Dr. Phil Shares: Lifting Weights Could Lower Your Risk of Type 2 Diabetes

Lifting Weights Could Lower Your Risk of Type 2 Diabetes

A whopping 30 million North Americans have been diagnosed with Type 2 diabetes — and more than 84 million more have higher than normal blood glucose levels (called prediabetes) and are at risk for developing the disease. Obesity is the leading risk factor for developing Type 2 diabetes.

The rising rates of Type 2 diabetes also mean increased potential for developing serious health complications ranging from heart disease and stroke to vision loss and premature death. Exercise could be the antidote.

THE IMPACT OF EXERCISE ON TYPE 2 DIABETES

Several studies have found exercise can prevent or delay the onset of Type 2 diabetes; some research has shown a 58% risk reduction among high-risk populations. While much of the research has looked at the impact of moderate-to high-intensity cardiovascular exercise, a new study published in Mayo Clinic Proceedings examined the potential impact of strength training on Type 2 diabetes risk. The data showed building muscle strength was associated with a 32% lowered risk of developing Type 2 diabetes.

Study co-author Yuehan Wang, PhD, notes resistance training may help improve glucose levels by increasing lean body mass and reducing waist circumference, which is associated with insulin resistance — and achieving results doesn’t require lifting heavy weights or spending countless hours in the gym.

“Our study showed that very high levels of resistance training may not be necessary to obtain considerable health benefits on preventing Type 2 diabetes,” Wang says. “Small and simple resistance exercises like squats and planks can benefit your health even if you don’t lose any weight.”

Think twice before abandoning the treadmill or elliptical trainer for the weight room, advises Eric Shiroma, ScD, staff scientist at the National Institute on Aging.

As part of a 2018 study, Shiroma and his colleagues followed more than 35,000 healthy women for 14 years and found women who incorporated strength training into their workouts experienced a 30% lowered risk of Type 2 diabetes but women who also participated in cardiovascular activities experienced additional risk reduction.

“When comparing the same amount of time in all cardio, strength [training] or a combination, the combination had the most Type 2 diabetes risk reduction,” Shiroma explains.

THE BOTTOM LINE

Researchers are still unclear about which type of exercise could have the biggest impact on reducing your risk. Wang suggests erring on the side of caution and following a workout regimen that blends both pumping iron and heart-pumping cardio, explaining, “Both strength training and cardiovascular aerobic training are important for the prevention of Type 2 diabetes.”

The biggest takeaway, according to Shiroma, is any amount of exercise is beneficial for reducing Type 2 diabetes risk so do pushups or take a walk around the block as long as you get moving.

by Jodi Helmer

Shared by Dr. Phil McAllister @ Forward Health Guelph

Dr. Phil Shares: Should You Get an Extra Hour of Sleep or a Workout?

Should You Get an Extra Hour of Sleep or a Workout?

You’re lying in bed, trying to decide what time to set your alarm for tomorrow. You could get a full seven hours of sleep if you wake up at your normal time, or you could wake up an hour and a half earlier to make that morning spin class. Which should you choose?

This seemingly simple riddle is one we’ve all faced at some point. The decision seems impossible. Sleep is essential for a healthy immune system and injury-prevention, but exercise can contribute to better, sounder sleep.

PRIORITIZE SLEEP

“Sleep and exercise are both incredibly important for your body, but if you have to choose one it has to be sleep,” says Amy Leigh Mercree, a wellness coach. “Adequate amounts of sleep gets your body the time it needs to replenish and refresh your cellular functioning. If you do not get to do that, your health will suffer greatly.”

Most experts agree that when forced to choose, they’d almost always choose sleep. Adults need 7–9 hours of sleep, according to the National Sleep Foundation, for optimal performance, memory retention and good health. But achieving a sound night’s sleep is largely dependent on your commitment to your body’s circadian rhythm, which is when we normally go to bed and wake up. A Northwestern study showed our muscles also follow that circadian cycle, meaning if you’re working out during the time when you’re normally asleep, your muscle repair will be less efficient.

EXERCISE IS IMPORTANT, TOO

But just because sleep is usually the answer doesn’t mean you should discount the need for exercise for your overall health if you’re always crunched for time. “Exercise changes the brain and is critical for brain health. What’s good for your body is good for your brain, too,” said John Assaraf, brain researcher and CEO of NeuroGym. “Through exercise, you are feeding your brain by increasing blood and oxygen flow.”

When you have to choose, remember a short workout is better than no workout at all. If you have only 10 minutes, do a quick workout at home with simple exercises like squats, jumping jacks and planks. There are also lots of apps that can give you a quick workout for a specific time frame using only your bodyweight.

BE HONEST WITH YOURSELF

If you find yourself constantly short on time, it might also be good to see where that time is actually going. Try tracking your days meticulously for a week to see where you might be wasting time. Almost everyone is guilty of too much time on social media or watching TV, so see if you could substitute that time for working out. This will help you get a proper night’s sleep and a workout.

by Tessa McLean

Shared by Dr. Phil McAllister @ Forward Health Guelph

Dr. Phil Shares: Do This Daily For a Healthy Spine

Do This Daily For a Healthy Spine

If you’ve ever hurt your lower back, you know how much it can affect your life. Whether you’re getting up from a chair, carrying groceries or hoisting a barbell overhead, your lower back is involved in nearly every movement.

While lower back injuries should be treated with the help of a doctor or physical therapist, many cases of lower back pain can be avoided with simple exercises that strengthen the core muscles and teach proper movement of the spine. Stuart McGill, PhD, professor emeritus at the University of Waterloo and the world’s premier authority on spinal health, designed exercises to build a healthy spine.

McGill’s research has been pivotal in helping people understand core training for a healthy spine should focus on stability exercises like planks. Movements that bend the spine like crunches and situps, could even contribute to lower back injuries if performed incorrectly or too often. McGill’s “big three” exercises can be combined into a daily routine that requires no equipment and can be done at home or in the gym.

If you’ve been injured and your doctor has cleared you to work out again, or if you’re perfectly healthy and want to give yourself the best chance to keep your spine pain-free, try these three simple exercises to start building a more resilient spine for all of life’s activities.

MCGILL CURLUPS

Back pain can often be traced to two simple culprits:

1. The lower back itself moves too much.
2. The joints around the lower back (e.g., hips and upper back) don’t move enough.

The McGill curlup teaches you to stabilize your lumbar spine (lower back) using your abs, while moving through the thoracic spine (upper back). The act of pushing the lower back into the floor is how you properly “brace” your abs, so remember how that feels because you should be using it for just about every other exercise you do.

The move: Lie on the floor, face up to the ceiling. Bend one knee until your heel is flat to the floor, a few inches away from your butt. Keep the other leg straight and dig the heel of that foot into the floor, pointing your toes to the ceiling. Place your hands under your lower back and actively push your lower back into your hands to engage your abdominal muscles. Bring your chin toward your chest but keep your head on the ground. Continue to push your lower back into the floor to gently lift your shoulders off the ground. Make sure not to curl your chin toward your chest or let your lower back leave the floor. Perform all your reps on one side, then repeat on the other side.

Sets and Reps: 2 sets of 5–10 reps per side, holding each rep for 3–10 seconds (hold each rep longer to make these more challenging)

BIRD DOGS

The McGill curlup teaches you how to brace your abs, now it’s time to put that stability to the test with bird dogs. This teaches you how to move your arms and legs around a solid core position without moving from your lower back.

The move: Start on your hands and knees with your hands directly under your shoulders and knees directly under your hips. Flatten your back by bracing your abs much like you did with the curlup, but instead of pushing your lower back into the floor, tighten your abs as if someone is about to punch you in the stomach. Reach out with your opposite arm and leg until both limbs are parallel to the floor. Be careful not to arch your lower back — imagine keeping your leg long and low. Repeat with the other arm and leg, making sure to brace your abs on every rep.

If you feel like a fish out of water when doing bird dogs because you’re not quite coordinated enough yet, try them with just your legs first. Once you’re able to lift your leg parallel to the floor without arching your lower back, add in your arms, too.

Sets and Reps: 2 sets of 5–10 reps per side, holding each rep for 1–5 seconds (hold each rep longer to make these more challenging)

SHORT SIDE PLANK

Curlups and bird dogs mostly work your ab muscles on the front of your body: the rectus abdominis and transverse abdominis. But we can’t forget the important oblique muscles, your “side abs.” The short side plank builds strength in your obliques to prevent unwanted twisting and side bending of the spine.

The short side plank resembles a traditional side plank but leaves your bottom knee on the floor for added stability. Think of it as a more user-friendly side plank so you can learn how to properly use your obliques to support your spine.

The move: Lay on your side with your bottom elbow and leg on the floor. Bend your knees until your upper and lower leg form a 90-degree angle. Tuck your bottom elbow tight to your side, squeezing your bottom fist. Lift your bottom hip off the ground while leaving your bottom knee and elbow on the floor. Pull your shoulders back and squeeze your glutes to keep a straight line from your head to your knees. Inhale through your nose and exhale through your mouth for the duration of the exercise. Repeat on the opposite side.

Sets and Reps: 2 sets of 5–10 seconds per side. Even though 10 seconds may seem quick, exhaling forcefully (like you’re blowing up a balloon) can make even just 10 seconds seem challenging.

by Tony Bonvechio

Shared by Dr. Phil McAllister @ Forward Health Guelph

Dr. Phil Shares: Why You Should Get up and Walk After Dinner

Why You Should Get up and Walk After Dinner

When you eat a heavy meal, it can often make you feel sluggish afterward and even disrupt sleep. But getting up and taking a short walk after eating can help combat this. Not only is walking a great low-impact activity to help you stay healthy overall, it can specifically aid digestion and control blood sugar levels — preventing crashes in energy. Here, a look at the research and why evening walks are particularly beneficial for digestion and controlling blood sugar:

EFFECTS OF HIGH BLOOD SUGAR

Chronic high blood sugar can negatively affect your health. Over time, it can cause damaged blood vessels, nerve problems, kidney disease and vision issues. Chronic high blood sugar can also lead to insulin resistance and impaired glucose tolerance, risk factors for Type 2 diabetes.

HOW WALKING AFTER EATING HELPS

While walking any time of the day can have positive effects on health, taking a stroll after a meal may be especially effective for managing blood sugar levels. A study published in Diabetes Care found walking for 15 minutes after a meal three times a day was more effective in lowering glucose levels three hours after eating compared to 45 minutes of sustained walking during the day.

Walking at night might be the most beneficial since many people eat their largest meal in the evening and then tend to sit on the couch or lay down after. Another study focusing on individuals with Type 2 diabetes found that even 20 minutes of walking post-meals may have a stronger effect on lowering the glycemic impact of an evening meal in individuals with Type 2 diabetes, compared to walking before a meal or not at all.

HOW IT CAN HELP DIGESTION

Individuals suffering from digestion problems and discomfort may also see some benefits from walking. A small 2008 study found walking increased the rate at which food moved through the stomach. Other research has found that walking after a meal may improve gastric emptying in patients with longstanding diabetes, where food may typically take longer to digest and empty from the stomach.

THE BOTTOM LINE

Walking is one of the most studied forms of exercise, with research demonstrating it’s an ideal activity for improving health and longevity. Try going for a brief walk after a meal (especially in the evening) to help with digestion and blood sugar control.

Amp up your walking in general with these 50 tips to get more steps.

by Sarah Schlichter and myfitnesspal

shared by Dr. Phil McAllister @ Forward Health Guelph

Dr. Phil Shares: 7 Exercises To Avoid

7 Exercises You Should Never Do Again

The next time you go to the gym, take a look around: you’ll probably see all kinds of exercises, some good and some not-so-good.

The unfortunate truth is that not all exercises are created equal. Some are incredibly effective at building muscle and melting fat; others are ineffective and can even do more harm than good. (Worse, the bad ones are sometimes very popular.)

Read on for our list of the worst exercises — the ones you should avoid at all costs. If you currently have them in your exercise routine, try our alternatives, which are far more effective and take your body to the next level.

1. SITUPS AND CRUNCHES

Situps and crunches are as old-school as it gets: You see them in PE class, boot camps and military training around the world. But get ready for some big news because these tummy exercises aren’t effective or good for you.

Your core — which consists of your rectus abdominis, external and internal obliques, transverse abdominis, pelvic floor, etc. — is designed to help your body stabilize and brace against twisting and bending (not generate it).

Situps and crunches, however, eliminate the bracing and put your body into bad positions: You pull your neck forward, round your shoulders, flex your spine and put a lot of stress on your lower back. (It also goes without saying that you should avoid the situp machine too for those reasons.)

Instead, choose ab exercises that help you maintain a good posture throughout the exercise. If you want to take your core strength to the next level and get washboard abs, try our super effective 14-day plank challenge: It uses many different variations to blast your midsection from different angles to test your muscles (and your mind).

2. SMITH MACHINE EXERCISES

With the exception of the inverted row, avoid all exercises on the Smith machine. It seems safe because the bar has a lock that activates when you let go, but it puts your body in unnatural positions because the bar only moves in a straight, rigid line, which is not how you move in real life.

Also, because the bar follows a straight path, you don’t get to improve your stability or balance and you won’t get the same muscle gains you’d like. Researchers found that free-weight squatsand free-weight bench presses activated more muscles than doing the same exercise on a Smith machine.

Stick to the free-weight version of your exercise: barbell squat, dumbbell bench press, etc. You’ll get more overall benefits and build more muscle and strength.

3. SEATED TWIST MACHINE

Remember what we said about how the core is supposed to move? Well, the vertebrae of your spine at your lower back can only twist 13 degrees in each direction, which is tinier than one hour on a clock. But the seated twist machines actually crank your body well beyond that range-of-motion.

If you want to improve your rotational strength, try the kneeling Palloff press. Get on both knees and set a cable handle to chest height. Facing perpendicular to the cable, bring the handle to your chest, and push it straight forward. Do it facing both ways. You have to brace your trunk to resist twisting and turning, which fires your core and keeps your spine in a safe position.

4. SUPERMANS

You might see these done in gyms or even physical therapy centers in an effort to “strengthen” your lower back. But the problem is it cranks your lower back into hyperextension while putting tremendous load and compression onto your lumbar spine. (Most people have a lower back that’s already too extended, which creates something called “lordosis.”)

Substitute supermans with another exercise if it’s a part of your current fitness program. Instead of directly targeting your lower back, focus on strengthening your entire trunk — back, abs, obliques, etc. — with core exercises where you maintain great posture throughout.

Try the single-arm farmers carry: Grab a heavy dumbbell in one hand, keep your chest up and shoulder blades squeezed, then walk. Maintain a neutral lower back and don’t arch excessively.

5. BACK EXTENSIONS

The back extension machine tries to strengthen your lower back by repeatedly flexing and extending it, which can cause problems. Worse, a lot of people hold a weight plate behind their head or at their chest, which further increases the stress on your spine.


READ MORE > 10 ESSENTIAL BODYWEIGHT EXERCISES 


6. UPRIGHT ROW

This popular exercise targets your shoulders and traps. Unfortunately, it’s one of the worst exercises you can do for your shoulders because it impinges your shoulder joints. The upright row actually forces you to internally rotate your shoulders and pull a heavy weight while in a poor position, which can lead to all kinds of problems.

Instead, to build strong and wide shoulders, replace upright rows with the dumbbell overhead press. It targets your upper body without adding unnecessary (and impinging) stress to your shoulder joint.

7. BEHIND-THE-NECK LAT PULLDOWNS OR BEHIND-THE-NECK PRESSES

Avoid any upper-body exercise where you pull or push from behind your neck because it puts tremendous strain on your shoulders. In a behind-the-neck position, your shoulders are almost at their maximal limit on extension in those positions — throwing weight on top of it just adds more strain to a fragile area.

Always do lat pulldowns, chin-ups, pullups, etc. toward your collar bones; if you’re going to press a weight overhead, start with the barbell at your collar bone or use dumbbells or kettlebells.

Shared by Dr. Phil McAllister @ Forward Health Guelph

Thanks to My Fitness Pal

Dr. Phil Shares: 5 Rules For Better Planks and a Stronger Core

 

5 Rules For Better Planks and a Stronger Core

Planks are one of the hardest exercises to get right. Yet, most of us incorporate planks into our workouts, whether it’s running, lifting or doing bootcamp. What many of us don’t realize is we’re planking all wrong.

“Planking is the gold standard exercise for core strength and stability,” explains Shana Verstegen, fitness director at Supreme Health and Fitness in Wisconsin. Doing them properly has real benefits. “They will make you a better athlete, help prevent/reduce back pain and allow you to move better in life.”

Here, learn how to maximize the perks of this exercise staple.

Most exercises can benefit from a bit of glute engagement, and planks are no exception. “Squeezing your glutes causes a bit of a stretch in your hip flexors, which transfers more of the workload to the abdominal muscles,” explains Greg Pignataro, certified strength and conditioning coach at Grindset Fitness. And your abdominal muscles are what you’re trying to work, right? “Additionally, contracting the glutes will reduce strain on your lumbar spine by preventing your lower back from sagging,” Pignataro adds.

Seriously. “Dr. Stuart McGill, a professor from the university of Waterloo who has spent 30+ years researching the spine and back pain, touts groundbreaking research about core ‘stiffness,’” Verstegen notes. “Holding planks for 10 seconds at high tension followed by a brief rest period before the next rep creates a much stronger core with fewer injuries.

“Pavel Tsatsouline, most famous for popularizing kettlebell training, agrees. He designed the ‘RKC’ plank around this philosophy of full-body stiffness and also promotes shorter, stronger plank holds.” Try doing a set of 3–10-second holds with maximum contraction for the best core strength gains.

Just as every body is different, every perfect plank setup is different, too. “Due to individual differences in body size and limb length, the ideal position is probably slightly different for every single person,” notes Pignataro. “This is important, because planks should challenge your core musculature, not hurt your elbows or shoulders. Experiment by moving your elbows and feet a few inches inward, outward, backward or forward until you find your sweet spot!”

Some people struggle to feel their abs firing during planks. If that sounds familiar, try this: “Once in plank position, pretend you are looking over a fence by pulling your elbows down so you can get your head and neck to feel taller,” recommends Brian Nguyen, CEO of Elementally Strong. “This will pull your hips and shoulders into alignment and you should feel more where you want it … abs, baby!”

“To make your planks count, every muscle needed to stabilize your spine is firing at a maximal effort,” says Kari Woodall, owner of BLAZE.

Doing so can even even help with your preferred method of exercise. “If I want to crush my deadlifts, I need the requisite core strength to pick up something heavy. If my body doesn’t understand what a maximal contraction feels like, then I am not only limiting how much I can lift, but I’m increasing my risk of injury if I do pick up something heavy,” she explains.

Not feeling the burn? “Squeeze your armpits like you have million-dollar bills tucked underneath each one, and you get to keep the money if no one can rip them away from you,” Woodall adds.

BY JULIA MALACOFF FEBRUARY 4, 2019 4 COMMENTSSHARE IT:

Shared by Dr. Phil McAllister @ Forward Health Guelph

Dr. Phil Shares: Prevent Winter Slip Ups!

Stay Standing This Winter!

Falling on ice can leave you red-faced with embarrassment, or far more seriously, hurt badly from taking a knee to the ice or falling awkwardly on icy snow. Slippery sidewalks, driveways and icy parking lots can be risk factors for falls in winter. Avoid a bad fall with these top tips!

Walk like a penguin

  • The penguin waddle helps you keep a center of gravity over the front leg as you step, instead of split between the legs. Short strides also help keep your center of gravity, which help avoid falls. When walking, extend your arms out from your sides to increase your centre of gravity. Don’t keep your hands in your pockets!  Walk slowly, with short strides and try to land your steps with a flat foot.

Keep walkways clear

  • Shovel snow and scrape ice as soon as possible. Liberally sprinkle ice melt product or sand onto walkways to provide foot traction and to make sure surfaces don’t turn to ice. This not only protects you and your family, but also postal carriers and others when they’re walking around your property. Where possible install or use handrails for extra support.

Take all precautions

  • Be extra cautious walking after a storm. Tap your foot on potentially icy areas to see if it is slippery. Hold a railing while walking on icy steps. Stay steady by wearing proper winter footwear. Lightweight boots with a thick, non-slip tread sole will provide good traction on ice. If a sidewalk is icy down the middle, walk on the snow beside it to avoid slips.

Lighten your load

  • Carry fewer bags on snow days, since excess baggage can throw off your balance and make it tougher to regain your balance once you lose it. Keep your hands free by putting away your phone while walking – you may need to catch yourself!

Boost balance with exercise

  • You can’t control the weather, but you can improve your balance through regular exercise. Exercise is an ideal way to help you stay safely on your feet because it helps improve balance, flexibility and strength. Talk to a chiropractor about ways to improve your balance and strength in order to prevent falls.

Visit your chiropractor

  • Don’t let a fall get you down. If you do take a tumble, visit your chiropractor. They’ll get you back to doing the things you love to do and will work with the rest of your care team to help prevent future falls.

Dr. Phil Shares: Not Taking a Multivitamin? Here Are the Top 5 Reasons You Should Be

You try to eat well to feel good and stay healthy. While it’s optimal to get your nutritional needs from the foods you eat, it’s not always possible. There is conflicting information out there on the benefits of supplements, but the Dietary Guidelines for Americans 2015-20201 say that supplements may be useful for providing the nutrients you may be lacking from diet alone.

Still on the fence? Consider these top five reasons to add a multivitamin to your daily regimen.

  1. Healthy aging. As we get older, our bodies have a harder time absorbing nutrients from food. The National Institute on Aging notes that starting around age 50, people begin to require increased amounts of certain vitamins and minerals.1 In fact, according to a study published in the June 2009 issue of the American Journal of Clinical Nutrition, researchers found that taking a daily multivitamin & mineral supplement may help improve micronutrient deficiencies associated with aging.3
  2. Making up for eliminated food groups. While some people have to cut certain foods like nuts or gluten out of their diets due to allergies, many eliminate particular foods or food groups from their diet voluntarily. This can cause vitamin deficiencies that would be helped with a multivitamin.
    Trying a paleo diet? You might risk a shortage of calcium or vitamin D by eliminating dairy or grains. Cutting back on red meat? A multivitamin will replace the iron and B12 you would normally get from diet.
  1. Getting the RDAs you’re not getting from food.You’ve probably heard that the typical Western diet doesn’t include nearly enough daily fruits and vegetables. As part of that, you don’t always get the vitamins those natural foods supply. Supplementing with a multivitamin containing phytonutrients from fruit- and vegetable-derived ingredients may help. In addition, it’s important to keep in mind that RDA levels are set to prevent nutrient deficiencies. But there’s a wide range between taking enough vitamin C to avoid scurvy and the optimal amount you can benefit from.
  2. Getting that extra energy to get through the day. In today’s “go-go-go” society, one of the top complaints is a general lack of energy. Instead of reaching for that third cup of coffee, remember that your cells require certain vitamins and minerals to power your busy life; especially if you’re not getting a full eight hours of sleep or eating a balanced diet, a multivitamin can help provide the nutrients you need to feel energetic throughout the day.4
  3. Managing stress. Daily life stressing you out? You’re not alone. But vitamins and micronutrients play a significant biochemical role in improving your brain’s cognitive processes, and studies have shown that a daily multivitamin—particularly one with high doses of B vitamins—can help to reduce stress and support a healthy mood.5

Ready to add a daily multivitamin to your diet? Be sure to check with your healthcare practitioner to see if he or she has a recommendation and to ensure that any medications you’re currently on won’t interfere with their effectiveness.

Shared by Dr. Phil McAllister @ Forward Health Guelph

Dr. Phil Shares: Menopause Belly: Why Fat Accumulates & How to Tackle It?

 

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.24 High 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

Shared by Dr. Phil McAllister @ Forward Health Guelph

Citations

  1. Yamatani H et al. Association of estrogen with glucocorticoid levels in visceral fat in postmenopausal women. Menopause. 2013;20(4):437-442.
  2. 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.
  3. Lovejoy JC et al. Increased visceral fat and decreased energy expenditure during the menopausal transition. Int J Obes (Lond). 2008;32(6):949-958.
  4. de Heredia FP et al. Obesity, inflammation and the immune system. Proc Nutr Soc. 2012;71(2):332-338.
  5. Prior JC. Progesterone for symptomatic perimenopause treatment – progesterone politics, physiology and potential for perimenopause. Facts Views Vis Obgyn. 2011;3(2):109-120.
  6. 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.
  7. 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.
  8. 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.
  9. Paredes S et al. Cortisol: the villain in metabolic syndrome? Rev Assoc Med Bras (1992). 2014;60(1):84-92.
  10. Incollingo Rodriguez AC et al. Hypothalamic-pituitary-adrenal axis dysregulation and cortisol activity in obesity: a systematic review. Psychoneuroendocrinology. 2015;62:301-318.
  11. 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.
  12. Andersson T et al. Tissue-specific increases in 11β-hydroxysteroid dehydrogenase type 1 in normal weight postmenopausal women. PLoS One. 2009;4(12):e8475.
  13. 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.
  14. 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.
  15. Castro AV et al. Obesity, insulin resistance and comorbidities? Mechanisms of association. Arq Bras Endocrinol Metabol. 2014;58(6):600-609.
  16. 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.
  17. 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.
  18. 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.
  19. 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.
  20. 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.
  21. Engin A. Diet-induced obesity and the mechanism of leptin resistance. Adv Exp Med Biol. 2017;960:381-397.
  22. 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.
  23. Diamanti-Kandarakis E et al. Mechanisms in endocrinology: aging and anti-aging: a combo-endocrinology overview Eur J Endocrinol. 2017;176(6):R283-R308.
  24. Levine JA. Sick of sitting. Diabetologia. 2015;58(8):1751-1758.
  25. Boutcher SH. High-intensity intermittent exercise and fat loss. J Obes. 2011;2011:868305.
  26. 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.
  27. 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.
  28. 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.
  29. Cramer H et al. Yoga for menopausal symptoms-a systematic review and meta-analysis. Maturitas. 2018;109:13-25.
  30. Pascoe MC et al. Yoga, mindfulness-based stress reduction and stress-related physiological measures: a meta-analysis. Psychoneuroendocrinology. 2017;86:152-168.
  31. Caputo T et al. From chronic overnutrition to metainflammation and insulin resistance: adipose tissue and liver contributions. FEBS Lett. 2017;591(19):3061-3088.
  32. 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.
  33. 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.
  34. Koren D et al. Role of sleep quality in the metabolic syndrome. Diabetes Metab Syndr Obes. 2016;9:281-310.
  35. 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.
  36. Sweatt SK et al. Sleep quality is differentially related to adiposity in adults. Psychoneuroendocrinology. 2018;98:46-51.
  37. Huang T et al. Habitual sleep quality and diurnal rhythms of salivary cortisol and dehydroepiandrosterone in postmenopausal women. Psychoneuroendocrinology. 2017;84:172-180.
  38. 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.

 

Dr. Phil Shares: Staying Keto over the Holidays

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.

General Wellness, Ketogenic

Shared by Dr. Phil McAllister @ Forward Health Guelph

Resources:

  1. McCarty MF et al. Lauric acid-rich medium-chain triglycerides can substitute for other oils in cooking applications and may have limited pathogenicity. Open Heart. 2016;3(2):e000467.