Your Doctor's Permission

Almost every exercise video or book I see always comes with a disclaimer: Do not perform any of these exercises without the consent of your doctor.

First of all, how many people are going to read the message, go to their doctor, show them the product, and then decide whether or not to use it? If they've already bought it, they're going to use it.

Even if they did ask their doctor, they'd be wasting their time. Sometimes we put too much faith in doctors. We think they are the fountain of knowledge and wisdom. They can answer all of our questions regarding health and nutrition. Their advise is gospel.

My experience indicates otherwise. A couple years ago I went to donate blood at the American Red Cross. They told me they couldn't take my blood because I was anemic (not enough hemoglobin in the blood, due to the lack of iron, a key component of this protein). Not too much longer a lesion formed on my pituitary gland which created bleeding in my eye.

Two years of visiting doctors never gave me an answer as to why this happened. "Pipes leak," was my conclusion. The bleeding resided within a couple weeks but it led to the discovery of a more troubling problem: a low level of testosterone. My testosterone levels had dropped to as low as 90 mg/dl, when it should have been at least 200-500 mg/dl.

To make a long story short, over the next two years I made countless trips to see my doctor, two endocrinologists (hormone doctors), two hemotologists (blood doctors), a brain surgeon, and an eye doctor. The result? No answers. I took one prescription that never worked, and another that worked one month but not the next.

That's just my story. I've heard so many stories of patients going all over looking for a doctor that can accurately diagnose their problem. Doctors often give conflicting information, recommend unnecessary surgeon, misdiagnose the problem, tell their patients to take a medication that either doesn't work or inflames the problem, or give misinformation. Doctors are dangerous too. One of the leading causes of death in America is poor handwriting on prescription notecards. Pharamicists misread the prescription and the patient gets the wrong medicine. No kidding.

Doctors know absolutely nothing about nutrition. They repeat standard disinformation (saturated fat is bad, cholesterol is determined by diet, grains are food but fat is bad, etc...) but certainly shouldn't be depended on for nutritional advise. From what I hear, most doctors aren't even required to take a course in nutrition in medical school.

If doctors had the best bodies then I'd rely on them for exercise and fitness advise, but look at your doctor. Does he have a six pack? Probably not. Is he overweight? Probably. If they practiced what they preached they'd look a lot better. That's why I recommend you don't consult your doctor before starting an exercise problem. Review your medical history with a qualified personal trainer who will then prescribe a program that takes into your account your contraindictions.

Are doctors worthless then? No, but they're like a dress: you need to find one that fits you. Does he understand your history and needs? Is he fit and active? Does he have any background in nutrition? Does he take a holistic approach? Does he do more than prescribe medicine that has negative effects on you health?

Sometimes you are your best doctor. Listen to your body, do your own research, consult with people who share a similar problem, and read as much as you can. If you do want to consult with a doctor, then get a recommendation.

Happy, healthy, and strong,

Kevin

Will Exercise Make you Fat?

Time magazine released an article last month about the inability of exercise to lower your weight. This might seem counterintuitive. Haven’t we been told to exercise to lose weight? Won’t a caloric deficit lead to fat loss? Isn’t physical activity essential for losing weight? The answers to all these questions are yes. This article highlights the second, and most critical, part of fat loss: proper nutrition. However, the author, John Cloud, doesn’t seem to recognize that. So ironically, his article makes a terrific point but fails to acknowledge it. But Cloud goes further and says hard work and exercise might make you fat.

Cloud says, “I get hungry after I exercise, so I often eat more on the days I work out than on the days I don't…exercise has another effect: it can stimulate hunger. That causes us to eat more, which in turn can negate the weight-loss benefits we just accrued.” He then quotes Steven Gortmaker at Harvard who says, “"If you're more physically active, you're going to get hungry and eat more." Again, this can easily be avoided with a meal plan that is palatable and pre-planned.

Cloud also makes a good point, but once again fails to acknowledge it. On days you don’t work out, your caloric demands will obviously be lower. If you normally eat a pre-workout meal, skip it on days you don’t. If you usually have a bowl of granola, a banana, and a cup of milk after your workout, reduce the portion of the granola or cut out the banana on days you don’t. This is called periodizing your diet, but I doubt Mr. Cloud, a journalist who reports on more than exercise and fat loss, and whose expertise probably lies elsewhere, understands this.

It’s true that if you workout on the Versaclimber or the Elliptical for 45 minutes and then eat a blueberry muffin and a scone at Starbucks, you’ll negate the weight-loss benefits of exercise. But you don’t have to do that. As I tell my clients, plan ahead and make your meals ahead of time. Determine your caloric needs, figure out what you’re going to eat, then go to the grocery store once a week, get what you need, and prepare all your meals for the week. That way, you don’t have to “wing it.” That is, when it’s time for breakfast, you’re not debating which fast food restaurant or baked good to choose. Breakfast will already be prepared, and of course, the macronutrients (protein, carbs, fat).

He cites research in Obesity Research that claims that muscle only burns 4 calories per day. This goes against all other research that estimates that muscle tissue burns 35-50 calories per day. This is the first time I’ve ever seen research that claims that muscle tissue only burns four calories per day. More recent research at James Madison University suggests it’s far more metabolically active.

Nonetheless, the article does make reference to the numerous health benefits of exercise: reduces risk of just about every disease imaginable, as well as psychological benefits. Cloud also says that moderate but sustained daily activity might actually be as good as structured exercise. Instead of running on a treadmill for an hour, you might be better off standing and walking throughout the day. Instead of driving, walk or drive a bike. Instead of using a power lawnmower, use a push mower. Small changes in your expenditure, just like small changes in your intake, can lead to enormous fat-loss benefits.

If you sit all day at your job, and you go to the gym religiously, that’s great. Assuming you’re adhering to a good nutrition plan, you’re probably losing fat or maintaining the weight your body wants you to stabilize at. But I also recommend you get up every hour and walk around. Take stairs, take daily walks, stand if you don’t need to sit. Don’t avoid manual labor. Adding a little movement here and there can certainly help you lose weight.

Cloud’s thesis seems to be backed by research, but anecdotal evidence overwhelmingly shows that when people start exercising, they lose weight and they keep it off. How many testimonials and stories do you have to hear to believe it? Whenever you ask people how they lose weight, they say the same thing: I just started running or lifting weights, and I cut out the beer and soda. The answer is never new, even though it seems like we’re expecting some miracle answer. Hundreds of thousands of people lose fat permanently just by making some subtle changes. It’s that extra glass of wine at night, or just adding some exercise five-six times per week. It’s pretty simple.

Let’s say Fred is overweight. He eats 3000 calories per day and his weight is stable. If he adds exercise to his daily routine and burns 500 calories during that hour of exercise, he should expect to lose a pound per week. This is reasonable. But Cloud seems to think that it’s inevitable that he will eat an extra 500 calories to compensate. This is possible, but it doesn’t have to happen. A meal plan of 3000 calories will achieve fat loss.

Cloud also thinks that if we exercise more, we’ll be more sedentary later. When people start exercising, they’re usually replace sedentary time with exercise. It’s not as if overweight people are constantly moving throughout the day and swinging on monkey bars. And then when they start going to the gym an hour per day, they all the sudden become more sedentary the rest of the day. Rather, most people who start exercising are adding activity to their lives, not subtracting it. Instead of sitting 16 hours per day, they’re sitting 15 and climbing the Stairmaster for one hour. My point is, in our society, adding activity is much more likely to increase expenditure than to decrease it.

So keep moving and stick to a solid nutrition plan. It won't make you fat.

Kevin

Should We Exercise Less as we Age?

An article in the Wall Street Journal can be misinterpreted to mean that old people shouldn't exercise, and that they should keep their heart rate below a certain number of beats. But let me disect this article to make sure you understand it. The author isn't lying, and he isn't being deceitful, but it can be easily misunderstood.

Sudden cardiac death (SCD) is natural death from cardiac cause within a short time period less than one hour after onset of symptoms. It's the most common fatal manifestation of cardiac disease. Almost 2/3s of deaths attributed to cardiac death are SCD. When SCD is exercise-related, it is associated with obstruction of two or more coronary arteries, or ruptured atheroslcerotic plaque and extensive blood cotting. Fatty depsoits break away from the artery wall and block the artery. During exercise, these ruptures can occur in the center of the artery. When this happens, you die.

Exercise can also cause an imbalance between oxygen delivery and oxygen demand, which can result in ventricular arrhythmias, or irregular heartbeats. When the symphatiec nervous system turns on the flight-or-fight mode, the coronary artries expand, but not in those with coronary heart disease. The chambers of the heart don't fill and this reduces cardiac output. So exercise really only increases SCD for those who already have risk factors for coronary heart disease. Risk factors include gender, age , smoking, family history, and hypertension. Low levels of physical activity are also associated with myocardial infarction and SCD. The US Physicians Health Study showed that people who exercised four times per week were at a much lower risk than those who exercised once a week or less.

So there are many risk factors associated with SCD, intense exercise among them. However, if you make sure you adhere to a diet of clean food, you don't smoke, you consider your family history, and you have no contraindications (unlike Mr. Helliker), intense exercise is unlikely going to kill you.

Back to the article. Kevin Helliker, the author, has been told not to cross 120 BPM at any time, even during the triathlons he competes in. He writes, "unquenched competitiveness can become a threat to their stiffening joints, ridgid muscles, hardening arteries and high-mileage hearts." First of all, none of those ailments are inevitable. A good routine of stretching, a healthy diet, and proper recovery will drastically reduce the risk of those ailments. Mark Allen, an avid proponent of heart rate monitor training, is quoted: "If you have to go as fast at 50 as you did at 20, you will grind yourself into the ground and become stressed out."



I think this is obvious. Does anyone really believe they can go as fast at 50 as they did at 20? It's possible, assuming you were totally deconditioned at 20 and now you're an avid athlete later in life. But really the article comes down to this: you can't exercise as much or as intensely in your middle ages as you did when you were a young adult. Is this really anything new?



The article continues: "exercise can provide substantial protection against chronic ailments ranging from heart disease and diabetes to dementia and depression, all the while helping weight control. But like any medical treatment, exercise can also cause damage." There's still nothing new here. Exercise (or movement as I like to call it) is essential at any age. By more is not always better. More is not better for any athlete. You should do as much exercise as you can absorb.



"Older athletes struggling against declining performance are prone to excess training, which can hurt the immune system and raise levels of the stress hormone, cortisol." All athletes are prone to excess training, especially type-A triathletes.



As you age, you have to accept that you're going to slow down, and you're not going to be as strong as you were when you were in your 20s. This should seem obvious, and we need to adjust intensity and volume as we age. But this doesn't mean we can't win our age group, be extremely fit, and test our body's limits. You just have to know how to rest and recover properly.



Don't forget, this author has an aneurysm in his aortic root, which is a major contraindication for high-intensity exercise. I don't know how common aneurysms are, but they're probably very rare, and most people don't have them. While exercise increases the risk of sudden heart attacks, there are too many proven benefits of exercise to not perform it because of a fear of sudden cardiac death during your bike ride. Keep moving, and stay happy healthy and strong.



Kevin

Should you Avoid Saturated Fat and Cholesterol?

My mother's doctor told her that her cholesterol levels were high. Her total was 270, but her LDL was too high, but her HDL was healthy. Her cholesterol has always been high, but never like this. After taking a second blood test to make sure the first wasn't inaccurate, her doctor prescribed a statin to lower it.

Cholesterol levels are not largely determined by the food you eat. Read that again. Eating red meat, shrimp, and eggs everyday will not determine your cholesterol level. Your cholesterol level is largely genetic and a response to internal damage and inflammation. So is cholesterol the cause or a response to coronary damage? If dietary cholesterol were the cause of high cholesterol, then it doesn't explain why my mother has such high levels. Her diet is immaculate: plenty of vegetables, a couple of protein bars, walnuts, salads, some soy chips (with no saturated fat), and the occasional splurge of light whip cream at night. She runs three times per week and goes to her fitness boot camp religiously three times per week. In short, her dietary cholesteral is very low and the amount of exercise she does suggests that it's not her lifestyle causing high levels.

Nonetheless, she started counting all the saturated fat in her diet. I told her she was wasting her time, and was mistakingly blaming saturated fat for her high cholesterol levels.

For the last 30-40 yeers it's been dogma that saturated fat is bad and that its consumption should be limited. Almost every nutritionist agrees that saturated fat should comprise no more than 10% of your total fat consumption (not total daily caloric consumption). The common belief is that saturated fat causes obesity, coronary heart disease, and high levels of LDL cholesterol. The problem is, no study has ever shown causation, only correlation. But these two terms are not the same. Even so, many studies haven't even shown a correlation between saturated fat and the health problems it's typically associated with. For more on that, I recommend Gary Tabuson's Good Calories, Bad Calories. Or read this article in Men's Health last year. Experience Life has two good articles about cholesterol: Skimming the Truth and Cholesterol Reconsidered.

If saturated fat is so bad, then why do the French, who consume so much full-fat cream and butter, have much lower rates of heart disease?

Why did a recent Harvard study find a relationship between healthy cholesterol levels and the highest saturated fat intakes?

Why is there no definitive study showing that saturated causes heart disease?

Why do some people in the world, like those in Greenland and some tribes in Africa, consume large amounts of saturated fat but have never heard of heart disease?

If saturated fat were the cause of coronary heart disease, why do most people who have heart attacks have normal levels?

In fact, saturated fat has plenty of proven health benefits:

-Absorption of vitamins. Vitamins A, D, E, K are all fat-soluable vitamins, which means you need to eat fats (including saturated) to absorb them properly
-Healthy metabolism. Adding fat to a food makes it more satiating. That is, you'll feel more satisfied after eating a high-fat meal than after a low-fat meal. So is it really better to eat low-fat foods that leave you hungry for more, or to eat a meal with more fat and feel full?
-Proper hormonal production. Fat is needed to proporal produce testosterone and to make a woman fertile. Low fat diets are associated with low fertility and low hormonal production. Adequate fat intake is associated with increased sex drive. Peanut butter as an aphrodisiac? Believe it.
-It tastes good. There's a reason why humans prefer the texture of guacamole, peanut butter, cheese, and ice cream. It has a lot of fat. This isn't a bad thing. For reasons I mentioned above, you need to eat a certain amount of fat. Aim for one gram per kilogram of body weight, or at least 20% of your calories.
-Low fat diets are almost impossible to adhere to. Why? Because we like the texture of fat. And fat makes us feel full. And it tastes good.

So what's my message? If you like milk, enjoy your full-fat milk. If you like ice cream, eat full fat ice cream. If you like butter, don't buy margerine. If you like beef, then enjoy it (as long as it's grass-fed. Don't buy grain-fed). At some point, you have to eat fat in you diet. Eating 'fat-free' or 'low-fat' or 'lean meats' all day will not give you the fat you need. If you're going to eat fat, eat real food (like beef, milk, eggs, coconut oil, etc.)

Enjoy those bad, fatty foods. As long as your insulin levels are normal and balanced, avoid sugars and excess starches, and you eat unprocessed food, you shouldn't worry about saturated fat. I don't.

Kevin

New York's Campaign Against Liquid Calories

Since it's well established that taxes on junk food and soda don't work well, New York City has started a new campaign against liquid calories, soda in particular. The campaign will last three months and cost $90,000. You can see a photo of the ad at the New York Times web-site. It shows body fat pouring out of a bottle and it could be very effective. It's simple and memorable. Drink your calories, and you'll get fat.

New York is the same city that banned trans fat in 2007. We're still not sure how much healthier New Yorkers are because of this. There are still plenty of ways to eat unhealthy without transfat. A diet of fast food, donuts, and beer will still have deleterious health consequences

While this campaign might work to reduce soda consumption, should New York take this initiative? Why is it the city's job to get people to reduce soda consumption? How will New York be better if people stop drinking excess calories?

What will people drink instead? Why don't they target orange juice (120 cal. per 8 oz, just as bad as soda just without high fructose corn syrup and some vitamin c) and milk? Why should soda be singled out? Why is there no campaign against lataes at Starbucks, or the ubiquitous energy drinks that fill the freezers at all convenience stores?

I'm still not sure what the goal of this campaign is. Should we stop drinking soda alltogether, or should we just reduce it? If I'm a fit healthy person who enjoys a can of soda every day, is that harming my health?

Some compare this campaign to the anti-smoking campaign, but this is a faulty comparison. Cigarrette smoking was harmful at any level, whereas a single can of soda is not going to kill you. In fact, if you drank nothing but soda everyday, you could remain at a normal weight and body fat if you didn't exceed the calories your body required.

This goes back to my philosophy that there is no such thing as junk food. You can eat anything you want in moderation. Clearly, Americans and New Yorkers consume too much sugar and soft drinks, but that doesn't make soda inherently bad. Our habits are bad, and I doubt a few signs on buses are going to change the way people drink. Like most government campaigns, it will only lead to further confusion.

Kevin