Five Best Exercises

Thanks to Meredith @HIITMama for bringing this project from Whole9 to my attention:

We brought together 12 fitness experts from a broad range of backgrounds–with bodies of experience ranging from weightlifting to track and field to mixed martial arts, and over two centuries of collective coaching experience–to ask them all the same question:

If you could only perform five exercise movements for the rest of your life, which five would you do? (Assuming your goals are general health, fitness and longevity, and not a specialized sport)*.

The answers may surprise you.

If you want an effective and time-efficient fitness program, I’d review this series carefully.  You may have to research some terms like Turkish get-ups, farmer carries, and dips.  Find examples at YouTube.
 
 

What Happened to Lard?

Lard? Wut choo talkin’ ’bout, Willis?

Lard may be making a come-back. An NPR article reviews its fall from grace, with mention of Crisco, Upton Sinclair, and Procter and Gamble.

Steve Parker, M.D.

h/t Laura Dolson

Hillfit Strength Training and Me

Last January I wrote a favorable review of Chris Highcock’s Hillfit strength training program for hikers.  Ten days ago I finished a six-week trial of actually following the the program, and I still like it.  It’s an eye-opener.

See my prior review for details of the program.  Briefly, you do four exercises (requiring no special equipment) for fifteen minutes twice a week.  Who doesn’t have time for that?

I did modify the program a bit.  I included high-intensity intervals on a treadmill twice weekly, right after my Hillfit exercises.  Here’s the 15-minute treadmill workout: 3 minute warm-up at 5.3 mph, then one minute fast jogging at 7–8 mph, then one minute of easy jog at 5.3 mpg. Alternate fast and slow running like that for 6 cycles.  So my total workout time was 30 minutes twice weekly.

Why the treadmill HIIT (high intensity interval training)?  For endurance.  I’m still not convinced that strength training alone is adequate for the degree of muscular and cardiopulmonary endurance I want.  I’m not saying it isn’t adequate.  That’s a self-experiment for another day.  In 2013, I’m planning to hike Arizona’a Grand Canyon rim to rim with my son’s Boy Scout troop.  That’s six or eight miles down, sleep-over, then six or eight  miles back up the other side of the canyon.  That takes strength and endurance.

One part of the program I wasn’t good at: Chris recommends taking about 10 seconds to complete each exercise motion.  For example, if you’re doing a push-up, take 10 seconds to go down to the horizontal position, and 10 seconds to return up to starting position with arms fully extended.  I forgot to do it that slowly, taking five or six seconds each way instead.

I’ve preached about the benefits of baseline and periodic fitness measurements.  Here are mine, before and after six weeks of Hillfit and treadmill HIIT:

  • weight: no real change (168 lb or 76.2 kg rose to 170 lb or 77.3 kg)
  • body mass index: no change (23.3)
  • resting heart rate and blood pressure: not done
  • maximum consecutive push-ups: 30 before, 34 after
  • maximum consecutive pull-ups: 7 before, 8 after
  • maximum consecutive sit-ups: 30 before, 37 after
  • time for one-mile walk/run: 8 minutes and 45 seconds before, down to 8 minutes and 35 seconds after
  • vertical jump (highest point above ground I can jump and touch): 108.75 inches or 276 cm before, to 279.5 cm after
  • waist circumference: no real change (92 cm standing/87 cm supine before, 92.5 cm standing/87.5 cm supine after)
  • biceps circumference: no real change (33 cm left and 33.5 cm right before; 33 cm left and 33 cm right after)
  • calf circumference: 39.5 cm left and 39 cm right, before; 38.5 cm left and 37 cm right, after (not the same child measuring me both times)
  • toe touch (stand and lock knees, bend over at waist to touch toes: 7.5 inches (19 cm) above ground before, 8.5 inches (22 cm) after

If these performance numbers seem puny to you, please note that I’m 57-years-old.  I’m not sure exactly where I stand among others my age, but I suspect I’m in the top half.  I’m sure I could do much better if I put in the time and effort.  My goal right now is to achieve or maintain a reasonable level of fitness without the five hours a week of exercise recommended by so many public health authorities.

Take-Home Points

Overall, this program improved my level of fitness over six weeks, with a minimal time commitment.  I credit Hillfit for the gains in push-ups, pull-ups, sit-ups, and perhaps vertical jump.

My time on the one-mile run didn’t improve much, if at all.  This fits with my preconceived notion that strength training might not help me with leg muscle  and cardiopulmonary endurance.

The Hillfit exercise progressions involve adding weights to a backpack (aka rucksack or knapsack) before you start the exercise.  I’m already up to 80 lb (36 kg) extra weight on the modified row, and 85 lb (39 kg) on the hip extensions.  That’s getting unwieldy and straining the seams of my backpack.  I can’t see going much higher with those weights.

I expect I could easily maintain my current level of fitness by continuing Hillfit and HIIT treadmill work at my current levels of intensity.  In only one hour per week.  Not bad at all.

It’s possible I could get even stronger if I stuck to the program longer, or slowed down my movements to the recommended 10 seconds each way.

The key to muscle strength gain with Hillfit seems to be working the muscles steadily, to near-exhaustion over 90 seconds, gradually adding a higher work load as the days or weeks pass.

I’m setting Hillfit aside for now, only because I want to start a new self-experiment.

Hillfit is an excellent time-efficient strength training program for those with little resistance-training background, or for those at low to moderate levels of current fitness.

Steve Parker, M.D.

Note to self:

When doing a mile run on the treadmill, I tend to start out too fast, then burn out and have to slow down.  That may be impairing my performance.  Next time, start at 7 mph for a couple minutes then try to increase speed.  Running a mile at 7 mph takes nine minutes.  A mile at 7.5 mph takes 8 minutes.  A mile at 8 mph takes 7 minutes and 30 seconds.

What’s Our Preferred Fuel?

Dr. Jay Wortman has been thinking about whether our bodies prefer to run on carbohydrates (as a source of glucose) or, instead, on fats. The standard American diet provides derives about half of its energy from carbs, 35% from fats, and 15% from proteins. So you might guess our bodies prefer carbohydrates as a fuel source. Dr. Wortman writes:

Now, consider the possibility that we weren’t meant to burn glucose at all as a primary fuel. Consider the possibility that fat was meant to be our primary fuel. In my current state of dietary practice, I am burning fat as my main source of energy. My liver is converting some of it to ketones which are needed to fuel the majority of my brain cells. A small fraction of the brain cells, around 15%, need glucose along with a few other tissues like the renal cortex, the lens of the eye, red blood cells and sperm. Their needs are met by glucose that my liver produces from proteins. The rest of my energy needs are met with fatty acids and these come from the fats I eat.

Dr. Wortman, who has type 2 diabetes, in the same long post also writes about oolichan grease (from fish), an ancestral food of Canandian west coast First Nations people.

Drs. Jeff Volek and Stephen Finney have done research on athletes using a low-carb, high-fat diet.

Steve Parker, M.D.

Miss California USA Following Paleo-Style Diet

See details at the Sacramento Bee website.

-Steve

Brenna Reviews Sugar Substitutes

Too late now!

Paleo diet purists don’t eat artificial sweeteners.  Yet many adherents eat paleo-style only 80 or 90% of the time, partly because they miss their sweets.  Fruits and honey don’t always hit that sweet spot.

Dietitian Brenna at Eating Simple has a post on sugar substitutes, which I sometimes refer to as non-caloric sweeteners (not entirely accurate). She reviewed sucralose, saccharine, aspartame, and acesulfame potassium.

A few days later, she reviewed sugar alcohols.

Many who have a sweet tooth, including myself, use sugar substitutes such as sugar alcohols. Sometimes they affect blood sugar levels, although not as much as table sugar (sucrose).

Brenna links to a Mayo Clinic article on artificial sweeteners.  Also at the Mayo Clinic website is an article by Dr. Maria Collazo-Clavell on use of artificial sweeteners specifically by people with diabetes.  Like Brenna, she notes that sugar alcohols can raise blood sugar levels in people with diabetes.

Dr. Richard K. Bernstein says acceptable sugar substitutes for PWDs (people with diabetes) are:

  • saccharin tablets or liquid
  • aspartame tablets
  • acesulfame-K
  • stevia
  • sucralose tablets and liquid Splenda

He says to be wary of any of these in powdered form because they are usually then mixed with dextrose (glucose) or maltodextrin or other type of sugar to increase bulk. So blood sugars go up.

I never got excited enough to cover this topic in detail myself. Thanks, Brenna!

Steve Parker, M.D.

Book Review: Low-Carbing Among Friends, Volume 1

About six months ago I read Low-Carbing Among Friends, Volume 1 by Jennifer Eloff, Maria Emmerich, Carolyn Ketchum, Lisa Marshall, and Kent Altena.

The paleo diet is often thought of as low-carbohydrate, even though Eaton and Konner have convinced me that’s not necessarily the case.  Eaton and Konner suggest that an ancestral diet, on average, provides 35 to 40% of total calories as carbohydrate.  Compare that to the 50-55% of carb-derived calories in the Standard American Diet.  Many hard-core low-carbers restrict digestible carbs to 10 or 20% of total calories.

Old Stone Age diet followers nearly always exclude grains.  Cookbooks that exclude gluten, derived from certain grains, could appeal to paleo dieters.  In that spirit, here’s my review of Low-Carbing Among Friends, Volume 1.  Many of these recipes use dairy products and artificial sweeteners, so if you’re eating strict pale, look for a different cookbook.

If you have a favorite pure paleo cookbook, do me a favor and tell me in the comment section.

♦   ♦   ♦

If you’re serious about low-carb eating, you’ll want this book.  Five well-known low-carb cooks and chefs present many of their best recipes in a straightforward format.  All 300+ recipes are gluten-free, wheat-free, and sugar-free.  I read through over half of the recipes and understood all the instructions; I’m confident I could make anything in this book.

Some of of the recipe ingredients will be a little hard to find. You may have to order a few of them online, and the authors tell you where to order. Unless you’re just dabbling in low-carb eating, you’ll want to stock up on some of these anyway.

I have an incurable sweet tooth.  I like to share my cooking with my wife, but she has, um, (ahem)… “gastrointestinal problems” with my usual non-caloric sweetener, Splenda.  That’s not very common, but is a well-known phenomenon.  I was glad to learn herein that erythritol is a trouble-free alternative, GI-wise.

One thing I miss about standard high-carb eating is baked sugary items like cakes and muffins.  Sure, I’ve read that if you stay away from those for four to six months, you’ll lose your desire.  Not me.  And I tried.  In my next stretch of days off, I’m making a batch of Jennifer Eloff’s Splendid Gluten-Free Bake Mix and spending some time in the kitchen!

Not being previously familiar with him, I was particularly impressed with Kent Altena’s background.  Starting at over 400 pounds (182+ kg), he lost over 200 pounds (91+ kg) and reenlisted in the U.S. National Guard and started running marathons (26.2 miles)!  Thank you for your service to our country, Mr. Altena.

The book is laced with commentary from low-carb proponents, including Dana Carpender, Jimmy Moore, Dr. John Briffa, Dr. Andreas Eenfeldt, Dr. Robert Su, and me.  I am honored to have been invited.

By the way, recipe measurements are given in both U.S. customary and metric units, which non-U.S. residents will appreciate.  Serving size nutrient analysis includes digestible carb grams (aka net carbs).  All recipe carb counts are under 10 g; most are under 5 g.

If you’re tired of eating the same old things, I’m sure you’ll find many new dishes here that will become time-honored classics in your household.

Steve Parker, M.D.

Disclosure: As a supporter of low-carb eating, I contributed two pages to the book.  I did not and will not recieve any remuneration, and I purchased my own copy of the book.

PS: Recipes I want to try: Cinnamon Swirl Cookies, Green Bean and Bacon Salasd, Gingerbread Biscotti, Tuan Burgers, Blueberry Muffins, Pecan Sun-Dried Tomato and Bacon Cauli-Rice, Spicy Shrimp with Avocado Dressing, 24-Hour Chili, Harvest Pancakes, Breakfast Casserole, Bacon Wrapped Jalapeno Poppers, Stuffed Mushrooms, Broccoli Bacon Salad, Seven Layer Salad, Sausage Quiche, Low-Carb Pancakes, Stuffed Hamburgers, Eggplant Parmeson, Flax Bread, Splendid Gluten-Free Bake Mix, and Mock Danish.

Aerobic Versus Strength Training?

“Resistance training, similarly to aerobic training, improves metabolic features and insulin sensitivity and reduces abdominal fat in type 2 diabetic patients,” according to a recent report in Diabetes Care.

Italian researchers randomized 40 type 2 diabetics to follow either an aerobic or strength training program for four months.  The increase in peak oxygen consumption (VO2 peak) was greater in the aerobic group, whereas the strength training group gained more strength.  Hemoglobin A1c was similarly reduced in both groups, about 0.37%.  Body fat content was reduced in both groups, and insulin sensitivity and lean limb mass were similarly increased.  Pancreas beta-cell function didn’t change.

According to this one study, neither type of training seems superior overall.  If you’re just going to do one type of exercise program, choose your goal.  Do you want more strength, or more sustainable “windpower”?

The Pennington Biomedical Research Center found somewhat different results in their larger and more complex study published in 2010.  However, they were primarily testing for diabetes control (as judged by hemoglobin A1c improvement), rather the improvements in strength or aerobic power.  They found the combination of aerobic and strength training is needed to improve diabetic blood sugar levels.  Both types of exercise—when considered alone—did not improve diabetes control.

As for me, I do both strength and aerobic training.

By the way, I only read the abstract of the current research, not the full report.

Steve Parker, M.D.

PS: PWD = people or person with diabetes.  Do you like that term or would you prefer “diabetic”?

Reference:  Bacchi. Elizabeth, et al.  Metabolic Effects of Aerobic Training and Resistance Training in Type 2 Diabetic Subjects
A randomized controlled trial (the RAED2 study)
.  Diabetes Care.  Published online before print February 16, 2012, doi: 10.2337/dc11-1655

Book Review: The Blood Sugar Solution

A few months ago, I read The Blood Sugar Solution: The UltraHealthy Progam for Losing Weight, Preventing Disease, and Feeling Great Now!  Published in 2012, the author is Dr. Mark Hyman. I give it three stars per Amazon’s rating system (“It’s OK”).  Actually, I came close to giving it two stars, but was afraid the review would have been censored at the Amazon site.

♦   ♦   ♦

The book’s promotional blurbs by the likes of Dr. Oz, Dr. Dean Ornish, and Deepak Chopra predisposed me to dislike this book.  But it’s not as bad as I thought it’d be.

The good parts first.  Dr. Hyman favors the Mediterranean diet, strength training, and high-intensity interval training.  His recommended way of eating is an improvement over the standard American diet, improving prospects for health and longevity.  His dietary approach to insulin-resistant overweight/obesity and type 2 diabetes includes 1) avoidance of sugar, flour, processed foods, 2) preparation of your own meals from natural, whole food, and 3) keeping glycemic loads low.  All well and good for weight loss and blood sugar control.  It’s not a vegetarian diet.

The author proposes a new trade-marked medical condition: diabesity. It refers to insulin resistance in association with (usually) overweight, obesity, and/or type 2 diabetes mellitus.  Dr. Hyman says half of Americans have this brand-new disorder, and he has the cure.  If you don’t have overt diabetes or prediabetes, you’ll have to get your insulin levels measured to see if you have diabesity.

He reiterates many current politically correct fads, such as grass-fed/pastured beef, organic food, detoxification, and strict avoidance of all man-made chemicals, notwithstanding the relative lack of scientific evidence supporting many of these positions.

Dr. Hyman bills himself as a scientist, but his biography in the book doesn’t support that label.  Shoot, I’ve got a degree in zoology, but I’m a practicing physician, not a scientist.

The author thinks there are only six causes of all disease: single-gene genetic disorders, poor diet, chonic stress, microbes, toxins, and allergens.  Hmmm… None of those explain hypothyroidism, rheumatoid arthritis, systemic lupus erythematosis, tinnitus, migraines, irritable bowel syndrome, Parkinsons disease, chronic fatigue syndrome, or multiple sclerosis, to name a few that don’t fit his paradigm.

Dr. Hyman makes a number of claims that are just plain wrong.  Here are some:
– Over 80% of Americans are deficient in vitamin D
– Lack of fiber contributes to cancer
– High C-reactive protein (in blood) is linked to a 1,700% increased probability of developing diabetes
– Processed, factory-made foods have no nutrients
– We must take nutritional supplements

Furthermore, he recommends a minimum of 11 and perhaps as many as 16 different supplements even though the supportive science is weak or nonexistent.  Is he selling supplements?  You betcha!

After easily finding these bloopers, I started questioning many other of the author’s statements.

I was very troubled by the apparent lack of warning about hypoglycemia (low blood sugar).  Many folks with diabetes will be reading this book.  They could experience hypoglycemia on this diet if they’re taking certain diabetes drugs: insulin, sulfonylureas, meglitinides, pramlintide plus insulin, exenatide plus sulfonylurea, and possibly thiazolidinediones, to name a few instances.

If you don’t have diabetes but do need to lose weight, this book may help.  If you have diabetes, strongly consider an alternative such as Dr. Bernstein’s Diabetes Solution or my Conquer Diabetes and Prediabetes.

In the interest of brevity, I’ll not comment on Dr. Hyman’s substitution of time-tested science-based medicine with his own “Functional Medicine.”

Steve Parker, M.D.

FDA Approves Exenatide for Once Weekly Injection

Once-weekly injection of exenatide, sold in the U.S. as Bydureon, has been approved for use by the U.S. Food and Drug Administration.  It’s the first-ever once-weekly drug for type 2 diabetes.  Bydureon’s main competitors are Byetta (exenatide  injected twice daily) and Victoza  (liraglutide).  Byetta and Bydureon are made by the same company, Amylin Pharmaceuticals.  Bydureon is a slow-release formulation of exenatide.

Victoza is the one that celebrity chef Paula Deen endorsed about a month ago, around the same time she revealed she’s had type 2 diabetes for three years.  Victoza’s injected once daily.

The New York Times has a January 27, 2012, article on Bydureon, focusing on business and investing.  The new drug is expected to retail for $4,200 (USD) a year.

Click for complete prescribing information.

Click for a press release approved by Amylin.

David Mendosa is excited about Bydureon.

These drugs are in a class called GLP-1 receptor agonists, which mimic the effect of glucagonlike peptide-1, a hormone that increases insulin secretion by the pancreas when blood sugar levels are high.  They are prescribed as adjuncts to diet and exercise in adults with type 2 diabetes.

Steve Parker, M.D.