue determinants in intense exercise. Int J Sport Nutr Exerc Metab. 2003 Mar;13(1):65–75.
37. Trudeau F. Aspartate as an ergogenic supplement. Sports Med. 2008;38(1):9–16.
38. Underground Training Tactics For Enhancing Endurance – Part 2
39. Nogueira, L., Hogan, D., & Hogan, M. (n.d.). Acute oxaloacetate exposure enhances resistance to fatigue iin vitro mouse soleus muscle. (2011). The FASEB Journal, (25), 1104.5.
40. Hou E, Sun N, Zhang F, Zhao C, Usa K, Liang M, Tian Z. Malate and Aspartate Increase L-Arginine and Nitric Oxide and Attenuate Hypertension. Cell Rep. 2017 May 23;19(8):1631–39.

WRITING ABOUT THE SEASONS AND THEIR AFFECTS ON OUR personal health has been part of my medical message for most all of my 40 years of practice. Connecting to Nature and our own true nature is a key to good health, learning and evolving as we become more self aware and also sensitive to all life on this planet, and our future. Eating from the Earth's bounty with simple foods from our gardens, farms and farmer's markets, and our local stores is principle number one of nutrition. A quote from my book suggests, "Every step away from the garden and orchards is a loss of vitality and nutrition."

I am so happy to see that my first book, Staying Healthy with the Seasons, initially published in 1981, has been influencing the public's health education with this simplest of natural messages. Hippocrates purported to "Pay attention to the seasons of the year and what affects they have on our health." Ideally, we pay attention to the times of seasonal change and look ahead to adapt to this ongoing cycle that has been around since the beginnings of life as we know it.

We have been enjoying the most playful of Seasons this Summer, except for these huge damaging hurricanes and rains in the south. The waters and the fires of this season are clearly out of balance. Is this a unique and isolated problem or one of the many signs of a changing planet in a bit of trouble? Please give it some thought and see if your behaviors can shift to support your best health and then extend that to your family and friends and the entire planet.

My Seasons book and writings involve multiple aspects of our health—as with physical, mental, emotional, and spiritual—along with many disciplines of health, such as Natural and Eastern medicines, foods, herbs, and lifestyle care combined into a Western medicine framework and mindset. I call this NEW Medicine. My 10 tips for Autumn follow and include ideas in many of these areas.

Attuning To Each Part Of The Year And Making appropriate lifestyle changes is key, but the ancient Chinese system also focuses on the time between the seasons—known as the Doyo. This is the period 10 days before and 10 days after each solstice and equinox, when we begin to adapt and make the appropriate changes to step forward into the new season, often with subtle shifts in our diet, exercise program, sleep, and work. Do-Yo literally means "All Have" and these 20-day periods contain a little of each element.

1. As with the gardens, open up to the harvest of your year from the seeds you have planted for your life, and be willing to work hard and discipline yourself as you head into a new season. If you are a student (we are all students of life), get back to your studies. Yes, it is time to shift from the fun and laziness of summer. Nature is so giving, and it helps to be receptive to her and what the Earth has to offer. What do we have to give to life for all the energy, love, and beauty I hope we all receive?

2. Relationships are important to all of us. This is a good time to deepen and clarify our love and family connections. This helps us discover more about our own needs and those close to us, as well as learn to listen to them (both the needs and the people). Also, learn to be alone and listen to your inner guidance and truth. Some folks focus relationships on their computers and TV, car or other electronic devices. Can you still your mind chatter, and let your body breathe deeply to your soul? Give it a try and your spirit will be calmed and can also fly free of the burdens of time.

3. Open to the creative Spirit. We can receive new ideas and actions necessary to fulfill our purpose and move us forward in our life. This can help to improve motivation with new energy and excitement for life. This could be writing about past experiences or our future goals, working on a book or personal story, reading a self-help book and applying it to improve our life, or taking up a new exercise. In other words, start a program now that you can develop and work on into the colder, darker months.

4. The foundation and fortification with our Foods and Diet is an important focus now. Again, this is Harvest time and there are a great many foods—apples and walnuts, sunflower seeds, zucchini and other squash, cabbages, peppers and tomatoes, plus many grains and beans. Learn some new recipes and enjoy good foods. Most of us need more protein and heat generating foods in the colder months, even the energizing spicy peppers such as cayenne and chilies. This will keep our blood and energy moving.

5. Exercise activity is crucial now as in any season. As the weather cools, stretching is even more important, as is having indoor exercises we can do. Yoga and other flexibility-enhancing movements are helpful at keeping us youthful. Remember, we feel as young as our spine is flexible. Our weight work and aerobic activities are vital to staying fit and toned, and strong to support our immune function and circulation. A vital body rarely gets sick.

6. Nutritional supplements are often useful this time of year. Many of my patients add some nutrients that support immune function so as not to pick up whatever is going around. Taking some Echinacea now is helpful as is the Chinese herb, astragalus. Some people prefer the use of mushrooms for immune support, as with maitake and reshitake. Maintaining daily vitamins C and E along with selenium and zinc is also immune protective and helps clear our body of certain toxins. Roots are helpful at tonifying our body at this time. Ginseng is quite good for building strength and endurance. Burdock root is good for the skin and lungs, an area of focus for this season. See the Autumn section of Staying Healthy with the Seasons book for further information.

7. Detoxification is a good idea for early autumn. I am doing a whole month myself and creating a 3-week program in September can provide a great benefit. Can you take a break from some of your routine habits, like caffeine, alcohol, sugar, or cannabis? Doing an effective Detox Diet or avoiding sugar, wheat and dairy for a couple weeks (as I write about in The False Fat Diet book) is often quite revealing and helps us to feel better, lighter and more youthful with greater energy. Since it is getting cooler this season, we will need to exercise and sauna or steam as a means to sweat to clear toxins. Regular sweating is important to health and longevity.

8. Prepare for the cold season. Gather your fuel and food, breathe, and exercise, as you should. In Chinese medicine, the fall season focuses on the lungs and large intestine. Overdoing it can lead to congestion and toxicity, as well as constipation and the clogging of the nose and sinuses. This leads then to upper respiratory infections as the germs grow in the mucus and then inflame the membranes. Staying clean and clear this season along with a healthy immune system will help keep you well. Try a facial steam and breathe in the herbal mist (you can use mints, rosemary, chamomile, lemon verbena, and other herbs) to help clear the sinuses.

9. Should you get any colds or flus, it is best to jump on those immediately. I start with hourly vitamin C of 500–1,000 mg, increased doses of vitamin A (not beta-carotene) 25,000– 30,000 IUs three times daily for just 3–4 days and then lower that dosage to 10–20,000 IUs twice daily for about a week (then take a break since excess vitamin A can be toxic if taken too long). I also use fresh garlic as several cloves at a time dipped in honey and chew them; I may repeat this several times the first day. That is a spicy and aromatic natural antibiotic and immune defender; you can alternately use the odorless garlic caps, several three times daily if you do not want to smell, but they are not quite as effective. You can alternatively press several cloves of garlic into your bowl of soup before you eat, instead of eating the garlic straight. Echinacea and goldenseal alcohol extract can also be used to support immunity and cleanse and disinfect the membranes. Some help may be achieved with olive leaf extract as a mild anti-viral herb. Of course, drink lots of water, herbal teas, and hot soup.

10. Take a rest now because the demanding holiday season is just around the corner. Do not burn your batteries out before November. Kindle your inner flame and firepower, which is protective from the invasion of harsh climates and germs. The winter blues comes partly from a loss of this fire energy. Shifting and balancing with the Seasons is vital to Staying Healthy

Assess your health, your strengths, as well as your problems and bad habits, and look for (ask yourself and take time to listen) the causes or basis of each concern. What are your issues? It’s best to ask for this deeper information and healing in your quiet, meditative place or before sleep to ask your dream imagery to come forth. (Review my Staying Healthy Tips on The Nature of Healing.) This is a time to work on solutions.

Make a list of your goals. What are you willing to work on, work out, and achieve? Do you need to lose weight; have more energy; or find a new doctor/practitioner to help you resolve a problem or illness? Or would a therapist or intuitive be more helpful? For example, you could assess your teeth in January, schedule a Thai massage and an acupuncture or chiropractic session in February, and a five-day health retreat in March. First assess your health budget and see what is covered by insurance if you have it, but also look at what you are willing or able to invest into the health of you and your loved ones.

Review your SNACC habits (sugar, nicotine, alcohol, caffeine, and chemicals). These are common substances that undermine most people’s health, and dealing with them is often the beginning of life improvement. Clearing the daily use (even temporarily) of these habits/abuses/ addictions that takes your vitality is often my first step in the Purification Process (see my book, The New Detox Diet). January is a perfect month to take a vacation from these habits. You may also choose two or three habits to get started. Rather than attempting too much at once, do what you know you can. Step by step still gets you along the health path.

Next, look at your food habits and what you may be overusing that stresses your body and causes reactions. Is it breads and baked goods, refined sugars, or a dependency on drinking cow’s milk or eating cheese? You may not be able to tell this unless you take a break and re-check your response again later. Most of us aren’t fully aware of how specific foods or meals effect us, but we know when we don’t feel fully alive or well, or maybe we want to digest better or reduce some aches and pains or sinus congestion, or just lose a few pounds. Here then, the ideas of The False Fat Diet book can guide you in this important process. A reminder is that this process is more difficult with a stress-filled schedule; thus, you may need to carve out some time both physically and mentally. I like starting my program on a Friday to have the weekend to adjust to the new plan.

Exercise your body, keep it moving! Just because it’s winter, don’t get lazy. Get your activity, but get your rest and sleep as well. Stretch that body and don’t let it get old, get it pumping, and tone those muscles. Cleanse and brush your skin daily as well. Inner clean creates outer sheen. Stay fit and stay healthy.

Do some positive therapies. There are many that can be of help, such as massage and other body therapies; acupuncture, counseling, or a personal reading for guidance. Sometimes merely a walk and talk in the trees with a good friend is all you need to set things right. Try something new or go back to something you liked. New experiences are helpful to growth and healing.

What is your spiritual practice? This may be prayer, religious studies, or meditation. We all come from different backgrounds and beliefs. Our reverence for life, our own and others, is the basic premise for a spiritual life. Treating our body as a temple of Living Spirit provides a motivation to treat ourselves as special and thus feed and care for ourselves in a loving and healthful way. It’s the base and the beginning of a healthy life.

Your career or work is often a core area for your well-being. Are you doing something that is important to you? Do you have a plan for life? Some jobs are what you wish for, others are on the way to somewhere else, and still others are there just to support you and your family. These are all important reasons. If you are not pleased with what you are doing, ask why and what can be done differently. Do you need to review this with a professional counselor? Do you need more education and training? Or will a shift in attitude help you to feel better about your work?

What can you complete this year? What’s been on your mind or sitting around your house? Make a list of a few or more areas that could use some of your valuable energy. (Add these to your list of goals.) This may involve old health habits, a messy room to clean up or rearrange, stuck areas in a relationship, or letting go of old patterns at work. Don’t be afraid to go for it this year.

Make your resolutions and commitments. Begin by looking at the key areas of your life. Health and personal habits, love and relationships, and career or work. And if LOVE moves into all those areas, that’s all the better as you’ll care for yourself and your life, plus your relationships in a positive way. Make more room for love to fill your daily life, and let it be the higher Love. Human love is temporal for many, yet love in the Spirit is everlasting. We are all blessed to share this garden, this Earth, which needs our love and protection. We must take the time to nurture nature, to nourish and flourish.

Often times after summer, we fall out of the fitness mentality and into the warm comforts of autumnal bliss. Sitting in front of the fire, we forget to move, and the idea of body awareness, movement and breath falls out the window. Instead of playing sports, we begin to watch them.

This fall, what can we do differently? How can we break our habits and increase our mindfulness, and mind-body relationship with itself and our environment?

Below are several ways to keep fitness at the forefront of your mind and body this fall with mindful meditation, exercise for the brain, body and breath.

Each morning, wake up 10 to 15 minutes earlier and spend a little extra time with yourself, focus on your breathing, how the breath enters the body, how it makes you feel as you breathe, and how it exits the body. Pay attention to what happens to the rest of the body as you continue to breathe and continue to do the exercises, playing with the lengths of the inhales and exhales. Make it an enjoyable experience, So that it is an opportunity to learn more about your breath, your body and yourself. There is always an opportunity to expand our mental, physical and emotional selves. And this is one of them.

Meditation is exercise for our brains. The central nervous system, which is run by the brain, controls our body and how it functions, making it a crucial element of our fitness regimes.

Taking care of our brain IS taking care of our body. A study led by Harvard researchers at Massachusetts General Hospital, found that meditating for only eight weeks actually changed the brain’s grey matter. Grey matter is associated with processing information as well as providing nutrients and energy to its neurons. This is why it is said that mediation has shown to improve memory, empathy, sense of self and stress relief.

When school is in session, mental acuteness is just as important for the parent as it is the child. Meditation is proven to sharpen the mind’s focus, lower stress levels and help manage anxiety for the student and teacher, and ultimately the parents. Meditation is key to prepare and react to your children’s energies. When sitting in the car line to pick up the children from school, arrive 20 minutes early to prepare mentally for the sprightly youth to jump into cars with inquisitive and ever-so exuberant minds and bundles of energy bouncing off the walls and in the car seats. Meditation lowers our stress, raises our endorphins and prepares us for anything that will ensue.

For those that require more of a structured schedule to hold us accountable, one can begin a yoga practice. It is a great mental and physical exercise that improves balance. Yoga, meaning union of the breath with the body, brings self-awareness, acceptance and peace with our body-mind relationship, and with our body and mind relationship with it’s surrounding environment. One can begin to practice at home or in a studio with others. The beauty of yoga and life is that the choice is ours. Yoga provides us the freedom to practice it anywhere: outside, inside, by ourselves or with others. And, it all begins with the breath. Yoga begins with the relationship of the breath and body. We clear our minds on the mat and nothing else matters nor does it have to even exist. Only the here and now matter with our body and breath. This form of meditation is a beautiful practice synchronized with movements, certain “asanas” or poses that have specific benefits, depending on what we need during that moment. Yoga is a mental, physical and even for some, spiritual exercise that provides balance for our habitual imbalances, whether that imbalance is in our bodies or minds.

The beauty of yoga is that there are different kinds for different people. The type of yoga that is most fitting at that moment is the type that works for the individual. There is no right or wrong answer. There is what is right now. We are blessed being of this technological age where knowledge is literally overflowing at our fingertips. With the touch of a button, all our questions can be answered. However, with such over saturation and access to knowledge, we can often get overwhelmed and weighted down with all these external stimuli being thrown at us. Which type of yoga is most fitting for us, for me, for you? There is meditative, spiritual, physical, hot, Bikram, Iyengar, Kundalini, power, restorative and many, many more. Thus, we stop searching and go within. We go back to the breath. Let’s keep it simple to keep us moving forward. Keeping it simple is essential moving forward. "One breath at a time" is an inviting and achievable place to start; it is a great motto to adapt so that we can reach our goals and keep moving, keep living and keep breathing. With the breath we remember that, although it appears simple, the benefits greatly outweigh it’s simplicity. Remember that breathing keeps us happy, lowers our stress, focuses our mind, and energizes our body. It is an empowering notion. So much can come from so little.

So this fall, sitting in front of the fire, we can gaze into the golden embers, get lost in their glow and begin to focus solely on our breath and body. As we cherish the relationship with our mind, body and breath, everything else fades away and out of existence. We can ignite life in our bodies, blood cells and brains by a single breath. The only constant in life, that ever present ebb and flow of air, we can begin to improve our relationship with ourselves and those that are around us by beginning a journey of mindful meditation. Exercising our brains and bodies, we fall in love with the mindful meditation, our mind, our bodies and ultimately ourselves. Thus, this fall we begin our fitness journey and the rest of our lives with one breath at a time.

References:

1. http://www.news-medical.net/health/What-is-Grey-Matter.aspx
2. http://www.medicaldaily.com/mental-health-benefits-meditation-itll-alter-your-brains-grey-matter-and-improve-319298
3. http://www.princeton.edu/~achaney/tmve/wiki100k/docs/Grey_matter.html
4. http://www.webmd.com/mental-health/features/meditationheals-body-and-mind
5. http://www.yogajournal.com/article/beginners/which-yogais-right-for-you-2/
6. http://chemistry.about.com/od/chemistryfaqs/f/aircomposition.htm
7. http://www.teachpe.com/gcse_anatomy/respiratory.php

For Sports and Health

Most readers who have heard of ketosis and ketogenesis likely associate the concepts with dieting and the works of Dr. Robert C. Atkins (Dr. Atkins’ Health Revolution, 1989; Dr. Atkins’ New Diet Revolution, 1992) that launched a bit of a movement in the 1990s. Much less well known is the role of ketosis in sports and the importance of being able to enter ketosis as an aspect of metabolic flexibility, meaning the ability to rapidly and easily shift between carbohydrates and fats as fuel substrates to match, on the one hand, dietary sources of calories and, on the other hand, particular physical demands for energy. In fact, the health implications of metabolic flexibility are significant and are related to the body’s degree of insulin sensitivity and thereby to the components of the metabolic syndrome. The latter condition often is defined as being based on insulin resistance and associated with abdominal (central) obesity, elevated blood pressure, elevated fasting plasma glucose, high serum triglycerides and low high-density lipoprotein (HDL) levels. This way of looking at matters makes ketogenesis and metabolic flexibility major determinants of health. One does not need to be diabetic or even pre-diabetic for these issues to be important, a point that Harry Preuss, MD and various coauthors, including myself, make in a recent article intended for practicing physicians, “Importance of Fasting Blood Glucose in Screening/Tracking Overall Health.”^1,2

Not only athletes for reasons having to do with competition, but also non-athletes for reasons of health likely would benefit from some form of supplement protocol or other approach that can achieve ketogenesis and maintain metabolic flexibility without depending entirely on the diet. Indeed, achieving ketosis via diet alone is hard to maintain over the long haul for a variety of reasons. Eating mostly protein and fat may sound like a treat at the beginning, but highly restricting all sources of carbohydrates quickly leads to a boring diet and even limited social interaction because few social events are built around ketogenic snacks! It also means avoiding many or most sources of phytonutrients, not eating adequate fiber for gut health and bowel regularity, probably inadequately eliminating toxins via the bile route in the stool, and even ramping up production of the hormone cortisol.³ Extreme ketosis leads to unpleasant breath (acetone breath) although this is not an issue with moderate and healthy ketogenesis.

Background on Ketosis and Ketogenic Diets
There are only two primary sources of energy, carbohydrates and fats. If needed for energy, protein can be broken down to yield a carbohydrate component, not a fatty acid component. Ketosis refers to the state in which the body meets its energy requirements largely through the oxidation of ketone bodies. These build up in the blood when glucose is not being used for energy and even the brain can run on ketone bodies. Glycolysis is the opposite number to ketosis in that it refers to the oxidation of glucose, for which all carbohydrates ultimately are a source, for energy. People sometimes associate ketosis with diabetes, but ketosis is a nutritional process whereas in diabetes the body either lacks sufficient insulin or cannot respond properly to insulin and therefore builds up ketone bodies due to a failure of metabolism while at the same time not properly harnessing fats for fuel. There is plenty of evidence to the effect that ketogenic diets can be healthful. Traditional Eskimo diets consisted almost entirely of raw meat and blubber (fat) and yet the Eskimos did not exhibit diabetes. Similarly, for certain neurologic conditions children are raised from early life into their thirties or later with completely normal physiologic and mental development without eating any carbohydrates at all.

Athletes and some "paleodieters" speak of keto-adaptation, which means simply moving the metabolism to preferentially accessing stored fats as fuel sources rather than depending on glucose. The body has quite limited stores of glycogen or "animal starch" stored primarily in the liver in contrast to virtually unlimited calories stored as fats. A quite standard assessment is that there may be 400 grams of glycogen in the liver and another 100 grams in the muscles. Glycogen is associated with water on a 1:3 to 1:4 ratio. A major problem in achieving keto-adaptation by diet alone is that most individuals who have been raised on Western-style diets can take six months or more to make the shift and this shift becomes ever more difficult as we age. Studies examining the role of carbohydrates in the metabolism with roughly 30 year old males in good physical condition have revealed, for instance, that even transitioning from a high glycemic index diet to a low glycemic index diet while maintaining the same ratio of carbohydrate, fat and protein can take more than four weeks. Shifting to fatty acid metabolism for energy can be difficult.

High fat diets were employed at the turn of the century to treat Type I diabetes, the form that begins in childhood with the destruction of the insulin-producing cells of the pancreas. Since the body can and will produce its own blood sugar from protein in order to feed the brain, there is always some role for insulin in the body regardless of the diet followed. Needless to say, those with juvenile diabetes almost invariably died young until the discovery of insulin.

In adult-onset or Type II diabetes, which typically begins fairly late in life and with those already overweight, diet and exercise often can completely control the problem. This and other clues have led a number of researchers to suspect that excess weight gain is related to insulin production either directly or indirectly, as discussed briefly above. Dr. Robert C. Atkins was one of the first to popularize the notion of dieting by bypassing the insulin mechanism through eliminating most carbohydrates from the diet while continuing to consume both proteins and fats. Atkins' Diet is both high in protein and high in fat.

High protein, low fat/very low carbohydrate diets have been common for some time, but not with the particular justification that they bypass the insulin mechanism. Generally the justifications have had to do with energy production, or rather the lack of it on these diets. In the Stillman Diet, for instance, it was argued that protein molecules are so large that they use up extra energy as a food for the body. This diet calls for the drinking of at least eight glasses of water a day, which truly is necessary to remove the waste products of excess protein consumption and from the oxidation of the body's own fats.

Very similar is the famous Scarsdale Diet, designed for use for only two weeks at a time. Both strictly limit carbohydrates and, somewhat less strictly, fats. Both do reduce weight in the short term, but such large amounts of protein are hard on the body. In contrast to these, the Dr. Atkins' Diet allows for unlimited amounts of both proteins and fats, but for restricted amounts of carbohydrates according to the theory that a faulty insulin mechanism is the cause of excess weight. A more limited form of this ketone-based diet popularized at about the same time as the Atkins Diet is presented by Dr. Calvin Ezrin in The Endocrine Control Diet (1990).

Athletes long have experimented with ketogenic diets. For instance, during the 1990s a number of top bodybuilders in the World Bodybuilding Federation adopted a diet similar to the one Atkins uses (roughly 40 percent of calories from protein and 60 percent from fat) in order to cut body fat and build muscle. These individuals were all undertaking extremely hard physical labor, so the diet itself cannot be a source of fatigue, but must in fact supply considerable energy.⁴ Nevertheless, even major competition class athletes ultimately generally give up on strict ketogenic diets. As admitted by Ben Greenfield, a serious triathlete who was tested with regard to the ergogenic benefits of a ketogenic diet, "after the study at University of Connecticut, I personally quit messing around with ketosis and returned to what I considered to be a more sane macronutrient intake of 50-60% fat, 20-30% protein, 10-30% carbohydrate."⁵

Ketogenesis with Supplements
Can ketogenesis be achieved using a more normal diet with the help of supplements? The answer appears to be "yes." Nevertheless, there are important considerations, among which are the following:

• The diet should not be high in simple sugars, fructose or refined carbohydrates. For non-athletes and those looking primarily to increase metabolic flexibility, the diet should resemble a modified Sears Diet, meaning approximately 20¨C 30 percent protein, 30¨C40 percent carbohydrate and 30¨C40 percent fat. For athletes and individuals who seriously want to initiate and maintain a fat-adapted diet, Ben Greenfield's suggestion is more in order: "50-60% fat, 20-30% protein, 10- 30% carbohydrate."
• It is helpful to support fat metabolism directly such as through improved transport of fatty acids into the mitochondria for oxidation.
• Insulin sensitivity must be improved and maintained and insulin levels kept low.
• The release of fatty acids from fat cells likely is less important than is disinhibiting fatty acid metabolism. The first is accomplished with caffeine, yet often with a downside such as increased cortisol levels, hence alternatives to caffeine and other similar stimulants are needed.
• Inclusion of substances that actively promote fatty acid oxidation is important to help kick-start the body's ability to metabolize fats.
• Excessive gluconeogenesis by the liver (creation of glucose from glycogen in response to the release of glucagon) should be inhibited to promote fatty acid oxidation as the alternative.
• With diets that are heavy in alcohol and fat, potential "reverse" effects must be prevented.

A small number of supplements, especially if taken together, may fulfill the above requirements and actually have been tested successfully in a pilot case. The subject in question was able to consume a normal diet, indeed one that included quite a bit of alcohol, by relying on only four supplements to remain in moderate ketosis during much of the day: hydroxycitric acid, wild bitter melon extract, sesame lignan extract and green coffee bean extract. The sources of these supplements were not generic and this should be kept in mind because different production methods lead to different products with different results. Published comparative trials, for example, with hydroxycitric acid have shown this definitively.

Potassium-Magnesium Hydroxycitrate
The key component in supplement-support ketogenesis is (-)¨Chydroxycitric acid (HCA). That some forms of properly manufactured HCA can be used to encourage ketogenesis has been known at least since 2000. In that year, Ishihara published that HCA ingestion for 13 days increased fat oxidation and improved endurance exercise time to fatigue by 43 percent compared to a placebo in mice.⁶ Over the following few years, three studies by Lim and others in trained athletes demonstrated that ingestion of HCA enhances endurance performance via increasing fat oxidation and sparing glycogen utilization during moderate intensity exercise. In fact, in trained athletes HCA ingestion for five days shifted fuel selection to fat oxidation at both 60 percent and 80 percent VO2max during exercise.⁷ Lim further demonstrated a number of significant findings. First, using mice as his model, he showed that chronic HCA ingestion alters fuel selection rather than the simple release of fat from stores as is true of lipolysis, i.e., mechanism for HCA is not the same as with caffeine, capsaicin, etc. Second, Lim's review data that showed that the combination of HCA plus L-carnitine improves glycogen status in liver and various muscle tissues versus placebo in exercised-trained rodents. Since the publication of Lim's papers, this finding has been repeated more than once with human athletes. Although L-carnitine improves the effect, it is not necessary.⁸ Third, Lim in his studies employed a pure synthesized trisodium hydroxycitrate salt rather than commercial calcium or calcium-potassium HCA salts, which did not yield his results. As is true of many herbal products, the benefits of HCA are highly dependent upon how the item is prepared. The acid must be stabilized by the addition of high pH ions (basic or alkali), such as those of potassium, magnesium or calcium. Using the wrong stabilizing counter-ions results in little or no activity. In the case of the acid derived from Garcinia cambogia and related sources, adding any calcium at all reduces some desired benefits and blocks other benefits entirely.⁹ This fact has been verified by more than one comparative trial.

Another benefit of HCA that supports ketogenesis is its impact on insulin sensitivity. At the 2005 Annual Meeting of the American College of Nutrition for the first time it was reported that the potassium-magnesium HCA salt in an animal model gave the same blood glucose regulation as found in the control arm of the test while almost literally cutting insulin levels in half.¹⁰ The same study demonstrated that this salt dramatically improved glucose clearance from the blood, lowered systolic blood pressure and also lowered several key indicators of inflammation, including C-reactive protein and tumor necrosis factor-alpha (TNF-alpha). In contrast, the potassium-calcium salt exerted no effect upon insulin and blood sugar regulation and only very poorly influenced blood pressure.¹¹ In the areas of insulin metabolism, glucose regulation and blood pressure, the proprietary potassium-magnesium salt was between five and seven times as active as the potassium-calcium salt of the fruit acid. A paper just published this year also indicates that HCA may help to regulate thyroid hormones and promote muscle protein synthesis.¹²

Wild Bitter Melon Extract and Sesame Lignan Extract
As indicated above, HCA appears to be extremely useful in freeing the body's metabolism regulators to allow a shift towards preferentially oxidizing fatty acids for energy. Increasing insulin sensitivity and reducing insulin levels removes one of the primary brakes on fatty acid metabolism. A complement to these actions is direct activation of fatty acid oxidation. Both wild bitter melon and sesame seed lignans help to do just this. Bitter melon previously has been discussed in these pages under the title, "Going WILD with Bitter Melon for Blood Sugar Support."¹³ As noted in that article, it has been found that extracts of bitter gourd activate cellular machinery to regulate energy production (technically, AMP-activated protein kinase or AMPK) and the way that fats are handled by the liver. These components can account for as much as 7.1 g/ kg of the dried wild material.

The sesamolin lignan found in sesame seeds (but not in most extracts) likewise increases fat metabolism. As pointed out in an important study, the "[e]ffects of sesamin and sesamolin (sesame lignans) on hepatic fatty acid metabolism were compared in rats. Sesamolin rather than sesamin can account for the potent physiological effect of sesame seeds in increasing hepatic fatty acid oxidation observed previously. Differences in bioavailability may contribute to the divergent effects of sesamin and sesamolin on hepatic fatty acid oxidation. Sesamin compared to sesamolin was more effective in reducing serum and liver lipid levels [with]sesamolin more strongly increasing hepatic fatty acid oxidation." "Sesamolin rather than sesamin can account for the potent physiological effect of sesame seeds in increasing hepatic fatty acid oxidation observed previously."¹⁴ "...gene expression of hepatic enzymes involved in fatty acid oxidation [was] much stronger with episesamin and sesamolin than with sesamin¡­[serum] half lives of 4.7±0.2, 6.1±0.3 and 7.1±0.4 h for sesamin, espisesamin and sesamolin, respectively...¹⁵

Green Coffee Bean Extract
After meals, up to 70 percent of the glucose from food is stored in muscle and other lean tissues. However, moment-to-moment regulation of blood glucose typically is handled by the liver. It does this via two processes, both of which are highly regulated. Gluconeogenesis generates glucose from certain noncarbohydrate carbon substrates, including certain amino acids and lipid components, such as triglycerides. Glycogenolysis is the freeing of glucose from glycogen stores. In the liver, but not the muscles, the hormone glucagon is involved. The liver also uses the enzyme glucose-6-phosphatase. With aging and as the metabolic syndrome develops, regulation of these two processes becomes impaired. Dysregulation is a particularly significant issue in diabetes.

Coffee, especially green coffee extracts, supply chlorogenic acid, which inhibits the glucose-6-phosphatase enzyme.^16,17 Chlorogenic acid also inhibits glucose absorption from the intestinal tract and thus reduces after meal blood glucose spikes.

Ketogenesis requires that the body preferentially use fatty acids for fuel. This cannot happen if either gluconeogenesis or glycogenolysis is not under proper control.

L-Carnitine and Astaxanthin
L-carnitine is a nutrient that, among other things, helps to shuttle fatty acids into the mitochondria for oxidation. In the discussion of HCA above it was noted that the combination of HCA and L-carnitine greatly improves the replenishment of glycogen stores after exercise. Unfortunately, tissue levels of L-carnitine are highly regulated and difficult to elevate to the extent necessary for ergogenic benefits in athletes. HCA improves L-carnitine metabolism by increasing uptake.HCA is an insulin memetic as well as an insulin sensitizer. HCA also shifts the body towards metabolizing fats, which makes L-carnitine's job easier. Another approach is to supplement with astaxanthin. Astaxanthin (≥4 mg/d) has been shown to reduce lactic acid accumulation during exercise, improve fatty acid oxidation and maintain better blood glucose levels while improving endurance. The mechanism may involve carnitine palmitoyltransferase I.^18,19

Conclusion
Studies have demonstrated the importance of metabolic flexibility for maintaining cardiovascular health and reducing the risk of developing metabolic syndrome components. Likewise, studies have shown that the related ability to enter ketosis as needed for athletic purposes can render rich ergogenic rewards. Nevertheless, enabling ketogenesis or keto-adaptation, however desirable this might be, through dietary measures alone under modern circumstances in Western countries is not only inconvenient, but downright difficult. Fortunately, it is possible to enable keto-adaptation through the use of appropriate supplements. These include properly manufacture HCA salts, wild bitter melon extract, sesame lignans and green coffee bean extracts. L-carnitine and astaxanthin are two more supplements that fit into this schema.

Endnotes

1. Preuss HG, Mrvichin N, Clouatre D, et al. Importance of Fasting Blood Glucose in Screening/Tracking Overall Health. The Original Internist. 2016, March:13-15,17.18.
2. Bjornholt JV, Erikssen G, Aaser E, et al. Fasting blood glucose: an underestimated risk factor for cardiovascular death. Results from a 22-year follow-up of healthy nondiabetic men. Diabetes Care. 1999 Jan;22(1):45.9.
3. Sears B. Anti-inflammatory Diets. J Am Coll Nutr. 2015;34 Suppl 1:14.21.
4. Mauro DiPasquale, M.D., "Let the Fat be with You: The Ultimate High-Fat Diet," Muscle Magazine International (July and September 1992); "High Fat, High Protein, Low Carbohydrate Diet: Part I," Drugs in Sports 1, 4 (December 1992) 8.9.
5. https://bengreenfieldfitness.com/2015/12/how-to-get-into-ketosis/
6. Ishihara K, Oyaizu S, Onuki K, Lim K, Fushiki T. Chronic (-)-hydroxycitrate administration spares carbohydrate utilization and promotes lipid oxidation during exercise in mice. J Nutr. 2000 Dec;130(12):2990.5.
7. Lim K, Ryu S, Suh H, Ishihara K, Fushiki T. (-)-Hydroxycitrate ingestion and endurance exercise performance. J Nutr Sci Vitaminol (Tokyo). 2005 Feb;51(1):1.7.
8. Cheng IS, Huang SW, Lu HC, Wu CL, Chu YC, Lee SD, Huang CY, Kuo CH. Oral hydroxycitrate supplementation enhances glycogen synthesis in exercised human skeletal muscle. Br J Nutr. 2012 Apr;107(7):1048.55.
9. Louter-van de Haar J, Wielinga PY, Scheurink AJ, Nieuwenhuizen AG. Comparison of the effects of three different (.)-hydroxycitric acid preparations on food intake in rats. Nutr Metab (Lond). 2005 Sep 13;2(1):23. See also notes 18 and 19.
10. Clouatre, D., Talpur, N., Talpur, F., Echard, B., Preuss, H. Comparing metabolic and inflammatory parameters among rats consuming different forms of hydroxycitrate. Journal of the American College of Nutrition 2005;24:429 Abstract.
11. Clouatre D, Preuss HG. Potassium Magnesium Hydroxycitrate at Physiologic Levels Influences Various Metabolic Parameters and Inflammation in Rats. Current Topics in Nutraceutical Research 2008;6(4): 201.10.
12. Han N, Li L, Peng M, Ma H. (-)-Hydroxycitric Acid Nourishes Protein Synthesis via Altering Metabolic Directions of Amino Acids in Male Rats. Phytother Res. 2016 May 4. doi: 10.1002/ptr.5630.
13. http://www.totalhealthmagazine.com/Vitamins-and-Supplements/Going-WILD-with-Bitter-Melon-for-Blood-Sugar-Support.html
14. Lim JS, Adachi Y, Takahashi Y, Ide T. Comparative analysis of sesame lignans (sesamin and sesamolin) in affecting hepatic fatty acid metabolism in rats. Br J Nutr. 2007 Jan;97(1):85.95.
15. Ide T, Lim JS, Odbayar TO, Nakashima Y. Comparative study of sesame lignans (sesamin, episesamin and sesamolin) affecting gene expression profile and fatty acid oxidation in rat liver. J Nutr Sci Vitaminol (Tokyo). 2009 Feb;55(1):31.43.
16. Henry-Vitrac C, Ibarra A, Roller M, Merillon JM, Vitrac X. Contribution of chlorogenic acids to the inhibition of human hepatic glucose-6-phosphatase activity in vitro by Svetol, a standardized decaffeinated green coffee extract. J Agric Food Chem. 2010 Apr 14;58(7):4141.4.
17. Bassoli BK, Cassolla P, Borba-Murad GR, et al. Chlorogenic acid reduces the plasma glucose peak in the oral glucose tolerance test: effects on hepatic glucose release and glycaemia. Cell Biochem Funct. 2008 Apr;26(3):320.8.
18. Malmsten C, Lignell A. Dietary Supplementation with Astaxanthin-Rich Algal Meal Improves Strength Endurance; A Double Blind Placebo Controlled Study on Male Students. Carotenoid Science. 2008;13:20.22.
19. Aoi W, Naito Y, Takanami Y, Ishii T, Kawai Y, Akagiri S, Kato Y, Osawa T, Yoshikawa T. Astaxanthin improves muscle lipid metabolism in exercise via inhibitory effect of oxidative CPT I modification. Biochem Biophys Res Commun. 2008 Feb 22;366(4):892.7.

Athletic training is based on principles such as physical overload, meaning that the body is taxed to near its limits and then allowed to recover with the expectation that recovery will be quicker in the future for the same level of exertion and that the body will over-compensate at recovery and thus allow even more exertion upon the next challenge. This demand-and-response model clearly taxes bodily reserves. Some supplements, for example, protein, are aimed mostly at recovery and super-compensation. Others, such as creatine, also provide super-physiologic levels of substrates, in this case a substrate for the replenishment of adenosine triphosphate (ATP), allowing the muscles to go beyond their normal physiologic capacity. There is not much question but that both of these objectives can be achieved to some degree, meaning that supplements can be valuable for supporting and increasing physical performance and, used properly, can reduce the risks of injury.

There is no one size-fits-all in supplementation, however. For instance, although it clearly is the case that supplemental amounts of certain antioxidants can help to maintain health and improve recovery, it also is true that the type, timing and amounts of antioxidants can exert other effects. Indeed, the physiological adaptations to exercise may be blunted when local oxidant production in the muscles is suppressed by supplemented antioxidants. Some aspects of muscle supercompensation in response to exercise challenges depend directly on the local formation of oxidants and free radicals.

Protein
The king of muscle building proteins probably is whey protein because of its high content of the branched-chain amino acid L-Leucine, which can induce muscle synthesis, but only if there are sufficient other nutrients available to sustain the creation of new muscle tissue. Whey protein is a favorite of most authorities and has the additional virtues, if it remains largely "natural" in its structure, of supporting the body's production of glutathione.

Because protein sources are digested and absorbed at different rates, one of the more interesting findings of recent years is that a mixture of proteins with different rates of digestion and assimilation is superior to single protein sources. In this case, adding casein and soy protein to whey protein in human trials, especially in the recovery phase, appears to improve results. Clinical finds thus suggest that multi-protein blends, properly constructed, may trump any single source of protein for supporting athletic performance. Pea protein recently has attracted a great deal of attention.

It is generally agreed that nutrients taken immediately after exercise are readily taken up into the muscles. Some studies have reported improved physical performance with the ingestion of carbohydrate-protein mixtures, both during exercise and during recovery prior to a subsequent exercise test.¹ Consuming simple carbohydrates and carbohydrate-only supplements, even prior to workouts, has fallen out of favor.

Also, it should be borne in mind that the initial meal of the day may play a large role in setting the flexibility of the metabolism for the rest of the day. A higher ratio of protein and fat at breakfast tends to make the metabolism of fat for energy easier throughout the day whereas excessive refined carbohydrates will have the opposite effect.

Pre- and post-workout supplements generally involve a considerable volume of ingredients. The tub-versus-bar option is really only about convenience. Tubs will deliver protein that is much less expensive gram-for-gram and not necessarily have a ton of fillers. Protein bars almost of necessity will include sweeteners and binders because these are required to make the bars palatable and to hold them together. On a gram basis, as long as the same quality protein source(s) is being used, there should be little difference in efficacy between these two deliveries.

Creatine
Workout supplements often involve tradeoffs. For instance, why would an athlete have to take creatine if they are already supplementing with a protein? Are here any additional health benefits to a person that takes both?

Creatine and protein do different things. Creatine primarily repletes a precursor to ATP to greater levels than can be accomplished under normal physiologic conditions. Creatine itself is not a "building block" for muscle tissue. Refined protein supplements seldom are sources of this compound. Although it is possible by taking extremely large amounts of arginine to provide the body with a means of increasing its own synthesis of creatine, this is not efficient. Some sources of protein, such as red meat, themselves can supply small amounts of creatine. However, again, this is not an efficient means of increasing muscle creatine levels compared to consuming creatine monohydrate directly. Athletes who benefit from creatine supplementation, therefore, should consume creatine for its particular benefits and protein for muscle repair/recovery/ augmentation.

Creatine has well established ergogenic benefits for strength and greater performance in a number of areas of athletics, primarily events that are short term and explosive in nature as opposed to being oriented towards endurance. For those individuals who train heavily, there are obvious benefits. Body builders who desire the greater bulk similarly may find the muscle edema to be acceptable for aesthetic reasons. Nevertheless, it is true that creatine supplementation that is not coupled to training primarily will lead to a certain amount of muscle edema without other benefits. Likewise, most endurance athletes will not find the weight issue to be counterbalanced by sufficiently enhanced performance to make supplementation beneficial for their sport.

Endurance
Nutritional regimens in sports often are planned with specific goals in mind because different goals strongly influence the roles of carbohydrate, fat and protein in supplements for athletes. For instance, building muscle mass is a goal with requirements different to those for getting lean or maintaining balance in terms of muscle and bodyweight. Caffeine is a common ingredient used by most athletes despite the fact that caffeine does not seem to be an ergogenic aid except for those who do not routinely consume it via coffee, soft drinks, tea, etc.

Pre-workout supplements, which usually are consumed 30 ?60 minutes prior to working out, are designed to increase energy during workouts and provide accessible calories to spare glycogen and thus extend time to failure. Common nutrients include nitric oxide precursors, such as forms of L-arginine and L-citrulline as well as vasodilating herbs. Some formulators suggest the addition of ribose, but others prefer to use ribose either after workouts and/or during workouts. Rhodiola, ginseng and astaxanthin are other supplements used to increase endurance, the latter for its role in improving the ability to metabolize fats for energy. Pre-workout energy drinks based on only carbohydrates or carbohydrates plus caffeine have not fared well in tests.²

Post-workout supplements are intended to take advantage of a 30?60 minute window of opportunity following workouts during which cells are especially open to absorbing and utilizing nutrients for recovery, including replacing glycogen and restoring lean muscle that often is lost in endurance training. The focus of these products typically is on carbohydrates to replete glycogen and, to a lesser extent, protein quality and quantity. A favored approach is based on replacing glycogen as the key to athletic recovery and therefore pushes high glycemic carbohydrates as primary via ingredients such as waxy maize, maltodextrin and starches from potato and rice. Ribose is another ingredient often seen in these formulas. It should be kept in mind that the wisdom of chronic ingestion of high glycemic index carbohydrates has been challenged by a number of health authorities. Micronized protein increasingly is added to increase insulin response and muscle uptake of nutrients. Taking a good quality hydroxycitric acid (HCA) supplement during recovery has been shown to significantly improve the replenishment of muscle glycogen.³ A proper HCA supplement can be very hard to find?the most thorough research in the area of sports performance had to use a synthesized trisodium hydroxycitrate to achieve results.⁴ Similarly, a relatively pure potassium HCA salt is more efficacious than a potassium-calcium salt.⁵

During (Intra) workout supplements are now common. Over the past decade, it has become more popular to consume nutrients during workouts and not just prior to workouts and after exercise. However, there does not appear to be a consensus as to whether intra-workout supplements should focus on carbohydrates alone or on combinations with small amounts of easily absorbed protein. Many products contain both. Common ingredients aside from the carbohydrates already named are branched-chain amino acids, glutamine, creatine and betaalanine. In recent trials, drinks that supplied less carbohydrate and replaced these calories with a moderate amount of protein led to significantly improved endurance performance in trained long-distance cyclists. It turned out to be the case that fewer calories with a lower level of carbohydrate and more protein worked better in extending time to exhaustion, reducing muscle damage and improving post-exercise adaptation to the challenge of exercise overload.

Caffeine is another contentious topic. Caffeine has numerous natural sources, including coffee beans, tea, cocoa beans (chocolate source), kola nut, guarana and yerba mate. However, caffeine does not tend to improve athletic performance unless used in quite large amounts and only during competitions. Alternatives include specialized ginseng extracts, L-tyrosine (may increase blood pressure in some individuals), schizandra berry extract and ashwagandha extract. Astaxanthin has been shown to increase endurance performance.

Endurance athletes in particular should pay attention to the issue of electrolytes. Although there are some unfortunate examples of excessive hydration in athletes, generally speaking, athletes can easily lose enough fluid to lead to reduced performance. Electrolytes, if nothing else, are necessary to bring ingested fluids to the isotonic molarity that will allow them to be readily absorbed by the body. Betaine, which is used in the manufacture of food and beverages, is well studied as a hydration agent. Betaine is an organic osmolyte that helps to stabilize metabolic functions in the face of dehydration and overheating. The usual electrolytes lost in sweat, of course, are potassium and sodium. Increasingly popular in Europe in this area is a combination of salts including potassium, sodium, magnesium and calcium in the form of glycerophosphates. Whether electrolytes are necessary beyond their role in promoting proper hydration remains highly debated.

Conclusion
Supplements can play important roles is exercise. The pure carbohydrate products in favor a few years ago, however, no longer are the best supported by research. Protein, protein/ carbohydrate mixtures and combinations of proteins from different sources now are favored. Similarly, athletes who are looking for performance enhancement rather than merely a psychological lift increasingly shy away from simple caffeine and other stimulants. Supplements should be picked for the sport (body building or endurance, for example) and keyed to the expected benefits.

References

1. Sports Med. 2010 Nov 1;40(11):941?59.
2. J Strength Cond Res. 2014 May;28(5):1443?53.
3. Br J Nutr. 2012 Apr;107(7):1048?55.
4. J Nutr Sci Vitaminol (Tokyo). 2005 Feb;51(1):1?7.
5. Nutr Metab (Lond). 2006 Jul 17;3:26.

(Adapted from Dr. Haas’ upcoming book, Staying Healthy with NEW Medicine)

We are designed to move, lift, swing and stretch. Exercise, in its varied forms, stimulates metabolism, circulation, oxygenation, lymphatic activity, and neurological function; strengthens our immune system; reduces stress; lessens inflammation, and with endorphin enhancement, exercise improves our overall attitude. A consistent program of balanced exercise supports the body and helps prevent or improve so many health issues. Depression is one example where regular exercise often helps, by improving mood and energy, reducing anxiety and promoting better sleep.

A Balanced Fitness Program Includes:

• Some exercise daily — with a goal of 7–10 hours of physical activity each week
• Stretching — for flexibility, also good before and after aerobics and/or weights
• Aerobic activity — running, hiking, biking, or swimming, for endurance, cardiovascular health and detoxification (sweating)
• Toning — using weights or resistance exercises, for strength and muscle mass
• Energy balancing — yoga, qigong, and Tai Chi (especially helpful for elders)
• Mood enhancing — dance and all aerobics support the feel good “endorphins”

Even with physical limitations, do what you can, from isometrics to using a stretch band, or even stretching or yoga in a chair. You can also do deep breathing along with tightening and relaxing muscles while sitting or working at your computer. Remember, if you aren’t already exercising regularly, have a physical exam before you begin and build your endurance at a healthy pace.

My attitude is (and it could be yours, too): “This is the only body I have and I am going to treat it with love.” Once we develop this approach, giving our body some vitamin L (Love), we develop an internal commitment to being healthy. With this essential feeling of body respect and love, we will often tend to eat better, exercise more regularly, learn to manage stress more effectively and take better overall care of ourselves.

The Best Exercise Program
“Do you know what your best exercise is?” Many will answer, “walking” or “swimming.” The BEST exercise program is “the one that you’ll do.” I find when people are given suggestions that are beyond their ability to enact, they won’t do anything. Of course, there are many aspects in regard to healthy exercise to support the body and avoid injury. We could also say this about dietary changes and the individuality of what we choose to eat.

Evaluate Your Exercise Program

• Do you enjoy exercise?
• Which activities do you like most?
• Do you exercise daily? If not, how often?
• How many hours of exercise do you average weekly?
• Do you dislike exercise and find it hard to pick something that motivates you?
• Do you stretch daily?
• Do you run or engage in other active aerobic activity?
• Do you lift weights or do other strength and muscle development activities?
• Do you like to go to a gym, or do you prefer to be on your own?
• Do you like team activities?
• Have you been accused of being an exercise fanatic or exercising too much?
• Have you injured yourself from any of your exercise activities?
• Do you sense that exercise is helpful for your long-term health?
• What can you do to improve or enhance your overall fitness program?

The benefits of staying fit can last a lifetime. It’s part of my Healthy Aging program. The difference in how we feel from staying fit has to do with our life attitude and vitality. So much of our health is up to each of us. How we live matters and we are totally worth it!

Every year at about this time most of us resolve that this year we are going to do things differently. We are going to lose weight, we are going to get more exercise, we are going to learn a foreign language, we are going to…. The aims involved almost always are desirable and chosen from a list of things that, no doubt, we really should do. All too often, these resolutions also are carryovers from the past year or, worse still, past years. As a result, we may ratchet up the ante, as it were, with a virtual carrot or stick, such as buying new clothes that we intend to be able to wear after carrying out our resolution or taking out an expensive gym membership.

This time around, my suggestion is to remove the pressure and adopt one or more low stress health resolution that may achieve some important goals indirectly. This way, success will come almost as a surprise even as benefits emerge from changes in habits.

Eat Breakfast Every Day
Over the years, a slew of studies have demonstrated a couple of points that need to be kept in mind. One is that the timing of meals can be as important as the contents of the meals.

Experiments have shown that with identical meals, calories eaten entirely at breakfast can lead to stable or reduced weight whereas the same number of calories eaten at night can lead to weight gain. Never skip breakfast. If you skip breakfast, your body will take this as a sign that you are “starving” and slow down your metabolism. There may be other unwanted effects in the brain. Substituting a cup of coffee and a sweet roll for breakfast is almost as bad as not eating that meal.

Another finding is that eating a relatively high protein breakfast with a significant number of calories tends to reduce the number of calories consumed at the next meal and even the propensity to snack throughout the day. Advice varies, but the argument from a number of researchers is that protein should make up 25–30 percent of the calories and fat should make up 35–40 percent of the calories with the remainder consisting of slow digesting carbohydrates. Many will recognize that this conforms to the diet proposed years ago by Barry Sears. Interestingly, research following subjects for one or two years has not validated the low-fat-is-best hypothesis. Instead, a diet consisting of 25 percent protein and the rest low glycemic index (from mixed carbohydrate and fat components) spontaneously leads to weight loss in many subjects who started the diet while overweight.

Morning Exercise and Sunshine
Today, many or even most families have both parents working. Schedules often make it hard to send the proper signals to the body by getting a bit of sun before lunch. Those who live in the northern latitudes also can attest that the sun rises quite late in the winter. Nevertheless, even a little bit of sun in the morning helps to keep the body’s internal clock working properly.

Light exposure and exercise go well together. Exercise burns calories, but the greatest benefit comes after the exercise has ended. If you walk briskly for a mere 30 minutes per day, you will increase your calorie burning for an entire 24 hour period. Adding a moderate amount of upper body exercise or weight lifting will improve your energy expenditure even more by adding calorie-burning lean muscle tissue to your body. For weight loss, plan on walking briskly for at least 30 minutes every day. This is best done either before or after breakfast. A walk early in the day while the body’s temperature is still rising will invigorate you for the rest of the day. Taking a short walk (10 to 15 minutes) in the afternoon or before supper similarly makes it more likely that your body will burn calories rather than store them. Finally, another time for a walk is after your last meal of the day. Walking after meals is a particularly good practice for diabetics and for those genetically prone to developing diabetes.

Choose Dietary Fats Wisely
A recent survey found that approximately 95 percent of all Americans consume too little omega-3 fatty acids (fish oils, flax seed oil and a small number of other sources) in relation to their total fatty acid intake. Instead, we eat mostly omega-6 fatty acids because, quite simply, these are cheap to derive from canola, corn, peanut, soy and other sources. Unfortunately, omega-6 fatty acids in excess promote inflammatory processes in the body.

Dietary saturated fats, after 60 years in the wilderness, no longer are under blanket condemnation by the Food and Drug Administration (FDA) or several other “official” bodies. Today, it increasingly is admitted that the evidence against, for instance, the egg, does not stand up and eggs, in fact, are good for you even in relatively large numbers per week. Similarly, the short-chain fatty acids in butter and other dairy products are good for the health of the gut and another fat from full fat dairy, palmitoleic acid, is associated with slightly lower adiposity, with higher high-density lipoprotein cholesterol levels, lower triglyceride levels, a lower total cholesterol–HDL cholesterol ratio, lower C-reactive protein levels, and lower insulin resistance. Trans-palmitoleate also is associated with a substantially lower incidence of diabetes.

As with the consumption of full fat dairy in the form of cheese, milk and yoghurt (obviously, not lots of whipped cream with sugar!), the evidence supports that improving the ratio of omega-3 fatty acids in the diet may moderately improve weight and cardiovascular health.

Eat More Vegetables
Most readers automatically will think “eating more vegetables” means eating more fiber. This, however, is not the whole of the story by any means. Let’s take fiber first. Fiber slows down food consumption so that your body has a chance to signal that you have eaten enough. It adds bulk to the meal to give you a feeling of satisfaction at having eaten. It slows the increase in the blood sugar level that follows meals. Fiber carries waste products from the body and, especially if it comes from lightly cooked vegetables, it supplies important minerals and antioxidants. Try to vary your fiber sources. Avoid too much scratchy wheat bran, but add grains such as oats and barley and starchy vegetables such as sweet potatoes and yams (without added sugar) to your menu.

Clinical studies that came out earlier this year now have added another dimension to the story. It turns out that the plant hormone abscisic acid is present and active in humans! Abscisic acid can be found in many fruits and vegetables. In one study, microgram amounts of abscisic acid in a fruit extract improved glucose tolerance and reduce insulinemia in both rats and humans! Another clinical study found that there is an impaired increase in abscisic acid in the blood in diabetes and gestational diabetes. The upshot of these studies is “eat more vegetables!”

Old Fashioned Versus Fast and Prepared Food
Most studies on food and health focus on the big three nutrients (carbohydrates, fats and protein), the glycemic index and various isolated food components. One novel approach that breaks this mold looks, instead, at the issue of food processing. Many foods that we think are either good or bad actually owe their effects to how they have been refined, manufactured and prepared. To give but one example, steel cut oats are excellent food, but instantized oats designed to become oatmeal with the mere addition of hot water become a high glycemic food akin to white bread or sugar. One Brazilian researcher writes that the issue is “ultra processing” and its impact on food.

This commentary distinguishes between three types of food and drink processing, and in turn three groups of foods and drinks, depending on the nature, extent and purpose of their processing. The first group are unprocessed (as defined here) or minimally processed foods. The second group are processed culinary or food industry ingredients. The third group are ultra-processed products—two examples of which are ready-to-eat eat breakfast cereals and burgers.

Today, at least 50 percent of all meals eaten by Americans are consumed outside the home with a good percentage being eaten in fast food restaurants. Good health depends, at least in part, on reducing the amount of ultra-processed food in the diet.

Conclusion Worthwhile resolutions do not need to be great or grand. With patience, small, practical changes can yield major improvements in health.

Endnotes

1. Breakfast-skippers may over-eat to compensate for low dopamine levels. See Hoertel HA, Will MJ, Leidy HJ. A randomized crossover, pilot study examining the effects of a normal protein vs. high protein breakfast on food cravings and reward signals in overweight/obese “breakfast skipping”, late-adolescent girls. Nutr J. 2014 Aug 6;13:80.
2. Larsen TM, Dalskov SM, van Baak M, Jebb SA, et al.; Diet, Obesity, and Genes (Diogenes) Project. Diets with high or low protein content and glycemic index for weight-loss maintenance. N Engl J Med. 2010 Nov 25;363(22):2102–13.
3. Mozaffarian D, de Oliveira Otto MC, Lemaitre RN, Fretts AM, Hotamisligil G, Tsai MY, Siscovick DS, Nettleton JA. trans-Palmitoleic acid, other dairy fat biomarkers, and incident diabetes: the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Clin Nutr. 2013 Apr;97(4):854–61.
4. Magnone M, Ameri P, Salis A, Andraghetti G, et al. Microgram amounts of abscisic acid in fruit extracts improve glucose tolerance and reduce insulinemia in rats and in humans. FASEB J. 2015 Dec;29(12):4783–93.
5. Ameri P, Bruzzone S, Mannino E, Sociali G, et al. Impaired increase of plasma abscisic Acid in response to oral glucose load in type 2 diabetes and in gestational diabetes. PLoS One. 2015 Feb 27;10(2):e0115992.
6. Monteiro C. The big issue is ultra-processing. ‘Carbs’: The answer. [Commentary]/ World Nutrition February 2011;2(2):86–97.

What are your goals for this year? When we arrive at December 2016, what will you be able to look back at to tell yourself you've had a fantastic year and have made progress towards optimizing your health? What would you like to be able to see, feel, or do?

• 10 pounds lighter? A dress size smaller? A 6 pack?
• No more Nanna naps? Waking up feeling rested in the mornings?
• Sticking to a regular exercise regime?

The first step to achieving something is to write it down and then make a plan to get there. If you don't know where you're going, you'll wind up someplace else. Set yourself:

1. 1–3 long term goals (6–12 months)
2. Break each one down to medium term goals (3 months)
3. Break these down to short term goals (4 weeks)
4. Set weekly targets to help you reach your short term goals–one step at a time!
5. 5. Set daily habits and actions that will help you reach your weekly targets

Your goals need to be SMARTE: SPECIFIC, MEASURABLE, ACHIEVABLE, RELEVANT, TIME SPECIFIC and EXCITING. They should be stated positively, be things you have control over and be things that YOU want, not that others want.

An example of a goal that needs to be re-thought and re-worded:

"By the end of 2016 I want to fit back into my old jeans because my husband thinks I look great in them."

This goal focuses on what someone else wants, not what the actual goal setter wants, thereby decreasing the likelihood the goal will be achieved. This person needs to think about what is important to them personally and then re-write their goal so it is something that inspires and excites them. For example:

“By the end of 2016 I will have completed my first 5km fun run because it’s something I have always wanted to do.”

Why is it important for you to achieve your goals? You must have a strong enough long term emotional reason to be successful in achieving your goals; otherwise it’s unlikely you will put in the required planning, preparation, time and effort required for success. E.g. a goal of losing weight needs to have a personal, emotional driver behind it to determine that it is important enough to achieve and maintain.

Keep asking yourself why you want to lose the weight and eventually you will get to the deep seated pain you want to avoid and/or pleasure you want to seek.

Your first answer to why could be, “I want to lose weight so I can feel fit and healthy.” This is not strong enough. Why do you want to be fit and healthy?

“So I can keep up with my kids, feel confident about the way I look and can avoid having any more heart scares.”

Getting closer now…ask yourself again why the above reason is important.

“I want to lose weight because when I had the heart scare a few weeks ago I was terrified that my kids might grow up without a dad and that I would play a role in that eventuation by failing to look after my health.” (Pain avoiding)

“I want to be alive, fit, healthy and full of energy at each of my children’s 50th birthdays and to know I have been there as a positive, healthy role model throughout their lives.” (Pleasure seeking)

Let’s look at the earlier goal that was established with the person who wanted to complete a 5km run.

“By the end of 2016 I will have completed my first 5km fun run because it’s something I have always wanted to do.”

This is a good goal. It’s time specific, measurable and relevant. We could make it even more likely to result in success by further asking why it is always something that person has wanted to do. This is also where the exciting part of goal setting comes in—it’s the emotional reasons behind the goals that will make a person excited to achieve them.

“I really want to complete the 5km run because I will feel so proud to be able to show my children that consistency and dedication pay off and that I am the role model I want to be. The increased energy I will have as a result of exercising regularly will allow me to spend more quality time with my family, and to feel inspired to bound out of bed every day. I am so excited about this because the opportunities that will result will be completely life changing for me.”

With this extended answer it is likely that this person will have asked themselves why at least a few times.

Once you have gotten to the really important reason(s) for wanting to exercise, remind yourself of them often, and this will be the first step to your success. What’s your why?

So grab a pen and write down your goal(s) for this year. Then, following the principles above, break them down into smaller goals, targets and habits so that it becomes apparent where you need to start. Put these goals in prominent places where you are going to be reminded of them (e.g. on your wall and fridge, and in your wallet) and then tell people about them—accountability is another factor that will contribute towards your success.

Ask a life coach or health and fitness trainer if you need additional help in setting goals or in following them through to completion.

Wow, another year has almost passed and the silly season is upon us! Food, family, food, friends, celebration, food, drinking, food, parties, relaxing, food . . . food is always a common theme at Christmas. We should all allow ourselves to break away from routine during this time, so that we feel refreshed and motivated in the New Year, but consider finding a balance between the good stuff and the not so good stuff…and you will thank yourself for it. Here I share six tips to help keep your body in tip top shape over the festive season.

1. Embrace new physical activities
Enjoy the sunshine and long warm days with plenty of outdoor physical activity. How about some beach cricket, body surfing, or taking a paddle boarding lesson? Hire a kayak or a mountain bike, or just pack up a picnic and take the family walking someplace you’ve never been before. Planning your day around physical activities that are outside of your normal routine will help invigorate your mind, body and spirit.

2. Fresh produce comes first
Depriving yourself of the tasty treats on offer at this time of year may make you feel resentful and more likely to binge later. Similarly, if you only opt for the treat foods, you’ll likely end up feeling tired, bloated and disappointed with your choices at the end of the festive season. A simple way to approach meals over the Christmas weeks is to first fill half your plate with salad and/or vegetables. Then fill the remainder of your plate with the other foods you would like to eat.

3. Drink sensibly
If you like a few alcoholic drinks over this time of the year, consider these ideas to help keep your drinking to a sensible level. You’ll feel more energetic, will be less likely to eat too much of the ‘wrong’ foods and will feel great leading into the New Year:

• Drink a big glass of water after each alcoholic drink, to help you stay hydrated
• Consider choosing low alcohol beer instead of full strength.
• If you’re a wine drinker, why not try a spritzer—half wine and half soda water

4. Eat mindfully
The body wasn’t designed to eat the vast quantities we often attempt to fill it with over the silly season, and it also wasn’t designed to eat at lightning speed. When we eat quickly, we’re also more likely to overeat, because in the time that we’ve shovelled everything in sight into our mouths we haven’t yet registered that we’re full. Had we eaten slowly, we would likely have realized we didn’t need to eat so much overall. As well as this, if we stop eating just before we feel full, chances are that 10–20 minutes after the meal we’ll realize we’ve had enough.

So chew, chew, swallow, put down your knife and fork for some conversation, then chew some more! If you need something a bit more concrete to work with other than just eating slowly, then aim to be the last person at the table to finish your meal, rather than the first.

5. Save some for lunch, or even next week!
No matter what your mother told you, you don’t need to eat everything on your plate. You don’t need to waste it either— when you’ve had enough, just put the leftovers in a container for lunch the next day. This is a great principle to follow during the festive season when jumbo sized meals are often created. In fact, it even opens up the opportunity to spend more time relaxing with friends and family because one batch of cooking can often last for a few meals. If you feel like you need to eat everything on your plate for some reason or another, then select appropriate portion sizes to begin with.

6. Start your goal setting early
If you’re feeling motivated, then why wait till 2016 to set your goals for the coming year? What are your goals for next year? When we arrive at December 2016, what will you be able to look back at to tell yourself you’ve had a fantastic year and have made progress towards optimizing your health? What would you like to be able to see, feel, or do?

• 10 pounds lighter? A dress size smaller? A 6 pack?
• No more Nanna naps? Waking up feeling rested in the mornings?
• Sticking to a regular exercise regime?

The first step to achieving something is to write it down and then make a plan to get there. If you don’t know where you’re going, you’ll wind up someplace else. Set yourself:

• 1–3 long term goals (6–12 months)
• Break each one down to medium term goals (3 months)
• Break these down to short term goals (4 weeks)
• Set weekly targets to help you reach your short term goals—one step at a time!
• Set daily habits and actions that will help you reach your weekly targets.

Welcome to Total Health's Health and Fitness Portal. As an innovator and educator in the online Wellness industry, we have the most advanced, comprehensive online health and fitness programs available. Our team of professionals includes Physicians, Nutritionists, Elite trainers, MLB Strength and Conditioning Coaches, and anatomy experts. Their expertise, along with the artistry of our graphics team and talented programmers, have created the first full service online health and fitness program, offering everything you need to reach your health, fitness and weight-loss goals. When you partner with Total Health it's like having a full staff of wellness professionals working just for you! All for the price of a Starbucks coffee, Big Mac or an Extra Large fry!

Visualize Your Transformation

For many of us, the hardest part of making lifestyle changes is in the very beginning. Trying to set goals and put an action plan into place to reach them can be challenging. A health and fitness plan is no different. It may be difficult to imagine what the changes may look and feel like, and figuring out what steps to take can be overwhelming. The Total Health 3D tool will jump start your fitness plan, and provide the constant motivation you need to be successful! Once you create your personal 3D replica, the Total Health tool will create multiple models that represent your body during various stages of your fitness plan. You have the opportunity to see the new you what you will look like during your journey to better health and fitness. Seeing the results before they happen is a great motivator!

Customized Meal Plans

Eating sensibly is the cornerstone of any successful health and fitness program, yet nutrition can be confusing! Let's face it: sticking to a strict meal plan, counting calories, and creating dishes that leave you unsatisfied makes dedication near impossible. If you aren't an expert, nutrition planning is a daunting task. Total Health is here to make your planning a breeze. Simply select the foods you most enjoy and will do the rest! We'll create dynamic meal plans suited to your individual tastes and fitness goals, even including your organized shopping lists and detailed preparation instructions. No need to worry about cooking every meal from scratch though, Total Health will also guide you to select the best options while dining out. In the click of a button, our easy-to-use mobile platform gives you the nutrition answers you need!

Customized Workouts

Exercise is the final element to ensure long-term health and fitness success. Finding an appropriate exercise routine for your skill level and abilities can be frustrating. Total Health offers unlimited options to ensure your motivation never wavers. You'll select your available times, current activity level and preferred work out location (home or gym), and Total Health programs provide you with detailed information on which exercise to perform, how many repetitions to do and which weights you should use. Don't be intimidated if you've never exercised, or consider yourself a beginner. Total Health has more than 3,000 short, instructional videos demonstrating every movement included in your personalized plans! You've totally got this!

Educational Tools

As a Total Health client, you have everything you need to turn your fitness goals into reality! In addition to your diet and exercise plans, we include hundreds of health and fitness articles, informative videos, and easy-to-use assessment calculators, all easily accessed from your member portal. Total Health is your one stop shop for health and fitness success!

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We have all been there before. You’re sitting at your desk and the day is just beginning and your neck or back starts to hurt and ache. But, you have no choice. You have to stay at work. So what can you do?

1) Set up a yogic environment—Just like alignment matters on a yoga mat, make sure your computer screen is in direct alignment with your eyes and you don’t have to turn your head left or right to see the screen, which will cut down on stressing your neck muscles. Also, be certain the screen is no more than 18–30 inches away from you to avoid poking the chin, straining the upper back, compressing the upper neck muscles, which often leads to headaches. Lastly, play some soft ambient music or pick a calming or inspiring screen saver to help influence your mood and make you remember some of the happier aspects of your life.

2) Take the strain off your spine by remembering to take breaks. Even in TED talks, sitting has been referred to as the smoking of our generation, so it’s of the utmost importance to remember to get up after sitting for 20–30 minutes to give the muscles, discs, and ligaments of your spine a chance to reset back to neutral. All you have to do is stand up and reach for the sky alternating with each arm a few times like you’re climbing a ladder for about 10–20 seconds and then sit back down. It’s that easy!

3) Stretch away the pain—Pain and discomfort build up in our bodies due to repetitive stress. And there’s nothing more repetitive than having to sit at your desk for hours on end. So, assist your body and your muscles in finding some freedom by working some good old-fashioned Yoga stretches into your day. Try reaching your left arm overhead to touch the top of the right ear and then guide your left ear closer to your left shoulder while relaxing your right shoulder away and spinning your chin to the right. This will help to free up tension where the shoulder meets the neck on the right side. Be sure to do the same stretch on the opposite side, too, to be a well-balanced yogi and help your body stretch away the pain.

The result of these easy to apply, simple yogic tips is that you might start to feel better, experience less pain and discomfort, and enjoy your day a little more while you’re at work. If you smile at just one person more per day and snap at one person less because of it, then you’re contributing to making the world a better place and you’ve done a great job in applying Yoga Therapy into your work and your daily life.

Exercise builds new brain cells. Until recently it was believed that the brain cells we’re born with were all we were ever going to have. If brain cells died or were damaged, that was it. However a process called neurogenesis was recently discovered that demonstrated that new brain cells are continuously being made and stored. Scientists at the Karolinska Institute in Stockholm, Sweden found that one-third of the neurons in the hippocampus, the area of the brain involved in forming, organizing, and storing memories, are regularly renewed throughout life. They calculated that roughly 1,400 new neurons were added per day with rates declining modestly with age.¹

Other studies indicated that experiences and learning strengthened these new neurons, causing them to branch out and make new connections. As the neurons were utilized, they developed even more connections and became stronger. The connections that were seldom used became weaker and died. Our brains are made up of billions of connections and the more neurons we have the bigger our brains and the better our cognitive functioning.

Exercise contributes to the growing of new neurons. Here’s how it works. As glucose, the body’s fuel derived from our food is digested and moved into the blood stream, it needs to be converted into energy. Within each cell are thousands of smaller molecules called mitochondria. The mitochondria are the cells’ energy factories. They turn the glucose into a substance called adenosine triphosphate (ATP). ATP is a high-energy compound that powers every one of our cells. The work that goes on within each of the 100 trillion human cells is because of the one billion ATP molecules in each cell. The origin of the ATP is the food we eat. To create ATP, glucose needs oxygen. Our breathing or respiration combines oxygen with glucose to create ATP. Exercise, the intake of oxygen through respiration, increases the production of ATP.²

Exercise also produces proteins that travel through the blood steam and in the brain, playing a critical role in our highest thought processes. The protein, insulin-like growth facto, is essential for the development and function of the brain and other organs. It plays a roll in neurogenesis and dendritic branching. Exercise also produces brain-derived neurotrophic factor in the hippocampus.³ BDNF builds and maintains the infrastructure of the brain, aids in neurogenesis and in repairing synapses.

Our bodies are designed to move and as we move hormones are released. Different movements send different messages to our brains to release specific hormones, which then tell the cells to burn fat or sugar, repair or build muscles, make new blood vessels, increase of decrease heart rate, or increase the levels of serotonin, norepinephrine, or dopamine. As we exercise, we amp up these functions and move them from maintenance and survival mode to creation and building mode.

An example of the benefits of exercise include a reduction of risk for Alzheimer’s disease and other forms of dementia for more physically active individuals. Larson et al. assessed 1740 adults over the age of 65 on the frequency of participation in a variety of physical activities (e.g. walking, hiking, bicycling and swimming). After an average follow-up of 6.2 years, 158 of the original participants had developed dementia. After adjusting for age, sex and medical conditions, individuals who exercised more than three times per week during initial assessment were found to be 34 percent less likely to be diagnosed with dementia than those who exercised fewer than three times per week.⁴

Sitting for long periods of time does more than keep us inactive. It causes fat to accumulate in the liver, heart and brain. Studies from NASA indicated that the astronauts muscles, bones and overall health was weakened by weightlessness, suggesting that weight bearing exercises are necessary for maintaining fitness.⁵ A study published in the journal Stroke found that walking at least three hours per week reduced the risk of stroke in women better than inactivity, and walking was more effective than high intensity cardiovascular exercise or moderate to heavy exercise.⁶ The same was not true for men. An article in the journal Neurology found that high intensity exercise in men reduced stroke risk and helped them recover from a stroke better and faster.⁷

As people age, some areas of the brain naturally shrink. For example, studies show that the hippocampus shrinks one to two percent annually in people without dementia, resulting in an increased risk for a decline in cognitive functioning. A study from the University of Illinois at Urbana-Champaign found that fitness however can change the aging brain and even people who haven’t exercised on a regular basis can improve their brain function later in life. Researchers divided a group of healthy, sedentary adults, ages 55 to 80, to participate in a yearlong exercise program. One group walked for 40 minutes three times per week and the other group performed a variety of strength and balance exercises. The group that walked increased the size of their hippocampus by two percent on average. The participants that completed the yearlong balance and strength-training program experienced a one percent decrease in the volume of the hippocampus. Both groups improved on the natural progression of brain aging.⁸

Another study involving women ages 70 to 80 with mild cognitive impairment participated in a six month, twice weekly program of aerobic training, resistance training, or balancing and toning. Researchers found women who participated in aerobic training significantly increased hippocampal volume. The others did not.⁹

Exercise has many other benefits as well. It helps control weight and lowers the risk of heart disease, stroke and some types of cancer. It helps improve sleep, memory, and concentration. It increases the brain’s plasticity and reduces possible damage and shrinkage of the brain by controlling blood sugar levels and type-2 diabetes. Higher levels of fitness relate directly to positive mood and lower levels of anxiety and stress.

Decades of research demonstrate that engaging in regular exercise leads to increased brain volume and improved cognitive functioning among many other benefits. Exercise is good at any age but it’s never too late to start.

References:

1. Ernst, A., Alkass, K., Bernard, S. et al. (February 20, 2014). Neurogenesis in the Striatum of the Adult Human Brain. Cell online. oi:10.1016/j. cell. 2014.01.044
2. Alberts B, Johnson A, Lewis J, et al. (2002). Molecular Biology of the Cell. 4th edition. New York: Garland Science. Retrieved from: http://www.ncbi.nlm.nih.gov/books/NBK26882/
3. Di Salvo, D. (October 13, 2013). How exercise makes your brain grow. Forbes.com. Retrieved from http://www.forbes.com/sites/daviddisalvo/2013/10/13/how-exercise-makes-your-brain-grow/
4. Larson, E.B., Wang, l., Bowen, J.D. et al. (2006, January 17). Exercise Is Associated with Reduced Risk for Incident Dementia among Persons 65 Years of Age and Older. Annals of Internal Medicine;144(2):73–81. doi:10.7326/0003-4819-144-2-200601170-00004
5. Vernikos, J. (2011). Sitting Kills, Moving Heals: How Everyday Movement Will Prevent Pain, Illness, and Early Death And Exercise Alone Won’t. Fresno, CA: Quill Driver Books, Linden Publishing Inc.
6. Walking reduces stroke risk among women. (Jan 7, 2013). Medical News Today. Retrieved from www.medicalnewstodya.com/articles/254632. php
7. Willey, J.Z., Moon, Y.P., Paik, M.C. et al. (2009, November, 24). Physical activity and risk of ischemic stroke in the Northern Manhattan Study. Neurology. (73)21, 1774–9. doi: 10.1212/WNL.0b013e3181c34b58
8. Society for Neuroscience. (2013, August 28). Physical Exercise Beefs Up the Brain Retrieved from: http://www.brainfacts.org/Across-the- Lifespan/Diet-and-Exercise/Articles/2013/Physical-Exercise-Beefs-upthe-Brain
9. Weuve, J., Kang, J.H., Manson, J. S. et al. (2004). Physical activity, including walking, and cognitive function in older women. Journal of the American Medical Association. 292(12), 1454–61. doi:10.1001/

When it comes to sports performance supplements, there are few ingredients better known than creatine. Creatine helps to supply energy to cells, particularly in muscle, by assisting in the formation of the body’s energy currency, adenosine triphosphate (ATP).

But athletes are often unaware that ATP generation requires creatine to first gain entry to muscle. Creatine floating around in the blood is useless if not absorbed by muscle tissue. Yet taken by itself (usually as creatine monohydrate), a significant portion ends-up being simply excreted, i.e., being useless. The reason: low insulin levels.

Insulin normally signals muscles to absorb creatine. But without food to signal insulin secretion, creatine uptake is minimal. Beyond taste, creatine formulas are often packed with sugars for this very reason. But as many performance athletes attempt to reign in their refined sugar consumption and avoid taxing their bodies with insulin spikes, they are left in a bind trying to eliminate caloric load while using creatine effectively.

Russian Tarragon: Sugar-less Creatine to Muscles
Enter Russian Tarragon (Artemisia dracunculus). Diabetes research programs have recently demonstrated Russian Tarragon to have insulin sensitizing action.¹ This means that although it doesn’t increase insulin secretion, it allows existing insulin levels to have a stronger influence on the body. This is important in Metabolic Syndrome (a.k.a. insulin resistance syndrome) in which there’s plenty of insulin in the body, but the body’s receptors have become “hard-of-hearing.”

For healthy individuals, this presents an alternative way to induce creatine clearance from blood without the caloric load or insulin spike. Recent research in healthy males demonstrated that taking one gram of a Russian Tarragon extract along with creatine monohydrate under test conditions led to a significantly greater clearance from blood (and presumably into muscle). The effect was comparable to that achieved by using 75 g of glucose or 50 grams of protein plus 47 grams of carbohydrates.² Five hundred milligrams taken 30 minutes prior to creatine supplementation did not affect whole body creatine levels and retention, however, meaning that a good response requires at least one gram per day.³

Glycostat® Bitter Melon: More Insulin Sensitivity & Creatine Uptake

Bitter melon (Momordica charantia) is another botanical that has a history of use in food and medicine. Like Russian Tarragon, bitter melon has shown tantalizing results in stimulating insulin sensitivity. This implies it may be useful in helping to induce creatine uptake from blood into muscles, an effect found with glucose also to be expected with amino acids.⁴ Work in diabetic animals suggests that a one-gram dose of a particular Wild Bitter Melon extract in humans can lead to a sustained 15 percent increase in the muscle uptake of nutrients like creatine for hours after ingestion.

Other research has shown that bitter melon is useful in the mobilization of fats for energy via beta-oxidation.⁵ Everyone knows fat is an excellent source of energy, but sometimes the body forgets how to utilize it. Bitter melon helps provide a reminder.

The biggest trick with bitter melon is finding a dried extract that retains the activity of the fresh fruit. Many do not. Glycostat® Wild Bitter Melon appears to be head-and-shoulders above the rest.⁶

Help enlighten those who take creatine. There are other ingredients out there that can make it more effective—without the added sugar.

References:

1. Cefalu WT, et al. Botanicals and the metabolic syndrome. Am J Clin Nutr. 2008 Feb;87(2):481S–7S.
2. Jäger R, et al. The effect of Russian Tarragon (artemisia dracunculus L.) on the plasma creatine concentration with creatine monohydrate administration. Journal of the International Society of Sports Nutrition 2008, 5(Suppl 1):P4.
3. Oliver JM, Jagim AR, Pischel I, Jäger R, Purpura M, Sanchez A, Fluckey J, Riechman S, Greenwood M, Kelly K, Meininger C, Rasmussen C, Kreider RB. Effects of short-term ingestion of Russian Tarragon prior to creatine monohydrate supplementation on whole body and muscle creatine retention and anaerobic sprint capacity: a preliminary investigation. J Int Soc Sports Nutr. 2014 Feb 26;11(1):6.
4. Wang ZQ, et al. Bioactives from bitter melon enhance insulin signaling and modulate acyl carnitine content in skeletal muscle in high-fat diet-fed mice. J Nutr Biochem. 2011 Nov;22(11):1064–73.
5. Chan LLY, et al. Reduced Adiposity in Bitter Melon (Momordica charantia)–Fed Rats Is Associated with Increased Lipid Oxidative Enzyme Activities and Uncoupling Protein Expression. J. Nutr. 2005; 135(11):2517–23.
6. Clouatre DL, Rao SN, Preuss HG. Bitter Melon Extracts in Diabetic and Normal Rats Favorably Influence Blood Glucose and Blood Pressure Regulation. J Med Food 2011 Dec;14(12):1496-504.

Contrary to popular belief, as it pertains to your metabolism, slow and steady does not win the race. Most people are under the impression they need to spend hours upon hours in a gym running on a treadmill or flying through the air on an elliptical machine, but most of them are just wasting their time. That is if their goal is to see real results!

Luckily, the notion that your results are proportional to time spent exercising can be considered dead and gone. Have you ever heard the saying; it’s not the amount of time you spend working that counts, it’s the amount of productivity you achieve while working? It may sound too good to be true, but you can get more results in much less time, if you are willing to exercise the right way.

Exercising the “right way” means chucking most 60-minute cardio sessions in the proverbial trashcan. Instead, research has shown that by adopting an entirely new and more effective approach to exercise, known as High-Intensity-Interval-Training or HIIT, you can see results in a fraction of the time—especially as you get older. Aging seems to make it more and more difficult to lose fat and gain muscle, however by changing our exercise patterns to HIIT, we may be able to experience the metabolism of our youth once again.¹

HIIT is an exercise strategy—lasting anywhere from four to thirty minutes, which incorporates short periods (i.e. 20–30 seconds) of intense resistance exercise (i.e. weight training or high resistance cardio) with cool-down recovery periods (30 seconds to one and a half minutes). It’s basically a higher-intensity form of cardio/resistance training done in a fraction of the time that most workouts take. Numerous studies have proven that interval training burns more fat in less time.^2,3

Take this study that compared interval training with old-school cardio for 15-weeks. One group did 20 minutes of interval training three times per week. The other group spent 40 minutes three times per week on steady-state cardio work. Even though the interval training group spent half as much time exercising, they lost six pounds of fat, while the steady-state group actually gained fat.⁴ In other words, even though it eats up more time, steady-state cardio created a group of smaller fat people.

Stop Resisting
I have always been a huge advocate for resistance training, as we cannot afford to lose even an ounce of muscle tissue, especially as we get older. Age is often associated with a loss of lean body mass and a gain in fat. Yes, our metabolisms do slow down, but that’s because muscle is the key metabolic engine of the body, dictating how effective we are at burning calories—even at rest. Jan Helgerud, PhD, from the Norwegian University of Science and Technology, states that, “High-intensity interval training is twice as effective as normal exercise. This is like finding a new pill that works twice as well… we should immediately throw out the old way of exercising.”⁵

When you use resistance exercises in your routine (i.e. elastic bands and/or weights), you can expect your muscles (and metabolism) to rev up. The best part is this happens even as stubborn fat melts away. Researchers from the University of Maryland recently found that women who did regular resistance training not only lost weight, but they were able to build muscle while the number on the scale took a nosedive⁶, which is music to any woman’s ears. Best of all, resistance training seems to laser-target nasty, stubborn, and inflammation producing abdominal fat.⁷

So the verdict is in, those that perform HIIT and resistance style training, find themselves with a higher metabolic rate than before. Think about it this way, for every pound of muscle you tack on, you can expect to burn a lot more calories each and every day. One study found that resistance training over a few weeks upped metabolic rate by an impressive 7 percent,⁸ and if you shrug your shoulders at a mere 7 percent, try thinking of it this way; that could equate to an impressive 50,000 extra calories⁹ burned off in one year, which could mean you’d be about 14 pounds lighter this time next year. Not so bad after all, is it?

References:

1. HIIT moves out of the exercise lab and into the real world. A modified version of the High-Intensity Interval Training may be a timesaving, effective way for older, less fit adults to stay in shape. Duke med Health News. 2014 Jun;20(6):3–4
2. Giannaki CD, et al. Eight weeks of a combination of high intensity interval training and conventional training reduce visceral adiposity and improve physical fitness: a group-based intervention. J Sports Med Phys Fitness. 2015 Jan 8.
3. Falcone PH, et al. Caloric expenditure of aerobic, resistance, or combined high-intensity interval training using a hydraulic resistance system in healthy men. J Strength Cond Res. 2015 Mar;29(3):779–85.
4. Trapp EG and Boutcher SH. Fat loss following 15 weeks of high intensity, intermittent cycle training. Fat Loss Laboratory, Faculty of Medicine, University of New South Wales, Sydney, Australia.
5. Telegraph Media Group. A week’s exercise could be squeezed into one hour, say experts. The Telegraph. 26 Feb, 2010
6. Schmitz KH, et al. Strength training and adiposity in premenopausal women: Strong, Healthy, and Empowered study American Journal of Clinical Nutrition. Sep 2007; 86: 566–72.
7. Shaw BS, Shaw I, Mamen A. Contrasting effects in anthropometric measures of total fatness and abdominal fat mass following endurance and concurrent endurance and resistance training. J Sports Med Phys Fitness. 2010 Jun;50(2):207–13.
8. Lemmer JT, et al. MEffect of strength training on resting metabolic rate and physical activity: age and gender comparisons. Med Sci Sports Exer. 2001 Apr;33(4):532–41.
9. Ehrman JK, Gordon PM, Visich PS, Keteyian SJ. Clinical Exercise Physiology. 2nd ed. Champaign, IL: Human Kinetics; 2009:135–46.

If you, like me, came into a family who was intently involved in music and dance, you KNOW you were born with a beat, a dance beat, that is. I began dancing around the age of six, mimicking my aunts who danced around the house, even while house-cleaning Saturdays to tunes that kept your toes tapping and hips jarring. That said, sixty plus years ago there was no mention of specific health benefits of dancing and, after all, you just couldn’t sit through those tunes without moving, I couldn’t. Today we KNOW there ARE health benefits, which only add to the internal beat of someone like me who finds dancing my best de-stressor and exercise.

New Life For A Tired Soul…
Dancing is magical and transforming. It can breathe new life into a tired soul; make a spirit soar; unleash locked-away creativity; unite generations and cultures; bring neutrality to two opposing views; inspire new romances or rekindle old ones; trigger long-forgotten memories; and turn sadness into joy! Dancing requires you to remember dance steps and sequences—that alone is brain-power that improves memory skills. Furthermore, it’s the best stress-reducer—ever tried dancing and worrying about other extraneous concerns? You can’t.

According to Costas Karageorghis, PhD, a music and sports researcher, we’re hardwired to sync-up our movements to music—possibly because even primitive cultures used rhythmic movements to express themselves. This instinctual response to rhythm actually begins in your brain—where musical vibrations “light-up” timing circuits intertwined with your brain’s communication and memory systems. This explains why you may find yourself singing, swaying, and choking-up to tunes that bring back memories of days gone by. Albeit you may not “feel” the beat like I do, it’s true some people’s mind-beat connection is stronger than others. The trick, it seems, is that environmental factors play an important role in the impact of the memories.

Re-wiring Your Brain…
According to Joe Verghese, MD, a professor of neurology at Albert Einstein College of Medicine, “The brain rewires itself based on use—you lose what you don’t use. The more time you spend dancing, for instance, the more you train your brain to open those feel-good floodgates the more you’ll start to amp-up your overall well-being.”

Scientifically Speaking…
A study in overall circulation found that people with cardiac conditions who danced for just 20 minutes three times weekly saw their heart health improve significantly more than those who stuck to their traditional cardio workouts. Dancing helps make your skeleton strong, according to the National Osteoporosis Foundation, AND, it works wonders for overall body chemistry. Researchers confirmed overall health benefits by comparing dancers to non-dancers and found evidence that dancing may preserve and enhance both motor skills and perceptual abilities.

Dancing releases ample flow of mood-improving chemicals that creates elevation of your overall mental state. Just one lively dance session can slay depression more than vigorous exercise or simply listening to upbeat music. According to a study in The Arts in Psychotherapy, having a dance partner leads to less stress and stronger social bonds—key factors in mental and physical health.

Saving Your Mind, Literally…
Dancing enhances your memory, coordination and focus by giving it an intense workout—leading to stronger synapses and beefed-up gray matter. In a New England Journal of Medicine study they reported that out of 11 physical activities, dancing was the ONLY one that actually lowered dementia risk by a whopping 76 percent. Maybe the question should now be, “May I have this dance? A better question to ask rather than what drug should I take for the beginning symptoms of dementia or any other cognitive disorder?” Just a thought…

The study results showed that dancers are sharper in the short-term and less likely to succumb to debilitating brain diseases of all kinds in the short and long term.

A 2003 study in the New England Journal of Medicine found that ballroom dancing at least twice a week made people less likely to develop or accelerate dementia. It also showed that people with Alzheimer’s disease were able to recall forgotten memories when they dance to music they used to know. Not ambulatory? Try chair-dancing, it’s very therapeutic for those with physical limitations.

Dancing 101…
When non-dancers, and my clients, find out I’ve danced for…more years than I’d like to admit…they want to know what type of dancing should they begin with. That’s a hard question because it depends on individual mobility and rhythm choices—maybe the following will help you get motivated.

Newbies: Line Dancing—The rhythm is generally easy-to-follow, movements are repetitive and easy to catch-on…life in the country lane of line dancing is fun and you don’t need a partner.

Burning Calories: Zumba—The type of dancing you see on television simply scorches the calories but its professional moves at professional speed are NOT for those untrained and out-of-shape. For something similar and more accessible, check out Zumba—the pace is intense but fun and you burn about 250 calories in just 30 minutes…and how can you resist all those beats?

Mood-Booster: Swing—You need a partner to dance swing and the touch factor, along with the high-energy music beat, helps trigger a mood-enhancing hormone called oxytocin—the “happy” hormone.

Strength/Endurance: Pole Dancing—I have to admit I tried it once and almost killed myself. Yes, this is great for toning your lower body and the activity at the pole provides great upper body and arm strength but you have to be in really good shape OR?

Stress-Relief: DANCE—any dance, just get out, find friends who will support your efforts and dance to upbeat music to not only reap the health benefits for your body but also for your mind as camaraderie helps to blow-out that excess stress.

The Way I See It….
If you’re not inclined to exercise or not motivated by that dusty treadmill in the corner, yet motivated to get healthier and fit, dust-off those dancing shoes and kick-up your heels…doctors’ orders!

Protein supplements are commonly used by people as part of a fitness program, and indeed there is good reason to do so. In fact, protein is one of the most important substances for the maintenance of good health and vitality. It is of primary importance in the growth and development of all body tissues including muscles, blood, skin, hair, nails and internal organs. Protein is also needed for the formation of hormones, enzymes and antibodies. In addition to being the major source of building materials for the body, protein may be used as a source of heat and energy. Each gram of protein provides four calories. This energy function of protein is spared when sufficient fats and carbohydrates are present in the diet.¹ While any protein source can serve these functions, whey protein provides distinct advantages as a source of supplemental protein.

WHEY PROTEIN IN GENERAL
Whey, a by-product of cheese manufacturing, contains proteins. These include alpha-lactalbumin, beta-lactoglobulin, lactoferrin, serum albumin, lysozyme, and immunoglobulins A, G, and M² and relatively large amounts of the amino acid cysteine.³ Whey also contains carbohydrates, primarily lactose, and the minerals calcium, sodium, phosphorus, and potassium.⁴

Whey protein is derived from whey and tends to provide a higher concentration of essential amino acids than other protein sources.⁵ Also, whey protein typically contains 24 percent branched chain amino acids, which are readily oxidized as an energy source during stress. In addition, whey protein is also a source of cysteine, a precursor to the vital intracellular antioxidant glutathione (GSH),⁶ which is depleted by oxidative stress, which occurs during exercise, infections, trauma, or major surgery.⁷ In fact, some researchers think that whey protein may help play a role in cancer prevention by providing GSH precursors and increasing levels of GSH in the tissues.⁸ This is consistent with animal research showing that protein from whey may protect against certain cancers.^9,10,11

Whey protein varies in the immunoglobulins and other proteins present, depending on the processing method used to produce the final form of whey protein.¹² These forms include whey protein isolate, whey protein concentrate, and hydrolyzed whey protein. This article will focus on whey protein isolate.

WHEY PROTEIN ISOLATE
Arguably, the best way to process whey protein isolate (WPI) is via cross-flow ultrafiltration. This process preserves protein microfractions and separates the protein from whey without the use of heat or damaging chemicals. As a result WPI is virtually fat and lactose free, is extremely digestible, and has a good taste. WPI does not tend to cause gas, bloating or other gastrointestinal distress.¹³ Furthermore whey protein isolate is easily digested and absorbed, and has received the highest score (1.14) of any protein tested according to the Protein Digestibility Corrected Amino Acid Score (PDCAAS), the preferred method for evaluating protein quality.¹⁴

WPI AND BODYBUILDING
Clinical research shows that taking 1.2–1.5 grams WPI per kilogram of body weight, per day in combination with strength training for 6–10 weeks increased lean body mass, strength, and muscle hypertrophy compared to placebo. ^15,16,17 In one double-blind study,¹⁸ recreational bodybuilders supplemented their normal diet with WPI (1.5 grams per kilogram of body weight, per day) or another protein for 10 weeks. The results were that the WPI group experienced a significant gain in lean mass compared to the other protein group (11 lbs versus 1.76 lbs) and a significant reduction in fat mass compared to the other protein group (-3.3 lbs versus +0.44 lbs). The bodybuilders also achieved significant improvements in strength.

WPI supplementation also results in higher blood amino acid concentrations compared to some other protein sources. This results in greater stimulation of protein synthesis,¹⁹ thus providing the foundations for preservation and production of muscle mass. Several studies involving supplementation with whey protein have been shown to be effective in augmenting the effects of resistance exercise, particularly when supplementation occurs in the hours surrounding the exercise training.²⁰ Research in healthy volunteers showed that consuming 10 grams WPI following exercise can stimulate muscle protein synthesis, which could potentially lead to increased muscle hypertrophy.²¹ Research also shows that men who ingest 45 grams of WPI had significantly increased levels of insulin. In research, WPI increased insulin secretion to a greater extent than HWP.²²

WPI AND FAT LOSS WPI and one of its components, glycomacropeptide (GMP), were fed to a group of rats, while other rats received a standard diet. The results were that body-weight gain was 21 percent lower on the WPI diet. GMP has an effect of reducing fat mass and insulin levels.²³ A meal replacement drink containing 15 grams of WPI enriched with GMP (GMP-WPI) was given to 72 participants, twice daily for 12 months. The results were that the participants lost fat weight, and decreased total and LDL cholesterol, triglycerides, glucose, insulin, and blood pressure.²⁴ One reason that WPI may be effective for fat loss is that it is better at creating a sense of fullness than other types of protein types. In research, feelings of fullness were greater after consuming WPI.²⁵

WPI AND GSH
Thirty-one healthy subjects given WPI produced increased levels of GSH. Those who ingested 45 grams daily of WPI had the highest increase in GSH, 24 percent.²⁶ This increase in GSH may be part of the reason that, in other research, WPI enhanced the ability of a chemotherapy drug to destroy cancer cells.²⁷

WHO NEEDS SUPPLEMENTAL PROTEIN?
While everyone needs protein, there are specific population groups that could benefit by supplemental protein. In addition to athletes/bodybuilders (as previously discussed), this includes pregnant women, those who have undergone bariatric surgery, young children who are picky eaters, some adolescent girls and older adults.

PREGNANT WOMEN
The protein RDA for women is 46 grams per day. The protein RDA for pregnant women is 71 grams per day. That’s 25 grams more per day than non-pregnant women.²⁸ Since pregnancy is often associated with indigestion and heartburn, ²⁹ it may make sense to supplement protein intake with an easily digested protein such as WPI.

BARIATRIC SURGERY PATIENTS
Individuals who have undergone bariatric surgery often experience a reduction in protein intake.^30,31 This is problematic since increasing protein intake to at least 60 grams per day is recommended to help those who have undergone bariatric surgery retain more lean mass (i.e., Muscle).^32,33 Given that bariatric surgery may be associated with digestion and absorption issues (i.e., gastric dumping syndrome),³⁴ the use of an easily digested protein such as WPI makes sense for supplementing protein intake.

CHILDREN WHO ARE PICKY EATERS
Research³⁵ has shown that children who are picky eaters are more likely to consume less than the recommended amounts of protein (i.e., meat and alternatives) as well as fruit and vegetables. Furthermore, research³⁶ has also shown that some top sources of protein for children include pizza, beef and burgers, which often contribute substantial saturated fat. WPI is a healthy, low-fat option for supplementing protein intake in children.

ADOLESCENT GIRLS
According to the National Health and Nutrition Examination Survey,³⁷ 7.7 percent of adolescent females consume protein levels below their estimated average requirement.

While the reasons for this are not clear, protein supplementation may have value

.

OLDER ADULTS
Muscle mass and function is progressively lost with aging, so that by the age of 60 many individuals have reached a threshold where function begins to be affected. Increasing protein intake may help. Dietary protein intake helps stimulates muscle protein synthesis and may lead to improved muscle mass, strength and function over time, which in turn may help improve health outcomes in older individuals. Some researchers suggest that the optimal protein intake for an older individual is greater than the RDA.³⁸ Since protein intake tends to decline with age, especially among 7.2–8.6 percent of older women consuming protein levels below their estimated average requirement,³⁹ this suggestion has merit.

CONCLUSION
Protein is important for multiple functions in the body, not the least the repair growth of muscles. As a supplemental source, whey protein offers several advantages and has significant research to support its use.

References:

1. Whitney E, Rolfes RR. Understanding Nutrition, 11th ed. Belmont, CA: Thompson Learning; 2008.
2. Whey Protein monograph. Natural Medicines Comprehensive Database. Retrieved February 24, 2009 from http://www.naturaldatabase.com/(S(t5ddowevmyxg3m2naxm45n55))/nd/Search.aspx?cs=&s=ND&pt=100&id=833&fs=ND&searchid=13583810.
3. Baruchel S, Olivier R, Wainberg M. Anti-HIV and anti-apoptotic activity of the whey protein concentrate: IMMUNOCAL. Int Conf AIDS 1994;10:32 (abstract # 421A).
4. Whey Protein monograph. Natural Medicines Comprehensive Database. Retrieved February 24, 2009 from http://www.naturaldatabase.com/(S(t5ddowevmyxg3m2naxm45n55))/nd/Search.aspx?cs=&s=ND&pt=100&id=833&fs=ND&searchid=13583810.
5. Cribb PJ, Wiliams AD, Carey MF, Hayes A. The effect of whey isolate and resistance training on strength, body composition, and plasma glutamine. Int J Sport Nutr Exerc Metab 2006;16:494–509.
6. Whey Protein monograph. Natural Medicines Comprehensive Database. Retrieved February 24, 2009 from http://www.naturaldatabase.com/(S(t5ddowevmyxg3m2naxm45n55))/nd/Search.aspx?cs=&s=ND&pt=100&id=833&fs=ND&searchid=13583810.
7. Whey Protein monograph. Natural Medicines Comprehensive Database. Retrieved February 24, 2009 from http://www.naturaldatabase.com/(S(t5ddowevmyxg3m2naxm45n55))/nd/Search.aspx?cs=&s=ND&pt=100&id=833&fs=ND&searchid=13583810.
8. Bounous G, Batist G, Gold P. Whey proteins in cancer prevention. Cancer Lett 1991;7:91–4.
9. Hakkak R, Korourian S, Shelnutt SR, et al. Diets containing whey proteins or soy protein isolate protect against 7,12-dimethylbenz(a) anthracene-induced mammary tumors in female rats. Cancer Epidemiol Biomarkers Prev 2000;9:113–7.
10. McIntosh GH. Colon cancer: dietary modifications required for a balanced protective diet. Prev Med 1993;22:767–74.
11. Papenburg R, Bounous G, Fleiszer D, Gold P. Dietary milk proteins inhibit the development of dimethylhydrazine-induced malignancy. Tumor Biol 1990;11:129–36.
12. Whey Protein monograph. Natural Medicines Comprehensive Database. Retrieved February 24, 2009 from http://www.naturaldatabase.com/(S(t5ddowevmyxg3m2naxm45n55))/nd/Search.aspx?cs=&s=ND&pt=100&id=833&fs=ND&searchid=13583810.
13. Farnfield MM, Trenerry C, Carey KA, Cameron-Smith D. Plasma amino acid response after ingestion of different whey protein fractions. Int J Food Sci Nutr. 2009 Sep;60(6):476–86.
14. U.S. Dairy Export Council. Protein. Retrieved January 30, 2013from http://www.usdec.org/Products/content.cfm? Item Number=82510.
15. Cribb PJ, Wiliams AD, Carey MF, Hayes A. The effect of whey isolate and resistance training on strength, body composition, and plasma glutamine. Int J Sport Nutr Exerc Metab 2006;16:494-509.
16. Cribb PJ, Williams AD, Stathis CG, et al. Effects of whey isolate, creatine, and resistance training on muscle hypertrophy. Med Sci Sports Exerc 2007;39:298–307.
17. Candow DG, Burke NC, Smith-Palmer T, Burke DG. Effect of whey and soy protein supplementation combined with resistance training in young adults. Int J Sport Nutr Exerc Metab 2006;16:233-44.
18. Cribb PJ, Williams AD, Carey MF, Hayes A. The effect of whey isolate and resistance training on strength, body composition, and plasma glutamine. Int J Sport Nutr Exerc Metab 2006;16(5):494-509.
19. Cribb PJ, Wiliams AD, Carey MF, Hayes A. The effect of whey isolate and resistance training on strength, body composition, and plasma glutamine. Int J Sport Nutr Exerc Metab 2006;16:494-509.
20. Hayes A, Cribb PJ. Effect of whey protein isolate on strength, body composition and muscle hypertrophy during resistance training. Curr Opin Clin Nutr Metab Care 2008;11(1):40-4.
21. Tang JE, Manolakos JJ, Kujbida GW, et al. Minimal whey protein with carbohydrate stimulates muscle protein synthesis following resistance exercise in trained young men. Appl Physiol Nutr Metab 2007;32:1132-8.
22. Power O, Hallihan A, Jakeman P. Human insulinotropic response to oral ingestion of native and hydrolysed whey protein. Amino Acids 2008 Aug 5. [Epub ahead of print].
23. Royle PJ, McIntosh GH, Clifton PM. Whey protein isolate and glycomacropeptide decrease weight gain and alter body composition in male Wistar rats. Br J Nutr 2008 Jul;100(1):88-93.
24. Keogh JB, Clifton P. The effect of meal replacements high in glycomacropeptide on weight loss and markers of cardiovascular disease risk. Am J Clin Nutr 2008;87(6):1602–5.
25. Burton-Freeman BM. Glycomacropeptide (GMP) is not critical to whey-induced satiety, but may have a unique role in energy intake regulation through cholecystokinin (CCK). Physiol Behav 2008;93(1-2):379–87.
26. Zavorsky GS, Kubow S, Grey V, Riverin V, Lands LC. An open-label dose-response study of lymphocyte glutathione levels in healthy men and women receiving pressurized whey protein isolate supplements. Int J Food Sci Nutr 2007;58(6):429–36.
27. Tsai WY, Chang WH, Chen CH, Lu FJ. Enchancing effect of patented whey protein isolate (Immunocal) on cytotoxicity of an anticancer drug. Nutr Cancer 2000;38(2):200–8.
28. Dietary Reference Intakes for Energy, Carbohydrate. Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (2002/2005). National Academy of Sciences. Institute of Medicine. Food and Nutrition Board. This report may be accessed via www.nap.edu.
29. National Collaborating Centre for Women’s and Children’s Health (UK). Antenatal Care: Routine Care for the Healthy Pregnant Woman. NICE Clinical Guidelines, No. 62. London: RCOG Press; March 2008:108–109.
30. Custódio Afonso Rocha V, Ramos de Arvelos L, Pereira Felix G, et al. Evolution of nutritional, hematologic and biochemical changes in obese women during 8 weeks after Roux-en-Y gastric bypasss. Nutr Hosp. 2012 Aug;27(4):1134–40.
31. Faria SL, Faria OP, Buffington C, de Almeida Cardeal M, Ito MK. Dietary protein intake and bariatric surgery patients: a review. Obes Surg. 2011 Nov;21(11):1798-805.
32. Moizé V, Andreu A, Rodríguez L, et al. Protein intake and lean tissue mass retention following bariatric surgery. Clin Nutr. 2012 Nov 14. pii: S0261-5614(12)00239–7.
33. Andreu A, Moizé V, Rodríguez L, Flores L, Vidal J. Protein intake, body composition, and protein status following bariatric surgery. Obes Surg. 2010 Nov;20(11):1509–15.
34. Encinosa WE, Bernard DM, Chen CC, Steiner CA. Healthcare utilization and outcomes after bariatric surgery. Med Care. 2006 Aug;44(8):706–12.
35. Dubois L, Farmer AP, Girard M, Peterson K. Preschool children’s eating behaviours are related to dietary adequacy and body weight. Eur J Clin Nutr. 2007 Jul;61(7):846–55.
36. Sources of Protein among US Children & Adolescents, 2005–06. Risk Factor Monitoring and Methods Branch Web site. Applied Research Program. National Cancer Institute. Updated December 21, 2010. Accessed December 10, 2012 from http://riskfactor.cancer. gov/diet/foodsources/protein/.
37. Fulgoni VL 3rd. Current protein intake in America: analysis of the National Health and Nutrition Examination Survey, 2003-2004. Am J Clin Nutr. 2008 May;87(5):1554S–7S.
38. Wolfe RR. The role of dietary protein in optimizing muscle mass, function and health outcomes in older individuals. Br J Nutr. 2012 Aug;108 Suppl 2:S88–93.
39. Fulgoni VL 3rd. Current protein intake in America: analysis of the National Health and Nutrition Examination Survey, 2003-2004. Am J Clin Nutr. 2008 May;87(5):1554S–7S.

Inflammation is a useful natural reaction that the body has in response to injury and certain other conditions. Chronic inflammation, however, can be more destructive than beneficial. Indeed, when we hear the word inflammation, we tend to associate with conditions like arthritis and other more serious issues. Nevertheless, there are many common causes of inflammation that are not associated with disease states. These include eating diets high in certain inflammation-promoting foods (e.g., polyunsaturated fats, simple carbohydrates— especially refined sugars¹, common allergens like casein and gluten²), being in colder temperatures³, experiencing menopause (with hormone fluctuations)⁴, experiencing psychological stress⁵ and exposure to environmental toxins.⁶

Ramifications Of Inflammation
That being said, there can still be ramifications associated with common, non-disease types of inflammation, even low-grade systemic inflammation. Examples include but are not limited to everyday aches and pains, alterations in digestion and absorption⁷, behavioral changes⁸, minor disruption in microcirculation and blood flow over the course of the aging process⁹, and a minor negative impact on immune health.¹⁰ In addition, obesity is associated with inflammation.

Specifically, overweight and obese children and adults have elevated serum levels of C-Reactive Protein and other known markers of inflammation. This is not to say that inflammation causes obesity, but rather the reverse: obesity causes low-grade systemic inflammation. While obesity is commonly thought of as adipose tissue, it is also associated with fat storage in other tissues—including the liver and skeletal muscle. This may lead to insulin resistance and may also stimulate inflammation. Obesity also changes the type of chemicals that our fat cells secrete, which may include the secretion of several pro-inflammatory mediators.¹¹ Since chronic inflammation is closely associated with cardiovascular risk factors, including cardiovascular and non-cardiovascular causes of death, this may help explain the increased risk of diabetes, heart disease, and many other chronic diseases in the obese.¹²

Anti-Inflammatory Nutraceuticals
One of the strategies to help decrease inflammation is the use of anti-inflammatory nutraceuticals—and there are many from which to choose. Following is a discussion of some of my favorite anti-inflammatory nutraceuticals, which includes resveratrol, grape seed extract, calcium fructoborate, turmeric (curcumin) and ginger.

Resveratrol
Resveratrol (RSV), a natural substance found in grapes, peanuts and Japanese Knotweed (Polygonum cuspidatum), made a big splash when it was introduced into the dietary supplement market because it was considered to contribute to the “French paradox,” the unexpectedly low rate of death from cardiovascular disease in the Mediterranean population, despite a diet that is relatively high in saturated fat. Since then research has demonstrated other benefits for RSV, among them its effectiveness as an anti-inflammatory agent. This was seen in a randomized, placebo-controlled study¹³ investigating the effectiveness of 40 mg RSV or placebo daily (for six weeks) on oxidative and inflammatory stress in normal subjects. The results were that RSV significantly reduced oxidative stress (P < 0.05) and also significantly suppressed levels of several inflammatory markers, including TNF-alpha, IL-6, and C-Reactive Protein (P <). There was no change in these indices in the control group given placebo.

Grape Seed Extract And Resveratrol
Grape seed extract contains phenolic compounds known as oligomeric proanthocyanidins (OPC). These OPC have significant antioxidant properties.¹⁴ In addition, they also appear to have significant anti-inflammatory properties—at least when combined with RSV. In a triple-blind, randomized, placebo-controlled, one-year follow-up, 3-arm pilot clinical trial¹⁵, 75 stable–coronary artery disease (CAD) patients received a combination of grape seed phenolics (i.e. OPC) and RSV, grape seed extract alone, or a placebo. The daily doses of the combination were as follows: 139 mg of grape seed OPC for the first six months, and then doubled for the following six months, which would require about 293 mg (a grape seed extract providing 95 percent OPC, 146.32 mg is required to yield 139 mg OPC); RSV was eight mg and 16 mg for the first six months and the remaining six months, respectively. The daily dose of grape seed OPC alone was 151 mg during six months, and then doubled for the following six months. The results showed that after one year, in contrast to the placebo and grape seed extract only groups, the combination group showed an increase of the antiinflammatory serum adiponectin (9.6 percent, p = 0.01).

In addition, in the combination group six key inflammation factors were significantly improved (p < 0.05) without any adverse effects.

Using the same dosage strategy and group types as in the last study, a randomized placebo-controlled, triple-blind, dose–response, 1-year follow-up study¹⁶ with three parallel arms was conducted in 35 in hypertensive male patients with type 2 diabetes mellitus (T2DM). Results showed that after 12 months there was a significant reduction in levels of the inflammatory markers ALP (p = 0.02) and IL-6 (p = 0.00) in the combination group. In addition, the production of proinflammatory cytokines was also reduced significantly.

Calcium Fructoborate
Calcium fructoborate (CF) is a form of the mineral boron, known for its role in bone health—but it is also good for joints and inflammation. A double-blind, placebo-controlled study¹⁷ examined the effect of 108 mg CF twice a day in patients with knee osteoarthritis (OA). Results showed that in the CF group, pain scores at Day seven dropped to 82 percent of the Day one value (from 74.0 to 59.9, p<0.05). By Day 14, the pain score reduced to 71 percent of the baseline (from 74.4 to 52.2, p<0.01). In contrast, there was no significant reduction in pain scores in the placebo group on either Day seven or Day 14. Other measures of pain were also significantly reduced (p< 0.05) on Day seven and Day 14 (p< 0.01). In addition, blood level of C-Reactive Protein were reduced up to 37 percent compared to Day one baseline levels in 79 percent of subjects. Interestingly, the study also showed that blood level of vitamin D was increased more than 19 percent compared to baseline, but not in the placebo group. The CF was well tolerated by all study subjects with no reports of adverse effect.

Calcium Fructoborate And Resveratrol
A 60-day, randomized, double-blinded, active-controlled, parallel clinical trial¹⁸ was conducted in three groups of subjects to evaluate the effects of oral supplementation with CF (112 mg/day), RSV (20 mg/day), and their combination (RSV – 20 mg/day + CF – 112 mg/day) for 60 days on the clinical and biological statuses of patients with stable angina pectoris. Of the total number of subjects included in study (n = 166), 87 completed the test treatment study period and 29 followed in parallel their usual medical care and treatment. Results showed that there was a significant decrease of high-sensitivity C-Reactive Protein in all groups at the 30-day and 60-day visits. At 60 days, this decrease was greater for CF (39.7 percent), followed by RSV + CF (30.3 percent). Markers for congestive heart failure were significantly lowered by RSV (59.7 percent) and by CF (52.6 percent). However, their combination induced a decrease of 65.5 percent. The improvement in the quality of life was best observed for subjects who received the RSV + CF mixture.

Turmeric (Curcumin)
Turmeric, a member of the ginger family, has been used as a traditional remedy in Chinese and Ayurvedic medicine as well as for condiment and flavoring purposes for over 2,000 years, based on records dating back to 600 BCE.¹⁹ Its primary active constituent is the flavonoid curcumin (diferuloylmethane), which is responsible for the plant’s yellow color and the compound providing most of its medicinal qualities.^20,21 Certainly, research has demonstrated that the curcumin molecules inhibit 5-lipoxygenase (LOX) and cyclooxygenase (COX), resulting in a well-established anti-inflammatory action.^22,23,24 This ability to help relieve common, everyday inflammation has been demonstrated in a significant number of published human clinical studies on curcumin.^{25,26,27,28,29,30,31,32,33,34,35}

Ginger
Although it’s probably more known for its anti-nausea properties (i.e., treatment of motion sickness and morning sickness), Ginger is also an effective anti-inflammatory herb that has historically been used for arthritis and rheumatism. In a study of patients with rheumatoid arthritis, osteoarthritis and muscular discomfort, the majority experienced (to varying degrees) relief of pain and swelling. None of the patients reported adverse effects during the period of ginger consumption, which ranged from three months to 2.5 years.³⁶

Another double-blind trial found ginger extract to be more effective than placebo at relieving pain in people with OA of the hip or knee.³⁷ Likewise, in another doubleblind study ginger was significantly more effective than a placebo in pain relief and overall improvement.³⁸ Ginger is considered to exert its anti-inflammatory activity by inhibiting COX-2 and lipoxygenase pathways.³⁹

Conclusion
Inflammation may be present in disease or non-disease states. In either case, resveratrol, grape seed extract, calcium fructoborate, turmeric (curcumin) and ginger may be helpful in reducing markers of inflammation, reducing pain, and improving other parameters of health.

References:

1. Lopez-Garcia E, Schulze MB, Fung TT, Meigs JB, Rifai N, Manson JE, Hu FB. Major dietary patterns are related to plasma concentrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr 2004;80(4):1029–35.
2. Caputo I, Lepretti M, Martucciello S, Esposito C. Enzymatic strategies to detoxify gluten: implications for celiac disease. Enzyme Res 2010 Oct 7;2010:174354.
3. Halonen JI, Zanobetti A, Sparrow D, Vokonas PS, Schwartz J. Associations between outdoor temperature and markers of inflammation: a cohort study. Environmental Health 2010;9:42.
4. Abu-Taha M, Rius C, Hermenegildo C, Noguera I, Cerda-Nicolas JM, Issekutz AC, Jose PJ, Cortijo J, Morcillo EJ, Sanz MJ. Menopause and ovariectomy cause a low grade of systemic inflammation that may be prevented by chronic treatment with low doses of estrogen or losartan. J Immunol. 2009 Jul 15;183(2):1393– 402. Epub 2009 Jun 24.
5. Black PH, Garbutt LD. Stress, inflammation and cardiovascular disease. J Psychosom Res 2002;52(1):1–23.
6. Watkins BA, Hannon K, Ferruzzi M, Li Y. Dietary PUFA and flavonoids as deterrents for environmental pollutants. J Nutr Biochem 2007;18(3):196 –205.
7. Peuhkuri K, Vapaatalo H, Korpela R. Even low-grade inflammation impacts on small intestinal function. World J Gastroenterol 2010;16(9):1057– 62.
8. Teeling JL, Felton LM, Deacon RMJ, Cunningham C, Rawlins JNP, Perry VH. Sub-pyrogenic systemic inflammation impacts on brain and behavior, independent of cytokines. Brain, Behavior, and Immunity 2007;21(6):836–850.
9. Payne GW. Effect of Inflammation on the Aging Microcirculation: Impact on Skeletal Muscle Blood Flow Control. Microcirculation 2006;13(4):343–52.
10. Ader R. Psychoneuroimmunology, Volume 1, 4th Ed. Elsevier Science & Technology Books; 2006:438.
11. Stienstra R, Duval C, Müller M, Kersten S. PPARs, Obesity, and Inflammation. PPAR Res. 2007;2007:95974.
12. Das UN. Is obesity an inflammatory condition? Nutrition. 2001 Nov-Dec;17(11-12):953–66.
13. Ghanim H, Sia CL, Abuaysheh S, Korzeniewski K, Patnaik P, Marumganti A, Chaudhuri A, Dandona P. An anti-inflammatory and reactive oxygen species suppressive effects of an extract of Polygonum cuspidatum containing resveratrol. J Clin Endocrinol Metab. 2010 Sep;95(9):E1–8.
14. Feringa HH, Laskey DA, Dickson JE, Coleman CI. The effect of grape seed extract on cardiovascular risk markers: a meta-analysis of randomized controlled trials. J Am Diet Assoc. 2011 Aug;111(8):1173–81.
15. Tomé-Carneiro J, Gonzálvez M, Larrosa M, Yáñez-Gascón MJ, García-Almagro FJ, Ruiz-Ros JA, Tomás-Barberán FA, García-Conesa MT, Espín JC. Grape resveratrol increases serum adiponectin and down regulates inflammatory genes in peripheral blood mononuclear cells: a triple-blind, placebo-controlled, one-year clinical trial in patients with stable coronary artery disease. Cardiovasc Drugs Ther. 2013 Feb;27(1):37–48.
16. Tomé-Carneiro J, Larrosa M, Yáñez-Gascón MJ, Dávalos A, Gil-Zamorano J, Gonzálvez M, García-Almagro FJ, Ruiz Ros JA, Tomás-Barberán FA, Espín JC, García-Conesa MT. One-year supplementation with a grape extract containing resveratrol modulates inflammatory-related microRNAs and cytokines expression in peripheral blood mononuclear cells of type 2 diabetes and hypertensive patients with coronary artery disease. Pharmacol Res. 2013 Jun;72:69–82.
17. Reyes-Izquierdo T, et al. Short-term Intake of Calcium Fructoborate Improves WOMAC and McGill Scores and Beneficially Modulates Biomarkers Associated with Knee Osteoarthritis: A Pilot Clinical Double-blinded Placebocontrolled Study. Am J Biomed Sci. 2012; doi: 10.5099.
18. Militaru C, Donoiu I, Craciun A, Scorei ID, Bulearca AM, Scorei RI. Oral resveratrol and calcium fructoborate supplementation in subjects with stable angina pectoris: effects on lipid profiles, inflammation markers, and quality of life. Nutrition. 2013 Jan;29(1):178–83.
19. Curcuma longa (turmeric). Monograph. Altern Med Rev 2001;6 Suppl:S62–6.
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21. Curcuma longa (turmeric). Monograph. Altern Med Rev 2001;6 Suppl:S62-6.
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23. Arora R, Basu N, Kapoor V, et al. Anti-inflammatory studies on Curcuma longa (turmeric). Ind J Med Res 1971;59:1289–95.
24. Mukhopadhyay A, Basu N, Ghatak N, et al. Antiinflammatory and irritant activities of curcumin analogues in rats. Agents Actions 1982; 12:508–15.
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27. Kulkarni RR, Patki PS, Jog VP, et al. Treatment of osteoarthritis with a herbomineral formulation: a doubleblind, placebo controlled, cross-over study. J Ethnopharmacol 1991;33:91–5.
28. Lal B, Kapoor AK, Asthana OP, et al. Efficacy of curcumin in the management of chronic anterior uveitis. Phytother Res 1999;13:318–22.
29. Mombaerts I , Goldschmeding R, Schlingemann RO, Koornneef L. What is orbital pseudotumour? Surv Ophthalmol 1996;41:66–78.
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31. Prucksunand C, Indrasukhsri B, Leethochawalit M, Hungspreugs K. Phase II clinical trial on effect of the long turmeric (Curcuma longa Linn) on healing of peptic ulcer. Southeast Asian J Trop Med Public Health 2001;32:208–15.
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38. Altman RD, Marcussen KC. Effects of a ginger extract on knee pain in patients with osteoarthritis. Arthritis Rheum 2001; 44:2531– 8.
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Arthritis is a real pain in the joints — and nearly 30 million Americans have to deal with it.

Twenty-seven million of us deal with pain and stiffness from the wear-and-tear of osteoarthritis, where the cartilage that covers and cushions the ends of your bones becomes thin or disappears, and your bones rub together and hurt.

Another 2.5 million endure the red, hot, swollen and painful joints of rheumatoid arthritis, which is an autoimmune disease that causes your immune system to mistakenly identify your cartilage and bones as foreign invaders (like viruses)— and attack them.

Arthritis isn’t an “equal opportunity annoyer.” It picks on seniors (65 percent of people over 65 have osteoarthritis) and on women (seven out of ten people with rheumatoid arthritis). With so many folks afflicted, you’d think modern medicine would offer some good, safe solutions for arthritis pain. Think again.

The most common class of pain-relieving drugs—nonsteroidal anti-inflammatory drugs (NSAIDs)—hospitalizes more than 100,000 Americans a year from bleeding ulcers, and kills more than 16,500!

Adding joint insult to digestive injury, NSAIDs don’t slow the progression of arthritis—and may even speed it up! The best advice? Take steps to optimize joint health, so you can minimize the chances of developing joint problems in the first place. And there are three easy ways to do just that.

Joint-Optimizer #1: Feed Your Joints

There are several nutrients and natural compounds that are uniquely effective for promoting healthy joints.

Glucosamine Sulfate: Feeding Your Cartilage
Glucosamine is a component of cartilage. When you take a glucosamine-containing supplement, the compound is incorporated into your cartilage molecules, which helps repair joints and reduce the pain that can result from overuse. I recommend the sulfate form (not glucosamine hydrochloride), because sulfate also promotes healthy joint function. The standard dose is 750 milligrams, two times daily, taken with or without food. After six months, you may find that you don’t need to take the supplement daily; at that point, you may choose to take it only when your joints feel like they need help.

Chondroitin Sulfate: More Cartilage Support
This compound also helps create, maintain and repair cartilage. One downside is that only 10 percent is absorbed. To improve absorption, use the “low molecular weight” form of chondroitin. (Look for those words on the label.) The standard dose is 400 mg three times daily, or 1,200 in a single dose.

MSM: Sulfur, a Surprisingly Important Nutrient
MSM is an abbreviation for methylsulfonylmethane, a sulfurcontaining compound that gives your proteins a key building block needed for tissue repair. Research show that MSM, chondroitin and glucosamine work well together. It is reasonable to take all three of these daily for the first six to twelve weeks after you begin the regimen. This will lay a solid nutritional foundation The best advice? Take steps to optimize joint health, so you can minimize the chances of developing joint problems in the first place from which you can begin to maintain healthy joint function. After that, you can scale back to a lower dose.

For Nutritional Insurance, Take a Good General-Purpose Supplement
Dozens of other nutrients are also helpful to promoting healthy joint function—like B vitamins, vitamin C, vitamin E, boron and zinc.)

Joint-Optimizer #2: Balance Immune Function

Curcumin and boswellia are two herbs that are particularly good at promoting a healthy and balanced immune system.

These can be found in a number of good herbal mixes. Both curcumin and boswellia are provided in the supplement Healthy Knees and Joints. Another excellent product that contains a highly absorbable form of curcumin is Curamin. Yet another herbal formula, End Pain, contains boswellia and willow bark (the herbal granddaddy of aspirin). The End Pain can be taken along with either the Curamin or Healthy Knees and Joints. Allow six weeks to see the full effect. You’ll be glad you did!

Another powerful immune regulator is fish oil. You can eat fatty fish like salmon, sardines, trout or mackerel a few times a week, or take a fish oil supplement.

Joint-Optimizer #3: Use Them or Lose Them

If you want to maintain flexible, healthy joints, you need to use them the way nature intended. Namely, you need to MOVE them! I suggest exercising at least 20 minutes daily. Go for a walk outdoors (also great for boosting levels of vitamin D, which supports healthy muscles and joints). Swim or exercise in a heated pool (the buoyancy and warmth make this an ideal exercise for joints that need a helping hand). Yoga, tai chi or any other form of stretching are also good.

Important: Pain is your body’s way of saying, “Don’t do that!” So if you feel unusual pain while exercising, STOP and DON’T try to push through it.

Heat and Stretch
A great way to improve flexibility: use a heating pad or any other kind of moist heat for five to fifteen minutes on an affected joint, then slowly and gently move the bothered joint, gradually reclaiming your full range of motion.

For joints in your hands, try the herbal-filled “bean bags” you can heat up in the microwave, putting them on your hands. After five to fifteen minutes, gently stretch your fingers.

How many times have you heard —"I can't exercise today because I hurt my?" ( Take your pick of back, neck, knee, shoulder, hip.) These are all valid reasons because we certainly don't want to exercise and injure ourselves further, right? Well, yes and no. When an injury to a joint becomes chronic, often the body itself will limit the joint's motion even after the initial injury has healed.

For example, let's say you injured your lower back last year. Ever since then, you have been unable to bend down to tie your shoes without pain. It's gotten to the point that you'd rather wear slip-on shoes than lace-ups to avoid feeling the back pain. Your initial injury and inflammation is long-gone yet you continue to suffer the consequences.

Wouldn't it be wonderful to simply "re-boot" ourselves like we can our computers?

Well, essentially we can by re-training, not the joint itself, but the Central Nervous System (CNS).

The Active Therapeutic Movements2 (ATM2) is an innovative, non-invasive device that helps low back, neck, hip, knee, and shoulder pain. This protocol utilizes an upright table that is modified to allow pain free active movement.

A key factor in the ATM2's success rate is it produces a pain-free range of motion, which "re-boots" our CNS. A good analogy for explaining how the ATM2 is able to give lasting, significant pain relief so quickly is to compare the CNS to a computer. When a computer goes "haywire" a quick fix is to simply re-boot the system. The same is true with the CNS and a painful joint. This ATM2 device essentially "clears the slate" and the body starts functioning normally again.

How Does the ATM2 Work? By affecting the Central Nervous System (CNS), the ATM2 retrains the muscles to function normally. When there is pain, the CNS tries to protect the area by restricting motion and altering the neuromuscular activation strategy. Normally, the body has a built-in ability to perform good quality, low-energy/ high-efficient movements. This simply means that normally we are able to freely move our limbs through a full range of motion. We don't even have to think about it...we just do it. But in the case of pain, our body, which is governed by the CNS, will change its neuromuscular activation strategy to a highenergy/ low-efficient movement. This causes the body to impair its movements long after the initial injury that produced the pain. The ATM2 changes that by allowing the body to "re-boot" itself. Essentially, educating the CNS and therefore the body, to move normally again.

Will I Feel Any Pain While on the ATM2?
No, that's the beauty of this protocol. The ATM2 energizes our CNS and allows our muscles to move normally again. The body learns that it can move through the point of motion that previously provoked pain.

How Long is a Typical ATM2 Session?
The typical session only takes 5-10 minutes out of your day. An examination is performed prior to your first session to rule out underlying pathologies. The number of sessions required to provide lasting relief is determined at that time.

How Soon Can I Expect Pain Relief?
The majority of patients experience 50-100 percent pain relief plus increased range-of-motion during their first session. I Have Chronic Knee Pain; Can the ATM2 Help Me Avoid Surgery? No one wants to have surgery if it can be avoided. The ATM2 is a safe, effective alternative for many knee pain sufferers.

Can the ATM2 Help My Golf Game?
World Long Drive champion, Gerry James, experienced an immediate 25 degree increase in his rotational range-of-motion upon his first session on the ATM2. His response was, "Wow… this will definitely increase my drive distance." He added, "For a person that trains six days a week and is at the peak of his performance, this is truly amazing. Can you imagine how this will effect non-professional players?"

To learn more about the ATM2, visit http://www.atm2fl.com or call Lanzisera Center at 813.253.2333. Dr. Frank Lanzisera, the director of Lanzisera Center in Tampa, Florida, is a chiropractic physician who regularly appears on the nationally televised NBC Daytime show.

Sugars are hiding out almost everywhere we turn, white flour and cornmeal-based products, bread, cereal, baked goodies, corn chips, etc.—line our grocery shelves. We are taught from childhood (through our trusted Food Pyramids) that if we want to experience “true health” we should consume anywhere from 6–11 servings of foods like bread, cereal, rice, and pasta.¹ The question is, have we been duped?

Well when you consider that the majority of us were never designed to eat the types and amounts of carbohydrates we have become accustom to since the advent of agriculture, approximately 8000 years ago², then the answer becomes a resounding YES!

Significant anthropological data suggests that our Paleolithic ancestors—which happened to be a lot healthier than we are today—ate a diet consisting of anywhere from: 19–35 percent protein, 22–40 percent carbohydrates and 28–47 percent fats3. And since we humans haven’t changed (biochemically) in over 40,000 years³, I would suggest that these same principles that governed our ancestor’s biochemistry still govern ours.

In today’s day and age, we seem to eat as many of the wrong types (I’ll get to that in a minute) of carbohydrates as possible. The majority of North Americans consume more than 50 percent of their dietary intake in the form of highly processed and nutrient void carbohydrates⁴ (like commercial breads, cereals and pasta)—the same ones responsible for robbing us of our health.⁵

Carbohydrates come almost exclusively from plant sources, including grains, vegetables, and fruits. In highly processed forms, carbohydrates become white flour, white sugar, corn flour, and syrups, which are used to make the breads, pastas, cookies, and sweets we love so much. We often hear people talk about simple carbs and complex carbs, but do they really understand the difference between them as well as which ones to avoid?

• Complex carbohydrates are referred to as polysaccharides (long chains of sugar molecules bonded together) and are found in foods like fruits, vegetables, legumes (peas and beans), and grains (bread, pasta and rice). Some complex carbohydrates are also referred to as dietary starches. These are mostly from the grain family (including cereals, breads, pasta, oats, wheat, rice and corn), but are also found in some vegetables like potatoes and legumes. The complex carbohydrates from the fruit and vegetable kingdom were the ones that made up the majority of carbohydrates consumed by our ancestors.
• Simple carbohydrates are just that, the simplest form carbohydrates come in. These are found as either single sugar molecules referred to as monosaccharides, (i.e. glucose, fructose or galactose) naturally occurring sugars found in most fruits, honey and milk, or double sugar molecules referred to as disaccharides (i.e. sucrose, maltose and lactose). The majority of disaccharides come from man-made processed sugars and should be avoided at all costs.

Do we actually need them?
Even though I believe that to perform at peak efficiency—and to ensure the body has a sufficient supply of phytonutrient antioxidant protection—we should never be without an ample amount of vegetables (and some fruits), the truth is that the human body does not necessarily need carbohydrates to survive.

This is due to a well-known biochemical process we have evolved with called gluconeogenesis, which refers to the creation of carbohydrates (glucose) from other noncarbohydrate sources like protein and fatty acids). Perhaps this is one of the reasons the National Research Council has never established an RDA (Recommended Daily Amount) for carbohydrates.

Every organ—with the exception of your brain at certain times—and every muscle in your body can operate at peak efficiency on by-products of fat metabolism called ketones.⁶ When the body does not have enough glucose, it is forced to use body fat for the majority of its energy needs and ketones are produced to fuel the body during these times. This is one of the ways in which low-carb diets propel fat loss, by forcing the body to use its own fat reserves for fuel. Research shows that once blood sugar levels are lowered for approximately three days, the brain will get at least 25 percent of its energy from ketones⁷ and this number will go up substantially if the body is deprived further of sugars.

It is important to understand that your body can use only a set amount of glucose to generate immediate fuel. When it can’t use sugars from dietary carbs immediately, the body stores them for future use in the form of long chains of glucose molecules called glycogen. The body’s glycogen containers are found in two areas: the liver and the muscles. The glycogen stored in the muscles is used as energy for the body but is virtually unavailable to the brain. Only the glycogen stored in the liver is accessible—through the bloodstream—as a backup source of brain food.

Whether you are lean or clinically obese, you only have the ability to store 300 to 400 grams of carbohydrate as muscle glycogen and another 90–110 grams as liver glycogen—the equivalent of about two cups of pasta or a couple of candy bars.⁸ Liver glycogen is so limited, that it can easily be used up within ten to twelve hours of normal activity. But during strenuous athletic activity it can be depleted as much as 3–4 times that of regular activity. The average bloodstream of a non-diabetic human has no more than one tablespoon of glucose at any given time.

Carbs and Body Fat

In today’s world, the average non-athlete consumes more carbohydrate energy then their body’s can either burn or store as short term energy—glycogen. We live in a society where the average citizen consumes 156 pounds of sugar per year⁹, which is the equivalent to approximately half a pound per day, and the Centers for Disease Control presented a paper showing that sugars equate to an extra 440 calories per day¹⁰—yikes! By over consuming carbs, we ensure that our liver and muscle glycogen tanks are always full. This would be a good thing if you were an athlete who needs full glycogen reserves, but for an average person it can spell disaster.

Any ingested sugars over and above what the body can use immediately or store as glycogen are converted into fatty acids—and eventually stored within your 30 billion fat cells— with the aid of the metabolic hormone insulin.¹¹

Insulin is secreted from our pancreas after we eat and following periods of elevated blood sugar. Under optimal conditions (i.e. the caveman diet), insulin is the body’s friend. It deposits extra blood sugar (glucose), along with amino acids (protein), in muscle so that we can move and function. It also synthesizes chemical proteins for building enzymes, hormones, and muscle.¹²

Insulin, however, is especially sensitive to dietary carbohydrates, which are metabolized quickly into sugar. When insulin is stimulated in great quantities—as in a processed carbohydrate meal—it stimulates a powerful enzyme called lipoprotein lipase or LPL, which promotes fat storage and also prevents fat from being released from the fat cells.¹³ Understanding that high insulin levels equate to excess body fat, can give you the knowledge to keep your 30 billion fat cells from growing exponentially.

So in order to free up the fat so that it can be burned in the muscle cells, you’ve got to lower your insulin levels. We can do that by exercising properly and eating in harmony with our genetic structure—in other words, by eating like our prehistoric ancestors.

References:
1. America: Drowning in Sugar” Experts Call for Food Labels to Disclose Added Sugars. Center For Science in The Public Interest issue date (1999).
2. Eaton, S.B, et al. “An Evolutionary Perspective Enhances Understanding of Human Nutritional Requirements.” J of Nutrition 126 (1996): 1732–40.
3. Cordain L, et al. J. Plant-animal subsistence ratios and macronutrient energy estimations in worldwide hunter-gatherer diets. Am J Clin Nutr 2000; 71: 682–92.
4. Simin L. Intake of Refined Carbohydrates and Whole Grain Foods in Relation to Risk of Type 2 Diabetes Mellitus and Coronary Heart Disease. J Am Coll Nutr August 2002 vol. 21 no. 4 298-306
5. Yudkin, J. “Evolutionary and Historical Changes in Dietary Carbohydrates.” Am J Clin Nutr 20, No. 2 (1967): 108–15.
6. King, MW. Oxidation of Fatty Acids. themedicalbiochemistrypage.org, LLC. 2013
7. Hasselbalch, SG, et al. “Brain metabolism during short-term starvation in humans. Journal of Cerebral Blood Flow and Metabolism (1994) 14 (1): 125–31.
8. Felig, P, Wahren, J. Fuel homeostasis in exercise. N Engl J Med 293(21): 1078-84, 1975.
9. Well FA, Buzby JC. Dietary Assessment of Major Trends in U.S. Food Consumption, 1970-2005. United States Department of Agriculture. Economic Information Bulletin No. (EIB-33) 27 pp, March 2008
10. Ervin RB, et al. Consumption of Added Sugar Among U.S. Children and Adolescents, 2005–2008. Centers for Disease Control and Prevention. Number 87, February 2012
11. King, B.J. Fat Wars: 45 days to Transform Your Body. Toronto: Macmillan, 2002.
12. Patterson, C.R. Essentials of Biochemistry. London: Pittman, 1983.
13. Taskinen, M.R., and E. Nikkila. “Lipoprotein Lipase of Adipose Tissue and Skeletal Muscle in Human Obesity” Metabolism 30 (1981): 810–17.

How many people like to exercise?

How many people are not so crazy about it?

How many people don’t have any time…

If you were Christopher Reeve…

No one can find more time

The questions:

1. Do you believe this is something you have to do?
2. What do you think it has to be?
3. How many people think you have to join a gym?
4. Your Paleolithic ancestors—did not go to a gym
5. How many people think you “need” motivation?

What you CAN do to exercise

Simple solutions:

• Park further from the mall
• Walk around the block once before dinner
• Climb the stairs—get off the elevator one flight early
• Get off the train or bus one stop early
• Walk for your errands
• Do some wall pushups
• Pick a group of exercises and do one at a time
• Water bottles
• Rent a video and do 15 minutes of it
• Don’t use the remote
• Find ten minute workouts
• Dance: free dance Tom Cruise risky business

With dedicated practice one can expect a longer, leaner looking physique, increased energy and stamina and fewer aches and pains from the stresses of everyday life.

Pilates has become a household word, often with creative spellings and pronunciations. No longer an exercise program reserved for the physically elite or financially flush, the Pilates Method is finding its way into people's homes, becoming a regular practice with lasting results. In the 1990s and into 2000 we have seen an incredible trend towards mind/body-based exercise. In the '80s we found our energy and power. In the '90s we learned how to harness it.

Pilates is in no way a new approach to physical fitness. The Pilates Method of body conditioning was developed by German-born Joseph H. Pilates more than 70 years ago. Originally developed for the rehabilitation of bed-bound soldiers during WWI, the work was then adopted by the dance and performing community of New York, where Pilates immigrated to after the war. For many years Pilates training remained a well-kept secret in the world of dance and the performing arts.

The Pilates Method is comprised of more than 500 exercises developed by Joseph Pilates. These exercises are performed on an exercise mat or by using special resistance equipment that emphasizes spring resistance. The central concept of Pilates training is strengthening the so-called "powerhouse" or core of the body-the deep abdominal muscles, buttock muscles and the muscles around the spine. A training program based on Pilates will stabilize the pelvis and shoulder girdle, stretching and strengthening the entire body with movement initiating from "the center."

The Pilates Method is a mind/body approach to fitness and like yoga, requires concentration, focus, practice and patience. The results are well worth the commitment. As a beginner to Pilates, the learning curve can be slow moving and steep to begin with but no work is wasted. As one's mind/muscle connections are developed and the understanding of how the breath and muscle contractions work in a synergistic manner, one's body strength increases and movements that were once thought impossible become a graceful series of power-packed exercises.

Joseph Pilates formulated six basic principles for his exercise technique:

1. Breathing-The pattern of breathing is connected with the pattern of movement. The use of the breath in this manner plays an integral part of the work. As a beginner, the breath is often overlooked because there is so much to think about. The instructor will always bring the student back to the breath with the knowledge that breath is the key to mastering the work.
2. Precision-The method emphasizes quality of movement over quantity. I have had clients comment time and again how the work actually becomes oddly more difficult as they get better at it. As their skill and precision increase, the truth behind "less is more" becomes evident.
3. Centering-Centering refers to the practice of initiating and controlling movement from the center core or "powerhouse"-abs, buttocks and back muscles. This concept lies at the heart of Pilates' work.
4. Flowing Movement-In combination the breath, the challenge of performing flowing movements while maintaining core stabilization, is where the beauty of the work really shines through as you get stronger from the center out, your movement through space becomes more graceful and filled with ease. This proves extremely beneficial whether you are a mother or an extreme athlete.
5. Control-Control and focus are vital to this work. Momentum is kept in check at all times. Through control, we work to correct old patterns of movement that may be unhealthy or hinder you in some way. This is largely where the mind part of body/mind resides.
6. Concentration-This is directly related to control and focus. It is through concentration that one masters the control and focus to truly benefit from the work. The mind and the bodywork together as team. Every exercise requires your full attention. Observe your body as it works; think about each stage of the movement.

Once Joseph Pilates immigrated to the U.S. he developed the mat version of Pilates to accompany his equipment-based program. This mat variation developed into an important component of the Pilates method and is the most appropriate place to begin one's Pilates practice. The floor work introduces the body to the key movements and breath patterns that are always used for Pilates.

These would include:

• Neutral Pelvis-This is a position where the hipbones and pubic bone are in the same plane, which helps to correct many postural imbalances that exist today.
• C-Curve and spinal articulation-These movements help to free up tight back muscles and poor posture patterns.
• Back muscle engagement-By learning to contract the large back muscles, called the latissimus dorsi (otherwise known as the "lats"), and relax the shoulder muscles, you are able to counteract the common hunched or rounded shoulder posture that is so prevalent today.
• Abdominal muscle engagement-Making this connection can be one of the hardest elements of this work. By creating the mind/muscle connection with the abs, you develop the ability to actively, and subconsciously, use your abs for better support, stabilization and power-meaning flatter tummies, less injuries and better functionality in all activities.
• Breath-Without it we die and with it used to its full capacity, we grow-stronger, longer, leaner.

There are 34 standard Pilates mat exercises created by Joseph Pilates. They are all important for various reasons, to challenge the body's musculature in different ways. As Pilates hits the mainstream and our knowledge about physiology increases, these exercises have been adapted to include different tools such as a Pilates circle, a resistance band and large fitness balls.

What does this mean for the average Joe or Josephine on the street who wants to get stronger, increase flexibility and generally feel healthy and vital? Is Pilates something that can work for them too?

Absolutely! More than ever Pilates is becoming increasingly accessible to the general public. At one time the only way you could get exposed to Pilates was through private one-on-one instruction. While this is ultimately still the best way to practice Pilates, there have emerged a number of affordable, less time-consuming options in the form of group mat classes such as those available through workout chains like Gold's Gym. Also semi-private sessions that range from two to four students with one instructor, using different kinds of Pilates equipment. In addition easy-to-follow videos are available that range from the most beginner to very advanced. The videos have largely helped the general fitness person make the transition into Pilates with ease and comfort, combining some of the elements of familiar fitness tools such as the fitness ball or resistance band with the key principles of Pilates.

So what can you expect from making Pilates a regular part of your fitness regimen? A longer, leaner looking physique, increased energy and stamina and fewer aches and pains from the stresses of everyday life.

The concepts behind Joseph Pilates' approach to physical and mental fitness can be employed for all ages, shapes and fitness levels. Once one learns these they can be incorporated into everyday activities such as walking down the street or standing at a bus stop. And for the elite athlete, the improvements to their performance are tremendously rewarding.

Some frequently asked questions about The Pilates Method:

1. How is Pilates different from other exercise programs?
   Each exercise engages the core abdominal muscles, and the method emphasizes the strengthening of the "powerhouse" region-abdomen, back, lower back, inner/outer thighs and buttocks. Strength is achieved through stabilization, with a focus on movement and functionality. Pilates concentrates on lengthening, strengthening and toning the body, without adding bulk to the muscles.
2. Is Pilates done with machines only?
   No. Joseph Pilates designed the spring resistance machines in association with a matwork program, and one's complete workout includes exercises on a combination of the Reformer, Wunda Chair, High Chair, Ladder Barrel, Spine Corrector, Half Barrel, Cadillac and the mat. Now the work has expanded to include useful tools such as the fitness ball, resistance band and Pilates circle.
3. Why are there so few repetitions of each exercise?
   Less IS more! Each Pilates exercise has only 3, 5 or 10 repetitions. The exercises were designed to work the body with precision and effectiveness, making additional repetitions unnecessary.
4. Why is Pilates considered a mind/body-conditioning program?
   Pilates is a very intelligent form of body conditioning. One's mind is engaged throughout a specific program of exercises rather than wandering aimlessly during a workout of repetitive activity. When one focuses and concentrates on the body's movements, s/he is performing a complete mental and physical workout.
5. How soon after beginning Pilates will I see results?
   Although individual results will vary, most people feel better in just a few sessions. With consistent practice you will gain increased strength in your "powerhouse" and be well on your way to achieving true mental and physical fitness.
6. When I look at someone doing Pilates, it doesn't seem vigorous enough for me. Can Pilates give me a good workout?
   When most people first start Pilates, there's a lot of new information for the body to learn, so you probably won't get an aerobic workout at the beginning. Pilates can be aerobic at intermediate and advanced levels when the movement patterns become more familiar. Also, Pilates combines stretching and strengthening, using springs and your own body weight as resistance. That may appear easier than other forms of exercise, yet you actually work harder and more deeply through the muscles.
7. I have had many injuries and physical problems during my lifetime. Can Pilates help me?
   Yes, definitely. The Pilates Method of body conditioning has a long history of helping people with old and existing injuries. Both physical therapists and chiropractors have collaborated with Pilates instructors to help heal soft tissue injuries and recover from various physical problems.
8. How often do I want to do Pilates?
   Pilates is similar to other forms of exercise. You want to be sure you give your body enough time to recover when muscles are taxed. Twice a week when you are just starting is good, leaving at least two days between workouts. As you get stronger with consistent workouts, increase to three times a week with at least a day's rest. Remember to vary your exercises often, as the body adapts quickly.

While virtually everyone is aware of the benefits of aerobic exercise, there still seems to be a lot of confusion about the subject of weight training and its place in an overall wellness program. Maybe it’s some residual confusion left over from the “Pumping Iron” days when weight training was something done only by bodybuilders and the Muscle Beach crowd. Who knows. Whatever the reason, it’s time to put some of the myths about weight training to rest.

We now know that weight training, far from being just a vanity pursuit, is a critical part of health and wellness and that it can benefit anyone, regardless of sex or age. Weight training may be one of the most effective strategies you can take to prevent osteoporosis, and that’s equally true if you’re a man or a woman. Weight training increases bone mineral density, it improves glucose metabolism, it’s one of the most effective things you can do to increase HDL (the “good” cholesterol), it raises your metabolism (making it easier to lose fat) and it improves your ability to function in the world independently as you get older. All that, and it makes you look good in the bargain!

Dr. William Evans, director of the Nutrition, Exercise and Metabolism Laboratory at the Center of Aging at University of Arkansas Medical School has shown that the capacity to respond to strength training exercises is preserved into very late life. Dr. Evans studied nursing home residents over the age of 80 and found that with ten weeks of strength training exercises it was possible to triple and quadruple muscle strength and improve walking speed and balance. His subjects had a renewed ability to climb stairs, giving them much more mobility and independence, and they showed an increased interest in other activities. His oldest subject was 98! These studies led to community based training programs in Massachusetts and Pennsylvania to initiate exercise programs for older people.

With younger people, the goal of a strength training program is to create or preserve enough muscle to prevent the metabolism from slowing down, to strengthen the bones, and to give the body shape and tone. With an elderly population, one of the main goals is to develop sufficient muscular strength and endurance to allow for a more complete and independent life.

There are psychological benefits from strength training as well as physical. Many people report having a wonderful sense of mastery when they begin to feel their physical strength improve. And a good weight workout can trigger feel-good neurochemicals called endorphins which can help boost mood and self-esteem and make you feel a lot more balanced.

It’s not hard to start a strength training program. You don’t even need any equipment, although it’s nice to have. You can begin with a few homebased exercises like push-ups and squats, lunges and crunches. Detailed descriptions of how to perform these exercises are very easy to find in books like “Weight Training For Dummies” by Liz Neperonet, and on the Internet at sites like i-Village. You can also do some basic weight training exercises at home with a simple set of dumbbells. And if you do have access to a gym, so much the better, as there will be an endless variety of machines and equipment to choose from.

Remember that weight training is not necessarily about building “big” muscles. And the idea that it will make women’s muscles huge and bulky is a complete myth. For one thing, muscle mass is highly dependent on levels of testosterone, and men have a good 20–30 times the amount that women do, making it much harder for women to build big muscles despite what we see on the covers of the bodybuilding magazines. Two to three reasonably challenging workouts a week will not make anyone’s muscles huge, regardless of gender. What it will do is produce noticeable and measurable health benefits, and in the bargain make you look a lot better as well.

Beginners should start with light weights and higher repetitions (say anywhere from 12–20 per movement). Pick a few movements (exercises) to start with and limit your workout to these three or four. I suggest only one set per exercise movement in the beginning though after a few weeks of getting used to it, you can certainly increase to two sets of each exercise. Always warm up with something that gets your circulation going, like walking or light stretching or just moving around to your favorite music—after that, even a full body routine needn’t take more than a half hour. Most people will notice a nice little progression in strength and ability to do the exercises after as little as three or four weeks.

There is sometimes a little bit of muscle soreness the day after a workout, especially in the very beginning. Not to worry. This is usually attributed to lactic acid, but is most likely due to a number of other muscular “waste products” as well. Be sure to drink plenty of water to flush all the metabolic byproducts out of the system, and make sure to give your body what it needs to tone, repair and rebuild in the form of real food and pure water.

The soreness is usually temporary. The benefits of strength training to your health—and to your mood and your sense of well-being—are not.

For the past two decades, fitness experts have been telling us that to get the benefits of exercise you had to do aerobics. And you had to work out hard. There was even a way to calculate whether your exercise was hard enough to do any good: You were supposed to subtract your age from 220, exercise intensely enough to get your heart rate up to 70–85 percent of that number and keep it there for twenty minutes.

Lose Weight, Get Healthy, And Live Longer

Now it turns out that the advice we were given was very far from the whole picture. “Moderate exercise can really produce enormous gains for health,” says Harvey Simon, MD, associate professor of medicine at Harvard Medical School. Dr. Simon should know. He was one of the strongest advocates for the “more is better” philosophy that’s predominated in the fitness industry for the last twenty years. “I used to say that golf was the perfect way to ruin a four mile walk,” Dr. Simon says ruefully, “because it was only exercise at a moderate level, it didn’t bring your heart rate up and your walk is constantly interrupted. Then a study was published in the American Journal of Medicine that found men who simply added golf playing to their normal daily routine lost weight, lowered their girth and improved their cholesterol levels. That got me thinking.”

Dr. Simon began researching the literature and found that indeed moderate exercise had profound benefits. Then why had the experts touted heart-pounding heavy exercise for so long? “The problem had to do with what we call “end-points,” Dr. Simon said. “When you want to find out if something is working, you have to choose some specific end point to measure. So if, for example, you're investigating a new teaching technique for reading, you want to measure whether kids actually read better. That's the 'end-point.' The old studies on exercise were looking at the 'end point' of aerobic capacity—how much oxygen your lungs could hold and how efficiently your body used it, he explained. To improve that specific measure of fitness—called VO2 Max, indeed, harder aerobic exercise is needed. But when you look at the 'endpoint' of good health, a very different story emerges.

"I reviewed 22 studies, involving 320,000 people, that evaluated the impact of moderate exercise on cardiovascular disease and longevity," Dr. Simon said. "The results were eye-opening. Moderate exercise was credited with 18.84 percent reductions in the risk of heart disease and 18.50 percent reductions in overall mortality. If you look at breast cancer, colon cancer, depression, heart attacks, stroke, sudden cardio death, diabetes, obesity, hypertension, even dementia, exercise is extremely beneficial," said Dr. Simon, "and it doesn't take aerobic exercise as traditionally defined to achieve those benefits."

Dr. Simon, in his, The No Sweat Exercise Plan has come up with a term called "Cardiometabolic Exercise" to describe the kind of moderate exercise he's talking about. "My theory is that all physical activities anywhere on the spectrum can benefit the heart and can benefit metabolism—things like blood sugar and body fat," he said. In his book, Dr. Simon assigns points to various activities so that people can set a goal for how many points they need a week to achieve measurable health benefits. He calls these CME points (for Cardiometabolic Exercise). Dr. Simon recommends that you achieve 150 CME points per day or 1000 CME points per week to attain significant health benefits, but you can work up to that over the course of nine weeks starting with as little as 25 CME points per day. (See table on previous page of CME points for selected activities).

Walking is the core exercise in Dr. Simon's "No-Sweat Exercise Program" and it gets a table all it's own in the book. The number of CME points you get for walking depends on both your weight and on your speed, but typically a 160 pound individual would chalk up about 125 CME points for every 30 minutes of walking. "I'm not at all opposed to harder exercise," Dr. Simon said, "and if people want to earn their 1000 weekly CME points by doing hard aerobics or weight training or sports, that's just fine. The point of this is not that those exercises aren't valuable, but that much more moderate exercise confers great benefits as well."

Those benefits include 21.34 percent reduction in the risk of stroke, 15.50 percent reduction for dementia, 40 percent for fractures, 30 percent for breast cancer and 30.40 percent for colon cancer. "Many of these benefits were obtained with as little as 55 flights of steps a week, an hour of gardening, or two to four hours of light leisure time activity." said Dr. Simon. "The little things really do add up."

In one study, after just three weeks of inactivity, healthy twenty-year-old men developed many physiological characteristics of men twice their age. After just eight weeks of exercise there was an improvement in virtually every physiological and metabolic measure, including cholesterol, heart rate stiffness, digestion, muscle mass and metabolic rate. "Exercise is just the best anti-aging medicine we have," Dr. Simon said.

From Bottom Line's interview with Harvey B. Simon, MD, associate professor of medicine at Harvard Medical School and the founding editor of Harvard Men's Health Watch. Dr. Simon is the award-winning author of five previous books on health and fitness, and received the London Prize for Excellence in Teaching from Harvard and MIT. His book is The No Sweat Exercise Plan (McGraw-Hill, 2006).

Obesity has gone prime time. We Find evidence of its presence where ever we look: in every neighborhood, every mall, every school and every workplace. Hardly a day goes by without the news reporting on some aspect of the looming obesity crisis. However, the epidemic is not confined to just the wealthy developed world. Even desperately poor countries such as Nigeria and Uganda are wrestling with the dilemma of obesity. China, which was once one of the world’s leanest countries, is not immune. In fact, it has one of the fastest-growing obesity rates in the world and one quarter of its urban youth is presently overweight. It is projected that by 2015, 200 million Chinese will be not just obese, but morbidly obese. The looming obesity epidemic is sending chills through the global community. Worldwide, more than 1.3 billion people are overweight, whereas only 800 million are underweight—and these statistics are diverging rapidly.

The problem of expanding waistlines is more than merely a vanity concern. There are serious health consequences from sporting that beer belly. Being overweight can radically change the course of a person’s life. Fat is toxic and potentially lethal. Just carrying as few as an extra 4.5 kilos (10 pounds), over your ideal weight is considered a serious risk factor for heart disease, diabetes, high blood pressure, dementia and Alzheimer’s disease, liver disease, hormonal imbalances depression and cancer. In fact, at least 30 different diseases are related to being overweight. So, what’s going on here? If people were to follow the advice offered by medical professional, public health officials and the experts from the weight loss industry, the problem should be easily solved. Their call to action basically involves turning your back on all those sugary, high carbohydrate, processed, junk foods and switch to a low calorie diet fortified by plenty of exercise. They say it all boils down to a very simple equation: take in fewer calories and burn more.

Sounds logical. The only problem is that this decades old approach is a dismal failure. For the vast majority of people, it doesn’t work. In fact, long-term success for attaining permanent weight loss is only achieved by a mere 2–5 percent of those very determined and lucky dieters.

A definition of insanity is doing the same thing over and over again and expecting a different outcome. It certainly appears that the traditional approach to winning the battle of the bulge does indeed, seem insane.

If there are answers and successful strategies to stem the tide of this serious health epidemic, they will need to be sought elsewhere.

It’s time to discover some of the missing pieces of the weight loss puzzle.

Secrets of the Brain-Belly Connection
Do you value your brainpower? Certainly the one faculty that everyone wants to hold onto throughout a life’s lifetime is a fully functioning, intact brain. Unfortunately belly fat can deliver a serious blow to your aspirations.

Overwhelming evidence now reveals that your expanding waistline will put a serious crimp on your brain size as well as brainpower.

Researchers set out to discover if being overweight posed a danger to the brain. They scanned the brains of 94 people over the age of 70. They were looking to see the differences in the brains of people who were of normal weight (BMI under 25), overweight (BMI 25–30), and obese (BMI over 30). (BMI stands for body mass index, an approximation of body fat based on height and weight.)

Their results were quit shocking. Overweight people have 4 percent less brain tissue than people of normal weight. And, for obese people, the findings were even worse. They had 8 percent less brain tissue than people of normal weight.

The study not only showed that carrying extra weight degenerated the brain but it also accelerated its aging. Researcher Paul Thompson shared his observation, “The brains of overweight people looked eight years older than the brains of those who were lean, and 16 years older in obese people. Type 2 diabetes, which is common in the overweight, is known to accelerate the aging of the brain and the onset of dementia. But the relationship between brain size and weight still stood when the researchers accounted for this, suggesting it is the fat itself that is causing the problem. It is thought that high levels of fat raise the odds of the arteries clogging up, cutting the flow of blood and oxygen to the brain. This could cause brain cells to die and the organ to shrink.” The high demands put on these brain areas may make them more sensitive to changes in oxygen levels.

Another study used magnetic resonance imaging to compare the brains of 44 obese individuals with those of 19 lean people of similar age and background. The obese individuals had more water in the amygdale—a part of the brain involved in eating behavior. It also showed smaller orbitofrontal cortices in obese individuals, important for impulse control and also involved in eating behavior. These findings strengthen the “slippery slope” theory of obesity. The neural changes that occur when you are overweight, affects the parts of your brain that influence and control so many behaviors necessary to make healthy choices.

Further studies indicate that those with the most belly fat (visceral fat mass) suffer the greatest mental declines over time—and that central or abdominal obesity, in particular, accounts for more than a three-fold increase in dementia risk.

What’s even more worrying is that increased belly fat is linked to decreases in total brain volume, independent of BMI. This can cause changes in another area of the brain, called the hippocampus, which is responsible for long-term memory, spatial memory and navigation. Finally, excess belly fat also appears to contribute to lesions in the brain’s white matter, especially in diabetic patients—linking it not just to memory loss, but also to increased risk of stroke.

Obesity is also causes changes to the immune system, which are fanning the flames of inflammation throughout the body. This increased inflammation can impact the brain and lead to a vicious cycle of gaining more and more weight: obesity leads to inflammation, which damages certain parts of the brain, which in turn leads to more uncontrolled eating and more obesity.

There are many areas of the brain that are affected by being overweight.

• Frontal and temporal lobes—critical for planning, memory and impulse control
• Anterior cingulate gyrus—responsible for attention and executive functions
• Hippocampus—important for long-term memory, spatial memory and navigation
• Basal ganglia—essential for proper movement and coordination

Here is the catch-22. Those extra kilos impair brain function and compromise the particular areas of brain that impact a person’s ability to have a keen memory, control impulses and follow through on any kind of planning. It, therefore, becomes more difficult to successfully commit to any kind of program, especially a weight loss program. Since the impulse control part of the brain is affected, controlling those urges to help yourself to another donut or a second helping of mashed potatoes is a Herculean effort and generally doomed to fail.

Vitamin D —A Key to a Healthy Metabolism
There is one really important nutritional player when it comes to our health. This superstar nutrient is the sunshine hormone, vitamin D. (Vitamin D is really a steroid hormone rather than an actual vitamin.)

Vitamin D truly deserves the title of superstar. Each year, vitamin D research discovers additional health benefits conferred by this sunshine vitamin. Vitamin D receptors are found throughout the body including the brain. Optimal levels are absolutely necessary to insure healthy bones, healthy arteries, a robust immune system, balanced moods, optimal cognitive function, protection from hypertension, allergies, multiple sclerosis, Alzheimer’s disease, autoimmune conditions, and fertility and PMS. Most significantly, vitamin D has been proven to be protective against 13 different kinds of cancer.

Optimal Levels of Vitamin D Are Critical for Health Here are some basic facts you need to know about vitamin D. It is a fat-soluble steroid hormone that is both made by the body and from our diet. In order for the body to produce vitamin D (cholecalciferol), the skin must be exposed to ultraviolet light, primarily from the sun. Vitamin D is further metabolized in the liver and kidneys to create the fully active form of vitamin D. Thus variations in sun exposure due to latitude, season, time of day, sunscreen use, skin pigmentation, and age will determine how much vitamin D the body makes.

Although it is known that vitamin D play a vital role for the well-being of infants, children, adults and the elderly, we presently have a global pandemic of chronically low vitamin D levels. It’s estimated that 85 percent of the American public are deficient, and as much as 95 percent of all its senior citizens. Vitamin D deficiencies are also widespread throughout the UK, with 86 percent of the population deficient in the winter and 57 percent in the summer.

Even though Australia’s is described as “sun burnt” country and is one of the sunniest countries in the world, a surprising number of its citizens are severely lacking in vitamin D. A recent report stated that as many as 1 in 3 Australians may have low vitamin D levels.

For all those on a weight loss quest, vitamin D is one of those missing pieces you have been searching for. There is overwhelming evidence that confirms the importance of keeping your vitamin D levels up to get your extra kilos down. Not only does it help achieve weight loss, it also improves other risk factors such as insulin resistance, metabolic syndrome and blood sugar imbalances. If you are feeling hungry all the time no matter how much you eat, you might want to have your vitamin D levels checked. What drives insatiable hunger is the relationship between low vitamin D levels and a hormone called leptin. Leptin is a messenger molecule made in fat cells that communicates to the hypothalamus, letting it know how much fat is stored in the body. It is the hormone that communicates that you are full.

Low vitamin D levels interfere with the effectiveness of leptin. Researchers at Aberdeen University, Scotland found that obese people produced 10 per cent less vitamin D than people of average weight. The study discovered that low levels of the vitamin in blood interfered with the function of leptin, which tells the brain when the stomach is full. The study also found that excess body fat absorbs vitamin D, stopping it from entering the bloodstream. Dr Helen MacDonald, of Aberdeen University’s department of medicine and therapeutics, said: “Obese people had less vitamin D and the link between obesity and vitamin D deficiency was statistically significant.” Overweight people, shirking the sun or not taking adequate vitamin D supplementation thwart their dieting efforts in another way. Low vitamin D levels have been shown to increases fat storage. A 2009 Canadian study found that weight and body fat were significantly lower in women with normal vitamin D levels than women with insufficient levels.

It seems that fat people may be less able to convert vitamin D into its hormonally active form. A Norway study found that the more participants weighed, the lower their vitamin D levels tended to be. The researcher, Zoya Lagunova, MD, believes that obesity is associated with lower vitamin D levels since vitamin D is a fat-soluble vitamin. “Much of the vitamin D produced in the skin or ingested is distributed in fat tissue, so obese people may take in as much vitamin D from the sun, food, or supplements as people who are not obese, but their [blood] levels will tend to be lower. Obese people may need more vitamin D to end up with the same levels as a person whose weight is normal.”

How much less vitamin does an overweight person make? As it turns out, increased fatty cells can decrease the ability to make vitamin D by a factor of 4. That means that if you are carry extra weight, you may make only one quarter the amount of vitamin D compared to a leaner person. Vitamin D is also an important factor in diabetes. Low levels of vitamin D has been linked to an increased risk of developing type 2 diabetes. After following more than 5,000 people for five years, an Australian research team found that those with lower than average vitamin D levels had a 57 percent increased risk of developing diabetes, compared to those within the recommended range.

Low levels of vitamin D are also known to nearly double the risk of cardiovascular disease if you already have diabetes. Diabetics, who are deficient in vitamin D and cannot process cholesterol normally, tend to have it build up in their blood vessels, hence increasing the risk of heart attack and stroke.

Vitamin D also helps keep blood sugar levels under control. In type 2 diabetes the body can’t use insulin it produces efficiently to control blood sugar levels. Vitamin D plays a role by increasing the release of insulin. In one study, researchers evaluated the vitamin D levels and the chance of developing unbalanced blood sugar metabolism. In this study, subjects were evaluated for serum vitamin D levels and followed for 7 years to determine the effects on blood sugar metabolism. The study showed that the subjects with the highest vitamin D levels had a 40 percent increase in supporting optimal future blood sugar balance.

If you want to lose weight and keep it off, it is critical to check your vitamin D levels. The higher your vitamin D levels the higher your leptin levels and the more your blood sugar will remain balanced. Vitamin D helps your body respond to the correct metabolic messages. High vitamin D levels increase your ability to lose weight and losing weight will increase your vitamin D levels. All of which will reduce your risk of metabolic syndrome, insulin resistance, diabetes, and cardiovascular disease, not to mention most chronic illnesses.

While it is important for most people to take vitamin D supplementation, especially the overweight, children and elderly, it is critically important to check your vitamin D levels. Taking a vitamin D supplement may not get you into optimal range, which is where you want to be. Its optimal blood vitamin D levels that count. The proper blood test is called 25-hydroxyvitamin D (25-OH), which is included in the basic blood workup. In Australia optimal levels should be 150–200 nmol/L. In the U.S., optimal levels should be between 70–100 ng/mL. Do not settle for less than optimal levels if your goal is the best health possible.

Less than 25 percent of adults exercise on a regular basis, thus, children - and adults - are spending more time performing sedentary tasks, such as surfing the Internet, playing video games, and watching television. This lack of exercise increases insulin resistance, hormone dysfunction, and inevitable weight gain. So, what can we do to keep fit and how do we fit exercise into our busy schedules?

Exercise Timing

One of the questions I am asked most often is: “Should I work out in the morning or the evening?” To enhance fat burning, the best time to work out is in the morning. Once you do 10 minutes of this fun program and eat protein for breakfast, you will rev up your fat-burning furnace by 25 to 40 percent and it will last for 12 or more hours throughout the day. Also, often after a hard day at home or the office, we don’t feel like exercising and we don’t want to rev up our metabolism a few hours before we go to sleep.

So, set your alarm 10 minutes earlier, have fun with this exercise regimen and you will be rewarded with a tighter, stronger body. Consistency is the key. Get out of bed, put on a T-shirt and shorts, get your water bottle and towel, and get started. Exercise, then hit the shower, and eat breakfast. Start Day 1 on Monday so that Day 6 and Day 7 will be Saturday and Sunday, which are usually the days we do more outdoor or family-oriented aerobic activities.

Fitness Fun 10 minutes a Day

Warm-up before you begin. Stretch your arms to the ceiling. Breathe deeply. Then reach towards the floor. Breathe deeply. Jog gently in place for 30 to 60 seconds. Drink water before you begin and remember to drink more water between the two sets of exercises. Dehydration can make you feel weak and dizzy.

The goal is to work up to three sets of each exercise with successively heavier weights. Start with the lighter weight and increase the weight slowly. Depending on your level of fitness, you may increase weight and repetitions more quickly. Whatever your level of fitness, build on your previous day’s success; if on Day 1 you lifted a light weight only three times, try to lift four times on Day 2. Then move on to a heavier weight and so on until you finally reach the goal of three sets of repetitions using successively heavier weights. The fact that you are trying is success. And remember, no matter what your age or fitness level, you will be able to do these exercises, so just have fun.

Day 1

Shapely arms:

Stand with your feet shoulder-width apart and extend your arms down the side of your body. With a light dumbbell in each hand, take a couple of deep breaths, exhale and curl both arms to a 90-degree angle. Make sure your elbows are at your sides and not bending outward. Hold for two seconds. Inhale as you lower the weight. If you are pushing your stomach out and bending backward, the weight is too heavy. Make sure you are standing straight and strong. Exhale and repeat the exercise 10 times. Do not pause between curls. Pick the medium weight and repeat 10 curls. Then choose the heaviest weight and repeat more 10 curls. If you find that you cannot complete the last set of 10 curls, then use the medium weight for both the second and third set of repetitions It is best to do the required 30 curls even if you have to use the smallest weight initially. This exercise also improves neck muscles and tightens sagging chins.

Arms without wings:

This is the exercise that makes the backs of your arms beautiful while also toning your abdominal muscles. Lie on the floor with your knees bent and the soles of your feet flat on the floor. Hold the lightest dumbbell by your ears with your elbows pointing up to the ceiling. Exhale as you raise the weight from your ears toward the ceiling. Your arms should be straight up now. Hold for two seconds and inhale as you lower the weight. Repeat 10 times. Do not pause between curls. Next, choose the medium weight and repeat 10 curls. Then use the heaviest weight and repeat 10 curls. To really get the benefit of this exercise, hold your abdominal muscles tight and push your lower back toward the floor after you inhale. Focus on your breathing. If you can’t complete all three sets with successively heavier weights, just use the lowest weight at the beginning and within a couple of weeks you will be able to progress to the heavier weight.

Day 2

Sexy calves:

Stand tall with your feet shoulder-width apart. Hold the lightest dumbbells in each hand with your arms at your side. Keep your shoulders back but relaxed, not pulled up toward your ears. Exhale as you raise your heels. You should now be up on the bottom of the front of your feet, but not so high that you end up on your tiptoes. Hold for two seconds. Inhale as you slowly lower your heels. Repeat for 10 lifts. Next, pick your medium weight and repeat. Then use the heaviest weight and repeat for 10 more lifts. Beautiful calves are the end result of this exercise. Once this exercise becomes effortless, instead of moving to heavier weights, add ankle weights while holding the dumbbells for increased results.

Tight thighs and cellulite reducer:

This is my favourite exercise as it gives the fastest results. Stand with your feet slightly wider than your shoulders, with your arms at your sides. Keep your back straight. Exhale as you squat down to about 90 degrees with your butt out, as if you were going to sit down. Your knees should be in line with your toes. Hold for one or two seconds. Inhale as you straighten up. This is called a squat. Do 10 squats, then rest for a count of 10. Do 10 more squats. Soon you will be able to do an additional 10 squats for a full 30 squats. This exercise sculpts great legs, and helps tighten the skin on your upper thighs and butt to reduce cellulite. Once you get very good at this exercise, add wrist weights.

Day 3

Chest and breast press:

Lie on your back with your knees bent and the soles of your feet flat on the floor. Hold your lightest dumbbell in each hand with your arms out from your body like a cross. Bend your arms at the elbows toward the ceiling. Exhale as you push the weight up toward the ceiling. Hold for a count of two and inhale as you bring the weight back to the starting position. Repeat for 10 presses. Then change to your medium weight and repeat for 10 presses. Finally, choose your heavier weight and repeat. This exercise makes for strong arms and builds chest muscles. It also tightens sagging breasts in women.

Tight abdomen:

We all want tight abdominals. You may be able to do only a few of these exercises at the beginning. Start slowly and add a few more repetitions every time you do this exercise, but try to do as many as you can, up to 10 in each set.

Lie on the floor on your back with your knees bent and the soles of your feet flat on the floor. Cross your arms over your chest. Exhale as you curl up toward your knees. If you can raise yourself only a few inches off the floor, don’t worry - it will get easier. Make sure your lower back is not arched upward. Repeat as many as you can. Remember, the more you do this exercise, the tighter your abdominals will become and the inches will fall off soon. You can do it.

Day 4

Butt lift:

Kneel on a rug or mat on all fours. You should have your hands and feet positioned so that you feel steady. While keeping your head up (do not look at the floor), exhale and raise your right leg until your thigh is even with your back and push toward the ceiling. Hold for one second and inhale as you return your knee to the original position. Do 10 repetitions for the right leg, and then repeat for the left leg. This exercise gives you the greatest butt lift. As you get better at this exercise, increase the number of repetitions to 15, and then 20 per leg.

Even better butt lift:

Pick a sturdy chair and lie on the floor on your back with the chair at your feet. Place your palms flat on the floor with your arms at your sides. Lift your legs and put your heels firmly on the chair. Exhale as you contract the backs of your thighs and lift your butt toward the ceiling. Hold for two seconds. Inhale as you slowly lower your body back to the starting position. Do 10 repetitions. Stop, rest for 10 seconds, do 10 more repetitions, and then the last 10 repetitions. Once you feel strong doing 10 repetitions, add another five, and so on.

Day 5

Shoulder lift:

Stand with your feet shoulder-width apart, your back straight, and your arms at your sides. Grip a light dumbbell in each hand then raise your arms out from your sides with your palms facing upward, until your arms are level with your shoulders. When you raise your arms to shoulder height, turn your palms down and hold for one second. Inhale as you lower the weight. Repeat 10 times. With the medium weight, repeat 10 times. Finally, do 10 more with your heavy weight. If you push out your stomach or arch your back, you are using too heavy a weight. Either use a lighter weight or reduce the number of repetitions.

No more back fat:

Sit in an armless chair. Pick up a dumbbell in each hand. Lean forward with your arms at the side of the chair and exhale as you point your elbows toward the ceiling. Stop when your hands are at the height of your thighs. Hold for two seconds and inhale as you lower your arms. Do this 10 times. Next, repeat 10 times with a medium weight. Finally, repeat with the heavier weight. This exercise gets rid of the flab that women accumulate on their back around their bra strap and strengthens back muscles.

Day 6 and Day 7

Move your body:

Go for a walk in the park, bicycle with your kids, swim, golf, play tennis, garden, or go dancing. Do anything that requires you to move your body. Add some exercise variety today and tomorrow. You have done fabulously and should be proud of yourself. Even after five days most people feel stronger and want to exercise. It is so easy to fit 10 minutes of exercise into your day. If you miss a day because you slept through your alarm, just remember to do your exercises the next day. Repeat these exercises as recommended and in a few weeks your body will reward you with tight muscles and a slimmer, sexier you.

Feel Like You Could Use More Energy?
One of the consequences of our stressful modern life is an increased need for energy. With less sleep and the depletion of nutrients in our food supply, however, it is getting harder and harder for our bodies to keep up.

There is a lot out there about how competitive athletes can up their energy. Although the approach we’ll discuss below is also excellent for athletes, it was developed, and is outstanding, for the rest of us. Whether you are a mom trying to juggle a fast paced hectic life, a student on a fast food diet, or just trying to optimize your day to day energy, here’s how to get from being fatigued to feeling fantastic!

Having spent the last 30 plus years specializing in treating chronic fatigue and chronic pain, we have learned about the keys to energy production. As an unexpected fringe benefit, these treatments have also offered enormous benefits to those suffering from heart disease.

Optimize energy production with the “SHINE Protocol” Ribose (and our overall approach to treating fatigue) has been highlighted by Dr. Oz, “America’s Doctor” on Oprah, in his wonderful new book YOU: Being Beautiful—The Owner’s Manual to Inner and Outer Beauty.

In addition, our research has shown that severely fatigued people with Chronic Fatigue Syndrome (CFS) and Fibromyalgia can increase their energy by an average of 90 percent (see the published study at www.Vitality101.com) by treating with “SHINE”: Sleep, Hormonal support, Infections, Nutrition and Exercise. For mild fatigue, the physical keys to optimizing energy are Nutrition, Sleep and Exercise, while the emotional key is to start paying attention to what feels good—while letting go of things that don’t.

How Do I Start?
Given my hectic schedule as an educator and physician, people often ask me what I do to keep my energy turbo charged. I like to keep it simple, so here is what I do personally. All of the vitamins, minerals and other essential nutrients are important to health, and the American diet is so highly processed that people have widespread deficiencies. Because of this, I like to use vitamins that make supplementation simple.

Why Ribose—And What Is Ribose?
Ribose, also called D-Ribose, is the key to your body’s energy production. Ribose is a special, five-carbon sugar (known as a pentose by biochemists) that is found naturally in our bodies. But ribose is not like any other sugar. Sugars we are all familiar with, such as table sugar (sucrose), corn sugar (glucose), milk sugar (lactose), honey (predominantly fructose), and others are used by the body as fuel. These sugars are consumed and, with the help of the oxygen we breathe, are “burned” by the body to recycle energy. Because they are used excessively, they become toxic— acting as energy loan sharks.

Ribose, on the other hand, is special. When we consume ribose, the body recognizes it is different from other sugars and preserves it for the vital work of actually making the special “energy molecules” (called ATP, NADH, and FADH) that power our hearts, muscles, brains, and every other tissue in the body. These represent the energy currency in your body, and are like the paper that money is printed on. You can have all the fuel you want, but if it cannot be converted to these molecules, it is useless. For years, I talked about the importance of B vitamins, which are a key component of these molecules. These helped improve energy to a degree, but it was clear that a key component was missing. In looking at the biochemistry of these energy molecules, they are also made of two other key components-adenine and ribose. Adenine is plentiful in the body and supplementing with adenine did not help energy production. We then turned our attention to Ribose.

Ribose is made in your body in a slow, laborious process and cannot be found in food. We knew that severe fatigue and stress causes your body to dump other key energy molecules like acetyl-L-carnitine. We then found that the body did the same with Ribose, making it hard to get your energy furnaces working again even after the other problems were treated.

This was one of those “Eureka!” moments where things came together. Not having Ribose would be like trying to build a fire without kindling—nothing would happen. We wondered if giving Ribose to people with fatigue and even CFS would jumpstart their energy furnaces. The answer was a resounding yes! Our recently published study (see the study abstract at www. Vitality101.com) showed an average 44.7 percent increase in energy after only three weeks (improvement began at 12 days) and an average overall improvement in quality of life of 30 percent. Two-thirds of the study patients felt they had improved. Usually a 10 percent improvement for a single nutrient is considered excellent. A 44.7 percent increase left us amazed, and I am now recommending Ribose for all of my chronic fatigue, chronic pain and fibromyalgia patients, for athletes, and for any one with fatigue or heart problems. Ribose recently became available (over the counter) to physicians, and is one of the few natural products actually starting with physicians and then moving out into supplement companies and health food stores. It is critical to use the proper dose for the first three weeks, which is five grams (5000 mg) three times a day. It can then be dropped to twice a day (and often even once a day in the morning with the vitamin powder to maintain optimized energy for those that are otherwise healthy).

Normal, healthy heart and muscle tissue has the capacity to make the ribose it needs. But when we are chronically stressed by life or illness, it helps to have extra ribose to help boost energy production.

The Scientific Link Between Ribose, Energy, And Fatigue
Clinical and scientific research has repeatedly shown giving ribose to energy deficient hearts and muscles stimulates energy recovery. Research in Ribose and fatigue began with a case study that was published in the prestigious journal Pharmacotherapy in 2004. This case study told the story of a veterinary surgeon diagnosed with fibromyalgia. For months, this dedicated doctor found herself becoming more and more fatigued, with pain becoming so profound she was finally unable to stand during surgery. As a result, she was forced to all but give up the practice she loved.Upon hearing that a clinical study on ribose in congestive heart failure was underway in the university where she worked, she asked if she could try the ribose to see if it might help her overcome the mind-numbing fatigue she experienced from her disease. After three weeks of ribose therapy she was back in the operating room, practicing normally with no muscle pain or stiffness, and without the fatigue that had kept her bedridden for many months. Being a doctor, she was skeptical, not believing that a simple sugar could have such a dramatic effect on her condition. Within two weeks of stopping the ribose therapy, however, she was out of the operating room and back in bed. So, to again test the theory, she began ribose therapy a second time. The result was similar to her first experience, and she was back doing surgery in days. After yet

a third round of stopping (with the return of symptoms) and starting (with the reduction of symptoms) the ribose therapy, she was convinced, and has been on ribose therapy since that time. I found this report intriguing and decided to design a larger study in patients with fibromyalgia or chronic fatigue syndrome which I began to discuss earlier. Our study included 41 patients with a diagnosis of fibromyalgia or chronic fatigue syndrome who were given ribose at a dose of five grams three times per day for three weeks. We found the ribose treatment led to significant improvement in energy levels, sleep patterns, mental clarity, pain intensity, and well being. Of the patients participating in the study, 65.7 percent experienced significant improvement while on ribose, with an average increase in energy of 44.7 percent and overall well being of 30 percent- remarkable results from a single nutrient! The only significant side effects were two people felt too energized and hyper/anxious on the ribose. This is simply dealt with by lowering the dose and/or taking it with food.

The good news is that we now have a wonderful tool to increase energy naturally. Take five grams of ribose three times per day for three weeks, then twice a day (can be mixed with any liquid or food) for two to three weeks, and then one to two times per day to see what it will do for you. You’ll be amazed!

If I had to make my list of the top 10 problems people have with starting a program, finding time for exercise would definitely be at the top of it. But here's the thing: if you're looking to find some spare time when you can fit exercise in, forget about it. We're living in the early part of the 21st century. No one has spare time. It's like "spare money." You can choose to budget money and time any way you want, but none of it is extra, none of it is spare.

Time is the great equalizer. The poorest person on the planet and the richest have exactly the same amount of it, 24 hours per day. No more, no less. So let's forget about finding extra time. (Where are you going to find it, under a rock?) Instead, let's talk about developing a budget. Let's talk about creating our life the way we want it to be.

As a writer, I'm always fascinated with what the writing process is like for other writers. Writing is right up there with exercise in the procrastination sweepstakes. There are thousands of failed writers all over the place who are sure that the only reason they're not successful is that they "couldn't find time," or didn't have the right computer, or the right quiet room, or because they had too many other responsibilities. But successful writers-like successful exercisers-don't have any more minutes in the day than unsuccessful writers. My favorite writing story is the one about the lawyer who wrote a novel in the wee hours of the morning before proceeding to go to work, where he put in a 60-hour week while supporting a family with three small children. It took him three years to complete the novel. The novel was A Time to Kill and the lawyer was John Grisham.

Oh, and did I mention the almost destitute young housewife with a young child and a burning desire to write no matter what? She'd sit in coffee shops and write by longhand while the baby would nap. Did it for a long time, by the way, with little support from the university. Her name is J.K. Rowling. Maybe you know her. She wrote the Harry Potter books.

So let's dispel this notion of "I can't find the time." Of course you can't. Neither can I. The problem is not one of time, it's one of habit development. It's about taking something that you're not used to doing-exercise-and turning it into something that you're not used to doing without. Work on the plan for habit acquisition and believe me, time will take care of itself.

So how do you build a habit?

Suppose you're playing catch with a little kid. A real little kid, one who can barely get her hands around the ball and is just learning to throw. What do you do? Do you throw the ball as hard and as fast as you can? Of course you don't because it would be impossible for her to catch it and she would get completely frustrated and give up. Sometime watch a father teaching his kid to hit a baseball. How does he pitch those first balls? Easy and gently. Underhand.

Now why do you do it like that?

Because you want the child to develop her skill. Because the one thing you don't want is for her to feel defeated. Because you don't want her to be frustrated. Because skill building has to start slowly, a little at a time. When she gets good at catching the ball with an easy throw, when he gets good at hitting the ball with an easy pitch, then you make it marginally harder. You keep the challenge level just slightly above the skill level, so that the skill can grow organically, step by step and the learner is always reinforced positively with a feeling of accomplishment.

And why, at the risk of repeating the obvious, do we do it this way?

Well, if I can be blunt, because no one likes to do what they suck at. If you keep having an unsuccessful experience with something, you just stop doing it. It's not fun to fail. And that's what most people have done with their exercise programs. They cut off a big chunk right at the beginning they can't chew it and they spit it out. And they stop.

And blame it on not having enough time.

You are going to teach yourself something new, a new skill, a new habit, just as surely as you would teach a child to catch and throw a ball. If you start with some ridiculous goal like "I must do one hour of jogging every day," it will be like throwing a fastball to the kid who never played catch before. You're going to be frustrated, you're going to think you stink at this game and you're going to give up. That you can take to the bank. So you have to do something different. You have got to stack the deck in your own favor.

You have to set the game up so you win.

See, the subconscious mind is very simplistic. It's very digital. It knows two states: on or off. Win or lose. Success or failure. If you set yourself an initial goal like "30 minutes on the treadmill" and you only do 20 minutes, whether you are aware of it or not, your subconscious mind logs that as a failure. You aimed for 30 and didn't make it. Somewhere in your subconscious is a little voice sticking out its symbolic tongue and yelling "loser!" But if you set a goal of five minutes and you do five minutes, guess what? Your mind logs that as a win. Which it is. Does it matter that it's "only" five minutes? Not on your life. What matters is that you had a positive experience.

In the first months of exercise, all we're trying to do is to log those positives. We're in a habit-building mode, not in "how much exercise did I do?" mode. It is not important how much you do-what is important is that you do something. Consistently. That's how we build a habit successfully. That's why the intro level "Shape Up" program begins with only 10 minutes of walking three times a week. What you're really trying to do here is condition your subconscious. You want to trick it into thinking that exercise is always a "win" situation for you. Maybe for you, right now, that means just doing five minutes a day. No problem. Your conscious mind may be saying, "Five minutes can't possibly make a difference," but it's dead wrong. What makes a difference-and believe me, this is the most important difference of all-is that you keep your word to yourself. You said you would do five minutes . . . and you did five minutes. You said you're going to walk half a block . . . and you walked half a block. It may not seem like much but on a subconscious level you were learning the most valuable lesson in habit development; you're learning to believe your own words.

I once trained a woman named Marnie, an absolutely lovely and charming occupational therapist who weighed around 250 pounds. She had never exercised successfully, hated the concept, didn't see how she could possibly fit it into her extraordinarily busy life, but had reluctantly come to the gym on doctor's orders. She had tried working out several times in the past and had been given long routines of weights and aerobics that she found both difficult and dull and had abandoned within a matter of days. She had very little hope that this would be different but had promised her doctor that she would give it one more shot.

The first training session we did nothing but talk. I didn't even let her change into her gym clothes.

At the end of our meeting, I gave her her first assignment: Show up for the next session. Which she did. Early, actually.

The second time we talked some more. What was her job like? Where did she want to be in a few years? What was her health life? How, if at all, did she feel her weight held her back? How did she feel about her body? You know, stuff like that.

The third time I showed her how the treadmill worked. She actually got on it and we walked together on adjoining treadmills.

For three minutes. Yes, you heard me right. Three minutes. And that was her assignment for the next two visits. Three minutes on the treadmill. No more, no less.

She had now logged in five successful trips to the gym. I upped her assignment to four minutes.

See where I'm going with this? The biggest mistake people make when it comes to incorporating exercise into their lives is concentrating on the amount they do and how quickly it will produce results. It's the wrong focus. Until it becomes something you can't imagine living without, the focus should be simply on doing something consistently. Do you realize that if you started with as little as one minute a day and over the next two months added no more than 30 seconds each day, you'd be up to a half hour of daily exercise in 60 days? You can always up the ante once you develop the habit. The trick is developing the habit.

In case you're wondering what happened with Marnie, she became one of the strongest athletes I ever trained. When she finally left me to move out West, she was regularly lifting weights, running in Central Park, going mountain biking on weekends and looking forward to learning how to ski.

You can do it, too. Or any version of it that suits your life.

If exercise is new to you, treat this part of the program as a remedial course in the power of your word. Trust me that it does not matter how little you do right now. What matters is that you promise to do it and then you keep that promise. Keep the bar low for now-in fact, I insist on it. You can always raise it. You will raise it.

When you say so.

But first you have to learn to negotiate this skill at the beginner's level, just like the little child learning to throw a ball. You have to believe in your own word again.

And if that little voice in your head tells you that a few minutes a day can't possible make any difference, well then, please tell her she's more than welcome to her opinion, but to please stop chattering for a few minutes while you go work out.