Post #44 – How to protect from the down-side of strength training?

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We have all heard about the benefits of strength training or weight training:

  1. It helps keep the fat weight lost off for good
  2. It protects bone health and helps build muscle mass
  3. It makes you stronger and fitter
  4. It helps build better body mechanics improving balance
  5. It plays a key role in disease prevention, e. g. improving insulin sensitivity and HDL cholesterol
  6. It boost your energy level and your mood
  7. It improves your metabolism so your burn more calories even when not working out

With so many benefits, it seems no brainer that strength training must be part of life style of anyone pursuing Optimal Health.  

If you search on Amazon.com, you will find hundreds of books on strength and weight training.  These books elaborate on the benefits and various techniques of strength training.  Here are two that use scientific basis in their approach.

Thes slow burn fitness revolution41B2S96EXYL

Is there any downside to the strength training?  What could possibly go wrong?

If you do a quick Google search on this topic, you will find that Injuries is what most people caution about as the downside of weight training.

That makes sense. Major types of injuries during weight training are hairline fractures, pulled muscles and damaged joints.  The causes of these injuries often are:

  • Using Impropriate weights
  • Not using proper form
  • Carelessness
  • Accidents

Making sure that you take precautions to avoid such injuries is very important. Even when you are very careful and conscientious, avoiding wrong form while strength training can require a lot of vigilance. That’s where it is important to learn from a trainer the basics of using weight, machines and even your weight.

However, in my experience, there is something even more subtle and insidious that can potentially creep in and that is easily preventable, if you are vigilant. And, no one seems to talk about this topic.

So, let me tell you my story to illustrate what this insidious issue is and lessons I learned on how to prevent it.

MY STORY

Many years ago, I used to do a simple yoga routine few days a week. I found that over time, my body became quite flexible. I felt energetic.  I did have spring in my feet. However, I found that my strength was continuing to decline. I was even surprised how few pushups I could do at a time. Abdominal fat around my belly was slowly getting worse.  I was becoming what we now call “skinny fat”.

So, I figured, instead of yoga, I would switch to exercise routine that involved working with light weights and body weight. As I started this new strength training routine, I found that I was getting stronger every week. I could do more and more pushups at a time. After several months, I even achieved my stretch goal of doing one hundred pushups in a single rep!

Then after about a year, I went back and tried my yoga routine. I immediately discovered that my flexibility had significantly decreased.  I was quite discouraged that within a year while I had made so much progress in my strength, I had lost the flexibility and even some balance.

At that point in time, I ran into my trainer Saleem, who I still work out with over 13 years later. I told him my dilemma and he showed me how to stretch my muscle after EACH weight training exercise.  So, if I had just done curls, I would stretch my biceps. If I had done squats and I would stretch my quads and so on. Doing these stretches routinely as part of my workouts, I noticed that it helped me retain flexibility in muscles while building strength. Training with him, I would also start my workout always with proper warmups and finish the workout with some cool down stretches.

Then Saleem started to add stretch workout days in between strength training workout days. So, after 4 or 5 sessions of weight training, he might add a stretch workout day. On the Stretch Workout day, we would simply do all stretching exercises – stretching back, hamstrings, quads, front, all big muscles and small muscles. With this new regimen I noticed that I was retaining my flexibility as I was developing strength.

In spite of all these precautions, about four years ago, I hurt my right shoulder from the workouts.  I was able to fix most of it by doing the various stretches etc. However, as I would lift my right arm, I would feel resistance and even pain in my shoulder- may be at a level of 1 to 3 on a scale of 10. That led me to start doing Bikram Yoga, about 3 ½ years ago.  As the shoulder got more and more limber with Bikram Yoga, resistance or pain at a level of 1 out of 10 still remained.  And this resistance/pain would get worse, whenever I did bench presses or some other exercises that put strain on my shoulder.

At that point, I really got curious. I wanted to figure out what exactly would it take for my shoulder to be 100% recovered and normal.

I found various methods of making my shoulders further limber.  Using foam rollers, such as below, was a big help.

Blue Foam RollerRumble Roller

Then I found massage balls (lacrosse balls), shown below. With these massage balls, I would find muscles around neck and shoulders that were tight and then use the ball to relieve pressure and loosen those tight muscles.

massage balls

Finally, I decided to engage a massage therapist to work those muscles.  And, she immediately found tight muscles and worked on those to loosen them up.  And, finally, my right shoulder got to a point of 100% recovered and normal.

MORAL OF MY STORY

So, what is the moral of this story? Here is the insidious process that I discovered:

  • Weight training induces tightness in muscles since strength training by design involves contracting of muscles
  • It requires active work to dissipate tightness in the muscles by stretching, foam rolling and/or massaging
  • If not properly loosened, during the following workouts your form may change subconsciously to compensate for the tight muscles, which may in-turn cause some other functional issues
  • Over time these compounding issues, like the layers of an onion, may give rise to issues whose root cause may be buried deep and not be readily visible.
  • Truly fixing such issues requires series of actions to fix one issue at a time, like peeling the onions, until you get to the root cause.Otherwise all fixes will be temporary.

BOTTOMLINE

If you are engaged in strength training, it is important to be hyper-aware of the tightness in muscles.

Incorporate yoga, stretching, foam rolling and massaging into your routines to immediately dissipate any tightness.  

Chronic musco-skeletal issues can be cured by working on muscles as peeling the layers of an onion. However, it may require a lot of patience.

What do you think of this topic?

Have you had similar experiences?

What has been your approach to stay limber while developing strength?

I would love to hear from you.  Please leave comments and questions to share your knowledge and wisdom.

Post #43 – What is the role of Testosterone Replacement Therapy for Optimal Health?

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“Are you tired? Have you lost your edge, you sense of vitality, your ‘mojo’? Does sex feel like work, or maybe it does not work out any more? Is your mood blah? Have you put on a gut even though you don’t seem to be eating any more than your ever did? May be it is your age. Or maybe just maybe, you have a medical condition called low testosterone, or, as I prefer to call it low T.”

So starts the book Testosterone for Life, by Abraham Morgentaler, M.D., Associate Clinical Professor at Harvard Medical School.

Testosterone for Life

In my previous blogs, I mentioned how early last year, for the first time in my life, I did a comprehensive blood tests. I got these tests done through Life Extension Foundation. These test included all basic hormones.

Only two items showed up not within the “Reference Ranges”: A1c and Free Testosterone. With respect to the LabCorp’s reference rages, my Hemoglobin A1c value of 5.8 was too high (reference range 4.8 to 5.6), even though my fasting Glucose was 91, well within the reference range.

On the other hand, my Free Testosterone value of 5.5 was too low (Reference Range 7.2 to 24.0), while Total Testosterone, DHEA-Sulfate and Estradiol where all within the reference rage.

Now I was quite familiar with A1c, even though I expected it to be normal since my fasting glucose has always been stable around 90 during all my wellness tests.

But Testosterone I did not know anything about. So, I hit the books. The above referenced book by Dr. Morgentaler was one of the first authoritative books I read on the subject. Male Hormone Restoration is another good source. There are also many papers on this subject on NIH Pubmed, for example: The benefits and risks of testosterone replacement therapy: a review.

One of the guidance that Dr. Morgentaler and others practitioners offer is that not all low Testosterone (or Low-T) cases need to be treated. Physicians must examine low-T blood test measurements and correlate with the clinical symptoms. List of symptoms looks the same as at the top of this post for this condition called Hypogonadism:

  • Are you tired?
  • Have you lost your edge, you sense of vitality, your ‘mojo’?
  • Do you have no or low libido (desire for sex)?
  • Do you have erectile dysfunction?
  • Is your mood blah?
  • Have you put on a gut even though you don’t seem to be eating any more than your ever did?
  • Do you have difficulty building muscle mass, bone mass or gaining strength even with workouts and right nutrition?

So per recommendation of practitioners, if some combination of above symptoms exists along with low-T, boosting testosterone may be in order.

I could answer yes to several of the questions above. I had also noticed that fat loss and muscle gain had also plateaued in spite of my continued regime of workouts and nutrition. In fact, in the book, The Life Plan, Jeffry S. Life, M.D., describes how at one point in life low-T became an impediment to maintaining his body composition.

The life plan

I immediately researched and added some supplements to my regime: Miraforte from Life Extension and Male Rejuvenator from Xtend-life. Over the following six months I noticed my Free Testosterone improve as much as 70%. However, my A1c even to increase.

Concerned with trend of my A1c, about six months ago, I started working with Benjamin Gonzalez, M.D. who specializes in functional medicine and hormone replacement therapy (HRT).

After reviewing my tests, conditions and efforts, Dr. Gonzalez started prescribing Testosterone Replacement Therapy (TRT).  In fact, he like many researchers, believes that optimal testosterone levels should be on the high end of the range, close to what men in their 20s will have. This can be a source of slowing down or reversing many age related issues.

The only known downside of TRT is that it is that the supplementation is not recommended if you have enlarged prostates – although that risk is still not proven in the research. 

The treatment involved once a day regime of DHEA supplements as pills and bio-identical testosterone applied as topical cream on wrists. It took about six weeks, before the impact of TRT became apparent. I started noticing that:

  • My daily energy level and “mojo” is up
  • Sexual performance is much better
  • Libido is much improved
  • My fat loss and muscle gain has resumed.

Just last week, I did a set of follow up tests and review with Dr. G. – about six months since starting TRT and coincidental with my 61st birthday. Free Testosterone, DHEA-Sulfate and Estradiol levels are now actually higher than the high end of respective reference ranges.   As a result, Dr. G. has advised, backing down somewhat the daily amount of testosterone.

Fortunately, my wife has also chosen to undergo HRT at the same time I did to balance and optimize her own hormones.  She is also experiencing very positive results.  So, we are well matched in energy and libido.  How lucky for me!

Having gone further up, my hemoglobin A1c is back down to 5.8, but I don’t have enough data points to see if the improvement in A1c is correlated to testosterone levels. So, getting my A1c down is still an active chase for me.

In the past couple of months, I have been talking to my friends and family, especially those over 50 to get their Testosterone levels checked and pursue treatments the levels are low and they have symptoms of hypogonadism.

To bring this issue to light, many researcher have been popularizing the term Andropause, which is like menopause for women.  However, for most men, the decline of testosterone is very gradual starting in their 30s and is not a sudden event as for most women.

So, how about you? Have you had any experience with hormone replacement?

What was your experience?

I would love to hear, so I can and others learn from your knowledge and experience.

Post #42 – Which sweeteners are best to use for optimal health?

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Every day, we are all faced with choices of how much sweeteners to use and which ones?

Every time, we drink a cup of coffee or tea, we have many choices of which sweetener to use.

Sweeteners

And, of course every time, we select any product and read the list of ingredients there are even more variations of sweeteners. Whether it is cookies, sodas, jams, jellies, fruit yogurts, juices, chewing gum, toothpaste, pickles, Kool Aid, frozen dinners, breath mints, iced tea, or any of the other thousands of products on the super market shelves, many have one or more sweeteners.

In addition to what is pictured above, the sweeteners may include:

  • High fructose corn syrup
  • Glucose
  • Dextrrose
  • Malt dextrin
  • Acesulfame K
  • Sugar alcohols: Maltitol, erythritol,xylitol, sorbitol, mannitol, isomalt etc.
  • Maple Syrup
  • Sorghum Syrup
  • Fructose
  • Molassses
  • Caramel
  • Lactose

So, which ones are desirable, okay, bad or ugly?

I recently attended a seminar on sweeteners at University of Maryland Medical Center Institute of Integrative Medicine given by a faculty member, Chris D’Adamo, Ph. D. and a Nutrition Coach at their clinic Rachel Druckenmiller.

They offered lots of great information. In fact, if you are interested, I will be happy to send you a copy of their presentation.

Here is some key information I learned.

First a quick math that may be useful in reading the food labels and keeping track of your carbohydrate consumption: 4 grams of sugar = 1 Teaspoon = 1 sugar cube.

It is very important to understand how much sugar you may be ingesting in a serving. Since, most of us understand teaspoons, this conversion can help visualizing. For example, 10 teaspoons in can of coke, 17 teaspoons in a bottle of lemonade and 7 teaspoon in one serving of Yoplait yogurt as pictured below. A 14oz can of condensed milk has 55 teaspoons of sugar. How can they even do that!

Sugar in Coke

Sugar in Lemonade Sugar in OJ Sugar in Yoplait Sugar in Condensed Milk

www.SugarsStacks.com  has many more such examples.

Glycemic Index and Glycemic Load are two related terms used to measure of how quickly a specified amount of food will cause a rise in blood sugar level.

Glucose has a glycemic index (GI) of 100 and fructose is 25. Sucrose (Ordinary sugar) which is made up of a combination of these two has a GI of 65.

This website http://www.sugar-and-sweetener-guide.com/glycemic-index-for-sweeteners.html gives Glycemic index of all different sweeteners.

Glycemic Load (GL) also accounts for the total amount of carbohydrate content, not just how fast it converts to glucose.

So, it would seem that we should pick the sweetener with the lowest Glycemic Load.

But alas, the life is not that simple!

Artificial Sweeteners have GI of zero and often very small GL, but they have other harmful effects on the body.  These are well documented in research, although FDA has these on it Generally Regarded As Safe (GRAS) list. 

Here is a quick summary:

Saccharin is known to cause increased risk of bladder cancer in humans, damages DNA in high doses and impairs recognition of calorie-containing sweets

Aspartame is known to induce DNA damage, causes oxidative stress in brain, has neurotoxic & carcinogenic metabolites, i.e., causes brain damage and cancer. Also, is known to cause depression, insomnia, seizures, memory loss, triggers headaches. It can also cause heart arrhythmias and hypertension.  It is also associated with weight gain and damages gut bacteria.  Just last week Pepsi announced that they will be discontinuing the use of Aspartame.

Sucralose – currently there are not enough human studies and no long term human studies. It has been observed to elevate blood glucose and insulin in some research studies, known to damage gut bacteria, has been involved in inflammatory bowel disease, may trigger migraine headaches. Coke has been introducing beverages with Sucralose.

Acesulfame K – negatively impacts thyroid, has produced thyroid tumor in rats, rabbits and dogs, and may have negative effect on neurometabolic function.

I think you get the idea! All artificial sweeteners have their down side. Saccharin and Aspartame are the worst.

High Fructose Corn Syrup or HFCS is everywhere in products. It is often the cheapest source of sweetening a product. But it has many adverse health effects.  HFCS digested, absorbed and metabolized differently than glucose.  HFCS is metabolized in liver and favor creation of fat.  It also increases triglycerides and VLDL. HFCS increase risk factors for cardio vascular diseases.

It is definitely advised to avoid High Fructose Corn Syrup. 

Bottom-line:

Best strategy for sweeteners that Chris D’Adamo recommends for optimal heaths is:

Avoid regular intake of artificial sweeteners. Infrequent intake is unlikely to do harm. However, there is enough evidence to suggest caution for regular use.

Make moderate use of natural sweeteners – Stevia, honey, molasses, maple syrup, coconut sugar, yacon, dates are the choices – within your personal dietary carbohydrate goals.

Do a gradual “sweetener taper”. Taste buds will adapt.

Eat moderate amount of whole fruits (preferably ones with low fructose) and berries for sweet taste and health benefits.

What do you think?

What is your take on the sweetener?

Post #41 – So, how to measure how close to optimal is your health? Or, how quickly are you aging?

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“How old are you?” someone asks. Number of years since birth is the generally the answer – that is your Chronological Age or CA.

But how hold do you feel? How old do you act? How old do you look? That is your Biological Age or BA.

Wouldn’t it be nice to actually be able to measure your biological age?

CA and BA is the difference between being 40 year old and going on 60. Or, may be being 60 year old and going on 40.

Wouldn’t it be more useful to have a single number like BA, than understanding individual factors like your total cholesterol, HDL, A1c, VO2 Max, etc?

Recently, in the media there has been a buzz about a recent research published by scientists led by Duke University School of Medicine about measuring biological age. For example, see the article in WSJ: How Quickly Are You Growing Old?

Now there are a quite a few websites, where you answer a bunch of question and they will tell you, your biological age as compared to your chronological age.

For example, here are three such sites, I tried (my CA is 60.9 years):

http://www.biological-age.com/ calculated my biological age as 36

https://www.sharecare.com told me my BA was 53.6.

http://www.growyouthful.com/gettestinfo.php said my BA was 46.

Each of the sites followed up with advice and helpful hints on what I could start or stop doing to further increase my expected health and lifespan.

Unfortunately, none of these websites show exactly what they do with the information you provide and how they arrive at the number they call Biological Age.

But this recent study, “Quantification of biological aging in young adults”, by Daniel W. Belsky et al, is very rigorous treatment of this subject and gives you all the details behind the curtain. And, for me, these details are not only fascinating but actually quite useful to understand what matters for biological age to start diverging from chronological age. In other words, what slows down or speed up aging.

The study calculated the aging rate of 954 men and women—taking various measurements of their bodies’ health—when they were each 26, 32 and 38 in chronological years. By analyzing how these measures changed over time, the researchers were able to see who aged faster and who slower than normal.

To measure the pace of biological aging, which the study defined as the declining integrity of multiple organ systems, the researchers relied on 18 separate biomarkers, summarized in figure below.

These ranged from common measures such as HDL-cholesterol levels and mean arterial blood pressure to more obscure ones like the length of telomeres—the protective caps on the ends of chromosomes that shorten with age.

Go on in Years

Chronological age of all participants was 38 years. However, researchers found that the biological ages varied from 26 years to 60 years.

For measuring how fast people aged, they calculated aging over 12 years. About 30 percent aged biologically one year for every calendar year. There were those who aged as much as 3 years for every calendar year. And, there were four members of the group who aged not at all or actually got biologically younger during the 12 year period.

BOTTOMLINE:

Finding one’s Biological Age is a fascinating concept and can be very useful in optimizing health and life span. However, this is not an exact science just yet, although good strides are being made in research.

However, if you want to focus on living optimally, you can focus on changing your lifestyle to optimize the basic 18 or so biomarkers used in this study. Most of these can be impacted by lifestyle choices. Only 20% depend upon genetics.

Proper food, hydration, exercise, supplements and medical care are the key methods to managing these primary biomarkers.

Websites that compute biological ages also suggest additional actionable items that seem to strongly correlate to optimal health span and life span. These include:

  1. Optimal sleep (7 to 9 hours)
  2. Reduced stress (meditation, perspective management)
  3. Reduced exposure to toxins (organic food, reduced use of chemicals, clean water)
  4. Increased social contact (having friends, family, living with a life partner)
  5. Purposeful living (satisfying work, hobbies, social endeavors)

What is your take on this subject?

Please feel free to leave comment to share your perspective.

Post #40 – How much Sun exposure should you have for Optimal Health?

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A couple of weeks ago my wife and I took a vacation in the Exuma Islands in the Bahamas to celebrate our 30th wedding anniversary. Now everyone knows what Bahamas Islands have plenty of: Water and the Sun. Lounging on the beach and swimming in the ocean with all shades of turquoise, we definitely got plenty of both water and the Sun. Case in point, this picture of me!

IMG_2995

And, that got me thinking: So, how much Sun exposure one should have for optimal health?

On the positive side, we know that being in the Sun is very therapeutic. It cheers us up. Both because it is good for our disposition and it is a major source of Vitamin D.

On the other hand, we have all heard of skin cancer, eye damage and hypersensitivity that excessive exposure to sun can cause.

So, how do we balance the two for Optimal Health?

First, how much Sun do we need for daily dose of Vitamin D?

Most of the “experts” sort of punt this question saying that there isn’t one recommendation for everyone. This is because the amount of time you need to spend in the sun for your skin to make enough vitamin D depends on a number of factors. These include your skin type (how dark your skin is or how easily you get sunburnt), the time of year and what time of day it is.

In the Northern Hemisphere, (e.g., US, Canada) short daily periods of sun exposure without sunscreen during the summer months (April to October) are enough for most people to make enough vitamin D. Evidence suggests that the most effective time of day for vitamin D production is between 11am and 3pm.

A short period of time in the sun means just a few minutes – evidence suggests that about 10 to 15 minutes is enough for most lighter-skinned people – and is less than the time it takes you to start going red or burn.

The larger the area of skin that is exposed to sunlight, the more chance there is of making enough vitamin D before you start to burn. People with darker skin will need to spend longer in the sun to produce the same amount of vitamin D.

In the Northern Hemisphere, our skin isn’t able to make vitamin D from winter sunlight (November to March) as the sunlight hasn’t got enough UVB (ultraviolet B) radiation. During the winter, we get vitamin D from our body’s stores and from food sources. Hence great emphasis on Vitamin D supplements in the US and other countries in the Northern Hemisphere located at higher latitudes.

How much sun before you do damage to the Skin?

Now on to how much sun is needed to produce sun damage to the skin. Here also the clear answer is: It depends.

In research, often the measurement of damage used is the amount of UV radiation needed to cause erythema – the red flushing of the skin caused by exposure to sunlight. The theory is that more the erythema, the greater is the likelihood of damage and cancer.

Because of the variables of geography and seasons, and variations in how an individual reacts to sunlight, it isn’t possible to come up with hard and fast rules – but here are some useful guidelines.

Avoid the midday sun

The time when the skin makes most Vitamin D is when it’s exposed to the midday summer sun – but that’s the time the skin is most easily damaged.

However, redness can occur in only eight minutes in a mid-day sun.

So in peak summer times from 10 am to 3pm, you should use protection against the sun; shade, hats, clothing, sunglasses and sunscreen.

But earlier in the day and later in the afternoon, for a similar period of sun exposure and vitamin D manufacture, you get much less skin damage.

During the summer months in the Southern states in the US, for example, 10 to 15 minutes of unprotected sun exposure of the face, arms and hands before 10am or after 3pm, three to four times a week, will give you enough Vitamin D without skin damage.

But this may not be enough in Northern part of the US or Canada, especially in winter. You’ll need longer periods of exposure or more flesh exposed to the sun.

Longer for dark skins

Note that the figures only apply to fair skinned people. People with very dark skin need around six times more exposure to UV radiation to produce as much vitamin D as someone with fair skin. These people may need sunlight exposure during peak times – i.e. the middle of the day – especially in the Northern states in the winter months.

On the other hand people with darker skins are less likely to get skin damage because of greater amounts of pigment in their skin. Even though they are still susceptible to getting skin cancer.

Bottom Line

Based on what I just learned, for Optimal Health, I am going to stick to my Vitamin D supplements to get sufficient Vitamin D, year-round and heed to the following recommendation I found on the Skin Cancer Foundation website:

Q: I’m going to the Caribbean this winter. Are there any special precautions I need to take to protect myself from the sun?

A: (By Neil Sadick, MD, FAAD, FAACS, FACP, FACPh) When the days get colder and the nights get longer many people enjoy a vacation to a warm place like the Caribbean, to catch some sun and “recharge their batteries.” Typical winter vacation regions are located close to the equator, with little distinction between the seasons and high temperatures year-round. The sunny weather in these regions is accompanied by strong ultraviolet (UV) radiation, as the sun’s rays hit the earth at a more direct angle and aren’t as well-absorbed by the atmosphere.

Furthermore, these sunny days tend to be long, sometimes with substantial amounts of UV until early evening. The ability to travel from a winter season to a sunny vacation spot in just a few hours is a great comfort in modern times, but also a heavy burden for the skin. Current studies now show that sun-filled vacations and sunburns play a key role in the development of melanoma, the most dangerous form of skin cancer.

Intermittent, intense sun exposure, the kind you are likely to receive on a sun-drenched winter vacation (the sort that often leads to sunburn), is associated with a much higher melanoma risk than regular, everyday sun exposure. Suffering one or more blistering sunburns in childhood or adolescence, or five or more by any age, more than doubles a person’s lifetime chances of developing melanoma. Important precautions that protect you from the sun on your vacation include shade, sun-protective clothing, and sunscreen, as well as sensibly limiting your sun exposure in general.

The sunscreen you use should have a sun protection factor of at least 30 and sufficiently block UVA as well as UVB rays. (Look for “broad spectrum” or “multi-spectrum” protection.) If you’ll be vacationing near the water, a water-resistant or very water-resistant sunscreen formula is recommended. Apply approximately one ounce of sunscreen (two tablespoons) to the whole body, and reapply every two hours or immediately after activities such as swimming, sweating, or rubbing/wiping.

Loose-fitting, long-sleeved shirts and long pants made from tightly woven fabrics offer the best protection from the sun’s UV rays. You may want to look for clothes that have a UPF (ultraviolet protection factor) label of 30+; a shirt with a UPF of 30, for example, will let just 1/30th of the sun’s UV radiation reach your skin. High-UPF athletic gear may be particularly helpful, since such clothes are meant to keep you cool and comfortable, no matter how hot the weather gets.

Finally, a hat with a brim at least 3” all the way around and UV-blocking sunglasses will also help protect the vulnerable skin on your head, face, neck, and tops of the shoulders. Sensible sun behavior means avoiding tanning and burning as well as seeking the shade between 10 AM and 4 PM (and especially between noon and 2 PM, when the sun’s rays are strongest).

What are your thoughts on this topic?

I would love to learn from you and share that knowledge with others.

Post #39 – Ever heard of foam rolling? Or, how to get a good massage without a masseuses?

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For years, our trainer Saleem has been asking us to foam roll whenever we do an intense workout with weights to loosen up and relax the muscles, and to help with their recovery. But that advice usually went by the way side, along with his other advice of taking Epsom salt baths.

That in spite of the fact, I would often get stiff shoulder after upper body workout with heavier weights. I never really saw the connection between rolling and workouts.

However, early last year, two things happened and all that changed. I attended an open house at University of Maryland Center for Integrative Medicine clinic and got a first hand experience of Rolfing and learned the theory behind it. That is, how Rolfing works on the principle of massaging and stretching fascia, also called myofascial release.

Fascia is a thin, tough, elastic type of connective tissue that wraps most structures within the human body, including muscle. Fascia supports and protects these structures. Osteopathic theory proposes that this soft tissue can become restricted due to psychogenic disease, overuse, trauma, infectious agents, or inactivity, often resulting in pain, muscle tension, and corresponding diminished blood flow. Although fascia and its corresponding muscle are the main targets of myofascial release, other tissue may be addressed as well, including other connective tissue.

Also last year, I read a book, The Life Plan, by Jeffrey S. Life, M.D. In the book, Dr. Life has a chapter on how he uses foam rolling for myofascial massage as PRE-WORKOUT warm up. I was intrigued.

The Life Plan

So, when I did an intense 21 day weight training program in the middle of last year, I started to use the foam rolling as a pre-workout warm up about half way through the program.

And that was a game changer for me. I had such a positive experience that since then foam rolling has become a part of my workout routine now. I spend anywhere from 15 to 20 minutes, rolling with the foam roller before every workout. Here is what I have experienced:

  1. First of all, it took a few weeks of regular use before the pains of using foam roller on knotted muscles such as iliotibial bands (aka IT Bands) disappeared and have mostly been gone since then.  Regular use during my 21-day program was every day. However, since then I only do strength training twice a week, foam rolling is therefore only twice a week.
  2. One downside I have discovered of intense strength training, especially with heavier weights, has been that my flexibility often diminishes, unless I do something about. Doing stretches while cooling down helps. Also, Bikram Yoga has been great help. However, foam rolling has definitely kept my body limber and flexible even after workouts with heavier weights.
  3. My shoulders, that used to stiffen up after upper body weight workouts, have been quite limber lately.
  4. My warm ups have changed significantly. Foam rolling does really provide a good pre-workout warm up for the body in general if I roll all of the body. My trainer then can focus on having me do warm up for the specific workouts we may be doing that day.

Apparently Sue Hitzmann was one of the pioneers of foam rolling. She developed The MELT method for Myofascial release as a self-treatment system to combat chronic pain using foam rolling.

The MELT Method

But now there is much written about foam rolling. Just Google ‘foam rolling’ or visit Amazon.com and look up all books and products, there is a plethora of information and products.

Searching for “foam roller exercises” on YouTube will give you a number of video on how to use a foam roller. Here are a couple of links for YouTube:

Full Body Rolling out Routine with Ashley Bordern.

Complete Foam Roller Workout, 13 Exercises.

We did have a couple of foam rollers around –the simple vanilla kind for quite a while. These worked just fine.

Blue Foam Roller

But as I really got into it, I started looking around and found some interesting choices to grow to. A product called Rumble Roller has bumpy surface. Rumble Roller not only stretches fascia and massages muscles, but it also gives deep massage. It almost feels like a Swedish massage.

Rumble Roller

The same company also has a product called Beastie. It is the size of a tennis ball, only with bumps. You can use Beastie to massage any body part even while watching TV. This is also handy especially for hard to reach areas like the crevice around the neck or forearms etc.

Beastie

I have been using both of these products now for over six months and definitely feel that those have been a welcome addition to my tool bag in my quest for Optimal Health.

Have you had experience with foam rolling?

Have you worked with fascia or done any activities for myofascial release to relieve chronic pain or just to gain flexibility?

I would love to hear. Please leave a comment.

Post #38 – What are some basic lab tests for monitoring optimal health?

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When I turned 40, I decided to visit my doctor and asked him to give me a 40,000 mile checkup. So, the doctor ordered some blood work, an EKG, and scheduled a full physical. On my scheduled physical, he asked me some questions about my lifestyle and if I had any issues. He checked my vitals, listened to my heart and lungs, and did a rectal exam to verify I did not have enlarged prostates. He reviewed my lab results and EKG. And, told me “everything was normal”. So I assumed I was in perfect health.

I repeated that same process every few years.

Few years ago, I started questioning, whether that process of physicals was sufficient for living an Optimal Health. As I started to study this subject, I learned that was not the case.

First of all, and as we discussed in my last blog post, that “everything is normal” does not necessarily mean I am living an Optimal Health. If my cholesterol or fasting glucose numbers are within the “reference range”, it does not mean that they are the best that may be desired for an optimal health.

Next, I started questioning whether the tests that my primary physician was conducting were adequate for optimal health. And, the answer came out be: no, it was not. For living an optimal health, my objective is to detect any issues at the earliest possible moment in time, which the physicals alone were not accomplishing.

Sooner I can detect an issue, I believe easier it is for me to do something about it. As my flight instructor drilled in my head when I was learning flying, “It is easier to make small corrections sooner than big corrections later”. I believe the same is definitely true for health as well.

So, what other tests should I undergo to detect any issues early? As I studied this topic some more, here is what I learned are the basic numbers I should know.

I am sure everyone is already well aware of measuring Total Cholesterol, HDL, LDL and Triglycerides, which most physicians very faithfully measure these days.

Hemogloblin A1c

Excess blood sugar is a huge issue for health. It has so many different implications to health.

Fasting Glucose level often measured by primary physicians is not adequate for early detection of blood sugar and insulin issues. Commonly called A1c, measured as percent of A1c or glycated blood cells is a very important to know to really understand if one is diabetic or pre-diabetic.

Last year, when for the first time I measured my A1c, I found that it was elevated and was in the pre-diabetic range. I had no data to compare with since none of my labs during physicals in the last twenty years had measured A1c. My physicians did not feel the need to measure it since my fasting glucose has always been and still is under 90 which is within the reference range and is considered “normal”.

Having tested it multiple times during the last 15 months, I noticed it is going up and I have been further investigating its root cause and aggressively treating it with further changes in my lifestyle.

Vitamin D, 25-Hydroxy

Although, called a Vitamin, it is really a hormone. When I leaned that every single cell in the body has receptors for Vitamin D, I really finally understood Vitamin D’s significance. It is implicated in so many health issues and is responsible for turning on/off as many as 500 different genes. Although, many labs don’t consider your Vitamin D deficient until below the reference range minimum of 30, many studies support a value of 50 to 60 as the optimal range.

TSH

Thyroids, either underactive or over-active, can be an issue and cause of a wide variety of symptoms. The thyroid-stimulating hormone (TSH) test is often the test of choice for evaluating thyroid function and/or symptoms of a thyroid disorder, including hyperthyroidism or hypothyroidism. TSH is good screening test and if noted abnormal doctors will want to further investigate by examining free T3 and T4.

Homocysteine

Homocysteine is an amino acid and breakdown product of protein metabolism that, when present in high concentrations, has been linked to an increased risk of heart attacks, strokes and Alzhiemer’s disease. High Homocysteine level also indicate deficiency in B12 and folic acid. There are no immediate symptoms associated with high levels of Homocysteine. So, it is useful to know your levels and make necessary adjustments in lifestyle if needed to prevent future issues.

C-Reactive Protein (CRP)

CRP is a protein made by the liver. The level of CRP rises when there is inflammation throughout the body. So, the CRP test is a general test to check for inflammation in the body. It is not a specific test. That means it can reveal that you have inflammation somewhere in your body, but it cannot pinpoint the exact location. Many consider a high CRP level to be a risk factor for heart disease. However, it is not known whether CRP is merely a sign of cardiovascular disease or if it actually plays a role in causing heart problems. Some researchers assert that Homocysteine and CRP are more important to monitor for cardiovascular health than cholesterol.

Testosterone

Both men and women have testosterone. In men, testosterone plays a key role in the development of male reproductive tissues such as the testis and prostate as well as promoting secondary sexual characteristics such as increased muscle, bone mass, and the growth of body hair. In addition, testosterone is essential for health and well-being as well as the prevention of osteoporosis. Low Testosterone (Low-T) can cause issues such as losing muscle mass, pre-maturely developing “man boobs”, losing “get-up and go”, erectile dysfunction, and low libido or sexual desire.

There is controversy over what the “normal” range should be as testosterone tends to decline as men age. Often, receiving testosterone through hormone replacement therapy can restore “get-up and go” and sexual desires and performance and other youthful traits. It is not only important to measure Total Testosterone, but also even more importantly Free Testosterone, which is the testosterone available for use by the body.

DHEA-Sulphate

DHEA-sulfate is a weak male hormone (androgen) produced by the adrenal gland in both men and women. DHEA is a pre-cursor of both Testosterone and Estradiol. A shortage of DHEA can lead to shortage of testosterone in men or estradiol in women.

Estradiol

Estradiol is a human sex hormone and the primary female sex hormone. It is named for and is important in the regulation of the estrous and menstrual female reproductive cycles. Estradiol is essential for the development and maintenance of female reproductive tissues but it also has important effects in many other tissues including bone. While estrogen levels in men are lower compared to women, estrogens have essential functions in men as well.

 So, how do you get these tests done?

First stop to get these tests should be your primary physician. Mark Hyman, M.D. has a very helpful report on his website:  How to work with your doctor to get what you need?  That report may be useful to read and bring along.

Your doctor may be reluctant to order these test even after you express your desire to have these test done. That was the case with my primary physician. So, I went ahead and found a place that will run these tests in the U.S.: Life Extension Foundation. You can order a variety of tests from them, but their Male Panel and Female Panel include all of the tests mentioned above. Additionally, these tests include metabolic panel with lipids (i.e., Cholesterol), Complete Blood Count and PSA (for men) and Progesterone (for women)

From Life Extension Foundation, you can order these tests online or over the phone. Your will then go to a local lab for blood draw and then receive results on hardcopy, email or online. They even have folks you can call to discuss the results.

Having studied these basic tests and their implication to optimal health, I even asked our twenty three year old twin boys to do their blood work for full male panel. They don’t have any health issues, but I thought it was important for them to have this information as their baselines when they are in top health and establish what is “normal” for them.

So, when they are 60 year old or if an issue arises they have baselines to compare against. They will not have to wonder like was the case for me, “How do my current testosterone levels or A1c compare to what I had when I was twenty three and in top shape?”

So, there you have it – the basic information you may want to know for optimal health.

What are your thoughts?

Is there something else basic that is important to measure to live optimal health?

I would love to hear from you!

Post #37 – When the doctor says “Everything is normal”, what does it mean?

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The following paragraph is from a handout I saw in the office of Ben Gonzales, M.D.:

Everything is Normal” … said the doctor to you. You went to your doctor because you haven’t been feeling yourself in a while. Something is not quite right. You feel a bit “off” but can’t quite put your finger on it. You may be gaining weight despite working out and eating right, your energy levels have been dropping, sex drive is decreasing or you simply are losing your ability to focus. Yes, you have the usual and may be unusual stresses at home, job, financially, relationships perhaps. Your sleep patterns are changing and you do not know why. The doctor did an exam, got some basic labs and tells you, “Everything is normal” But you don’t feel normal. What is “normal” when it comes to labs? Why is it that results vary in “normal ranges” from lab to lab?

Or, maybe it is the opposite scenario, as described below an excerpt from Labs Online website:

Your test was out of the normal range,” your doctor says to you, handing you a sheet of paper with a set of test results, numbers on a page. Your heart starts to race in fear that you are really sick. But what does this statement mean, “Out of the normal range”? Is it cause for concern?

Doctors may use the words “normal” informally, but labs these days more often than not use the word reference range.

For example, blood work for Cholesterol may look like this:

(If the figure is legible, just click on it)

Figure

In this above example, Total Cholesterol, Triglycerides, HDL, VLDL are all within their corresponding Reference Ranges. While LDL Cholesterol, which is a calculated value from other measurements is outside the range, marked here with bold font and also with letter H (for High) in the next to the reference range.

First of all, where do these Normal or Reference Ranges come from and what does it mean to be within the range or outside the range – doctors and you may refer to as Normal or Not-Normal after a quick review of the lab results?

For some tests, guidance may come from National Institute of Health (NIH) or some expert panel of the corresponding physician’s association. For example, in the case of Cholesterol, the reference range is taken from the NIH Heart, Lung, and Blood Institute publication called Third Report of the Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults, or Adult Test Panel III or ATP III. NIH has developed this publication by organizing expert panels of medical professionals and researcher to review all the literature and then develop recommendations.

For some other tests, ranges are derived by collecting data for a large enough group of people and then performing some statistical analysis to derive what is “normal” for them

The first step in determining a given reference range is usually to define the population to which the reference range will apply, for example, healthy females between 20 and 30 years old. A large enough number of individuals from this category are tested for a specific laboratory test. The results are then averaged and a range (plus or minus 2 standard deviations of the average) of normal values is established.

And that becomes the reference range, based on which, you may be told “Everything is normal” or the opposite of it.

So, given this background, what should you be watching out for or questioning in this process? Here are some questions to ask, that may lead you to dig further into your labs:

  1. Does the lab data correspond to how I feel?
  2. Do I belong to the category from which the reference range was derived?
  3. What is the optimal range, not just normal range?

There is an intriguing story of a woman who during her pregnancy felt awful but her doctor kept telling her that everything was normal and she even had a miscarriage. She eventually figured out that she was suffering from Hypothyroid and found the right doctor to work with, thus totally transforming her life. She became a crusader in educating women on this thyroid issue and launched HypothyroidMom website.

Then there is even a bigger question: Are the lab tests that are being used for screening issues the right tests?

Dr. Gonzalez in his flier concludes:

Many basic labs are left out in an initial general physical workup. Understanding what labs to obtain in evaluating your physiologic function is not a basic skill seen in many primary care clinics. Again, simply because most clinics are looking for disease results in your labs, not optimal results as they relate to your long term good health. This is an issue in our current health care system. Finding a provider who understands optimal ranges in your labs and how nutrition fits into managing your health can be challenging. Seek that provider.

Because everything may not be “normal”.”

In my next post I will share some more information about what are some overlooked labs that your primary physician may be reluctant to order but are these days considered vital for managing optimal health.

So, what are your experience on this subject.

I would love to hear and learn.

Post #36 – What is most important for Optimal Health – Body, Mind or Spirit?

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Let me first define each of these three terms. Starting point could be our handy-dandy Merriam Webster dictionary.

Body, it says, is “A person’s or animal’s whole physical self.” So, that is straightforward – Arms, legs, heart, head, arteries, liver, hands, toes, and so on, make up the Body.

Mind, again according to the dictionary, is “the part of a person that thinks, reasons, feels, and remembers.

Spirit per the dictionary is the force within a person that is believed to give the body life, energy, and power.

So, which one is most important for optimal health?

Or, in other words, if I were to focus on living the longest possible and the healthiest possible which one should I focus on first?

Writing this blog post, at this point I got stuck. I did not know where to go with this topic.   I took a long break and when I returned to my writing I found website for The Bravewell Collaborative, which has been doing pioneering work in Integrative Medicine as a catalyst of change in healthcare.

When I read the article The Connection Between Mind and Body on their site, I felt it perfectly captured my sentiments and thoughts on this topic, albeit from a much more authoritative source. So, here I share this article verbatim. Bold highlights are mine. There is, of course, a lot of additional good stuff on the The Bravewell Collaborative website.

Modern scientific research supports this age-old tenet of medical wisdom [of mind-body connection]. It began in the 1920s, when Harvard scientist Walter Cannon, MD, identified the fight-or-flight response through which the body secretes hormones called catecholamines, such as epinephrine and nonepinephrine. When they enter the blood stream, these hormones produce changes in the body—i.e. a quickened heart or increased breathing rate—that put the person in a better physical state to escape or confront danger.

In the following decade, Hungarian-born scientist Hans Selye, MD, pioneered the field of stress research by describing how the wear-and-tear of constant stress could affect us biologically. Since then, scores of scientific breakthroughs have illuminated the mind-body connection in health.

Experimental psychologist Neal Miller, PhD, discovered that we can be trained to control certain physical responses, such as blood pressure, that were previously considered to be involuntary. This discovery gave birth to biofeedback, which has now been found to be effective in the treatment of anxiety, attention deficit disorder, headache, hypertension, and urinary incontinence.

Harvard cardiologist Herbert Benson, MD, identified the flip side of the stress response, which he called the “relaxation response.” Benson demonstrated that meditation, yoga, and other relaxation techniques can bring about physiological changes including a lower heart rate, lower breathing rate, and decreased muscle tension along with positive changes in brain waves. Mind-body techniques that elicit this relaxation response have been successful in treating many stress-related disorders.

Research by psychologist Robert Ader, PhD, at the University of Rochester provided a link between the brain, behavior and immune function, and founded the new field of psychoneuroimmunology, which researches ways to increase immune function through the use of the mind.

Based on a Buddhist meditation practice, Jon Kabat-Zinn, PhD, at the University of Massachusetts, developed Mindfulness Based Stress Reduction (MBSR), a mediation technique that has successfully reduced physical and psychological symptoms in many medical conditions, including pain syndromes.

“When we are on automatic pilot, trying to get someplace else all the time without being attentive to where we already are, we can leave a wake of disaster behind us in terms of our own health and wellbeing, because we’re not listening to the body. We’re not paying attention to its messages; we’re not even in our bodies much of the time,” explains Kabat-Zinn. “Mindfulness—paying attention on purpose in the present moment nonjudgmentally—immediately restores us to our wholeness, to that right inward measure that’s at the root of both meditation and medicine.”

Guided imagery, which utilizes the power of imagination to heal, has been shown to reduce anxiety and pain in people with a wide range of medical conditions, including asthma, back pain, and headache, and to help patients better tolerate medical procedures and treatments. “Imagery utilizes the natural language of the unconscious mind to help a person connect with the deeper resources available to them at cognitive, affective and somatic levels,” explains Martin L. Rossman, MD.

Innovative research by Dean Ornish, MD, and his colleagues found that a program integrating mind-body techniques such as yoga, meditation, stress management, and group support with diet and exercise reversed coronary artery disease. “What we are finding is that comprehensive lifestyle changes may ‘turn on’ the beneficial parts of the genome and ‘turn off’ the more harmful parts,” says Dr. Ornish.

Today, these breakthroughs in our understanding of the mind-body connection have translated into effective therapies that support a patient’s journey through illnesses and trauma. Virtually every major medical center now has a stress management or mind-body clinic, and practices such as meditation, yoga, and group support are woven into the medical treatment of heart disease, cancer, and other serious illnesses.

James Gordon, Director and Founder, Center for Mind-Body Medicine, has conducted mind-body skills trainings for patients and health care practitioners around the world. Gordon has said, “Mind-body medicine requires that we ground information about the science of mind-body approaches in practical, personal experience; that we appreciate the centrality of meditation to these practices; and that we understand—experientially as well as scientifically—that the health of our minds and the health of our bodies are inextricably connected to the transformation of the spirit.”

So, looks like to me that Body, Mind and Spirit are all EQUALLY important to Optimal Health. These three are inter-connected. And, we need to focus on all three of these in an integrative fashion for Optimal Health.

What do you think?

What is your experience on this topic?

I would love to hear about your thoughts.

Post #35 – What is Optimal Health? Some observations from my ski vacation.

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Two weeks ago, I took a vacation to go skiing with my son Justin in Colorado. We skied (actually I ski, Justin snow boards) in Breckenridge, Keystone and Vail. On the first day snow conditions were okay for Colorado. But during the next two days, it snowed and with the fresh snow the conditions were great.

Every once in a while, I would stop in the middle of my skiing to check up on my body, admire the mountains and the vistas all around me, to express my gratitude, or to be simply mindful of  the phenomenal opportunity I had to be there.

I was very happy with my body. It was providing me all the energy, endurance, strength, balance, quickness and flexibility that I needed to be able to enjoy the slopes. And, on top of that I was able to push myself just to improve my skills by attempting some challenging expert trails.

I did take a few spills too. With the flexibility and quick reflexes that my body afforded me, the spills were uneventful.

Throughout our time on the slopes, Justin kept saying, “Come on dad, lets do what we came here to do.”  And, that led me to the following thought.

Justin Snowboarding

Justin Snowboarding

Me Skiing

Me Skiing

In the previous posts on this blog, I have talked about how Bio Markers are used to define Optimal Health. Reflecting upon the ski experience, I thought a good “clinical” way of defining Optimal Health beyond the Bio Markers was simply “having the ability to do what one wants to do”.

On a typical day, it could simply be the energy you need from when you wake up in the morning until the end of the day. Or, as I often like to say, “Optimal Health is to run out of the day before you run out of energy”.

But through the ski vacation, it is clear that what we need is more than the energy. Isn’t it?

So, for Optimal Health, in addition to Energy, we also need:

Endurance – to be able to go the distance, when we need it. Not all days are equal.

Strength – to conduct whatever our work or play requires

Flexibility – some say that flexibility is the real power or strength

Balance – the stories abound over the last two weeks of slips and slides on the ice and snow

Quick Reflexes – we require quick reaction times to adapt to the circumstance

So, Optimal Health for me is not only all bodily systems working well without any fuss or muss, but also having sufficient Energy, Strength, Endurance, Flexibility, Balance and Quick Reflexes that matches your lifestyle.

How do you define Optimal Health?

I would love to hear from you.

Please feel free to leave your comments or questions to this post, so others can participate, share and learn.