Do you pay attention to how much sodium you take in?
Maybe you should!
It turns out that sodium may not be as bad as we previously thought. In fact, sodium is essential for many metabolic processes. Sodium is responsible for regulating blood pressure, maintaining blood volume and is required for neuron function and signal transduction.
Many believe that high (or adequate) salt intake will lead to high blood pressure. Most cases of hypertension are actually a result of genetics or stress. A small percentage of the people who are sodium sensitive may experience an increase in blood pressure, but an overwhelming benefit for the rest of the population cannot be ignored.
During high intensity exercise, the body actually responds better to a higher blood volume. This improves delivery of oxygen and nutrients to the working cells of the body. High blood volumes are also optimal for kidney filtration and removal of toxins and metabolic waste products.
Low dietary sodium and elimination diets can have detrimental effects for high performance athletes. Low salt intake will decrease overall blood volume, making the blood thicker. This can cause muscle weakness, cramps and lethargy.
What Type of Salt?
I recommend iodized salt. Iodine helps with thyroid function and regulates metabolism. Unbleached, pure Himalayan salt is also a good option.
So if you are hitting a wall during your workout it may be due to sodium depletion. Bottom line, make sure you are drinking plenty of water, eating sufficient carbs for your training needs, getting a balance of micronutrients from a variety of whole foods, and don’t be afraid to sprinkle a little salt on your meals every once in a while!
Many women notice after age 45 that fat seems to accumulate readily at the waist. There are even terms for it, like menopause belly, muffin top, or “meno-pot.” What does the science tell us about menopausal belly fat and how to get rid of it? What are the hormonal drivers and are they amenable to change with personalized lifestyle medicine? Certainly belly fat, specifically subcutaneous and visceral abdominal fat, increases during menopause,1-3 when the changing hormonal environment can bring with it a remodeling of fat storage patterns. Abdominal fat, especially visceral fat, is biochemically different and more metabolically active than fat stored in other areas, secreting more pro-inflammatory cytokines and adipokines.4 That means preventing or reversing belly fat is not just a vanity project, it’s a meaningful step in managing a woman’s overall health, as abdominal fat has been consistently linked with insulin resistance, impaired glucose control, and overall higher cardiometabolic and breast cancer risk. Practitioners are often asked ‘How can I get rid of menopausal belly fat?’, and it is important to remember that effective management is multifaceted – encompassing an understanding how changes in sex steroids interact with other endocrine systems and also with lifestyle choices, and recognizing the best time to implement a lifestyle medicine approach is in the years before a woman’s final menstrual period.
The changing hormonal environment
A robust understanding of the hormonal changes associated with perimenopause and menopause can guide women toward effective intervention. Here are the top five hormonal changes associated with the menopausal transition.
Changes in estrogen and estrogen dominance: Menopause is often framed simply as the loss of estrogen, but the road from pre- to post-menopausal estrogen levels is not necessarily smooth. Although loss of estrogen itself is linked with increasing abdominal fat,2,3 paradoxically the estrogen dominance that occurs in perimenopause and that may continue into menopause is seen clinically as a culprit in expanding abdominal fat mass.5 Between age 35 and 45, most women are beginning to run low on ripe eggs and experience hormonal changes linked with advancing reproductive age.6 During this time reduced progesterone coupled with high and erratic estrogen occurs.6,7 Estrogen declines but is in relative excess to progesterone. This is the definition of estrogen dominance: having a progesterone level that’s less than 100X the level of estrogen, creating an imbalance in the estrogen-progesterone partnership and essentially an inadequate level of progesterone to keep estrogen in check. Local estrogen production in adipose tissue can also contribute to estrogen dominance during this time. For example, aromatase enzymes, responsible for converting androgens to estrogens, are more active in visceral adipose tissue of post-menopausal women in response to cortisol.8
Cortisol: Dysregulation of the HPA axis and cortisol excess can manifest as increased central and visceral fat mass and metabolic disturbances such as insulin resistance.9,10 Increased production of cortisol,11 and conversion of cortisone (inactive) to cortisol (active) has been described in post-menopausal women,12 indicating that increased cortisol synthesis and conversion could contribute to metabolic dysfunction in these women. Cortisol is regulated in part by sex steroids, and estrogen down-regulates the expression and activity 11β-HSD1, the enzyme involved in converting inactive cortisone to active cortisol13 – so higher estrogen, lower 11β-HSD1 and less active cortisol formed. Declining estrogen levels during menopause can have a knock-on effect on cortisol formation, and 11β-HSD1 has been shown to be upregulated particularly in visceral fat in post-menopausal compared with pre-menopausal women. 1,11,12 As well as contributing directly metabolic dysfunction, higher cortisol can feed back to hormonal environment and contribute to estrogen dominance occurring at this time through cortisol-induced aromatase activity.8,14
Insulin: Fat cells accumulating in the abdomen is linked with insulin resistance. The pro-inflammatory cytokines produced by abdominal fat interferes with insulin signaling.15 This results in insulin resistance where cell response to insulin is lost, which creates a cycle where greater production of insulin is required to manage blood glucose levels. Insulin is a gatekeeper of metabolism, and rising insulin levels can set off a chain reaction that ultimately leads to a cycle of weight and abdominal fat gain. Insulin can lower production of sex hormone binding globulin (SHBG) in the liver.16,17 Lower SHBG results in greater free androgens and estrogens in circulation, and is linked with visceral fat and insulin resistance in menopausal women.18,19 In addition, insulin resistance can have a knock-on effect on leptin, insulin’s cousin.
Leptin: Leptin is the put-down-your-fork hormone, the one that tells you when you are full.20 Elevated insulin levels eventually lead to elevated leptin, which despite what you may think, does not mean you are more likely to put down your fork and stop eating. Instead, consistently elevated leptin levels lead to a dysfunction of leptin receptors and they stop sending signals to the brain to tell you to stop eating – this is called leptin resistance.21 The mechanisms driving leptin-resistance are complex, but high intakes of refined carbohydrates have linked with its development.22
Thyroid hormones: Thyroid hormones, which regulate how quickly we burn calories and maintains our metabolism, can becomes unbalanced with age, a trend that has been labeled ‘thyropause’. If the thyroid becomes underactive, this can lead to symptoms including weakness, fatigue, and weight gain.23
What can be done?
One of the biggest myths in women’s health is that once hormones change with menopause, abdominal adiposity is immovable – however addressing modifiable hormones such as cortisol and insulin in the following ways can have an impact.
Make foundational changes to dietary intake. When evaluating diet, consider factors that influence insulin levels, such as high carbohydrate intakes or intake of refined carbohydrates which require greater insulin response to manage spikes in plasma glucose. Remove inflammatory or trigger foods, as inflammation can contribute to insulin resistance.31 Add in foods rich in antioxidants which promote detoxification. Eliminate alcohol which robs you of deep sleep and lowers metabolism by more than 70% for 24 hours. Choosing when to eat during the day can also make a positive impact to insulin levels and insulin sensitivity. Time-restricted feeding (TRF) protocols, a type of intermittent fasting, where food is consumed during a limited number of hours per day (often 6 or 8) has been shown to reduce body weight and abdominal fat32 and improve insulin sensitivity even without weight loss.33
Add more movement to the day. Sitting is like the new smoking. Approximately 35 chronic diseases and conditions are associated with sedentariness, and sedentary behavior makes people more prone to gain body fat.24High intensity interval training (HIIT) is effective at reducing abdominal and visceral adiposity, as well as improving insulin sensitivity and building muscle.25,26 Studies in post-menopausal women show that HIIT training results in greater abdominal and visceral fat mass loss compared to continuous exercise programs (where heart rate was maintained at a constant level)27,28 showing that HIIT is a time-efficient strategy for improving central obesity in this population. In addition to HIIT programs, practicing yoga can be recommended for menopausal women, showing significant reductions in menopausal symptoms.29 In broader populations, interventions that included yoga asanas were associated with reduced evening and waking cortisol levels, as well as improved metabolic symptoms.30
Support reparative sleep. A primary step to losing belly fat is to get enough sleep and to make it quality sleep. Epidemiological studies have repeatedly shown links between sleep duration and the risk of obesity and central adiposity.34 People sleeping 7-8 hours/night night have been shown to accumulate less visceral fat mass than those sleeping for ≤6 hours/night.35 Sleep debt leads to changes in leptin and other hormones related to satiety, greater feelings of hunger, dietary indiscretion and poor food choices, as well as reduced physical activity and insulin resistance.34 In other words, getting that solid sleep needs to be a priority. As well as sleep quantity, sleep quality has to be considered, as poorer sleep quality is associated with higher visceral fat mass.36 Subjective poor sleep quality is linked with altered cortisol response37 and insulin resistance in postmenopausal women.38
by Sara Gottfried, MD and Annalouise O’Connor, PhD
Yamatani H et al. Association of estrogen with glucocorticoid levels in visceral fat in postmenopausal women. Menopause. 2013;20(4):437-442.
Shen W et al. Sexual dimorphism of adipose tissue distribution across the lifespan: a cross-sectional whole-body magnetic resonance imaging study. Nutr Metab (Lond). 2009;6:17.
Lovejoy JC et al. Increased visceral fat and decreased energy expenditure during the menopausal transition. Int J Obes (Lond). 2008;32(6):949-958.
de Heredia FP et al. Obesity, inflammation and the immune system. Proc Nutr Soc. 2012;71(2):332-338.
Prior JC. Progesterone for symptomatic perimenopause treatment – progesterone politics, physiology and potential for perimenopause. Facts Views Vis Obgyn. 2011;3(2):109-120.
Hale GE et al. Hormonal changes and biomarkers in late reproductive age, menopausal transition and menopause. Best Pract Res Clin Obstet Gynaecol. 2009;23(1):7-23.
Hale GE et al. Endocrine features of menstrual cycles in middle and late reproductive age and the menopausal transition classified according to the Staging of Reproductive Aging Workshop (STRAW) staging system. J Clin Endocrinol Metab. 2007;92(8):3060-3067.
McTernan PG et al. Glucocorticoid regulation of p450 aromatase acitivty in human adipose tissue: gender and site differences. J Clin Endocrinol Metab. 2002;87(3):1327-1336.
Paredes S et al. Cortisol: the villain in metabolic syndrome? Rev Assoc Med Bras (1992). 2014;60(1):84-92.
Incollingo Rodriguez AC et al. Hypothalamic-pituitary-adrenal axis dysregulation and cortisol activity in obesity: a systematic review. Psychoneuroendocrinology. 2015;62:301-318.
Li S et al. Effects of menopause on hepatic 11β-hydroxysteroid dehydrogenase type 1 actvity and adrenal sensitivity to adrenocorticotropin in healthy non-obese women. Gynecol Endocrinol. 2011;27(10):794-799.
Andersson T et al. Tissue-specific increases in 11β-hydroxysteroid dehydrogenase type 1 in normal weight postmenopausal women. PLoS One. 2009;4(12):e8475.
Andersson T et al. Estrogen reduces 11β-hydroxysteroid dehydrogenase type 1 in liver and visceral, but not subcutaneous, adipose tissue in rats. Obesity (Silver Spring). 2010;18(3):470-475.
McTernan PG et al. Gender differences in the regulation of P450 aromatase expression and activity in human adipose tissue. Int J Obes Relat Metab Disord. 2000;24(7):875-881.
Castro AV et al. Obesity, insulin resistance and comorbidities? Mechanisms of association. Arq Bras Endocrinol Metabol. 2014;58(6):600-609.
Plymate SR et al. Inhibition of sex hormone-binding globulin production in the human hepatoma (Hep G2) cell line by insulin and prolactin. J Clin Endocrinol Metab. 1988;67(3):460-464.
Loukovaara M et al. Regulation of production and secretion of sex hormone-binding globulin in HepG2 cell cultures by hormones and growth factors. J Clin Endocrinol Metab. 1995;80(1):160-164.
Davis SR et al. The contribution of SHBG to the variation in HOMA-IR is not dependent on endogenous oestrogen or androgen levels in postmenopausal women. Clin Endocrinol (Oxf). 2012;77(4):541-547.
Janssen I et al. Testosterone and visceral fat in midlife women: the Study of Women’s Health Across the Nation (SWAN) fat patterning study. Obesity (Silver Spring). 2010;18(3):604-610.
Klok MD et al. The role of leptin and ghrelin in the regulation of food intake and body weight in humans: a review. Obes Rev. 2007;8(1):21-34.
Engin A. Diet-induced obesity and the mechanism of leptin resistance. Adv Exp Med Biol. 2017;960:381-397.
Harris RBS. Development of leptin resistance in sucrose drinking rats is assocated with consuming carbohydrate-containing solutions and not calorie-free sweet solution. Appetite. 2018;132:114-121.
Diamanti-Kandarakis E et al. Mechanisms in endocrinology: aging and anti-aging: a combo-endocrinology overview Eur J Endocrinol. 2017;176(6):R283-R308.
Levine JA. Sick of sitting. Diabetologia. 2015;58(8):1751-1758.
Maillard F et al. Effect of high-intensity interval training on total, abdominal and visceral fat mass: a meta-analysis. Sports Med. 2018;48(2):269-288.
Maillard F et al. High-intensity interval training reduces abdominal fat mass in postmenopausal women with type 2 diabetes. Diabetes Metab. 2016;42(6):433-441.
Nunes PRP et al. Effect of high-intensity interval training on body composition and inflammatory markers in obese postmenopausal women: a randomized controlled trial. Menopause. 2018;Oct 1.
Cramer H et al. Yoga for menopausal symptoms-a systematic review and meta-analysis. Maturitas. 2018;109:13-25.
Pascoe MC et al. Yoga, mindfulness-based stress reduction and stress-related physiological measures: a meta-analysis. Psychoneuroendocrinology. 2017;86:152-168.
Caputo T et al. From chronic overnutrition to metainflammation and insulin resistance: adipose tissue and liver contributions. FEBS Lett. 2017;591(19):3061-3088.
Gabel K et al. Effects of 8-hour time restricted feeding on body weight and metabolic disease risk factors in obese adults: a pilot study. Nutr Healthy Aging. 2018;4(4):345-353.
Sutton EF et al. Early time-restricted feeding improves insulin sensitivity, blood pressure, and oxidative stress even without weight loss in men with prediabetes. Cell Metab. 2018;27(6):1212-1221.e3.
Koren D et al. Role of sleep quality in the metabolic syndrome. Diabetes Metab Syndr Obes. 2016;9:281-310.
Chaput JP et al. Change in sleep duration and visceral fat accumulation over 6 years in adults. Obesity (Silver Spring). 2014;22(5):E9-12.
Sweatt SK et al. Sleep quality is differentially related to adiposity in adults. Psychoneuroendocrinology. 2018;98:46-51.
Huang T et al. Habitual sleep quality and diurnal rhythms of salivary cortisol and dehydroepiandrosterone in postmenopausal women. Psychoneuroendocrinology. 2017;84:172-180.
Kline CE et al. Poor sleep quality is associated with insulin resistance in postmenopausal women with and without metabolic syndrome. Metab Syndr Relat Disord. 2018;16(4):183-189.
Sara Gottfried, MD
Sara Gottfried, MD is a board-certified gynecologist and physician scientist. She graduated from Harvard Medical School and the Massachusetts Institute of Technology and completed residency at the University of California at San Francisco. Over the past two decades, Dr. Gottfried has seen more than 25,000 patients and specializes in identifying the underlying cause of her patients’ conditions to achieve true and lasting health transformations, not just symptom management.
Dr. Gottfried is the President of Metagenics Institute, which is dedicated to transforming healthcare by educating, inspiring, and mobilizing practitioners and patients to learn about and adopt personalized lifestyle medicine. Dr. Gottfried is a global keynote speaker who practices evidence-based integrative, precision, and Functional Medicine. She has written three New York Times bestselling books: The Hormone Cure, The Hormone Reset Diet, and her latest, Younger: A Breakthrough Program to Reset Your Genes, Reverse Aging, and Turn Back the Clock 10 Years.
Annalouise O’Connor, PhD, RD
Dr. Annalouise O’Connor is the R&D Manager for Therapeutic Platforms and Lead for Cardiometabolic and Obesity platforms at Metagenics. Her role involves research coordination, as well as developing formulas for targeted nutrition solutions and programs to assist practitioners in the optimal management of their patients’ health. Annalouise trained as an RD and worked in clinical and public health settings. Dr. O’Connor completed her PhD in the Nutrigenomics Research Group at University College Dublin (Ireland) and postdoctoral work at the UNC Chapel Hill Nutrition Research Institute.
It’s the most wonderful time of the year, but for those following a diet, the holidays may stir up stress and anxiety around food. The ketogenic diet is not the most “social” diet, but there are ways to stick to it, even in the most daunting of times, such as holiday celebrations.
If you can’t eat keto, at least aim for low-carb
Your holiday party may not be stocked full of keto-friendly foods, but there is a high probability that you can nibble on some low-carb options. The cheese platter is, more often than not, a pretty safe bet for cheese (of course!), but also for other low-carb foods such as nuts and meats. Just stay clear of candy-coated nuts, dried fruits, and cured meats you suspect may have added sugar!
Another low-carb holiday party go-to is the veggie platter. Lucky for you, this usually gets the least attention by guests, thereby giving you full access to it. Stick to the low-carb vegetables options such as broccoli, cauliflower, celery, and cucumber. If your event is serving dinner, opt for the meats or any salads (without sugar-loaded dressings), and low-carb vegetables. Things to stay away from are the mashed potatoes, any bread/pastry-like foods, sauces, and, of course, the sweets. Sticking with low-carb as opposed to ditching the diet completely will make transitioning back into ketosis much easier.
Prepare for success and give yourself options
If you are uncomfortable not knowing what food options will be available at your holiday gathering, prepare some food in advance. Better yet, prepare a keto-friendly dish to share with everyone! Take a high-fat dip to pair with that veggie platter and a salad dressing you can pour on any dry salads to avoid sugary dressings. You can also pack some snacks such as high-fat nuts (e.g. macadamia nuts) to graze on throughout the evening. Additionally, medium-chain triglyceride (MCT) oil is a great tool for ketogenic living. Fill a small jar with MCT oil to take with you and use on any dish or in beverages. MCTs are highly ketogenic and have even been shown to increase ketone production without carbohydrate restriction.1
The popularity of the ketogenic diet has made it simple to find recipes that anyone can enjoy. Consider making a ketogenic dessert to bring and share so you can “indulge” too, while also preventing you from caving into the temptations of sugar-laden treats.
Stay positive and remember your “why”
It can be difficult to gain the support of those around you when your dietary choices are perceived as something as radical as a ketogenic diet may seem to some. You may even be tempted to ditch the diet for the sake of your peers or those family members who just won’t back down from having you try “just one bite.” Be prepared to explain to others what the ketogenic diet is and why you follow it. Remember that there is no one-size-fits-all diet, and it is perfectly fine to have different views from others. Just stay true to yourself, remember your “why,” and stay positive, because there is nothing worse than engaging in a debate over food choices!
Tips for alcohol
Alcohol isn’t generally conducive to living a ketogenic lifestyle, and if you have no problem abstaining from it completely, that is your best option. If having a drink in your hand makes you feel more comfortable in a crowd, take club soda and sliced lemon with you; this will help you feel less segregated. With all this said, celebrations may be times when you can make exceptions (within reason). There are ways to enjoy a drink or two and stick to your goals; you just have to know what to look out for. For wines, opt for the driest you can find, white or red, and avoid sweet wines such as rosé. Most liquors are acceptable on their own or enjoyed with club soda or sugar-free beverages. Beers typically contain more carbohydrates, and they should probably be limited to one. If nutrition labels are available, check to see what the lowest-carbohydrate beer options are. Coolers and ciders are to be avoided due to their high sugar content.
Be kind to yourself and don’t overthink it
If you take into consideration all of the recommendations above, there is no reason to be stressed or anxious about your diet as you enter into the holidays. You are following a ketogenic diet to improve your health, right? Well, being kind to yourself is part of healthy living, and sometimes that means accepting that your diet can’t always be perfect. Also, keep in mind that you can always jump right back into the swing of things; a few days of indulging does not mean you have “failed.” There is more to health than simply what you put in your mouth, so do the best you can, be prepared, but most importantly, don’t get down on yourself if things don’t go as planned. Instead of focusing on your food options, focus on enjoying your time with loved ones over this holiday season.
As we said, the holidays are the most wonderful time of the year, and your diet shouldn’t change that for you.
One in three North Americans—including half of those age 60 and older— have a silent blood sugar problem known as insulin resistance. Insulin resistance increases the risk for prediabetes, type 2 diabetes and a host of other serious health problems, including heart attacks, strokesand cancer.
What is Insulin Resistance?
Insulin resistance is when cells in your muscles, body fat and liver start resisting or ignoring the signal that the hormone insulin is trying to send out—which is to grab glucose out of the bloodstream and put it into our cells. Glucose, also known as blood sugar, is the body’s main source of fuel. We get glucose from grains, fruit, vegetables, dairy products, and drinks that bring break down into carbohydrates.
How Insulin Resistance Develops
While genetics, aging and ethnicity play roles in developing insulin sensitivity, the driving forces behind insulin resistance include excess body weight, too much belly fat, a lack of exercise, smoking, and even skimping on sleep.4
As insulin resistance develops, your body fights back by producing more insulin. Over months and years, the beta cells in your pancreas that are working so hard to make insulin get worn out and can no longer keep pace with the demand for more and more insulin. Then – years after insulin resistance silently began – your blood sugar may begin to rise and you may develop prediabetes or type 2 diabetes. You may also develop non-alcoholic fatty liver disease (NAFLD), a growing problem associated with insulin resistance that boosts your risk for liver damage and heart disease. 5
Signs and Symptoms of Insulin Resistance
Insulin resistance is usually triggered by a combination of factors linked to weight, age, genetics, being sedentary and smoking.
– A large waist. Experts say the best way to tell whether you’re at risk for insulin resistance involves a tape measure and moment of truth in front of the bathroom mirror. A waist that measures 35 inches or more for women, 40 or more for men (31.5 inches for women and 35.5 inches for men if you’re of Southeast Asian, Chinese or Japanese descent)6 increases the odds of insulin resistance and metabolic syndrome, which is also linked to insulin resistance.
– You have additional signs of metabolic syndrome. According to the National Institutes of Health,7 in addition to a large waist, if you have three or more of the following, you likely have metabolic syndrome, which creates insulin resistance.
High triglycerides. Levels of 150 or higher, or taking medication to treat high levels of these blood fats.
Low HDLs. Low-density lipoprotein levels below 50 for women and 40 for men – or taking medication to raise low high-density lipoprotein (HDL) levels.
High blood pressure. Readings of 130/85 mmHg or higher, or taking medication to control high blood pressure
High blood sugar. Levels of 100-125 mg/dl (the prediabetes range) or over 125 (diabetes).
High fasting blood sugar (or you’re on medicine to treat high blood sugar). Mildly high blood sugar may be an early sign of diabetes.
– You develop dark skin patches. If insulin resistance is severe, you may have visible skin changes. These include patches of darkened skin on the back of your neck or on your elbows, knees, knuckles or armpits. This discoloration is called acanthosis nigricans.8
Health Conditions Related to Insulin Resistance
An estimated 87 million American adults have prediabetes; 30-50% will go on to develop full-blown type 2 diabetes. In addition, up to 80% of people with type 2 diabetes have NAFLD.9 But those aren’t the only threats posed by insulin resistance.
Thanks to years of high insulin levels followed by an onslaught of cell-damaging high blood sugar, people with insulin resistance, prediabetes and type 2 diabetes are at high risk for cardiovascular disease. Insulin resistance doubles your risk for heart attack and stroke – and triples the odds that your heart attack or ‘brain attack’ will be deadly, according to the International Diabetes Federation.10
Meanwhile, insulin resistance and metabolic syndrome are also linked with higher risk for cancers of the bladder, breast, colon, cervix, pancreas, prostate and uterus.11, 12 The connection: High insulin levels early in insulin resistance seem to fuel the growth of tumors and to suppress the body’s ability to protect itself by killing off malignant cells. 13
How You Can Prevent or Reverse Insulin Resistance
Losing weight, getting regular exercise and not skimping on sleep can all help improve your insulin sensitivity. Don’t rely on dieting or exercise alone: in one fascinating University of New Mexico School of Medicine study, published in the International Journal of Obesity, overweight people who lost 10% of their weight through diet plus exercise saw insulin sensitivity improve by an impressive 80%. Those who lost the same amount of weight through diet alone got a 38% increase. And those who simply got more exercise, but didn’t lose much weight, saw almost no shift in their level of insulin resistance.14
Turn in on time, too. In a study presented at the 2015 meeting of the Obesity Society, researchers found that just one night of sleep deprivation boosted insulin resistance as much as eating high-fat foods for six months.15
By 2020, more than 20% of the US population will be 65 and over.1 Healthy aging is and will continue to be an important focus in many Functional Medicine offices.
Sarcopenia, the gradual loss of muscle mass that occurs in healthy adults as they age, begins after the age of 30 and accelerates after 60. The difference between the muscle mass of a 20-year-old vs. an 80-year-old is about 30%.2
Loss of muscle contributes to reduced mobility, increased hospitalizations (fragility and falls), prolonged recovery, and mortality.3 Factors that contribute to earlier onset and more rapid progression of sarcopenia include lack of physical activity, inflammatory conditions, blood sugar imbalances, history of smoking, hormone imbalances, and low vitamin D status.4 Addressing these risk factors is part of an individualized, preventative approach.
Therapeutic considerations that may slow this sarcopenic process down and improve overall quality of life (QOL) in an otherwise healthy, aging adult include:
Adequate, daily protein intake is essential for muscle health and possibly even more important in the aging population. Based on the evidence, the ideal protein intake for a healthy, older adult is 1.0-1.2g protein/kg body weight/day, while higher intake levels may be required in patients with acute or chronic disease.5
Achieving optimal protein intake may generally be more difficult for elderly patients at high risk for sarcopenia. Based on the results of a 2011 analysis of health and aging trends, nearly 1/2 of all US adults over age 65 have difficulty or receive help with daily activities.6 Protein powders with added BCAAs are a convenient way to support patients in meeting their protein requirements and obtain critical nutrients to help address sarcopenia.7-8
Adequate protein may also reduce risk of other age-associated events such as strokes9 and hip fractures.10 Furthermore, a practitioner does not have to wait until signs of sarcopenia are present before assessing protein requirements. In combination with physical activity, adequate protein throughout adult life may offer protection against early onset and progression of sarcopenia.11
Key clinical points:
Addressing increased dietary guidelines for protein intake is important for preventing loss of muscle mass in older adults7
Higher protein intake and lower fat mass might be positively associated with physical performance in elderly women12
Practitioners may help delay onset and progression of sarcopenia by assessing protein intake prior to presence of clinical signs and symptoms11
Marine omega-3 fats
The diverse, significant health benefits of omega-3 polyunsaturated fatty acids (PUFAs), namely, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are well documented. Specific to the aging population, research points to benefits in cognitive health and cardiovascular markers, as well as physical function.13
Despite the evidence, dietary intake of omega-3 fatty acids is consistently insufficient in North America, with over 90% of the population consuming <500 mg/day of EPA and DHA.14 This is a far cry from the therapeutic intake (for muscle mass and function) suggested in clinical trials of 2g-4g/day.15 Nutritional guidance around omega-3 intake provides a therapeutic opportunity for clinicians to support their aging patients.
Key clinical points
Supplementation with fish oil helps address the EPA+DHA nutrient gap from one’s diet14 and may help slow the decline in muscle mass and function in older adults.16
Increased omega-3 intake stimulates muscle protein synthesis and may be useful in prevention and treatment of sarcopenia15
Improvement in grip strength and muscle tone are positive benefits that may be achieved with fish oil supplementation16
Vitamin D deficiency is a common occurrence in the elderly population, and its relationship to bone health is well-established. Furthermore, normal vitamin D status has also been positively correlated with functional outcomes in the elderly.18 Optimizing vitamin D status may prove to be an essential component of a protocol addressing age-related frailty and sarcopenia, especially when combined with physical activity and a protein-rich diet.17
Key clinical points
Treating vitamin D insufficiency and deficiency may lead to improved muscle performance, reduced risk of falls, decreased bone loss, and reduced fracture incidence18
Meta-analysis data indicates that serum 25-hydroxyvitamin D levels are significantly and directly associated with the risk of frailty19
Regular exercise is important in the prevention and treatment of sarcopenia. By positively influencing blood sugar levels and body composition, physical activity helps reduce many of the risk factors associated with early onset of sarcopenia. Exercise also directly supports healthy muscle mass and function.
Whether young or old, encouraging patients to live an active lifestyle is an important and healthy addition to a sarcopenia prevention and management plan. Therapeutic benefit is optimized when fitness programs include resistance and endurance exercises 3x/week.2
Key clinical points
Physical activity consistently mitigates frailty and improves sarcopenia and physical function in older adults20
Older patients who participate in resistance and endurance exercise programs may improve not only their function and independence but also their quality of life21
The implications of sarcopenia are potentially severe. Many complications may be reduced and QOL improved with a Functional nutrition approach.
Ortman J et al. Population Estimates and Projections Current Population Reports. https://www.census.gov/library/publications/2014/demo/p25-1140.html. Accessed September 14, 2018.
Frontera W et al. Aging of skeletal muscle: a 12-yr longitudinal study. J Appl Physiol. 2000;88(4):1321-1326.
Prado CM et al. Implications of low muscle mass across the continuum of care: a narrative review. Ann Med. 2018:1-19.
Szulc P et al. Hormonal and lifestyle determinants of appendicular skeletal muscle mass in men: the MINOS study. Am J Clin Nutr. 2004; 80(2):496-503.
N. Deutz et al. Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group. Clin Nutr. 2014;33(6):929-936.
Disability and Care Needs of Older Americans: An Analysis of the 2011 National Health and Aging Trends Study. https://aspe.hhs.gov/report/disability-and-care-needs-older-americans-analysis-2011-national-health-and-aging-trends-study
Garilli B. https://www.metagenicsinstitute.com/articles/bcaa-leucine-supplementation-increases-muscle-protein-synthesis-healthy-women/. Accessed September 14, 2018.
Devries MC et al. Leucine, not total protein, content of a supplement is primary determinant of muscle protein anabolic responses in healthy older women. J Nutr. 2018;148(7):1088–1095.
Zhang Z et al. Quantitative analysis of dietary protein intake and stroke risk. Neurology. 2014;83(1):19-25.
Kim BJ et al. The positive association of total protein intake with femoral neck strength (KHANES IV). Osteoporos Int. 2018;29(6):1397-1405.
Paddon-Jones D et al. Protein and healthy aging. Am J Clin Nutr. 2015;101(6):1339S–1345S.
Isanejad M et al. Dietary protein intake is associated with better physical function and muscle strength among elderly women. Br J Nutr. 2016;115(7):1281-1291.
Casas-Agustench P et al. Lipids and physical function in older adults. Curr Opin Clin Nutr. 2017;20(1):16-25.
Richter CK et al. Total long-chain n-3 fatty acid intake and food sources in the United States compared to recommended intakes: NHANES 2003-2008. Lipids. 2017;52(11):917-927.
Smith GI et al. Fish oil–derived n−3 PUFA therapy increases muscle mass and function in healthy older adults. Am J Clin Nutr. 2015;102(1):115–122.
Smith GI et al. Dietary omega-3 fatty acid supplementation increases the rate of muscle protein synthesis in older adults: a randomized controlled trial. Am J Clin Nutr. 2011;93(2):402-412.
Bauer JM et al. Effects of a vitamin D and leucine-enriched whey protein nutritional supplement on measures of sarcopenia in older adults, the PROVIDE study: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc. 2015;16(9):740-747.
Dawson-Hughes B. Serum 25-hydroxyvitamin D and functional outcomes in the elderly. Am J Clin Nutr. 2008;88(2): 537S–540S.
Ju SY et al. Kim. Low 25-hydroxyvitamin D levels and the risk of frailty syndrome: a systematic review and dose-response meta-analysis. BMC Geriatr. 2018;18(1):206.
Phu S et al. Exercise and sarcopenia. J Clin Densitom. 2015;18(4):488-492.
Landi F et al. Exercise as a remedy for sarcopenia. Curr Opin Clin Nutr Metab Care. 2014;17(1):25-31.
Ketogenic protocols have become an important therapeutic option for a variety of health issues including weight management, cardiometabolic dysfunction, and epilepsy.1 The potential of the ketogenic diet (KD) to help optimize body mass has important implications for the reduction of metabolic syndrome and its related chronic disease aspects such as heart disease, fatty liver, and type 2 diabetes (T2D).
Additionally, the ketogenic dietary approach has gained widespread attention within the professional sports performance and wellness communities for its ability to enhance weight loss and optimize body composition, both critical components in accomplishing training goals for this population.2-3 However, concerns exist in the sports performance community regarding the impact of a KD, including the possibility that lowering total body mass may reduce the ability of an individual to optimize muscle hypertrophy through resistance training (RT) due to increased central fatigue and other related factors.3
To learn more about the effects of a KD in combination with RT, a randomized, controlled, parallel arm, prospective study was conducted, with results published in the Journal of International Society of Sports Nutrition.3 The study’s authors hypothesized that, “a KD with caloric surplus in combination with RT in trained men would have a positive impact in fat reduction, and it would benefit the gains in lean body mass (LBM)”.3
Healthy, athletic men (N=24) from Spain (average age: 30, weight: 76.7kg, BMI: 23.4) with at least 2 years of continuous overload training experience were randomized into 1 of 3 groups: KD, non-KD, or control group.3 The participants followed their approved diets for 8 weeks along with supervised hypertrophy training protocol 4 days/week: 2 days of upper body and 2 days of lower body workouts. The KD group was monitored weekly by measuring urinary ketones with reagent strips to ensure they achieved and remained in ketosis. Body composition was assessed using DXA.
Participants all consumed a similar number of calories, which was set for a moderate energy surplus of 39 kcal/kg/day.3 The KD group consumed 20% of calories as protein (2g/kg/day), 70% as fat (3.2g/kg/d), and <10% of their calories as carbohydrates (approximately 42g/d).3 The non-KD consumed the same 20% of calories as protein (2g/kg/day), 25% as fat, and the remaining 55% as carbohydrates.3 Both groups were encouraged to eat 3-6 meals per day, and individuals in the control group were asked to maintain their current exercise and dietary routines throughout the study.
KD: ↓ fat mass (FM) and ↓ visceral adipose tissue (VAT); non-significant reduction in total body weight; non-significant increase in lean body mass (LBM)
Non-KD: No significant changes in FM or VAT; significant ↑ in total body weight and ↑ LBM
Control: No significant changes in FM, VAT, total body weight, nor LBM
The overall results indicate the KD intervention was able to achieve a positive change in body composition with a decrease in body weight (non-significant) and reduction in FM and VAT.3 LBM did not increase significantly in the KD group, and the results indicate that LBM may be enhanced through an adequate carbohydrate intake (as was provided in the non-KD and control group diet protocols of this study) while also consuming a calorie surplus with a higher protein intake to support muscle hypertrophy.3
In summary, the implementation of a KD in male athletes taking part in regular resistance training may lead to lowering of VAT and FM, both important factors for body mass optimization and reducing risk of cardiometabolic disease processes.3 However, the lack of lean body mass accrual in this study indicates that the KD may not be an optimal strategy for building muscle mass in trained athletes when utilized alongside a resistance training program.3 Longer study duration with larger samples, both genders, and less fit individuals (e.g. overweight) would be valuable for further exploration.
Why is this Clinically Relevant?
KD in trained men combined with resistance training protocols may improve VAT and FM levels, both risk factors for cardiovascular disease3
Trained men desiring to increase LBM and increase muscle hypertrophy may need to consider a dietary approach which includes a calorie surplus with high protein content along with adequate carbohydrate intake
Paoli A et al. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. Eur J Clin Nutr. 2013;67(8):789–796.
McSwiney FT, Wardrop B, Hyde PN, Lafountain RA, Volek JS, Doyle L. Keto-adaptation enhances exercise performance and body composition responses to training in endurance athletes. Metabolism. 2018;81:25-34.
* Vargas S, Romance R, Petro J, et al. Efficacy of ketogenic diet on body composition during resistance training in trained men: a randomized controlled trial. J Int Soc Sports Nutr. 2018;15:31.
*Note: In the Vargas S et al. 2018 article, there are discrepancies in body composition outcomes in the written Results section of the article, however, the quantitative results in Table 2 and the Abstract are correct and are summarized above.
Knowing you’re in love feels different for everyone. Some have been in love often and know the feeling well, and others may be not so sure if it’s love or just a deep infatuation.
Luckily, your body has some pretty sneaky ways of tipping you off to whether these feelings for your partner are more than just a passing phase. Keep an eye out for these tell-tale signs the next time you catch yourself wondering if you’re actually in love.
You can’t stop staring at them.
If your partner has ever caught you staring at them lovingly, it could be a sign that you’re head over heels. Eye contact means that you’re fixated on something, so if you find that your eyes are fixed on your partner, you may just be falling in love.
Studies have also found that couples who lock eyes report feeling a stronger romantic connection than those who don’t. It goes the other way too: when a study had strangers lock eyes for minutes at a time, they reported romantic feeling towards each other.
You feel like you’re high.
It’s completely normal to feel out of your mind when falling for someone.
A study from the Kinsey Institute found that the brain of a person falling in love looks the same as the brain of a person who has taken cocaine. You can thank dopamine, which is released in both instances, for that feeling.
This is a good explanation for why people in new relationships can act absolutely nonsensically.
You always think about them.
If you love someone, you may feel like you can’t get them off of your mind. That’s because your brain releases phenylethylamine, aka the “love drug” when you fall in love with someone. This hormone creates the feeling of infatuation with your partner.
You may be familiar with the feeling because phenylethylamine is also found in chocolate, which may explain why you can’t stop after just one square.
You want them to be happy.
Love is an equal partnership, but you’ll find someone’s happiness becomes really important to you when you’re falling for them.
So-called “compassionate love” can be one of the biggest signs of a healthy relationship, according to research. This means that you’re willing to go out of your way to make your partner’s life easier and happier.
If you find yourself going out of your way to keep your partner dry when walking in the rain or making them breakfast on a busy weekday morning, it’s a sign you’ve got it bad.
You’ve been stressed lately.
Although love is often associated with warm and fuzzy feelings, it can also be a huge source of stress. Being in love often causes your brain to release the stress hormone cortisol, which can lead you to feel the heat.
So if you’ve noticed your patience is being tested a little more than normal or you’re kind of freaking out, you may not need to carry a stress ball just yet; you may just be in love.
You don’t feel pain as strongly.
Falling for someone might be painful, but if you’ve noticed that literally falling doesn’t bother you as much anymore, it could be a big sign you’re in love.
A study conducted by the Stanford University School of Medicine had participants stare at a photo of someone they loved and found that act could reduce moderate pain by up to 40%, and reduced severe pain by up to 15%.
So if you’re getting a tattoo, you may want to keep a photo of your partner handy. Just in case.
You’re trying new things.
Everyone wants to impress their date in the beginning of their relationships, but if you find yourself consistently trying new things that your partner enjoys, you may have been bitten by the love bug.
In fact, a study found that people who have claimed to be in love often had varied interest and personality traits after those relationships. So even if you hate that square-dancing class you’re going to with your partner, it could have a positive effect on your personality.
Your heart rate synchronizes with theirs.
Your heart may skip a beat when you think about the one you love, but a study showed that you may also be beating in time with each other. A study conducted by the University of California, Davis, suggests that couples’ hearts begin to beat at the same rate when they fall in love.
Although you may not be able to tell if this has happened without a few stethoscopes, feeling a deep connection to your partner is a good a sign as any that you’re in love.
You’re OK with the gross stuff.
If you’re a notorious germaphobe and totally cool kissing your partner after just watching them pick their nose, you might just be in love. In fact, a study by the University of Groningen in the Netherlands found that feelings of sexual arousal can override feelings of being grossed out.
So that means if you’re super attracted to your partner, you may just let them double dip. That’s love, baby.
You get sweatier.
If you’re nauseous and sweaty, you either have a bad stomach bug or are falling in love. A study found that falling in love can cause you to feel sick and display physical symptoms similar to that of anxiety or stress, like sweat.
Although this feeling will probably pass once you really get comfortable with your partner, it may be a good idea to carry around an extra hanky, just to be safe.
You love their quirks
If you really get to know a person, chances are you’ll pick on the little things that make them uniquely them. And if you’re in love with them, these are probably some of the things that attract you most about them.
A study found that small quirks can actually make a person fall deeper in love with someone rather than just physical attributes because people have unique preferences. So although you may have judged your partner a little harshly on first glance, if you find that you’re suddenly in awe of their uniqueness, you might be in love.
Keep in mind, everyone’s tolerance level for colds and sniffles varies — one person feels like they can sustain a normal workout routine, while another feels too draggy to even consider it.
“Studies show that exercise is beneficial because it can boost your immune system before, during and after sickness,” says Nicola Finely, M.D., integrative medicine specialist at Canyon Ranch in Tucson.
Note: If you have a chronic health condition, such as asthma, you may want to consult your doctor first before exerting yourself.
Does Exercise Boost the Immune System?
“Exercise allows your white blood cells to circulate faster throughout the body, and white blood cells are the immune warriors that fight off infections,” explains Finely.
The American College of Sports Medicine backs that up, too, stating that regular and moderate exercise lowers the risk for respiratory infections and that consistent exercise can enhance health and help prevent disease.
In one study in the American Journal of Medicine, women who walked for 30 minutes every day for a year had only half the number of colds as those who didn’t bust a move.
Working out almost daily at a moderate pace can help keep your immune system strong.
But overtraining and pushing yourself too hard for too long can decrease the levels of IgA, which are antibodies on the mucosal membranes, such as the respiratory tract. These antibodies are needed to battle bacteria and viruses.
You have a garden-variety cold but no fever. Exercise can help relieve you from stuffiness by opening up your nasal passages, says the Mayo Clinic.
Your symptoms are above the neck like a runny nose, nasal congestion, sneezing or a slight sore throat.
“Keep the intensity at a moderate-to-low pace,” cautions Finely.
For example, if you typically go for a 30-minute run every day, take a brisk walk instead. And if you start to feel worse with exercising, then you should stop, she says.
Skip Exercise With a Cold If:
You have a fever, discomfort in your chest, or difficulty breathing.
Your symptoms are below the neck, such as chest congestion, a hacking cough or an upset stomach.
You’re tired, you’re running a fever, or you’re especially achy. “I’d suggest any patient refrain from exercise if fever is higher than 101.5 degrees Fahrenheit,” says Finely, who points out that a fever is considered any temperature over 100 F. Exercising during this time increases the risk of dehydration, and can worsen or lengthen the duration of your cold, she explains.
There’s no great advantage in tiring yourself out when you’re feeling ill. After all, you don’t want to risk making yourself sicker, and taking a few days off shouldn’t affect your overall performance. “When you get back to exercise, make sure to gradually increase your level as you begin to feel better,” Finely advises.
Exercising during a cold can be beneficial, but don’t push it.
With all of the go, go, go that comes with being a busy, working woman, sometimes our own health falls to the wayside. We get it, not everyone has the time to hit a two-hour Pilates class every day…we certainly don’t! We’re all about striking a balance here and figuring out simple ways to improve our health on the daily. Let’s keep it simple and dive right into our five quick and easy wellness tips to improve your week.
Increase Your Intake of Hydrating Foods
Every wellness article you read is going to tell you to drink your body weight in water, and you should! But just in case you’re not the best at guzzling gallons of water in one sitting, try snacking on it! Foods like cucumbers, watermelon, strawberries, tomatoes and zucchinis are about 95 percent water. Increase your intake of these tasty snacks and you’ll kill two birds with one stone. We also love mixing in a shot of this hydrating inner beauty boost into our water!
Micro-Dose Your Vitamin D
Set a timer on your phone, write it on your to-do list, do whatever you need to do to incorporate fresh air into your day. Before lunch each day, head outside for a 15-minute walk and soak up the sunshine. Fifteen minutes may not sound like much, but it’s enough to get your blood pumping and also shift your mindset. Pencil in a minimum of one walk per day, but if you can swing more, do it!
So many of us (*guilty hand raised*) eat like it’s just something else to check off our to-do list. We often eat our lunch at our desk in front of a computer, or at home in front of the television. This often leads to overeating or mindless snacking! When it’s time to eat a meal, choose somewhere intentional to sit that doesn’t involve devices with screens. This will help you feel mindful as you eat, breathing between bites, and taking note of when your body is satisfied.
Try Dry Brushing
Never heard of dry brushing? It has a surprising number of benefits, including lymphatic system stimulation. The lymphatic system is responsible for collecting and transporting waste to the blood. Dry brushing can stimulate the lymphatic system as it stimulates and invigorates the skin. It helps with everything from improving the appearance of skin to supporting digestion. Try our favorite brush here.
Do Bedtime Yoga
This is one of our favorite ways to end the day. You literally do yoga in your bed, what could be more relaxing? We follow this routine, but feel free to find one that you look forward to doing each night!
Between work, social obligations and general life responsibilities, it can be difficult to fit everything into one day. That often leads to healthy activities like working out being relegated to extracurricular status and never becoming part of your routine.
Given all that, squeezing in a lunchtime workout might seem impossible. And yet … below we’ve got eight reasons to do exactly that. Once you start reaping the physical and mental benefits of midday exercise, you might never go back.
IT WILL DE-STRESS YOUR DAY
Nothing wards off stress quicker than a good sweat session. Per Harvard Medical School, exercise “has a unique capacity to exhilarate and relax, to provide stimulation and calm, to counter depression and dissipate stress.” It’s been successfully used to treat anxiety disorders and even clinical depression, so it can help you cope with a day full of meetings or that big presentation.
YOUR WORKOUTS WILL BE MORE EFFICIENT
If you’ve got nowhere to be, it’s easy to move slowly through a workout, taking time to check your phone, scroll through your playlist or just sit and relax on a weight bench. But when you’re due back in the office, you’ve got extra incentive to make the most of your time. And fortunately, between cardio, weight circuits and HIIT classes, you don’t need more than 30–40 minutes to get in a great workout.
YOU’LL UNDO DESK-RELATED DAMAGE
It’s just not healthy to sit all day. Over the years, studies have shown sedentary behavior is associated with obesity, insulin resistance, heart disease and poor circulation. In fact, research published in the American Journal of Clinical Nutrition showed a 61% increase in mortality rates in those who sit and watch TV for seven hours or more per day. So getting up from your desk to stretch or walk around is a great start. Getting up from your desk to exercise for 30–45 minutes is even better.
IT FREES UP YOUR EVENINGS
If you’re tired of choosing between the gym and dinner with friends, well, now you won’t have to. Exercise during lunch and your night will be free to spend as you please, without the guilt of knowing you’ve missed yet another workout.
YOU’LL BEAT THE CROWDS
Sure, this article could cause everyone to make a mad dash to the gym. But the reality is that, on weekdays, most people work out in the morning or in the evening. That leaves the gym less crowded for lunchtime exercisers like you, so you can nab a coveted bike in that popular spin class or knock out a quick gym session without waiting on machines.
YOU’LL MAKE BETTER FOOD CHOICES
Even though you may feel hungry after working out, studies show exercise can help to regulate appetite and even promote satiety. It does this by releasing hormones that help the body better recognize when it’s full. So if you work out during the day, you’re not only getting the healthy benefits of exercise, but you’re more likely to make smart choices at lunch and dinner.
YOU’LL FEEL MORE ENERGIZED
A good workout gets the endorphins flowing, and endorphins contribute to that feeling of euphoria, often referred to as a “runner’s high.” That good feeling doesn’t stop the second you stop moving. Instead, the increased heart rate and blood flow can be accompanied by improved mood and energy for several hours after a workout, which means you’ll have the energy you need to tackle the rest of your afternoon.
IT’LL BOOST YOUR PRODUCTIVITY
In addition to improving your physical energy, exercise can also increase mental alertness and creative thinking. According to British researchers, workers who spent 30–60 minutes exercising at lunch reported an average performance boost of 15%. And 60% of workers saw improved time management skills, mental performance and ability to meet deadlines on days they exercised.
With all those reasons to work out during lunch, you might as well give it a try. And if your boss gives you a hard time about leaving in the middle of the day, just say (diplomatically) that you’re exercising because you care about your job and want to perform at your best.