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exercise

I’ll Just Exercise it Off…Critical Reason Why This is a BAD Idea

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exercise with poor diet
fabioberti.it / Dollar Photo Club

I hear it all the time.  “I’ll just exercise it off.”  Or, someone will say something like “he’s an athlete, he’ll burn it off.”  All of this over the “comes-with-a-hand-truck” sized drink at Starbucks.

If only it were that simple.  If only all you had to do was exercise more to burn off any excess calories you took in, regardless of the quality of those calories, obesity and diabetes would be a rare thing.  But have you ever looked down on the “calories burned” indicator on the elliptical or treadmill you’re using?  Disappointing, isn’t it?  All that work and you’re lucky if you’ve burnt off enough calories to account for even half of a small Starbucks mocha.

What about those crazy high activity runner?  Let’s say you are a marathon runner in training and you just finished a 1/2 marathon.  That’s approximately 1200 calories burned.  While that sounds like a lot, it’s not even enough to burn off the calories in a Big Mac Value Meal.

So why even bother with exercise?

Because, quite frankly, it’s the right thing to do.  The benefits of exercise cuts across every organ and every disease state.  But it has little to do with the calories that you burn during exercise.  One benefit of consistent exercise is that it does increase the amount of lean body mass that you are carrying around.  Muscle, unlike fat, burns off quite a bit of calories.  This is reflected in your basal metabolic rate (BMR)–the more muscle mass you have, the more calories you burn at rest.

Imagine if you could boost your BMR by a mere 100 calories per day?  Do the math…that’s 3,000 per month and 36,000 more calories burned per year.  It adds up.

Despite all of this, the benefits of exercise do not stand on their own.  Diet, stress management and environmental exposure consciousness needs to be a part of the equation as well.  So, if you are the type of person who hits the gym every day, bikes to work 35 miles each way uphill, swims 750 laps before most of our alarm clocks are buzzing or runs more miles in a week than many of us drive…BUT, eats, quite frankly, like crap (and you know who you are…) just thinking you’re going to “burn it off,” than this particular article is for you.

It in, researchers looked at the communication between skeletal muscle and the beta cells of the pancreas (the cells that produce insulin) in samples of human skeletal muscles that had been subjected to exercise or were left at rest.  These samples were then mixed with beta cells to see if inflammation played a role in protecting or damaging these insulin-producing cells.  Here’s what they found:

  • When inflammation (IL-1β plus IFN-γ) was present, there was an increase in the death of beta cells and a weaker insulin response (not good).
  • Without inflammation, the myokine IL-6 (a chemical released by the muscle during exercise that generally does good things), blocks the death of the beta cells of the pancreas (good thing).
  • However, when inflammation is present, IL-6 from exercise WORSENS beta cell death (very much NOT good).

Maybe this seems a little complex, but the take home message is that, in the presence of inflammation, the normally protective compounds released by the muscles during exercise actually damage the beta cells of the pancreas–a situation that absolutely will set you up for diabetes given enough time.

This means that exercising in the context of an otherwise unhealthy lifestyle may not allow you to just “burn off the calories.”  Rather, this lifestyle may actually prove toxic to the incredibly important beta cells of the pancreas that are constantly fighting to keep blood sugar under control and stave off diabetes.

Think about that the next time your half marathon takes you to that fast food restaurant.

 

What Kind of Exercise are YOU Doing to Lose Weight?

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irisin levels with exercise
eyetronic/Dollar Photo Club

You understand that, to lose weight or to maintain an ideal body composition, exercise is a key component.

I met an old friend in the store the other day and the short conversation steered towards his blood pressure, which had slowly crept up over the years.  Along with some extra padding around his middle.

In the few tips I quickly gave him, the subject of exercise was brought up by him.  He knew that exercise was an important component to good health.

But society has been led to believe that a consistent plan of walking around the block several times per week (carrying a BPA-laden plastic water bottle, I might add—like a walk around the block is going to put you at risk of drying up to a husk…).

If this was the answer, I think we’ve had far less problems with obesity and diabetes than we do.  But it’s not.

Not that I would discourage you from moving versus sitting on the couch—clearly movement is going to win out over sedentary behaviors.

But what about the cultures that have walking as part of the daily routine and obesity is much less of a concern?  Clearly there is some link between walking and health.

I think the difference here is quantity.  Ever taken your kids to Disney?  I’ve figured that, on an average day in Disney with my family, we put in some 10+ miles PER DAY.  Other cultures in other countries such as Peru (I only use this country of an example after a patient of mine went there to visit and was astonished at home much walking they do as part of daily life) put in miles and miles and miles per day.  The quantities we are talking about in cultures like this are far different than what you are going to put in by walking 3 times per week for 30 minutes.

So, if you ARE walking 10 miles per day, don’t worry about it.  If, however, this doesn’t quite fit your exercise profile, then it’s got to be short-burst aerobic.

I have written rather extensively about the benefits of short-burst aerobic activity over sustained aerobic activity for quite a few years now.  And the research continues to support the idea that this type of exercise is more in tune with what you were designed for.

And this particular study is no different.  In it, researchers looked at the relatively-newly-discovered hormone called irisin.  Irisin is released from muscles in response to exercise and may be responsible for a large chunk of the benefits of exercise (read more about how whole body vibration can increase irisin levels by clicking here).

One particular benefit that has been identified is the increase in the amount of brown fat in your body.  Brown fat is fat that literally burns calories in order to make heat.  Pretty cool concept.  More brown fat leads to a lower risk of obesity and diabetes.

In this study, researchers looked at the levels of irisin produced in response to 4 different exercise patterns that varied in intensity and duration.  Here’s what they found:

  • There were no variations in hormone levels during the day (diurnal variations).
  • Irisin levels were not affected by meals and levels decreased with age.
  • Levels were strongly related to the amount of lean body mass.
  • There was a clear and immediate increase in irisin levels after acute strenuous cycling.
  • Longer (six weeks) or chronic (one year) increases in physical activity did not affect irisin.

This is not to say that you should not plan on settling into an exercise routine for the long haul.  But this study just confirms that you can never give up on the idea that you NEED to be challenging yourself aerobically.  It is NOT AN OPTION.

Personally, I am always looking for the opportunity to RUN up the stairs or RUN for the car any chance I get.  And my aerobic exercise routine involves either an elliptical or treadmill in a short-burst fashion.  While MY short-burst may be different from YOUR short-burst, on the elliptical I do 10 sets of 30-second bursts on the highest resistance as fast as I can reasonably go.  On the treadmill, it’s a 10 degree incline on 8-10 miles / hour for the 30-second burst.

If you’re not already doing this type of routine, start TODAY.  There is no reason to consider a sustained 45 minute exercise routine in lieu of a short-burst one.

 

Prostate Cancer Survival and Exercise: How Much is Enough?

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exercise and prostate cancer
CLIPAREA.com/Dollar Photo Club

It goes without saying that preventing prostate cancer in the first place is the better idea. But there are clearly times when the cat is out of the bag and you need to do whatever you can to increase your odds of prostate cancer survival.

Increasing your odds of surviving prostate cancer as well as avoiding prostate cancer recurrence are a topics I have written about in previous blog posts.  Some simple tips can include:

  1. Checking specific hormones to tell if you are at risk of your cancer becoming aggressive.
  2. Making sure you are living an anti-diabetic lifestyle, since this greatly contributes to the likelihood of prostate cancer coming back.
  3. Cutting all dairy out of your life since it has been linked time and time again to prostate cancer.
  4. Androgen deprivation therapy has been shown to worsen your outcome.

This particular article adds another tool to your list of ways to make sure that you don’t become another prostate cancer statistic.  And, given just how important #2 is above when it comes to preventing ANY chronic disease, it should come as no surprise what tool was able to drastically increase prostate cancer survival.

Exercise.  Big shocker there.

But what this study looked into in more detail was just how much exercise was able to make a difference.  Overall, they looked at 4,623 men who had been diagnosed with localized prostate cancer and followed up with them to find out how much exercise had an impact on their overall survival.  Recreational exercise was measured in MET-h/day, or the number of exercise hours in a day.  As an example, one MET-h/day is about the equivalent of sitting on your duff.

With that in mind, here’s what they found:

  • Men who engaged in at least 5 recreational MET-h/d were 37% less likely to die of any cause.
  • Walking/bicycling more than 20 min/day led to a 30% lower risk of dying.
  • Performing household work for more than an hour/day led to a 29% lower risk.
  • Exercising for at least an hour per week led to a 26% lower risk.
  • When the cause of death was narrowed to prostate cancer related deaths, those men who walked/bicycled more than 20 min/day had a respectable 39% lower risk of dying from prostate cancer, while those who were exercising at least an hour per week had a 32% lower risk.

Either way you look at it, exercise saved the day.  But what was really surprising was just how little exercise it took.  One hour per week.

That’s like 8.57 minutes per day to greatly increase your chance of survival.

But let’s change the perspective on this.  You’ve been diagnosed with prostate cancer and your life potentially hangs in the balance of the choices you make.  If you are looking at the 8.57 minutes per day thinking that you MIGHT be able to pull that off, you’ve got the wrong attitude.

If you can’t dedicate yourself to exercise (you can pull off a good strength-training routine and aerobic routine in 45 minutes 3 times per week) to save your life, and would instead rather resort to hope and the best medicine has to offer, then you should just hang it up now and go back to sitting on the couch.

 

Prediabetes, Exercise and Cholesterol; Does it Help?

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exercise for cholesterol
McCarony/Dollar Photo Club

 

You can’t see a cholesterol lowering drug commercial without hearing some poor guy saying he tried everything, but diet and exercise just wasn’t enough.

Once I finish yelling at the TV and vomiting the remnants of my lunch in disgust, I’m reminded that this is just marketing.

The reality, however, is that exercise will not change cholesterol levels very much in the short run (pun intended).  I remind patients of this frequently when we have discussions on cholesterol levels.  If you want to bring your cholesterol back under control quickly, diet is the only answer.

But for many, the exercise component is much easier to adopt.  Dietary changes are perceived as far more invasive.  Walk around the block a few days per week?  No problem.  Avoid refined carbohydrates and processed foods?  No way.

Exercise is the LONG term solution to cholesterol levels.  This is because the vast majority of cholesterol issues are caused by being prediabetic.  There are very few instances where prediabetes is NOT an issue, but it’s a pretty rare situation.  Unfortunately, this little tidbit is rarely explained to patients by their doctors.  Maybe it’s because most doctors don’t understand the relationship.

This does not mean that exercise is not important for short term management of cholesterol issues because it absolutely is.  But all too often the benefits of exercise are not what you would expect them to be.

Patients get frustrated when they exercise and do not take off weight.  I have covered the problem with this thought process in a previous blog post that can be read by clicking here.

(A quick note on my recommendations for exercise.  I am a huge fan of short-burst aerobic exercise consisting of some variation of 30 second all-out bursts performed in 10 sets.  I strongly do NOT feel that the standard “walk-30 minutes a few times per week” recommendations cut it.  Hitting that anaerobic zone is very, very important and the straight walking for exercise protocols do not do it.  This is likely why most studies on exercise do not have a short term effect on cholesterol levels.  To read more about this feel free to read a prior blog article by clicking here.)

HDL (the “good”) cholesterol is not a single molecule.  The reality is that there are some 100+ different forms of HDL cholesterol.  But the biggest classification of HDL molecules is into types 1, 2 and 3.  HDL (3) is generally considered the most protective form of HDL.

This has to do with an enzyme called paraoxonase-1 (PON1) that has very strong antioxidant properties.  PON1 levels are higher in HDL (3) molecules, which likely accounts for the strength of the protection of this type of HDL molecule.

This means that even if you have a high total HDL number, it may not be as protective as you think if most of the HDL is made up of the 1 or 2 subtypes.  Although more specific lab testing that includes these HDL subtypes is available, I have found a need to order these because the information from standard lipid profiles is enough for me to understand where your cardiovascular risk lies.

This particular study puts the concepts of exercise, prediabetes and HDL cholesterol subtypes into perspective.  In it, researchers studied a group of 39 patients with prediabetes and put them into two groups: a control group and an exercise group who followed a 10-week walk/run training program.

Here’s what the researchers found:

  • Exercise did NOT affect cholesterol levels.
  • Exercise did, however, increase the activity of the antioxidant paraoxonase-1 (PON1).
  • Exercise also decreased the levels of an oxidative stress marker called malondialdehyde.
  • Even better, the HDL3 the exercising prediabetic patients protected the blood vessel walls from damage by the high-powered inflammatory molecule tumor necrosis factor-a (TNF-a).
  • Exercise also decreased the ability of damaging immune cells to stick to the blood vessel lining (markedly decreased monocyte chemotactic protein-1, vascular cell adhesion molecule-1 expression as well as TNF-alpha-induced monocyte adhesion).
  • Lastly, exercise also increased levels of endothelial nitric oxide synthase (leading to higher levels of nitric oxide, a molecule that relaxes the blood vessels).

These are all pretty darn potent and beneficial effects that have been shown to greatly protect against heart disease and stroke.  If I had to balance the beneficial effects of these changes against a lower cholesterol level on protection from heart disease, they are not even on the same plane.

In other words, exercising led to very powerful effect on protecting your blood vessels from damage.  Given that the bulk of the evidence suggests that statin drugs to lower cholesterol pretty much suck at preventing heart attacks, the review suggests that exercising, whether or not it results in lower cholesterol levels, is far, far more powerful at preventing heart attacks and stroke.

Remember this–you are not exercising to lose weight or to lower your cholesterol.  You are exercising BECAUSE IT IS THE RIGHT THING TO DO.

 

 

Exercise, Memory, Depression and Your Brain; Great News!

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The list of things you can do to protect your brain and improve brain function is quite long, but there is one things that is always at the top.

Exercise.

There is absolutely, positively no doubt that exercise is incredibly important for your brain.  And this is regardless of what you are worried about or what you are dealing with.  Parkinson’s, Alzheimer’s, depression, anxiety, chronic migraine headaches, seizures, multiple sclerosis…

Sadly, this tool is brought into play far too seldom.  The second you walk into your neurologist’s door, the first question he or she should be asking is how is your exercise routine going. All too frequently medications are the only item of discussion.

How exactly exercise helps the brain is yet to be figured out, but it’s likely working by several mechanisms:

  1. Improved blood flow to the brain.  More blood flow means more nutrients and healthier brain cells.
  2. Release of the hormone irisin through exercise.
  3. Muscles use glucose.  More muscle means better glycemic control and lowered risk of diabetes.  Prediabetes and diabetes destroy the brain.

And probably several more ways that I can’t think of right now.  This particular article adds to the list.  In it, researchers looked at the effect of the hormone adiponectin on the brains of mice.

Adiponectin is a hormone produced by the fat cells in the abdomen.  This hormone is essentially an anti-diabetes hormone.  As I mentioned, since diabetes is so bad for the brain, it might make sense that adiponectin would have positive effects on the cells of the brain.

But the specifics are what were so surprising:

  • Adiponectin can cross the blood–brain barrier.  Higher levels in the brain increased the number of brain cells and decreased depression-like behaviors.
  • A deficiency of adiponectin, however, cut short the beneficial effects of exercise in increasing the number of brain cells in the hippocampus (the region affected by Alzheimer’s dementia).

Because researchers were using mice, they were able to modify the hormone levels.  But, in your own brain, these same effects can be achieved through a combination of living an anti-diabetic lifestyle and exercise.

The anti-diabetic lifestyle will increase the levels of adiponectin being released by your fat cells.  The higher levels of adiponectin will give you the best possible effects of exercise on your brain.  Specifically, according the this study, the hippocampal region of your brain will benefit.  This is the region that is heavily involved with memory.

So, if you are a migraine sufferrer, it is not exercise alone that is going to protect your brain and your memory.  Exercise needs to be coupled with an anti-diabetic diet to have the full effect on protecting your brain.

Want to avoid Alzheimer’s dementia?  Same story.

Depression?  Anxiety?  Same story.

Get the point?  You cannot change or improve one aspect of your lifestyle without making changes in other areas as well.  Anything less will not give you the full benefit.

 

Exercise for Your Heart, Lungs and… Bacteria??

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We all know that exercise is essential to good health.  And you also know that the bacteria in your gut are critically important to good health as well.

But I would be surprised if, even in your wildest physiology-based dreams, you thought that these two were somehow linked.

The benefits of exercise on human health have been extensively studied.  Benefits to your muscles, bones and brain are clear.  Lowered risks of most types of cancers.  Dramatic protection for your brain on migraines, seizures, Parkinson’s disease and Alzhemier’s dementia.

A lot of the mechanisms by which this protection happens have been ironed out.  Some of the effects are indirect (i.e. exercise causes muscles to suck more glucose out of the bloodstream, lowering the risk of diabetes) and some are direct (exercise lowers glutamate levels in the brain cells, protecting these brain cells from damage).

But, I have to admit, that this particular study finds a very indirect effect of exercise on health.  So indirect, actually, that the exercise is not really even helping our own cells.

In it, brilliant and forward-thinking researchers studied professional athletes from an international rugby union squad to see what effect intensive exercise had on the bacteria in the gut of these athletes when compared to a control group of non-athletes.  Here are a few of the important findings:

  • Overall, athletes had a higher diversity of bacteria in the gut, representing 22 distinct phyla.
  • Higher protein consumption led to more microbial diversity.
  • The athletes with a lower BMI had higher percentages of the bacteria Akkermansia when compared with the high BMI group.

Regular readers of the Rantings will know that bacterial diversity in the gut has been linked to many of the protective effects of probiotics.  We will likely never find a single bacterial strain that is the holy grail of good health.  Rather, as has been demonstrated by researchers in recent studies, it is the broad diversity of the gut that is important.

The diversity may center around a few different strains of bacteria, leaving the grouping of multiple types of bacteria as the important factor.  And these clusters will likely vary based on the health of the individual.  As an example, having an abundance of the bacteria Akkermansia muciniphilla seems to protect against obesity and the diseases associated with obesity.

In general, it likely boils down to the fact that anything that increases bacterial diversity in the gut (like exercise in this study, probiotic supplementation, breastfeeding and a good quality diet) will be good for health and anything to destroys bacterial diversity will be bad for health.

And, in case you didn’t already know, antibiotics DECIMATE bacterial diversity.

I’m just sayin’…

 

The New Statin Guidelines: Surprisingly Inferior Compared to this

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No one has ever accused me of being a friend of the statin class of drugs to lower cholesterol.

An entire eBook devoted to the side effects of statins and natural ways to lower cholesterol that do not involve statins pretty much cinches that.

Despite all the continued evidence that statin drugs are only minimally effective at saving lives, the powers-that-be are perpetually trying to jam more of them down our throats.  The latest guidelines, if interpreted loosely enough, could lead to millions more patients being eligible for statin prescriptions.

What a windfall for the drug companies at the expense of unsuspecting patients.

I will be the first to admit that statin drugs are effective at lowering cholesterol.  Quite frankly, NO ONE cares what his or her cholesterol is; we just don’t want to have a heart attack or stroke.  And we’ve been brainwashed to believe that lowering cholesterol with drugs is the way to get this done.

But it’s just not true and we’ve seen it time and time again.  At the bottom line, for the average patient, you have to treat 1,000 patients for 5 years to prevent a measly 11 heart attacks.  Eight of these unfortunate souls will develop diabetes (and will then die of a heart attack or stroke from the diabetes).

It took years for the drug companies to realize this.  Or maybe, it just took years for them to let the unsuspecting patients know that they knew that statins sucked at saving lives.  Regardless, this leaves them with a conundrum.  A multi-billion dollar engine that needs to be fed before the world wakes up to the fact that you have to treat 100 patients to prevent a single heart attack (leaving the other 99 with side effects and costs).

What would you do if you had a product that would soon have no use?

You got it—re-purpose it.

Just think if the guy who created the pet rock later marketed it as a paperweight.  He’d own a small island by now.  Or if the VHS cassette tape people could’ve later marketed the tapes as mini-storage device to hide money and valuables in bookcases…  You get the idea.

So, the latest attempt to prove value to drugs to lower cholesterol is to see if they can reverse plaguing in the arteries of your heart.  Sounds like a good idea, right?  Less plaque in your arteries would be a good indicator that the statin drugs were doing something positive for your cardiovascular health.

That’s what researchers did in this particular study.  They looked across multiple studies to see if high dose statin therapy could lead to shrinking of the plaque in the arteries of the heart regardless of what your cholesterol levels were or how much inflammation you had (as measured by CRP).  And they looked at high dosages because the side effects and costs are going to be greater so they need a stronger justification for the use of these drugs.

In other words, they are looking for a rationale to treat patients carte blanche without needing to worry about pesky reasons like high cholesterol or high inflammation.  They want to create a rationale to treat patients with high dose statins because it protects the heart, NOT because you have a risk factor that has been shown to be lowered with statins (since we saw how poorly that worked out using just total cholesterol).

They found 8 studies in all that included 1,881 who maintained or switched to 18- to 24 months of high-intensity statin therapy (rosuvastatin 40 mg or atorvastatin 80 mg) and were evaluated using coronary intravascular ultrasound to look at the plaque in the arteries of the heart.

As expected, lipids levels changed for the better.  Here’s where it gets exciting:

  • The plaque in the heart arteries dropped by 0.7%.
  • The total volume of the plaque dropped by 8.2 mm3.

For the icing on the cake, the effect was seen regardless of what the cholesterol or CRP levels were.

BUT…

Before we pop the cork on the champagne bottle, let’s saunter on over across the hall to this particular study published in the same issue of the same journal.

In this much smaller study (because hundreds of billions of dollars were not at stake), researchers looked at the effects aerobic exercise on this same parameter—plaque regression.

They compared aerobic interval training (my favorite) to moderate continuous training in 36 patients who had significant coronary artery disease who were already optimal medical treatment (i.e. “fully drugged up”).

The interval training used intervals at 90% of peak heart rate and the moderate continuous training used 70% of peak heart rate) 3 times a week for 12 weeks after they had a cardiac procedure to put a stent in. Here’s what they found:

  • The necrotic core inside the plaque (that nasty, dead tissue just waiting to break off and cause a heart attack) shrunk in both exercise groups by 3.2% with the interval and 2.7% with the continuous.
  • Overall plaque was reduced by a respectable 10.7% in both groups.

Now compare the two.  Which would prefer—0.7% or 10.7% less plague ready to explode in the blood vessels of your heart?  And one was done in 3 months instead of 2 years.

While you can’t make an exact direct comparison, it is clear that exercise is far more effective in a shorter period of time, with NO side effects and no cost (outside the cost of the study).

And yet, when the time comes for your doctor to give you your options, which do you think he was told about?  The one that is going to make the drug companies untold billions but has a small effect on your blood vessels, or the more powerful one that no one is making a buck off of?

Which is Better? Exercise in the Morning or Split Up in Day?

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interval aerobic training wins again
Photo courtesy of https://www.flickr.com/photos/knight725/

I hate to beat a dead horse, especially if he dropped dead from too much aerobic exercise, but society just does not seem to be getting the point about aerobic exercise.

Quite frankly, we’re doing too much.

I know that many of you are disappointed to hear this. After all, in today’s rush-rush society everyone is getting the recommended 30 minutes minimum of aerobic exercise at least 3 times per week, right? Yeah. Reality check–most Americans still do not have regular exercise as part of their lifestyle routine. And, even if they are, it’s likely they are not doing the most beneficial type.

The research continues to support a short-burst, high intensity, aerobic activity rather than a single bout of light to moderate intensity workout. Personally, when I’m doing one of my short bursts on the treadmill or elliptical, I’m going all out for that 30 second session. It’s not a leisurely pace at which I could maintain a conversation on my cell phone to some out of the country customer service rep for my mortage. When I’m done with my burst, it takes some time (1-2 minutes) to recover somewhat from the oxygen debt I have accumulated.

This particular study is yet another one to chalk up for the short-burst aerobic crowd. This small study looked at 11 obese individuals (aged 18–35 years) who were prediabetic and had them performed differently on three different days:

1. Sedentary behavior with no exercise
2. Otherwise sedentary behavior with 1-hour of morning exercise at 60%–65% peak VO2
3. Same sedentary behavior with 12-hourly, 5-min intervals of exercise at the same intensity

Researchers than checked sugar and insulin levels in the bloodstream. Here are the results:

• Glucose levels were actually lower in the interval exercise and sedentary situations.
• Glucose levels were higher in the 1 hour exercise situation than in the sedentary situation for about 2.5 hours.
• Glucose levels were also higher in the 1 hour exercise situation than the interval exercise situation for about 4 hours.
• The production of insulin was 20% higher with the interval exercise when compared to the other two situations.

While this study was not on high-intensity aerobic activity, it does demonstrate the benefit of breaking up the exercise routine into small groups instead of a single time period.

How do YOU spend your time exercising??