The fundamentals of health and wellness with special reference to football

Thank God.  It’s that time of year again.  Football season is upon us.  Each season brings the sense of renewed hope, optimism, and promise.  Last year your team might have stunk but with the start of a new year we all start off at 0-0.  Last year doesn’t matter (that’s even what the 2015 College Football Champion Ohio State Buckeye coaches are saying).  The start of football is kind of like New Year’s Day for the health & wellness industry, a new year and a new beginning!

During your team’s offseason coaches preach and teach the fundamentals of football, blocking and tackling.  Time and time again, when your team falters and loses, coaches go back to the fundamentals; because if you can’t tackle and you can’t block, there is no sense in trying to practice anything more complicated than the basics.

All too often, we in the health and wellness industry lose sight of the fundamentals, the things that can actually improve our health and win us some games, and instead focus on all of the more complicated matters of health & wellness.  If we don’t have a good grasp of our fundamentals, why are we trying to master the more complex aspects of health & wellness? 

If we don’t have a good mastery of the fundamentals, we are going to have some success but we will ultimately fail and fail again, which leads to frustration and disappointment.  If however, we master the fundamentals, we may lose a game or two, but at least we are bringing our “A” game to the fight.

My Three Health & Wellness Fundamentals are

1. Movement outside of the gym
2. Movement inside the gym
3. Your Nutrition

and I have made a video demonstrating how these three fundamentals can be easily accomplished.

Good luck to everyone this season and Go Buffs, Rams, Broncos, Badgers, Packers, and Bills!

My love/hate/love relationship with exercise

This week's article is a guest post written by my good friend, Jody Gavin.

Like many women, my love/hate relationship with exercise started in college.

College was the first time in my life I had to work out on my own.  Up until then I had coaches pushing me along, but in college it was all on me.  I was terrified of gaining the “freshmen fifteen” so I pushed as hard as I could.  And thus began my obsession with the elliptical.

Elliptical Blues  

Everyday I would begrudgingly walk across campus to the gym and force myself to spend 60-90 minutes on the elliptical pushing myself to my breaking point.  Then I would reward myself with beer.  Lots and lots of beer.

Drinking Lots and Lots of Beer (or in this case wine).

It seems completely crazy when I think about it now – no wonder I gained weight in college.  But at the time, I couldn’t see it.  I would get so upset with my skinny friends that could eat and drink whatever they wanted and never went to they gym, when I was there busting my butt everyday.  It seemed so unfair.  Yet I knew if I stopped obsessively ellipticaling everyday I would gain double the weight (because cutting down on my booze intake was just NEVER going to happen), so I kept pushing and pushing.  For four years.  It was one of the most un-healthy periods of my life.

A Love Affair with Running

After college I moved out West and found a new obsession – long distance running.  One 10K and I was hooked.  I replaced late-night drinking with carbo-loading for long runs.  I signed up for a half marathon and then a full.  And then another full, and eventually another.  I liked having something to work for – something that forced me to workout everyday even when I wasn’t in the mood.  But as much as I liked being held to a schedule, I also hated it.  Come Thursday I would start dreading the thought of my weekend long run.  All day Friday I would obsess over it.  And then if I didn’t get up first thing Saturday morning and run, my entire weekend would be spent feeling guilty.  But once I did complete that week’s long run I would feel like a million bucks.  Runner’s high is a REAL thing I tell you.  A real, wonderful, beautiful thing. 

Experiencing the Runner's High After Running the Army 10 Miler!

I kept up with running for several years - through several jobs, diet crazes, heartaches, and cross-country moves.  Running was always there for me.  No matter where I was, I could put on my running shoes and in a matter of minutes be pounding the pavement – taking my fears and frustrations out on the road.

Downward Spiral

But then came that fateful day when running let me down.  I was training for my fourth marathon and started dealing with some terrible foot pain.  I went to a specialist that confirmed a case of tendonitis and he didn’t recommend doing the race.  I was upset, but also relieved.  My long runs were causing me so much anxiety and the post-run “highs” just weren’t outweighing the dread anymore.  When the doctor told me to take a break I did.  I took the longest exercise break of my life. Nearly an entire year.  And while I thought it would be really good for me to dial things down it turned out to be one of the lowest points of my life.

Not exercising broke me.

I became deeply depressed- some days not even wanting to get out of bed.  I had some dark, dark days, but eventually I woke up to what was happening and realized I needed to bring exercise back into my life.  I met with a personal trainer and that’s when everything started turning around.  

It feels super crappy to be injured and as a result not being able to exercise.

I traded 2-3 hour long runs and 90-minute elliptical sessions for 30-45 min circuit training sessions 4-6 days a week. I also incorporated strength training into my exercise program for the first time since high school.  And almost immediately my mood changed.  I started to feel more like myself again.  I was happy and hopeful and re-energized about exercise.

Now that I am back in balance, I FEEL GREAT AGAIN!

I looked back at my relationship with exercise over the years and realized that it really had kept me sane.  But it also made me crazy because I couldn’t find a healthy balance.

Today, I feel like I’ve finally found that healthy balance and by reframing the benefits – mental health first, physical benefits second – I can honestly say that I love exercise again.  I don’t love/hate it. I simply love it.  It’s my favorite part of the day!

6 Nutrition Myths Debunked!

My good friend Mike Polis MS, RD, LD of Cornerstone Training and Nutrition and I recently put together a list of some of the most common nutrition misconceptions.  Here are the top 6 that we came up with:

Myth #1:

I need to limit my intake of fruits and vegetables because they contain too much sugar:  Of all the nutrition claims out there, this one ranks as one of the craziest. 

In my experience this misconception is often the result of the following situation: a personal trainer or nutritionist asks a client to recall the foods they ate in the past few days.  The client recalls his/her diet and the diet the client recites is nearly perfect: appropriate amounts of fruits, vegetables, lean meats, whole grains, and low-fat dairy. 

The nutritionist/personal trainer usually knows where the trouble spots in a diet are and realizes the client needs to cut calories to reach his/her weight loss goals but in this situation cannot figure out where the client needs to cut calories to reach these goals.  After analyzing the diet the trainer isn’t going to suggest cutting back on sources of lean protein such as fish, chicken, low-fat dairy or healthy fats/vitamins such as avocadoes, or salads.  Instead, fruits and vegetables, especially starchy vegetables, or those perceived as starchy vegetables (carrots) are going to be “called out” as the culprits and eliminated from the diet. 

The client will be told that he/she cannot lose weight because they are eating too much sugar coming from fruits and vegetables.  As a nation, we have become fixated on sugar when really we should be concerned with calories, not sugar.  Do you know how many calories are in this 2 pound bag of baby carrots? 

How many calories are in this entire 2 pound bag of baby carrots?

1. 225 calories
2. 350 calories
3. 563 calories
4. 851 calories

If you ate this entire 2 pound bag of baby carrots you would still only be consuming 350 calories (or the equivalent of eating less than 2/3 of a Big Mac).  Another example of how few calories carrots (a supposedly high sugar vegetable) contain, one baby Twix bar (50 calories) contains the same number of calories as 14 baby carrots!

You would have to eat 14 baby carrots to consume the number of calories found in 1 Mini-Twix bar.

I think that most of us would agree that, on average, fruits contain slightly more sugar than vegetables.  Yet, if we compare the number of calories in a baby Twix bar versus ½ cup of commonly eaten fruits (Table 1) you will see that in 17/21 cases you would actually save calories by eating ½ cup fruit in comparison to a baby Twix bar! 

Table 1. The number of calories found in 1/2 cup of fruit is NOT high.

When someone tells you to stop eating fruits and vegetables because there is too much sugar in them, tell them to 1) shut up and that 2) their math doesn’t make any sense.

I would NEVER cut fruits and vegetables out of your diet.  Instead, focus on 1) expending more energy through daily activity and/or 2) reducing the serving sizes/portions of every part of your diet (lean meats, whole grains, etc), not just fruits and vegetables.

Myth #2: 

Dairy products promote inflammation and chronic disease:  When you hear the term “inflammation” a negative connotation likely comes to your mind.  We have been conditioned to dislike inflammation and rightfully so.  Chronic low grade inflammation has been associated with the development of cardiovascular disease, diabetes, and some forms of cancer (1).  For the good of our health, we are told to avoid (or suppress) inflammation at all costs. 

So does this mean we should avoid dairy to limit inflammation? 

If you Google search “dairy products and inflammation” your suspicions that dairy produces considerable amounts of inflammation will be confirmed.

Google searching "Dairy Products and Inflammation" provides the results shown here.

The first four search results indicate that your friend or trainer (or the internet) who told you dairy wasn’t good for you was right.  However, the scientific community, by enlarge, has come to the opposite conclusion! 

Dairy consumption actually reduces inflammation!  In a recent cross-sectional study individuals consuming >2 servings/dairy/day had concentrations of molecules associated with inflammation in their blood between 10 and 30% lower than individuals consuming <1 serving/day (2).  Now to be fair, there are studies for and against dairy’s role in promoting inflammation; however the majority of systematic reviews of this issue demonstrates that dairy actually improves your inflammatory profile by lowering inflammation, not raising it (1, 3, 4).

The reasons why dairy may actually improve your inflammatory profile are complex and poorly understood but may be due to the calcium, magnesium, vitamin D or other yet undefined proteins found in dairy products. 

So the bottom line is, if you currently eat dairy, keep eating it.  If you don’t like dairy or can’t eat dairy don’t worry, there are other foods you can eat to obtain the nutrients you would otherwise consume by eating dairy.  Dairy and inflammation?  Keep worrying about your real problems and don’t waste your energy on those that are pretend.

Myth #3: 

Processed food is junk food and should not be eaten: A recent review article on processed food posed the question, “Is ‘Processed’ a Four-Letter Word?...” (5).

This question is indicative of the stigma that processed foods conjure up when discussed by many health conscious Americans.  In response to the term “processed” food, some health conscious Americans are prone to saying things such as

“I would never allow my children to eat processed foods.”

“Processed foods contain dyes, additives, adulterants, and chemicals harmful to you or your children.”

“You should only be eating whole, natural foods.”

Yes, I agree that we should all be eating whole, natural foods but not all of us have the taste, time, culinary skills, or budget to prepare and eat only whole, natural foods.  Processed food, like virtually every nutrition topic, is not black or white, 1 or 0, yes or no.  There is a certain amount of gray area in the discussion of nearly every “processed” food’s nutritional content.

There is a difference between processed food and what you would call “junk food” and not all processed food should be considered junk food.  Yes, Doritos, Cheetos, soft drinks, cakes, and cookies are junk food as they deliver essentially ZERO nutritional value but what about cereal, pasta, bread, fortified products, canned beans, and canned fruits and vegetables?  These foods have been considerably processed and are far from their native, natural state, yet in many cases, are vital contributors to the nutritional quality of the typical American’s diet. 

When we dissect an American’s diet between the years 2003 and 2008 on the basis of the 2010 Dietary Guidelines for Americans (6), we see that processed foods contributed

• 55% of dietary fiber
• 48% of calcium
• 43% of potassium
• 34% of vitamin D
• 64% of iron
• 65% of folate
• 46% of vitamin B-12

These nutrients are extremely important to our health and processed foods contributed to greater than 50% of several of them.  On the other hand, processed foods also contributed to

• 57% of total calories
• 52% of saturated fat
• 75% of added sugars
• 57% of sodium

Whether a food comes in a can, is frozen in a bag, is far removed from its original state (cereal), is dried, fortified, or enriched, processed foods contribute a considerable amount of nutrition to the American diet.  Without food processing and food fortification many Americans would not meet their dietary goals.  Processed food doesn’t necessarily mean junk food.  Processed food that is nutrient dense (tightly packed with nutrients) is NOT junk food.  Junk food is food that is calorie dense (tightly packed with calories) and not nutrients. 

Before you stigmatize someone for telling you they recently ate a “processed” food, consider whether that food was nutrient dense or calorie dense.  Is processed food a four letter word?  I don’t think so.

 

myth #4:

To lose weight you should eat 5-6 small meals a day.  If you have ever stepped foot in a gym I think you have probably heard this line before, “The best way to boost your metabolism and lose weight is to eat 5-6 small meals/day”.  The theory behind this nugget of wisdom is that your metabolism increases each time you consume a meal and decreases in between meals.

To keep your metabolism “firing” it is best to spread your meals out throughout the day to take advantage of this increase in metabolism with meal consumption (known as the thermic effect of food).

But is this story really true?

Let’s dive into this issue by first examining the driver of weight gain or weight loss, energy balance.

Energy Balance is the driver of weight gain or weight loss.

Energy Balance

In simplest terms, think of nutrition as a system with an input and an output sector.

Input includes the foods and beverages we consume (calories).

Output includes our resting energy expenditure (REE), the thermic effect of food (TEF), structured exercise energy expenditure, and involuntary movement.

• REE refers to the rate at which the body expends energy while at rest to operate basic life functions -- such as breathing, sweating, filtering blood, and heart rate.
• TEF is the energy used to digest, absorb, and distribute the nutrients in the food and drink you consume.
• Structured exercise energy expenditure is just that. The amount of calories we burn during (and after) exercise. This is typically referred to as active energy expenditure (AEE).
• Involuntary movements include energy expended through non-planned exercise activities such as fidgeting at our desks, tapping our foot, pacing, or walking to your vehicle after work. These movements are also referred to as NEAT (non-exercise activity thermogenesis).

Exercise and REE: Burn baby, burn

"Stoking the Metabolic Fire"

Eating frequently in an effort to crank your metabolism into high gear stems from archaic epidemiological research and non-evidenced based claims perpetrated by fitness enthusiasts.

As calories are restricted, the TEF is reduced and if we are trying to lose weight, eating smaller, more frequent meals may actually do more harm than good.

In essence, the fewer calories (energy) we take in combined with a high meal frequency, may lower the overall response of the TEF (7).

To make matters worse, evidence has indicated that as we decrease the number of calories we consume, we also typically become less active.  Not necessarily less active with conscious exercise, but perhaps less active expending energy via NEAT and involuntary bouts of movement (8).

Combine this with a decrease in REE (a natural byproduct of a decreased calorie intake and weight loss) and we are drastically decreasing our overall caloric burn.

Yet another reason not to get on the “small frequent meal bandwagon” is that research has suggested the effect of meal frequency on metabolism does not lead to a greater fat oxidation (9).

Please note: fat oxidation is required for weight loss.

Finally, it should also be noted that the TEF constitutes a measly ~10% of total daily energy expenditure while BMR and exercise (including NEAT) make up the bulk (90%) of energy expenditure (see picture below).

The thermic effect of meals is trivial to total energy expenditure (10).

So, what should I be doing?

Shifting one’s focus to:

1. controlling calories and macronutrients based on your estimated needs while
2. using exercise to increase energy expenditure,
3. acquiring (lean body mass) development via resistance training, and
4. reaping the benefits of the” after burn” effect from high intensity training and thereby creating the real “thermic effect.”

In summary, there is no conclusive evidence that an increase in meal frequency correlates with a higher metabolic rate and/or reduction in body fat – given total calorie intake is controlled for (11, 12), which ties in with evidence which suggests no correlation between a higher meal frequency and fat oxidation (9).

The TEF is completely independent of REE, the energy burned at rest by the human body.  Lean body mass (LBM) and activity level, both of which are independent of TEF, are the primary drivers of your metabolic capacity.

If the TEF resulted in a higher “metabolic rate,” an increase in meal frequency would likely increase LBM and BMR.

To date, there is no data supporting this hypothesis.

As I mentioned earlier, but cannot stress enough, a decrease in metabolic rate is the byproduct of restricted calories and perhaps a decline in NEAT vs. a lower meal frequency.

So, what do I know?

Eating 5-6 small meals may actually:

1. Decrease the thermic effect of food (TEF)
2. Do nothing for weight loss or increased fat oxidation.

Practicality of meal structure

Select a meal pattern that is most appropriate for your schedule and needs.

Listen to your hunger cues and become more in-tune with your body’s physiology by answering the following questions:

• Are you mistaking hunger for thirst?
• Are you low on dietary protein consumption? (Note that dietary protein promotes feelings of fullness and satiety, which can keep hunger levels at bay).
• How many meals/day feels right to me?
• Do I need to change the times I eat my meals to get through the day?
• Do I need to eat a larger breakfast or lunch to make it to supper?

Following an arbitrary “8 meals per day” protocol because your favorite professional bodybuilders and figure competitors do so is only opening the door for unwanted gastrointestinal distress and a decline in finding enjoyment in your food.

Select the meal pattern that is most appropriate for you schedule and your needs and call it the (insert your name here) plan.

 

myth #5:

For building muscle, the more protein, the better.  Dietary protein has long been associated with “muscle building” in the general fitness community. And there is certainly some truth to that. However, context is also important.

Let's take a look.

Protein requirements are individualized based on your goals, height, weight, age, gender, body composition, and activity level.

More protein in the diet does not necessarily translate to more muscle on Jane Doe’s frame. There is a dose dependent response with protein, and possibly an anabolic cap to just how much protein you can effectively absorb and digest.

Strength athletes and folks focused on building muscle may benefit from a higher protein intake but how much is too much and how much is just right?

Protein needs are very individualized and goal-specific.

The current Recommended Daily Allowance (RDA) for protein for folks at a healthy body weight (BMI<25) is 0.8g-1.0/kg body weight; however, this estimate does not take into account metabolic demands and stressors related to training.

For the strength athlete or physically active individual, 1.4-2.0g/kg of bodyweight is a safe, effective baseline recommendation for protein intake.

In fact, this recommendation may actually enhance training adaptations according to the International Society of Sports Nutrition (13).

Why do athletes benefit from an elevated protein intake vs. the current RDA recommendation?

Protein synthesis is increased, leucine oxidation is decreased, and nitrogen balance is preserved with an increased protein intake (14). This phenomenon creates an atmosphere conducive to muscular growth and hypertrophy.

Protein intake is a highly individualized component of nutrition that requires consideration of training variables, overall calorie intake, energy expenditure, current LBM, and overall goals.

The ISSN recommendation of 1.4-2.0g/kg serves as a great baseline for protein intake and the athlete or active individual.

Higher protein intakes may be warranted for resistance-trained, lean bodybuilders with a lower body starting point, especially when in caloric restriction, in efforts to preserve fat free mass (FFM) (14).

For example, a trained individual deep into contest prep for a bodybuilding or figure competition on a calorie restricted diet may benefit from protein needs beyond the 1.4-2.0g/kg recommendation.

Implications for dietary protein intake during contest prep.  What does the science say?

A competitive powerlifter with low body fat (more metabolically active tissue) who’s training consists of high frequency with periodized mesocycles of volume and intensity blocks may have more of a metabolic demand for higher protein intakes as well – given total caloric intake is accounted for.

Furthermore, trained natural athletes typically add lean body mass at a relatively slow pace.

In my experiences, if a natural athlete can add 1-3 lbs. of actual lean body mass a year -- that is remarkable.

Marketing ads claim you can add 15-20 lbs of muscle a year by taking this natural XYZ supplement or by following this XYZ diet.

This simply is not feasible for a trained, natural athlete.

Adding lean body mass to one's frame is a tedious process that takes time, patience, and precision in both nutrition and training.

Again, protein intake needs to be individualized within the parameters of one’s diet and goals.

One size does not fit all.

 

myth #6:

Creatine is a harmful, unnatural substance.

Let me preface this section of the article by stating that creatine is not a steroid.

Just the other day, I heard overheard a grown man at the gym stating creatine was a steroid.

False.

Creatine is a molecule used in the body’s innate energy systems that produces adenosine tri-phosphate (ATP).

Creatine is not hormonal. Creatine is a safe supplement with over twenty years of research (15).

In fact, creatine is found naturally in small quantities in most of our meat products such as chicken, turkey, fish, and red meat.

When an individual supplements with creatine, the body stores the creatine as phosphocreatine to later be released as energy from the cell during bouts of high-intensity exercise such as sprinting or completing a 3 repetition max (3RM) on the barbell squat.

Creatine supplementation can improve high intensity exercise output.

Most literature reviews and meta-analysis studies report positive effects when creatine is supplemented during periods of high-intensity exercise (17).  When the effects of creatine supplementation on performance and training adaptations were reviewed, some research reports an average increase in sprint performance upwards of 5% and increases in both muscular strength and repetitions to failure by 5-15% (17).

However, if you are a long distance runner (any distance greater than 1 mile), creatine will not improve your performance because your body is relying on a different set of energy systems for this duration of exercise.

There are several forms of creatine on the market, but creatine monohydrate is the:

a) most commonly used in studies
b) most heavily researched
c) most cost-effective

If I want to supplement with creatine, the manufacturer recommends I “load”. Is loading really necessary?

Creatine loading refers to “cycling” creatine with a loading phase, a maintenance phase, and an “off week.”

For the loading phase, an individual would take 20g creatine for 5-7 days. This is “necessary” for creatine reserves to accumulate/top off in our muscle cells.

Then for the following 4 weeks, 5g each day is recommended. After 4 weeks of taking 5g per day, take a week off from supplementing creatine.

This is an example of a loading phase.

In my opinion, the more common (and the more cost-effective method of taking creatine) is simply supplementing 3-5g creatine daily. Your rate of muscle saturation with creatine will be much less vs. loading initially, but muscle creatine saturation will eventually be equivocal.

1 teaspoon of creatine monohydrate (roughly 5g).

Bottom line: loading creatine is not necessary and the benefits are doing so are trivial compared to traditionally taking 3-5g creatine daily.

Taking creatine is safe and, in power based sports of short duration, is effective in potentially increasing performance by up to 15%.

If you are looking for a little boost in your performance and don’t mind shelling out a couple of bucks, creatine may be your supplement.

 

References:

1. Da Silva MS, Rudkowska I. Dairy nutrients and their effect on inflammatory profile in molecular studies. Molecular nutrition & food research. Jul 2015;59(7):1249-1263.
2. Panagiotakos DB, Pitsavos CH, Zampelas AD, Chrysohoou CA, Stefanadis CI. Dairy products consumption is associated with decreased levels of inflammatory markers related to cardiovascular disease in apparently healthy adults: the ATTICA study. Journal of the American College of Nutrition. Aug 2010;29(4):357-364.
3. Labonte ME, Couture P, Richard C, Desroches S, Lamarche B. Impact of dairy products on biomarkers of inflammation: a systematic review of randomized controlled nutritional intervention studies in overweight and obese adults. The American journal of clinical nutrition. Apr 2013;97(4):706-717.
4. Markey O, Vasilopoulou D, Givens DI, Lovegrove JA. Dairy and cardiovascular health: Friend or foe? Nutrition bulletin / BNF. Jun 2014;39(2):161-171.
5. Dwyer JT, Fulgoni VL, 3rd, Clemens RA, Schmidt DB, Freedman MR. Is "processed" a four-letter word? The role of processed foods in achieving dietary guidelines and nutrient recommendations. Advances in nutrition. Jul 2012;3(4):536-548.
6. Weaver CM, Dwyer J, Fulgoni VL, 3rd, et al. Processed foods: contributions to nutrition. The American journal of clinical nutrition. Jun 2014;99(6):1525-1542.
7. Miles CW, Wong NP, Rumpler WV, Conway J: Effect of circadian variation in energy expenditure, within-subject variation and weight reduction on thermic effect of food. Eur J Clin Nutr 1993, 47:274-284.
8. Rosenbaum, M et al. Effects of experimental weight perturbation on skeletal muscle work efficiency in human subjects. Am J Physiology Regul Integ Comp Physiology.. 2003 Jul;285(1):R183-92. Epub 2003 Feb 27.
9. Marjet J. M. Munsters, Wim H. M. Saris. Effects of Meal Frequency on Metabolic Profiles and Substrate Partitioning in Lean Healthy Males. PLoS One. 2012; 7(6).
10. McArdle, William D., Frank I. Katch, and Victor L. Katch. Exercise physiology: nutrition, energy, and human performance*. Lippincott Williams & Wilkins, 2015.
11. Taylor MA, Garrow JS. Compared with nibbling, neither gorging nor a morning fast affect short-term energy balance in obese patients in a chamber calorimeter. Int J Obes Relat Metab Disord. 2001 Apr;25(4):519-28.
12. Verboeket-van de Venne WP, Westerterp KR. Influence of the feeding frequency on nutrient utilization in man: consequences for energy metabolism. Eur J Clin Nutr. 1991 Mar;45(3):161-9.
13. Campbell B, et al International Society of Sports Nutrition position stand: protein and exercise . J Int Soc Sports Nutr. (2007).
14. Wilson J, Wilson GJ Contemporary issues in protein requirements and consumption for resistance trained athletes. J Int Soc Sports Nutr. (2006).
15. Helms ER, Zinn C, Rowlands DS, Brown SR: A systematic review of dietary protein during caloric restriction in resistance trained lean athletes: a case for higher intakes. Int J Sport Nutr Exerc Metab 2013.
16. Groeneveld GJ, et al. Few adverse effects of long-term creatine supplementation in a placebo-controlled trial . Int J Sports Med. (2005).
17. Kreider RB. Effects of creatine supplementation on performance and training adaptations. Mol Cell Biochem. (2003) 244(1-2):89-94.

Taking Back Control

It is a demoralizing and hopeless feeling to try as hard as you can and still fail.  Effort does not meet reward.  The reasons we experience failure are numerous, yet they all stem from one thing: we did not control ALL of the variables.  If you have been having trouble losing weight or keeping it off, it’s not due to a lack of effort, it’s because you are not in complete control of all of your variables.

To be in complete control, you must control EVERYTHING that controls your weight.  In the companion post to this one, “Your Body is the Result of Your Lifestyle”, we learned that the body operates as a demand driven system.  It responds to the challenges (or lack thereof) placed upon it to get stronger or weaker, fatter or thinner.  Now that we know how the system works, how do we control the variables that make up the system?

First, we need to define the variables we are attempting to control.  I’m not going to create a list just yet but I will say that there are a finite, quantifiable number of variables that determine your health and wellness.  By controlling these variables you control your body.  Now you may be saying, “Todd, there are thousands of variables that contribute to my health and wellness and in turn these thousands of variables interact to produce millions of possible outcomes...............how am I possibly going to control them all.”  My response to this is, “by developing a health & wellness framework.”

We rely on frameworks every day to make our lives easier.  Frameworks are mental shortcuts that we take to figure things out quickly.  For example: if a food (i.e. Chili’s Awesome Blossom) has >1000 calories in it, do we really need to know how much total fat, saturated fat, trans fat, sodium, carbohydrate, protein, or for that matter vitamins or minerals are in that food?  NO.  Based on our mental framework (I shouldn’t eat foods with too many calories) I know that that food cannot possibly be good for me because it has greater than 1000 calories.  Case closed, no further discussion required.  We don’t have to waste our time and mental energy worrying about all of the aspects on the nutrition label. 

Chili's Awesome Blossom and Ribs.  The Awesome Blossom contains well over an entire day's worth of calories!

It has been said that our brain is a muscle and that over the course of the day it fatigues (1), just as muscles do at the end of a long race.  Our willpower and our mental energy is a finite resource.  When it’s gone, it’s gone.  If we only have so much mental energy to go around each day, why waste it on trying to figure out the appropriate amount of total fat, saturated fat, and so on when all we really need to look at is the total number of calories?

I am going to make it easy for you.  Instead of trying to control the thousands of variables and millions of interactions, I will ask you to keep track of just 3 variables: 1) programmed exercise, 2) non-programmed exercise, and 3) nutrition.

I recently released a video profiling the services we provide at Energy Balance Nutrition Consulting (EBNC) that gives a brief overview of these three components.  If you’re not up for reading on, you can watch the video shown below.

1) Programmed Exercise: the activity you do purposefully to exercise.  Think about it as exercises you perform at the gym.  It also includes activities performed outside such as biking, running, or swimming.  The American College of Sports Medicine (ACSM) recommends performing 30-60 minutes of moderate to vigorous intensity programmed exercise on all or most days of the week.  The National Weight Control Registry, a database of individuals who have lost more than 30 pounds and kept it off for more than a year, contends that the majority of individuals successful at maintaining weight loss exercise a minimum of 60 minutes/day.

2) Non-programmed Exercise: includes activities of daily living such as household chores or taking the stairs.  Most health professionals recommend taking a minimum of 7000 steps/day and striving for greater than 10,000 steps/day (2).  As a frame of reference, the average American takes ~5,000 steps/day (3).  I recommend purchasing a Fitbit Zip to track your non-programmed physical activity.

The bottom line is when it comes to physical movement you need to balance out your programmed and non-programmed exercise.  You cannot exercise 30-60 minutes/day and sit and do nothing the rest of the day.  I also would not recommend neglecting programmed exercise and only focusing on non-programmed exercise.  You should do a combination of both for optimal health and depending on what your goals are. 

Now it must be pointed out that, although this is anecdotal on my part, I have personally witnessed numerous individuals who perform no traditional, gym-type programmed exercise but are committed to daily walking and live well into their 80’s and 90’s.  If your goal is to live a healthy life and don’t care about body composition, then you can probably get away with just a robust walking program.  On the other hand, if you are trying to lose weight or change your body composition, programmed exercise cannot be neglected.  There is not a one size fits all recommendation for the amount of programmed and non-programmed exercise you perform.  It depends on what your goals are and where you want to be on the continuum between couch potato and marathoner.  As always, remember your Nutrition Exercise Return on Investment (NEROI)!

3) Nutrition: nutrition is the most controversial of the three topics.  Less than 10% of the United States adult population is able to comply with the nutrition standards set forth by the United States Department of Agriculture (USDA) (4).  My suggestion is to eat the majority of your meals in the home (or packed from the home), save eating out as a treat, manage your recipes and meal planning with the Paprika recipe application, and answer the questions provided in the “Who, What, When, Where, Why, and How of Grocery Shopping”.  The grocery store is paramount to your healthy eating success.  Again, I am not going to provide specifics when it comes to nutrition because nutrition is another case of “it depends”.  Different nutrition strategies work for different people.  Depending on how dedicated you are to your exercise routine and how much volume of programmed and non-programmed exercise you perform will determine how much you can eat.

By controlling these three things you have created the framework by which you can control the thousands of variables and millions of interactions that contribute to weight gain or weight loss.  Don’t make it more difficult than it needs to be.  Follow the KISS principle:

Keep

It

Simple

Stupid

There are numerous “fine tuning” adjustments that can be made within each category, but I wanted to show you the forest first.  You can worry about the trees later.  If you don’t get the basics of the forest, you’ll just be lost in the trees.

You are your very own experiment.  Track these three points and see where it gets you on the exercise and nutrition continuums.  Don’t ever give up.  For every problem there is a solution.  Control ALL the variables by first controlling these three points and you will TAKE BACK CONTROL of your health!

Todd M. Weber PhD, MS, RD

References:

1. Hofmann W, Friese M, Wiers RW. Impulsive versus reflective influences on health behavior: a theoretical framework and empirical review. Health psychology review. Sept 2008;2(2):111-137.

2. Tudor-Locke C, Craig CL, Brown WJ, et al. How many steps/day are enough? For adults. The international journal of behavioral nutrition and physical activity. 2011;8:79.

3. Bassett DR, Jr., Wyatt HR, Thompson H, Peters JC, Hill JO. Pedometer-measured physical activity and health behaviors in U.S. adults. Medicine and science in sports and exercise. Oct 2010;42(10):1819-1825.

4. Krebs-Smith SM, Guenther PM, Subar AF, Kirkpatrick SI, Dodd KW. Americans do not meet federal dietary recommendations. The Journal of nutrition. Oct 2010;140(10):1832-1838.

Your Body is the Result of Your Lifestyle

Although we sometimes don’t want to admit it, our bodies are the result of our lifestyles.  We need to have these frank conversations; we need to be honest with ourselves.  Once we do this, once we hold ourselves accountable and stop blaming our metabolisms, big food, and busy schedules, we can identify the things that are truly holding us back and TAKE BACK CONTROL.  The old saying, “You are what you eat” is true..........to a certain extent.  In my opinion this saying should be rephrased and taken one step further to say

You are HOW MUCH you eat and you are HOW MUCH you move.

Something that I learned in graduate school and tell all of my Anatomy & Physiology students is that “the body is a demand driven system” (Dr. P. Darrell Neufer taught me that).

What I mean by this is that your body adapts to the demands placed upon it.  For example, the stress of exercise causes an increase in:

• muscle size
• bone mineral density and bone strength
• tendon and cartilage resiliency
• muscle capillary density and blood supply to the muscle
• hemoglobin and oxygen carrying capacity of your blood
• blood volume and improved thermoregulation (earlier onset of sweating to cool the body)
• the strength of the heart, the amount of blood pumped with each heartbeat, and a decrease in resting heart rate
• the ability to produce energy in your muscles due to increased mitochondria (and the type of muscle fibers you have become more oxidative and can use oxygen more efficiently)

When you stop exercising the opposite is true!  No demand = No improvements in heath (or actual decrements in health). 

The thing that we need to realize is that our bodies operate on a continuum.  In everything we do we are either training or detraining.  The way that your body looks now is not by chance or accident.  It is a reflection of where you are on the continuum.  Now, before I move on I want to address the elephant in the room, your genes.  We know that genetics plays a prominent role in our health and body image but at the same time we cannot allow ourselves to fall into the “whoa is me”, “genetics” trap.  This type of thinking is self-defeating.  You will lose before you even begin.  There is always someone better off or more blessed than you and there is always someone worse off than you.  Let’s take what God gave us and make the most of it! 

Now back to the continuum.  On one side of the continuum we have the couch potato and on the other side we have the ultra fit marathon runner.  Each of these alter egos (couch potato or marathon runner) resides within each and every one of us.  Sure, our genetic program dictates our upper level capacities but we are all born with more than enough ability to run a marathon.  Some of us will never break the 4:00 mark in the marathon, no matter how hard we train, but I refuse to accept when people tell me they cannot run a marathon.  A 90+ year old woman recently ran the San Diego marathon.  If you WANT to run a marathon and have the dedication to complete the training, you CAN run a marathon.  As I have previously written, we must make daily physical activity a priority in our lives. 

92-Year-Old Runs to Break Marathon Record in San Diego (courtesy of competitor.com).

It is also important to remember that you do not have to run a marathon or perform “traditional” exercise to be healthy.  Did you know that even if you don’t go to the gym, swim, bike or run that you are still exercising everyday?  Your activities of daily living (i.e. cooking, cleaning, going to work or school, chasing after your kids, or sitting at your computer) provides a training stimulus!!!  Yes, you read that correctly, even the act of sitting upright, which is normally classified as a sedentary behavior requires muscle activation and on some level can be considered training.  Technically, any movement performed against gravity is training!  The training stimulus of sitting is quite small; however, compare and contrast the amount of muscle activation in a person sitting upright to someone who is bedridden or who is experiencing the microgravity of space.

Critically ill patients placed on mechanical ventilators (which do the work of breathing) lose diaphragm mass (the muscle responsible for breathing) within 18-48 hours of being placed on a ventilator (1,2).  As little as 7 days of bed rest in otherwise healthy individuals causes them to lose 1-4% of their back and lower extremity muscle mass (3).  Casting of the lower leg for 6 weeks after an ankle fracture can decrease lower leg muscle volume by ~17% (4).  In each of these cases, the demand place upon the muscle decreased and so did the muscle volume.  Use it or lose it!

In the microgravity environment of space as few as 5 days (and the loss of the stimulus of gravity, against which your muscles pull when you move) caused muscle cross sectional area, a measurement of muscle size, to decrease by as much as 24% in type II muscle fibers (5).  The longer the space flight, the greater the loss of muscle size becomes (6,7).  Again, Use it or lose it!  Of course, these are extreme examples of disuse, but they serve a point as to how quickly physical inactivity can have negative health consequences.

So, whether you believe it or not, your daily physical activity is still training.  The more daily movement you have, the more you are training.  Stand up from your chair = training.  Washing your hands = training.  Walking to your car = training. 

Figure 1: The Exercise Continuum from Bed Rest to Trained Athlete.  ADLs = Activities of Daily Living

Bed rest and the microgravity of spaceflight are representations of our most sedentary, detrained states and are found on the far left side of the continuum (Figure 1).  Activities of daily living (ADLs) keep you more towards the middle of the continuum.  Performing more activities of daily living will push you towards the right side of the continuum but if you really want to be on the right side of the continuum you’ll need to perform traditional resistance training (e.g., weight lifting) or aerobic training (e.g., brisk walking/running).

Protein synthesis, the impetus behind bigger, more tone muscles and fit bodies, increases almost immediately after working out (3 hours after) and remains elevated for more than 24 hours in novice exercisers (during which time protein synthesis peaks at around 150% of baseline) (8).  This is why exercising at least every other day is so important.  If you exercise every other day, as soon as your rate of protein synthesis decreases, you can stimulate your muscles to increase in size again (Figure 2). 

Figure 2: Muscle Protein Synthesis Increases Dramatically after a Single Session of Weight Training (8).

Starting a new exercise program also yields an excellent return on investment.  As few as three exercise sessions (in 1 week) has been shown to increase muscle size (9) and in most individuals a noticeable increase in muscle size occurs in less than 3-4 weeks of training (10).  Now, I know that not everyone is seeking an increase in muscle size.  In fact, most women are scared of lifting weights because they are afraid their muscles will become too big.  Contrary to anecdotal reports, women simply cannot bulk up to the degree their male counterparts do in response to resistance training (11).  In women, resistance training will tighten and tone, not bulk and burden.

Nutrition is also very important to how our bodies look and how we feel about them.  If we created a continuum for nutrition it would span from anorexia to normal to obese (with normal being optimal).  In the interest of time (and your attention spans) we will not discuss nutrition in the amount of detail that we discussed exercise.  In brief, when we consume too many calories we place a demand on our adipose (fat) tissue to store these calories.  When we eat too few calories, now the demand shifts towards releasing those calories from the adipose to be burned in other tissues such as skeletal muscle.  Our fat stores reflect whether we have been ingesting more calories than we are burning over a prolonged period of time.  The more food we eat, the bigger our bodies will get.  The converse is also true.  The less food we eat, the smaller we get, sometimes to the point of unhealthiness, anorexia, and even death (Figure 3).

Figure 3: The Energy Balance/Nutrition Continuum. The amount of food we eat and the amount of energy we burn contribute to where we find ourselves on the nutrition continuum.

When we have the right mindset, when we know exactly what we are up against, and we know how the body works, we can design a plan to create the type of body we want to have.  The human body is highly malleable.  THIS IS A GOOD THING!  You can work to shape it the way you want it by knowing that the human body is a “DEMAND DRIVEN SYSTEM”.  If we increase the demand of our muscles, they get stronger/bigger/more tone.  If we increase the demand from our fat stores by eating less, they get smaller.  Everyone has a different idea of what is right for them, there is no one size fits all to what someone should look like, just like there is no one size fits all for where someone should sit on the exercise or nutrition continuum.  The important thing is that you are aware of where you sit, and that you are happy with it.

When you understand that the body is a demand driven system and you know the elements that are causing the body to be too big, too small, or just about right, YOU ARE IN CONTROL OF YOUR BODY and YOU can manipulate it to fit YOUR DEMANDS.

Todd M. Weber PhD, MS, RD

In the companion blog to this article, Taking Back Control, find out how you can use a simple three piece framework to mold your body into the way you want it.

 References:

1. Grosu HB, Lee YI, Lee J, Eden E, Eikermann M, Rose KM. Diaphragm muscle thinning in patients who are mechanically ventilated. Chest. Dec 2012;142(6):1455-1460.
2. Levine S, Nguyen T, Taylor N, et al. Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. The New England journal of medicine. Mar 27 2008;358(13):1327-1335.
3. Shangraw RE, Stuart CA, Prince MJ, Peters EJ, Wolfe RR. Insulin responsiveness of protein metabolism in vivo following bedrest in humans. The American journal of physiology. Oct 1988;255(4 Pt 1):E548-558.
4. Psatha M, Wu Z, Gammie FM, et al. A longitudinal MRI study of muscle atrophy during lower leg immobilization following ankle fracture. Journal of magnetic resonance imaging : JMRI. Mar 2012;35(3):686-695.
5. Edgerton VR, Zhou MY, Ohira Y, et al. Human fiber size and enzymatic properties after 5 and 11 days of spaceflight. Journal of applied physiology. May 1995;78(5):1733-1739.
6. Fitts RH, Trappe SW, Costill DL, et al. Prolonged space flight-induced alterations in the structure and function of human skeletal muscle fibres. The Journal of physiology. Sep 15 2010;588(Pt 18):3567-3592.
7. Widrick JJ, Knuth ST, Norenberg KM, et al. Effect of a 17 day spaceflight on contractile properties of human soleus muscle fibres. The Journal of physiology. May 1 1999;516 ( Pt 3):915-930.
8. Damas F, Phillips S, Vechin FC, Ugrinowitsch C. A review of resistance training-induced changes in skeletal muscle protein synthesis and their contribution to hypertrophy. Sports medicine. Jun 2015;45(6):801-807.
9. Ogasawara R, Thiebaud RS, Loenneke JP, Loftin M, Abe T. Time course for arm and chest muscle thickness changes following bench press training. Interventional medicine & applied science. Dec 2012;4(4):217-220.
10. DeFreitas JM, Beck TW, Stock MS, Dillon MA, Kasishke PR, 2nd. An examination of the time course of training-induced skeletal muscle hypertrophy. European journal of applied physiology. Nov 2011;111(11):2785-2790.
11. Ivey FM, Roth SM, Ferrell RE, et al. Effects of age, gender, and myostatin genotype on the hypertrophic response to heavy resistance strength training. The journals of gerontology. Series A, Biological sciences and medical sciences. Nov 2000;55(11):M641-648.

Everything You Eat Will Kill You!

Did you know that Everything You Eat Will Kill You?

Yes, that’s right.  Everything you eat will kill you!  Or at least that’s what the media and many health & wellness professionals will lead you to believe.  When I say that everything you eat will kill you I AM NOT referring to the bisphenol A (BPA) in plastics and canned food linings, pesticides in/on our fruits and vegetables, food additives such as the Subway bread additive, azodicarbonamide, the same chemical found in yoga mats, nitrates in meats, arsenic in wines, hormones and antibiotics in our meats or genetically modified organisms GMOs. Those are an entirely different discussion for a different day.

What I AM referring to that will purportedly kill you are actually the foods themselves (without mention of additives, chemicals, pesticides or other alterations). These are foods that we eat on a regular basis, foods that are staples of our diets, and foods that we usually associate with BEING GOOD FOR US such as wine, tomatoes, tea, potatoes, onions, milk, lemons, eggs, corn, coffee, cheese, carrots, and bread!

If this seems ridiculous to you it’s because it is.  To highlight the type of nutritional paranoia that the media exposes us to, two clever scientists, Jonathan Schoenfeld and John Ioannidis performed a study in which they chose 50 common ingredients from a cookbook (could be your mom’s) and scoured the scientific literature in search of evidence for or against the risk of cancer associated with the consumption of each ingredient.  The researchers found that a whopping 72% of the common ingredients in everyday recipes were linked to an increased or decreased risk of cancer. 

The Figure below (Figure 1) has been taken from Schoenfeld & Ioannidis’s article and lists many of the staples of our diets that we deem to be healthy.  Each dot on the figure represents one research study and the relative risk of cancer.  “1” represents a neutral risk for developing cancer, less than 1 represents a reduced risk of developing cancer, and greater than 1 suggests an increased risk of developing cancer.

Commonly Eaten Foods and Cancer Risk

Figure 1: Common ingredients in Foods Eaten and Cancer Risk. Each dot represents one research study.  “1” represents a neutral risk for developing cancer, less than 1 represents a reduced risk of developing cancer, and greater than 1 suggests an increased risk of developing cancer.

It is extremely difficult to eat a diet that will not kill you, especially if we consider how the United States Department of Agriculture (USDA) recommends we eat.  When I was growing up the USDA recommended we model our diets after the Food Guide Pyramid (Figure 2).  They have since revised their figure (ChooseMyPlate) but the overall recommendations remain similar.  Half your plate should be fruits and vegetables, a quarter of your plate should contain whole grains, and the remainder of your plate should contain protein.  Milk and dairy products should also be consumed.

How Should I Eat?

Figure 2: United States Department of Agriculture (USDA) Guidelines for Healthy Eating Past and Present.

Depending on whom you listen to, an entire food guide pyramid can be constructed out of foods that will supposedly harm you.  It’s of little wonder why people are so confused as to what they should be eating!!

Figure 3: Eating by the USDA Food Guide Pyramid will Purportedly Kill You.  You can fill the entire Food Guide Pyramid with the foods that will kill or at the very least harm your health. 

Some of the most common arguments presented by the “food paranoists” for each segment of the food guide pyramid are presented below. (Note: These descriptions are not meant to scare you out of eating any of these items, it just serves as a summary of how many confusing and frankly, off base, ideas are out there.)

Grain: Giving up gluten, the protein found in wheat, rye, and barely, is super trendy (and frankly very disrespectful to individuals who actually have Celiac disease).  People subscribing to the “Paleo diet”, the Paleolithic diet of our ancestors do not believe in eating grain either.  We’ve only been eating grain for 10,000 years but we might as well give it up now (sarcasm).  I am of the opinion that we developed farming, in part, because we were tired of starving and dying, but sure give up grain.  Some people believe grains also contribute to the development of diseases such Alzheimer’s (see Wheat Belly book).

Fruits and Vegetables: Unless you are eating organically grown, pesticide free, natural fertilizer fed, GMO free fruits and vegetables you are poisoning yourself (according to some).  You also shouldn’t eat potatoes, carrots, corn, peas, apples, grapes, and bananas because they contain too much sugar.  You may think I am exaggerating here but I am continually asked the question from very concerned, health conscious individuals whether they should watch their fruit and vegetable intake to limit their sugar intake.  Let me say this as simply as I can: it is IMPOSSIBLE to consume too much sugar by eating fruits and vegetables.  It’s what you eat the fruits and vegetables with/on that can harm your health, not the fruits and vegetables themselves.

Dairy: Dairy is a great source of calcium, right?  Yes, but it also contains saturated fat, promotes inflammation, doesn’t prevent osteoporosis rather promotes osteoporosis, and causes cancer.  Many of us get our vitamin D through dairy consumption.  If you can’t eat dairy you can still get your vitamin D from exposure to the sun.  Oh wait, the sun’s UV radiation causes skin cancer so we better avoid that.  Then drink fortified orange juice, oh wait you can’t do that because there is too much sugar.  Fish?  Nope, wrong again, you’ll get mercury poisoning.  Can I take a pill?  Better take the right one or it won’t be properly absorbed.

Meat: Red meat is associated with an increased risk of cancer, chicken is pumped full of antibiotics and hormones, and pork is too fatty/unclean.  Your alternative is to eat fish but it is contaminated with toxic levels of mercury so I guess fish is off limits as well unless you can capture it yourself from an uncontaminated stream or lake (good luck).

Sugar: Sugar is Toxic.  Sugar is the 21st Century’s scapegoat much the same as fat was the 20th Century scapegoat.  It seems like everyone these days is jumping on the “I hate sugar because it’s evil” bandwagon.  People are up in arms over the amount of sugar in pretty much anything that is remotely processed.

Water: The human body cannot survive longer than 5-7 days without water.  Most of us have also had it drilled into our heads that we should be drinking 8 cups of water (64 ounces) on a daily basis and the Nalgene company has profited greatly from this recommendation.  However, did you know that consuming too much water can kill you?  In 2007, a Sacramento, California, woman died from drinking too much water (water intoxication) as part of a radio contest.  Drinking an excessive amount of water in a relatively short period of time can dilute your blood’s sodium concentration (hyponatremia) to a level that is lethal.  People running marathons and half-marathons are also at risk of hyponatremia.

What’s the Bottom Line?

There is WAY too much fear mongering in nutrition.  Everything you eat will apparently kill you.  I don’t know about you but I enjoy eating foods from every food group.  Demonizing one food or nutrient and completely cutting it out of your diet only hurts you.  You’re depriving yourself from a wonderful human experience, enjoying food!  There is not one single food or nutrient that will significantly improve your health and there isn’t one single food or nutrient that will significantly harm your health. 

It always surprises people when I tell them that I eat pizza, I like donuts, drink beer, eat Doritos, enjoy bacon, and really like cheesecake.  I refuse to believe that any of these foods are “bad for me” in moderation.  In addition, I’d like to point out that I also enjoy whole grains, carrots and dip, bananas, lean meat, and dairy.  As I have pointed out in a previous blog post you have to set your own nutrition rules and balance out the supposed “bad foods” with the supposed “good foods”.  Eat a balanced diet of foods from each food group, eat in moderation, and ignore all the noise about how everything you eat will kill you.  Food is meant to be enjoyed, not feared, so ENJOY IT! 

Todd M. Weber, PhD, MS, RD

References:

Figure 1: Commonly Eaten Foods and Cancer Risk:

http://ajcn.nutrition.org/content/early/2012/11/27/ajcn.112.047142.abstract

Figure 2: USDA Guidelines for Eating: 

https://fnic.nal.usda.gov/dietary-guidance/myplate-and-historical-food-pyramid-resources

Figure 3: Food Guide Pyramid of Foods You Should Not Eat:

• Sugar: http://www.tipografica.com/whats-wrong-with-our-diet/
• Sugar: http://www.worldhealthstore.com.cn/Blog/how-and-why-we-need-anti-sugar.html
• Dairy: http://www.adirbakery.com
• Dairy: http://riversbridgesandwoods.blogspot.com/2012/07/busting-dairy-myth.html
• Bacon: http://www.portlandmercury.com/BlogtownPDX/archives/2009/01/29/can_we_be_done_with_bacon_ple
• Meat Free Zone: http://www.yogalifestyle.com/yogaResources/yogaResourcesFreeVegPosters.htm
• Eggs: http://www.adirbakery.com
• Fruits and Veggies: http://www.personal.psu.edu/kmb5823/blogs/la101h/2011/04/
• Fruits and Veggies: http://www.marksdailyapple.com/zero-carb-diet/#axzz2lyZqwqY2
• Fruits and Veggies: http://thereversevegan.blogspot.com/2010/12/sugar-fructose-part-4-fruits-are-not.html
• Fruit: http://lilmisskiddo.blogspot.com/2011_05_01_archive.html
• Grains: http://www.mojlekar.eu/index.php?str=news&od=90&selekcia=1
• Grains: http://my.firefighternation.com/profiles/blogs/healthy-eating-rules-for-the-firehouse
• Grains: http://daiasolgaia.com/?p=3917

Nutrition and Exercise Return on Investment (NEROI)

Return on investment (ROI) is a commonly used economic term to indicate the benefits (profits/returns) you get back from investing a resource (time/money).  I have coined a term that I believe we should be talking about in the health & wellness industry called NEROI: Nutrition and Exercise Return on Investment.  To put it simply, NEROI is a measure of how much time you exercise and plan/prepare your food and the positive returns in health that result from your efforts.  To help you begin to define your NEROI you need to ask yourself a few simple questions.

INVESTMENT

How much time do I spend exercising each week?  0 minutes, 30 minutes, 300 minutes?

How much time do I spend planning meals, grocery shopping, and preparing food?  0 minutes, 30 minutes, 300 minutes?

RETURN

Am I happy with how healthy I am, physically and emotionally speaking? Am I happy with my progress towards my health and wellness goals?

Take a few minutes to consider your answers to these questions............Most people will probably answer that they can and should be doing more.  Even the best trained athletes in the world (professionals) tend to think they should be putting more work into their training and nutrition. 

I want you to consider the NEROI questions carefully and follow them up by asking YOURSELF, "how much investment is enough, how much is optimal, and how much is too much for me?" 

Clearly, spending 30 minutes on your NEROI is better than spending 0 minutes but is spending 300 minutes better than 30?

Like anything in this world, the answer is, “It depends”.  It depends on how much time you have, the resources available to you, what your goals are, and how much it means to you.

Several professional organizations have defined what they believe to be the appropriate amount of exercise to live a ‘healthy’ life.  The Centers for Disease Control and Prevention, the American College of Sports Medicine (ACSM), and the American Heart Association (AHA) recommend: 

• 30 minutes of moderate intensity aerobic activity on all or most days of the week (5 days) totaling 150 minutes.
• Resistance training should be performed 2-3 days/wk using a variety of exercises and equipment.

Surprisingly, when it comes to our nutrition, there are no professional recommendations on the amount of time per week one should spend planning, purchasing, and preparing food. 

What we do have are recommendations on the quantity and types of food we are supposed to be eating (2000 calorie/day example: 6 grains, 2 fruits, 3 vegetables, 3 dairy, 3 protein, limit fats) without any type of roadmap whatsoever on how to achieve these recommendations.  It is obvious this does not work, as less than 10% of people follow the recommended nutrition guidelines (1) and only 20% of Americans meet the recommended physical activity guidelines (2).

If you’re like the vast majority of Americans not meeting the recommended guidelines should you simply throw your arms up in the air and give up?  Hell no!  Let’s consider how much exercise and nutrition preparation are enough, optimal, and excessive.

EXERCISE ROI

When it comes to physical activity and exercise, some people have used the expression, “Just do SOMETHING!” and this is for the most part, accurate.

Figure 1: Morality rates across fitness levels in women and men.  Increasing your level of fitness from low to moderate drastically reduces your risk of premature death (3).

Figure 2: Daily physical activity duration and all-cause mortality reduction.  Increasing physical activity reduces your risk of dying prematurely, even at a moderate intensity (i.e., brisk walking) (4).

The two graphs above show that when it comes to exercise, the greatest return on investment is going from doing nothing (0 minutes/day) to doing something.

Increasing your fitness from moderately fit to really fit, to super fantastically fittest of the fit doesn’t protect you much more from dying prematurely any more than moving just a little (Figure 1).  The least fit people are the most likely to die at a young age whereas those that are just a little more fit (those that move around a bit more) are FAR less likely to die early.   

In Figure 2 you can see that increasing your total physical activity (red line) from 0 minutes/day to 15 minutes/day reduces your risk of dying prematurely by ~14%.  If you add another 15 minutes/day of exercise you further reduce your risk by ~5% to a total risk reduction of ~19%.  Your first 15 minutes yields a 14% risk reduction and your next 15 minutes yields 5% risk reduction.  Clearly, your best ROI is moving from nothing to something (although I am not discouraging you from doing more).

NUTRITION ROI

Research scientists and clinicians are constantly trying to identify the types of behaviors that help people lose weight and the types of behaviors that may cause you to gain weight or to regain the weight you lost.

Figure 3: Weight loss ROI by behavior type.  The relative importance of each behavior adopted over a 3 year period to weight loss success (Adapted from reference 5).

People don’t gain weight due to a single factor nor do they lose weight due to a single factor (gluten, saturated fat, omega-3s, antioxidants; none of them work alone or will ruin your diet).  Generally speaking, there isn’t one behavior that will make, or break your health (outside of smoking maybe).  The pie chart above was adapted from the results of a 2004 research study (5) showing the behaviors most and least beneficial to maintaining weight loss over a three year period.  As you can see, not all behaviors are weighted equal (Figure 3).  Some behaviors, such as establishing a “meal rhythm” are more helpful than “rigid control of eating”.  The graph above is by no means an all inclusive list but it helps us to identify some of the behaviors most (and least) helpful in maintaining weight loss.

The line graph below (Figure 4) is another way of viewing behavior modification (nutrition) return on investment and has been adapted from the results of the same study discussed in the paragraph above (5).  The vertical, y axis, shows the percentage of weight loss participants who were successful at maintaining their weight loss three years after the study’s end.  As you can see, even adopting “1” new nutrition behavior lead to a 20% success rate in keeping their weight off.  With the addition of each new behavior (ie: flexible eating, coping with stress, etc) these individuals were able to increase the likelihood of maintaining their weight loss after 3 years.  In this study, the adoption of each additional positive behavior increased the participant’s chances of weight loss success; that is until you reach “5” new behavior modifications, at which time your ROI levels off. 

Figure 4: Weight loss ROI by the number of behaviors adopted.  The number of healthy behaviors adopted over a 3 year period and weight loss success (Adapted from reference 5). 

The fact that the participants received “less bang for their buck” may seem like bad news but it is actually great news.  Individuals adopting “8” healthy behaviors were not any more successful in maintaining their weight loss than those individuals adopting “5” new healthy behaviors!  This tells us that you don’t have to be perfect to achieve and maintain weight loss success, but you do need to select a few new healthy habits that suit you well and be really good at maintaining those behaviors.

TAKE HOME MESSAGE

You don’t have to be an avid runner, extreme weightlifter, or Whole Foods connoisseur to live an active, healthy lifestyle and you don’t have to be perfect in your nutrition and exercise choices to have a great NEROI.  Exercising for as little as 10 minutes/day and taking time to plan and prepare your meals will go a long ways towards improving your health.  Your meals don’t have to be perfect and they don’t have to be a salad, low-fat dressing, and chicken breasts.  As we saw in the pie chart above (Figure 3), planning the meal (meal choice) and eating consistently (meal rhythm) provides a great nutrition ROI.

We live in a society of extremes (marathons, ultra marathons, extreme sports, supermodels, etc.) where everyone seems to be “the best” at something and we often feel compelled to emulate them.  Trying to be like them is not realistic or achievable for 99% of us, me included.  I’m not a professional athlete so why would I train like one?  Instead of focusing on what we can’t do (train like a professional athlete), let’s focus on what we can do.  There is no doubt that losing weight, maintaining weight loss, eating healthy, and maintaining a consistent exercise routine is hard work.  But it can be done and it starts with setting small, achievable goals.  Although tempting, lofty, magic, cure-all, easy short term fixes do not work in the long run (Nutrisystem, Slimgenics, hcG, low carb, etc).

Going forward, I suggest you determine a level of nutrition and exercise that you’re comfortable with and can consistently maintain, create a plan to execute this level of nutrition and exercise, and give your plan 3-4 weeks to start to see your results (NEROI).  If you’re happy with your NEROI, keep up the good work!  If you are not seeing the results you would like to see, revisit your plan and see what you can change or do better.  It is important to remember that “consistency is king”.  If you are not consistent and fail to adhere to your plan, you will have no idea whether your new program really worked and you will have to repeat the test all over again.

Stay tuned for my next post in which I will talk about HOW TO CREATE your nutrition and exercise plans.  Knowing how to create the right plan for you is the first key to success.  For now you can start brainstorming with the NEROI questions I posed above.

Todd M. Weber, PhD, MS, RD

References:

1. Krebs-Smith SM, Guenther PM, Subar AF, et al. Americans do not meet federal dietary recommendations. Oct 2010 J Nutr. 2010;140(10):1832-1838.
2. CDC Press Release. One in five adults meets overall physical activity guidelines. May 2013. Accessed Feb 26, 2015.
3. Church TS. The low-fitness phenotype as a risk factor: more than just being sedentary? Obesity. Dec 2009; 17 Suppl 3:S39-42.
4. Wen CP, Wai JP, Tsai MK, et al. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet. Oct 1 2011;378(9798):1244-1253.
5. Westenhoefer J, von Falck B, Stellfeldt A, Fintelmann S. Behavioural correlates of successful weight reduction over 3 y. Results from the Lean Habits Study. International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity. Feb 2004;28(2):334-335.

Don't Just Tell Me what to do, Show Me how to do It!

All too often we are told what do to and are not shown how to do it.  Online video, seminars, and lectures are great for disseminating large quantities of nutrition and exercise information, but how effective are they in facilitating behavior change?   I’m sure many of you are aware that you should drink eight 8-ounce glasses of water, eat 5 servings of fruits and vegetables, get 4+ servings of whole grains, eat a diet low in saturated fat, and perform a minimum of 30 minutes of exercise each day for optimal health.

My Daily Food Plan: The United States Department of Agriculture outlines the types and quantities of foods to eat but how do we incorporate these foods into our lives to meet these requirements?

For most of us these “suggestions” have been thoroughly drilled into our heads as something we need to do on a daily basis to “be healthy” but how do we actually accomplish this?  I have been told hundreds of times to eat more fish.  How do you think that’s gone for me?  Answer:  Not well. 

People are fond of saying that knowledge is power.  However, what is knowledge if you don’t know how to use it? 

We can watch online videos, we can read tutorials, we can listen to lectures, but unless we are actually practicing these behaviors in a hands on, real world setting, how effective are these methods?  If video is so great why do we even bother employing teachers anymore?  Why don’t we just make a ton of Khan academy type videos and make teaching as extinct as dinosaurs?  Because learning is unscripted.  Learning is spontaneous.  Because learning is hands on.

People are unique individuals, each with diverse responsibilities, obstacles, and day-to-day challenges.  Telling someone to drink more water or eat more fruits and vegetables without first learning about each individual’s unique responsibilities, obstacles, challenges, and preferences is short sighted.

As a society (and many health related businesses as well) we value efficiency over effectiveness.  We would much rather spend a small amount of money on a quick fix or a fad diet to remedy our problems only to fail, repeat, fail, repeat, and fail again.  In the end, we spend more money over numerous failures than we would have otherwise spent on getting to the root of the problem and fixing it from the start.

One of the things I pride myself on is that I am constantly working to develop materials that help people discover how they can incorporate good nutrition and exercise habits into their own personal, unique, individual lives.

Technology (and videos) are great but they can’t solve everything.  Seminars and lectures disseminate large amounts of information quickly, but don’t necessarily lead to any meaningful change.  Top ten lists may be idea generators, but are, for the most part, pointless.

Instead of relying on people to tell you what to do (there’s plenty of them out there), have someone show you how to do it.  I can tell you what to do (establish your own nutrition rules, make fitness and nutrition a priority in your life, answer the who, what, when, where, why, and how questions of grocery shopping, utilize a recipe manager to plan your meals and grocery shopping, expand your exercise toolbox by taking new exercise classes or hiring a personal trainer, and track your physical activity with a Fitbit) but I would rather have the opportunity to show you how to do it!

Todd M. Weber, PhD, MS, RD