Review of Chris Highcock’s Hillfit

Chris Highcock over at Conditioning Research has just released a new ebook on strength training for hikers: Hillfit: Strength.  Hiking is one of my favorite hobbies.  I particularly like walking up hills and mountains.  If you’re ready to reap the benefits of resistance training, this jargon-free plan is an excellent starting point, and may be all you’ll ever need.  Even if you never go hiking.

Chris is a fitness columnist for “TGO (The Great Outdoors).”  He lives and hikes in Scotland.  Chris’s goal with the program is to increase your enjoyment of hiking by increasing your level of fitness. 

He clearly presents four basic home exercises requiring no special equipment; they’re bodyweight exercises.  You get it done in 15 minutes twice a week!  The key is to do one set of each exercise, slowly, to exhaustion.  What’s slow?  Ten seconds for both lift and lowering.  For instance, when you do the push-up, you push up over  the course of 10 seconds, then let your body down slowly over 10 seconds.  The exercises are for both upper and lower body.

I’m reading about similar exercise ideas from Skyler Tanner, Doug McGuff, Nassim Taleb, Jonathan Bailor, and Doug Robb.  Bailor, in his recent book, also recommends only four exercises.  Highcock’s look a little safer for rank beginners. 

The idea is to recruit three different types of muscle fiber during the muscle’s movement.  If you move explosively and finish too soon (get your mind out of the gutter!), you’re only using  one type of muscle fiber (fast twitch, I think).  You want to stimulate a strength and growth response in all three types of muscle fiber.  And explosive or rapid movements are more likely to cause injury, without any benefit. 

Once you get the basic program down, Chris takes you through some easy variations (called progressions) to make the exercises gradually harder, so you continue to improve your strength and fitness. 

Chris understands that many folks can’t do a single push-up.  He takes you through pre-push-up movements to get you prepared  to do actual push-ups.  This goes for all four exercises.  I bet even my little old lady patients could use this program.  (This is not blanket clearance for everybody to use this program; I don’t need the lawsuits.  Get clearance from your own doctor first.)

The exercises incorporate our five basic movements: push, pull, squat, bend/hinge, walk/gait.  The four exercises are: wall sit (squat), push-up, modified row, and hip extension.

My only criticism of the book is that Chris should have used young, attractive, bikini-clad models to illustrate the exercises.  The existing photos are clear and helpful, however.

But seriously, the only suggestion I have for the next version of Hillfit would be to mention that it will take a couple or three weeks to see much, if any, improvement in strength once you start the program.  Same for when you increase the workload with the exercise progressions.  Perhaps this is in there, but I missed it.  You don’t want people quitting in frustration that they’re not seeing progress soon enough.

The author provides scientific references in support of his program, so he didn’t just make this stuff up.  Only one of the references involved mice!

Several “take home” points for me personally are: 1) stretching before or after exercise does nothing to prevent injury or soreness, and may hurt short-term athletic performance, 2) don’t hold your breath, 3) train to “momentary muscular failure.”  I’m not entirely sure what momentary muscular failure means.  It may not be Chris’s term, but it’s prominent in one of his best scientific references.  I use free weights and don’t think I can safely go 100% to momentary muscular failure.  Hitting momentary muscular failure, by the way, is more important than the amount of weight you’re moving.

Highly recommended.

Steve Parker, M.D.

PS: I’d like to see Hillfit available on Amazon’s Kindle and Barnes and Noble’s Nook.

PPS: When you go to the Hillfit website to order, you’ll find the price is £9.95 (that’s GBP, British pounds sterling).  I’ve never ordered anything priced in GBP.  In today’s U.S. dollars, that’s a little under $16.00.  You can pay via PayPal or a major credit card.  I assume the conversion from one currency to another is automatic and seamless.  I don’t know if there’s a extra fee by the payment processor for doing the conversion.

Disclosure:  Chris kindly sent me a free digital copy of his ebook.  I don’t know Chris.  I will receive no remuneration for this review, nor for book sales.

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Aerobic Versus Strength Training for People With Diabetes

“Resistance training, similarly to aerobic training, improves metabolic features and insulin sensitivity and reduces abdominal fat in type 2 diabetic patients,” according to a report in the current issue of Diabetes Care.

Italian researchers randomized 40 type 2 diabetics to follow either an aerobic or strength training program for four months.  The increase in peak oxygen consumption (VO2 peak) was greater in the aerobic group, whereas the strength training group gained more strength.  Hemoglobin A1c was similarly reduced in both groups, about 0.37%.  Body fat content was reduced in both groups, and insulin sensitivity and lean limb mass were similarly increased.  Pancreas beta-cell function didn’t change.

Per this one study, neither type of training seems superior overall.  If you’re just going to do one type of exercise program, choose your goal.  Do you want more strength, or more sustainable “windpower”? 

The Pennington Biomedical Research Center found somewhat different results in their larger and more complex study published in 2010.  However, they were primarily testing for diabetes control (as judged by hemoglobin A1c improvement), rather the improvements in strength or aerobic power.  The found the combination of aerobic and strength training is needed to improve diabetic blood sugar levels.  Both types of exercise—when considered alone—did not improve diabetes control. 

As for me, I do both strength and aerobic training.

By the way, I only read the abstract of the current research, not the full report. High-intensity intervals on a treadmill help me git’r done quicker.

Steve Parker, M.D.

PS: PWD = people or person with diabetes.  Do you like that term or would you prefer “diabetic”?

Reference:  Bacchi. Elizabeth, et al.  Metabolic Effects of Aerobic Training and Resistance Training in Type 2 Diabetic Subjects
A randomized controlled trial (the RAED2 study)
Diabetes Care.  Published online before print February 16, 2012, doi: 10.2337/dc11-1655

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Oral Drugs for Type 2 Diabetes: Which Are The Best?

A guideline committee established by the American College of Physicians recently reviewed oral medications for treatment of type 2 diabetes.  Assuming blood sugars were still too high after diet and lifestyle modification, the firmest drug recommendations were:

  • Use metformin first.
  • If blood sugars are still too high, add a second agent to metformin.

This was not nearly as helpful as I’d hoped it would be!

The Problem: Too Many Options

We now have 11 classes of drugs for treatment of 26 million diabetics in the United States.  Clinicians are often at a loss as to which drug(s) to recommend for a particular patient.  For most of these drugs, we know very little about the long-term implications, such as effects on overall death rates, diabetes complications, heart attacks, cancer, and strokes. 

I can think of three diabetes drugs once approved by the U.S. Food and Drug Administration, but are now off the market or severely restricted due to serious adverse side effects: phenformin, troglitazone (Rezulin), and rosiglitazone (Avandia).  I fully expect one or more of our current drugs will have a similar fate; only time will tell which ones.

France took pioglitazone off the shelves in 2011 because of a link with bladder cancer.  It’s still available and popular in the U.S.

When you get into multi-drug therapy with two or three different oral drugs, the situation becomes even cloudier.

Some Needles in the Haystack

I reviewed the report from the guideline committee and found just a few clinical pearls to share with you. 

  • They didn’t mention at all the FDA’s recent restrictions on rosiglitazone, so I assume they don’t believe it’s more toxic to the heart than is pioglitazone.
  • Most oral drugs reduce hemoglobin A1c by an average of 1% (absolute decrease).
  • All double-drug regimens were more effective at controlling blood sugars than monotherapy (using only one drug): adding a second drug drops hemoglobin A1c another 1%.
  • “It was difficult to draw conclusions about the comparative effectiveness of type 2 diabetes medications on all-cause mortality, cardiovascular morbidity and mortality, and microvascular outcomes because of low quality or insufficient evidence.”  It was so difficult that they didn’t draw any firm conclusions.  In other words, in terms of overall deaths , heart attacks, heart failure, and strokes, it’s hard to favor some of these drugs over others.  However…
  • Compared to sulfonylureas, metformin was linked to a  lower overall death rate and cardiovascular illness (e.g., heart attacks, heart failure, angina).
  • Sulfonylureas and meglitinides tend to cause more hypoglycemia.
  • Thiazolidinediones are linked to a higher risk of heart failure; they shouldn’t be used in patients who already have serious heart failure.
  • Thiazolidinediones may increase the risk of bone fractures.
  • Metformin helps with loss of excess weight, reduces LDL (bad) cholesterol, and lowers triglycerides.
  • Metformin is cheaper than most other diabetes drugs.
  • For double-drug therapy: “No good evidence supports one combination therapy over another, even though some evidence shows that the combination of metformin with another agent generally tends to have better efficacy [better blood sugar control] than any other monotherapy or combination therapy.”

In contrast to these guidelines, the American Association of Clinical Endocrinology guidelines of  2009  recommend that  the following should be used earlier and more frequently:  GLP-1 agonists (exenatide) and DPP-4 inhibitors (sitagliptin, saxagliptin, linagliptin).  Furthermore, sulfonylureas should have a lower priority than in the past. From my limited perspective here in the Sonoran desert, I have no way of knowing how much influence, if any, Big Pharma had over the AACE guidlelines.

My concern about long-term safety of some these drugs compels me to favor carbohydrate restriction, which reduces the overall need for drugs.  Sure, that’s not true for everybody and it may not last forever.  The more carbs you eat, the more drugs you’re likely to need to keep blood sugars in control in an effort to avoid diabetes complications.

Don’t get me wrong; I’m not anti-drug.  As an internist, I prescribe plenty of drugs every day.  They are a major weapon in my armamentarium.  Regardless of the condition I’m treating, I always try to avoid drugs with unknown and potentially serious long-term consequences.

Steve Parker, M.D.

Reference: Qaseem, Amir, et al.  Oral pharmacologic treatment of type 2 diabetes mellitus: A clinical practice guideline from the American College of PhysiciansAnnals of Internal Medicine, 156 (2012): 218-231.

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Does Eating Meat, Poultry, and Fish Ruin Your Mood?

Cow's in a good mood. What a great place to live!

Your mood might improve if you restrict meat, poultry, and fish, according to a pilot study in Nutrition Journal.  I don’t have time to read it anytime soon.  Why don’t you, and comment below?

-Steve

Reference:  Beezhold, Bonnie and Johnston, Carol.  Restriction of meat, fish, and poultry in omnivores improves mood: a pilot randomized controlled trialNutrition Journal 2012, 11:9 doi:10.1186/1475-2891-11-9.  Published: 14 February 2012

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173 Years of US Sugar Consumption

US Sugar Consumption: 1822-2005

 Thanks to Dr. Stephan Guyenet and Jeremy Landen for this sugar consumption graph.  I’d never seen one going this far back in time. 
 
Dr. Guyenet writes:
It’s a remarkably straight line, increasing steadily from 6.3 pounds per person per year in 1822 to a maximum of 107.7 lb/person/year in 1999.  Wrap your brain around this: in 1822, we ate the amount of added sugar in one 12 ounce can of soda every five days, while today we eat that much sugar every seven hours.
The U.S. Department of Agriculture estimates that added sugars provide 17% of the total calories in the average American diet.  A typical carbonated soda contain the equivalent of 10 tsp (50 ml) of sugar.  The average U.S. adult eats 30 tsp  (150 ml) daily of added sweeteners and sugars.
 
Note that added sugars overwhelmingly supply only one nutrient: pure carbohdyrate without vitamins, minerals, protein, fat, antioxidants, etc.
 
Do you think sugar consumption has anything to do with diseases of affluence, also known as diseases of modern civilization?  I do.
 
Was our pancreas designed to handle this much sugar?  Apparently not, judging from skyrocketing rates of diabetes and prediabetes.
 
 

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What Happened to Lard?

Lard? Wut choo talkin' 'bout, Willis?

Lard may be making a come-back.  An NPR article reviews its fall from grace, with mention of Upton Sinclair, Procter and Gamble, and Crisco.

Steve Parker, M.D.

h/t Laura Dolson

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Book Review: Choose to Lose: The 7-Day Carb Cycle Solution

I saw the author of Choose to Lose on a rerun of Dr. Oz in early January.  Then I checked the book’s sales rank at Amazon.com (22nd overall—a blockbuster in my view).  (Don’t get me wrong; I’m not in the habit of watching Dr. Oz.)  Here’s my review of 2012’s Choose to Lose: The 7-Day Carb Cycle Solution, by Chris Powell.  The book is for the general public, not people with diabetes.  I give it three stars per Amazon.com’s five-star system.

♦   ♦   ♦

Will it work?  Certainly for some, quite possibly a majority.  Like most published programs, it’ll work for for you if you work the program.  Question is, can you do it?

The underlying idea is to alternate high-carb and low-carb eating days, which supposedly revs up your metabolism and tricks your body into thinking it’s not on a diet so it won’t go into self-preservation starvation mode.  Mr. Powell calls this carb cycling.

The high-carb days are also low-fat, and the low-carb days are low-calorie.  Actually, both days are reduced-calorie if your goal is the most dramatic results.  A moderate calorie deficit is built into the program.  Women get about 1350 calories; men around 1700.  Those levels are lower than necessary. Other than that, it appears you’ll get all the other nutrients you need, which is good.

I can see how the diet would work for some because it drastically reduces consumption of our most fattening carboydrates.  Loser Choosers aren’t supposed to eat baked goods, white flour, refined sugar, beer, candy, chips (crisps, for those in the UK), conventional breads, cookies, crackers, ice cream, sugar-sweetened beverages, corn syrup, and milk.  I suspect if we all stopped eating those right now, the overweight rate in the U.S. would drop by at least 10% in the next 12 months.

The author allows no wheat or white rice except for whole wheat bread and pasta.  Potatoes, peas, and corn made it to the “approved” list.  You eat mostly natural, minimally processed foods (yay!).

I don’t know Mr. Powell, but he comes off as earnest, honest, compassionate, experienced, and intelligent.  He’s not a scammer.  Mr. Powell has more faith than I do in the benefits of exercise for weight loss.  He notes that nutrition is more important.  We agree that exercise is often critical for prevention of weight regain.  He barely, if at all, mentions the benefits of exercise in prevention of disease and prolongation of longevity.  His well-illustrated exercise recommendations are  a good start for fitness beginners.  He wants you to exercise for 10-30 minutes on six days a week, doing a combo of cardio intervals and body weight resistance training.  No expensive equipment to buy.

Carb cycling like this is supposed to “boost your metabolism to burn fat quickly.”  It does not, to any clinically meaningful extent.  Nor is carb cycling mentioned in this year’s massively referenced The Smart Science of Slim.  Contrary to the author’s opinion, neither eating five meals a day nor eating carboydrates revs up your metabolism.

Mr. Powell provides some helpful mind tricks to prepare you for a lifestyle change.

My favorite sentence: “Success doesn’t just happen.  It’s a result of the 4 Ps of action: Planning, Preparation, Performance, Persevance.”

My least favorite sentence: “Water is imperative for loosing [sic] weight.”  A close second was: “Alcohol is a powerful diuretic (it flushes water out of your system), so it dehydrates you, causing water retention and bloating for one to three days after you drink.”  Huh?

I like his incorporation of cheat meals, although he allows more than I would.  To his credit, the all-important maintenance phase is covered well.

Mr. Powell recommends supplementing with probiotics and digestive enzymes, being unaware of their uselessness for most dieters.

I note that Amazon sells Choose to Lose by Dr. Ron and Nancy Goor, and The Carb Cycling Diet by Dr. Roman Malkov.  Coincidence ? 

In terms of complexity, the program is about average. 

I wonder if you’d do just as well by swearing off the fattening carbohydrates I listed above.  If you’re looking to lose weight, you could do a lot worse than Choose to Lose.  And you could do better.

Steve Parker, M.D.

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Noteworthy People With Diabetes

dLife maintains a list of famous, prominent, or noteworthy folks who have or had diabetes.  I mention it here in case you have diabetes and sometimes feel like it’s got you by the throat and is ruining your life.  Be inspired.

Steve Parker, M.D.

B.B. King is No.3 on Rolling Stone's list of 100 Best Guitarists of All Time

PS: Who has a list of infamous diabetics?

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FDA Approves Exenatide for Once Weekly Use

Once-weekly injection of exenatide, sold in the U.S. as Bydureon, has been approved for use by the U.S. Food and Drug Administration.  It’s main competitors are Byetta (exenatide  injected twice daily) and Victoza  (liraglutide).  Byetta  and Bydureon are made by the same company, Amylin Pharmaceuticals.  Bydureon apparently is a slow-release formulation of exenatide.

Victoza is the one that celebrity chef Paula Deen endorsed about a month ago, around the same time she revealed she’s had type 2 diabetes for three years.  Victoza’s injected once daily.

The New York Times has a January 27, 2012, article on Bydureon, focusing on business and investing.  The new drug is expected to retail for $4,200 (USD) a year. 

Click for complete prescribing information.

Click for a press release approved by Amylin.

David Mendosa is excited about Bydureon.

These drugs are in a class called GLP-1 receptor agonists, which mimic the effect of glucagonlike peptide- 1, a hormone that increases insulin secretion by the pancreas when blood sugar levels are high.  They are prescribed as adjuncts to diet and exercise in adults with type 2 diabetes.

Steve Parker, M.D.

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What About Sugar Alcohols?

Dietitian Brenna at Eating Simple recently posted an article on artificial sweeteners exclusive of sugar alcohols.  Now she’s reviewed sugar alcohols.  Many who have a sweet tooth, including myself, use sugar substitutes such as sugar alcohols.  Sometimes they affect blood sugar levels, although not as much as sugar.

Dr. Maria Collazo-Clavell at the Mayo Clinic wrote about use of artificial sweeteners by people with diabetes.  Like Brenna, she notes that sugar alcohols can raise blood sugar levels in people with diabetes.  The Mayo Clinic has another article on sugar substitutes.

Steve Parker, M.D.

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