Thursday, May 9, 2019

Build your core muscles for a healthier, more active future

Diet-wise, I was good yesterday. I had a scrambled egg with salsa for breakfast; spinach salad with grilled chicken for lunch; a handful of almonds for a snack; a small piece of salmon, broccoli, and brown rice for dinner; and fruit for dessert.

I say “good” because I like to limit my carbohydrates to one meal a day—dinner, in this case. It makes me feel better than having carbs throughout the day. I’m not following any particular diet, but just trying to eat in what I think is a healthy way. That means having more protein-based meals than carb-based meals. It turns out I’m not alone.

The International Food Information Council Foundation reports that 50% of consumers are interested in including more protein in their diets and 37% believe protein helps with weight loss. A study in the May/June 2013 issue of the Journal of Nutrition Education and Behavior found that 43% of women surveyed are using the practice of eating more protein to prevent weight gain, and this strategy was associated with weight loss.

But just because people are doing something doesn’t make it healthy. I asked Dr. Michelle Hauser, a clinical fellow in medicine at Harvard Medical School and a certified chef and nutrition educator, if it’s a good idea to eat extra protein and cut back on carbs.

“If you’re eating more protein but you have a good mix of fresh fruits, vegetables and whole grains to make up the rest of it, that’s fine,” Dr. Hauser told me. One of the advantages of eating more protein-rich foods is that people who do it also tend to eliminate overly processed carbohydrates, such as white breads and prepackaged foods like cookies and crackers. Such foods are rapidly digested and turned into blood sugar, and tend to be low in healthful nutrients.

But it isn’t necessary to eliminate all carbohydrates and focus only on protein. Such an eating strategy may have a short-term payoff for weight loss, but it may also come with some long-term risks.
Understanding protein

Protein is a critical part of our diet. We need it to build and repair cells, and make healthy muscles, organs, glands, and skin. Everyone needs a minimum amount each day. The Institute of Medicine recommends 0.8 grams of protein per kilogram of body weight. For someone who weighs 150 pounds, that means 54 grams of protein per day. Another guideline is to make sure at least 15% of your daily calories come from protein.

How might more protein and fewer carbs in the diet make a difference for weight loss or weight control? “Protein takes more energy for you to digest than refined carbohydrates, and also gives your body a feeling of satiety,” says Dr. Hauser. Low-carb diets have been shown to help some people lose weight.

But over the long term, too much protein and too few carbohydrates may not be the healthiest plan. This kind of eating pattern has been linked to an increased risk of developing osteoporosis. That’s because digesting protein releases acids into the bloodstream. The body neutralizes these acids with calcium—which can be pulled from bone if necessary. Eating too much protein also makes the kidneys work harder. In healthy people, this usually doesn’t pose a problem. But those with kidney disease or diabetes (which is associated with kidney disease) need to watch their daily protein intake so they don’t overload their kidneys.

Depriving yourself of carbohydrates can also affect the brain and muscles, which need glucose (the fuel that comes from digesting carbs) to function efficiently. The fiber delivered by some carbohydrate-rich foods help bowels move. And remember that healthy sources of carbohydrates, such as fruits, vegetables, and whole grains, come with a host of vitamins, minerals, and other nutrients.
Making wise protein choices

It’s okay to cut back on carbs and eat more protein, but make sure you’re also getting some carbs in your daily diet. “If you take any healthy diet, 40% to 60% of calories should come from unprocessed carbs,” says Dr. Hauser. For someone on a 2,000 calorie-a-day diet, 40% would be 800 calories or 200 grams of carbs. (Note to self: increase servings of carbohydrates.)

But there are good carbs and bad carbs, as well as good proteins and bad proteins. Foods that deliver whole, unrefined carbs, like whole wheat, oats, quinoa, and the like, trump those made up of highly processed wheat or other grains. Lean meats, poultry, seafood, and plant sources of protein like beans and nuts are far more healthful than fatty meats and processed meats like sausage or deli meats.

The good-bad thing can be confusing, so Dr. Hauser suggests a few simple principles.

Pick the healthful trio. At each meal, include foods that deliver some fat, fiber, and protein. The fiber makes you feel full right away, the protein helps you stay full for longer, and the fat works with the hormones in your body to tell you to stop eating. Adding nuts to your diet is a good way to maintain weight because it has all three.

Avoid highly processed foods. The closer a food is to the way it started out, the longer it will take to digest, the gentler effect it will have on blood sugar, and the more nutrients it will contain.

Choose the most healthful sources of protein. Good protein-rich foods include fish, poultry, eggs, beans, legumes, nuts, tofu, and low-fat or non-fat dairy products.

These three strategies fit in with the Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets. The DASH diet includes 2 or fewer servings of protein per day, mostly poultry or fish. “The Mediterranean diet uses protein from fish as a centerpiece of a meal, and other meats as more of a component of a meal,” says Dr. Hauser.

I had to ask if it’s important to spread carbs throughout the day or if it’s okay to limit them to one meal, the way I do. “If it makes you feel better to eat carbs at one meal a day versus spreading them throughout the day, that’s fine. You can scatter the carbs as you see fit,” says Dr. Hauser.
“Whole grain” has become a healthy eating buzzphrase, and food companies aren’t shy about using it to entice us to buy products. Browse the bread, cereal, or chip aisle of your favorite grocery store and you’ll see what I mean. Last year, nearly 3,400 new whole-grain products were launched, compared with just 264 in 2001. And a poll by the International Food Information Council showed that 75% of those surveyed said they were trying to eat more whole grains, while 67% said the presence of whole grains was important when buying packaged foods.

But some of the products we buy may not deliver all the healthful whole-grain goodness we’re expecting. If sugary Froot Loops can tout itself as a whole-grain food, there’s something amiss.

What’s the best way to identify a healthful whole-grain food? I struggle with this question often while shopping. There several competing recommendations. The current Dietary Guidelines for Americans says to choose grain products that have the word “whole” before any grain in the ingredient list. The USDA’s MyPlate recommends choosing grain products with a whole grain as the first item in the ingredient list or listing whole grain as the first item and containing no added sugars. The nonprofit Whole Grains Council promotes the Whole Grain Stamp, which a company can place on its packaging if the product contains at least eight grams of whole grains per serving.

There’s a better way. Use this rule when choosing whole-grain foods: for every 10 grams of carbohydrate there shouldCarb fiber on label be at least one gram of fiber. Why 10:1? That’s about the ratio of fiber to carbohydrate in a genuine whole grain—unprocessed wheat. This recommendation comes from a new report from the Harvard School of Public Health published online in the journal Public Health Nutrition.

The Harvard researchers evaluated 545 grain products from two major grocery store chains, Stop & Shop and Walmart. They tallied up grams of whole grains in each product, along with the amounts of carbohydrates, fiber, added sugar, trans fat, and sodium, plus the number of calories. Foods that met the 10:1 ratio tended to have less sugar, sodium, and trans fats than those that didn’t.

“You aren’t alone if you are confused about whole-grain foods,” said Rebecca Mozaffarian, a project manager for the HSPH Prevention Research Center and first author of the study. She and her colleagues started this project when they realized there was little evidence-based information for guiding consumers, schools, and other organizations about choosing healthful whole grain foods.

The drawback to using a ratio is that you need to do a little math. The advantage is that the information needed is easily found on food labels, which list both total carbohydrates and fiber (see illustration). Divide the grams of carbohydrates by 10. If the grams of fiber is at least as large as the answer, the food meets the 1:10 standard. I find this a lot easier than reading through an ingredient list, which can be long and baffling (plus there are at least 29 different whole grains that can appear in the ingredients list).

In the nutrition label shown here, for example, one serving of this whole-grain roll has 23 grams of carbohydrate. Divide that by 10 and you get 2.3. It also has 5 grams of dietary fiber, which is definitely bigger than 2.3. That signals a healthful whole-grain food.

Why bother eating whole grains? They deliver everything an intact grain has to offer—fiber, vitamins, minerals, antioxidants, and other phytochemicals. As long as they aren’t overprocessed, the body digests them more slowly, which can delay hunger. And large, long-term studies have shown that consuming whole grains is one way to help reduce the odds of developing heart disease, diabetes, and other chronic conditions. They also taste better than processed grains.

Intact grains—wheat berries, oat berries, brown rice, quinoa, and the like—are the best source of whole grains. “They’re a slam dunk,” says Mozaffarian. Ground whole grains come next, as long as they still deliver a good dose of fiber and don’t also deliver added sugar, trans fats, or sodium. To find those, I’ll be using the 10:1 carbohydrate-to-fiber guide. Greater use of generic drugs could save the healthcare system—and American consumers—billions of dollars that would be better spent elsewhere. What’s holding us back? Some consumers are reluctant to use generic medications, thinking they are inferior to “the real thing.” Doctors are also a big part of the problem. Up to half of physicians hold negative perceptions about generic drugs. And a new study to published online today in JAMA Internal Medicine shows that about 4 in 10 doctors sometimes or often prescribe a brand-name drug just because their patients ask for it.

Prescribing a brand-name drug when a generic is available “is a huge source of wasteful spending that can be prevented,” says Eric G. Campbell, Ph.D., professor of medicine at Harvard Medical School and Massachusetts General Hospital, who led the new study.
Generic vs. brand name

Every medicine has a generic name. It is almost always the name of the drug’s active compound. Brand names are added by the marketing department of pharmaceutical companies.

To stimulate research and offset the cost of developing new medications, the FDA allows a company that develops a new drug to be the only one to sell it for a specified period. When that’s over, other companies can sell a medication made with the same active ingredient. These are the generics.

Some people think of generics as knock offs of the original, like the “Rolex” watch or “Prada” bag a street vendor might sell. That’s not correct. Generic drugs are chemical clones of their brand-name counterparts. By law, a generic drug must

    contain the same active ingredients as the brand-name drug
    be identical in strength, dosage form, and administration
    work the same way in the body (be bioequivalent)
    meet the same standards for identity, strength, purity, and quality
    be made by the same rules the FDA has set for the brand-name drug.

What’s different is the look of the drug and the inactive ingredients. Generics contain different coloring agents, binders, and preservatives than the brand-name drug. These can make a difference in how the drug works for some individuals, but that’s uncommon.

There are several ways to find out if the medications you have generic versions. The best is the Food and Drugs Administration’s Drugs@FDA. Others include (free registration required) and
Who’s likely to say “yes”

Campbell’s team crunched numbers from a survey of nearly 2,000 physicians from seven specialties. Overall, 37% said they sometimes or often prescribed a brand-name drug over a generic one when a patient asked for it. It was more common among

    doctors who had been practicing for more than 30 years (43%) than those practicing for 10 years or fewer (31%),
    doctors working alone or with one partner (46%) than those in a group practice or medical school setting (35% to 37%),
    and doctors who took free drug samples, were paid for pharmaceutical company speaking or consulting, or received food, gifts, or travel reimbursement from a pharmaceutical company.

Resisting the push for brand-name use

It’s hard to resist a patient’s request for a brand-name drug, says Campbell. Doctors are often evaluated on how satisfied their patients are—it’s easier to say yes than risk a negative evaluation. They tend to have packed schedules, and it takes less time to write the brand-name prescription than it does to explain why the generic will do just fine. And some are influenced, consciously or not, by their interactions with drug company representatives.

According to the Generic Pharmaceutical Association, the use of generic prescription drugs in place of their brand-name counterparts saved $192 billion last year. We could be doing even better. Seven of the 10 top best-selling drugs in the United States (accounting for $39 billion in sales last year) are brand-name drugs that are also available as generics.

Much of the extra cost of brand name drugs falls on you. A co-pay for a brand name product usually costs a lot more than its generic equivalent. And the higher costs of brand-name drugs that aren’t covered by co-pays are reflected in higher health insurance costs.

In most states, a doctor has to write “brand only” on the prescription if he or she does not want you to have a generic. Next time you need a refill, why not ask “Hey doc, can I get a generic?” instead of asking for the brand-name version. Many exercise programs these days spotlight the ever-present abs (abdominal muscles) but pay little attention to the other muscles that form the body’s core. Yet building up all of your core muscles is essential for staying strong and flexible and improving performance in almost any sport. It’s also vital for sidestepping debilitating back pain.

Your core includes your back, side, pelvic, and buttock muscles, as well as the abdominal muscles. The core forms a sturdy central link between your upper and lower body. Much like the trunk of a tree, core muscles need to be strong yet flexible. A weak or inflexible core drains power from many movements and can make it downright difficult to do some.
Benefits of a stronger core

No matter where motion starts, it ripples upward and downward through the core. That means a strong, flexible core underpins almost everything you do.

Everyday acts. Bending to put on shoes or pick up a package, turning to look behind you, sitting in a chair, or simply standing still are just a few of the many mundane actions that rely on your core. Even basic activities of daily living, like bathing or dressing, call on core muscles.

On-the-job tasks. Jobs that involve lifting, twisting, and standing all rely on core muscles. But less obvious tasks — like sitting at your desk for hours — engage your core, too. Phone calls, typing, computer use, and similar work can make back muscles surprisingly stiff and sore, particularly if you’re not strong enough to practice good posture and aren’t taking breaks when needed.

A healthy back. Low back pain can be prevented by exercises that promote well-balanced, resilient core muscles. When back pain strikes, a regimen of core exercises is often prescribed to relieve it, coupled with medications, physical therapy, or other treatments if necessary.

Sports and other activities. Biking, running, swimming, golf, tennis or other racquet sports, baseball, volleyball, kayaking, rowing, and many other athletic activities are powered by a strong core. Sexual activity also calls for core power and flexibility.

Housework, fix-it work, and gardening. Bending, lifting, twisting, carrying, hammering, reaching overhead — even vacuuming, mopping, and dusting spring from, or pass through, the core.

Balance and stability. Your core stabilizes your body, allowing you to move in any direction, even on the bumpiest terrain — or stand in one spot without losing your balance. Viewed this way, core exercises can lessen your risk of falling.

Good posture. Good posture trims your silhouette, projects confidence, lessens wear and tear on the spine, and allows you to breathe deeply. By contributing to slouching, weak core muscles undermine these benefits.

Weak, tight, or unbalanced core muscles can undermine you in any of these realms. So while it’s important to build a strong core, it’s unwise to aim all your efforts at developing rippling abs. Overtraining abdominal muscles while snubbing muscles of the back and hip can set you up for injuries and cut athletic prowess.
Core exercise examples

In Core Exercises, a Harvard Medical School Special Health Report that I helped develop, we worked with personal trainers to develop a series of exercises to strengthen core muscles. Writer Annmarie Dadoly wrote about the right and wrong ways to do three core-building exercises: lunges, squats, and planks.

Here are four of the nine exercises from the Vertical Standing Core Workout, one of the six complete workouts detailed in the report.
Side leg lift

Side leg lift

Reps: 10 per leg
Sets: 1–3
Intensity: Light to moderate
Tempo: 2–2
Rest: 30–90 seconds between sets

Starting position: Stand up straight with your feet together and your hands on your hips.

Movement: Exhale as you lift your left leg straight out to the side until your foot is about six inches off the floor, then return to the starting position. Keep your hips evenly aligned throughout. Finish all reps, then repeat with the right leg.

Tips and techniques:

    Keep your spine neutral and your shoulders down and back.
    Tighten the buttock on your standing leg for stability throughout the lift.

Knee lift

 Knee lift

Reps: 10 per leg
Sets: 1–3
Intensity: Light to moderate
Tempo: 2–2\
Rest: 30–90 seconds between sets

Starting position: Stand up straight with your feet together. Put your hands out to the sides, elbows slightly bent.

Movement: Lift your right knee toward the ceiling as high as is comfortable, then lower the foot to the floor. Finish all reps, then repeat with the left leg.

Tips and techniques:

    Keep your chest lifted and your shoulders down and back.
    Tighten your abdominal muscles throughout.
    Squeeze the buttock of your standing leg for stability.

Alternating reverse lunges

 Alternating reverse lunges

Reps: 10
Sets: 1–3
Intensity: Moderate to high
Tempo: 2–2
Rest: 30–90 seconds between sets

Starting position: Stand up straight with your feet together and your hands at your sides.

Movement: Step back on the ball of your right foot and sink into a lunge, bending your knees and bringing your hands up in front of your chest, elbows bent. Your left knee should align over your left ankle, and your right knee should point to the floor. Exhale as you return to the starting position. Repeat with your left leg. This is one rep. Continue to alternate legs as you finish all reps.

Tips and techniques:

    Keep your weight evenly distributed between the right and left foot.
    In the lunge position, your shoulder, hip, and rear knee should be aligned.
    Keep your spine neutral, and your shoulders down and back.



Reps: 10
Sets: 1–3
Intensity: Moderate
Tempo: 2–2
Rest: 30–90 seconds between sets

Starting position: Stand up straight with your feet wider than your hips. Turn your toes slightly outward (rotating from the hips) and rest your hands on your thighs.

Movement: Keep your back straight as you bend your knees and lower your buttocks toward the floor. Stop before your buttocks reach knee level. Exhale as you return to the starting position.

Tips and techniques:

    Keep your knees aligned over your ankles when in the plié position.
    Keep your spine neutral, body upright, and your shoulders down and back as if you have a rod in your spine.
    Tighten abdominal muscles throughout.

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