Muscle Mass Beats BMI as Longevity Predictor – Who Knew!?

I’ve written a couple of times (here and here) about my dislike of the imperfect science of body mass index. In particular, I’ve stated that it does not accurately assess the elderly because of low muscle mass. The elderly are likely to have a “healthy” BMI despite being anything but. As people age they lose weight through muscle loss. This brings their BMI down and may even bring it into what is considered an optimal range. The problem is muscle mass loss reduces strength, which increases the likelihood of falls and a reduced ability to exercise. The last point is particularly problematic.

Now new research shows that when it comes to longevity, a focus on weight loss may be misplaced. Because BMI isn’t actually a very reliable indicator of life span. A more useful measure, some physicians say, might be muscle mass. Researchers analyzed BMI and muscle mass data from more than 3,600 seniors in a long-term study. And they tracked which seniors had died, a decade later. Turns out BMI wasn’t much good at predicting chance of death.

But muscle mass was: more muscle meant better odds of survival. The study appears in The American Journal of Medicine. [Preethi Srikanthan and Arun S. Karlamangla,Muscle Mass Index as a Predictor of Longevity in Older-Adults]. For more information see here.

Critics argue that it’s nearly impossible for the elderly to build muscle. I think they are missing the point. It’s not necessarily that the elderly need to bulk up. It’s that they need to minimize muscle loss. This is done through resistance training. Anyone, yes even the elderly, can resistance train. By doing so muscle loss is minimized. This may mean you don’t fit into the BMI scale perfectly, however, it does mean you are healthier. So, here’s to weight lifting!

Activity or Exercise? Do you know the difference?

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Exercise is the key to staying healthy.  Studies show that exercise is an important part of a healthy lifestyle because it reduces heart disease, cancer, depression, stroke and dementia to name just a few.  However, I find that most people do not know what exercise really is.  All too often they confuse it with activity.  Exercise and activity are cousins, but they are not the same thing.

In all of my new patient appointments I ask each person about their exercise habits.  Some people truly exercise, but the vast majority get no regular exercise. Still others think they exercise when in fact they are just active.  What’s the difference?

First, let me say that being active is without a doubt better than being a couch potato. However, it does not substitute for regular exercise.

So what exactly do I mean? Doesn’t being active mean I exercise? Not necessarily.

Here are the two scenarios I hear in my office the most.

The first is the busy mother of a small child.  Routinely they tell me, “I don’t need to exercise, I chase my small child around all day and pick him up and put him down.  That’s plenty of exercise.” Unfortunately that’s incorrect.  This person is active, but does not exercise and cannot possibly gain the benefits of exercise by looking after a small child.  Unless this mother is repeatedly picking up and putting down their child and squatting down over and over in a short period of time to do so and their heart rate is significantly elevated while doing so, they are not exercising.

Now, I understand that caring for a small child is tiring, but so is sitting at the library and doing research. Activities that make us tired do not always qualify as exercise.

The second scenario I hear most often in response to my question of exercise habits is actually one of two things; people will say, “I walk a few times per week,” or “I like to garden on the weekend.” Both of these again, are activities.  Very few people walk fast enough or the distances required for walking to be considered exercise.  I have one patient in particular who actually does walk far and fast enough for it to be exercise, but that’s a rarity.  Gardening will never be considered exercise.  Again, it may be tiring but two things disqualify it as exercise.  First, it does not increase the heart rate enough and second it is not done with enough regularity to be exercise.

Again, I want to stress that being active is a great start and is far superior to sitting on the couch and watching television.  But it’s just that – a start.

Exercise is something that drives heart rate, builds muscle and changes body composition. It should be done with regularity – at least 3 times per week for a minimum of 30 minutes.

I would ask you to consider this question; If you are a person who falls into one of the above scenarios and believe your lifestyle creates an environment in which you do not need to exercise because you are active consider this.

Are you happy with the results?

Are you tired and/or overweight despite chasing your small child around all day or gardening on the weekend?

If you answered no to the first question and yes to the second you should consider changing your point of view on what you consider exercise.

Remember, activity is a good thing. However, it is not exercise and cannot be used as a substitute.  I would encourage you to make time to exercise even if you are busy and active.  It will only help you in the end.

Want a better brain? Lift Weights!

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Exercise has long been known to increase brain function.  Most of the research, however, focused on the benefits of purely cardiovascular exercises like running.  New research shows that weight training has the same effect.

Conventional wisdom has stated that the benefits of cardiovascular exercise on brain function was from the significant increase in blood flow to the brain during aerobic type exercises.  It was concluded that because weight training didn’t cause this to happen for extended periods of time, it would not have the same benefit.

The creation of new brain cells, or neurogenesis, is thought to be dependent on a spike of blood flow to the brain. In fact, running and other aerobic exercises have been shown to increase neuron production in the areas of the brain associated with memory and thinking in both mice and humans.  However, this was thought not to apply to resistance training.  That is changing.

“In a study presented at the annual meeting of the Society for Neuroscience in November, researchers from Brazil secured weights to the tails of a group of rats and had them climb a ladder five sessions a week. Other rats on the same schedule ran on a treadmill, and a third group just sat around. After eight weeks, the running rats had much higher levels of brain-derived neurotrophic factor (B.D.N.F.), a growth factor that is thought to help spark neurogenesis, than the sedentary rats. So did the rats with weights tied to their tails. The weight-­bearing rats, like the runners, did well on tests of rodent learning and memory, like rapidly negotiating a water maze. Both endurance and weight training seemed to make the rats smarter.” (From The NY Times)

A similar study from Japan at the same conference came to the same conclusions.

“The animals that were assigned to the loaded wheels showed significantly increased levels of gene activity and B.D.N.F. levels within their brains. The higher the workload the animals managed to complete, the greater the genetic activity within their brains.” (From The NY Times)

The genetic activity is important.  That’s precisely how the human brain adapts.  It changes the expression of certain genes in order to respond to certain environmental input.  That input may be in the form of exercise like weight training or it may be more cognitively based like learning to play the piano.  Whatever the input may be, the brain changes in response to the activity being performed.  This is a phenomenon called plasticity.  And the brain remains plastic our entire lives!  That means it can change right up to the day we die.

Just how does this resistance training increase brain function?  No one knows for sure, but there are theories.  The researchers propose that because weight training reduces many cardiovascular risk factors and does increase the strength of the heart it may also help the brain through similar mechanisms that aerobic exercise does.

I have another theory.  Ninety percent, yes that’s 90%, of the input that comes into our brains during any given day comes from the receptors in our muscles and joints.  That means that if we take into account all of the sensory input that our brains receive during the day – light, sound, touch, smell, proprioception – a full 90% of that input is coming from our muscles and joints.  If the body requires that much input from our musculoskeletal system it must be important, right?  It is.  This input keeps the brain functioning normally and maintains the health of just about every type of neuron in the brain.

Resistance training makes this input more efficient.  By training the muscles with weights they send more regulatory information to the brain and you also increase the amount of information coming from the joints.  The stronger your muscles the more force is applied through your joints.  This combination is a winning one in terms of brain function.

The best type of exercise program is one that includes both cardiovascular and resistance type training.  People are often hesitant to start a weight training program because of lack of knowledge on how to properly do it.  If you are concerned hire a knowledgeable trainer to show you how to do it.  The benefits will far outweigh your hesitance to start.

 

4 Simple Ways To Help You Lose Weight

One of the major health issues facing Americans today is obesity.  As a matter of fact more than two thirds of Americans are overweight or obese.  In my clinic we see lots of people who simply want to lose weight and get healthy.  While every case is a little different there are several things that you can do that will greatly improve your chances of losing weight and certainly get you feeling better.  Below I’ve listed somethings that are critically important in our program for people to get fit and most importantly, stay there.

1. Increase Your Activity Level With Exercise

This one seems like a no brainer, but when I talk to people about exercise I find that they don’t really understand what is necessary for them to actually see results.  I always ask people what they do for exercise.  For women, one of the standard answers is, “I have a young child at home and that gets me plenty of exercise.”  For men, a standard answer is, “My job is very physical so I don’t need to exercise.”  Other general answers patients give me for the dreaded exercise question include, “I walk to dog every day,” or “I like to garden on the weekend,” or “I don’t have time to exercise.”

Now, I can certainly appreciate that taking care of a young child can be fatiguing.  I can also understand that a physical job like construction is taxing.  I also know that walking the dog and gardening might seem like exercise, but if we examine these a little closer we will see that they do not qualify as exercise unfortunately.

Taking care of a young child and a job in construction are something that must be done every day (or almost every day).  At one point both of those might have burned you enough calories to qualify as an increase in your activity level.  However, after doing these things over and over again, your body figures out a way to to expend the least amount of energy possible while still performing those tasks.  This means that they no longer qualify as “exercise.”  Take this example.  If you went to the gym and you wanted to start getting in shape you might start by running on the treadmill.  You might start my running just a single mile.  Over time this single mile would no longer be difficult for you and would no longer qualify as exercise or produce the results you are looking for.  The same principle applies to your daily activities.

So to see the results you want, you must include exercise into your activities.  You don’t need to exercise every single day but at least several times per week.  Patients often tell me there is no time in their day for this.  The fix for this is simply that you must make the time.  No magic solutions for that one.

The exercises that I like people to include are weight training with high intensity interval training for cardiovascular health.  Weight training has many benefits.  It raises the amount of calorie you burn when you are at rest, it improves strength which reduces injury and it helps keep bones healthy and strong.  The high intensity interval training is cardiovascular work mostly using your body weight for resistance.  Often times this work is no more than a single 8-10 minute session after a weight training session.  The benefits are well studied and the shorter duration work out is equivalent to much longer workouts that are purely cardiovascular in nature.

2. Improve Your Diet

Again, this one sounds so simple, yet when done incorrectly will lead to poor results.  I always recommend that people reduce carbohydrate in their diet.  For a jump start I generally recommend that people get no more than 20-40 grams of carbohydrate per day.  For a little perspective on that, a single slice of whole wheat bread has about 15 grams of carbohydrate in it.  I also recommend that they get ketone strips from the local pharmacy.

Ketones are a by product of fat metabolism.  When you are exclusively burning fat for energy (as opposed to sugar) ketones will be excreted into your urine.  You may test this with ketone strips.  Simply pass them through a stream of urine several times per day and compare the color coded strip with the reference chart of the bottle.  You will want to see a trace to small amount of ketones.  This ensures that you are burning your body stores of fat for energy.

A diet low in carbohydrate will also help you gain control of a hormone called insulin.  People who have diets high in carbohydrate over produce insulin.  This is problematic because insulin is a storage hormone.  It causes your body to store energy in the form of fat.  Obviously if you produce too much of this hormone you will tend to store fat very easily.  Insulin is released in response to carbohydrate in your diet.  Reduce the carbohydrate and you reduce your fat storing hormone!

As a side note, continually over producing insulin will lead to diabetes and all the health complications associated with it.  Do not take insulin over production lightly.

3. Take Fat Burning Supplements

Many supplements tout their ability to lose weight for you.  No supplement will lose the weight for you.  To do that you will have to do the first two steps above.  There are, however, supplements that will help you lose weight.

One great example is something called carnitine.  It is available from many sources.  It works because carnitine is necessary for the body’s cells to transfer fat into the mitochondria.  This mitochondria is the power house of each cell.  It is what produces energy so the cell can keep up with it’s daily activities.  In order for it to burn fat it needs carnitine.  It is simple to take and is available in capsule form.  It is also very safe, unlike many other weight loss supplements.

Y0u may also benefit from taking supplements to stabilize blood sugar and reduce insulin production.  These are available through reputable supplement companies and I would urge you to see a doctor that specializes in functional medicine to find these types of supplements.

4. Check Your Thyroid

The thyroid can be thought of as the thermostat on the metabolism.  If it is under active your metabolism will be under active as well.  This means you will tend to gain weight very easily among other symptoms like lethargy, insomnia and general low energy.  Checking the thyroid is simple to do through a blood test.  I routinely check my patients on it.

There are several things to look for.  Many times physicians will order something called a TSH or thyroid stimulating hormone.  TSH is a brain hormone that tells the thyroid to secrete it’s hormone.  TSH is inversely proportional to thyroid function.  That means that the higher the TSH the lower your actual thyroid function is.  The reference ranges for most labs for TSH are 0.30-5.0.  This range is far too large.  A more appropriate range is actually 0.3-3.0.  In my practice if a patient’s TSH is above 2 I like to treat them and help them optimize thyroid function.  Other things that need to be checked are the actual thyroid hormones called T3 and T4.  Sometimes those are low, but the TSH is normal.  If the only test ordered is a TSH you might miss the fact that your thyroid is under active.  I also like to see something called the thyroid antibodies.  Sometimes people have antibodies to their own thyroid which reduces its effectiveness.

This list is by no means all inclusive.  It does, however, provide you and insight into the first few steps that go through my mind when someone asks for my advice in helping them lose weight.  We have been very successful in helping people get fit and achieve their weight loss goals.  It is not something that can be done for you, but the reward for achieving your goals is a great one.