Fitness: It’s the (Not So) Little Things That Count

So here we are, a couple months into 2008. You made that New Years Resolution to get in shape. You’re hitting the gym like a madman and following all the workout advise that you read about in some magazine by some insane personal trainer/physical therapist who thinks he knows what he is talking about; you even bought this crazy kettlebell thing he kept saying is so great. So why isn’t the weight pouring off? Why don’t you still have enough strength to lift yourself off the couch or the energy to even care. What is going on here?

Now, let me preface what I am about to say by stating clearly that I am not a nutritionist or registered dietician; nor do I have any special training in analyzing sleep patterns. But, I am aware of many of the problems out there that people have and I am going to attempt to make you more aware, too.

Fitness is like a love triangle with constant battles between the exercise component, the rest/sleep element, and the nutrition/diet factor. If one is out of balance, none of it will fit together right. I always talk about exercise, so now we are going to focus on the other two.

Sleep/Rest

The National Sleep Foundation reports that while exact sleep requirements differ among people, the general rule of thumb is:

Adults = 8 hours

Teens = 9 hours

Younger = more

You need to realize that working out hard is great, but muscles don’t grow or get stronger when you work out, it is the recovery process where muscles repair themselves from the workout and can become bigger and/or stronger. The National Sleep Foundation further notes other areas that are affected by improper sleep:

• Memory and learning – Sleep seems to organize memories, as well as help you to recover memories. After you learn something new, sleep may solidify the learning in your brain.

• Mood enhancement and social behaviors – The parts of the brain that control emotions, decision-making, and social interactions slow down dramatically during sleep, allowing optimal performance when awake. REM sleep seems especially important for a good mood during the day. Tired people are often cranky and easily frustrated.

• Nervous system – Some sleep experts suggest that neurons used during the day repair themselves during sleep. When we experience sleep deprivation, neurons are unable to perform effectively and the nervous system is impaired.

• Immune system – Without adequate sleep the immune system becomes weak and the body becomes more vulnerable to infection and disease.

• Growth and development – Growth hormones are released during sleep and sleep is vital to proper physical and mental development.

There is more to sleeping properly than just getting in the required number of hours. Proper sleep actually involves 4 stages ranging from light sleep to deep and dreaming stages. A person cycles through these stages throughout their sleep time. To insure that all stages are achieved, and achieved enough, consistency is needed. It is important to generally go to sleep and wake up at roughly the same time each day (straying every now and then won’t kill you). If there are any factors that are limiting your ability to fall asleep at a consistent time, you need to address them. Things like eating too soon before bed, watching TV while falling asleep, and participating in physically or mentally stressful activities too close to bedtime are common disrupters of sleep (although not for everyone). My advice is to keep a sleep log for one month. A sleep log is fairly simple and should include information such as: bedtime, time you actually fell asleep, time you woke up, number of times you awoke during the night, how well you slept, how you felt when you woke up, and how you felt the rest of that day. Try it and see how you feel.

Nutrition/Diet

So, is anyone confused about what the heck they are supposed to eat? With all the diets out there it’s enough to drive a person absolutely crazy. It would be nice to think that all of the diets were created in an attempt to truly improve a person’s life in terms of weight loss, energy, control of diseases like diabetes, etc; but while some of that may be true, a lot of the diets are only improving the bank accounts of the diet “creators.” For most people, it is not hard to know how to eat right; it is doing it that’s the problem. Let’s face facts, many people cannot lose weight via diet because either they just eat too much or what they eat is garbage. You don’t have to be a rocket scientist to know that eating pizza, cheeseburgers and drinking beer daily is not a staple for proper nutrition. Many of the diet programs out there do work and the reason people do not have success is because they do not do them correctly.

All that being said, there are many others who do not overeat, and eat what they think is healthy and still have problems. Before I let you know some details, let me first say again, that if you are using weight loss as the benchmark of proper diet, you must consider whether the other areas are balanced (exercise and rest). Assuming they are, here are some things to consider:

1) Calories: 3500 calories = 1 lb. (an excess 3500 calories = gaining 1 lb., a deficit of 3500 calories = losing 1 lb); 1 gram of protein and/or carbohydrates = 4 calories, 1 gram of fat = 9 calories, 1 gram of alcohol = 7 calories

Sounds simple right? Wrong. It is not just about total calories you eat or do not eat, but how you utilize those calories.

2) Metabolism: The number of calories used by your body during various activities, including rest.

Example: 2000 calorie per day diet – 500 calories burned during exercise = 1500 calories left to use for the rest of daily activities. If 2000 calories are required for daily activities, then there is a deficit of 500 calories. Therefore, in 7 days one pound of body weight will be lost (500 x 7 = 3500); however, if only 1000 calories are required for daily activities, then there is an excess 500 calories. Therefore you would gain 1 lb. in 7 days. This is metabolism – the higher the metabolism, the more calories burned. Factors that affect metabolism include: body size/weight (heavier = more calories used, although this mostly refers to calories used during activity vs. rest), body composition (greater lean body mass/muscle = higher metabolism), age (metabolism decreases with age), sex (sorry ladies, men burn more calories), drugs (don’t do drugs!), heredity, hormones, stress/anxiety, and temperature (good news for Michiganders – more calories are used in colder temperatures). To calculate your metabolic rate, use these formulas:

Women = 655 + (4.36 x W) + (4.32 x H) – (4.7 x A)

Men = 66 + (6.22 x W) + (12.7 x H) – (6.8 x A)

* W = weight (lbs.) H = height (inches) A = age (years)

3) Food quality: These days everything is about being quick and convenient – welcome to fast food. Not only do we have to deal with fast food, but in an attempt for certain industries to make money, things like preservatives, chemicals, and basic “fake food” are rampant. It is very difficult to look at an ingredient label and see less than a dozen ingredients, half of which you need a degree in biochemistry or nutrition to even know what it is. Last, just because the calorie count may be low (such as with carbohydrates), your body only uses so much before it gets stored as excess, generally as fat.

So with all this information, now which diet should you choose? Realize that weight loss will not happen overnight, and even with proper diet, the loss may not always be consistent.You may even experience some weight gain at certain points, especially if you are exercising.

The best thing I can tell people is to start keeping a food log. Record everything you put in your mouth, how much of it, and what time you did it. Be as specific as possible. For example: turkey sandwich with whole wheat bread (2 slices), 5 slices of lean turkey, lettuce, tomato, mustard at 11:15 a.m.; 16 ounces of water at 1:33 p.m.; 3 jellybeans at 10:42 p.m.

Doing this may make some things more obvious. I had a client who thought she was eating healthy, and then via her food log, discovered she was eating Oreos every hour! It was only one or two at a time, but it adds up. Eventually what you want to see is about six small meals per day, spaced fairly equally. No eating right before bed. Try to balance carbs and protein – most people are excessive with their carbs (most of your snacks/munchies – the things you throw a handful of in your mouth without thinking are either carbs or fat) and the body only uses so much at a time. Eat a lot of vegetables and a decent amount of fruit. Try to have real food.

These are very basic rules for a difficult task. Unlike exercise, which only takes about an hour, you have to think about what you eat the whole time you are awake (which should only be 16 hours – see above). Two excellent resources for nutritional information are: The Metabolism Advantage by John Berardi, and The Anti-Estrogenic Diet by Ori Hofmekler (for both men and women).

Rest and nutrition are two areas that are all too often neglected, and just as important (if not more so) than anything else. Put some time into focusing on these areas if you truly are looking for improved fitness and life quality.

For more information regarding rest/sleep, and nutrition/diet; as well as to download sleep and food logs – contact Bob at bob@functional-strength-training.com, or visit his website at www.functional-strength-training.com.

Are You Suffering From Sleepless Nights?

With Gary Trock, MD

There are many different types of disorders that affect sleep, but the two most common are sleep apnea and insomnia. The two conditions are different in many ways but can both have negative effects on our bodies, minds and overall health.

INSOMNIA

According to Gary Trock, M.D, of Beaumont Hospital, approximately 30-50% of people will suffer from acute insomnia, while 10% of the population suffers from chronic insomnia; defined as lasting three months or longer.

“Insomnia is when you have difficulty falling asleep, staying asleep, waking up too early or when you do not get non-restorative sleep,” says Dr. Trock. “Most times it is temporary due to stress levels or other factors, but a stressful event may cause the insomnia that changes ones habits or behaviors and leads to chronic insomnia.”

Chronic insomnia is generally a psychophysiologic insomnia and may be caused by a variety of factors including mental illness, substance abuse, chemical imbalance or changes in lifestyle. Many people with mood disorders also have a preexisting sleep condition.

TREATMENT OF INSOMNIA

There are many prescription medications available to help manage insomnia, but they generally help a person fall asleep or maintain sleep through the night. However, for more severe conditions you may need treatment at a sleep disorder clinic.

One way to begin understanding your sleep patterns is to maintain a sleep diary, says Dr. Trock. This will allow you and your physician to better understand how much sleep you are getting, when you are falling asleep or waking, and what some of the circumstances around you may be contributing to your insomnia.

One form of treatment is called Sleep Restriction Therapy. Dr. Trock explains that this entails making the patient get out of bed as soon as they wake. For example, if a patient lies in bed for nine hours but only sleeps for five hours, you make the patient get out of bed at the end of the five hours regardless of the time of the day or night.

Other non-medicinal therapies include Stimulus Control Therapy and Paradoxical Intention Therapy, says Dr. Trock. Each can help you manage your insomnia. With Paradoxical Intention Therapy you tell yourself you are going to do the opposite of your intention. For example, “I am not going to fall asleep.”

With Stimulus Control Therapy, you don’t stay in bed any longer than 20 minutes without falling asleep. If you are still awake, you get out of bed and read a book, watch television, work on the computer or other project until you become tired again.

Another mistake people make with insomnia is doing other activities in bed other than sleep. “The bed is for sleep and sex, no televisions, stereos, computers,” warns Dr. Trock.

SLEEP APNEA

This condition receives a lot of attention because of the physicality of the condition. Sleep apnea occurs when your sleep is interrupted by pauses in your breathing. This leads to an interrupted sleep pattern which causes the patient to feel tired or fatigued during the day. According to the National Institute of Health, the interruption in breathing can last 10-20 seconds, and occur 20-30 times in a night.

Snoring is one of the symptoms and obesity is one of the risk factors for sleep apnea. Generally, the spouse or loved one identifies the problem because of the snoring, says Dr. Trock.

“Snoring is a symptom for most, but not all. Bed partners hear the snoring, but the patient can experience sudden awakening, shortness of breath with their heart pounding, and dreaming that you are suffocating or drowning,” says Dr. Trock. “Other symptoms include decrease performance at home, work or school, in ability to concentrate and falling asleep during the day. Another medical symptom is high blood pressure that doesn’t respond to medication.”

With the lack of oxygen in the blood due to the pauses in breathing, a patient can suffer immediate dangers such as cardiac arrest or run the risk of stroke.

Dr. Trock says that diagnosis requires a sleep study to determine the severity of the apnea. The patient is often prescribed CPAP (Continuous Positive Airway Pressure) to help correct the problem once the diagnosis is made. CPAP is the most common, long term treatment option for patients with moderate to severe sleep apnea. It is a process of forcing oxygen into the lungs and prevents apneas from occurring. Because it is a recognized treatment, the CPAP machine is covered by insurance.

Surgery is also an option reserved for mild to moderate cases, says Dr. Trock. However, it is an option most often reserved for patients who cannot tolerate CPAP, or if there are other physical blockages causing sleep apnea.

If you suspect you may have sleep apnea it is important to see a sleep specialist to get the proper diagnosis, says Dr. Trock. To improve your sleep, it is important to recognize symptoms of problematic patterns. For sleep apnea, obesity is a definite risk factor, says Dr. Trock. Weight loss can be an effective way to relieve the severity of your apnea.

It is also important to recognize how much sleep your body needs. This can vary depending on your age and health habits. “Sleep patterns can change over time. You can condition yourself on how much sleep you need,” says Dr. Trock. “There are short sleepers or long sleepers that function well as long as they get their designated amount of sleep. This could be 4-5 hours for short sleepers and 10-12 hours for long.”

It is important to recognize the signs and symptoms of sleep problems and address them with your physician. This is mostly due to the other health problems that can occur as a result of sleep deprivation.

So the next time you think you are a little sleepy, pay attention to how often you feel that way. You may be suffering from a sleep disorder.

Gary Trock, M.D., is board certified in pediatrics, neurology, clinical neurophysiology and sleep disorders. He received his medical degree from the University of Michigan and completed his Residency in pediatrics at the University of Minnesota followed by Fellowships in Adult and Child Neurology and Clinical Neurophysiology. His Fellowship in Sleep Medicine is from Georgia Tech. He has been at Beaumont since 1980.