New weight-loss drugs

You may have heard about a relatively recent weight loss and diabetes drug, Semaglutide. This drug, from Novo Nordisk, is marketed as Wegovy for weight loss and at a lower dose as Ozempic to treat Type-2 diabetes. Both are administered as a once-weekly injectable. Semaglutide works by mimicking the GLP-1 (glucagon-like peptide-1) satiety hormone in our bodies. When we eat, GLP-1 is released from our intestines and sends signals to our brain centers that control appetite. This is having remarkable weight loss results in patients taking the drug.

However, much like the speed-based weight loss drugs of the past, when patients stop taking the medicine, they start to feel hungrier and regain the weight. This is concerning because insurance coverage for semaglutide is spotty. Medicare does not cover weight loss drugs and many insurers follow Medicare's lead. The lowest price among all retailers is $1,304 per month for people paying out of pocket, which is out of reach for most people.

Another concern is long-term effects, especially if these drugs have to be taken indefinitely. There's ongoing research to evaluate the drug's effect on the cardiovascular system, and it has caused thyroid tumors in rodents. It is also important to remember that Wegovy is only recommended for people with a BMI of 30 or higher, or people with a BMI of at least 27 with weight related conditions.

Of course, exercise and diet modification are still the first strategies to try. But given that about 70% of Americans are overweight or obese, nearly half of adults in the U.S. have hypertension and more than 1 in 3 have pre-diabetes, doctors' groups cite an urgent need to layer on more interventions.

I think these medications can be used to help people who qualify for whom diet and exercise alone hasn't helped. Semaglutide can work together with exercise and diet modifications to help those with obesity and diabetes. I do wonder whether the drugs will have staying power or if they'll fall out of favor, like their predecessors, either from side effects or decreased effectiveness.

Have you had any experience with medications for weight loss? Do you think they can be part of combating the obesity epidemic, or do you think a "magic pill" is too good to be true?

Can compression devices enhance recovery?

Some of you may have heard of compression devices designed to enhance recovery from exercise. NormaTec is an intermittent pneumatic compression device that features chambers that sequentially inflate, starting with the ankle, working their way up the leg, and then deflate. You may have seen these devices in a hospital setting, where they are used to reduce blood pooling and prevent the onset of deep vein thrombosis in the lower extremities of patients who must spend long stretches of time in bed. The idea is that by facilitating venous return we may increase the speed of the clearance of lactic acid and thereby speed recovery.

The study recruited 15 healthy male college-age students and after baseline testing had them perform 3 bouts of High-Intensity Interval training. After each training, the participants recovered through Passive recovery (reclining with the legs elevated), Active recovery (cycling at a low intensity), and NormaTec recovery (reclining with the feet elevated while wearing the NormaTec Pulse 2.0 Recovery System at the maximal setting) for 30 minutes.

Blood lactate clearance for both the NormaTec and active recovery conditions was significantly faster than passive recovery. The study participants also completed some performance tests to measure if the recovery methods would impact athletic performance. There was no significant difference in performance after 24 hours of either of the 3 recovery methods.
The results indicate that the NormaTec or active recovery may be most beneficial to people training twice or more per day. For the typical gym goer, who takes a 24 hour recovery between workouts, recovery mode did not impact performance. However, anecdotal statements by the study participants emphasize how good NormaTec feels. The massage-like experience provided relaxation and a potential stress-relief or mental-health benefit.

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Overcoming Your Home-Gym Challenges

Exercising at home can be difficult for a myriad of reasons. Some factors are impossible to overcome, while others can be worked around. Below are some modifications and suggestions that have benefited me and I hope will be helpful to you and your workouts.

Lack of Equipment:

• Sliders: For hard floors: use felt furniture movers or a shammy towel; for carpets: use plastic plates, frisbees, or paper plates
• Dumbbells: Fill up glass jars with water or wet sand; Use aluminum cans. Wrap cordage or straps around bricks.
• Core work: many of the exercises you've done with a physioball can be similarly done with a foam roller. Try using the foam roller for glute bridges, single leg hamstring curls.
• Gravity: You can adjust your body position to maximize the effect of gravity to mimic some exercises usually done with a pulley system. Seated-cable-row can become a bent-over-row and cable rear-delt-fly can become a bent-rear-delt-fly. Check out these other upper back exercises that don't require any equipment.
• Barbell: Use a dowel or pvc pipe and gallon jugs to make a barbell. Wrap socks around either end of the bottle to minimize shift or incorporate the balance challenge into your workout.

Not enough weight:
Lifting more weight is only one way to increase your workout intensity. Here are some more:

• Slow it down: Count the duration of each rep as you're lifting. Instead of one-second-up, one-second-down, try one second up, holding for 5 seconds at the end range of motion, then 3 seconds down. This increases time under tension.
• Range of motion: Most lifts, with their full complete range of motion, biomechanically provide you with a rest on each repetition. For example, the lateral raise is done with arms at the sides, then lifted straight out to the sides so the body forms a T, then back down. If you're lowering your arms down to your sides on each rep, that is a rest. If you only go down partway, then come back up, you'll keep the deltoids (the target muscle) activated the whole time. This is another way to increase time under tension.   
  
• Lever length: A weight will feel heavier if it is positioned further from the moving joint (fulcrum). If you're limited on weights, substitute lateral raises for shoulder presses. Hold your hands extended overhead in line with your torso to make crunches more challenging.
• Less Rest: Take a shorter break between exercises and your workout will become much harder.

Too Hot:
The gym provides a temperature controlled environment that feels ideal for exercise. Our homes, however, are usually a little bit warmer. Air conditioning can be effective, but usually results in cooling your entire home, which the other residents might not appreciate. A fan is a great way to temporarily make one room feel cooler without affecting the temperature in the rest of the house. If you're sweating, the fan will be even more effective at cooling you. And hey, you can probably wear less clothes at home, too.

Immune Boosting Foods

The COVID 19 pandemic has had an increasing number of cases, hospitalizations, and deaths—and it hasn’t yet peaked. In addition to isolating yourself and your family for the next several weeks, what can you do to help prevent illness?
Doctors recommend frequent hand-washing, getting adequate sleep, and moderate exercise, which I outlined in my last email.
Another important step you can take is right in your kitchen—strengthening your natural immune system with a diet dense in protein, vitamins, minerals and other nutrients found in whole, unprocessed foods.

Flu Fighting Nutrition
A strong immune system is your best defense against disease. Even in isolation, our visits to the store or with relatives put us at risk of being exposed to COVID 19, which can then be brought into the home environment. Maintaining a healthy immune system should be a priority all year—like maintaining weight, muscle mass, or even our teeth—but if that hasn’t been the case, right now is a good time to start! Here’s a look at some immunity-building nutrients and the foods that provide them.

VITAMINS AND MINERALS
Vitamin A
Function: Helps maintain the mucosal lining of the respiratory and gastrointestinal tracts to protect against infection. Also strengthens the adaptive immune system to help fight invasive viruses and bacteria.
Food Sources: Orange foods, such as sweet potatoes, carrots and apricots; dark leafy greens, like spinach and kale; eggs; and bell peppers.

Vitamin B6
Function: Supports numerous biochemical reactions that help your body fight infection.
Food Sources: Meat, such as grass-fed beef, turkey or chicken breast; fish, such as salmon and tuna; pistachios, sunflower or sesame seeds; pinto or garbanzo beans; avocados; grains, such as amaranth.

Vitamin C
Function: Has a wide-ranging impact on the immune system, including the activity of T-lymphocytes, which recruit and coordinate the body’s disease-fighting cells, and phagocytes, which engulf and destroy foreign invaders.
Food Sources: Citrus fruits, such as oranges, grapefruits and tangerines; strawberries and papaya; vegetables, such as spinach, kale, Brussel sprouts and broccoli.

Vitamin D
Function: Regulates both the innate and adaptive immune systems to quickly identify and destroy pathogens that enter the body.
Food Sources: Fatty fish, such as salmon, herrings and sardines; shellfish, such as oysters and shrimp; egg yolks; mushrooms; fortified milk, juice or cereal. Your body also synthesizes Vitamin D when exposed to sunlight.

ZINC
What to eat: shellfish, such as cooked oysters, crab and lobster; meats, especially grass-fed beef and lamb; toasted wheat germ; spinach; cashews; pumpkin, squash and sesame seeds; dark chocolate.
Function: Develops and activates T-lymphocytes. When taken at the first sign of illness, zinc prevents cold viruses from binding and replicating in the mucous membranes of the nose.

PROBIOTICS
What to eat: yogurt with live and active cultures; kefir; milk with probiotics, such as buttermilk or sweet acidophilus; cultured vegetables, such as unpasteurized sauerkraut and kimchi; miso; kombucha; soft cheeses, such as those made from goat’s or sheep’s milk; sourdough bread; sour pickles or olives cured in brine, not vinegar.
Function: Healthy human intestines support some 10-trillion microorganisms which not only break down particles of food, but also dangerous bacteria, viruses, germs and fungi. Keeping a healthy bacteria balance in your gut prevents pathogens from entering the bloodstream.

SEASONINGS AND SPICES

• Raw Garlic contains alliin, which converts to allicin when the clove is crushed or chewed. Allicin increases the cold- and flu-fighting response of certain white blood cells.
• Onions contain a variety of nutrients that boost your immune system, plus a powerful antioxidant called quercetin which has antiviral and histamine-regulating properties.
• Ginger has powerful anti-bacterial, anti-viral and anti-inflammatory compounds that target stuffy noses and keep rhinoviruses from binding to cells in the mucus membranes.
• Turmeric contains curcumin, a compound widely known for its anti-inflammatory properties, but research has also shown that it has the ability to support and modulate the immune system.

PROTEIN
What to eat: meats and fish; low-fat dairy products, such as yogurt, milk and cottage cheese; plant-based combinations, such as beans and brown rice; soy products; nuts and nut butters.
Function: The protein you consume is broken down into smaller pieces, known as amino acids. These pieces are then reassembled into proteins your body needs to function, including antibodies and complement proteins that support your immune system cells.

HYDRATION
Drinking eight to ten glasses of water every day is one of the most effective ways to flush toxins from your body and support the health of your immune system.
Water is also critical to maintaining colon health, the most important pathway for the elimination of toxins and waste. If toxins are allowed to accumulate in the colon, healthy bacteria will die off and unhealthy microorganisms will grow. In fact, studies have shown that 80 to 90 percent of all diseases are directly or indirectly related to gut health.

The best part of how nutrition can boost your immune system, is that we have complete control over what we put in our bodies and the bodies of our kids. I hope you discover some healthy foods that you'll enjoy eating!
Please contact me to ask any questions about exercise and healthy eating during your stay at home.

Exercise is More Important Now than Ever

Fit Athletic Club and many other fitness centers recently closed their doors for the foreseeable future. Many of us are nervous about the potential impact of COVID-19, and I'd like to encourage you to continue physical activity for two key reasons. First, research shows that exercise can support our immune system and second, exercise supports our mental health. Some contemporary evidence shows that leading a physically active lifestyle reduces the incidence of communicable (e.g., bacterial and viral infections) and non-communicable diseases (e.g., cancer), implying that immune competency is enhanced by regular exercise bouts. In 2018, a study by University of Birmingham and King’s College London found that 125 non-smoking amateur cyclists aged 55 to 79 still had the immune systems of young people. Other recent research supported this fact by establishing that those who undertake strenuous exercise such as marathon runners tended to report less annual sick days. We all understand that exercise supports our physical health, however, during times of crisis such as this, it is the first activity we tend to ignore. Being active can not only keep us healthy, it can also help us fight off infection. Exercise is also unique in that it can boost our mental health, and during this anxious time it’s more important than ever to keep our minds clear and focused.

So, how do you go about exercising solo at home? My recommendation would be to alternate between a cardiovascular workout and a strength workout throughout the week. A cardiovascular workout can be a walk or run outside, bike ride, stationary bike, treadmill, elliptical etc, done for a duration of 20-60 minutes. If you do opt to exercise outside, there are many trails which will be less busy. Remember to reach moderate intensity with the talk test: you should be slightly out of breath, making conversation a challenge.

A strength workout should consist of a combination of upper body, lower body, and core exercises done for 10-15 reps and 2-4 sets. The best way to start a strength workout is with a dynamic warm up.

Below are 2 examples of a full body strength workout which require minimal equipment.
Strength 1:
Push ups
Wall shoulder external rotations
Squats -- Squat jumps (if you choose to progress the exercise)
Lunges -- Lunge jumps(optional)
Knee to opposite elbow
Toe touch crunches

Strength 2:
Inchworms
Shoulder press (holding cans of food if you don't have dumbbells)
Floor Bridge
Side Lunge
Sit Up
Side Plank

Most of the exercises are challenging with body weight only, however, you can always hold more weight (cans, water jugs) to increase the intensity of any of these exercises. These exercises require minimal equipment, however, if you have equipment at home, that just increases your opportunities for the types of exercise you can do.

Now, how do you structure your week? Alternating your strength days with cardio will allow your body to focus on maximizing the benefit of the exercise as well as allow adequate rest between bouts. Here is an example of a week with 5 days of exercise:
Monday: Cardio
Tuesday: Strength 1
Wednesday: rest
Thursday: Cardio
Friday: Strength 2
Saturday Cardio
Sunday: rest

Your week can have more or less days of exercise, however, please reach at least 4 days of exercise weekly.

Keep Healthy!

New InBody Test

I'm excited to announce that Fit now has the InBody body composition test. The InBody is Bioelectric Impedance type of body composition measurement and it is the final type outlined below. You may recall that we had previously been measuring body fat using the Fit3D scan. Please reach out to me to schedule your InBody body composition test. I absolutely consider the InBody more accurate than the Fit3D scan. There several different ways to measure body composition, with some being more accurate, reliable, or replicable than others. I've outlined them below:

Skinfold Calipers
This is also known as pinch test. As the name implies, this method involves pinching the subcutaneous fat layer with fingers and measuring the thickness using a caliper.
Calipers are easily portable, and measurement is simple and inexpensive. However, this method involves estimating the total Percent Body Fat (PBF) based on subcutaneous fat.
Although a large portion of body fat is subcutaneous fat, the measurement may not be accurate for people whose body fat distributions vary. Also, measurement is difficult if the subcutaneous fat layer thickness is 5 cm or more and reproducibility of the result varies greatly depending on the skills of the measurer.

Hydrostatic Weighing
Underwater weighing calculates the total body fat by the density of the body. It is based on Archimedes’ principle: when an object is submerged in water, the difference between the mass of the object in the air and its mass in water is the object’s volume.
Body density = Mass of air /(Mass of air – Mass of water )
Underwater weighing is regarded as the gold standard for body composition measurement as it is one of the only body composition technologies that have been compared directly to cadaver analysis. Unfortunately it is very uncomfortable as the examinee has to exhale all the air from the lungs prior to fully submerging in water.

Air Displacement Plethysmography
This method measures the volume of a human body by measuring the volume of air according to the changes in pressure in a chamber.
First, weight and volume of the person are used to calculate body density and then Percent Body Fat and the fat-free ratio.
Density = Mass / Volume
Percent Body Fat = (495 / Density) – 450
Fat free ratio = 100 – BF%
Time required for measurement is relatively short at 3-5 minutes and the examinee can continue breathing in the chamber as opposed to underwater weighing. This method is known as a gold standard because it allows body composition analysis and produces accurate measurements using volume just like underwater weighing. This is often called the "Bod Pod" due to its appearance.


Dual Energy X-Ray Absorptiometry (DEXA)
DEXA is an imaging method that measures the body weight in terms of BMC, lean, and fat based on the decrement of X-ray on the images obtained by exposing to two different X-rays. With the patient lying down, photons of the X-ray beams of different energy levels scan the patient. It takes about 5 to 30 minutes.
As a standard method for body composition analysis, DEXA has high accuracy along with hydrodensitometry. Its advantage is that it can measure the body composition of bone density, body fat and muscle mass for different parts. Advancements to the technology affords DEXA the ability to differentiate lean and fat, allowing this technology to advance from a 2 compartment model to a 3 compartment model.
In order to get a DEXA scan performed, you will typically need to make an appointment with a hospital or clinic that has a DEXA device. You may need to do some research; not all hospitals and clinics will have DEXA devices. You can get a free DEXA scan at the UCSD Bone School (more info).


MRI (Magnetic Resonance Imaging)
Magnetic resonance is a form of imaging technique where the body water may be mapped (but not quantified). The body is scanned in segmental (slices) scans are used to predict whole-body values. MRI is considered to be the most accurate tool for in vivo quantification of body composition. It is an ideal evaluation tool for measurement of skeletal muscle mass and adipose tissue (and can divide adipose into visceral and subcutaneous depots).
MRI’s use a high-strength magnet, thus all metal must be removed. Individuals with metallic chips, materials, surgical clips, artificial joints/prosthetics, pacemakers, metal implants, artificial heart valves, metallic cochlear implants, bullet fragments, or insulin pumps should not test. However, since there is no ionizing radiation, this is a preferable option for many (elderly, children, etc.)
A whole-body scan is roughly 25-30min for scan and 3 hours to analyze via computer software.

Bioelectric Impedance Analysis (BIA)
Bioelectrical Impedance Analysis (BIA) is a method of measuring impedance by applying alternating electrical currents to a user to measuring their volume of water through impedance values.
This non-invasive method involves the placement of electrodes on a person’s feet, hands, or both. A low-level electrical current is sent through the body, and the flow of the current is affected by the amount of water in the body. BIA devices measure how this signal is impeded through different types of tissue (muscle has high conductivity but fat slow the signal down).
As BIA determines the resistance to flow of the current as it passes through the body, it provides estimates of body water from which body fat is calculated using selected equations. The InBody test only requires the examinee to remove shoes and socks.

Which active workstation is the best?

More and more negative effects are being reported from extended sitting times. One study even found that after 4 days of mostly sitting with no exercise, a 1 hour bout of vigorous exercise failed to improve the body's metabolic response. Some may find it difficult to incorporate more frequent bouts of exercise, and so, active workstations have become a way to exercise while working.

Investigators compared the benefits of standing, treadmill, and cycling workstations. Results showed that all of these active workstations contributed to short-term productivity benefits, and cycling stations enabled workers to process simple tasks more quickly.

Using treadmill workstations boosted upper-body muscular activity more than standing desks or cycling, however, the treadmill activity affected keyboarding motor skills. Both cycling and treadmill stations improved heart rate and energy expenditure, increased alertness and reduced boredom more than standing stations; however, cycling setups improved task-processing speeds the most.

"Ultimately workers and corporations should be able to critically examine the benefits and limitations of each type of workstation and determine which is most appropriate for worker's specific needs and tasks," researchers reported.

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Do you have any experience with any of these workstations or other workplace ergonomic aids?