A 2011 study in the Journal of Clinical Endocrinology Metabolism said the waist-to-height ratio (WHtR) was the strongest predictor of cardiovascular disease and mortality.

WHtR is calculated by dividing waist size by height. It takes gender into account. WHtR is thought to give a more accurate assessment of health, since the most dangerous place to carry weight is in the abdomen.

JAMA (Journal of the American Medical Association) Cardiology in July of 2019 said, “normal-weight central obesity in women (postmenopausal) was associated with excess risk of mortality, similar to that of women with BMI-defined obesity with central obesity.”

BMI (body mass index) – your weight in kilograms divided by your height in meters squared – is the standard measure used to define obesity in clinical and public health guidelines.” However, BMI has an inherent limitation in that it does not distinguish body shape or body fat distribution.

Normal weight at 18.5 to 24.9, overweight at 25 to 29.9, obese 30 or greater, while central obesity in females was defined as having a waist circumference (WC) equal to or greater than 88 centimeters (35 inches).

The JAMA study concluded that, “normal-weight, central obesity was associated with a higher risk of all-cause, cardiovascular disease, and cancer mortality compared with normal-weight without central obesity”

Fat in the abdomen, which is associated with a larger waist, is metabolically active and produces various hormones that can cause harmful effects, such as diabetes, elevated blood pressure, and altered lipid (blood fat) levels.

Many athletes, both male and female, who often have a higher percentage of muscle and a lower percentage of body fat, have relatively high BMI’s but their WHtRs are within a healthy range. This fact also holds true for women who have a “pear” rather than an “apple” shape.

For instance, a male with a 32-inch waist, who is 5’10” (70 inches) would divide 32 by 70, to get a WHtR of 45.7 percent.

WOMEN WHtR
Ratio less than 35: Abnormally Slim to Underweight
Ratio 35 to 42: Extremely Slim
Ratio 42 to 46: Healthy
Ratio 46 to 49: Healthy
Ratio 49 to 54: Overweight
Ratio 54 to 58: Seriously Overweight
Ratio over 58: Highly Obese

MEN WHtR
Ratio less than 35: Abnormally Slim to Underweight
Ratio 35 to 43: Extremely slim
Ratio 43 to 46: Healthy
Ratio 46 to 53: Healthy, Normal Weight
Ratio 53 to 58: Overweight
Ratio 58 to 63: Extremely Overweight/Obese
Ratio over 63: Highly Obese

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Osteoporosis is a disease that causes the skeleton to weaken and the bones to break. While we mainly think of osteoporosis as a post-menopause female disease, it also poses a significant threat to men.

WebMD.com says as many as 2 million American men already have osteoporosis, with twelve million men are at risk – many having bone loss and low bone mineral density called osteopenia.

According to the April 2020 issue of Life Extension Magazine, that fractures in men, resulting from osteoporosis, are more severe – with one-third of all hip fractures world-wide occurring in men.

The mortality rate for men over 60 years of age, who sustain a hip fracture is 37.5% – with an increased risk to die from an infection during the first two years, after the hip fracture.

Negative lifestyle factors, such as low body mass index, a genetic predisposition resulting from a parent with osteoporosis, high alcohol intake, smoking, glucocorticoid treatment, type 1 diabetes, rheumatoid arthritis, thyroid disorders, and chemotherapy treatment for cancer, raise a man’s bone fracture risk. Measures to reduce the risk to osteoporosis include bone strengthening modes,
such as physical activity, weight-bearing exercising, resistance training, while also including adequate amounts of calcium, vitamin D, magnesium, vitamin K, zinc, manganese, boron, and silicon.

Calcium provides the predominant mineral content of bones.
Vitamin D3 promotes calcium uptake from the gastrointestinal tract.
Magnesium controls calcium in and out of bone cells.
Zinc stimulates new bone formation.
Manganese is a cofactor to enzymes that stimulate bone growth.
Vitamin K activates the bone hormone osteocalcin needed for bone strength.
Silicon improves the quality of bone matrix.
Boron regulates calcium metabolism and other bone building minerals.

Lifeextension.com also said that, “curcumin, and extract of the turmeric plant, has powerful anti-inflammatory properties. Chronic systemic inflammation is now being recognized as a contributor to osteoporosis risk.”

A man or woman has many options to reduce the risk to this bone weakening disease. It’s important to work with you doctor to assess your risk to osteoporosis as you age.

Prior research has established that the consumption of green tea or coffee has been said to reduce the all-cause mortality in the general public. However, as to the similar effects in those with health challenges, such as diabetes, research is either controversial or devoid – until now.

Japanese researchers publishing the Additive Effects of Green Tea and Coffee on All-Cause Mortality in Patients with Type-2 Diabetes Mellitus: the Fukuoka Diabetes Registry, which appeared in October 2020 in the open-access online BMJ (British Medical Journal) Diabetes Research & Care, determined that, “higher consumption of green tea and coffee was associated with reduced all-cause mortality: their combined effect appeared to be additive in patients with type-2 diabetes.”

The Japanese researchers from the Departments of Medicine and Clinical Sciences, Graduate School of Medical Sciences and the Division of Internal Medicine, Fukuoka, Japan, comment that green tea derives benefits from fresh leaves of Camellia sinensis – containing various chemicals, such as phenolic compounds, theanine, and caffeine, which possess antioxidant, anti-inflammatory, or anti-bacterial properties.

Coffee, note the Japanese, contains phenolic compounds and caffeine that offer antioxidant, anti-inflammatory, and ant-mutagenic benefits – especially to type-2 diabetics, those with abnormal lipid profiles, and malignancy.

To reach this conclusion, the investigators, after appropriate exclusion criteria, used data from 4923 study participants enrolled between April 2008 and October 2010, in the Fukuoka Diabetes Registry, “a multicenter prospective study designed to investigate the effects of modern treatments and lifestyle on the prognoses of patients with diabetes mellitus.”

Using a self-administered questionnaire, the participants provided information regarding their diagnosed diabetes duration, smoking habits, alcohol intake, leisure-time physical activity, sleep duration, depressive symptoms, and history of coronary heart disease, stroke, and cancer. Their smoking habits and alcohol intake were classified as either current or not.

Body weight, height and body mass index were ascertained – along with blood pressure. Medical charts were reviewed for all medications, including insulin, oral hypoglycemic agent, antihypertensive drugs, antiplatelet drugs, and statins. The Japanese commented that using self-reported answers to dietary questions, “we categorized the participants into the following four groups by beverage: green tea, none, ≤1 cup/day, 2–3 cups /day, ≥4 cups/day; and coffee, none, <1 cup/day, 1 cup/day, ≥2 cups/day. There were no questions about the consumption of
decaffeinated or caffeinated drinks because decaffeinated beverages are uncommon in Japan.”

From a laboratory perspective, blood samples and spot urine samples were obtained. Hemoglobin A1c (HbA1c) was determined by high-performance liquid chromatograph. Serum low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, creatinine, and urinary creatinine, and albumin were measured – with the glomerular filtration rate (GFR) and calculations of the urinary albumin-creatinine ratio levels.

It was concluded that, “our results suggest that consuming green tea and coffee may have beneficial effects on the longevity of Japanese people with type 2 diabetes.” How this data translates to all of us outside Japan, will require further research.

Until then, keep my green tea and black coffee consumption – in moderation – flowing.

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Prior research, which appeared in the British Journal of Sports Medicine in 2016, corroborates that physical activity has a protective effect against an individual’s
overall cancer mortality risk, specifically, as it applies to colorectal and breast cancer.

Current research – Effect of Time of Day of Recreational and Household Physical Activity on Prostate and Breast Cancer Risk (MCC-Spain Study) – which appeared in the September 2020 issue of the International Journal of Cancer, said, “a recent meta‐analysis on breast cancer reported an approximate 20% reduction in risk associated with physical exercise for both premenopausal and postmenopausal women.”

Additionally, “evidence for recreational physical activity and prostate cancer is less consistent, although long‐term occupational physical activity seems to reduce prostate cancer risk.”

Factors, such as circadian rhythm disruption from dietary patterns, work hours, environmental cues (light exposure) and melatonin production, can affect cancer risk. The circadian rhythm is knocked off balance, when external factors – like light exposure during sleep – may interfere with the normal nighttime production of melatonin.

Mayoclinic.org says that melatonin, which declines with age, is a hormone produced and released in the brain – increasing when it’s dark and decreasing when it’s light.

The study authors, from various university and government departments in Spain, report that, “in 2007, the International Agency for Research on Cancer classified shift work, which includes circadian disruption as probably carcinogenic to humans.” Further stating that, “exposure to artificial light at night and particularly exposure to blue light spectrum light has been associated with higher breast and prostate cancer risk.”

In 2018 in the same study population, researchers report in the International Cancer Journal that a study examining circadian timings and chronotype (a human attribute that correlates with diurnal preferences for activities in morning or evening), concluded that morning exercisers had the highest protection, when following diurnal patterns of diet compared to those having late supper (last evening meal).

Using a refined cohort of 5365 participants – breast cases: 1438 female controls: 1593; prostate cases: 1004, male controls: 1330) – in the MCC-Spain population
that included five cancer types and 10,106 subjects (51.8% males), data was collected between September 2008 to December 2013 in 23 hospitals, and the rosters of primary health care centers (controls) in 12 Spanish provinces.

The 5365 participants, who initially responded to circadian timing questionnaires, had a computerized questionnaire administered by experienced personnel in face-to-face interviews – with subsequent information taken, as to residential history, personal and family medical history, sociodemographic factors, occupational and lifestyle history, height, weight, along with securing biological samples.

The participants were told, “we are going to ask you about any physical activity done outside working hours, including walking, any exercise, and going to the gym. We are interested in any physical activity you did continuously and for at least six months throughout your life.”

Then, the participants were asked, “what activity do you do, or did you use to do?”  Appropriate medical information was obtained, so as to identify multiple facets of breast and prostate cancer status in those respective participants. The Spanish study authors, “observed that the overall protective effect of recreational and household physical activity for cancer may vary depending on the
time of the day of the activity.”

“We found,” they comment, “that early morning activity might be more protective than late morning‐afternoon activity for both breast and prostate cancer risk. Findings on evening activity differed with a moderate protective effect observed only for prostate cancer.”

Of note, was the fact that, “the biological pathways associated with a differential effect of physical activity during the day are unclear and may be related to circadian hormonal patterns.”

As to the general benefits of regular exercise participation and its associated benefits, the best time to exercise is, when you chose to or can do it. Get moving.

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In 2018, the World Health Organization said the prevalence of a cancer diagnosis reached 18.1 million people – with 9.6 million cancer deaths. Positive lifestyle – such as exercise and diet – reduce the risk to certain forms of cancer.

Adherence to a Mediterranean-style eating strategy – higher intake of fruit, vegetables, and whole grains, limited lean meat, fish, and olive oil – reduces the risk to colon and breast cancer.

Research is still searching for the optimum plan once an individual is diagnosed with cancer. According to The Facts About Food After Cancer Diagnosis: A Systematic Review of Prospective Cohort Studies, which appeared in the August 2020 issue of the online, peer reviewed journal Nutrients, “to prevent malnutrition, energy and protein requirements for cancer patients are largely widespread by international guidelines, but little is known about the food choices and dietary regimen a cancer patient should benefit from.”

The Italian study researchers point out that, “many ‘cancer diets’ are often restrictive, avoiding a whole nutrient class (i.e., meat or dairy products) in the misleading belief that certain foods “feed the tumor.”

The Italians sought to determine any possible associations between diet patterns, after a cancer patient’s diagnosis, that is affected by a solid tumor, relative to outcomes – mortality, cancer progression, and recurrence.

Those study criteria included a meta-analyses (similar studies) that used an adult population over 18 years of age diagnosed with breast, gastrointestinal, gynecological, lung, and urological cancers; post-diagnosis dietary patterns – such as consumption of fruit, vegetables, diary, meat, fish, and cereals; prospective or retrospective cohort studies; over-all survival, all-cause mortality, cancer-specific mortality, death from a non-cancer cause, cancer progression, disease-free survival, cancer recurrence, and recurrence-free survival.

The study authors determined that, “the overall results of this systematic review highlight that none of the food categories should be eliminated by cancer patients. Especially, there is no clear association between consumption of meat or animal products and cancer progression/recurrence or CSM (cancer specific survival), after a cancer diagnosis.”

However, the Italians also emphasized there was, “a significant positive association between detrimental dietary patterns, such as Western-type Diet (characterized by processed meats, sugar-sweetened soft drinks, and refined grains) and cancer progression.”

Note the investigators, “on the contrary, high consumption of fiber, such as whole grain cereals, green and cruciferous vegetables, seem to be protective against cancer progression and mortality.”

In conclusion, “detrimental dietary patterns, such as the Western Diet and the high consumption of some food categories (saturated/trans fats, high-fat dairy products) could worsen prognostic outcomes in breast, colorectal and prostate cancer patients. Nevertheless, animal proteins, such as fish, poultry, low-fat dairy products and meat, should not be excluded from cancer patient’s diet.”

More research is needed relative to a cancer post-diagnostic diet, as it applies to the most common forms of cancer – lung, stomach, gynecological, bladder, and pancreatic cancer.

Interested in Listening to a Podcast? Check Out Maximum Wellness, Episode 06: Spice Up the Diet and Reduce Cardiovascular Disease Risk

It’s estimated that in the U.S., five million young athletes compete on high school swim teams – with an additional 336,000 competing on club teams. According to the National Collegiate Athletic Association (NCAA), between 2015-2016, 22,000 college swimmers were participating in competitive leagues. Master level swimmers, who may reenter to compete in the sport at an older age, number about 65,000.

According to Swim-Training Volume and Shoulder Pain Across the Life Span of the Competitive Swimmer: A Systemic Review, which appeared in the January 2020 issue of the Journal of Athletic Training, “injuries in competitive swimming primarily arise from repetitive strain and microtrauma. This is not surprising, when one considers the amount of swimming to which the athletes are exposed.”

The investigators from the Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium, and the Department of Physical Therapy, Arcadia University, Glenside, Pennsylvania, note that, “because of these demanding and time-consuming training programs, competitive swimming has essentially developed into a year-round intensive sport, with athletes at young ages focusing solely on swimming.”

It’s also pointed out that in 10 to 15-year swimming careers, “swimmers often practice 5 to 7 days per week and sometimes twice daily. This excessive exposure to swimming has been linked to overtraining , and increases the risk of soft tissue injury, pain, and dissatisfaction. Shoulder pain is particularly frequent, and, with prevalence rates reported as high as 91%, is a major cause of missed practice.” These researchers sought to determine, if there was a correlation between a specified amount of swim training and shoulder pain in competitive swimmers, by examining relevant studies within PubMed, Web of Science, and Medline.

It was determined that 12 studies met the qualified criteria, as grouped by age: young (less than 15 years old), adolescent (15-17 years), adult (18-22), and masters (23-77).

Based on the data of this first of a kind analysis, the researchers concluded that, “evidence suggests that swim-training volume was associated with shoulder pain in adolescent competitive swimmers.”

As for recommendation, it was stated that, “year-round monitoring of the athlete’s swim training is encouraged to maintain a well-balanced program. Developing athletes should be aware of and avoid a sudden and large increase in swimming volume.

It was also pointed out that additional research is necessary to determine cutoff values, in order to make data-based decisions regarding the influence of swim training.”

In our experience helping both high school and collegiate swimmers, especially female athletes, there is a consistent anterior (front) shoulder dominance from significantly more overhead, forward strokes – with inadequate posterior shoulder stabilization during the dry land training. In other words, if your throw, hit, or swim forward, you need to train in reverse to rebalance the shoulder to reduce the risk to unnecessary shoulder injury.

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

Preservation of metabolically active lean muscle tissue – muscle mass – is of critical importance to an athlete or an individual just seeking healthy aging. Unchecked, muscle mass declines – myopenia – by as much as 10 % in adults between the ages of 20 to 50 compared to adults, who lose between 30-40% of their muscle mass between 50 to 80 years of age.

Research has also demonstrated that by the third decade of life, muscle strength peaks and remains constant through the fifth decade – declining by 12 to 15% in later years – characterized as dynapenia.

The combined myopenic and dynapenic state is called sarcopenia, that according to research – Creatine Supplementation During Resistance Training in Older Adults –a Meta-Analysis, which appeared in 2014 in Medicine & Science in Sports & Exercise, “is characterized by type II muscle fiber atrophy, myofiber necrosis, and myofiber type grouping, and increased intramuscular content of non-muscle tissue, such as intramyocellular lipid and connective tissue.”

The study researchers from the Exercise Metabolism Research Group, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada, point out that, strategies to reduce the negative impact of sarcopenia are of importance to promote healthful aging.

One such proven method to increase both muscle mass and strength is resistance training (RT). “In older adults (ages 65–75), 16 weeks of progressive RT increased mixed muscle protein synthesis (MPS) by approximately 50%, muscle mass by 1.5 kg, and overall strength by 60%,” note the Canadians. The muscle increase associated with RT can be improved by consuming a protein supplement, after a resistance exercise session for both young and older individuals.

Both protein consumption and resistance exercise independently stimulate MPS, if protein is consumed post-resistance exercise (a two-hour window). “It has also been determined that a greater dose of protein (approximately 40 grams) is required to maximally stimulate MPS in older, as compared with young (approximately 20 grams) persons,” comment the researchers.

Besides protein consumption post-RT, creatine monohydrate supplementation, with or without RT, has also proven to increase lean body mass, strength, and performance during short duration, intense exercise bouts. Mayoclinic.org says, “creatine (Cr) is an amino acid located mostly in your body’s muscles, as well as, in the brain. Most people get creatine through seafood and red
meat — though at levels far below those found in synthetically made creatine supplements. The body’s liver, pancreas and kidneys also can make about 1 gram of creatine per day.”

The Canadian researchers set out to determine, via a meta-analysis (many similar studies), whether the addition of creatine to RT would improve body composition and increase strength and performance in older adults. Randomized, placebo- controlled trials involving older adults – 357 with an average age of 64 – supplemented with Cr – with and without participation in RT programs of greater than 6 weeks in duration or a placebo group – encompassed the data base – with the appropriate body composition determination and strength assessments pre and post participation.

On average, from the 10 studies included in the analysis, the loading dose used ranged from 7 to 25 grams. The dose of creatine used during the maintenance phase of the trials ranged from 3 to approximately 8.6 grams per day. The review concluded that, “retention of muscle mass and strength is integral to healthy aging. The results from this meta-analysis are encouraging in supporting a role for Cr supplementation during RT in healthful aging by enhancing muscle mass gain, strength, and functional performance over RT alone; however, the limited number of studies indicates further work is needed.

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The May 2021 Issue of the online, peer reviewed journal Nutrients provided an excellent narrative review of the ketogenic diet from researchers in the Department of Biology, Western Kentucky University. 

Ketogenic diets, which traditionally have emphasized keeping total carbohydrate intake to less than 50 grams per day, have increased in usage from its inception in the 1930’s to treat epilepsy. Restricting carbohydrate consumption, emphasizing moderate protein intake and increasing caloric consumption from fat, causes the body to draw more from fat for energy than from glucose metabolism.

According to the Nutrients research – The Potential Health Benefits of the Ketogenic Diet: A Narrative review – “recent studies utilizing Low-carbohydrate, High-fat (LCHF) diets, such as the ketogenic diet, show promise in helping patients lose weight, reverse the signs of metabolic syndrome, reduce, or eliminate insulin requirements for type II diabetics, reduce inflammation, improve epigenetic profiles, alter the microbiome, improve lipid profiles, supplement cancer treatments, and potentially increase longevity and brain function.”

That’s important, since WebMD estimates that 27 million people are Type 2 diabetic – 86 million pre-diabetics. In addition, the Centers of Disease Control and Prevention (CDC) says almost 40% of adults and around 20% of American children are obese.

The Western Kentucky reviewers segment the ketogenic diet (KD) into two classifications versus the standard American diet. The therapeutical keto diet’s caloric distribution is 5% carbohydrate, 5% protein, and 90% fat, while the standard keto variation is 5% carbohydrate, 20% protein, and 75% fat. The standard American diet is 55% carbohydrate, 15% protein, and 30% fat.

The researchers point out that, “ketosis is normally achieved through either fasting or carbohydrate restriction. It is important to clarify that a low-carb diet typically refers to a diet with an intake of 50 to 150 g of carbohydrate per day. However, although this is a lower amount of carbohydrates than the standard American diet, it is not low enough to enter nutritional ketosis. Only when a patient restricts carbohydrates to less than 50 g/day will the body be incapable of fueling the body by glucose and will switch to burning fat.”

The areas of focus by the Kentucky investigators centered on the effects of the keto diet (KD) on the microbiome (intestinal bacteria), epigenome (changes “on top” of the genome, which modify our gene expression), diabetes, weight loss, cardiovascular disease, and cancer.

The microbiome is composed of trillions of microscopic organisms housed in the intestinal tract – supporting 70% of our immune function. While there is limited long-term data on the effects of the keto diet, “based on various studies, many predict that the diet will positively affect the microbiome by increasing the Bacteroidetes and Bifidobacteria species associated with improved health and decreasing microbial species known to increase health risks,” comment the reviewers. 

As for the epigenome, our heritable markers, it’s suggested that by changing our environment to a more favorable status, we can affect our genetic predisposition to heritable disease risk. According to the reviewers, “the benefits of the ketogenic diet might also go beyond treating existing disease, and instead help prevent chronic and degenerative disease.”

From a weight-loss perspective, the ketogenic diet should be followed under the direction of the primary care physician, due to the potential complexity of the individual’s current medical status. The researchers point to a long-term (56 week) ketogenic study conducted on 66 obese people with a body mass index (BMI) >30 (obese).

“All patients were instructed to eat <20 grams (g) of carbohydrates in the form of green vegetables and salads for 12 weeks and then they could increase the carbohydrates to 40 g/day for the remainder of the study. The weight and body mass index of all patients decreased significantly.”

 More interestingly, comment the reviewers, “the patients were advised to maintain a state of nutritional ketosis and they were able to show continued decreases in both BW (body weight) and BMI throughout the study.”

The CDC says there are currently in the US an estimated 30-millions diabetics – 84 million with pre-diabetes, which predicts that 45% of Americans are either diabetic or pre-diabetic. As with the objective of weight-loss, the prediabetic or diabetic person should be followed by their primary care physician to monitor appropriate metabolic criteria affected by the KD.

A few randomized controlled studies looked at the effects of the KD on diabetes. One study noted was recently conducted at Indiana University – one of the first long-term studies that required use of routine blood tests to determine the patients’ state of nutritional ketosis, while maintaining a KD diet. Patients were highly compliant, and experienced improved diabetic conditions. 

“The diet intervention also reversed the diabetic status of some patients, whose HbA1cs became normal. The 2-year follow-up to this study revealed that 74% of KD group remained enrolled. This group had a significant improvement in HbA1c, fasting glucose, and fasting insulin while the usual care group had no changes from baseline.”

From a cardiovascular disease prevention and lipid (fat) lowering perspective, the KD, with its potential for a high saturated fat intake, has resulted in controversy. Interesting, the Kentucky reviewers say only a few studies have evaluated the health impact of very high fat intake on overall health – including weight management, lipid profiles, and inflammatory markers. 

“One study compared a KD to the standard American diet (SAD) and the SAD plus exercise. Not only did the KD outperform the other groups in multiple health outcomes, but it also showed a much more significant decline in triglycerides.” 

Cancer is the second leading cause of death in the US next to heart disease. The KD’s impact on cancer has mixed reviews. 

“The data of the effect of KD in human patients is limited mostly to case studies and cohort studies. A meta-analysis of 24 human studies, found that 42% found that the KD can reduce tumor growth. In addition, it has been found that most human studies had positive impacts, with many other studies found it stabilized disease, and one study found a pro-tumorigenic effect of the KD. However, another review of 14 studies of the use of KD in cancer found mixed results.”

Until more diverse long-term research of controlled trials on various disease populations is completed, it’s best to check with your doctor, before embarking on dietary experimentation. Let’s leave that to the experts.

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Today we would like to take an educated observation into how a pandemic, in this case Covid-19, can affect the motivation to exercise. We will look at a few studies detailing the pandemic’s affect on runners, sports participation, and where an individual exercised. To start things off, Runrepeat.com, the world’s largest online, athletic shoe review company, as noted on its site, surveyed 3961 current runners to understand how many of those runners began their first steps to fitness during the Covid-19 pandemic. It appears that 28.76 % of the current runners were motivated to strap on their running shoes and head out during the pandemic.

This result compares to doing outdoor activities, as the top trend in 2020 and in 2021 – consisting of running, hiking, walking, cycling, and any other form of outdoor workouts, exercises, or training. Exercising outdoors, notes the website, “was voted the best way to stay fit in 2021 by 59.1% of active adults, increasing 14.6% from the start of 2020.”

It was also determined that 19.82% of the novice runners were less likely to participate races in-person over the following 12 months – an assumed pandemic-related fear of crowds. 

“Motives for running are changing – physical health is the primary motivation for 72% of new-pandemic runners, up 18.03% from runners who began running before the pandemic,” according to the website.

The survey noted the following data points: 34.27% less likely to run for competition or achievement, 31.44% less likely to run for social interaction, 14.81% less likely to run for mental or emotional health, 3.00% less likely to run for their confidence or self-esteem.

The study investigators concluded that, “there has been a significant boom in running during the pandemic. The situation and circumstances that these people have taken up running are drastically different than their pre-pandemic counterparts.”

Another trend that has grown in popularity is exercising at home – spawned by the pandemic world-wide lockdowns. Notes the survey, “a lot of people made the decision to start investing in at-home gym equipment or make use of the fitness equipment they already had” – with the percentage of active adults seeing at-home fitness equipment, as the best way to stay fit increased by 49.6%, making it the fastest growing trend of 2021. In the US, this trend has grown explosively by 218.3%.

The pandemic took a hit on sports participation – with the percentage of active adults relying on sports to stay fit decreasing by 25.2% over the year, noting only 6.0% still seeing it as their best option for 2021. Female sports participation saw a decrease in this trend – down 53.0% – which was more than double that for men, who were down by 23.8%.

Another characteristic change, resulting from the pandemic, was the positive impact of online fitness content, courses, classes, and subscriptions. “The trend of online fitness exploded in America, with 134.7% more active American adults switching to this new trend to reach their fitness goals, as the pandemic continues into 2021, noted the Runpeat survey. 

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Prior research supports the effectiveness of a Ketogenic diet (KD) – based on a reduced carbohydrate intake (less than 30 grams per day or 5% of total energy intake), high fat intake, with adequate protein intake (0.9 grams per kilogram daily) – to facilitate weight loss, improve some metabolic disorders, cardiovascular disease, and type 2 diabetes – under medical supervision.

The keto diet plan works via ketogenesis, which starts in the liver and is facilitated through the creation of energy in the form of ketone bodies, that can be effectively used by other tissues, as an energy source via the Krebs cycle. After four to seven days on the KD, the main energy source is through lipolysis – the breakdown of adipose fatty acids. In short, fat as fuel.

New research – Effects of Two Months of Very Low Carbohydrate Ketogenic Diet on Body composition, Muscle Strength, Muscle Area, and Blood Parameters in Competitive Body Builders – which appeared in the January 2021, online issue of the journal Nutrients, tested the outcome of a KD diet on nineteen, experienced, male body builders (BB) between the ages of 20 to 40, allocated to a KD diet and control group, who followed a western-type diet (WD).

The subjects, after exclusion criteria, were assessed pre and post in this randomized study by blood sampling, after an overnight fast, body composition attained by Bioelectrical Impedance Analysis, metabolic studies (resting energy expenditure and quotient), and muscle strength.

The caloric intake of the dietary patterns provided, commented the Italian study investigators, was calculated by assigning an energy expenditure of 45 kcal/kg of muscle mass, while the protein intake was maintained at 2.5 g/kg/body weight. The two protocols, as noted in the study, differed in the distribution of fats and carbohydrates; the latter were kept below 5% daily (less than 50 g/day) in the KD group while they represented 55% of the caloric intake in the WD group.

The researchers found that, “a keto diet plan may represent an adequate dietary approach for BB athletes. Despite the lack of hypertrophic (increase in muscle mass) response in the KD group, muscle mass was maintained, a phenomenon that often does not occur during low-calorie diets. Similarly, although the time of year was not the one that athletes usually dedicate to training for fat loss (“cutting”), KD proved to be a good strategy to reduce body fat.”

It was also referenced that, “KD is not a regime to be followed lightly and independently but requires the presence of a professional; in these circumstances KD represents a fundamental tool in the nutritionist’s baggage to face various conditions and needs, including those of sports.”

One caveat that was reported, while on a protracted KD diet, is the potential loss of muscle mass. “KD may be used during body building preparation for health and leaning purposes, but with the caution that hypertrophic (muscle growth) muscle response could be blunted,” as concluded by the investigators.

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In a systematic review of literature published before March 15^th, 2021 – regarding an association between Vitamin D deficiency and the risk to Covid-19 in an aged population, French researchers report that, “vitamin D deficiency appears to expose these subjects to a greater risk of adverse outcomes. Because of its simplicity of administration, and the rarity of side effects, including vitamin D in preventive strategies for certain viral diseases, it appears to be an attractive option.”

This study – Relation Between Vitamin D and Covid-19 in Aged People: A Systematic Review – which appeared in the April 2021issue of the online, peer reviewed journal Nutrients, used 707 studies identified to assess adverse outcomes and the benefits of Vitamin D supplementation for people 60 years and older with Covid-19 exposure. Studies included data from aged patients on vitamin D use and Covid-19, while basic science articles, editorials, and correspondence was excluded from the analysis.

Since its inception in December of 2019, Sars-CoV-2, Covid-19, has become a worldwide pandemic. Most infections cause mild-to-moderate signs, while severe forms – acute respiratory distress secondary to lung damage – of the disease can lead to death, especially in aged people or those with comorbidities, such as obesity, hypertension, pulmonary issues, and heart disease.

It’s also known that respiratory complications beyond seven days were caused by a dysregulation of the immune system – referenced as a cytokine storm. Vitamin D has proven to support an immune response through activation of the innate immunity, which reduces the overactivity of the adaptive immune system.

According to the researchers, “there was a high prevalence of low vitamin D levels, even in countries with abundant sunshine, particularly in aged people. Observational studies suggest an association between low serum vitamin D level and susceptibility to acute respiratory tract infection.”

Further, comment the French researchers, “concerning the relationship between vitamin D level and outcomes in COVID-19, patients with vitamin D deficiency have worse clinical outcomes than non-deficient patients in terms of mortality.”

Also noting that, “aged people are at greater risk of severe forms of COVID-19 infection and at risk of vitamin D deficiency, prompting some authors to suggest that vitamin D supplementation may improve the prognosis of aged people infected by SARS-CoV- 2.”

The good news is that you can check your vitamin D status with a blood test. Depending on the laboratory reference range, a vitamin D blood value of less than 20 ng/mL is considered deficient, while a reference range of between 20-30 ng/mL is considered insufficient. 

Your primary care physician can provide you with appropriate supplement guidelines, which might include a prescription vitamin D, if deficient.

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If you are interested in reading more about vitamin D and it’s relationship with Covid-19.. Check out African Americans with Low Vitamin D Status Have Increased Covid-19 Risk

Prediabetes, which affects over 86 million adults in the United States, is established by achieving a fasting blood sugar in the range of 100-125 mg/dl and / or an impaired glucose tolerance test. The good news is that prediabetes can be, in many cases, returned to a normal blood sugar status, with appropriate, positive lifestyle changes, that involve a combination of dietary resistance, restriction and exercise.

There is also evidence that type 2 diabetes may be reversed with more invasive strategies – such as bariatric surgery – in a select, overweight/viscerally fat population.

According to research – a Single Bout of Premeal Resistance Exercise Improves Postprandial Glucose Metabolism in Obese Men with Prediabetes – which appeared in the April 2021 issue of Medicine & Science in Sports & Exercise, the (2002) Diabetes Prevention Program Research Study demonstrated that lifestyle interventions, which targeted a 7% weight loss with 150 minutes per week of moderate-intensity endurance exercise, “reduced the incidence of T2D by 58% and was significantly more effective than treatment with metformin alone in individuals with prediabetes.”

Yet, there is insufficient research to establish the effects of resistance exercise (RE) on glucose metabolism in prediabetics. Some evidence has demonstrated that, in older, overweight subjects with prediabetes, twelve weeks of RE improved glucose tolerance, but not insulin sensitivity, during an oral glucose tolerance test.

The Medicine & Science researchers, from Washington University School of Medicine in St. Louis and the Department of Orthopaedics, Duke University in North Carolina, chose to establish the effects of a single bout of RE on post-meal (postprandial) glucose metabolism, after a mixed meal in obese, sedentary men with prediabetes.

Ten sedentary, prediabetic, obese men enrolled in the randomized, cross-over study. After an overnight fast, the participants were guided to complete a single session of RE – seven exercises, 3 sets of 10-12 repetitions at eighty percent of their predetermined maximum strength (1-rep max), or an equivalent rest period.

After the RE, the subjects consumed a mixed test meal, while simultaneously having an intravenous glucose infusion, to establish their basal and post-meal rate of glucose appearance and disappearance from their plasma, insulin insensitivity, and an insulinogenic index to measure beta cell function in the pancreas.

“Skeletal muscle biopsies were obtained 90 min post-meal to evaluate pyruvate-supported and maximal mitochondrial respiration. Whole-body carbohydrate oxidation was assessed using indirect calorimetry,” according to the researchers.

The researchers concluded that, “a single bout of RE moderately reduced the glycemic response to a mixed meal, significantly improved insulin sensitivity, and reduced the glucose-normalized insulin response in obese, middle-age men with prediabetes.”

It was also noted that, “there were limited effects on postprandial glucose clearance, insulinogenic index, whole-body carbohydrate oxidation, or skeletal muscle pyruvate-supported respiration.”

As with any such research, with a small group of subjects, additional research is needed to determine how RE brings about positive changes after a meal, which typically in the US, is high in fat and sugar.

Before you embark on changes to your exercise or diet, especially if you are a male, who is sedentary and obese, with known or undiagnosed prediabetes or type 1 or 2 diabetes, check with your primary care physician.

Interested in reading more? Check out Vitamin D & Calcium: Fighting Gestational Diabetes

Based on epidemiology data, as to the higher incidence of risk to complications related to Covid-19 exposure in African Americans, science has been exploring a number of possible reasons. 

New research – Does the High Prevalence of Vitamin D deficiency in African Americans Contribute to Health Disparities – which appeared in the online, peer-reviewed journal Nutrients in February of 2021 – says there is a higher prevalence of Vitamin D deficiency in many African Americans – the result of people of African descent having brown-black melanin skin pigment, versus Angelo-Celtics, who have a yellow-to-reddish melanin. 

That means African Americans are particularly at risk for vitamin D deficiency (less than 20 ng/mL in the blood) at high latitudes, where vitamin D synthesis depends on exposure to solar UVB radiation. At high latitudes, the UVB radiation dose is lower – causing a lower Vitamin D production, which starts in the skin. 

The researchers from the University of California, Berkley, Sunlight, Nutrition and Health Research Center in San Francisco, Harvard T.H. Chan School of Public Health, and Brigham and Women’s Hospital – both in Boston, comment that, “vitamin D deficiency can be corrected rapidly and inexpensively.”

Vitamin D, a seco-hormone, which is a critical component of skeletal integrity, also regulates the activity of many thousand protein-encoding human genes.

 Vitamin D’s conversion from 25(OH)D2 to 1,25(OH)D3 is a multi-step process in the body. The process begins, when “vitamin D3 is synthesized in human skin by the UVB-dependent conversion of 7-dehydrocholesterol to vitamin D3. Vitamin D3 is then converted to 25(OH)D3, a precursor of the crucial vitamin D steroid hormone, 1,25-dihydroxyvitamin D3, or calcitriol, in a reaction requiring magnesium.”

Evidence points to the fact that higher serum 25(OH)D levels can reduce the risk or severity of acute respiratory tract infections, possibly including COVID-19 – with Vitamin D’s positive impact on innate and acquired immunity.

The researchers cite evidence, which says the, “incidence and mortality of COVID have been far higher in African Americans than in European Americans; after adjustment for age, African Americans are 4.5 times more likely to die from COVID-19 than European Americans.

As for Vitamin D’s effect on reducing Covid-19 patients from advancing into intensive care units, “in a non-randomized intervention study conducted in Spain among hospitalized patients hospitalized for COVID-19, high doses of vitamin D (as 25(OH) D3) were administered in combination with standard care; only 1/50 required admission to the intensive care unit compared to 13/26 comparable control patients.”

Vitamin D is mainly found in fish and fortified foods, such as milk, and sun exposure (if possible), which is why vitamin D supplementation, based on laboratory studies, is required to meet Institute of Medicine’s (IOM) level of at least 20ng/mL. 

However, “levels between 20 and 30 ng/mL have also been associated with lower risks of colorectal cancer, total mortality, dementia, multiple sclerosis, and bone mineral density.”

Yet, according to the Nutrient’s investigators, “three-quarters of African Americans not already taking supplements have levels that do not ensure adequacy even by the IOM definition (20 ng/mL), and 96% have levels below 30 ng/mL. Notably, for African Americans living in Boston, 4000 IU/day was required to achieve serum levels of 30 ng/mL.”

The researchers concluded by stating, “while further research is needed to identify the optimal strategy for vitamin D supplementation and fortification, no reason exists to delay addressing vitamin D deficiency among populations with high prevalence of deficiency, such as African Americans. The potential benefits promise to be large, and much evidence indicates that the risks of supplementation up to 4000 IU per day vitamin D are minimal.”

In today’s world of high sports participation and recreation, much less the effects of normal human aging, and irrespective of the contact and non-contact trauma that the physical games we play can yield, pain, injury, and skeletal diseases are common occurrences. Today we will be discussing how collagen peptides may reduce pain associated with common sports-induced knee-injuries.

Anterior cruciate ligament (ACL) sprains and tears, many of the non-contact type, are at epidemic proportions in female athletes participating in sports like basketball, soccer, and volleyball. 

Research points to the increased female ACL injury risk being associated with the anatomical design of the female hip, poor landing technique during jumping activities, reduced muscle stiffness, and faulty recruitment of the hamstring musculature during deceleration, to name a few. 

The female athlete is at four times the risk to an ACL injury versus their male counterpart – with, as much as, a 24% increased risk to ACL injury in the uninjured knee, upon return to sport.

According to research – The Influence of Specific Bioactive Collagen Peptides on Knee Joint Discomfort in Young, Physically Active Adults: A Randomized Controlled Trial – which appeared in the February 2021 issue of the online journal Nutrients, “collagen type I and II are the most important structural and functional components of the extracellular matrix of tendons, ligaments and cartilage.”

The researchers from Germany and Austria cite research that says, “an increased risk of anterior cruciate ligament rupture or shoulder dislocation is also attributed to an impaired architecture of the connective tissue. Although most complaints are related to sport, non-athletes may also sustain recurrent overuse injuries.”

Once tissue or a joint is damaged, inflammation, a normal reaction to trauma, is initiated, which can be associated with pain. “Regardless of whether muscles, tendons or cartilage tissue are affected, the cause is a disproportion between load and load tolerance of the tissue,” as noted in the Nutrient’s paper.

Excessive training, inadequate recovery periods, and constant competitive stresses on the muscles and joints can be extrinsic factors that potentially increase the incidence of stress-induced injuries in every age group.

Intrinsic factors – like reduced flexibility of a muscle group, loss of range of motion in a joint, and anatomical differences, such as a leg-length discrepancy, can place the active individual to increased injury risk.

The researchers reference the outcomes of preclinical studies, which indicate that consumable collagen peptides have a particularly high absorption rate – the result of their low molecular weight and the high proportion of proline and hydroxyproline, that permits, “a high resistance to intestinal digestion and higher transport efficiency.”

 It’s also proven that collagen-derived peptides accumulate in the cartilage tissue, where they can stimulate extracellular matrix molecules, and, therefore, counteract progressive tissue degeneration.

The European investigators note prior research that, “imply that the intake of 5 g of specific collagen peptides for 12 weeks is sufficient to significantly reduce pain intensity during physical activity. Based on the survey of the participants, it can be assumed that medical treatment options, such as drugs or physiotherapy could be reduced by the pain-relieving effect of collagen peptides.”

The investigators chose to confirm the efficacy of the same collagen peptides in a comparable study population. 

Recruiting 180 active men and women aged between 18 and 30 years, with exercise-related knee pain, but no diagnosed joint disease, the participants were randomly assigned to either a group receiving 5 g of specific collagen peptides – FORTIGEL – (CP-G) or to the placebo group (P-G). The study period was 12-weeks.

The primary outcome was to examine the changes in pain during or after exercise from pre-to-post-intervention – using the Visual Analog Scale (VAS). 

It was determined that the young, active male and female participants, “showed that the intake of 5 g of specific collagen peptides per day for twelve weeks can significantly reduce the intensity of activity-related knee joint pain assessed by the participants compared with placebo.”

Collagen peptides are an inexpensive, readily accessible product in powder or liquid form, that with your primary care physician’s approval, may be a viable option for knee related pain associated with strenuous exercise or an aging population.

Interested in reading more? Check out 8500 Daily steps reduce a high-fat meal risk to cardiovascular disease