Should You Eat Before Endurance Exercise?

Researchers at the Sports Performance Research Institute and the Auckland University of Technology in New Zealand comment in, What Should I Eat Before Exercise? Pre-Exercise Nutrition and Response to Endurance Exercise: Current Prospective and Future directions, which appeared in November 2020 issue of the journal Nutrients, that, “despite being relevant to anyone performing exercise, many questions relating to the effects of nutritional intake on endurance training responses and adaptations remain unanswered.”

Many exercise participants employ targeted strategies – some more scientific than others – to alter nutrient availability, which may include exercising in the overnight-fasted state, restricting carbohydrate (CHO) ingestion between training sessions, and supplementing with CHO intake in various modalities before, during, and after exercise.

Exercising in a fasted state, at an exercise intensity below the ventilatory threshold  (VT) – typically anywhere from 70 to 85% of maximum heart rate (220-age) in a healthy, fit recreational athlete – tends to increase the fatty acid expenditure during the session – even after – from excess post-oxygen consumption (EPOC).

The New Zealand researchers sought to review, the current knowledge of the influence of pre-exercise nutrition ingestion on the metabolic, physiological, and performance responses to endurance training.

An understanding of the energy utilization sequence is provided pertaining the role the liver plays, as a key metabolic regulator during extended exercise – in spite of the fact that there is roughly a 40% reduction in liver glycogen following an overnight fast.

The blood glucose level can be maintained at normal levels during exercise due to increased gluconeogenesis (energy derived from non-carbohydrate sources) and/or decreased utilization of glucose in skeletal muscle, comment the reviewers.

When CHO’s are restricted between training sessions, such as with a ketogenic diet, it may cause exercise to be undertaken at reduced muscle glycogen concentrations – yielding an increase in the oxidation of fat and amino acids, and a reduction in muscle glycogen breakdown.

However, exercise performed under normal muscle glycogen levels nets a muscle glycogen breakdown similar between that of a fed and fasted state, while being reduced, if ingesting CHO during the exercise session.

With respect to the duration of an exercise session, the respiratory exchange ratio (RER) – a measure of the type of energy (glucose, fatty acids, glycerol, or amino acids) oxidation – decreases with exercise duration. A lower RER is indicative of  an increased reliance on fat oxidation, as time progresses.

Exercise intensity determines the type of energy utilized during the session – with time above the VT more reliant on carbohydrate versus fat stores. However, comment the reviewers, “the glycemic index (speed of energy breakdown in the stomach) of the pre-exercise meal appears to have minimal effects on the relationship between intensity and substrate oxidation.”

Relative to the amount of carbohydrate consumed before exercise, the reviewers said, “several studies have directly compared varying amounts of CHO ingested before exercise, either showing no differences in substrate oxidation with varying amounts of pre-exercise CHO, or differences throughout all or portions of the exercise bout.”

As to the meal timing effect, differences in RER between exercising in the fed vs. fasted state and following low vs. high glycemic diets are limited” – with “no differences in substrate oxidation were found, when the same meals were ingested 15, 45, or 75 min and 30, 60, or 90 min before exercise. When consumed within 4 hours of exercise, the amount of time prior to exercise does not have a meaningful impact on substrate oxidation.”

From a performance perspective, pre-exercise CHO intake tends to enhance training sessions lasting longer than 60 minutes, especially 90 minutes or longer in duration. Shorter than 60 minutes, specifically, less than 30 minutes, may risk a bout of reactive hypoglycemia (low blood sugar) in susceptible individuals.

Additionally, a pre-diabetic or diabetic condition will require specific attention by a trained professional, such as a clinical or sports dietetic nutritionist, to anticipate the effects of the training on blood sugar responses.

Forewarned is forearmed.

Fiber Is An Essential Component of A Healthy Diet

Fiber, an essential part of any healthy diet, comes in two forms: soluble and insoluble. Soluble fiber, unlike insoluble fiber, “dissolves in water and can be metabolized by the ‘good’ bacteria in the gut.”

It’s recommended that you consume 38 grams of fiber per day, if you are male, and 25 grams, if you’re female. Unfortunately, almost 95% of American adults don’t consume enough fiber.

One of the most important functions of fiber is the role that it plays in our digestion and intestinal health. There are around 500-1000 different species of bacteria in our intestines – accounting for over 38 trillion cells.

These gut bacteria, known as probiotics, play key roles in weight control, blood sugar control, immune function, and brain function. Specifically, these probiotic bacteria create short chain fatty acids, such as acetate, propionate, and butyrate, which are used by cells in the colon to reduce inflammation and improve digestion.

Maxwell Nutrition’s Probiotic Complex 40 Billion CFU utilizes MAKTREK® Bi-Pass Technology, so that the 40 billion colony forming unit of four unique probiotics will make it to your GI Tract to aid with a healthy gut microbiome. It also contains the prebiotic fiber, fructooliogosaccharide, which helps feed the good bacteria in the intestine.

Just like humans, gut bacteria require energy to function properly, which is where fiber comes into play. Fibers, classified as a prebiotic, provide food for the healthy gut bacteria to help them survive and thrive in your gut. Prunes, for example, contain sorbitol, which increase water content in your stool, can be beneficial for bloating and constipation. Other forms of fiber, like glucomannan, aid in weight loss by acting as an appetite suppressant.

Below are 10 foods that are great sources of fiber and other nutrition needs:

  • Lentils: A ¼ cup serving of lentils (58 calories) provides 4 grams of dietary fiber, 4.5 grams of protein and 182.8 mg of potassium (~5% of the RDA*)
  • Black Beans: A ¼ cup serving of black beans (55 calories) contains 4.1 grams of fiber, 3.6 grams of protein, and 184.8 mg of potassium (~5% of the RDA)
  • Avocados: One serving of an Avocado (1/2 of an avocado is 120 calories) contains 5 grams of fiber. Avocados are also chalk full of healthy fats, vitamin C, potassium, magnesium, vitamin E, and multiple B vitamins. ½ of an Avocado contains 7 grams of monounsaturated fat and 1.35g of polyunsaturated fats. They contain 10.8 mg of vitamin C (~12% of the RDA) and 354 mg of potassium (~10% of the RDA).
  • Kale: A 1 cup serving size of Kale (8 calories) contains 2.4 grams of fiber. Kale also contains 1,000 mg of calcium (100% of the RDA), 3015 mcg of Vitamin A (~335% of the RDA), 72.4 mg of vitamin C (80.4% of the RDA), and 329 mg of potassium (~9% of the RDA).
  • Blackberries: A 1 cup serving of blackberries (61 calories) contains 7.6 grams of fiber, 418 mg of calcium (~41.8% of the RDA), 27 mg of vitamin C (30.2% of the RDA), 142 mcg of vitamin A (~15.8% of the RDA), and 233.3 mg of potassium (~7% of the RDA).

Green Gold Nutrition’s All-In-One Formula is a great source of dietary fiber and loaded with 200 different ingredients for optimal health. This is a great way to supplement your micro nutritional needs.

  • Raspberries: A 1 cup serving of raspberries (78 calories) contains 8 grams of fiber, 29 mg of vitamin C (~32.2% of the RDA), 308 grams of calcium (30.8% of the RDA), and 185.7 mg of potassium (~5% of the RDA).
  • Broccoli: A 1 cup serving of broccoli (30 calories) contains 2.4 grams of fiber. There is also 73 mg of Vitamin C (~81.2% of the RDA), 428 mg of calcium (~42.8% of the RDA), 252 mcg of vitamin A (~28% of the RDA), and 287.6 mg of potassium (~8% of the RDA).
  • Oats: A ½ cup serving of oats (73 calories) has 4 grams of fiber. Oats contain beta glucan, a soluble fiber that is beneficial for blood sugar control and cholesterol levels
  • Chickpeas: A ¼ cup serving of chickpeas (50 calories) contains 2 grams of fiber and 2.5 grams of protein
  • Beets: A serving size of 1 beet (35 calories) contains 2.3 grams of fiber. Beets are also chalk full of beneficial nutrients such as iron, copper, folate, manganese, and potassium.

*RDA= Recommended Daily Amount


Ellis, E. (2020, November 3). Fiber. EatRight. Retrieved April 19, 2022, from

Guarner, Francisco, and Juan-R Malagelada. “Gut flora in health and disease.” Lancet (London, England) vol. 361,9356 (2003): 512-9. doi:10.1016/S0140-6736(03)12489-0

Gilbert, Jack A et al. “Current understanding of the human microbiome.” Nature medicine vol. 24,4 (2018): 392-400. doi:10.1038/nm.4517

Ley, Ruth E et al. “Microbial ecology: human gut microbes associated with obesity.” Nature vol. 444,7122 (2006): 1022-3. doi:10.1038/4441022a

Quagliani, Diane, and Patricia Felt-Gunderson. “Closing America’s Fiber Intake Gap: Communication Strategies From a Food and Fiber Summit.” American journal of lifestyle medicine vol. 11,1 80-85. 7 Jul. 2016, doi:10.1177/1559827615588079

Sender, Ron et al. “Revised Estimates for the Number of Human and Bacteria Cells in the Body.” PLoS biology vol. 14,8 e1002533. 19 Aug. 2016, doi:10.1371/journal.pbio.1002533


Defining “Moderate” vs. “Vigorous” Exercise

When long time fitness guru Mackie Shilstone was asked, what is the difference between moderate-to-vigorous (MVPA) and vigorous physical activity, his simple answer was mild to moderate exercise is not breaking a sweat, while vigorous exercise is highly sweat conducive.

From a physiological perspective, moderate exercise generates 3 to 6 Mets – a measure of metabolism – with vigorous greater achieving greater than 6 Mets. The key element is to decide which form of exercise best fits a person’s lifestyle, health profile, and time allocation.

According to “What is Moderate to Vigorous Exercise,” which appeared in the September 2021 open access journal Frontiers in Physiology, physical activity is defined as: “…any bodily movement produced by skeletal muscles that results in energy expenditure.” 

The investigators—from the Faculty of Kinesiology, University of Calgary and the School of Kinesiology, Western University in Canada—point out that exercise intensity—the rate of metabolic energy demand during exercise—can be expressed in absolute terms (e.g., oxygen uptake in liters per minute, power output in watts, heart rate in beats per minute, and speed of locomotion in meters per second or kilometers per hour), or in relative terms (i.e., relative to any of the following: body weight, maximal oxygen uptake, maximal heart rate, or heart rate reserve). 

However, additional factors such as genetics, fitness status, and comorbidities like diabetes, obesity, cardiovascular disease status, need to also be considered in the exercise intensity definition.

In his prior, multiple hospital-affiliated wellness and sports performance programs, he used laboratory assessments to determine appropriate exercise intensity.

Those assessments included:

  • VO2 Max is defined as maximum endurance capacity – expressed in ml/kg/min.
  • VT (ventilatory threshold) occurs, when the system passes a threshold shifting more energy contribution from fat to carbohydrate stores.
  • RER (respiratory exchange rate) is used to demonstrate a shift in energy metabolism.
  •  RQ (respiratory quotient) is indicative of a similar state as RER but at rest. 
  • Keep in mind, our clients testing was performed in a controlled, laboratory setting – with a cardiac nurse supervising the test, and a preventive-oriented cardiologist interpretating the data – setting the appropriate target heart rates for exercise prescription, based on the client’s objectives.

Here’s how the Canadian researchers described the difference between moderate and vigorous physical activity:

Moderate intensity: Walking 2.5–4 mph (64–76% of heart rate maximum). HRmax can be estimated by subtracting your age from 220, or in certain cases using the formula 208 – (.7 x age).

Moderate intensity exercise examples: Walking briskly, dancing, and playing doubles tennis, or raking the yard, slow and swimming 

Vigorous intensity: Fast walking >4 mph (77–93% HRmax) 

Vigorous intensity examples: Jogging, running, carrying heavy groceries, or other loads upstairs, shoveling snow, or participating in a strenuous fitness class, and fast swimming. 

Before you attempt to increase your intensity of exercise or restart your exercise from a long layoff, especially with age, check with your personal physician for guidance.

Interested in Reading More? Check Out Nutrition & Physical Activity May Modify Covid-19 Risk

Coffee Consumption Does Not Seem to Increase Risk of Rapid Heart Rate

Coffee is one of the most prevalent beverages consumed worldwide – estimated in 2020/2021 to be around 166.63 million kilograms, a slight increase over 164 million bags in the previous year.

According to “Coffee Consumption and Incident Tachyarrhythmias Reported Behavior, Mendelian Randomization, and their Interactions,” which appeared in July 2021 online in JAMA Internal Medicine, “coffee consumption may have multiple beneficial properties, often attributed to antioxidant and anti-inflammatory effects, and is associated with reduced risks of cancer, diabetes, Parkinson disease, and overall mortality. Indeed, the benefits appear to be most pronounced when caffeinated coffee is consumed.”

Mendelian randomization is a method of using measured variation in genes of known function to examine the causal effect of a modifiable exposure on disease in observational studies.

Tachyarrhythmias are defined as arrhythmia characterized by a rapid irregular heartbeat – “with cardiac arrhythmia at a rate greater than 100 beats per minute,” notes 

Arrhythmias can occur “when the electrical impulses that coordinate your heartbeats don’t work properly.” comments the Mayo Clinic.

The JAMA investigators, from the Division of Cardiology, Institute for Human Genetics, Department of Epidemiology and Biostatistics, University of California, San Francisco, state that, “although professional society guidelines that suggest avoiding caffeinated products to diminish the risk for arrhythmia have relied on assumed mechanisms and a small observational study from 1980, more recent investigations have consistently not demonstrated an increased risk of tachyarrhythmia among coffee consumers. 

The California researchers investigated the association of coffee intake with the risk of tachyarrhythmias in a large, population-based cohort, using participant self-reporting, mendelian randomization, and an analysis of related interactions to elucidate these associations. 

The cohort population came from the UK Biobank, a prospective study of 502,543 participants in the UK National Health Services, who were 40 to 69 years of age, and resided within 40 kilometers of 22 assessment centers. 

The participants were recruited between January 1, 2006, and December 31, 2010. They completed questionnaires, underwent physical examinations, and provided biological samples. 

Coffee consumption, assessed from the participant questionnaires, segmented into 8 categories, which corresponded into the following daily coffee intake: 0, less than 1,1,2,3,4,5, and 6 or more cups daily. Excluded were those people, who answered “do not know” or “prefer not to answer.” 

The primary outcome of interest, note the investigators, “was incident tachyarrhythmia, ascertained between January 1, 2006, and December 31, 2018, using International Classification of Diseases, Ninth Revision (ICD-9) and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes available from inpatient and outpatient records.”

Race and ethnicity were ascertained from the baseline survey, while educational level was categorized as middle school graduate, high school graduate, college degree, other professional degrees, and none of the above. Body mass index was based on height and weight.

Physical activity was categorized by the number of days per week of moderate physical activity greater than10 minutes. Hypertension, diabetes, hyperlipidemia, coronary heart disease, congestive heart failure, valvular heart disease, cerebrovascular disease, peripheral artery disease, chronic kidney disease, and cancer were determined by ICD-9 and ICD-10 codes from inpatient and/or outpatient visits between January 1, 2000, and December 31, 2005, commented the California researchers.

The data analysis determined that, “there was no evidence that the association between coffee intake and arrhythmia risk was affected by genetic variants associated with caffeine metabolism. The mendelian randomization analyses failed to provide evidence that caffeine consumption leads to a greater risk of arrhythmias.”

Walnuts are a Life-Extension Food

Walnuts, like other nutrient-dense foods, are high in beneficial unsaturated fats, proteins, vitamins, minerals (magnesium) and fibers. From a general classification perspective nut consumption is associated with a lower risk of cardiovascular disease, obesity, and type-2 diabetes.

According to the “Association of Walnut Consumption with Total and Cause-Specific Mortality and life Expectancy in U.S. Adults,” which appeared in the August issue of the online journal Nutrients, “in the U.S. diet, intakes of nuts and seeds have increased from 0.5 serving/d to 0.75 serving/d from 1999 to 2012. The increased consumption of nuts partly contributed to a modest improvement in dietary quality among US adults.”

Worldwide, walnuts are among the most commonly consumed tree nuts—providing a lower mortality risk—attributed to their high alpha-linolenic acid (ALA) content—a plant-based omega-3 fatty acid associated with improving blood lipids and endothelial function.

Researchers from the T.H. Chan School of Public Health in Boston, the Department of Internal Medicine, Rush University Medical Center in Chicago, and the Channing Division of Network Medicine, Department of Medicine, Brigham and Woman’s Hospital and Harvard Medical School in Boston, sought to examine the association between walnut consumption with total mortality and mortality from cardiovascular disease and cancer—along with life expectancy.

The research data base included the Nurse’s Health Study – a prospective cohort study of 121,701 female nurses aged 30–55, when first enrolled in 1976, and the Health Professionals Follow-up Study (HPFS) established in 1986, with 51,529 male U.S. health professionals (dentists, optometrists, osteopaths, podiatrists, pharmacists, and veterinarians) aged 40–75 years.

Background on the study population included follow-up questionnaires sent every two years to update medical and lifestyle information and identify newly diagnosed cases of various diseases—with self-reported food frequency questionnaires (FFQs) completed every four years. 

The assessment of data included dietary assessment—with participants reporting how often, on average, they had consumed a particular amount of walnuts, other tree nuts, and peanuts, respectively, during the previous year. Participants with sustained cancer, myocardial infarction, and stroke were excluded—along with other relevant exclusion criteria.

Information, such as age, ethnicity, medical conditions (presence of diabetes, hypertension, or elevated cholesterol), and family history, was also collected via self-reported biennial questionnaires. Lifestyle factors were collected every 2 years. 

Participant deaths were identified from state vital statistics records, the National Death Index, reports by family members, and the postal system in response to the follow-up questionnaires—with physician reviewed death certificates or medical records to classify the cause of death using the International Classification of Diseases.

It was determined that during a follow-up period of up to 20 years, “that participants with higher amounts of walnut consumption, as well as, the frequency, had a lower risk for all-cause mortality and CVD mortality compared with non-consumers.”

Specifically, “per 0.5 increase in daily walnut consumption was associated with 9.0% lower risk of total mortality and 14% of CVD mortality, independent from background diet quality and other potential risk factors of participants. There was around one year gained life expectancy at age 60, when compared with the extreme category of walnut consumption.”

Looks like you’re nuts not to include walnuts in your diet.

Retired NFL Players Carry Considerable Damage into Their Next Life

With the NFL back at full strength post-Covid-19 pandemic’s major restrictions, the players and their respective fans are experiencing a rebirth, so to speak, of excitement, team pride, and euphoria, from a year of world-wide trauma that spared no single population on the planet.

With any traumatic, contact sport, like the NFL, casualties are an expected part of the game—much like what the military, albeit heroic, projects for potential wars and conflicts.

Over the last few years, the NFL’s injury focus was to address the alleged mismanagement and under diagnosis of concussions—which the NFL eventually settled a class-action lawsuit by former players.

While concussion diagnosis and management are critical to a player’s long-term health and career extension, it’s dwarfed by the level of musculoskeletal injuries experienced and endured by both current and retired NFL players.

Having previously analyzed the weekly, mandated NFL team injury reports (Wednesday & Thursday) for the Washington Post’s fantasy website, I can attest to the fact that NFL is a train wreck on every play, with the associated damage that can be potentially career-limiting or, in a worst case, career ending, forcing a retired player to live his post-NFL life with pain and discomfort expanding with age.

According to Musculoskeletal Injury History Is Associated with Lower Physical and Mental Health in a Historic Cohort of Former National Football League players, which appeared in the June 2021 issue of the Journal of Sports Rehabilitation, “as a collision sport, American football has a high risk of serious physical injury. Data from the National Football League (NFL) indicate that up to 68% of NFL players may be injured in a season.”

The study authors, from the University of North Carolina, Chapel Hill, Duke Cancer Institute, Durham, NC, and Ohio University in Athens, Ohio, estimated that most NFL players have experienced three or more injuries during their career. Such injuries, comment the university researchers, “can be associated with long-term outcomes alongside loss of playing time, such as psychological stress, chronic pain and long-term pain and disability, and an increased prevalence of arthritis and osteoarthritis.”

To address the gap in information from retired NFL players on their self-reported health status, the authors chose to use the recognized Health-Related Quality of Life (HRQOL) – a multidimensional concept that includes aspects of physical, psychological, and social functioning, and how these can be affected by experiences, expectations, and individual beliefs. “Specifically, gaining insight to how a previous musculoskeletal injury can affect self-reported HRQOL of former NFL players.”

The researchers employed a cross-sectional study, using a group (3647) of former professional football players, who had played at least one NFL season between the years 1940 to 2001, and completed the Retired NFL Players General Health Survey (GHS). Those players that didn’t respond were followed-up by mail, e-mail, and/or telephone follow-up during the subsequent year – with 2537 former players responding.

From a career injury perspective, respondents were asked to provide how many  serious musculoskeletal injuries (bone, ligament, muscle), which they sustained, while playing professional football – with serious injury being defined as “involving any of the following: a fracture, torn ligament, or ruptured muscle; required surgery; and/or caused you to miss at least 2 games or 2 weeks of practice.”

In addition to the GHS, the Short Form 36 Measurement Model for Functional Assessment of Health and Well-Being included the Physical Health Composite Score (PCS) – measuring physical functioning, role physical, bodily pain, and general health – and the Mental Health Composite Score (MCS) – measuring vitality, social functioning, role emotional, and mental health.

Demographic information, such as age, race/ethnicity, body mass index, exercise, tobacco use, alcohol consumption over the last year, and medication for physical and mental complaints, was assessed via the GHS.

The University researchers determined that “among this historical cohort of former NFL players, over 90% reported sustaining at least one musculoskeletal injury during their professional careers. Respondents self-reported that many of these injuries required surgery, resulted in their professional playing careers prematurely ending, and still affected them.”

“The additional findings highlight the large percentages of NFL players reporting surgery (60.7%), a premature end to their professional football career (40.3%), and still being affected by injury (74.8%), further augment the concern about the effects from musculoskeletal injuries on overall functioning across the lifespan,” commented the investigators.”

That led to the following comment: “Despite these limitations, this study highlights the need for more research on a wide range of care for both former and current NFL players.”

Next time you see a traumatic NFL hit, exhale because the damage is just getting started.

Short-Term, Intense Exercise Might Curtail Your Daily Step Count

In the September issue of Medicine & Science in Sports & Exercise, researchers from the Human Performance Laboratory, Department of Kinesiology and Health at the University of Texas at Austin, report that, “when completing an intense short-term exercise training program, decreasing daily background steps from 16,000 to approximately 5000 steps per day blunts some of the classic cardiometabolic adaptations to training.”

Previously, the Texas researchers have described a phenomenon—exercise resistance—as, “inactivity-induced (e.g., low daily steps) lack of improvement in fat metabolism during the 16- to 22-hour period after acute exercise (1 h of running) that normally elicits robust increases in fat oxidation and the post-prandial (after meal) lowering of plasma triglycerides.”

The low daily step count—5,000 or less—after a short-term, intense exercise session (running), might be attributed to being fatigued, causing energy conservation by sitting, less movement, or laying down.

At a St. Louis Blues Hockey training camp during my 10-year tenure as their Performance Conditioning and Nutrition consultant, I observed that after the mandated 3-hour practice, many rookies would go back to the hotel to rest, while their veteran counterparts would head out to play golf.

The Texas investigators examined how acute inactivity impairs a broad range of whole-body adaptations, such as fat metabolism, after short-term intense aerobic training.

Sixteen untrained participants, with an average age of 24 years, completed intense (80%–90% V ̇O2peak) short-term training, which included five bouts of exercise over nine days.

Post-training, eight participants averaged 4767 (low) daily steps, while eight participants averaged 16,048 (high) daily steps.

Prior to intervention and after the short-term, intense exercise, the participant’s resting metabolic responses were ascertained using a six-hour high-fat meal tolerance test.

In addition, responses during submaximal exercise were recorded both before and after training during 15 minutes of cycling (~79% of pretraining V ̇ O2peak).

It was determined that reducing steps to approximately 5000 steps per day prevented some classic whole-body training adaptations during submaximal exercise, such as a significant reduction in heart rate, blood lactate, muscle deoxygenation, and rate of perceived exertion.

The take-away message is taken from the philosopher Buddha, “be moderate in all things.”

The key is to exercise at an intensity somewhere between 72 to 87 percent of your maximum heart rate; either 220-age or 208 – (0.7 x age), in a mode of exercise determined by your trainer or healthcare provider and based on your medical history, with appropriate modifications as recommended.

Interested in reading more? Check out Metabolic Syndrome: How Exercise Can Be Medicine

Edible Mushrooms May Lower Risk of Depression

In November 2021, researchers at Penn State University’s College of Medicine reported that, “mushroom consumption may lower risk of depression.” The research was published in the Journal of Affected Disorders.

Prior research – “Higher Mushroom Consumption Is Associated with a Lower Risk of Cancer” – states that, “individuals who ate 18 grams of mushrooms daily had a 45% lower risk of cancer compared to those who did not eat mushrooms.”

From a premature death standpoint, “adults who ate mushrooms had a lower risk of premature death, regardless of their demographics, lifestyle choices, and other dietary factors,” according to Penn State College of Medicine News.

To reach their conclusions, as to the positive affect mushroom consumption has on cognitive performance, Penn State researchers compiled statistics from 24,000 U.S. adults – average age 45 – between 2005 and 2016 on diet and mental health. The survey participants were primarily (66%) non-Hispanic white people.

The researchers comment that, “mushrooms contain ergothioneine, an antioxidant that may protect against cell and tissue damage in the body. Studies have shown that antioxidants help prevent several mental illnesses, such as schizophrenia, bipolar disorder and depression.”

The most commonly consumed mushroom in the U.S., the white button variety, contain potassium, which is believed to lower anxiety.  Edible mushroom species, like Lion’s Mane, may stimulate the expression of neurotrophic factors, such as nerve growth factor synthesis – potentially preventing neuropsychiatric disorders including depression.

The Penn State survey revealed that college-educated, non-Hispanic, white women were more likely to eat mushrooms.

The investigators observed, “a significant association between mushroom consumption and lower odds of depression, after accounting for socio-demographics, major risk factors, self-reported diseases, medications, and other dietary factors.” However, “there was no clear additional benefit with relatively high mushroom intake.”

It was noted that the data did not provide details on the types of mushrooms, and it could not be determined the effects of specific types of mushrooms on depression.”

You can read the survey here.

Interested in reading more? Check out Nutritional Supplementation with Resistance Exercise Increases Lean Muscle

The Amino Acid Glutamine Is Another Weapon for COVID-19 Prevention

In March of 2021, Mackie Shilstone offered a column on the positive effects, which the conditionally essential amino acid L-glutamine offered to reduce Covid-19 immune activated symptoms. In that column, he commented that initial Covid-19 research demonstrated that individuals with co-morbidities, such as obesity, diabetes, cardiovascular and pulmonary disease, were at greater risk to severe Covid-19 complications.

Glutamine, the most abundant amino acid in the blood, is released mainly from skeletal muscle, then transported to multiple tissue sites. It’s also used for the manufacture of glutathione (GSH), a powerful antioxidant.

A diverse group of researchers – Japan, China, and United States, report in Cell Death & Differentiation (CDD) in October 2021– “Comorbidity-Associated Glutamine Deficiency Is a Predisposition to Severe COVID-19” – that, “while it is presently unclear whether glutamine supplementation post-infection leads to an overall positive outcome, addressing glutamine deficiency prophylactically for those in high-risk groups is a safe and simple strategy for their protection in the era of COVID-19.

These same investigators cite 2012 research in the journal Circulation, which said that plasma glutamine and the glutamine-glutamate ratio are inversely associated with metabolic risks – leading to further research that concluded that low levels of glutamine were negatively correlated with COVID-19 disease severity.

In severe cases, SARS-CoV-2, COVID-19, can cause acute respiratory distress (ARD) and impair the body’s ability to coagulate (clot). Autopsies from COVID-19 patients demonstrated, that the average weight of the lung was 3.2 times that of a normal lung – yielding the name “heavy lungs,” resulting from the overproduction of hyaluronan (HA), an extracellular matrix of glycosaminoglycan polymers, which are used in the body as a lubricant or shock absorber.

Overproduction of HA in the lungs is not a desirable occurrence.

It also appears that a low glutamine status and a high glucose level could predispose high-risk COVID-19 groups to produce larger amounts of the HA.


The study authors state that, “glutamine deficiency in the high-risk groups may have previously established low levels of immune dysfunction and HA overproduction prior to infection.”

As for the antioxidant protection afforded by glutamine, “after SARS-CoV-2 infection, the cells are exposed to intense oxidative stress, which consumes intracellular glutamine for the production of the antioxidant, glutathione. This would further exacerbate the glutamine deficiency, potentially leading to grave metabolic dysfunction in the high-risk populations.”

The researchers say as to prevention and treatment of severe COVID-19, a top priority is to address glucose stability. “Studies have revealed that glutamine supplementation can lead to a decrease in the levels of fasting blood glucose and postprandial glucose, and an increase in insulin production,” as referenced in the CDD research paper.

There are certain situations, where glutamine supplementation may be contraindicated. “In 2013, a randomized clinical trial study, REDOXS, showed that high-dose glutamine use in critically ill patients was associated with increased mortality, with no beneficial effects,” which led the researchers to comment that, “clearly, the effects of long-term use of high-dose glutamine supplementation need to be carefully determined.”

The CDD study authors concluded that, “glutamine deficiency and HA overproduction appear to be the primary metabolic commonalities that not only are shared amongst the COVID-19 comorbidities, but also contribute to the immunological dysfunction that is exacerbated by SARS-CoV-2 infection.”

Interested in a Podcast? Check Out Maximum Wellness, Episode 113: Determining the Correct Diet Post Cancer Diagnosis

Resistance Exercise with Nutritional Supplementation Increases Lean Muscle

The synergistic combination of sports nutrition and performance training – such as resistance exercise (RET) – have been a winning, research-based combination for many years. One of the most important, intended results is the increase (hypertrophy) of lean body mass (LBM).

One aspect of the sports nutrition objective of muscle hypertrophy, once the proper macro & micro dietary component is put into place, is the medically approved use of nutritional supplements to facilitate muscle repair and growth.

Whey protein, specifically whey isolate, has a high essential amino acid content, including the anabolic branch chain amino acid leucine, which stimulates muscle protein synthesis (MPS) and promotes hypertrophy.

According to “The Effect of a Multi-Ingredient Supplement on Resistance Training-Induced Adaptations,” which appeared in the August issue of Medicine & Science in Sports & Exercise, “leucine is a critical amino acid for increasing MPS and suppressing muscle protein breakdown. It is unique among amino acids in its ability to independently stimulate MPS through activation of the mechanistic target of rapamycin complex 1 pathway.”

In my book, Lean & Hard – the body you always wanted in 24 workouts, which was based on an applied, six-week research study, during my prior tenure as an Associate professor in the School of Public Health and Preventive Medicine at the LSU Health Sciences Center, RET, in combination with whey protein and other medically approved nutritional supplements, was demonstrated to be effective at augmenting lean body mass (LBM) and muscle strength.

The Medicine & Science study authors, from the Department of Kinesiology, McMaster University and the Toronto Rehabilitation Institute in Canada, comment that, “ingredients such as creatine, vitamin D, and calcium citrate are widely utilized and often studied together, showing an improvement in lean tissue mass and lower body strength in conjunction with resistance training.

What’s been missing, according to the study authors, has been that few studies have included female participants, with emphasis on the effect of nutritional supplements on muscle hypertrophy is women.

As a result, the Canadians, in their double-blind, randomized, controlled trial, chose to, “determine whether there is an augmented effect of a multi-ingredient, nutritional supplement on skeletal muscle hypertrophy and strength in male and female adults involved in a 10-wk linear resistance training program” – compared to a placebo supplement containing the equivalent amount of nitrogen (what amino acids net) and non-essential amino acids.

It was speculated that, “the combined effect of whey protein, leucine, creatine, calcium citrate, and vitamin D, in addition to resistance exercise, would induce hypertrophy and increases in strength to a larger degree than resistance training with the placebo supplement in healthy young adults.”

Creatine was included in the study protocol, resulting from its ability to increase muscle mass and strength with resistance training (as was the case with my study) in younger and older adults. “Vitamin D, and calcium citrate are widely utilized and often studied together, showing an improvement in lean tissue mass and lower body strength in conjunction with resistance training,” note the Canadians.

Then study group included twenty-six (13 male, 13 female) healthy young adults – average age of 22 – who were randomized to either the SUPP (supplement) group (13 participants; 20 grams (g) of whey protein, 2 g leucine, 2.5 g creatine monohydrate, 300 mg calcium citrate, 1000 IU vitamin D) or the PL (placebo) group (13 participants; 20 g collagen peptides, 1.4 g alanine, 0.6 g glycine) groups, ingesting their respective supplements twice daily.

Measurements – including dietary assessment, body composition, ultrasound muscle thickness & cross-sectional area (CSA), muscle fiber type & CSA, were obtained before and after a 10-week, linear, progressive RET program, which included weekly training blocs of 4-days per week (two alternating upper & lower body resistance exercises).

The exercise selection on Monday and Thursday included squat, deadlifts, lunges, hamstring curls, leg press, calf raise, and leg extension. Tuesday and Friday included bench press, standing military barbell press, incline dumbbell press, single-arm row, seated row, pronated and supinated latissimus dorsi pull-downs, and supinated incline bicep curls – all in progressive variations of 3-5 sets and repetitions of 8-12 – based on an initial 80 percent of the individuals one-repetition maximum.

At the conclusion of the 10-week intervention, the Canadians reported that, “the twice-daily consumption of a multi-ingredient supplement containing whey protein, creatine, leucine, calcium citrate, and vitamin D was effective in augmenting LBM gains and upper-body muscle CSA and thickness, as well as, type II fiber CSA in conjunction with a 10-week RET program,” compared to the placebo group.

Interested in reading more? Check out Edible Mushrooms May Lower Risk of Depression

Nutrition & Physical Activity May Modify Covid-19 Risk

With the surge of the Delta Covid-19 variant, the world has a new pathogen enemy among us – the hidden villain that spares no one, especially those unvaccinated. What began in Wuhan, China in December of 2019 and declared in March of 2020 a pandemic, Covid-19, the disease spawned by the SARS-CoV-2 virus, has transformed life as we know it. It’s here to stay in some form or another.

The effects of lockdowns, the use of protective masks, social distancing, and more has had a direct impact on an individual’s nutrition status and movement pattern.

A person’s susceptibility to Covid-19 has as much to do with their nutrition status, as it does to any comorbidities on board, such as obesity, hypertension, pulmonary dysfunction, diabetes, and cardiovascular disease.

 Researchers, from Spain, Columbia, and Greece, used a narrative review, “with the aim of collecting published literature and articles regarding dietary patterns, body composition, nutritional deficiencies, vitamin interventions, and physical activity in the COVID-19 pandemic.”

The study – Nutrition in the Actual Covid-19 Pandemic. A Narrative Review – which appeared in the June online issue of Nutrients, found that the COVID-19 lockdown promoted unhealthy dietary changes and increases in body weight of the population, showing obesity and low physical activity levels, as increased risk factors of COVID-19 affection and physiopathology.”

What’s more, “hospitalized COVID-19 patients presented malnutrition and deficiencies in vitamin C, vitamin D, B12, selenium, iron, omega-3, and medium and long-chain fatty acids, highlighting the potential health effect of vitamin C and D interventions.”

The search methods, from February 1st, 2020, through April 13th, 2021, included PubMed, Embase, SciELO, Science Direct Scopus, and Web of Science, employing MeSH-compliant keywords including, COVID-19, Coronavirus 2019, SARS-CoV-2, 2019-nCoV, Nutrition, Diet, Dietary Patterns, Body Compositions, Vitamins, Nutritional, Immunology, Physical Condition, and Physical activity.

Here’s the summary of the findings, as noted in the narrative review of the data base:

The COVID-19 lockdown promoted unhealthy dietary changes (inactivity, daily intake, snacks, alcohol), increasing body mass and fat, and showing obesity-overweight people poor diet habits.

Obesity is a risk factor for COVID-19.

A healthy balanced diet is an integral part of personal risk management.

Vitamins C and D improve health-related outcomes in COVID-patients.

Sufficient vitamin intake and an active lifestyle are strongly recommended as a preventive measure to the general population.

There is a large prevalence of malnutrition among hospitalized patients with COVID-19.

Nutritional support and rehabilitation exercise are needed to avoid muscle atrophy and sarcopenia in COVID-19 hospitalized patients. They should be considered as an integral part of the therapeutic approach.

Deficient states of vitamin C, D, B12 selenium, iron, ω-3, and medium and long-chain fatty acids increase the probability of hospitalization and mortality from COVID-19.

The gut microbiome profile is altered due to COVID-19, being involved in the magnitude of COVID-19 severity via modulating host immune responses.

A healthy gut microbiome serves as a preventive and protective factor, appropriate nutrition and probiotics are good strategies for its enhancement.

Active lifestyle and physical activity allow a lower risk, and mortality rate in COVID-19 patients, due to its positive effect on metabolic health and inflammation.

The reviewers were quick to point out that more research of this evolving disease and its variants is needed relative to the impact of nutrition and other lifestyle modifications consistent with risk stratification.

Interested in Listening to a Podcast? Check out Maximum Wellness, Episode 111: Nutritional Factors Modify Risk of Covid-19 Infection

Nutritional Factors May Modify Risk to Covid-19

Covid-19 – the infectious disease initiated by SARS-CoV-2 – that primarily attacks respiratory (breathing) function – has not only spread rapidly over the prior year, but also has spawned more contagious variations, such as the current Delta variant.

The human immune system – innate and adaptive – activates the body’s response to the Covid-19 antigen. Individuals with comorbidities, like obesity, hypertension, pulmonary dysfunction, diabetes, and cardiovascular disease, are at increased risk to adverse complications.

Supporting the body’s challenge to the invading antigen is an individual’s dietary behavior that influences nutritional status.

With respect to Covid-19 and the association of dietary behaviors, researchers from the Department of Preventive Medicine, Research and Information Services, and the Department of Medicine, Feinberg School of Medicine, Northwestern University in Chicago, chose to use data from the UK Biobank (UKB) to examine the dietary behaviors measured in 2006-2010 and Covid-19 infections in 2020.

The American researchers linked the UKB geo-data to UK Covid-19 surveillance data to account for Covid-19 exposure.

The UKB is an international health resource of over 500,000 participants aged 37–73 years at 22 centers across England, Wales, and Scotland.

The UKB participants, who underwent physical measurements, assessments about health and risk factors (including lifestyle and dietary behaviors), and blood sampling at baseline (2006–2010), agreed to follow-up on their health status.  Country-wide surveillance data was used to identify UKB participants exposed to COVID-19.

Based on the data analysis, it was determined that, “consuming more coffee, vegetables, and being breast fed, as well as, consuming less processed meat intake were independently associated with lower odds of COVID-19 positivity. These associations were attenuated (reduced), when accounting for the UK’s COVID-19 case rate (i.e., exposure).”

The data analysis reflected that, “habitual consumption of 1 or more cups of coffee per day was associated with about a 10% decrease in risk of COVID-19, compared to less than 1 cup/day,” while, “consumption of at least 0.67 servings/d of vegetables (cooked or raw, excluding potatoes) was associated with a lower risk of COVID-19 infection.”

The UKB American investigators found that processed meat consumption (refers to any meat that has been transformed through salting, curing, fermenting, smoking, or other process to enhance flavor or improve preservation) of as little as 0.43 servings/day was associated with a higher risk of COVID-19.

However, comment the Americans, “red meat consumption presented no risk, suggesting meat per se does not underlie the association we observed with processed meats.”

Finally, it was found that, “a long-term favorable association between being breastfed as a baby and COVID-19 infection in UKB contribute to the growing evidence in support of nutrition early in life for optimal immunity for life.”

The study analysis concluded, “our results support the hypothesis that nutritional factors may influence distinct aspects of the immune system, hence susceptibility to COVID-19.”

Interested in Reading More? Check Out COVID-19: Immune Support Update 3

Lean & Hard: Creatine Monohydrate for Older Adults

In 2007, Mackie Shilstone’s book, Lean & Hard – the body you’ve always wanted in 24 workouts – was published by John Wiley & Sons. L&H offered a comprehensive six week, four workouts
per week diet, nutritional supplement schedule, resistive exercise, and sprint-interval program – designed to increase lean muscle mass.

The L&H book was based on a research study of Shilstone’s concepts that followed a cross section of athletes and non-athletes over six weeks, when he was an Associate Professor in the LSU School of Public Health and Preventive Medicine.

One of the nutritional supplements tested in the applied research study and utilized in Lean & Hard was creatine – an organic acid that is created internally from the action of the amino acids arginine, glycine, and methionine, which are constructed in the liver and regulated through kidney function.

Creatine predominantly resides in skeletal muscle – mostly as phosphocreatine – with roughly two percent degrading to creatinine, a metabolic by-product, which is why too much creatine may skew a creatinine clearance test assessing kidney function.

Creatine use by athletes has been widely studied for its side effect of weight gain, which was initially thought to be fluid gain, but with years of research, is now determined to be lean muscle development, when used correctly.

Shilstone came to a conclusion, after observing the results of an LSU applied study and his continued research on creatine, that someday creatine monohydrate would offer additional benefits to an ageing population – specifically to address sarcopenia – the age- related loss in muscle strength (dynapenia), muscle mass, muscle quality, and physical performance (frailty issues).

That day has now arrived.

New research – Current Evidence and Possible Future Applications of Creatine Supplementation for Older Adults – which appeared in the March 2021 online, peer- reviewed journal Nutrients – comments that, “sarcopenia typically occurs in 8–13% of adults ≥60 years of age, and, is associated with other age-related health conditions, such as osteoporosis, osteosarcopenia (muscle related bone loss), sarcopenic obesity, physical frailty, and cachexia (muscle loss due to disease).”

Muscle mass decreases by 0.45% in men and by 0.37% in women. However, these decrements climb to 0.9% for men and to 0.7% for women starting in their seventh decade.

The age-related decrease in muscle strength – a strong predictor of poor health outcomes, such as mobility disability, falls, fractures, and mortality in older adults – occurs more rapidly (2–5 times fold faster) than the reduction in lean (muscle) mass.

The Canadian and Australian study authors performed a narrative review evaluating the current research involving creatine (CR), with and without resistive training (RT), on properties of muscle and bone in older adults, “in order to provide a rationale and justification for future research involving CR in older adults with osteosarcopenia, sarcopenic obesity, physical frailty, or cachexia.”

Here’s what was determined.

As it pertains to addressing sarcopenia, “CR (≥3 grams/day) and RT (≥7 weeks; primarily whole-body routines) can improve some measures of muscle accretion, strength, and physical performance in older adults. Independent of RT, a CR loading phase and/or high relative daily dosage of creatine (≥0.3 g/kg/day) may be required to produce some muscle benefits in older adults.”

Relative to creatine monohydrate usage with osteoporosis – the age-related loss of bone mineral density – “collectively, the vast majority of studies show no greater effect from CR, with and without RT, on properties of bone in older adults.”

For use with sarcopenic obesity, which the researchers say occurs in approximately 20% of the older adult populations, “CR and RT appear to be an effective intervention for decreasing body fat% in older adults. However, the effects of CR alone on adipose tissue biology in older adults are unknown.”

With respect to physical frailty – a syndrome of physiological decline in later life, characterized by vulnerability to adverse health outcomes (hospitalizations, falls, social=isolation, and reduced quality of life) – “despite the preclinical and clinical evidence demonstrating an effect from creatine on multiple pathophysiological mechanisms associated with frailty, no RCT has been performed examining the effects of CR (alone or in combination with exercise) in frail older adults.”

As to CR reducing the impact of cachexia – muscle tissue wasting and severe weight loss from cancer, COPD, chronic kidney disease, and heart failure – the researchers concluded that, “creatine has the potential to target several of the mechanisms associated with cachexia; however, research investigating the effects of creatine and cachexia is very limited.

The initial creatine utilization protocols with resistive training and explosive-type events, such as American Football and combative sports, called for a loading phase of 20 grams per day (5 grams four time daily) for 5 days followed by 5-10 grams per day for a maintenance phase for the prescribed time period.

Over time, that protocol has evolved to a 3-day loading phase of 20 grams per day, followed by 5 grams per day for the maintenance phase.

My Sports and Lifestyle Nutritionist, Jodie Muhleisen, a Registered Dietitian Nutritionist, certified in sports nutrition, who has worked with Shilstone’s various sports performance, fitness, and wellness hospital-affiliated programs over the last decade, reinforces that, “we first established that each creatine utilization candidate met the appropriate medical (normal kidney and liver function) and performance criteria.”

Then, “once the 3-day loading phase is complete, 5 grams of creatine per day is used, only on days in which resistive or explosive-type training is performed – with a combined loading and maintenance phase of six weeks.”

As referenced in the Nutrients study, other creatine protocols call for between 0.3 grams/kilogram/day to 0.1 grams/kg/day, as determined in conjunction with the guidance of your personal physician and dietitian, who is experienced in managing a creatine protocol.

Interested in Listening to a Podcast? Check out Maximum Wellness, Episode 68: How to Offset the Effects of Age-Associated Muscle Loss

Covid Infected Pro Athletes & Inflammatory Heart Disease

When the Covid-19 management strategy unfolded over 2020 – which included assessment, treatment, prevention, and immunization – return to normal safety protocols became a complex, yet vital part, of preventing further devastation to human life and the world’s economy.

As time and the control of the coronavirus disease unfolded, the major North American professional sports leagues were among the first to implement a return- to-play (RTP) scenario – with the appropriate prevention measures in place – like no fans, player and staff bubbles, daily Covid-19 testing, sequestering players that tested positive, and much more.

As a result of the unknown incidence of “cardiac sequelae” (consequences of a particular condition) – resulting from Covid-19 infection, a conservative RTP cardiac testing program mirroring the American College of Cardiology
recommendations, was implemented for all athletes, who tested positive for Covid-19.

In new research – Prevalence of Inflammatory Heart Disease Among Professional Athletes with Prior COVID-19 Infection Who Received Systemic Return-to-Play Cardiac Screening – which appeared in March of 2021 in the online issue of JAMA Cardiology (Journal of the American College of Cardiology), a diverse group of medical experts sought to, “to assess the prevalence of detectable inflammatory heart disease in professional athletes with prior COVID-19 infection, using current RTP screening recommendations.”

This descriptive study, a cross-sectional evaluation of cardiac testing performed between May to October 2020, followed the Strobe (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines.

It included 789 professional athletes from Major League Soccer, Major League Baseball, National Hockey League, National Football League, and the men’s and women’s National Basketball Association – with an average age of 25 – composed of 777 men, of which 460 athletes had prior symptomatic COVID-19 illness, and 329 were asymptomatic or paucisymptomatic (minimally symptomatic)

A summary of the study group’s cardiac health status was as follows: “Thirty athletes were sent for additional cardiac testing, as a result of abnormalities on the initial cardiac screening tests that raised concern for potential COVID-19–associated cardiac injury. Cardiac magnetic resonance (CMR) imaging was performed in 27 of these 30 athletes. Downstream testing confirmed diagnoses of inflammatory heart disease in 5 of 27 athletes: 3 athletes with CMR-confirmed myocarditis (inflammation of the heart muscle) and 2 athletes with CMR- confirmed pericarditis (swelling of the thin, saclike tissue surrounding the heart).

The remaining 25 of 30 athletes (83.3%) who underwent additional testing, did not ultimately have findings to suggest acute cardiac injury and returned to play.” RTP cardiac screening for professional athletes testing positive for COVID-19, noted the investigators, “demonstrated that 0.6% (5 of 789 athletes) had imaging findings, “suggestive of inflammatory heart disease, that resulted in restriction from play in alignment with American Heart Association/ACC guidelines.”

The researchers concluded that, “while long-term follow-up is ongoing, few cases of inflammatory heart disease have been detected, and a safe return to professional sports activity has thus far been achieved.”

Interested in Listening to a Podcast? Check out Maximum Wellness, Episode 100: The Covid-19 Pandemic Changed the Way We Exercise

Postmenopausal Women: Chocolate May Help Control Appetite

Having been exposed to the medical, metabolic, and physiological gender-based factors associated with weight gain, weight loss, body composition changes, and the psychological aspects in a diverse cross-section of male and female participants in Mackie Shilstone’s prior hospital-affiliated wellness and weight management programs over the last thirty years, he attests to the fact that what you eat, when you eat – along with age and health profile, account for many of the complex issues associate with weight control. The question at hand is, “Can chocolate help control appetite in postmenopausal women?”

Biologically speaking (circadian rhythm), late night eating certainly has its drawbacks on metabolic rate, cardiometabolic health, hormone secretion (melatonin production), and fat oxidation versus storage. Prior research and common sense have demonstrated that eating chocolate late at night has been associated with long-term weight gain, especially in postmenopausal women (average age of 51), who are vulnerable to weight gain. It appears now that chocolate and the timing of its consumption may have earned a bad rap.

Research – Timing of Chocolate Intake Affects Hunger, Substrate Oxidation, and Microbiota: a Randomized Controlled Trail – reported in the July online issue of the FASEB journal (the journal of the Federation of American Societies for Experimental Biology), suggests that, “chocolate, in the morning or in the evening/night, in a narrow window of time (1 hour), results in differential effects on hunger and appetite, substrate oxidation, fasting glucose, microbiota composition and function, and sleep and temperature rhythms.”

“The intake of a rather high amount of chocolate (100 grams),” comment the researchers from Brigham and Woman’s Hospital in Boston, “concentrated in a narrow (1 hour) timing window in the morning could help to burn body fat and to decrease glucose levels in postmenopausal women.”

This determination involved 19 postmenopausal women, who completed a nine week, randomized, controlled, cross-over trial of “ad libitum food” intake – with either 100 grams of chocolate (~33% of their daily energy intake) in the morning, defined as within one hour after waking time, or at evening/night – within one hour before bedtime, compared to no chocolate intake. The duration of each intervention was two weeks, which included a transition period.

The study participants underwent the following tests and measurements: Body weight (baseline and three additional timed dates), height, body fat, dietary food intake record, visual analog scale before and after each meal (hunger & appetite assessment), body temperature, activity, sleep duration, number of awakenings, nap frequency and duration, metabolic rate assessment, salivary cortisol determinations, fasting glucose, and analysis of their gut microbiota (short- chain fatty acids from fecal samples).

The study found that the 19 postmenopausal women did not gain body weight with the chocolate intake. In fact, comment the investigators, “while the volunteers had an increase of energy intake due to chocolate’s extra calories (extra 542 kcal), as compared to the non-chocolate condition, they spontaneously reduced their ad libitum energy intake by 16%, when eating chocolate in the morning.”

This situation occurred even though the females consumed milk chocolate that has been shown to have less of an effect in decreasing appetite than dark chocolate. Further stated, “results show that when eating chocolate, females were less hungry and had less desire for sweets than with no chocolate, especially when taking chocolate during the evening/night. Moreover, daily cortisol levels were lower when eating chocolate in the morning than at evening/night.”

Lower cortisol levels have been shown to cause a reduced stress-related appetite, “which may partly explain the better caloric compensation by the females, when eating chocolate in the morning.”

The researchers stated, “our results also show that chocolate in the morning decreases fasting glucose. Chocolate may improve glucose homeostasis by slowing carbohydrate digestion and absorption.”

There were also favorable changes in the participants microbiota’s short chain fatty acid content that may have accounted for better hunger control.

Before you make a B-line to the nearest chocolate bar, this study involved a small number of targeted female participants – postmenopausal women. One size does not fit all.

Interested in Reading More? Check Out Can Small Amounts of Chocolate Be Good For You?

Metabolic Syndrome: How Exercise Can Be Medicine

One third of the US adult population is affected by metabolic syndrome (MetS), a cluster of events – prediabetes, prehypertension, increased waist measurement, and dyslipidemia – that can lead to type 2 diabetes and cardiovascular disease. 

Thirty-five percent of those adults with metabolic syndrome take, at minimum, two or more daily medications to assist in controlling those conditions associated with MetS – with the potential for adverse drug interaction side effects.

Exercise, as part of a healthy lifestyle modification program, can help to reduce the burden of polypharmacy – many medications taken simultaneously – on MetS individuals. 

University researchers in Spain, reporting in the July 2021 issue of Medicine & Science in Sports & Exercise, sought to determine the effects of a 5-year exercise intervention on MetS, health-related variables, and medication use. 

Using a randomized, controlled trial, 64 middle-age men and women with MetS, who were physically inactive (less than150 minutes per week of moderate-intensity physical activity) were allocated to three alternate day exercise sessions per week or a standard care group – with a block on age, number of MetS factors, and body mass index (BMI). 

The researchers analyzed data at the start of program, and after a 5-year follow-up – using data from a previously published 2-year follow-up. The intervention period lasted 4 month each year of the 5-year period.

The exercise session included a 10-min warm-up at 70% of peak heart rate (HRmax) followed by four 4-min intervals at 90% of HRmax interspersed with 3-min active recovery at 70% of HRmax and a 5-min cooldown period. Heart rate (HR) was continuously displayed on a large screen – with participants self-adjusting the workload to reach their individual HR target value. 

At baseline and at the conclusion of the 5-year intervention period, the study participant’s height, weight, waist circumference, and body composition were assessed. Lab values for serum glucose, insulin, lipid levels (triglyceride, total, HDL, and LDL cholesterol) were obtained – along with a 3-day nutritional diary, which was analyzed for calorie intake and macronutrient composition.

Additionally, the participants, who were under the care of their primary physician for MetS medication and lifestyle guidelines, underwent a maximal, graded cardiopulmonary exercise test to assess heart rate max (HRmax) and maximum oxygen uptake (VO2 Max).

The Spanish researchers concluded that, “exercise training can attenuate (reduce) the increase in medication that would be otherwise required to manage MetS over a 5-yr period. These findings have potential for translation into a real-life scenario, because benefits were observed with only 4 months of supervised training per year and with no concomitant body weight loss or dietary intervention.”

The take-away message is exercise is medicine, when performed under appropriate guidelines, as outlined by your healthcare professional. 

Interested in Reading More? Check out Waist-to-Height Ratio’s (WHtR) Connection to Disease

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