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8 Weight Loss Myths

March 1, 2016 by Dr. Steve Chaney

Why Your Weight Is Increasing Rather Than Decreasing

Author: Dr. Stephen Chaney

Usually I review scholarly publications of clinical studies, but occasionally I find an article in the popular press that’s so good I just have to share it with you. The lead article about weight loss by Bonnie Liebman in the April 2015 issue of Nutrition Action is just such an article. She called it “8 Weight Mistakes”, but I think “8 Weight Loss Myths” would be a better title.

There are certain weight loss myths that are repeated so often that most people believe they are true. Unfortunately, each one of these myths is a “fat trap” that can sabotage your efforts to achieve a healthy weight. If your New Year’s weight loss resolution isn’t going as well as you would like, it may be because you are still holding on to one or more of these myths.

Weight Loss Myth #1: I Can Lose It Later

It’s easy to tell yourself that you don’t need to watch your weight during the holidays or while you are on vacation. After all you can cut back a bit when those special occasions are over and lose that extra weight. What makes that belief particularly insidious is that it actually worked for you when you were in your teens or early twenties. Why doesn’t it work anymore? There are 4 reasons:

On most diets you lose muscle as well as fat. I have talked about this in a previous article, High Protein Diets and Weight Loss , but muscle is important because it burns off calories much faster than fat.

Your organs become smaller. For example, as you lose weight your heart doesn’t have to service as many miles of blood vessels, so it can become smaller as well. That’s important because your heart works so hard pumping blood that it burns off calories much faster than resting muscle.

Once you have lost a significant amount of weight exercise burns fewer calories. If you don’t believe that, try lugging an extra 10 or 20-pound weight up a flight of stairs.

Your metabolism slows down. This is particular true if you try to lose weight too fast as I have explained in my “3 Things Every Successful Diet Must Do” eBook, which is available at Health Tips From the Professor.

Just in case you are still a doubter, Ms. Liebman shared a study in her article that showed most people never lose all of the weight they gained during the holidays before the next holiday season starts. Does that sound familiar?

Weight Loss Myth #2: Once It’s Off, It’ll Stay Off

You’ve heard this one before. However, even on the most successful diets, weight loss is temporary. Most people eventually regain all the weight they’ve lost and more. Again I’ve also covered the reason for this in my “3 Things Every Successful Diet Must Do” eBook, which is available at Health Tips From the Professor. To spare you the trouble of reading the book I will share the secret with you. Simply put: “Diets never work long term. Only true lifestyle change can lead to long term weight loss.”

However, that doesn’t stop people from believing that the next “magic” diet will be their ticket to permanent weight loss. It always amazes me that people fall for this same myth time after time.

Weight Loss Myth #3: Fat Is Fat, No Matter Where It Is

Most of you probably already knew that belly fat (the so-called apple shape) is metabolically more dangerous to our health than thigh & leg fat (the so-called pear shape). However, some of the other information Ms. Liebman shared was a surprise to me.

It turns out that belly fat is actually easier to lose than thigh & leg fat. As you add fat to your lower body you create lots of new fat cells (2.6 billion new fat cells for every 3.5 pounds of fat). Once you add that extra fat to your lower body you’re pretty much stuck with it.

Of course, you can’t add new fat to your belly forever without creating new fat cells, and once you’ve created those new fat cells you may be stuck with your belly fat as well.

Weight Loss Myth #4: You Have To Go Out Of Your Way To Overeat

It’s really difficult to understand how anyone could believe in this myth. The fact is that we live in a “fat world”. There are fast food restaurants on virtually every street corner in every city and in virtually every mall in this country. Restaurant portion sizes are through the roof. Every social interaction seems to be centered around food or drink.

You don’t need to go out of your way to overeat. Overeating has become the American way. You actually need to go out of your way to avoid overeating.

Weight Loss Myth #5: All Extra Calories Are Equal

Research has confirmed what many of you probably suspected already. All calories are NOT equal. Calories from alcohol, saturated fats, trans fats and sugars make a beeline for your belly where they are converted into the most dangerous form of fat.

Weight Loss Myth #6: I Can Just Boost My Metabolism

Many Americans cling to the false hope that they can eat whatever they want as long as they take some sort of magic herb or pill to boost their metabolism. The fact is that natural metabolic boosters like green tea have a very modest effect on metabolism. They can play a role in a well-designed diet program, but they will never allow you to eat whatever you want and lose weight.

As for those magic herbs and drugs that promise to burn off fat calories without you lifting a finger, my advice is to avoid them like the plague. I’ve talked about many of them in my previous “Health Tips From the Professor” articles. For example, you might be interested in my articles “Are Dietary Supplements Safe?” or “Are Diet Pills Safe?”. The bottom line is that these metabolic boosters are dangerous – and they just might kill you.

Weight Loss Myth #7: There’s A Magic Bullet Diet

Hope springs eternal. Perhaps that’s why so many new diets appear each year. Some diets are low fat, some are low carbohydrate, some hearken back to cave man times, and others are just plain weird. Some of them actually do give better weight loss than others short term. However, when you follow people on those diets for two years or more, none of them work very well (see myth #2), and there isn’t a dimes worth of difference between them.

Weight Loss Myth #8: I Can Work Off The Extra Calories

This is perhaps the most pervasive myth of all. This is the one that sells millions of gym memberships every January.

Don’t get me wrong. Diet plus exercise can be very beneficial because it helps you retain muscle mass as you are losing weight, especially if you are consuming enough protein to support the exercise.

However, exercise alone isn’t going to help you nearly as much as you think.

You’d have to ride your bicycle for an hour and 25 minutes to offset the 500 calorie dessert you just consumed at your favorite restaurant.

Exercise helps some people more than others. Studies show that some people get hungrier when they exercise. As a result, they eat more calories and actually gain weight rather than losing it.

Finally, don’t rely on your fitness trackers. Most of them grossly overestimate the calories you burn through exercise. If you use a fitness tracker you should cut their estimates for calories burned by 50% or more.

The Bottom Line

A recent article shared the 8 most common weight loss myths. If you actually believe any of these myths, you will have a very difficult time getting your weight under control.

I can lose it later.

Once it’s off, it’ll stay off.

Fat is fat, no matter where it is.

You have to go out of your way to overeat.

All extra calories are equal (A calorie is a calorie).

I can just boost my metabolism.

There is a magic bullet diet.

I can work off the extra calories.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Do Calcium Supplements Prevent Bone Fractures? – Part2: Preventing Osteoporosis

February 2, 2016 by Dr. Steve Chaney

Creating A “Bone Healthy” Lifestyle

Author: Dr. Stephen Chaney

$prevent bone fractures$ A recent study (Tai et al, British Medical Journal, BMJ/2015; 351:h4183 doi: 10.1136/bmj.h4183)reported that calcium supplementation for women over 50 resulted in only a very small increase in bone density, which translated into a very small (5-10%) decrease in the risk of bone fractures. They concluded that the standard RDA recommendation of 1,000 – 1,200 mg/day of calcium for adults over 50 is unlikely to help in preventing osteoporosis or reducing the risk of bone fractures.

In last week’s issue of “Health Tips From the Professor,” I discussed the many flaws of the study. In brief:

The study was a meta-analysis of 51 published clinical studies. Normally, meta-analyses are very strong, but they have an “Achilles Heel” – something called the Garbage-In, Garbage-Out Simply put, this means that the meta-analysis is only as strong as the individual studies that went into it. The authors included 40 years of clinical studies in their meta-analysis, and most of those studies had an inadequate design by today’s standards.

The study also made a number of what I would call apples to oranges comparisons that were of questionable validity.

In this week’s issue of “Health Tips From The Professor”, I would like to explore the other side of the coin. I would like to consider the possibility that the study might be correct and discuss what that might mean for you.

What Is A “Bone Healthy” Lifestyle?

Despite the concerns I just mentioned, let’s assume for a minute that the study might just be correct in spite of its many flaws. Let’s assume that the “one size fits all” RDA recommendation of 1,000 – 1,200 mg/day of calcium if you are over 50 may actually be flawed advice. If so, perhaps it’s time to say good riddance! It may finally be time to put away the “magic bullet”, “one size fits all” thinking and start seriously considering holistic approaches.

Now that I have your attention, let’s talk about what you can do to prevent osteoporosis – and the role that supplementation should play. Let’s talk about a “bone healthy” lifestyle.

#1: Let’s start with supplementation: Bone is not built with calcium alone. Bone contains significant amounts of magnesium along with the trace minerals zinc, copper and manganese – and all of these are often present at inadequate levels in the diet. Most of us know by now that vitamin D is essential for bone formation, but recent research has shown that vitamin K is also essential (Kanellakis et al, Calcified Tissue International, 90: 251-262, 2012). An ideal calcium supplement should contain all of those nutrients.

#2: Next comes diet: Many of you probably already know that some foods are acid-forming and other are alkaline-forming in our bodies – and that it is best to keep our bodies on the alkaline side. What most of you probably don’t know is that calcium is alkaline and that our bones serve as a giant buffer system to help keep our bodies alkaline. Every time we eat acid-forming foods a little bit of bone is dissolved so that calcium can be released into the bloodstream to neutralize the acid. (My apologies to any chemists reading this for my gross simplification of a complex biological system).

Consequently, if we want strong bones, we should eat less acid-forming foods and more of alkaline-forming foods. Among acid-forming foods, sodas are the biggest offenders, but meat, eggs, dairy, and grains are all big offenders as well. Alkaline-forming foods include most fruits & vegetables, peas, beans, lentils, seeds and nuts. In simple terms, the typical American diet is designed to dissolve our bones. Calcium from diet or supplementation may be of little use if our diet is destroying our bones as fast as the calcium tries to rebuild them.

#3: Test your blood 25-hydroxyvitamin D level: 25-hydroxy vitamin D is the active form of vitamin D in our bloodstream. We need a sufficient (20-50 ng/mL) blood level of 25-hydroxy vitamin D to be able to use calcium efficiently for bone formation. We now know that some people who seem to be getting adequate vitamin D in their diet still have low 25-hydroxyvitamin D levels. In fact, various studies have shown that somewhere between 20-35% of Americans have insufficient blood levels of 25-hydroxy vitamin D. You should get your blood level tested. If it is low, consult with your health professional on how much vitamin D you need to bring your 25-hydroxy vitamin D into the sufficient range.

#4: Beware of drugs:The list of common medications that dissolve bones is a long one. Some of the worst offenders are anti-inflammatory steroids such as cortisone & prednisone, drugs to treat depression, drugs to treat acid reflux, and excess thyroid hormone.

I’m not suggesting that you avoid prescribed medications that are needed to treat a health condition. I would suggest that you ask your doctor or pharmacist (or research online) whether the drugs you are taking adversely affect bone density. If they do, you may want to ask your doctor about alternative approaches, and you should pay a lot more attention to the other aspects of a “bone healthy” lifestyle.

#5: Exercise is perhaps the most important aspect of a bone healthy lifestyle:Whenever our muscles pull on a bone it stimulates the bone to get stronger. I’ll put the benefits of exercise in perspective in the next section.

Exercise Is A Critical Part of Preventing Osteoporosis

Instead of just quoting more boring studies, I’m going to share a couple of stories that help put the importance of exercise into perspective.

The first is my wife’s story. She ate a very healthy diet with minimal meat and lots of fruits and vegetables for years. She took calcium supplements on a daily basis. She walked 5 miles per day and took yoga classes several days each week. Yet when her doctor recommended a bone density scan in her early sixties she discovered she had low bone density. She was in danger of becoming osteoporotic!

Her doctor prescribed Fosamax. My wife tried it for one day and decided the side effects were worse than the disease. So she started asking holistic health practitioners what she should do. They recommended she find a personal trainer and start pumping iron. That was not an easy solution, but it was the right one. When she went in for her second bone scan 3 months later, her doctor excitedly announced that her bone density had increased by 7%. Her doctor said “We never get results that good with Fosamax”. When my wife told her she wasn’t taking Fosamax, her doctor became even more excited. (Most doctors actually do prefer holistic approaches. They just don’t recommend them.)

The moral of this story is that you can be doing everything else right, but if you’re not doing weight bearing exercises – if you’re not pumping iron, everything else you are doing may be for naught. Weight bearing exercise is an absolutely essential part of a “bone healthy” lifestyle!

But, can exercise do it alone? Some people seem to think so. That brings up my second story. About 30 years ago one of my UNC colleagues, who was an expert on calcium metabolism, was doing a bone density study on female athletes at UNC. One of the tennis players was nicknamed “Tab.” Tab was a popular soft drink at that time, and Tab was all she drank – no milk, no water, only Tab. When my colleague measured the bone density of her playing arm, it was normal for a woman of her age. When he measured the bone density of her non-playing arm, it was that of a 65 year old woman. The reason is simple. When we exercise a particular bone, our body will add calcium to that bone to make it stronger. If we are not getting enough calcium from our diet, our body simply dissolves the bones elsewhere in our body to get the calcium that it needs.

The moral of this story is that exercise alone is not enough. In terms of bone health, we absolutely need exercise to take advantage of the calcium in our diet, and we absolutely need sufficient calcium in our diet to take advantage of the exercise.

This is the most glaring deficiency of the meta-analysis I described last week. None of those studies included exercise. No wonder the increase in bone density was minimal!

Putting It All Together – A “Bone Healthy” Lifestyle

If you seriously want to minimize your risk of osteoporosis, there are a few simple steps you can take (simple, but not easy).

Consume a “bone healthy” diet that emphasizes fresh fruits and vegetables, minimizes meats, and eliminates sodas and other acidic beverages. For more details on whether your favorite foods are acid-forming or alkaline-forming, you can find plenty of charts on the internet.

Minimize the use of medications that adversely affect bone density. You’ll need to work with your doctor on this one.

Get plenty of weight bearing exercise. This is an absolutely essential part of a bone healthy lifestyle. Your local Y can probably give you guidance if you can’t afford a personal trainer. Of course, if you have physical limitations or have a disease, you should consult with your health professional before beginning any exercise program.

Get your blood 25-hydroxy vitamin D level tested. If it is low, take enough supplemental vitamin D to get your 25-hydroxy vitamin D level into the sufficient range – optimal is even better. Sufficient blood levels of 25-hydroxy vitamin D are also absolutely essential for you to be able to utilize calcium efficiently.

Consider a calcium supplement. Even when you are doing everything else correctly, you still need adequate calcium in your diet to form strong bones. “I’m not necessarily recommending a “one-size fits all” 1,000 to 1,200 mg/day. Supplementation is always most effective when you actually need it. For example:

If you are not including dairy products in your diet (either because they are acid-forming or for other health reasons), it will be difficult for you to get adequate amounts of calcium in your diet. You can get calcium from other food sources such as green leafy vegetables. However, unless you plan your diet very carefully you will probably not get enough.

If you are taking medications that decrease bone density, that may increase your need for supplemental calcium. Unfortunately, we don’t yet have guidelines on how much is needed.

If you do use a calcium supplement, make sure it is complete. Don’t just settle for calcium and vitamin D. At the very least you will want your supplement to contain magnesium and vitamin K. I personally recommend that it also contain zinc, copper, and manganese.

Unfortunately, we don’t really have good guidelines for how much calcium you need. Studies like the one described above are challenging the old RDAs, but we don’t yet have enough studies to know how much calcium we need to build strong bones when we are following a “bone healthy” lifestyle that includes proper diet, sufficient 25-hydroxy vitamin D blood levels and plenty of exercise.

What About Medications For Preventing Bone Loss?

The danger is that, as the conclusions of this meta-analysis get widely publicized and doctors stop prescribing calcium supplements, they probably aren’t going to recommend a holistic approach. They probably won’t recommend a “bone healthy” lifestyle. Instead, they will most likely recommend drugs to prevent bone loss. In fact, the authors of the study described last week specifically praised the use of bisphosphonate drugs (Fosamax and Zometa), and a related drug (Xgeva) that works by a similar mechanism because they increased bone density by 5-9% over 3 years.

However, these drugs have a dark side, and it’s not just the acid reflux, esophageal damage and esophageal cancer that you hear about in the TV ads. These drugs all act by blocking bone resorption, the ability of the body to break down bone. In the short term, this prevents the bone loss associated with aging and reduces the risk of bone fractures.

However, you might remember from last week’s article that bone resorption is also an essential part of bone remodeling, the process that keeps our bones young and strong. When these drugs are used for more than a few years you end up with bones that are dense, but are also old and brittle. Long term use of these drugs is associated with jaw bones that simply dissolve and bones that easily break during everyday activities. This is yet another example of drugs with side effects that look a lot like the disease you were taking the drug for in the first place.

The Bottom Line

A recent study has reported that the RDA recommendation of 1,000 – 1,200 mg/day of calcium for people over 50 provides only a minimal increase in bone density (0.7-1.8%) over the first year or two. This translates into a very small (5-10%) decrease in risk of bone fractures. It did not matter whether the calcium came from dietary sources or from supplementation. The authors concluded that adding extra calcium to the diet, whether from foods or supplements, was not a very efficient way to increase bone density and prevent fractures.

2. This study suffers from some serious flaws, which I discussed in last week’s “Health Tips From the Professor”

3. Unfortunately, many doctors are likely to take this study to heart. They are likely to stop recommending calcium and other natural approaches and start relying even more heavily on drugs to preserve bone mass. That’s bad news because, while the most frequently proscribed drugs do increase bone mass and prevent fractures short term, they also cause your bones to age more rapidly. After a few years you end up with bones that are dense, but are also incredibly brittle and fracture very easily. That’s right. If you use these drugs long enough, they will cause the very condition you were trying to prevent.

4. We should also consider the possibility that this study may just be correct. Let’s assume for a minute that the RDA recommendation of 1,000 – 1,200 mg/day of calcium for everyone over 50 may actually be flawed advice. If so, it may finally be time to put away the “magic bullet” thinking and start seriously considering holistic approaches to preserving bone mass.

5. A far better choice is to follow a “bone healthy” lifestyle.

Start with a “bone healthy” diet. Avoid acid-forming foods like sodas, meats, eggs, dairy, and grains. Instead choose alkaline-forming foods like most fruits & vegetables, peas, beans, lentils, seeds and nuts.

Check on the medicines you are using. If they are ones that adversely affect bone density, ask your health professional if there are bone-healthier options.

Check your blood level of 25-hydroxy vitamin D on a regular basis. If it is low, consult with your health professional on the amount of vitamin D you need to take to bring your 25-hydroxy vitamin D into the optimal range.

Get plenty of weight bearing exercise. This means pumping iron. It is an absolutely essential part of a bone healthy lifestyle. Of course, if you have physical limitations or have a disease, you should consult with your health professional before beginning any exercise program.

If you are not getting sufficient calcium from your diet, consider a complete calcium supplement. In addition to calcium and vitamin D, a bone-healthy calcium supplement should at the very least contain magnesium and vitamin K. I also recommend it contain zinc, copper, and manganese.

Just don’t rely on a calcium supplement alone to keep your bone density where it should be. If your 25-hydroxy vitamin D isn’t where it should be and/or you aren’t doing weight bearing exercise on a regular basis, your calcium supplement may be almost useless. All the aforementioned may aid in preventing osteoporosis. In my opinion, that may be the biggest take-home lesson from the recent meta-analysis.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Skinny Fat

January 5, 2016 by Dr. Steve Chaney

Overweight Vs. Obesity

Author: Dr. Stephen Chaney

Are you skinny fat? Weight loss season is upon us. Many of you are jumping on your bathroom scales so that you can decide how much weight you need to lose this year. For some the motivation for these New Year’s resolutions to lose weight is purely cosmetic. You just want to look better. For others the motivation for losing weight is better health. Obesity is a killer. It is associated with increased risk of diabetes, heart attack and stroke – and that’s just the tip of the iceberg.

But what if your bathroom scale says that you are normal weight? Are you off the hook? Maybe not. A recent study suggests that if you are normal weight but have central obesity (a fancy scientific term for belly fat), you are more likely to die prematurely than someone with normal fat distribution regardless of how overweight they are. That’s a pretty scary thought. It has even generated a new risk category called “skinny fat”.

How Can You Be Obese Without Being Overweight?

In recent years there has been some controversy about the health risks of obesity. Part of that controversy has arisen because obesity can be defined in multiple ways. Most of us simply hop on the scale and rely on actuarial tables to tell us what a healthy weight is for our height. Scientists, on the other hand use two very different measures of obesity.

#1 is Body Mass Index or BMI.BMI is a person’s weight in kilograms (kg) divided by his or her height in meters squared. By this measure:

Normal body weight is defined as a BMI of 18.5-24.9 kg/m².

Overweight is defined as a BMI of 25-29.9 kg/m².

Obesity is defined as a BMI of ≥30 kg/m².

#2 is waist to hip ratio or WHR. WHR is a measure of central adiposity (belly fat). By this measure:

Obesity is defined as excess central adiposity (excess belly fat), which is a waist to hip ratio ≥0.85 in women and ≥0.90 in men.

In general BMI and WHR correlate. However:

11% of men and 3.3% of women are normal weight according to BMI measurements, but have excess belly fat according to WHR measurements.These are the individualswho are obese according to their WHR measurements without being overweight according to their BMI measurements. These are the individuals often referred to as “skinny fat”.

There are similar percentages of men and women who are overweight or obese according to BMI measurements, but have low WHR measurements. These are often referred to as “pear shaped” obese individuals to distinguish them from the “apple shaped” obese individuals with a lot of belly fat.

Being Skinny Fat Can Kill You

Numerous studies have shown that “apple shaped” obesity is much more likely to be associated with disease and premature death than “pear shaped” obesity, but there have been very few studies comparing health outcomes for normal weight individuals who have excess belly fat (people who are “skinny fat”) with health outcomes of overweight and obese individuals. This study (Sahakyanet al, Annals of Internal Medicine, 2015 Nov 10 doi: 10.7326/M14-2525) was designed to fill that void.

These scientists analyzed data from the National Health and Nutrition Survey III (NHANES III). NHANES III collected BMI, WHR and health data from 15,184 Americans (52.8% women) aged 18 to 90 years (average age 45) and followed the study participants for 14.3 years. By that time 3222 of them had died, with 1413 of those deaths being due to heart disease. The results were enlightening:

Normal weight individuals with excess belly fat (“skinny fat” individuals) were 1.5 – 2.0 fold more likely to die during the 14.3 year follow up period than individuals who were normal weight and had little belly fat (“skinny lean” individuals). This was expected because this had been shown in several previous studies.

However, the surprising finding was that normal weight individuals with excess belly fat were also more likely to die than individuals who were overweight or obese. Specifically:

Men who were “skinny fat” were 2.2 – 2.4 fold more likely to die prematurely than men who were either overweight or obese, but did not have excess belly fat (men with a “pear shaped” fat distribution). “Skinny fat” women were 1.3 – 1.4 fold more likely to die prematurely than overweight or obese women with “pear shaped” fat distribution.

Men who were “skinny fat” were even slightly more likely to die prematurely than overweight or obese men with excess belly fat (men with “apple shaped” fat distribution). “Skinny fat” women were just as likely to die as overweight or obese women with “apple shaped” fat distribution.

When they looked at deaths due to cardiovascular disease the results were essentially the same.

These results were novel and should, perhaps serve as a wake-up call for normal weight individuals with excess belly fat.

The authors concluded:

“Our analysis of data…show that normal-weight U.S. adults with central obesity [excess belly fat] have the worst long-term survival compared with participants with normal fat distribution, regardless of BMI category.”

“To our knowledge, our study is the first to show that normal-weight central obesity, measured by WHR, is associated with an increased risk of cardiovascular mortality.”

“Our findings suggest that persons with normal-weight central obesity may represent an important target population for lifestyle modification and other preventative strategies.”

Why Is Being Skinny Fat So Dangerous?

As the authors of this study pointed out, it is well established that excess belly fat is associated with:

Insulin resistance, which can lead to diabetes and predispose to heart disease.
High triglycerides and high levels of “bad” cholesterol, which can lead to heart disease.
Inflammation, which can lead to a number of deadly diseases.

The metabolic effects of excess belly fat are sufficient to explain why someone who is “skinny fat” is more likely to die prematurely than someone who is “skinny lean”. However, the effect of excess belly fat is not sufficient by itself to explain why a “skinny fat” individual is more likely to die prematurely than someone who is overweight or obese.

To understand this we need to recognize that both fat and muscle contribute to body weight (and to BMI). The “skinny fat” individual has more fat mass AND less muscle mass than a “skinny lean” individual of the same weight. That is a huge factor because metabolically speaking muscle is protective. It opposes all of the bad metabolic effects of belly fat.

Simply put, being “skinny fat” is extremely dangerous because you have increased all the bad metabolic effects of excess belly fat, ANDyou have decreased the protective metabolic effect of muscle mass.

How Do You Go From Being “Skinny Lean” To “Skinny Fat”?

Most of us were lean in our younger years. For those of us who end up as “skinny fat” as we age, it is pretty obvious that there are two processes going on simultaneously.

#1: Loss of Muscle Mass:It would be easy to say that becoming “skinny fat” is a natural part of aging. The natural tendency is to loose muscle mass and replace it with fat mass as we age. If we “just go with the flow” all of us will end up being “skinny fat” at some point. However, the loss of muscle mass as we age is accelerated by our sedentary lifestyle and our diet (more on that below).

#2: Gain of Belly Fat:To some extent whether we store excess fat as “pears” or “apples” is genetically determined. However, what we eat can also exert a major influence. For example:

Alcohol: The term “beer belly” says it all. Excess alcohol consumption is associated with an increase in belly fat. Once you understand the metabolism of alcohol the explanation is pretty simple. Alcohol causes blood sugar to drop, which increases appetite. Alcohol also interferes with our judgement, which can cause us to make poor food choices.

Excess saturated fat tends to be stored preferentially as belly fat.

Excess sugars and simple carbohydrates are rapidly converted to fat stores and stored as belly fat.

What Can You Do If You Are Already Skinny Fat?

Let’s start with what you shouldn’t do. You should not go on a reduced calorie weight loss diet to get rid of your excess belly fat. The last thing you want to do is to end up being underweight with excess belly fat! Here is what you should do:

#1: Increase Your Muscle Mass:I said that loss of muscle mass was a natural part of aging. I didn’t say that it was an inevitable part of aging. If you want to prevent or reverse loss of muscle mass you need to:

Get really serious about exercise. I’m talking about 30 minute workouts at least 3-5 times per week. These workouts need to include strength training as well as aerobics and flexibility exercises. I would suggest you ask your health professional what kind of exercise program is best for you and start your exercise program under the guidance of a personal trainer or physical therapist.

Make sure that your diet contains enough protein and enough of the essential amino acid leucine to maximize the gain of lean muscle mass following your workouts. I have covered the latest age-appropriate recommendations in, leucine and muscle gain, a previous “Health Tips From The Professor.”

#2: Lose Your Belly Fat:To some extent you will start to lose your belly fat naturally if you follow the recommendations above. In addition, you will want to:

Drink alcohol in moderation.

Make food choices that allow you to replace saturated fat with monounsaturated fat and polyunsaturated fats, especially the omega-3 polyunsaturated fats.

Replace excess sugars and simple carbohydrates with complex carbohydrates from fresh fruits and vegetables along with modest amounts of whole grain foods.

The Bottom Line

A recent study has shown that being “skinny fat” (having normal body weight, but excess belly fat) is more likely to result in premature death than if you were overweight, or even obese.

The most likely explanation for this alarming statistic is that someone who is “skinny fat” has excess belly fat, which predisposes to a number of diseases, and a loss of muscle mass, which protects against those same diseases.

If you are overweight or obese, you need to reduce your caloric intake to lose weight. However, if you are “skinny fat”, you don’t want to reduce your caloric intake. You need to change your exercise and diet habits.

Loss of muscle mass and gain of fat mass is a normal part of aging. However, you can slow or reverse the age-related loss of muscle mass with an exercise program and enough protein and leucine in your diet to maximize the effects of that workout program (details above).

You can prevent or get rid of excess belly fat by:

Following the exercise program and nutritional support of that exercise program described above.

Making food choices that replace saturated fats with monounsaturated fats and polyunsaturated fats, especially omega-3 polyunsaturated fats.

Replacing foods high in sugar and simple carbohydrates with fresh fruits and vegetables and whole grains in moderation.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Repetitive Strain Injury From Sleeping

September 15, 2015 by Dr. Steve Chaney

Get Off To A Great Start Every Morning

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

How Can Sleep Cause Repetitive Strain Injury?

For most of us during sleep we stay in one position for hours at a time. So if you wake up with back pain after sleeping, you are experiencing the side effects of muscles held in one position for hours. This is an example of repetitive strain injury or repetitive stress injury.

Because the muscles have to contract to pull your body into your favorite sleeping position and then the muscles stay in a shortened position for hours this can cause pain and tension in your back.

When you wake up with back pain after sleeping you may think you need a new mattress. You might, but it’s definitely worthwhile to address the tight muscles first as they may be the whole problem.

Have you ever seen a dog do their “downward dog” stretch after a nap? Before the dog bounces back into the world it takes time to awaken its body. This is your pain relief “role-model” for stretching your back after sleeping. You’ll be amazed at how simply moving in bed before starting your day eliminates pain and tension.

Let’s get started! While still in bed begin moving around; raise your arms over head and stretch your legs out and flex your feet. Maybe roll to each side stretching the sides of your body. Try these 3 stretches we recommend

Repetitive Strain Injury Treatment: 3 Stretches After Sleeping

The following stretches will help relieve symptoms of repetitive strain injury due to sleeping in one position for long periods.

When you are ready bring yourself to a seated position (still in bed!).

One at a time, bring your arm across the front of your body. Pull your shoulder and shoulder blade toward the front, but without moving the rest of your trunk. This is a great stretch for your triceps, shoulders and upper back.

Next stretch! Bring your feet together, as pictured here.Start with a straight spine then slowly roll your chin into your chest, rounding your back. Mmmmm…this feels good!

And finally, try this juicy spinal twist.Sit with left leg straight out or you can bend it as pictured. Cross the right foot over the left leg, press your right hand behind you, place your left elbow on your right knee now twist. Stretch as far as you are comfortable. Try holding it 15-20 seconds.

This stretch will even help to loosen your hips if you sit as pictured!

As with all stretches, start out easy – stretching should feel GOOD. You’ll feel the tension ease as the blood starts flowing.The tight muscles that cause back pain after sleeping can hamper your entire day, but doing these simple stretches will make a world of difference!

Wishing you well,

Julie Donnelly

About The AuthorJulie Donnelly is a Deep Muscle Massage Therapist with 20 years of experience specializing in the treatment of chronic joint pain and sports injuries. She has worked extensively with elite athletes and patients who have been unsuccessful at finding relief through the more conventional therapies.

She has been widely published, both on – and off – line, in magazines, newsletters, and newspapers around the country. She is also often chosen to speak at national conventions, medical schools, and health facilities nationwide.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Leucine And Muscle Gain

August 25, 2015 by Dr. Steve Chaney

Should Your Post-Workout Protein Shake Contain Added Leucine?

Author: Dr. Stephen Chaney

If you are an athlete – or just someone who is exercising to create a lean and healthy body, you are probably interested in increasing your lean muscle mass following each workout. You may already use leucine. Of course, if you read any of the “muscle magazines”, you’ve seen the ads. “Explode Your Muscles.” “Double Your Gains.” They all claim to have the perfect post-workout protein shake, backed by science. They all sound so tempting, but you know that some of them have to be scams.

I told you about some of the sports supplements to avoid in previous “Health Tips From the Professor”. In this issue, I’m going to ask “What does the perfect post-workout protein shake look like?”

For years athletes have been using protein beverages containing branched chain amino acids after their workouts to maximize muscle gain and recovery. There was some science behind that practice, but the major questions were unanswered. Nobody really knew:

How much protein is optimal?

What kind of protein is optimal?

What amount of branched chain amino acids is optimal?

Are some branched chain amino acids more important than others?

Does the optimal amount of branched chain amino acids depend on the amount of protein?

As a consequence, after workout protein supplements were all over the map in terms of protein source, protein amount, branched amino acid amount and type of branched chain amino acids. Fortunately, recent research has clarified many of these questions.

How Much Protein Do You Need and What Kind?

Recent research has shown that the optimal protein intake for maximizing muscle gain post workout is 15-20 gm for young adults (Katsanos et al, Am J Clin Nutr 82: 1065-1073, 2005; Moore et al, Am J Clin Nutr, 89: 161-168, 2009) and 20-25 gm for older adults (Symons et al, Am J Clin Nutr 86: 451-456, 2007).

More protein isn’t necessarily better. The effect of protein intake on post workout muscle gain maxes out at around 25 gm for young adults and 30 gm for older adults (Symons et al, J Am Diet Assoc 109: 1582-1586, 2009).

Whey protein is the best choice for enhancing muscle gain immediately after a workout. Other protein sources (soy, pea, casein, chicken) are better choices for sustaining muscle gain over the next few hours.

Leucine: The Only Branched Chain Amino Acid To Stimulate Muscle Protein

It turns out that leucine is the only branched chain amino acid that actually stimulates muscle protein synthesis (Am J Physiol Endocrinol Metab 291: E381-E387, 2006). And protein is what gives muscles their strength and their bulk.

Recent research has shown that 2-3 gm of leucine (2 gm for young adults; 3 gm for older adults) is sufficient to maximize post workout muscle gain if protein levels are adequate (Am J Physiol Endocrinol Metab 291: E381-E387, 2006).

Unanswered Questions About Optimizing Muscle Gain Post-Workout

Do the other branched chain amino acids play a supporting role, or is leucine alone sufficient to drive post-workout muscle gain?

Can leucine still help maximize post-workout muscle gain if protein intake is inadequate? If so, how much leucine is needed?

Does Leucine Enhancement Improve Low Protein Shakes?

A recent study (Churchward-Venne et al, Am J Clin Nutr, 99: 276-286, 2014) seems to answer those two questions. The authors compared the effect of 5 protein-amino acid combinations on muscle protein synthesis in 40 young men (~21 years old) following unilateral knee-extensor resistance exercise. The protein shakes contained:

25 gm of whey protein, which naturally contains 3 gm of leucine (high protein)

6.25 gm of whey protein, which naturally contains 0.76 gm of leucine (low protein)

6.25 gm of whey protein with 3 gm of leucine (low protein, low leucine)

6.25 gm of whey protein with 5 gm of leucine (low protein, high leucine)

6.25 gm of whey protein with 5 gm of leucine + added isoleucine and valine (the other branched chain amino acids). (low protein, branched chain amino acids).

The results were clear cut:

The high protein shake (25 gm of protein) was far superior to the low protein shake (6.25 gm of protein) at enhancing post workout protein synthesis. This is consistent with numerous other published clinical reports.

Adding 3 gm of leucine to the low protein shake had no effect on post-workout protein synthesis, but 5 gm of added leucine made the low protein shake just as effective as the high protein shake at supporting post-workout protein synthesis.

In short, leucine can improve the effectiveness of a low protein shake, but you need more leucine than if you chose the high protein shake to begin with.

Adding extra branched chain amino acids actually suppressed the effectiveness of leucine at enhancing post-workout protein synthesis. These data suggest:

Leucine probably is the major amino acid responsible for the muscle gain reported in many of the previous studies with branched chain amino acids.

If the other branched chain amino acids play a supporting role in the muscle gain, the quantities that occur naturally in the protein are probably enough. Adding more may actually reduce the effectiveness of leucine at stimulating muscle gain.

While this is a single study, it is consistent with numerous other recent clinical studies. It simply helps clarify whether leucine can increase the effectiveness of a low protein supplement. It also clarifies the role of branched chain amino acids.

Also, while this study focused on protein synthesis, numerous other studies have shown that optimizing post-workout protein and leucine intake results in greater muscle gain (for example, Westcott et al., Fitness Management, May 2008)

The Bottom Line

Research on post-workout nutrition to optimize muscle gain from the workouts has come a long way in recent years. It is now actually possible to make rational choices about the best protein supplements and foods to support your workouts.

If you are a young adult (17-30), you should aim for 15-20 gm of protein and about 2 gm of leucine after your workout.

If you are an older adult (50+), you should aim for 20-25 gm of protein and 3 gm of leucine after your workout.

If you are in between you are on your own. Studies haven’t yet been done in your age group, but it’s reasonable to assume that you should aim for somewhere between the extremes.

If you are getting the recommended amounts of whey protein, the leucine level may also be optimal. If you are using other protein sources you may want to choose ones with added leucine.

The research cited above shows that you can make a low protein supplement effective by adding lots of leucine, but that’s going to require artificial flavors and sweeteners to cover up the taste of that much leucine. I would recommend choosing one that provided adequate protein to begin with.

While the research in this area is still somewhat fluid, I would avoid protein supplements with added branched chain amino acids other than leucine. If the paper I cited above is correct, you probably get all of the other branched chain amino acids you need from your protein and adding more may actually interfere with the effect of leucine on muscle gain.

I’d pretty much forget all the other “magic ingredients” in post-workout supplements. If you’re a novice there is some evidence that arginine and HMB may be of benefit, but if you have been working out for more than 6 months, the evidence is mixed at best. As for the rest, the clinical studies are all over the map. There’s no convincing evidence that they work.

Whey protein is the best choice for enhancing muscle gain immediately after your workout. Soy, pea, and casein are better choices for sustaining muscle gain over the next few hours. If you’re looking at meat protein, chicken is a particularly good choice. Four ounces of chicken will provide the protein and leucine you need to sustain muscle gain for several hours.

Even if you are not working out, recent research on dietary protein and leucine has important implications for your health. In a recent “Health Tips From the Professor” High Protein Diets and Weight Loss, I shared research showing that optimizing protein and leucine intake helps to increase muscle retention and maximize fat loss when you are losing weight.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Emergency Treatment for Calf Cramps

August 18, 2015 by Dr. Steve Chaney

To Stretch or Not To Stretch

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

A calf cramp is caused by several different conditions, such as dehydration and mineral deficiency. These each need to be addressed to prevent future calf cramps, but when your calf spasms wake you with a jolt at night or send you crashing to the ground in agony, you need a solution NOW!

And, stretching is definitely NOT the first thing to do.

Emergency Treatment for Calf Cramps

A muscle always contracts 100% before releasing. Once started, a calf cramp will not partially contract and then reverse because you stretch, as it may cause the muscle fibers to tear, which will cause pain to be felt for days afterward.

As a result, it is most beneficial to help your muscle complete the painful contraction before you try to stretch it. It sounds counter-intuitive, but it cuts the time of the calf cramp down, and enables you to start flushing out the toxins that formed during the sudden spasm.

Your muscle will be all knotted up, screaming in pain, so it’s good to practice this self-treatment when you are not having a calf cramp.

Grab your calf muscles as shown in this picture. Hold it tightly, and then as hard as you can, push your two hands together.

The intention is to help the muscle complete the contraction as quickly as possible. During an actual calf cramp it won’t be as “neat” as the picture shows, but anything you can do to shorten the muscle fibers will hasten the completion of the spasm.

Follow These Steps To Release Your Calf Cramps

Hold your hands and continue pushing the muscle together until you can begin to breathe normally again. Continue holding it another 30 seconds, bringing in as much oxygen as possible with slow, deep, breathing.
Release your hands and keep breathing deeply.
Repeat #1. This time it won’t hurt, but you are helping any last muscle fibers to complete the contraction before you move to release the spasm.
Begin to squeeze your entire calf as if you were squeezing water out of a thick towel. Move from the top of your calf and go down toward your ankle. This will feel good, so do it for as long as you can.
It is now safe to stretch your calf muscle because the cramp has completed and you have flushed out the toxins. Stretch slowly, and don’t go past the point of “feels so good”. You don’t want to overstretch.

This calf cramps emergency treatment has been proven successful by endurance athletes who have written to me saying how they could continue their race (or training) without any further pain.

This is a very important tip to share with all athletes. Please tell your friends on Facebook and Twitter, it helps athletes prevent injury and pain.

Wishing you well,

Julie Donnelly

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

About The Author

Julie Donnelly is a Deep Muscle Massage Therapist with 20 years of experience specializing in the treatment of chronic joint pain and sports injuries. She has worked extensively with elite athletes and patients who have been unsuccessful at finding relief through the more conventional therapies.

Hamstring Stretches

July 21, 2015 by Dr. Steve Chaney

What To Do For Tight Hamstrings

Author: Julie Donnelly, LMT –The Pain Relief Expert

Editor: Dr. Steve Chaney

You are about to begin your run, or maybe you have just finished running. Your hamstring feels really tight. Maybe it is even painful. It seems obvious that you need to stretch it, but that could be exactly the wrong thing to do!

You Need To Release Muscle Fiber Knots Before You Do Hamstring Stretches!

Stretching can be dangerous if the muscle is shortened by spasms. A spasm (also called a muscle knot or trigger point) is like tying a knot in the center of the muscle. And while each spasm may only involve a few fibers; there can be multiple spasms throughout the muscle.

Each spasm feels like a bump when you slide your fingers deeply down the length of the muscle. These spasms normally form over an extended period of time, often from repetitive strain on the muscle fibers.

Muscle Spasms Are At The Heart of the Stretching Misconception

It is important that you think of a spasm as a knot in the muscle fibers in order to understand why it can hurt to stretch.

A muscle begins on a stationary bone, crosses over a joint, and then inserts into a moveable bone. When the muscle pulls on the moveable bone, the joint moves, however, if the muscle has a “knot” in it you can cause micro-tears to the fibers as you stretch.

As you stretch, knots within the muscle get tighter, this also causes the fibers on either side of the spasm to overstretch. Overstretching can cause fiber tears either along the length of the muscle or where the fibers attach to the bone. In most cases this can be avoided by simply applying pressure to the muscle to release the spasm before you stretch.

What Do Hamstrings Do?

Your hamstrings are responsible for bending your knee. Every time you take a step, sit down, or climb stairs, you contract your hamstrings.

The only time your hamstrings aren’t contracting is when you are standing up straight. This means they are frequently repetitively strained and contain multiple spasms along the muscle fibers. These tight muscles put a strain on the back of your knee and at the origination point (the bottom of your posterior pelvis).

What Causes Tight Hamstrings?

The hamstrings are a bit unique from other muscles because while they can certainly have spasms in the fibers from repetitive strain injuries, they are also overstretched because of two major muscles that rotate the pelvis down in the front.

The two muscles that cause tight muscles to be overstretched are the iliopsoas (a muscle on the front side of the lumbar vertebrae) and the quadriceps (front of the thigh).

As these muscles get tight, primarily from sitting, they cause the pelvis to rotate forward and down. As your pelvis rotates down in the front, it rotates up in the back.

Since your hamstrings originate on the bottom of the posterior pelvis, as it is moving up, the muscle fibers are already overstretched – so you don’t need to stretch them further. In fact, if you stretch them they could potentially tear.

What Should You Do Before Your Hamstring Stretches?

It’s actually a 3-step process. The key is to release tension in the front of the body before you can safely stretch the hamstrings.

First you need to release the tension in your quadriceps, this will take the tension off the front of the pelvis. You do this by rolling out your quadriceps muscles which releases trigger points (muscle spasms).

Next, stretch your iliopsoas. A low lunge is a great way to stretch the iliopsoas. This causes the pelvis to rotate up in the front and down in the back. As that happens tension is removed from the hamstrings.

Now you can release the spasms in the hamstrings. You do this by sitting on a trigger point therapy ball, ironing out your hamstrings. Stay on specific points of pain; these are the knots in the muscle fibers you need to release. The direct pressure forces out the toxins, draws in blood and causes muscle fibers to lengthen.

Releasing muscle knots in your quadriceps, stretching your iliopsoas and releasing muscle knots in your hamstrings MUST be done before you can safely perform your hamstring stretches.

Do yourself a big favor and take these short steps; you will notice a difference!

Wishing you well,

Julie Donnelly

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

About The Author

Do Omega-3s Prevent Age-Related Muscle Loss?

June 23, 2015 by Dr. Steve Chaney

Does Fish Oil Build Muscle?

Author: Dr. Stephen Chaney

Omega-3-rich fish oil supplements have attracted their share of controversy in recent years, but there appear to be lots of reasons to make sure that you get enough omega-3s from your diet.

There is actually pretty good evidence that omega-3s offer a natural approach for people who wish to lower their blood pressure (https://www.chaneyhealth.com/healthtips/do-omega-3s-lower-blood-pressure/) or heart attack risk (https://www.chaneyhealth.com/healthtips/fish-oil-really-snake-oil/). There is also some evidence that omega-3s may be important for brain development in infants (J Protzko et al, Perspectives on Psychological Science, 8: 25-40, 2013), for mental performance in children (https://www.chaneyhealth.com/healthtips/omega-3s-improve-reading-skills/) and for preventing cognitive decline in the elderly (https://www.chaneyhealth.com/healthtips/omega-3s-slow-cognitive-decline/).

If the latest headlines are to be believed, we can add preventing age-related muscle loss to the benefits of an omega-3-rich diet.

Why Is Age-Related Loss of Muscle Mass a Problem?

The term for age-related muscle loss is sarcopenia, and it is a big problem for older adults. After age 50 we lose 1-2% of our muscle mass each year. As you might expect, our strength declines as well. Each 1% loss of muscle mass translates into about 1.5% loss in strength. That means after age 50 we lose 1.5% of our muscle strength each year, and once we hit 60 the rate of loss increases to around 3% per year.

That may not sound like much on an annual basis, but it adds up over time. With a little bit of higher math you can calculate that you could easily have lost 45% of your muscle strength by the age of 70 and a whopping 75% by the age of 80. At that point even the simplest physical activities – lifting a grandchild or a bag of groceries – can become challenging. That loss of strength also contributes to a loss of balance that can lead to debilitating falls.

The most effective way of preventing age-related muscle loss is regular resistance training, especially when coupled with adequate intake of protein and leucine (https://www.chaneyhealth.com/healthtips/protein-needs-for-older-adults/). However, resistance training is hard work, so many older adults gravitate to quick fixes like testosterone, growth hormone, or DHEA – even though each of those treatment regimens have significant side effects and risks.

That’s why the recent headlines suggesting that a risk-free approach like omega-3 supplementation might increase muscle mass and strength in older adults is so enticing.

Do Omega-3s Prevent Age-Related Muscle Loss?

A previous study had suggested that omega-3 supplementation enhanced the effect of strength training in elderly women (Rodacki et al, AJCN, 95: 428-436, 2012). Although the mechanism of that effect is unclear, the authors of this study decided to go one step further. They asked if omega-3 fatty acids might prevent loss of muscle mass even in the elderly in the absence of a structured exercise program (Smith et al, AJCN, doi: 10.3945/ajcn.114.105833, 2015).

The study consisted of 44 men and women age 60-85 (average age 69) who were not exercising on a regular basis. They were given either 4 gm of fish oil (containing 1.86 gm of EPA and 1.5 gm of DHA) or a placebo containing corn oil each day for 6 months. Muscle mass and four measures of muscle strength were performed at the beginning of the study and again at 6 months. The measures used were thigh muscle volume (a measure of muscle mass), hand grip strength, overall muscle strength (the maximum weight that the subject could lift in a single repetition for leg press, chest press, knee extension, and knee flexion) and isokinetic power (the power attained in knee extension and flexion exercises). The results were pretty impressive for the omega-3 group compared with the control group:

Thigh muscle volume (muscle mass) increased by 3.6%

Handgrip strength increased by 6%.

Overall muscle strength increased by 4%.

Isokinetic power increased by 5.6%.

Other than complaints about fishy breath, there were no adverse effects in the omega-3 group.

The authors calculated that the increase in muscle mass and strength during 6 months of omega-3 supplementation was sufficient to offset 2-3 years of normal age-related muscle loss and strength loss.

The increase in muscle mass and strength associated with omega-3 supplementation was less than can be attained from regular resistance exercise coupled with adequate protein intake. However, it was the same or greater than could be obtained from testosterone, growth hormone or DHEA – and didn’t have the risks associated with those treatments.

For example, a recent study has concluded that testosterone injections are associated with a significant risk of stroke, acute coronary syndromes, hospitalization and death (Layton et al, JAMA Internal Medicine, doi: 10.1001/jamainternmed.2015.1573).

The authors concluded ”Fish oil-derived omega-3 therapy slows the normal decline in muscle mass and function in older adults and should be considered a therapeutic approach for preventing sarcopenia and maintaining physical independence in older adults.”

Limitations of the Study

Before you all run out and stock up on fish oil supplements, I should point out that this study has several limitations.

It is a very small study. It needs to be replicated by future studies.

It used a very high dose of fish oil (4 gm/day). High doses are often used in an initial study like this one just to establish whether there is an effect worth further study. However, this study needs to be repeated at lower doses to see if this benefit of omega-3 supplementation is also seen at more physiological doses (500 – 1,000 mg) of omega-3s.

Because of these limitations, I am not yet ready to agree with the authors that omega-3 supplementation “…should be considered a therapeutic approach for preventing sarcopenia and maintaining physical independence in older adults.” This is an interesting finding that holds the promise of an inexpensive, risk-free, natural approach for maintaining muscle mass in older adults, but it needs to be verified by future studies before it can be widely recommended.

There are many reasons to supplement with omega-3s, but at this point in time I would definitely not recommend fish oil supplementation as an alternative to resistance exercise and adequate protein intake for older adults who wish to prevent age-related loss of muscle mass and strength.

However, the health risks of testosterone, growth hormone, and DHEA supplementation are significant. For someone who is absolutely set on pursuing an exercise-free solution to maintaining muscle mass and strength as they age, I would recommend omega-3 supplementation first rather one of the riskier alternatives.

The Bottom Line

A recent study has suggested that omega-3 supplementation may prevent age-related loss of muscle mass and strength. The study was performed in both men and women age 60-85 who were not exercising on a regular basis.

Omega-3 supplementation was less effective than regular resistance exercise coupled with adequate protein intake, but equal to or greater in effectiveness than testosterone, growth hormone, or DHEA treatment.

This was a very small study and it used a very high dose of omega-3s. It is a promising finding because it represents an inexpensive, risk-free, natural approach for maintaining muscle mass in older adults, but it needs to be verified by future studies before it can be widely recommended.

There are many good reasons to supplement with omega-3s, but at this point in time I would definitely not recommend fish oil supplementation as an alternative to resistance exercise and adequate protein intake for older adults who wish to prevent age-related loss of muscle mass and strength. Resistance training combined with adequate protein is a proven intervention. Omega-3 supplementation is not.

However, the health risks of testosterone, growth hormone, and DHEA supplementation are significant. For someone who is absolutely set on pursuing an exercise-free solution to maintaining muscle mass and strength as they age, I would recommend omega-3 supplementation first rather one of the riskier alternatives. It might just work, and it is a lot less risky.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Protein Needs For Older Adults

February 10, 2015 by Dr. Steve Chaney

How Much Protein Do We Need?

Author: Dr. Stephen Chaney

What are the protein needs for older adults? In previous “Health Tips From the Professor” I have covered the optimal amount of protein for weight loss diets in high protein diets and weight loss and following workouts . In this issue of “Health Tips From the Professor” I will review the latest information about protein needs as we age.

To put this in perspective, many Americans suffer from sarcopenia (loss of muscle mass) as they age.

Some of you may be saying “So what? I wasn’t planning on being a champion weight lifter in my golden years.” The “So what” is that loss of muscle mass leads to loss of mobility, a tendency to fall (which often leads to debilitating bone fractures) and a lower metabolic rate – which leads to obesity and all of the illnesses that go along with obesity.

How Can We Prevent Loss of Muscle Mass As We Age?

Fortunately, sarcopenia is not an inevitable consequence of aging. There are things that we can do to prevent it. The most important thing that we can do to prevent muscle loss as we age is to exercise – and I’m talking about resistance (weight) training, not just aerobic exercise.

But we also need to look at our protein intake and our leucine intake. Protein is important because our muscle fibers are made of protein.

Leucine is an essential amino acid. It is important because it stimulates the muscle’s ability to make new protein. Leucine and insulin act synergistically to stimulate muscle protein synthesis after exercise. I have covered the evidence behind leucine’s importance in maintaining and building muscle mass in a previous “Health Tips From the Professor”, Leucine Triggers Muscle Mass.

Do Our Protein Needs Increase As We Age?

Interestingly, our protein needs actually increase as we age. Campbell et al (Journal of Gerontolgy: Medical Sciences 56A: M373-M380, 2001) showed several years ago that RDA levels of protein were not sufficient to maintain muscle mass in both men & women aged 55 to 77 years old.

Many experts recommend that those of us in our golden years should consume the amount of protein in grams that is equivalent to half our body weight in pounds every day.

When Should We Eat Our Protein?

When we consume the protein is also important. Forget that continental breakfast, salad for lunch and protein-rich dinner. As we age we increasingly need high quality protein at every meal.

In one study, young adults (average age = 31), experienced increased muscle protein synthesis when they consumed as little as 15 grams of protein at a meal, but older adults (average age = 68) experienced no increase in muscle protein synthesis in response to the same low protein meal (Katsanos et al, Am J Clin Nutr 82: 1065-1073).

However, when the amount of protein in a meal was increased to 30 grams (equivalent to a 4 oz piece of chicken or beef) both younger and older adults were able to use that protein to build muscle (Symons et al,Am J Clin Nutr 86: 451-456, 2007).

But, 30 grams seems to be about optimal. Protein intakes above 30 grams in a single meal resulted in no further increase in muscle protein synthesis (Symons et al, J Am Diet Assoc 109: 1582-1586, 2009), which means you can’t hope to get all of the muscle building benefits of protein in a single meal.

As a consequence of these studies most experts recommend that we “golden agers” aim for 20 to 30 grams of high quality protein with every meal.

How Much Leucine Do We Need?

The story with leucine is similar. 1.7 grams of leucine was not sufficient to increase muscle protein synthesis following exercise in older adults, while 2.7 grams was sufficient (Katsanos et al, Am J Physiol Endocrinol Metab 291: E381-E387, 2006). So the experts recommend that older adults get 3 grams of leucine in our diet following workouts to maximize the effect of the workout.

And, of course, if we want to maximize the effects of resistance training, both the protein and leucine need to be consumed after we exercise, not before (Fujita et al, J Appl Physiol 106: 1730-1736, 2009).

Where Do We Get the Protein and Leucine We Need?

So, where do we get the amount of protein and leucine that we are looking for?

If you want to get them from food alone, 4 oz servings of meat are a good starting place – with chicken being the best (35 grams of protein and 2.7 grams of leucine). Dairy, eggs and vegetable foods are much lower in leucine, protein or both.

Unfortunately, I keep running into seniors who are fully convinced that broccoli and tofu will meet their protein needs. I fully understand the rationale for choosing vegetarian protein sources, but you need a bit more than broccoli and tofu if you are going to meet your protein needs in your golden years.

For example, a 4 ounce serving of tofu provides only 10 grams of protein and 0.8 grams of leucine, and a 1.5 cup serving of broccoli provides only 4.2 grams of protein and a miserly 0.36 grams of leucine. That makes it very difficult to meet your target of 20-30 grams of protein and around 2.7 grams of leucine with each meal.

I’m not saying that you can’t get enough protein and leucine to maintain muscle mass on a vegetarian diet. However, you will need to plan that diet very carefully.

So, if you want to know what the old professor does, here it is:

I work out almost every day. On the days when I work out in the morning I rely on a protein shake immediately after the workout to meet my protein and leucine goals. On the days when I train at the gym in the late afternoon, I rely on 4 oz of chicken or fish with dinner to meet those goals.

Those of you who know me know that I will never be featured in muscle magazine, but at least I’m gaining muscle mass – not losing it.

The Bottom Line

As we age many Americans suffer from sarcopenia (loss of muscle mass). The loss of muscle mass leads to loss of mobility, a tendency to fall (and break things) and a lower metabolic rate – which leads to obesity and all of the illnesses that go along with obesity.

The most important thing that we can do to prevent muscle loss as we age is to exercise – especially resistance (weight) training exercise – at least 30 minutes every day. It is also important to make sure that we are getting adequate intake of protein and the essential amino acid leucine.

Our protein needs increase as we age. Recent studies suggest that the RDA levels of protein are not sufficient to maintain muscle mass in people over the age of 55. Many experts recommend that those of us in our golden years consume the amount of protein in grams that is equivalent to half our body weight in pounds every day.

Recent studies show that it is important to spread that protein out through the day rather than consume one protein rich meal at the end of the day. If we are over 50 we should be aiming at 20-30 grams of protein per meal. However, more than 30 grams of protein at a single serving appears to provide no additional benefit.

Seniors also appear to need more leucine in each meal than younger adults if they wish to preserve muscle mass. Young adults need only around 1.7 grams of leucine per serving to stimulate muscle protein synthesis, while mature adults may need as much as 2.7 grams per serving.

Well-designed protein shakes and 4 ounces of lean meats are the easiest way for seniors to meet their protein and leucine needs. Vegetarian diets can provide the protein and leucine needed to maintain muscle mass in seniors, but those diets need to be very well planned. Broccoli and tofu just don’t make the grade if you are serious about preserving muscle mass.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Does Exercise Make You Live Longer?

January 27, 2015 by Dr. Steve Chaney

Run Long and Prosper

Author: Dr. Stephen Chaney

Does exercise make you live longer? If you are a fan of the original Star Trek series, you may remember the phrase “Live Long and Prosper”. That sounded great, but it was just a wish – a platitude. It said nothing about how you might accomplish the feat of living longer and prospering.

What if something as simple as increasing your exercise levels might help you live a longer, healthier life? A recent study provides pretty convincing evidence that exercise can increase longevity. If that is really true, maybe the proper phase should be “Run Long and Prosper”.

In my past “Health Tips From the Professor” I have talked about how hard it is to prove the value of any individual lifestyle change on improving our longevity – whether we are talking about more exercise, lower fat diets or individual nutritional supplements.

Most studies have too few subjects and last too short a time to show any significant effect. That’s why the study I’m featuring this week (Byberg et al, British Journal of Sports Medicine, 43: 482-489, 2009) is so remarkable.

How Was The Clinical Study Designed?

The study was designed to answer the question of whether exercise can actually help people live longer.

But what was remarkable about the study was the number of people enrolled in the study and how long the study lasted. The study enrolled 2,204 men aged 50 from the city of Uppsala Sweden in 1970-1973 and followed the men for 35 years!

At the beginning of the study the participants completed a survey on leisure time physical activity and were categorized into low, medium or high activity groups. Participants were re-examined at ages 55, 60, 70, 77, and 82 years and changes in physical activity were recorded.

Other information, such as body mass index, blood pressure, cholesterol levels, smoking status and alcohol use, was also collected at each survey. And, of course, the researches recorded how many of the initial participants were still living at each of those ages.

Is Living Longer One of the Benefits of Exercise?

After adjusting for other risk factors (obesity, smoking, excess alcohol consumption, elevated cholesterol or blood pressure), the researchers found that men who reported high levels of physical activity from age 50 lived 2.3 years longer than sedentary men and 1.1 years longer than men who reported medium levels of physical activity.

They also looked at what happened to men who started at low or medium levels of activity and increased their exercise level during the study. After 5 years of increased activity there was no apparent benefit. But after 10 years of increased activity the risk of dying had been reduced just as much as if they had always been exercising at that level!

I find that last finding particularly significant because most studies of this type last 5 years or less. If this study had been concluded at the end of 5 years, you might be tempted to say: “Why bother. If I haven’t exercised before, there’s no point in starting now.” But, this study did last more than five years – so the conclusion was completely different.

The Bottom Line

We’ve known for years that exercise reduces the risks of several types of diseases and improves the quality of life. This study clearly answers “Does exercise make you live longer?” with a yes.

If you haven’t exercised before, it’s never too late to start. Just don’t expect instantaneous results.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.