INSOMNIA

Dr. Chuck Wile is a supervising physician at Cheng Integrative Health Center/Doctor’s Weight Loss Center, Columbia, SC.  Dr. Wile served in the US Air Force Medical corp and is a retired Air Force Colonel.

          It is exhausting and frustrating when you have difficulty falling asleep or staying asleep. Sleep deprivation is not the same as insomnia. In sleep deprivation one has an adequate ability to fall asleep yet an inadequate opportunity to sleep. In insomnia, one has an adequate opportunity to sleep yet an inadequate ability to sleep with sufficient quantity and/or quality of sleep. Insomnia is defined as an inability to have adequate sleep 3 or more times per week for 3 months, without co-existing mental nor physical disorder that causes sleep impairment resulting in dissatisfaction with the quality and/or quantity of sleep AND daytime impairment or distress. 1/9 Americans meet these criteria with equates to over 40 million people. Women are twice as likely as men to suffer with insomnia. African Americans and Hispanic people experience insomnia more than Caucasians. About 2/3 people experience sleep impairment 1 night/week. There is an hereditary aspect to the problem 28 to 45 percent of the time (depending on the study). >$30 Billion per year is spent on medications for sleep in the USA.

          Our sleep-deprivation is caused by many socially engineered factors. Too much light, especially blue wavelength light from LEDs; use of alarm clocks because we have to punch time cards for work; room temperatures too high; the use of caffeine, tobacco and alcohol. Also, internal factors such as aging and worrying have a significant influence. Our over-active sympathetic nervous system  causes a release of the adrenal hormones Epinephrine and Norepinephrine that support a flight-flight-freeze response to threats to our survival {both real and imagined}, which increases our heart rate and blood pressure and keeps us alert). Also, with the release of Cortisol from the adrenals (which supports our ability to sustain stress) there is an additional stimulus to remain alert. These hormones also cause an increased metabolic rate with consequent increased core body temperature; stimulation of the thalamus gate-keeper to remain open for sensory input for processing by the cerebral cortex,; and, for the emotion generating area of the limbic system (the amygdala) plus the memory recollection center (the hippocampus) to remain active. The result is ALERTNESS thwarting sleep. PLUS, our sleep-procrastination is a problem. Due to our fears of missing out we amuse ourselves with late-evening TV and digital entertainments which can interfere with achieving a good sleep pattern.

          A Key Principal for managing insomnia is find the cause then treat the cause.

CAUSES OF INSOMNIA:   1) Acute Insomnia: Transient and short-term cause of insomnia include: jet lag; shift work; high altitude;  poor sleep environment: uncomfortable room temperature—too hot or too cold; excessive or unpleasant noise; situational stresses: illness or death of a loved one, unemployment, separation or divorce, exam prep; acute medical/surgical illness or hospitalization; use of stimulants such as caffeine, amphetamines, tobacco, cocaine, MDMA, methylphenidate, modafinil, and phentermine; withdrawal from alcohol, sedatives, stimulants; and, excessive mental or physical stimulation in the hours before bedtime. 2) Chronic Insomnia: is typically linked to psychiatric or medical conditions including: a) Common Psychiatric Conditions: anxiety with intruding ruminations, depression (which can also trigger hypersomnolence), mania (bipolar disorder), PTSD and schizophrenia. b) Chronic Medical Conditions:  pain, obstructive sleep apnea, restless leg syndrome and periodic leg movements, menopause or andropause, coronary artery disease with nocturnal dyspnea or angina, GERD, degenerative neurological disorders such as Parkinson’s disease and Alzheimer’s disease with dementia with nocturnal agitation, brain tumors, strokes, brain trauma, circadian rhythm disorder, medications such as stimulants for ADHD and narcolepsy, alcohol and drug users, nocturnal asthma and pregnancy.

          ***A thorough history and physical examination with diagnostic testing, especially considering a sleep lab study, is very important in order to make an appropriate diagnosis and precision treatment recommendations. Suggestions about supplements and medicinal essences are intended for educational purposes and are not prescriptions for managing your health concerns. Be sure to inform your physician of any supplements that you are taking in order to evaluate any possible conflicts with prescription medications.

DEVELOP STRICT SLEEP HYGIENE HABITS:   

           Here are some suggestions to try before considering a prescription medication. AVOID CAFFEINE (coffee, tea, caffeinated sodas), NICOTINE, and other  Stimulants such as chocolate, Sudafed or Afrin nasal spray, or, if that is too much of a challenge, then don’t use any for at least 6 hours before bedtime. AVOID HEAVY MEALS and  ALCOHOL before sleep. AVOID SUGARY OR SPICY FOODS 4 to 6 hours before bedtime. However, if awakening during the night is a problem, then try eating a light snack  of good fats (not carbs) before bedtime. A couple almonds, a few spoons of yogurt, a couple teaspoons of almond butter or peanut butter on a cracker can frequently do the trick. Drinking warm milk and/or eating a banana may help you get ready for bed. The amino acid tryptophan in these foods can help you to sleep.

           Allow enough time for sleep. Most people need 7 to 9 hours of sleep each night. Fix a bedtime and an awakening time. Avoid napping during the day. And especially in the evening.  Arrange a sleep environment that is very dark, comfortable, quiet and cool {set the thermostat for 65 degrees in the bedroom} to facilitate falling asleep quickly and staying asleep. Use comfortable bedding and keep the room well ventilated. Block out all distracting noise. Consider a white noise generator. Reserve the bed for sleep and sex. Don’t use the bed as an office, work or recreation space. Let your body learn to associate the bed with sleeping. AVOID TV in the bedroom. Don’t take your worries to bed. Worrying is a prayer for that which you don’t wish to happen. Instead, practice relaxation techniques before going to bed. Yoga, deep breathing, visualizations, progressive muscle relaxation can all help relieve anxiety and muscle tension. Establish a pre-sleep ritual such as a warm bath (especially using Epsom salts—5 cups: the magnesium will relax your muscles), or a few minutes of reading or praying. Get into your favorite sleeping position. If you don’t fall asleep within 15-30 minutes, get up and go into another room and read until you get sleepy. Consider elevating the foot of your bed a few inches to increase circulation to your brain.  Regular AEROBIC EXERCISE is the best way to improve your sleep and modify pain. However, don’t do heavy exercise within 3 hours before bedtime because it raises your core body temperature and it takes several hours to return your core body temperature to normal. The best time for aerobic exercising is in the morning.

          COGNITIVE-BEHAVORAL THERAPY (CBT):  is the most effective psychological intervention to help with insomnia. It consists of a comprehensive program for educating and modifying behaviors.  The most effective use of CBT combines several of these methods. Rather than just relieving symptoms, it addresses the underlying cause(s) of insomnia. 1) Sleep Education: understanding the sleep cycles and learning how beliefs, behaviors and outside factors affect sleep. 2) Cognitive Control and Psychotherapy: helps control or eliminate negative thoughts and worries that keep one awake. It may help to eliminate worrisome beliefs about sleep such as a single restless night will make one sick. 3) Sleep Restriction: limiting the amount of time spent in bed rather than lying in bed awake which can become a habit leading to poor sleep. 4) Remaining Passively Awake: avoiding any effort to fall asleep. Worrying that one can’t sleep can keep one awake. 5) Stimulus Control Therapy: helps remove factors that condition the mind to resist sleep. Eg. One is coached to use the bed only for sleep and sex; and, to leave the bedroom if unable to sleep within 15 minutes. 6) Sleep Hygiene: changing basic lifestyle habits that can influence sleep: eg. Smoking or drinking caffeine late in the day; drinking a “nightcap” of alcohol; not regularly exercising; avoid napping; winding-down 2 hours before sleep time. 7) Relaxation Training: learning to calm the mind and body: eg. meditation, progressive muscle relaxation and hypnosis. 8) Biofeedback Training: learning to influence heart rate, skin temperature, muscle tension and skin electrical conduction. 9) Sleep Diary: keeping a detailed record of sleep patterns and influences for 2 weeks.

***This handout is intended for sharing information. If you consider trying any non-prescription supplements, please discuss this with me so that we can be sure that there will be no drug-supplement adverse interactions, and to be sure that your choice may be good for your overall care and health.

NON-PRESCRIPTION ALTERNATIVES:

          These products will support and enhance normal sleep mechanisms. Consider using: 1) VALERIAN ROOT capsules– 150 to 300 mg of a standard extract (0.8% valeric acid). Use 1 capsule at bedtime. Note: it smells like dirty gym socks, however, it is an ingredient in many proprietary sleep aids because it is effective. Don’t take with alcohol. 2)  MELATONIN–this comes as capsules, drops and lozenges. Women should start at 1 mg to 3 mg at bedtime and increase the dose every 4-7 days to 3 to 10 mg (may use up to 30 mg); Men should start at 3 mg to 5 mg and increase the dose every 4-7 days to 10 to 15 mg (may use up to 30 mg). 3) LAVENDER ESSENTIAL OIL (to be used topically)–add to a warm bath before bedtime or use as aromatherapy by placing some drops in an air  infuser or sprinkled on bed clothes/bedding. 4) The following TEAS (which can also be used as tinctures)  have been found to be helpful: a) lemon balm, b) passion flower, c) chamomile, d) catnip, e) hops, and/or rooibos. 5) Consider 5-hydroxy-tryptophan (5-HTP) 50 to 200 mg at bedtime. (CAUTION: Don’t use this if taking an anti-depressant.) 6) Consider GLYCINE 3 gm at bedtime. People fall asleep quicker, drop into delta-wave sleep faster, and report increased alertness with less daytime drowsiness, improved memory performance and less fatigue. 7) Consider using an aqueous extract derived from peeled rhizomes and roots of a non-mouldy Noble KAVA cultivar, limiting use to 250 mg kavalactones daily for acute or intermittent use. This will minimize a very rare hepatotoxicity risk. It is wise to limit its use to 6 weeks at a time and discontinue its use if there is persistent nausea, jaundice or weight loss. Then, get liver enzyme testing if there are any adverse findings. Used wisely, kava is a safe and effective aid for good sleep and to relieve moderate anxiety. 8) ZIZYPHUS seed (Suan Zao Ren; red date; the spiny jujube) is a Chinese herb beneficial for sleep, menopausal symptoms and anxiety. The dose is about 4.5 gm of the dry seed extract. 9) Magnesium L-Threonate 1,000 to 2,000 mg taken at bedtime can be very helpful with sleep management. This form of magnesium most easily crosses the blood-brain barrier with comprehensive benefits for sleep, anxiety and cognitive function. {It can be obtained from www.LifeExtension.com.}  However, magnesium oxide 400-800 mg, magnesium glycinate 400-500 mg, and magnesium asporatate 400-500 mg can also be very effective. 10) SAMe (s-adenosylmethionine) 800 to 1600 mg daily can benefit insomnia. It promotes the function of the enzyme that converts N-acetylserotonin to melatonin. 11) A proprietary blend called “SleepCycle” from www.puretango.com  has Xylaria Nigripes or “Wulinshen” as a main ingredient. It is a fungus containing GABA which improves sleep, shortening the time to fall asleep while helping to stay asleep longer, awakening refreshed without bothersome side effects. In fact, it has the pleasant side effect of improving cognitive function and a sense of well-being. Wulinshen also seems to have a cumulative effect, improving sleep quality with continued use. Additionally, melatonin, 5-HTP, L-Theanine plus a blend of valerian, passion flower, lemon balm, Dong quai, Hops, polygala and Jujube are added to the mixture for additional sleep benefits. The recommended dose is 2 capsules 30 minutes before bedtime. 12)  Lactium is a protein hydrosolate that can be used to relieve stress and promote restful sleep without side effects. Drinking warm milk has often been suggested for promoting sleep. Unfortunately, adults no longer have the enzymes of a newborn child which allows the release of this relaxing milk peptide. Lactium 150 mg taken 1 hour before bedtime improves sleep quality and reduces the time for sleep onset after 2 weeks of use. There is no awakening-sedation nor addiction with continued use.  Additionally, bioactive milk peptides activate brain cell receptors for neurotransmitters that reduce anxiety, such as GABA, serotonin and dopamine. Unlike benzodiazepine drugs, which activate the same receptors but which can become habit forming, bioactive milk peptides induce relaxation and sleep without the disinhibition side effects that are associated with risk taking behavior with such drugs. Studies demonstrate supplementing with bioactive milk products compared with placebo additionally improved digestion, cardiovascular function, cognitive function and social difficulty and reduced the stress response, including elevated blood pressure, heart rate ad cortisol levels. {Eur J Nutr. 2005;44(2):128-32.} 13) If your main problem is an active mind ruminating about things that happened during the day or things that need to happen in the future, then consider using the amino acid L-Theanine 200 mg: take 1 or 2 tabs once or twice per day. 14) Passion Flower rebalances signals in the endocannabinoid system that acts like a dimmer switch to tone down the amount of neurotransmitters that get released. It is useful to help you fall asleep and to stay asleep and to restore your sense of a calm focus. It is safe to use with children. It has been found to be useful helping to calm kids with Autism and with ADHD. A good proprietary product is called “Neural Balance” and is available from www.neural-balance.com 15) “PharmaGABA” is a proprietary product that modifies the natural neurotransmitter gamma-amino-butyric acid (GABA) in a fermentation process with the bacteria  Lactobacillus hilgardii. It can help to improve sleep quality and decrease awakenings. Additionally, it can help to relieve anxiety. The dose is 50 mg up to 200 mg daily.

OVER-THE-COUNTER MEDICATIONS:

          Antihistamines are used for the side-effect of drowsiness. {Histamine is a key neurotransmitter for alertness.} Typically they contain Diphenhydramine (Benadryl, Sominex, Sleep-Eez, Nytol) or Doxylamine (Unisom). Prescription Hydroxyzine (Atarax or Vistaril) may also be used. Side-effects include: daytime drowsiness, cognitive impairment, dizziness, drunken movements, urinary hesitancy, blurred vision, dry mouth and dry throat. Caution should be exercised in people with glaucoma, benign prostatic hypertrophy and cardiac dysrhythmias. BE AWARE: studies show in people >60 yo who use anti-histamines regularly have impaired memory and an increased risk for developing dementia!!

PRESCRIPTION ALTERNATIVES: 

          Caution: People who are recovering from alcoholism should AVOID using benzodiazepines, Zalepion (Sonata), Zolpidem (Ambien) and Eszopiclone (Lunesta) for insomnia because there is strong evidence of relapse associated with their use. Trazodone up to 100 mg at bedtime is the preferred medication for recovering alcoholics and people with an addiction history.

          “Sleeping Pills” are a misnomer. There is a significant difference between natural sleep and drug-induced SEDATION. Sedation does NOT equal sleep. Sedatives anesthetize the cerebral cortex but do NOT produce the electrical activity that is associated with sleep nor any of the restorative benefits! They produce an imbalance in the chemicals which  signal the brain to achieves normal sleep, and they  significantly limit restorative NREM slow-wave sleep. Also, the unconscious  “limbo state” produced can result in abnormal sleep behaviors which range from the harmless and humorous to the disturbing and dangerous.

          Currently there are no prescription medications used for sleep that enhance health and longevity. They all have serious potential side-effects. Thus, I believe that the risks do NOT outweigh the benefits of their use which, when compared to using a placebo, only minimally shortening the time for falling asleep. Compare this to the real risks of DEATH and CANCERS. The risk of death increases with the quantity used. For example in a 2 ½ year long study: ½ to 18 pills/year increased the risk by 3.6 times and >132 pills/year increased the risk 5.3 times. The risk of death occurs because of increased infections {since there is no immune benefit which is gained with natural sleep}; increased fatal car crashes; increased falls and consequent hip fractures {especially in the elderly}; and, increased heart disease and strokes. Especially worrisome is the fact that >50% of all sleeping pill prescriptions are for the elderly.

           In addition to the above non-pharmacological suggestions, I may be willing to prescribe A SHORT COURSE of medication for people who suffer from chronic insomnia. REMEMBER: the first-line therapy is CBT-I. Medications are intended only for short-term use (7 to 10 days) and really should never exceed 4 weeks. Unfortunately, they are being used off-label for extended periods of time.

          Weighing the risks versus benefits is fundamental. ALL of the sedative-hypnotics carry the risks of dependency, withdrawal and rebound insomnia. These include both the benzodiazepines and non-benzodiazepine hypnotics, although the older medications such as benzodiazepines carry a higher risk.  Anti-depressants can also be used for their side-effect of drowsiness.

  1. Benzodiazepines:  non-selectively target receptor sites in the brain that modulate the effects of the neurotransmitter gamma-aminobutyric acid (GABA). There are 3 categories: a) Long-acting: common brands include: Clonazepam (Klonopin), Diazepam (Valium), Flurazepam (half-life 70-90 hours) and Quazepam (Doral). b) Medium-acting: common brands include: Triazolam (Halcion), Lorazepam (Ativan) and Temazepam (Restoril). c) Short-acting: common brands include: Alprazolam (Xanax) and Oxazepam. These may be useful for air-travelers who want to reduce the effects of jet lag. Side-effects for all the benzodiazepines include allergic reactions, including angioedema of the face; increased depression; respiratory depression; residual daytime drowsiness with risks of motor vehicle accidents and falls in the elderly; memory loss—sleep walking, sleep eating, odd mood states: significantly aggravated by drinking alcohol and using antihistamines; and, urinary incontinence, especially in the elderly. NOTE: I am concerned about some recent studies that show a strong association between using benzodiazepines and significantly increased risks for dementia. When used for 3 to 6 months, the risk of developing Alzheimer’s disease is increased by 32%. When used for more than 6 months, the risk increases to 84%. Also, these drugs cross the placenta and enter breast milk and should be avoided in pregnancy and with nursing. First trimester use is associated with cleft lip in newborns. Interactions: although relatively safe if taken alone in an overdose, benzodiazepines are potentially very dangerous for respiratory depression in combination with drinking alcohol. Prolonged use creates physical dependence making discontinuation very problematic. Withdrawal symptoms: can last for 1 to 3 weeks after stopping the drug and include gastrointestinal distress, sweating, cardiac dysrhythmias, and, in severe cases, hallucinations and seizures. Rebound insomnia: paradoxically, benzodiazepines can cause nocturnal sleep disturbance and anxiety. There is a higher incidence of these problems especially when using the short-acting drugs.
  2. Non-Benzodiazepine hypnotics: although they have been advertised as causing less physical dependency than benzodiazepines, they are still subject to abuse. a) Ambien: typically induces sedation for 7 to 8 hours. AMBIEN IS A MEMORY ERASER RATHER THAN A MEMORY ENGRAVER. The FDA has recommended lowering the previous typical dose of 10 mg to 5 mg or lower, particularly for women who eliminate the drug more slowly than men. Although very popular, PLEASE NOTE: I choose NOT to prescribe Ambien because I believe that it is a dangerous drug which significantly impairs the memory and cognitive function. b) Lunesta: mayslightly improve both sleep maintenance and daytime alertness. It is the first medication approved to be taken on a long-term basis. c) Sonata: is short-acting lasting about 4 hours and useful for inducing sleep or for people with the inability to return to sleep once awakened in the middle of the night. d) Rozerem: is the only non-controlled medication. It targets melatonin receptors. However, I believe that it is an irrational choice: why not use OTC melatonin instead of the expensive prescription? e) Belsomra (suvorexant): is a new orexin-receptor antagonist being heavily advertised with a cute cuddly cat logo. “It might help you nod off a few minutes faster or stay asleep slightly longer, but that small benefit comes with some big safety concerns, such as being too drowsy to drive the next day or feeling like you can’t move or talk.” {ConsumerReports.com, July 12, 2015.} The FDA initially rejected doses of 30 to 40 mg because they posed too great a risk for causing motor vehicle crashes. The dose of 10 mg is no better than using a placebo. Compare: using Ambien 10 mg: sedated 20 min faster than a placebo and remained unconscious 34 min longer than placebo, with Belsomra 20 mg: sedated 6 min faster than placebo and remained unconscious 16 min longer than placebo. Neither are impressive nor, in my opinion, worth the risk. ***All these medications have serious side-effects: including daytime drowsiness and abnormal sleep behaviors: sleep-walking, sleep-eating, sleep-driving and social interactions with NO MEMORY for what has transpired. They impair short-term memory and can cause hallucinations and sleep paralysis. All these effects are augmented when consuming alcohol.
  3. Anti-Depressants: are used predominantly off-label for the side-effect of drowsiness. They are NOT addictive. They can be useful for modifying the pain threshold if pain is a confounding problem aggravating insomnia. They can be useful for concomitant depressive symptoms. They are my drug of choice for chronic insomnia. The preferred agents block serotonin 5 HT2A or 5 HT2C receptors and lack strong cholinergic activity such as: {for initial dosing} Trazodone (Desyrel) 50 mg, Doxepin (Sinequan) 25 mg and Mirtazapine (Remeron) 15 mg.  Although the older tricyclic agents have a higher side-effect profile because of their strong cholinergic activity, they can also be useful, such as Amitriptyline (Elavil), Nortriptaline (Pamelor), Imipramine (Tofranil) and Desipramine (Norpramin). However, I am not cavalier about using the anti-depressants because they change the architecture and function of the brain. {READ: “Anatomy of an Epidemic” by Robert Whitaker, published in 2010.}

***Also, consider reading “The Sleep Revolution” by Arianna Huffington. AND, “Why We Sleep” by Matthew Walker, PhD.

          ***THE GLYMPHATIC SYSTEM:  The more waste products lying around the brain, the greater the chance for Alzheimer’s disease to take root. Since 25% of the body’s overall energy is consumed by the brain, there are a lot of waste products to be cleaned up. The glymphatic system is the brain’s clean up system. Specialized brain cells scavenge diseased and damaged bits of protein and metabolic waste. With age, these cells become impaired. Also, the neuron surrounding supportive glial cells shrink in size when sleeping, opening spaces between cells by as much as 60% which allows cerebral spinal fluid to be pumped through and clear out waste. Lymphatic vessels surrounding the brain then deliver the waste to the lymphatic system of the body which gets rid of the toxins. With aging, adults often struggle to get enough sleep, which impairs the clean up system. THUS, since sleeping is crucial to removing toxins, keeping a regular sleep schedule becomes increasingly important with aging. Irregular sleep hours and long day time naps can disturb an effective sleep cycle clean up process. Also, sleeping on your side, in a fetal position, rather than on your back or stomach, does a better job of cleaning house. And, sleeping on your left side maximizes your body’s circulation, because most venous return travels up your right side and these veins can be compressed when you lie on them. However, getting good sleep is much more important than worrying about whether or not you sleep on your side and what side you sleep on.

REF.  Dr. Elsie Taveras “Lack of Sleep linked to behavioral problems I kids”, March 2017, Reuters.com. “ Children who aren’t getting the recommended amount of sleep (>11 hours) have more difficulties with attention, with emotional control, wit reasoning, with problem solving, and also have behavioral problems.” …”The more chaotic and less predictable a sleep schedule, the more difficulty kids tend to have with sleep.” Consequences of sleep deprivation include: problems in school due to poor concentration, falling asleep in classes, problems with teachers; behavioral issues due to poor impulse control and bullying; mental disorders such as ADHD and depression; and, negativity and stubbornness resulting in a poor attitude and poor cooperation, isolation, poor performance, and poor social skills. While adults get lethargic with a lack of sleep, kids speed-up, become emotionally weak and violent, and have mood swings. They are unable to understand what is wrong with them.

SUGGESTIONS:

  1. Maintain a regular bedtime and getting-up time, including weekends and holidays, if possible.
  2. Create a winding-down time in the evening, and a relaxed bedtime ritual—eg. reading or telling stories together, and tucking-in for the night with a lullaby.
  3. Avoid caffeine, colas, and chocolate at night.
  4. Avoid heavy meals and sweets at night.
  5. Keep the bedroom a comfortable temperature (around 65 degrees), with darkness and quiet.
  6. Avoid all screens and music.
  7. Exercise for at least 60-minutes daily, but not within 2 hours of bedtime.
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EXERCISE AS MEDICINE AND ENHANCED PERFORMANCE

EXERCISE AS MEDICINE AND ENHANCED PERFORMANCE

Dr. Chuck Wile is a supervising physician at Cheng Integrative Health Center/Doctor’s Weight Loss Center, Columbia, SC.  Dr. Wile served in the US Air Force Medical corp and is a retired Air Force Colonel.

“Eating alone will not keep a man well, he must also take exercise.” {Hippocrates, 400 B.C.)   

“Exercise is loathsome.” {Mark Twain}   

“The best exercise is the one you like because then you are likely to stick with it over time.” {Martin Bibals}        

“GET MOVING; KEEP MOVING; AND, DON’T STOP.” {Jordan D. Metzl, MD}

          Regular exercise is a key to health, wellness and longevity. In the early 1900s, Medicine shifted its focus from the prevention of disease to its treatment. Simultaneously and coincidentally, Americans fell in love with spectator sports. Physical activity was no longer the medicine for the masses, but it became the privilege of elite athletes. We forgot/ignored the benefits of exercising: Regular exercise will help you to sleep better. Exercising increases blood flow to the brain helping to create new brain cells and blood vessels because of the increased Brain-Derived Neurotropic Factor (BDNF). This repairs and protects the brain cells from degeneration, both by repairing and restoring cellular mechanisms. Exercising releases endorphins and other chemicals that dull pain and improve your mood, especially decreasing your anxiety and lightening your depression. This helps with building and maintaining your resiliency.

          Regular exercise enhances memory and quicker learning. Your work will be more productive. Also, you’re medical costs will be less. You’ll have decreased risks for developing chronic diseases: for example, type 2  Diabetes is both preventable and treatable, as well as CAD and CVD. Exercising helps to burn fat better for energy, causing fat cells to shrink. {Since muscle mass is heavier than fat, don’t be over-focused on your scales, because your weight may actually increase while your body fat decreases. The real question is do your clothes fit better?} You can help to prevent and treat dementias. The increased blood flow reduces toxins (beta-amyloid and alpha-synuclein) that cause aging and cell death, and reduces inflammation. You can protect your chromosomal telomeres and slow your cellular aging: exercise increases Nuclear Respiratory Factor 1 (NRF1) which protects telomeres from shortening. You can increase blood flow to your skin and help wounds to heal faster. By producing weight bearing muscle contractions, you can make your muscles grow, and, also, increase your bone density. You can decrease your risk for at least 13 different types of cancer, including breast, ovarian and colon cancers. Regular exercising can help with rehabilitation from strokes, and help to  improve other chronic physical diseases and emotional problems.

          You will experience few or no adverse side-effects. Your costs will be low or absent. Exercise is safer and more effective than any drug on the market for health. Although it is much easier to take a pill for what ails you, the risks and side-effects are much more problematic. Exercise benefits both young and old, women who are pregnant, and people who are well or ill. You don’t need a fancy health club, clothes or equipment. JUST MOVE. ***Some exercise is better than none, and even a little exercise can do you a lot of good.

          Humans are notoriously bad at assessing the long-term benefits and risks of their lifestyle choices. The promise that: “exercise is good for you” is not a strong enough motivator to make regular exercising a part of one’s daily lifestyle and choices. Here is a glimpse at the problem: only 20% of Americans get the recommended 150 min of strength and aerobic training per week. More than 50% of “Baby Boomers” take zero exercise per week. Over 80 million Americans (over 6 years old) are inactive. Many schools have eliminated Gym classes from their curriculums. Half of High Schools don’t have weekly PE classes. Only 15% of Elementary Schools require PE 3 days per week. The result is Exercise Deficit Disorder. Long term consequences include: obesity;  increased osteoarthritis; increased low back pain; increased anxiety; increased depression; poor skin complexion; increased risks for heart disease, cancers, dementia, diabetes, and early death.

          Humans are motivated by immediate rewards. Although people are motivated for health and personal growth, knowledge alone is usually not sufficient to motivate change. And, the best motivation is not externally imposed, but, rather, elicited from within the person. The hardest part of any work-out regimen is getting started. Don’t be stopped by the most common excuses: “I’m too…busy, tired, lazy”. Know that exercise releases “feel good” endorphins, and there are ways to manage Delayed Onset Muscle Soreness (DOMs).

  1. ***Rather than focus on how good exercise is for your health, {which it really, really is, but it is a nebulous standard}, focus instead upon how exercise will give you an energy boost, improve your mood, enhance your productivity, and improve your sleep.
  2. PICK AN EXERCISE PROGRAM THAT YOU ENJOY. Forget the idea that exercise is supposed to hurt or feel like punishment, or else its not helping you– {“no pain, no gain”}, and, therefore, not worth doing. THIS ISN’T TRUE. If you enjoy something, then you will look forward to participating again, and, thus, you will most likely take the time to make the activity a part of your daily routine.
  3. Make exercising a social opportunity. A friend will offer you encouragement and will help to keep you accountable to yourself (possibly because you want to avoid their judgmental disappointment and disapproval). Exercise can be a time for high quality personal connections with your friend(s).
  4. Don’t back down from a little competition. A competitive atmosphere focuses on different qualities than a chummy  one does. With competition, the most active participants become the benchmarks to beat, and, thus, everyone’s activity level is increased. In a social group, people who drag their feet seem to draw the most attention, draw down the group energy, and give others an excuse for less participation.
  5. Make exercising non-negotiable. Be sure to make yourself prominent reminders, and, become aware of your self-sabotaging triggers. Your goal is to make regular exercising an automatic choice.
  6. Put money on the line. Studies show that people are motivated more by losses than by gains, and that they prefer getting rewards now rather than later. For example, if you are trying to lose weight, consider sending a donation, each day that you don’t meet your exercise goal, to an organization that you hate. AND, give yourself a non-food reward for accomplishing your goal.
  7. Use a Fitness Tracker. {In order to avoid unrealistic expectations, be aware of  the caveat: a tracker can’t force you to change your behavior, it is merely a source of information.} First, establish your exercise baseline for a week. Then start your exercise program and evaluate your data over time, looking for any improvements. Then, understand what you changed so that you can do it again and continue improving. Once you have a realistic assessment of your abilities, it will be easier for you to commit yourself to an individualized program and a long term behavioral change. Remember, “it’s the learning, not the digits.” {Ref. Martin Gibala: “The One Minute Workout.”}        

                                                 AEROBIC EXERCISING:

  1. Doing an aerobic exercise program for at least 30 minutes 3 times per week will maintain your body’s basal metabolic rate (BMR). Your weight will remain stable if there is a balance between caloric input and energy output. If you don’t have an aerobic program, and you restrict calories, your BMR will decrease to conserve energy during relative starvation. In order to lose weight and remain healthy, it is necessary to maintain a normal BMR, and then restrict caloric intake.  The WHO and US CDC recommend making your exercising goal be 150 minutes per week (divided however you choose) in order to effectively lose weight, achieve cardiovascular fitness, and enhance your overall health and sense of well-being. {This includes time for twice weekly muscle strengthening.} {NOTE:  For time-conscious people: ***High Intensity Interval Training can produce the same results in half the time.***} Think of your exercise as THE BEST MEDICINE you can give yourself. REMEMBER:  in order to prevent injuring yourself by over-doing it initially, because of your enthusiasm to see results quickly, when starting out: GO SLOWLY, and then steadily build up to your desired goal. And, more is NOT necessarily better. There is a “sweet zone”. Too much exercising can stress your joints and your heart-lung capacity.
  2. Look OUTWARD (rather than the usual advice to look inward) to support your motivations for exercise. Motivation is often thought of as a quantity of inward reserve, and people often lament its absence as a personality flaw. Instead, manipulate your environment to support your motivation. For example, purchase an audiobook that you’ll really enjoy and look forward to listening to, and make it available ONLY when working out. Your desire to engage with the plot will support your motivation to exercise.
  3. When choosing an aerobic exercise activity, have FUN! Pick something that you will enjoy doing so that you will incorporate it into your lifestyle changes. If you go power walking, walk with a partner that enjoys a good conversation. Or, vary your activities from working out at a gym, to swimming, to dancing in order to keep it fun. Or, create your own energetic music CDs so that you can crank up the volume for an exuberant work out. Try exercising mindfully: bring attention to your breath, your steps, your surroundings, and you will find that your pains will be alleviated.
  4. If you choose RUNNING more is NOT better, especially as we get older. A 2 to 3 mile run is all that is needed. Runners with the greatest longevity ran at a slow to moderate speed for 1 to 2 hours/week. Time is required for recuperation after a work-out. After age 45, people generally have their joints feel better after a brisk walk compared to a run. Women runners have a greater risk to injuring their bodies than men. Women have higher arches, and, when running, point their toes outward, and land with a heel strike which increases their skeletal impact. Also, they generally have less hip and core body strength, have an anatomical shift in their hips and their knee alignments, and have increased body fat. {In contrast, women have more joint flexibility than men, and they are better at pacing themselves in a race.}  Remember that stretching and warming-up your muscles is important to preventing injuries. Also, remember to stretch again after running. If you suffer from arthritis, it is much better to participate in non-impact aerobic activities such as swimming, working out on a glider or an elliptical trainer, or rowing.
  5.           However, a theory proposed by Dennis Bramble and Daniel Lieberman in a paper published in Nature in 2004 proposes that humans are born to run and to run far. The theory proposes that early humans evolved endurance adaptations for running to be able to chase prey animals “until the animals collapsed from exhaustion and heat stroke. Winning the footrace meant dinner. In addition to being furless, we have far more sweat glands than most other mammals, giving us an advantage over furrier animals that have to stop and pant to cool down. A larger gluteus maximus muscle—a big butt—is a distinctively human feature.We rely on it minimally for walking, but it’s crucial to stabilizing us when we run. Our legs have long tendons—that act like springs, helping generate force and reducing the energy cost of running. And they don’t seem to provide much benefit to walking, another piece of evidence that our bodies are made for running.” {Reported in Discover Magazine, July/August 2018, pp. 50-51.}
  6.           “There are 2 types of muscle fibers: Type 1 (slower contracting or slow-twitch fibers) and Type 2 (faster contracting or fast-twitch fibers). Everyone has a mix of both fibers in their muscles. Fast-twitch fibers are for short, powerful bursts; they contract quickly but also fatigue quickly. Slow-twitch fibers have more mitochondria (the cell’s powerhouses that use oxygen to make energy) so they don’t fatigue as easily and are ideal for longer activities. Sprinters have more fast-twitch fibers, while endurance athletes have more slow-twitch. Although partly genetic, there’s some evidence we can train in order to change the proportion of fibers our muscle have.” {Reported in Discover Magazine, July/August 2018, p. 50.}
  7. WALKING lowers your risks for diseases and probably will extend your life. Walking helps to keep you limber longer and helps to make you feel happier. In a study of 80,000 women, their risk of breast cancer was decreased by 42% by walking for a few hours per week. Other studies similarly demonstrate a decreased risk of kidney and prostate cancer mortality by walking. Walking has the lowest “quit rate” of any exercise. In a study of 400,000 Taiwanese who walked for 15 minutes daily, they lived 3 years longer than their sedentary peers. A 5-minute walk outdoors can elevate your mood and enhance your creativity, decrease your anxiety and depression, and increase your sense of well-being. SUGGESTIONS for success: pick-up your pace so that it becomes a power-walk rather than a stroll. {Maintain a pace that makes you a little breathless when walking and talking.} Count your steps: your goal is 7,000 to 10,000 steps/day, with 3,000 purposeful steps. Break-up your day into 50-step mini-walks every 45 minutes. Walk with a group for mutual support.
  8. ***High-Intensity Interval Training (HIIT) alternates periods of intense exercise with periods of less-intense exercise or recovery time. “If you want the benefits of very time-efficient exercise, then you need to push hard. There is no way around that.” {Martin Gibals} For example, consider riding a stationary bike for 10-minutes 3 days per week for a total of 30 minutes per week: after a 3-minute warm-up, pedal very hard and fast for a 20-second spurt of intense energy, then pedal less hard for a minute, then repeating this sequence two additional times, followed by 3 more minutes of slower pedaling.
  9.                                                       TOTAL FITNESS
  10.           1)   In addition to regular aerobic exercising, Total Fitness is achieved by enhancing your muscle strength, doing regular stretching, and, improving your balance and coordination.
  11.           2)  What counts as moderate-intensity exercise? Brisk walking, playing with your kids, dog walking, carrying heavy groceries, mowing the grass with a push mower, raking leaves, car washing, gardening, snow shoveling, etc. when done for at least 10-minutes at a time. ALL movement counts. Plus, to protect against injuries and to build muscle and bone, you need interval strength training. In addition to using free weights and resistance training, Tai Chi, Yoga and Pilates are excellent forms of strength training.
  12.             3)  In studies, dynamic resistance training is superior to static (isometric) resistance training for building muscles through the full range of motion of your joints. Pilates and working out with Nautilus equipment are two example of effective dynamic resistance training.
  13.             4)  RESISTANCE TRAINING increases your muscle mass, thus, generating more strength, and faster muscle force (power). Unless you over do it, you won’t become muscle bound. Resistance training also helps to make your bones more dense. Ten million Americans (80% are women) have osteoporosis (thin and breakable bones). {A decrease in sex hormones with aging helps to create this common problem.}  Resistance training also helps to improve your metabolism, increase your glucose tolerance (or, said another way, decrease your insulin resistance) and decrease your risks from type 2 diabetes. It also helps to decrease both coronary artery disease and cerebrovascular disease risks. Other than doing free weight lifting or using a dynamic weight resistance machine, such as a Nautilus device, there are various simple ways to do resistance training such as: Yoga, Tai Chi, Pilates, using flexible bands, sitting up and down using a chair and your own body weight, swimming, doing Zumba dancing, doing heavy gardening such as raking and digging, doing vigorous house cleaning, taking the stairs rather than using an elevator, jumping rope, etc. The stronger you are,  the more self-esteem, confidence, and positive thinking you will usually have.  However, because resistance training requires work and effort, only about 20% of people actually follow strength training recommendations. PLEASE DON’T BE LAZY.
  14.               Resistance exercises have a greater impact on cognitive function than aerobic exercises. It increases blood flow to the brain, thus, increasing oxygenation and the provision of nutrients. It helps to promote angiogenesis from existing blood vessels and neurogenesis from stem cells in the hippocampus {an area responsible for organizing memories}. It increases the production of neurotransmitters: serotonin {which helps to regulate mood and sleep}, acetylcholine {which helps with cognition, learning and memory}, and GABA {the main inhibitory modulator}. It also increases neurotropins {proteins that regulate neuron survival}.  [Mavros, et. al. “Mediation of cognitive function improvements by strength gains after resistance training in older adults with mild cognitive impairment: outcomes of the study of mental and resistance training,” J. of the American Geriatric Society, October 2016.]
      1.             5)  In my opinion, Hatha Yoga and Pilates are the best ways to completely stretch your muscles and joints, tone and strengthen your muscles, especially your “core” abdominal muscles, and achieve overall physical fitness, and mental, emotional and spiritual balance, inner harmony, and peacefulness.
      2.             6)  I applaud the American Academy of Sports Medicine’s program: “Exercise Is Medicine”. They recommend that physicians should inquire about exercise with each health visit. They recommend following the 5 A’s approach: Ask, Advise, Agree, Assist, and Arrange. People should be asked about what barriers they face in order to exercise and what helps to facilitate their choice to exercise. After assessing a person’s physical activity level, the practitioner is advised to prescribe physical activities that the person will agree to pursue. Physical activity counseling can be offered along with referral resources to help facilitate the process. Within a person’s social and economic context, it is important to support and empower the person, just like a good coach, by emphasizing that they have both choices and competence. Motivational interviewing is useful to explore and resolve ambivalences and insecurities and to understand and encourage/support internal motivators for behavioral changes. By understanding a person’s values and goals, a health care provider can help people to envision a better future. Depending upon a person’s personality, they may choose to “leap-into the deep end of the pool” and make massive changes in their lifestyle, which can be disruptive and stressful.  Or,  they may choose to ease into the “shallow end of the pool” and take baby-steps, focusing upon small and measurable goals and achievements. Either way, the exercise prescription must be “patient-centered” and individualized in order to be effective for the long term. Setting goals work best when they are realistic, specific and present oriented. Challenges to maintaining changes is the rule and not the exception. Thus, it is very helpful to maintain a continued coaching partnership in order to  encourage and support a person’s health goals.
  1.     SUPPLEMENTS TO CONSIDER FOR ENHANCED ATHLETIC PERFORMANCE
  1. Consuming an over-abundance of calories for a long time will suppress the AMPK (adenosine monophosphate-activated protein kinase) system—the metabolic master switch. AMPK activation: reduces insulin resistance and supports glucose transport, inhibits the metabolic syndrome’s associated inflammation, increases utilization of stored fat for energy, improves mitochondrial fat burning, reduces weight gain by enhancing the effect of the anti-obesity hormone: adiponectin, and improves immune function and other bodily functions that support longevity. A suppressed AMPK system leaves the body in a state of continued energy storage and reduced energy utilization. Cutting calories forces the body to activate AMPK. Exercise is another powerful AMPK activating strategy. (Note: Only when you are adding exercising will calorie reduction be truly effective for weight loss.) ***For people who have problems exercising because of physical problems, there are supplements to promote AMPK activation.*** Two documented ingredients include:  a) Gynostemma pentaphyllum and b) Trans-tiliroside. A proprietary product is available, called “AMPK Activator” from www.LifeExtension.com. Also,  Hesperidin, found in citrus peel extracts and in orange juice, activates AMPK, as does the medication Metformin. AMPK activation helps to remove excess stored fat, particularly metabolic abdominal fat, and to decrease metabolic syndrome risk factors. Increased AMPK activity also normalizes hyper-activated mTOR activity. {Excessive mTOR accelerates cell aging and malignant transformation, and depletes stem cells.}
  2. RE-FUEL YOUR MITOCHONDRIA:  “Mitochondrial Dysfunction” results in obesity, insulin resistance, diabetes, anxiety, depression, neuro-degenerative diseases, aging, chronic fatigue syndrome and fibromyalgia syndrome. {Consider: if the blood test Reverse T3 is high, then mitochondrial dysfunction is present.} The following NUTRIENTS can help to re-fuel the mitochondria energy generating centers in each cell:  a) D-Ribose 5 gm/tsp: 1-2 tsp three times per day. b) ALA (Alpha-Lipoic  or R-Lipoic Acid) 300 mg to 400 mg/day. c) CoQ 10 (or its activated form Ubiquinol) at least 200 mg/day. d) NADH (Nicotinamide Adenine Dinucleotide –reduced form) 10 mg twice per day. e) L-Carnitine 2,000 to 3,000 mg/day.
  3. Short term supplementation with powdered cherries boosts athletic performance. Using 480 mg of powdered cherries caused half-marathon runners to average 13% faster finish times compared to taking placebos. Inflammatory markers were 47% lower, and there were attenuated markers of muscle catabolism, a better maintained redox balance, increased performance, and post-run muscle pain faded faster. {J Int Soc Sports Nutr. 2016 May 26.}
  4.         Tart cherry juice is also helpful for osteoarthritis pain and other inflammatory conditions, particularly gout. It is easier to take when mixed in a fruit smoothie. For example, 100 patients with a history of gout received 1 Tbs of Brownswood Acres tart cherry juice concentrate [which can be obtained at Whole Foods] twice per day. 92% of the patients had >50% reduction in the number of gout attacks. Their uric acid levels did not change. Tart cherry constituents can switch critical genes off and on; modulate cell-signaling molecules like tumor necrosis factor; and, target multiple cardiovascular factors producing a 65% reduction in early mortality. Tart cherries surpass red wine and dark chocolate in antioxidant content. Tart cherries are rich in the flavonoid anthocyanin and contain novel anthocyanins absent from blueberries or bilberries. They also contain higher amounts of phenolics and anthocyanins than sweet cherries. It is useful for treating osteoarthritis, inflammation related to obesity and the metabolic syndrome, and lowering triglycerides associated with cardiovascular disease.
  5.           Rich sources of polyphenolic compounds, such as tart cherries, play a neuro-protective role and exert a variety of anti-carcinogenic effects. 20 women were given 2, 10.5 ounce bottles of tart cherry juice or a placebo for 3 weeks. Those taking the cherry juice had reduced levels of the inflammatory marker C-reactive protein. Obese adults given 8 ounces daily of tart cherry juice for 4 weeks had markedly decreased inflammatory markers: sedimentation rates, tumor necrosis factor levels, and monocyte chemotactic protein. Runners were given tart cherry juice or a control drink for 5 days before, on the day of, and for 2 days after a marathon race. Runners drinking the tart cherry juice had significantly lower inflammation biomarkers (Interleukin-6 and C-reactive protein) than the placebo group. They also recovered isometric strength quicker and demonstrated an accelerated recovery following strenuous exercise. Runners in a double-blind trial participating in a 24-hour relay race drank two 355 ml beverages containing either tart cherry juice or a placebo daily for 1 week prior to the race and during the race. Both groups reported muscle pain after the race but the runners who drank tart cherry juice experienced a substantially smaller pain increase after the race.
  6. Cordyceps sinensis extract is a parasitic fungus that grows on caterpillar larvae native to high altitude regions of China, Nepal and Tibet. It has pharmacologically active anti-oxidant, anti-inflammatory and lipid lowering properties. It enhances the immune system and increases stamina for endurance athletes through greater aerobic capacity and oxygen use. It stabilizes blood sugar metabolism and increases libido and sexual functionality.
  7. Velvet Deer Antler (VDA) is a pillar of Traditional Chinese Medicine used to strengthen and replenish blood, reduce and reverse signs of aging, relieve pain and inflammation, overcome exhaustion, accelerate wound healing, reduce blood pressure, treat insomnia, relieve headaches, improve mood and memory, help infertility, restore vitality, heighten libido and increase muscle strength and endurance. One key component is a growth hormone called insulin-like growth factor “IGF-1”. This keeps muscles strong and helps to heal cartilage and tendon injuries. Also, glycosaminoglycans are plentiful which help to restore healthy cartilage. It contains Type II collagen along with a rich supply of minerals including potassium, sodium, calcium, copper, zinc, iron, selenium, magnesium and phosphorus. A proprietary product called “VDA Pure” can be obtained from www.VDAPure.com . The recommended dose is 2 caps daily before eating.
  8. Asian ginseng (Panax ginseng) and Siberian ginseng (Eleutherococcus senticosus) “can be used as a tonic to combat feelings of lassitude and debility, lack of energy and ability to concentrate, and during convalescence,” according to the German Commission E advisory about herbs.  The suggested dose is 1 tsp steeped in a cup of boiling water to make a tea.  Ginseng can improve athletic performance when taken regularly for up to a month, and it can also beneficially stimulate the immune system.  It is an adaptogen for managing adrenal stress, and improves alertness, coordination and memory.
  9. Dimethylglycine (DMG): is an amino acid adaptogen made in the liver which diminishes in quantity as we age. It was formerly promoted by athletes as “vitamin B-15”. DMG aids in critical processes associated with cellular respiration and energy production, immune response, and oxygen utilization in the body. It helps to prevent fatigue, improve physical endurance and performance, and supports mental clarity. DMG stimulates both antibody response and cellular immunity. It has also been used to support cardiac function in heart disease. Additionally, it makes all other nutrients taken with it work better. High quality DMG can be obtained from www.TargetedNutrients.com . Typically usage is 1 cap once or twice daily.
  10. Beetroot juice can raise serum nitrate levels which can improve athletic performance, lower blood pressure and protect against glaucoma. Nitrate is metabolized to nitric oxide which helps to dilate smooth muscles, and improve blood vessel flexibility and tone. It enables athletes to use less oxygen while exercising at the same intensity, which makes exercising easier, and one can continue it for longer. Blood nitrate levels peak two to three hours after consuming beetroot, and remain elevated for six to nine hours. The key is to drink beetroot juice three hours before exercising, and take it daily to maintain higher blood levels of nitrate. One of the leading 2.4 ounce beetroot “sport shots”, called “Beet It”, provides 400 mg. Most blood pressure lowering studies have used 180 mg of beetroot juice daily. So, you could take half of “Beet It” one day and half the next. Serious athletes can use one or two shots daily. Two shots will saturate the blood stream and provide maximum benefits, so larger amounts will have no additional effects. Be aware, your urine may turn pink, but this is a harmless side effect.
  11. Resistance training is supported by key nutrients. And, when used together, they  provide synergistic benefits: a) Whey Protein: helps to preserve lean body mass. Although the Institute of Medicine recommends 0.8 grams/kg body weight (which equals about 58 gm in an aging adult weighing 160 lbs), the optimal dose is 1.0 to 1.3 gm/kg body weight (which equals 73 to 94 gm in an aging adult weighing 160 lbs). b) Creatine:  improves the Type 2 (fast contracting) muscle fibers that commonly atrophy in older adults. It helps to increase muscle force, power and mass and to decrease fatigue. c) Branched Chain Amino Acids (BCAAs):  especially leucine, isoleucine and valine (which are also found in whey protein), helps to promote muscle tissue synthesis. Also, they help to decrease the perception of exertion and mental fatigue during exercising. d) Glutamine:  helps to replenish muscle stores of glycogen (a ready source of stored energy). Also, in healthy adults, taking 2 gm of the amino acid glutamine will increase the output of human growth hormone by four times. e) Vitamin D3:  helps to preserve Type 2 muscle fibers and to protect cognitive function. f) Carnitine:  is an amino acid which helps to transport fatty acids into the intracellular mitochondria for fuel for the production of ATP energy. It supports exercise recovery, enhances performance, and decreases general fatigue. Propionyl-L-carnitine helps to regulate levels of ATP. g) D-Ribose:  helps to facilitate ATP production and to facilitate the speed of muscle function recovery after high-intensity exercising.  h) Omega-3 Fatty Acids:  eicosapentaenoic acid (EPA) helps to preserve muscle mass. And, both decosahexaenoic acid (DHA) and EPA are anti-inflammatory, and help to manage sarcopenia. 6 gm of deep sea fish oil can help to eliminate muscle soreness after resistance training.

                   DELAYED ONSET MUSCLE SORENESS (DOMS)

          Immediate muscle soreness is due to the partial metabolism of glucose (for energy) into lactic acid, which accumulates waiting for increased oxygenation after an exertion has finished, in order to be fully metabolize into carbon dioxide and water: the “oxygen debt”. The results of the incomplete oxidation of glucose  into lactate resolves within a few hours after exercise. DOMS occurs a day or two later as a consequence of repairing the micro-tears in the muscles caused by the exercise. The soreness, stiffness, mild swelling, tenderness, decreased strength and decreased range-of-motion will resolve in a few days. And, with your next exercise, you will be stronger and DOMS will be milder. Since it takes time for healing, it is important to space-out your resistance training during the week.

          You CAN have gain without (a lot of) pain. Drinking 2 cups of tart cherry juice can reduce both exercise-induced  inflammation and DOMS. {Be aware of  consuming the extra calories.} NOTE: A pre-emptive use of NSAIDs the day before and the day of a long distance race did NOT reduce DOMS (compared to non-users), and the users had mild endotoxemia due to the consequent drug-induced leaky-gut. Using NSAIDs intermittently for pain management after exercising may be helpful, if needed. BOTH localized Cold Therapy and Heat Therapy can reduce joint and muscle soreness, but cold is superior. However, tub hopping from hot water to cold water and repeating, probably isn’t worth the effort. Therapeutic Massage can help with DOMS. {Most studies look at massage within 3 hours after exercising for at least 20 minutes.} A foam roller is a low-cost alternative for self-massaging.

                  PRECISION EXERCISE RECOMMENDATIONS

  1. For Weight Management:  Initially, focus on adjusting your diet to decrease your total calorie intake.  Adjusting one significant lifestyle change at a time is a successful strategy to increase your own compliance and persistence. {For example, a decreased input of 500 cal/day equals 3,500 cal/week, which equals 1 pound of body fat reduced per week. Compare this to vigorous walking for 2 hours which equals using 500 cal.} In a 12-week comparison study, people who attended Weight Watchers lost about 9 lbs, versus people who simply worked-out at a Gym, who lost about 3 lbs. So, initially establish a structured eating-plan that you will adhere to, that includes reducing your portion size and the amount of food that you actually consume. And, for exercise, at first, simply determine to move more.
  2.           Once you have experienced successful weight loss, then combine your dieting with exercise. {It becomes easier once you have lost some weight and feel better rather than when you feel heavy and lack energy.} Pair cardio training with resistance training. Cardio activities burns calories and resistance training keeps you toned so that you lose fat rather than muscle. People who regularly work-out are twice as likely to keep the weight off than those who don’t. Exercise stimulates hormones which signal burning more fat as fuel. Emphasize to yourself how much better you feel when you are active. This may help to cancel-out any feelings of deprivation which could result in self-sabotaging behaviors. Remember that exercising is NOT a free-license to binge eating.
  3. To improve your Stress level, Self-Esteem and Mood:  In a 1999 study at Duke University, people who did aerobic exercise for 45-minutes 3x/week improved their moods equivalent to matched sedentary people using the SSRI Zoloft. Exercise increased their serotonin levels and their endorphin levels, and decreased their cortisol levels. The effect on mood only lasted for about 24 hours, so, regular exercise is the key to success. Mix-up your activities for fun and fitness: vary the kinds of exercise, frequency, timing and intensity. Remember that you need both cardio and strength training.
  4. To increase your Energy and decrease your Fatigue:  try a low to moderate intensity exertion for 20 minutes, 3 to 4 times per week. You will feel better within 4 weeks for all conditions. The intracellular size and number of your mitochondria {energy centers} will increase. You will increase burning your fat for energy, decrease your insulin resistance with a consequent good decrease in your glycation process, and balance both your intracellular and extracellular salts and fluids. You will sleep better: fall asleep quicker, remain asleep longer, and awaken more refreshed. Exercise energizes you. Don’t give-in to feeling drained of energy. Fake yourself-out: instead of saying that you feel “too tired”, say that you will walk for just 10-minutes—you’ll likely go longer because you will start to feel better.
  5. To ease chronic health problems and limit medical visits:  monitor yourself with a fitness tracking device such as FitBit or a Garmin watch. All movement counts. An encouraging 2013 study compared people doing short activity bursts, such as raking leaves or pacing when talking on the phone, with 150 min/week of aerobic bike riding. The groups had similar BP, lipid levels, waist circumference, and C-reactive protein inflammatory markers. When starting out: be sure to see a Pro and Go Slow. Increased endorphins will ease your pains. Try to minimize IMPACT aerobic activities: your joints will feel happier because they will be better lubricated and respond to inflammation more effectively, thus, easing your arthritis. Your heart rate and blood pressure will decrease, and your glucose intolerance will improve. Anticipate a slow and steady improvement.

                             EXERCISE AND CARDIOVASCULAR DISEASE

          An observational study published in Circulation, 5/15/2018, of 11,000 adults in the Atherosclerosis Risk in Communities (ARIC) study, demonstrated people doing 150 minutes of vigorous exercise weekly were 31% less likely to develop congestive heart failure (CHF). Couch potatoes who started exercising decreased their risk of CHF by 23%. This study supports the JAMA July 22/29, 2009 study of 20,000 male physicians who had a healthy lifestyle for more than 20 years who developed significantly less CHF. A similar study of 36,000 Swedish women published in the Archives of Internal Medicine, 5/11/2009 who were eating a DASH diet (to manage hypertension) along with doing regular exercise for 7 years had a 37% decrease in CHF.

                     THE PROBLEM OF SARCOPENIC OBESITY IN AGING

          After age 50 there is an exponential drop in muscle function. (This starts to occur after age 40 and accelerates after age 75.) Sarcopenia means a loss of muscle mass, strength and function. There is a faster decline in Type 2 (fast contracting) muscle fibers compared to Type 1 (slower contracting) muscle fibers. Therefore, there is a decreased speed of muscle contractions with aging. Evaluating muscle function and strength is more important than evaluating muscle mass. Muscle “power” is a function of force-strength and velocity. {Imagine the difference between just placing a fist against the side of a head (force) and then adding velocity to the fist placement (power)}. Power drops quicker than muscle mass. With decreased muscle power, especially in the core and lower extremities, there is decreased capacity to accomplish the functional tasks of daily living and an increased risk of falls and injuries, with an increased risk of consequent death. Because women start out with less power then men, older women have increased problems with a loss of balance and decreased muscle power which increases their risk of falls and hip and vertebral fractures (especially with their additional increased risk for osteoporosis.) This is primarily caused by suboptimal sex hormonal support, inadequate dietary protein intake and nutritional deficiencies, oxidative stress and inflammation. This is most often found in people who are physically sedentary and inactive.

          Obesity has become a significant increasing problem in America. In a study of nursing homes, in 1992 about 15% of patients (mostly women) had a BMI (Body Mass Index: weight divided by stature) of >30 (defining obesity). By 2002 the average BMI had increased to >25%. A fall risk for over-weight people was 15% compared to a fall risk for obese people of 25%. The combination of obesity plus sarcopenia (decreased muscle power) makes the loss of independence 2 to 3 times more likely because of diminished capacity for activities of daily living (ADL).

          Our aging population needs a combination of power training (eg. high velocity dynamic muscle resistance training using lower weights at higher speeds) twice per week along with aerobic interval training three times per week in order to improve their functional outcomes. While aerobic training helps the cardiovascular and cerebrovascular systems, resistance training provides superior protection against injuries. It stimulates human growth hormone which supports cell growth and regeneration. It also supports local mechano-growth factors. And, it enhances bio-identical hormone replacement therapy (BHRT) interventions.

           A report in the magazine The Week, 6/15/2018, (from reviewing an article on  MedicalNewsToday.com,) states that moving the large muscles of the legs (walking, climbing stairs, running) triggers brain stem cells to renew brain neurons. Researchers immobilized the hind legs of mice for 28 days then they examined the subventricular zone in their brains. They found a 70% decrease in neural stem cell activity. This helps to explain why people who are bedridden often deteriorate rapidly in their cognitive functions.

                                        JUST DO IT!   {Nike Shoes Slogan}

A good reference is “The Science Of Exercise” edited by Siobhan O’Connor and Mandy Oaklander, TIME Inc. Books, 2018.

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Coronary atherosclerosis is preventable and can be reversed

Highlights: 1/3 of Americans 45 years or older have atherosclerosis. Young and asymptomatic men with calcium deposits in the coronary artery have 12 times higher risk of develop coronary heart disease! Atherosclerosis kills! Atherosclerosis (esp. early stages) is preventable and reversible!

About Richard Cheng, M.D., Ph.D.. Dr. Cheng is director of Cheng Integrative Health Center/Doctor’s Weight Loss Center, Columbia, SC. He is also a Fellow of American Academy of Anti-Aging & Regenerative Medicine and a functional medicine consultant to the Queen Medical Hospital, Doha, Qatar. A medical graduate of Shanghai Medical University, Dr. Cheng served on the clinical staff at the National Center Institute, NIH as well as Chief of Laboratory Medicine, Army Hospital at Ft Jackson.

Brief Introduction: Calcium deposition into tissues other than our bones (called ectopic deposits) are commonly associated with chronic diseases and aging including coronary artery atherosclerosis. Proper nutrition supplements with or without other drug therapies (hormonal balance) can slow down or reverse atherosclerosis. Probably like me, you don’t want to wait to get started on this easy and inexpensive way of slowing down and reversing your CAD and aging process. We are offering you a great opportunity to participate in our clinical study. This is how it works: we will refer you to a local hospital or imaging center to for a Coronary Artery Calcium (CAC) score, a 10-minute, around $100 test which is also very safe. You will then follow our lifestyle counseling and take our TotoCell Nutrition Supplements (a simple powder packet, mix in water or juice and drink once a day). We’ll ask you to repeat the CAC test every 6 – 12 months for a total of 2 years. If you are interested in participating in this project, please email info@drwlc.com or call (803)233.3420 and ask for CAC Project.

Coronary artery atherosclerotic heart disease is the No. 1 killer in America! Coronary calcium deposits are a hallmark of atherosclerosis. Coronary artery calcium score (CAC) is a sensitive, specific and reliable indicator of atherosclerosis. Extensive lab research and preliminary clinical studies show atherosclerosis is primarily a nutrition deficiency disease and nutritional intervention can slow down or reverse atherosclerosis process.

1. Calcium excess is seen in many chronic diseases, in aging process and is involved in the mechanism leading to cell death.

Calcium is an essential nutrient in normal physiology. But increased levels of calcium both intra- and extra-cellularly have been well documented in nearly all chronic diseases and aging.
– The final mechanism for cell death is high level of intracellular calcium (23250754, 2220009).
– Toxins increase intracellular calcium (23160928, 22927718, 23049237).
– ALS, Parkinson’s, Alzheimer’s disease and many other chronic diseases show elevated intracellular calcium (20493207, 21884755, 21697951).
– Calcium channel blockers (CCBs) block the intracellular movement of calcium, thus effectively lowering the intracellular calcium levels. Originally developed as antihypertensive drugs, CCBs have many other effects than blood pressure lowering. CCBs prevent neurological damage from methylmercury in rats (8882354); long-acting CCBs decrease all-cause mortality (10323641, 10923432, 15716708, 19451836), CCBs use is inversely related to prostate cancer incidence (19451836), CCBs decrease cytoplasmic iron accumulation, the latter is implicated in malignant transformation (21860702).
– Ectopic calcifications occur in cancer patients frequently. In a study involving 23 prostate cancer patients, 22 showed prostate calcification (23308170). Women with the highest scores of bone density testing had an increased risk of developing breast cancer (9032046). Mammography on women with breast cancer often have macro and micro-calcifications (23370209).

2. Coronary artery calcium deposition is an integral part of atherosclerotic coronary heart disease.
– One third of Americans 45 years of age or older have arterial calcification (positive CAC)(15337212). Positive CAC not only indicates increased cardiac events and increased all-cause mortality, it also indicates a state of excess calcium load in the body. Anytime overt calcification is seen outside of the bones, a state of excess calcification exists by definition. Logically, a significant degree of calcium excess will be present well before calcium deposition finally occurs (Thomas Levy).
– In a large study involving over 4000 patients and following between 1 and 16 years, Progression of CAC was significantly associated with mortality (21163451).
– Another study involved 938 subjects of 50 years or older with the median follow up of 21.5 months. Cardiovascular or all cause mortality were measured as Hazard Ratios (HR). Compared the CAC 0; CAC 1-100, 3.00; CAC 101-1000, 6.13; CAC >1000, 10.93 (22357989).
– CAC is a sensitive exam to assess atherosclerosis. It is also inexpensive and safe (PMID: 26965738; 16365194; 22357989; 11451257). The radiation dosage of a modern day CAC is only a small fraction of the natural background radiation in the United States. A CAC exam takes less than 10 minutes and costs around $100.
– Any detectable coronary calcium in young, asymptomatic men was associated with a 12-fold increased risk in coronary heart disease (20730016).
– CAC reliably predict not only death from heart disease, but also death from all causes (22357989, 23206921), indicating that the main indicator of extracellular calcium excess, ectopic calcium deposition, reliably predicts increased risk of death from any chronic degenerative disease. This further indicates that the presence of a chronic extracellular calcium excess will reliably indicate secondary chronic intracellular calcium excess.

3. How to reduce coronary calcium excess?

Vit C on calcium. VC plays an essential role in the etiology of atherosclerosis (Levy, T. 2011;
– Men with highest levels of plasma VC had the lowest CAC (15003962).
– Increased inflammatory markers, always associated with lower levels of VC, related to increased progress of CAC (23340891).
– VC promotes calcium solubility (Ruskin, S. 1938. Am J of Dig Dis 5:408-411.)
– People with highest levels of VC have the longest lifespan with reduced all-cause mortality (11247548, 17442130).

Magnesium (Mg) on calcium.
– Mg is a natural antagonist of calcium (Ca) channel blocker (10618948).
– Mg dissolves Ca deposits (2133625).
– Mg deficiency increases intracellular Ca (11811859).
– Mg increases bone density and decreases fracture rates (16274367).
– Mg decreases all-cause mortality (7908076, 12845247).

Vit K2 on calcium.
– activates proteins like osteocalcin and MGP which inhibit ectopic calcifications (22416724).
– helps dissolving existing calcifications (17138823).
– is inversely related to all-cause mortality and aortic calcification (15514282).
– neutralizes Warfarin (which promotes ectopic calcification)(9743228).
– decreases fracture and improves bone quality (19949271).
– decreases cardiac and all-cause mortality (15514282).

Vit D on calcium.
– in therapeutic range, decreases all-cause mortality (19953106, 23446902).

Essential fatty acids on calcium.
– some with calcium channel blocking effect (20206488, 21664114).
– high levels protect bone loss (22392875, 22507833).
– blood levels inversely related to all-cause mortality (20551373).

Estrogen on calcium.
– decreases coronary calcification (22747181);
– the higher the blood level, the lower CAC scores (20512078);
– inhibits a protein that promotes calcification (20595654);
– deficiency increases inflammatory cytokines (11815671);
– lessens incidence of osteoporotic fractures (22612613);
– deficiency increases all-cause mortality (23460719).

Testosterone on calcium.
– deficiency a clear risk factor (2246104);
– deficiency increases all-cause mortality (21143567, 22280063);
– has calcium channel blocking effect (21439799);
– inversely related to CAC (22522505).

Lysine and proline play important roles in atherosclerotic plaque formation and are able to prevent or reduce the plaques. Lysine binds to circulating Lp(a) as well as dislodge Lp(a) that’s bound to atherosclerotic plaque. This makes lysine an additional important supplement for reversing/resolving atherosclerosis (Rath, M. Reducing the risk for cardiovascular disease with nutritional supplements. J of Orthomol Med 7(3):153-162). Lysine + Vit C were repeatedly observed to be able to dramatically reduce anginal chest pain (Linus Pauling).

4. Preliminary clinical studies show atherosclerosis can be slowed or even reversed.
– Katz (1992) reported a case of 62 year old female heart patient. She was given Vit C, proline and lysine along with other supplements. Repeat angiography of her heart showed significant improvement over a period of 19-months.
– Pauling (1991, 1993) reported 2 cases with significant atherosclerotic blockages in their coronary arteries responding very well to vitamin C and lysine. One of them, a 62 years old woman showed a reduction from 75% to 40% of her right coronary artery blockage and from 50% to no blockage of her left coronary artery after 19 months of Vit C and lysine supplementation. The 3rd patient didn’t have visible blockage but clinically responded very well to Vit C and lysine with reduced anginal chest pain.
– Rath and Niedzwiecki in 1996 reported the significant regression of atherosclerosis with nutrition therapy. They reported their study of 55 patients with documented coronary artery disease. They used coronary calcium score as an index of evolving coronary atherosclerosis. They found: annual progression rate without intervention to be 44%; 15% decrease of progression over one year with supplements; No progression with patients with early stages of coronary atherosclerosis. Their nutritional program, however, contained 150 mg calcium and 1.5 mg copper daily. Their vitamin C dose was 2700 mg, Vit D only 600 IU, L-Lysine only 450 mg and L-Proline only 450 mg. And yet a clearly positive response compared to no nutritional intervention was seen.

Summary: Excess calcium accumulation, reflected by ectopic calcium deposits in soft tissues including coronary artery, is an important part of coronary heart disease, many other chronic diseases and aging. Coronary calcium score (CAC) is a sensitive, reliable, safe and inexpensive test to detect the presence, and monitor the progression of, heart disease and aging. Modified and advanced nutrition program including Vit C, Mg, K2, D3, proline, lysine and other vitamins and nutrients can slow down or reverse coronary heart disease.

References:

Most references cited can be found in Pubmed.com with their PMID number in (). References without PMID numbers are listed below.

Levy, Thomas. Primal Panacea. Medforx Publishing. 1st Ed. 2011

Levy, T. STOP AMERICA’S #1 KILLER! Medfox Publishing, 2nd Ed. 2015

Pauling, L. Case report: lysine/ascorbate-related amelioration of angina pectoris. 1991 Journal of Orthomolecular Medicine 6(3&4):144-146.

Pauling, L.Third case report on lysine-ascorbate amelioration of angina pectoris. 1993 Journal of Orthomolecular Medicine 8(3):137-138.

Rath and Niedzwiecki. Nutritional supplement program halts progression of early atherosclerosis documented by ultrafast computed tomography. 1996 J. of Applied Nutrition 48:68-78. http://www4fr.dr-rath-foundation.org/bibliotheque/publications_scientifiques/dr_rath/pub18.html)

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Exercise (HIIT)

One of the easy and probably the most effective exercise regimen is High Intensity High Interval Training (HIIT). HIIT can be done at almost all ages, almost anywhere, with or without any special equipment. Best of all, you can do it at home!

This is how to do it:

Warm up for 15 minutes, adding a few 20-second bursts at the end to prepare for the workout. Run, bike, or row for 30 seconds at a nearly all-out effort. Take three minutes active recovery and repeat the 30 on/3 off pattern five or six more times. Finish with a 10-minute cool down.  You can do this on a stationary bike, or in a swim pool, or outside on the grassland, or even up and down the stairs.  Of course, make sure you do this in a safe environment.  You don’t want to hurt yourself nor others who may be around.  Repeat this 3-5 times a week.

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Healthy Eating Habits

Healthy Eating Habits:

  1. Eat your last meal at least 3 hours before your bed time (before 7 pm for most people).
  2. Wait between 13 and 18 hours before you eat another meal.  In other words, if you eat your supper of the previous day at around 7 pm, then don’t eat breakfast until at least 8 am, or better, until 12 noon!  This is intermittent fasting (13-18 hours fasting without food, you can drink water though) allows your mitochondria (an important cellular organ in metabolism) to recover.
  3. The first meal of the day should be the biggest,  should be heavily fat with 80-90% of the calories from healthy fat. One won’t feel much hungry throughout the day after such a fatty meal.
  4. Try to fast for at least 24 hours a week (e.g., on a Saturday), drinking water only.

The above measures are proven to improve your health, improving your mitochondria and helps you to lose weight.

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Our New Weight Management Programs

Introduction: Obesity and overweight are caused by multiple factors, are often an indication of unhealthy lifestyle or underlying health problems.  Some of the contributing factors are under your control but others require medical intervention.  At Cheng Integrative Health Center/Doctor’s Weight Loss Center, we never stop learning, researching and developing new ways to help our patients to achieve better health.  The following list of weight management programs is a combination of different ingredients targeting different causes of obesity and chronic diseases.  The more causes we target, the more effective the program will be.  Of course, in medicine, there is no “One size fits all” solution, we provided customized services based on your needs.  Also, at Cheng Integrative Health Center (a full service anti-aging/functional medicine clinic), we offer much more medical services than listed here.  Just talk to one of us. 

 hCGPhenKetoDiet Plus:  

  • Our most comprehensive program, it consists of prescription appetite suppressants, fat busting hCG, TotoCell Nutrients, Liver Detox, large dose VC, ketogenic diet and exercise coaching. This integrative program targets most important causes of our modern-day diseases: elevated oxidative stress (free radicals), damaged mitochondria, overloaded toxicity and carbohydrate-dominant metabolism. The program helps to break the carb craving and facilitate fat burning, by switching your body from burning carbohydrates (dirty fuel) to burning healthy fat (cleaner fuel) as fuel. This program not only helps you to lose weight, to lay the foundation of a healthy lifestyle, but also to improve other chronic diseases that one may have. This program is particularly suitable to those who are in relatively poor health with not just obesity/overweight, but also with other chronic issues such as lack of energy (fatigue), mental fog, poor sleep, dysfunctional tract, body aches, diabetes, hypertension or high blood lipids, heart disease, or autoimmune disorders, to name just a few. 
  • Regular (initial and then every 1-3 months) office visits required.  
  • Costs:  Initial $599, then $549. 

hCGPhenKetoDiet 

  • Our most comprehensive program, it consists of prescription appetite suppressants, fat busting hCG, TotoCell Nutrients, large dose VC, ketogenic diet and exercise coaching. This integrative program targets most important causes of our modern-day diseases: elevated oxidative stress (free radicals), damaged mitochondria, overloaded toxicity and carbohydrate-dominant metabolism. The program helps to break the carb craving and facilitate fat burning, by switching your body from burning carbohydrates (dirty fuel) to burning healthy fat (cleaner fuel) as fuel. This program not only helps you to lose weight, to lay the foundation of a healthy lifestyle, but also to improve other chronic diseases that one may have. This program is particularly suitable to those who are in relatively poor health with not just obesity/overweight, but also with other chronic issues such as lack of energy (fatigue), mental fog, poor sleep, dysfunctional tract, body aches, diabetes, hypertension or high blood lipids, heart disease, or autoimmune disorders, to name just a few.  This program is similar to our hCG-Phen-KetoDiet Plus, just a less expensive version without Liver Detox.  
  • Regular (initial and then every 1-3 months) office visits required.  
  • Costs:  Initial $479, then $429. 

hCGKetoDiet Plus: 

  • Our most comprehensive program, it consists of fat busting hCG, TotoCell Nutrients, Liver Detox, large dose VC, ketogenic diet and exercise coaching. This integrative program targets most important causes of our modern-day diseases: elevated oxidative stress (free radicals), damaged mitochondria, overloaded toxicity and carbohydrate-dominant metabolism. The program helps to break the carb craving and facilitate fat burning, by switching your body from burning carbohydrates (dirty fuel) to burning healthy fat (cleaner fuel) as fuel. This program not only helps you to lose weight, to lay the foundation of a healthy lifestyle, but also to improve other chronic diseases that one may have. This program is particularly suitable to those who are in relatively poor health with not just obesity/overweight, but also with other chronic issues such as lack of energy (fatigue), mental fog, poor sleep, dysfunctional tract, body aches, diabetes, hypertension or high blood lipids, heart disease, or autoimmune disorders, to name just a few.  This program is similar to our hCG-Phen-KetoDiet Plus, just a less expensive version without appetite suppressant.  
  • Regular office visits recommended. 
  • Costs:  Initial $499, then $449. 

hCGKetoDiet: 

  • This program consists of fat busting hCG, TotoCell Nutrients, large dose VC, ketogenic diet and exercise coaching. This integrative program targets most important causes of our modern-day health: elevated oxidative stress (free radicals), damaged mitochondria, overloaded toxicity and carbohydrate-dominant metabolism. The program helps to break the carb craving and facilitates fat burning, by switching your body from burning carbohydrates (dirty fuel) to burning healthy fat (cleaner fuel) as fuel. This program not only helps you to lose weight, to lay the foundation for a healthy lifestyle, but also to improve other chronic diseases that one may have. This program is particularly suitable to those who are in relatively poor health with not just the weight issue, but also with other chronic issues such as fatigue, mental fog, poor sleep, dysfunctional tract, body aches, diabetes, hypertension or high blood lipids, heart disease, or autoimmune disorders, to name just a few.  Compared to our hCG-Phen-KetoDiet Plus, this program doesn’t use appetite suppressant and Liver Detox, and is less expensive.  
  • Regular office visits recommended. 
  • Costs:  Initial $399, then $349. 

PhenKetoDiet Plus: 

  • This program consists of prescription appetite suppressant, TotoCell Nutrients, Liver Detox, large dose VC, ketogenic diet and exercise coaching. This integrative program targets most important causes of our modern-day health: elevated oxidative stress (free radicals), damaged mitochondria, overloaded toxicity and carbohydrate-dominant metabolism. The program helps to break the carb craving and facilitates fat burning, by switching your body from burning carbohydrates (dirty fuel) to burning healthy fat (cleaner fuel) as fuel. This program not only helps you to lose weight, to lay the foundation for a healthy lifestyle, but also to improve other chronic diseases that one may have. This program is particularly suitable to those who are in relatively poor health with not just the weight issue, but also with other chronic issues such as fatigue, mental fog, poor sleep, dysfunctional tract, body aches, diabetes, hypertension or high blood lipids, heart disease, or autoimmune disorders, to name just a few.  Compared to our hCG-Phen-KetoDiet Plus, this program doesn’t use appetite suppressant, and is less expensive.  
  • Regular (initial and then every 1-3 months) office visits required.  
  • Costs:  Initial $369, then $319. 

PhenKetoDiet: 

  • This program consists of prescription appetite suppressant, TotoCell Nutrients, large dose VC, ketogenic diet and exercise coaching. This integrative program targets most important causes of our modern-day health: elevated oxidative stress (free radicals), damaged mitochondria, overloaded toxicity and carbohydrate-dominant metabolism. The program helps to break the carb craving and facilitates fat burning, by switching your body from burning carbohydrates (dirty fuel) to burning healthy fat (cleaner fuel) as fuel. This program not only helps you to lose weight, to lay the foundation for a healthy lifestyle, but also to improve other chronic diseases that one may have. This program is particularly suitable to those who are in relatively poor health with not just the weight issue, but also with other chronic issues such as fatigue, mental fog, poor sleep, dysfunctional tract, body aches, diabetes, hypertension or high blood lipids, heart disease, or autoimmune disorders, to name just a few.  Compared to our hCG-Phen-KetoDiet Plus, this program doesn’t use appetite suppressant and Liver Detox, and is less expensive.  
  • Regular (initial and then every 1-3 months) office visits required.  
  • Costs:  Initial $269, then $219. 

TotoCell-Detox-VC-KetoDiet: 

  • This program consists of fat busting hCG, TotoCell Nutrients, large dose VC, ketogenic diet and exercise coaching. This integrative program targets most important causes of our modern-day health: elevated oxidative stress (free radicals), damaged mitochondria, overloaded toxicity and carbohydrate-dominant metabolism. The program helps to break the carb craving and facilitates fat burning, by switching your body from burning carbohydrates (dirty fuel) to burning healthy fat (cleaner fuel) as fuel. This program not only helps you to lose weight, to lay the foundation for a healthy lifestyle, but also to improve other chronic diseases that one may have. This program is particularly suitable to those who are in relatively poor health with not just the weight issue, but also with other chronic issues such as fatigue, mental fog, poor sleep, dysfunctional tract, body aches, diabetes, hypertension or high blood lipids, heart disease, or autoimmune disorders, to name just a few.  Compared to our hCG-Phen-KetoDiet Plus, this program doesn’t use appetite suppressant and Liver Detox, and is less expensive.  
  • Regular office visits recommended. 
  • Costs:  Initial $289, then $289. 

Detox-VC-KetoDiet: 

  • This program consists of large dose VC, Liver Detox, ketogenic diet and exercise coaching. This program provides colon cleansing and whole body detox to improve metabolism and fat burning, with the KetoDiet helping you to switch from carb burning to fat burning. For those who need to lose less than 30 lbs, this is an economic and effective program.  
  • Regular office visits not required, but recommended. 
  • Costs:  Initial $139, then $139. 

TotoCellVCKetoDiet: 

  • This program consists of TotoCell Nutrients, large dose VC, ketogenic diet and exercise coaching. This program provides a wide spectrum of vitamins  and nutrients in optimal dosing including sufficient amounts of anti-oxidants and nutrients to boost mitochondrial function, two key factors for efficient metabolism and weight loss. For those who need to lose less than 30 lbs, this is an economic and effective program.  
  • Regular office visits not required, but recommended. 
  • Costs:  Initial $189, then $189. 

Others: please visit us for more info. 

 

 

 

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Presentation (@1pm Monday, Apr. 2nd, 2018):KetoDiet for Weight Loss and Health

In our regular Monday Lecture Series, Dr. Cheng will present on Ketogenic Diet (KetoDiet for short) for Weight Loss and Health. Topics to be discussed include:

  1. What is Ketogenic Diet?  Why (healthy) fats are good for you.  Why carbs are bad. KetoDiet, it‘s health benefits.
  2. Why is KetoDiet a foundation for all chronic disease?
    1. Case studies of KetoDiet and nutritional therapy for autoimmune diseases like psoriasis, skin rash.
  3. Nutritonal KetoDiet (for health or for chronic disease management) vs. Restricted KetoDiet (for cancer management).
  4. How to eat on ketogenic diet, introduce some keto recipes.
  5. Other factors in a healthy diet.
    1. Brief introduction to oxidative stress, mitochondrial health, and nutritional approach to health.
  6. How to combine KetoDiet with our current weight management protocols to better manage your weight and other chronic diseases (autoimmune disorders, diabetes, heart disease and even cancer).

Date and Time: Apr. 2nd, 2018, Monday, at 1 pm.

Address: Cheng Integrative Health Center/Doctor‘s Weight Loss Center, 6149 St. Andrews Rd., Columbia, SC 29212 (across stree from Cici’s Pizza, in fornt of the K-Mart).

Dr. Richard Cheng, MD

 

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Ketogenic Diet

Ketogenic means ketone producing.  ketone is produced when fats are digested.  So ketogenic diet means ketone producing diet, or in other words, ketogenic diet contains predominantly (healthy) fat, very little carbs and appropriate amounts of proteins. Ketogenic diet is different from Atkins diet, and is NOT a high fat diet.  The total calories one needs to consume is limited (to one’s needs).

Benefits of ketogenic diet:

  1. weight loss
  2. anti-inflammatory (anti-oxidant)
  3. lower cancer risk
  4. muscle strengthening
  5. inhibiting appetite
  6. reducing insulin levels (insulin inhibits fat release.  So this reduction in insulin release can help in more fat release and weight loss).

Ketogenic Diet:

  1. Healthy fats calories, about 80-85% of the total calories.
  2. Protein calories: about 10% of the total calories
  3. Carb calories: 5-8%.

Healthy Eating Habits:

  1. Intermittent Fasting: Every day there should a period of 13-18 hour without food intake, water is ok. One may choose either to skip breakfast or skip dinner.  Research shows this type of intermittent fasting boosts your mitochondrial (Mito) function.  Mito is the rechargeable battery in your cells.  Dysfunction of Mito is found to be a major contributor to most, if not all, chronic diseases esp. cancer, and aging, including obesity.
    1. Skipping breakfast. For example, if one finishes dinner at 7 pm, then do not eat anything until at least 8 am (13 hours fasting) or, even better, 11 am (16 hours).
    2. Skipping dinner: Don’t eat anything after 4pm.  Then eat breakfast at around 8-10 am (that’s 16-18 hours fasting).
  2. Ketogenic Diet (see above). One other reason why I advocate ketoDiet is the drastic reduction of carbohydrates.  Carbs cause lots of problems, esp. today’s carbs are heavily contaminated by all sorts of pesticides, herbicides, more so than other foods.  Carbs like wheat are a major to cause to many GI problems such as leaky gut which contribute to our autoimmune diseases and symptoms.  Allergy is just one of them. (I have been on the KetoDiet for a while now.  I really feel the difference: improved stamina, reduced seasonal allergy symptoms (I used to take Zyrtec daily.  But now, even in this pollen season, I have gone a whole week without needing Zyrtec.  This is amazing since for the last 25 years, I have never, NEVER, skipped several days, let alone a whole week, without an allergy pill).

 

 

 

 

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I have not taken my allergy pill for a whole week!

I didn’t realize it is the allergy season again, until I saw the yellow green stuff on the ground.  Funny thing is, I have been out of allergy pill (cetirizine) for a whole week.  I have been taking these allergy pills for the last 25 years or so.  Tried all of them, Allegra, Claritin, Zyrtec, and others.  I usually take one a day which controls my symptoms.  But during the pollen season, one tablet often is not enough, I would still develop symptoms, itching, sneezing and even runny nose.  A week ago, I ran out Cetirizine.  I have been busy, plus I didn’t notice any symptoms, so I waited until this morning to get my one year supply of Cetirizine at Sam’s Club.  A whole week without allergy pill!  This has not happened in the last 25 years! The secret? KetoDiet, Vit C & TotoCell Nutrients!

The reasons are obvious.  I have been on KetoDiet, Vit C & TotoCell Nutrients for quite a while now.  KetoDiet produces ketones in your body which are anti inflammation (allergy is an inflammation). Vit C and TotoCell Nutrients which contain optimal doses of anti oxidants (and other vitamins and mitochondrial supplements) are all anti inflammatory.  By definition, KetoDiet means minimal amounts of carbs.  Carbs are dirty fuels that produce lots of free radials, promoting inflammation.

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Case studies: Root cause for most autoimmune skin rash is GI and oxidative stress

Most, if not all autoimmune disorders have a dysfunctional gastrointestinal tract and elevated oxidative stress (a fancy word for non infectious inflammation including elevated free radicals). The common problems of the GU include Leaky Gut and Dysbiosis.

These GI conditions result in increased GI permeability which allows large food particles to enter the blood circulation, causing immune reactions against your own cells.  These immune reactions can happen anywhere in your body, some of the common sites include skin, thyroid, and joints.  When you go to visit a regular doctor, s/he mostly likely will treat these autoimmune diseases with steroid hormones or other symptomatic agents.  It’s difficult to cure these conditions.

With anti aging/functional medicine, we look at health and diseases holistically.  These autoimmune diseases including skin rashes often have a GI link and also elevated oxidative stress (a fancy word for inflammation).  By cleaning up the gut, changing the diet and adding enough antioxidants, people usually get significant improvement of their conditions, if not outright cure.  Here are just a few examples of such approach.

Case 1. Ms. T, with intestinal cancer and skin rash, came to our integrative cancer service, just about a month ago (Feb. 2018).  Her medical history includes GI complaints.  We started her on a restricted ketogenic diet (about 600 calories, no carbs, limited proteins a day), along with oral TotoCell Nutrients (loaded with anti oxidants, mitochondrial boosting agents) as well as facial cream.  In just about a month, her facial skin rash has improved significantly.  This case illustrates that skin rashes or other skin problems, oftentimes are a reflection of our internal problems, esp. GI problems.  Leaky Gut or other GI dysfunction allows foreign antigens to enter our blood circulation and wreak a havoc on our body, with skin rash as a clear reflection.  The elevated oxidative stress (a fancy word for increased non infectious inflammation) is a common biochemical pathway.  Our TotoCell Nutrients are designed to reduce oxidative stress and improve mitochondrial function.  KetoDiet is designed to reduce pollution contaminated carbs which increase oxidative stress as well as helpful in healing your gut. No Rx drug or steroid hormone was used.

Case 2. A young baby with skin rash of unknown causes.  Food allergy testing inconclusive.  Advised the father to feed the baby with healthy fats, to reduce significantly the carbs and also to take our TotoCell Nutrients oral + cream and probiotics.  The rash cleared quickly. The photos below are about 2 months apart, before and after treatment.

Case 3. A young man (32 yo), the father of the baby above.  Similar medical history, although his skin rash was all over the body, much more severe than that of the baby.  Sought medical help from several other doctors without much improvement.  We placed him on KetoDiet + large dose oral Vit C + Liver Detox + TotoCell Nutrients oral and skin cream, as well as probiotics.  The photos show the difference in a time span of 3 months (before and after).

Case 4. A young man, 34 yo, 300 lbs and skin rash (was diagnosed psoriasis elsewhere). He sought medical care of several other local doctors (Columbia, SC) without much improvement.  The patient was clearly depressed thanks to his weight and skin problems among others.  We put him on KetoDiet along with hCG, appetite suppressant, TotoCell Nutrients oral +Cream.  He stayed on KetoDiet, appetite suppressant and hCG for 11 months and was also on TotoCell Nutrients (oral and cream) for 3 months.  He has lost 103 lbs in 11 months and skin skin rashes are all gone now!

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