Dietary Supplements

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According to Partnership Capital Growth, LLC, an investment concern, the dietary supplement industry sold $109 billion in 2009, representing a 4.4% increase from the previous year. Additionally, it estimates that 87% of Americans take some form of dietary supplements. Back in “the day”, when I was in medical school, the philosophy regarding nutrition was decidedly anti-supplement. The snide remark I remember one professor

making was that supplements did nothing more than produce “very expensive urine”. He was implying that most vitamins and supplements were of no use, and were absorbed from the gastrointestinal tract into the blood stream, and then simply filtered out by the kidneys and excreted into the urine, with no benefit to the individual. Despite the dramatic increase in supplement use since that time, I still occasionally hear this opinion expressed by colleagues. On the other hand, some health care practitioners have embraced supplements for a variety of reasons. Some doctors have come to see the health benefits of supplements, while others have discovered that there are profits to be made by marking up supplements and selling them to patients. Since supplements universally fall outside of health insurance coverage, selling them can be a boon to physicians and other practitioners. Given the lingering attitude that supplements are useless, and the legitimate concern that supplement sellers are interested in profit over health benefits, individuals are generally left to their own devices to decide whether or not to take supplements.making was that supplements did nothing more than produce “very expensive urine”. He was implying that most vitamins and supplements were of no use, and were absorbed from the gastrointestinal tract into the blood stream, and then simply filtered out by the kidneys and excreted into the urine, with no benefit to the individual. Despite the dramatic increase in supplement use since that time, I still occasionally hear this opinion expre

I can tell you that I believe, based on clinical research, that there are several vitamins and supplements that are relatively inexpensive, and that I believe provide enough benefit to justify the cost. Much of the information I find on supplements comes from the Life Extension Foundation, which does, in fact, sell a line of supplements (I don’t buy mine from them, nor do I sell any supplements). While the Life Extension Foundation does have a profit motive by virtue of selling supplements, I find their articles to be generally well written, and very well supported by clinical research. For those interested in a thorough education on supplements, the LEF is

Vitamin B complexa good starting point. In any case, I thought I would list the supplements I use, and expand on the reasons why I use them in future posts. Here is my list:

  • Vitamin C
  • Vitamin D
  • Vitamin E
  • Alpha lipoic acid
  •  CoQ 10
  • Astaxanthin
  • Resveratrol
  • Fish oil
  • Magnesium

In future posts, I’ll highlight one or more of these supplements, including the clinical evidence supporting them.

Progress Report on My Barefoot Running

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This post would be more accurately titled “Oh Well, So Much for Barefoot Running”. I gave it a good try – really, I did. But unfortunately, it just didn’t work out for me. My main problem were the recurrent calf strains I suffered using my minimalist shoes. I tried everything, from extra warm ups, extra stretching, hot pack, ice, rest…and nothing helped. Just when I thought my calf was ready to go, one mile into a “barefoot”, I would inevitably feel the beginning of a new or recurrent calf strain. I’d have to stop, turn around, and walk home defeated. Finally, after three repeats of this scenario, I gave up. I went back to running in my conventional New Balance trainers, and lo and behold! No calf problems whatsoever.

I’m glad I tried to work things out for as long as I did, even if it set me back a bit in my fitness training. I feel as though I gave minimalist running more than a fair trial, and found that it’s just not for me. I still like the minimalist shoes, though, and I often wear them for walking, or as “everyday” casual shoes. I feel as though walking in them has strengthened my intrinsic foot musculature, and has made my conventional runs seem easier than before.
So, I guess I’d have to give the barefoot movement a mixed review, based on my person experience. I’d give minimalist shoes a positive review for walking, and negative for running. As always, your results may vary, so give it a try if you’re so inclined.

Resistance Training Can Slow the Aging Process

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When those of us over 40 (and some of us over 30) think of “staying in shape”, thoughts commonly turn to cardiovascular training (cardio). Activities such as brisk walking, jogging, cycling and using indoor cardio equipment all come to mind when thinking of fitness, and rightly so. These forms of exercise are important for maintaining and improving lung capacity, cardiac health, weight control, and overall endurance. Because the benefits of cardio are so widely recognized, weight training is treated as an afterthought by most people. It seems that only the most dedicated fitness enthusiasts regularly incorporate resistance/weight training into their routine. This is a mistake. When it comes to preservation of muscle mass as we age, weight training, along with consumption of adequate protein in the diet is more important than cardio activities.

Most people are aware that we lose muscle mass as we age. The term “sarcopenia” refers to the lack of muscle in older people. Sarcopenia is generally accompanied by a loss of strength in the individual, causing a loss of independence, increased functional disability, and decreased life expectancy. When we think in these terms, we can come to appreciate the importance of strength training for overall health as we age.

How to Strength Train

For individuals who are new to strength training, body weight exercises are a good, safe way to get started. I generally advocate the “K.I.S.S.” (Keep It Simple, Stupid) principle for beginners. One should focus on basic movements, that work large muscle groups – pushups, pull ups (assisted if necessary), and squats (without weights). A session or two with a qualified athletic trainer should be all that is needed for even a total newbie to get started. As one progresses physically, the intensity of the workouts should be slowly increased, to avoid stagnation, boredom, or a physical plateau. Intensity can be increased by either increasing the number of repetitions done per session, decreasing the resting time between sets, or adding weights to the exercises. Again, the guidance of a qualified trainer is invaluable if one is unsure about how to move forward with a program.

As in most things, balance is the key for optimum health and fitness as we age. There are no shortcuts, and there is no ‘best’ exercise program out there. Whatever one chooses, he/she must strike a balance between cardiovascular and resistance training, to maintain or improve overall fitness. Stretching and nutrition are the other factors in this complex equation. Finally, a qualified trainer can help design an appropriate program, and modify it as the individual progresses.

Stretching is Important for Fitness

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Stretching is an often overlooked, but vital part of any fitness program. It’s easy to skip stretching. On any given workout day, most people are anxious to get right into the cardio or weight training. Stretching just seems like a boring hurdle to jump over, before getting into the “real” stuff. Additionally, it’s difficult to know when to stretch. Doing it at the beginning of a workout increases the risk of injury (by stretching cold muscles). Static stretching performed immediately before or during a workout can decrease performance (see here). These realities relegate stretching to one of three possible times: the end of a workout, when one is already tired and pressed for time, later in the day on workout days, or on separate, non-workout days.

Personally, I fit in some stretching late in the day most day, after work. Even though I’m usually pretty tired at that point in the day, I don’t find the effort needed for a short, effective stretch routine too much to give. This is in contrast to my usual exercise routines, which I find really hard to do late in the day after work. I’m mindful of always getting my stretching in, because of the benefits of maintaining flexibility. This is particularly true as we age. Loss of flexibility, along with loss of strength, are the two biggest causes, in my opinion, for a declining quality of life in older people.

Here are some of the benefits of stretching regularly:

  • Reduced muscle tension.
  • Increased range of movement in the joints.
  • Enhanced muscular coordination.
  • Increased circulation of the blood to various parts of the body.
  • Increased energy levels (resulting from increased circulation).
  • Improved athletic performance.
  • Increased sense of well being.

Some of these benefits may seem vague, but in my own personal experience, I’ve seen every one of the benefits listed above. In particular, a sense of overall well being is one of the most important “side-effects” of stretching. I believe that the post stretch relaxed glow accounts, in part, for the ever increasing popularity of disciplines such as yoga and tai chi. These forms of exercise incorporate various stretches throughout a session. Having done some yoga myself, I can attest to the pleasant psychic effects that accompany a good stretch.

For those who would like to begin stretching without any formal classes or training, several good, basic moves are demonstrated here. Give it a try for a week or two, and see if it improves your flexibility, as well as your general outlook.

The Importance of Rest and Recovery

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While many exercise programs (correctly) focus on a variety of exercise techniques, not enough is said, in my opinion, on the importance of rest. I’m not talking about laziness, or skipping workouts. I’m talking about scheduling days with no exercise as part of the plan. It’s often been said in the body building world that one works out in the gym, but grows outside of the gym. Weight lifting stimulates muscle growth by stressing the tissue and causing microscopic damage to muscle fibers. After the stimulus is applied, the body rebuilds the muscle, causing it to grow stronger, and larger. The repair process only occurs is one allows time for recovery from the exercise. Rest, and proper nutrition are both essential to optimum recovery after exercise. Without time allowed for repair, and a supply of the necessary building blocks, muscle growth won’t happen. As to how much recovery time is needed – well that depends on many factors. Older people (like me) for example, require more recovery than younger people (add that to the list of age-related bummers). I know that in my younger days, I was able to lift weights three days per week, and run 5-6 days per week, and feel pretty good over all. Now, I invariably need a rest/recovery day following a running day. I usually feel to drained the day after a run to do much heavy exercise. While I don’t like it, I accept that without the recovery time, I’d likely set my fitness back, so I rest.

I mention all this mainly as a warning, particularly to those that may be new to exercise. When an individual dedicates him or herself to a new program, it is usually with great intentions and much enthusiasm. While that determination is a necessary ingredient for success, it can sometimes backfire. When the enthusiasm becomes a compulsion to exercise, many of the benefits are lost. If taken too far, the build up of fatigue can lead to loss of motivation, or physical injury.

Any reasonable program should have built in rest days, to allow for a mental and physical recharging of the batteries. The only formal exercise program that I ever participated in had one built in rest day per week. The other six days were divided between strength training (3 days), cardiovascular training (2 days) and yoga (1 day). When I began the program, I was skeptical about the once per week rest, as I was a “more is better” guy at the time. I decided to follow the program strictly, and not skip the rest days. I was rewarded with significant gains in strength – better than any gains I had seen in a few years of “doing my own thing” in the gym.

So, to summarize, it is wise to take one to two rest days per week in any serious exercise program. The positive effects of rest include:

  • Decreased physical fatigue.
  • Improved mental outlook, and renewed enthusiasm.
  • Decreased risk of injury.
  • Improved strength gains, with fewer days in the gym.

 

 

Compound exercises are the Key to Improved Fitness

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I went to my local club’s gym the other day, for the first time in a couple of weeks (normally I work out at home, in my garage gym). We have a heat wave here in Southern California lately, making it too hot in work out in the garage. The gym was pretty busy for a weekday morning, with both men and women, mostly in the 40-60 year age range. Since I usually work out alone, I was kind of surprised by what I saw. Most of the cardio equipment was in use – not so unusual for most gyms. What really struck me was the type of weight training people were doing. Almost everyone I saw was doing isolation exercises – bicep curls, tricep extensions, shoulder lateral raises, leg extensions and leg curls. I saw people doing these moves with intensity and determination, so I know they were serious about  improving their strength and fitness. The only problem is, these exercises are very limited in their effectiveness. Just think about it – these movement work a tiny strip of muscle tissue in the upper arm, or the upper leg. This is unlikely to lead to any sort of significant gain in overall strength, fitness or improvement in body composition.

Why then, do most people focus on these isolation movements? I think there are a few reasons:

  • They hit the “glamor” muscles, such as biceps and shoulders.
  • Many personal trainers use them as a low risk form of weight training for new clients.
  • General lack of knowledge, for most people, about which exercises are most effective.
  • Imitation of the bodybuilding model, which features multiple sets of isolation exercises, in an attempt to form as close to a perfect physique as possible.

Over use of isolation movements is a fundamental error in almost all cases (the exception being competitive bodybuilders).  The vast majority of people would benefit from focusing on compound movements, such as squats, deadlifts, bench presses, push ups, pull ups (assisted if needed), lunges and barbell rows. Focusing on these movements has several advantages:

Focusing on the large muscle groups, leadis to overall gains in strength and fitness.

These multi-joint movements work larger muscles, leading to better overall core conditioning. They are also more taxing to perform, resulting in improved fitness.

Reduces overall workout time.

Compound exercises, performed intensely, are very efficient in building strength.  Generally, 3-5 working sets, excluding warm up sets, of each movement is all that is needed.  The need to perform fewer sets for the routine reduces the time needed to get a full body workout.  In addition, compound exercises work both side of the body simultaneously, as opposed to isolation movements, which are done one side at a time.

Allows more time for supplemental cardio work.

By effectively working the whole body in a shorter weight training session, this allows for other forms of exercise, such as cardio training to be included in a session. A good total body workout can be performed in 30-45 minutes. This allows for addition of some cardio work in the same session, without the time at the gym becoming unrealistically long.

So, next time you head to the gym, give some thought to focusing on the classic compound exercises. If you are not familiar with proper technique, hire a trainer for a session or two, to get comfortable. If you can stick with a routine focused on these types of movements, you’ll see a dramatic improvement in your fitness in short order.

Does Compression Apparel Improve Performance?

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The increased use of compression apparel by athletes is a trend one can’t help but notice. Football players, baseball players, basketball players, and even golfers are often seen sporting skin tight, lycra/spandex pants, shirts or extremity sleeves, as part of their game day wardrobe. The theory is that compression apparel has multiple beneficial effects for the athlete, including:

  • Improved muscle performance.
  • Reduced fatigue.
  • Decreased risk of injury.
  • Improved muscle recovery after exercise.
  • Decreased muscle soreness after exercise.

But, does this clothing (which is on the expensive side) really live up to its billing? I found an excellent review blog on the subject, by Joe Friel. You can see Joe’s review of the recent literature regarding the efficacy of compression apparel here. To summarize, the claims of increased performance due to the clothing don’t seem to pan out. On the other hand, there is some evidence of improved recovery and decreased soreness when compression apparel is worn. Based on my own personal experience with the gear, I would concur.

I own two pieces of compression apparel – a shirt and a leg sleeve. I bought the shirt at a sporting goods store, and tried it out while running, and when playing golf in colder weather (at least what passes for cold here in Southern California). I found that I definitely felt warmer, even with one less layer, using the compression shirt, over a high end thermal long sleeve shirt. This was particularly helpful on the golf course, where I felt a little more comfortable when swinging a club. I don’t think that this increased warmth ultimately translated into a better score though. The shirt also made running more pleasant, due to the (in my opinion) superior warming effect I experienced. But, I’m pretty certain that I didn’t run any faster.

The leg sleeve is a different story. I now consider it an essential piece of gear for running. I first bought it after suffering repeated calf strains on the left, particularly on longer runs. A friend referred me to this website, which makes great stuff (although again, it’s kind of costly). I have been repeatedly impressed with the apparent injury/calf strain protection I get from this sleeve. I have never suffered a strain while wearing it. In fact, I have been able to resume running after mild calf strains far sooner than before.

My recent foray into minimalist running has me breaking out the calf sleeve again. I suffered a strain in my right calf while trying my new shoes, and still felt discomfort there even after (temporarily) switching back to standard running shoes. Well, I wore it for yesterday’s run, as I was still a bit sore in my calf. It was like magic! No pain, or recurrent strain! Placebo effect? Maybe. But this has been my experience in the past as well, so I believe that for me at least, the sleeve is helpful in this regard.

So, if you suffer little nagging injuries, try using compression apparel, and see if it helps. I would love the feedback!

Barefoot or Minimalist Running to Improve Foot Health

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Recently, I’ve been exploring the world of “barefoot” or “minimalist” running. The idea of running in thin, non-supporting shoes has been gaining traction in the press. The theory is, the thick, padded, constricting running shoes that have been around for decades are actually doing more harm than good. Mark Sission, blogger from Mark’s Daily Apple a big proponent of barefooting, has taken to calling conventional running shoes “casts” or “coffins” for the feet. The theory of barefoot running goes something like this – we have evolved over 2 million years to walk without modern shoes, which have only been around a few hundered years at most. Therefore, the healthiest, most beneficial way to exercise is in bare feet.

Now, I’m not about to go running on city streets with no shoes or socks. I think if I did, I be bleeding within three minutes, after getting cut up by various forms of debris on the road. Most barefoot runners do wear something on their feet to protect them. These “minimalist” running shoes have a flexible, unpadded, protecting sole, and some form of thin nylon “upper”, and that’s it. The most striking minimalist shoe is the Vibrams Five Fingers, which essentially looks like a glove for the feet. I find that look a bit off-putting, so when I decided to try barefooting, I went with a pair of more traditional looking shoes from New Balance, called the Minimus, which is described in detail here. I like the look of these shoes, although I have gotten some stares when wearing them out and about.

The transition to minimalist shoes must be done gradually. The conventional, cast-like running shoes that are commonly worn support out feet to the point of weakening the muscles. Therefore, full bore running in these shoes, without a proper adaptation period, will lead to injury.  New barefoot runners must learn proper mid-foot strike running technique, and slowly ramp up mileage and intensity to gradually strengthen the feet and calves.

I’ve had flat feet (aka, fallen arches) since I was a kid. It seems to run in the family, and may very well be genetic. So, I was intrigued to see if running in minimalist shoes would improve my arch as my foot muscles strengthened, as barefooting proponents suggest.

So far, my transition is still a work in progress. Even though I have a lot of running experience, I’ve been careful to use restraint. I began by going for long walks in my new shoes – no running. I definitely felt the difference right away.  At first I had a propensity to toe-walk (forefoot strike) in the shoes, but I ,was able to slowly shift to the desired mid-foot strike with practice. I definitely felt fatigue in areas that I hadn’t felt from either walking (or running for that matter) with these shoes. The primary area of fatigue was my calves, followed by my mid-feet. With traditional shoes I would mostly feel mild fatigue in my quads, and to a lesser extent, my calves.  This is probably due to the so-called “drop” of conventional shoes ( drop is the difference in height between the heel and the toe of the shoe. Most running shoes have a wedge shaped sole, with a pretty significant drop). The drop of conventional shoes also puts undue stress, most likely, on the knees.  Extra knee stress is something I definitely don’t need, having had two surgeries on my left knee in the past.

After a series of sequentially longer walks, I decided to give running a try. I figured a short, 1.5 miler, at a very easy pace would be a good start. This seemingly conservative plan didn’t work out as I had hoped.  I strained my right calf about 3/4 of the way through the run, and had to walk home.  I took a one week break from running to allow the mild strain to heal.  I tried again, and this time, success! My pace was slow, and I was very careful, but I made it though, calves intact. I have to say that I was very sore in both calves the next day. Since my first run, I’ve gone on two additional, slightly longer runs. So far, I’m only using the minimalist shoes once a week, and running in traditional shoes for two or three other runs per week. I’m pleased with my progress, and I definitely feel stronger in my calves, and to a lesser extent, my feet.

I’ll keep you posted on future progress.

Exercise proper caution to avoid heatstroke

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This recent article in the Wall Street Journal addresses the issue of heat stroke.  Most of us are familiar with the basics – heat stroke is a life threatening condition where the body’s temperature climbs to dangerous levels, usually due to exposure to an outside source of heat, or due to exertion (or both, as with summer exercise).   Early symptoms of heatstroke include heavy sweating, muscle cramps, tiredness, dizziness, headache and nausea.  Later symptoms include confusion, erratic behavior and loss of consciousness.  If there is any question as to whether an individual is suffering heatstroke, the best course of action is one of caution.  Cessation of activity, cooling of the individual, and activation of 911 would be appropriate in most cases.

So, those are the basics. The Journal article brings up a few additional facts that are not so well known:

  • Heat stroke can occur in as little as 1/2 hour from the onset of heat exposure
  • Heat stroke can occur even if the individual is well hydrated.
  • There is controversy as to the optimum method of treating heat stoke in the immediate, or acute phase (some advocate cooling as rapidly as possible with ice water, while others advocate slower, more gentle cooling).

But, the best case scenario is to avoid heatstroke altogether.  Here are a few tips for fitness enthusiasts to stay safe in the heat:

If it’s too hot, skip the workout.

This seems obvious, but it is often ignored, especially by either novice or dedicated exercisers.  We sometimes get so wrapped up in fitness “goals”, that the idea of skipping a workout is blasphemous.  This stubbornness may lead to disaster.  Better to skip your training session if its too hot, than to suffer the consequences.  I have some experience in this area, but I’m happy to say that that was in my younger days.  I’m more sensible now, and look at these days as needed “rest” to recover from previous workouts, recharge my exercise batteries, and avoid injury.

Alter your exercise schedule.

If you are planning an outdoor exercise session, choose an appropriate time of day,  Here in Southern Calfornia we get a huge variation in temperature throughout the day.  Early morning temperatures (around 6:00-7:00 am) are usually the 60′s in June, July and August, while late afternoon highs often top 95 degrees.  Amazingly, I’ll see people running as I’m driving home from work, when my car thermometer shows an outside temperature near 100 degrees.  Not smart.  When I run, I go in the early morning, to take advantage of the cooler temps.  It’s not that I love running at 6:30 am, but its better than the alternative.

Change your exercise activity.

When it comes to cardiovascular training, running is my preferred activity.  But, if I don’t get in that early morning run, an afternoon swim will work as a decent substitute.  I’m not a fan of swimming (for exercise), but it beats passing out from the heat.  If I really need a run, I’ll go to the gym and run indoors on a treadmill (?dreadmill?).  Again, indoor running is not my favorite, but if I really want to get the workout in, and it’s hot outside, I’ll suck it up and go to the gym.

Dial back the intensity.

When the temps are high, its best to scale back the workout.  If you are running, take a few walking breaks during the session.  Decrease your distance for the day.  Slow down the pace.  There is no need to shoot for a personal record when conditions aren’t right.

Consult your doctor.

As always, if you have any underlying health issues, ask you physician about modified exercise plans for the heat.

 

 

 

Stepping out of the comfort zone

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What does it mean, to have a “comfort zone”.  Pretty self-explanatory I think.  It’s the “zone” in which we are most “comfortable”.  It’s also a place where we are not challenged.  While the comfort zone can be a safe and nurturing place, too much time spent there can lead to stagnation, atrophy, boredom and depression.

Take fitness, for example.  Active fitness participants generally have a favorite workout or activity.  Pilates, yoga, weight training, running and cycling are all great ways to stay fit.  However, focusing on one of these areas, to the exclusion of all other forms of physical activity is a mistake (unless one is a competitive professional – and even then, some degree of cross training is desirable).  Many of us will reside safely in the “zone” of a favorite exercise routine, because we are familiar with, we are good at it, and we feel confident when we participate in it.  Over time, though, we cheat ourselves by failing to challenge ourselves, outside of the “zone”.

I have personal experience with this issue.  For years, I was in a fitness rut, consisting of lifting free weights (nothing works like free weights, right?), alternating with running.  I kept meticulous workout journals, tracking reps, sets, and progress.  Thing is, there was very little progress after a while (amazing that I stuck with it, despite the lack of measurable results).  In fact, I was slowly losing a bit of strength in my bench press and squat numbers, which I attributed to getting older.  I was truly stuck in the comfort zone.  My workouts had ceased to challenge me, and as a result, I grew stagnant.  It was only after I was introduced to yoga and body weight exercises, that I began to feel challenged again.  As a result, my “power” numbers are now the same as they were in my 20′s, plus I am more flexible than I have ever been.  I attribute this to the willingness to leave the comfort zone, and take on new fitness challenges.

Leaving the comfort zone can be helpful in other aspects of life as well.  Feeling bored professionally, socially, or academically?  Try taking up a new challenge, and shake up the routine.  The change will leave you invigorated, and give you a new appreciation of your normal everyday life.  As for me, I’m shaking it up a bit professionally.  I recently went on my second audition for a TV commercial (playing a doctor – not exactly a stretch), something I never imagined I’d do.  While it is way outside my comfort zone – I haven’t been an “actor” since the fifth grade school play – it certainly has given me a fresh perspective on my career, and a new appreciation for how lucky I am professionally.

So, what are you going to do to break out of the rut, and leave the comfort zone?