It’s easy to lose weight. The hard part is keeping the weight off.

About 1 in 5 overweight or obese Americans successfully loses weight and keeps the weight off. What if you could survey thousands of these successful losers to determine what habits they have in common — essentially crowdsourcing their top tips for weight loss success?

This is exactly what the National Weight Control Registry (NWCR) is doing. The NWCR is a database founded in 1994 by Rena Wing, Ph.D., of Brown University, and Jim Hill, Ph.D., of the University of Colorado. The NWCR was established to answer two key questions:

• Are there people who have successfully maintained a substantial weight loss? (Yes!)
• What common characteristics and strategies have helped these people achieve and maintain weight loss?

To be eligible for the NWCR, participants have to be 18 years of age or older, and have lost a minimum of 30 pounds and kept the weight off for at least 1 year. The registry now has more than 6,000 ‘losers’ who have lost an average of more than 60 pounds, and have kept off the weight for more than 5 years! (Almost 20% of NWCR participants have lost 100 pounds or more.)

These volunteers have answered questions about their eating behaviors, physical activity, and other habits. Thus most of the information is based on self-reports. About 90% had lost weight before, but had regained it (the average lifetime weight loss was 270 pounds over several previous attempts).

What’s different this time? The participants cite medical, emotional and/or social reasons or triggers for their successful loss and maintenance. They are committed to making — and keeping — behavioral changes that influence both the calories they consume and the calories they burn off.

7 Habits of Highly Successful Weight Loss Maintainers

1. Engage in regular physical activity. More than half of the NWCR members burn more than 2,000 kcal week. This is about 200 minutes a week (30 minutes/day) of moderate-intensity exercise. Popular activities include walking, stationary and/or road cycling, aerobics, walking or running on a treadmill, jogging, and strength training.

200 minutes a week is not a lot, and is just a bit more than the 150 minutes a week recommended in the U.S. Physical Activity Guidelines for Americans.
How many minutes of physical activity do you engage in each day? Can you add in 5–10 minutes a few days a week?

2. Limit television watching. About 63% of NWCR members report watching less than 10 hours a week of television (less than 1.5 hours a day on average).

According to the Bureau of Labor Statistics, Americans watched TV ~19 hours/week (2.7 hours a day) on average in 2010, while Nielsen pegs the number at ~32 hours/week (more than 4.5 hours a day) across ages 2 and up. How many hours a day do you spend watching TV?

3. Eat a low-calorie, low-fat diet. NWCR members report consuming 1,380 kcal/day, with less than 30% of the calories coming from fat.  When shopping, they often reach for foods (such as salad dressings, dairy, and soft drinks) that have been modified to contain less sugar and fat.

A typical diet is assumed to be around 2,000 calories a day, but when it comes to calories, it’s definitely not ‘one size fits all.’ You can calculate the estimated calories you need each day, plus receive a daily food plan at Choose My Plate, from the USDA.

4. Eat a consistent diet and don’t splurge. NWCR members tend to eat the same foods regularly. They prepare most of their meals at home and typically have less than one fast food meal a week. They don’t splurge on high-calorie foods on weekends, holidays, or other special occasions.

5. Eat breakfast. Almost 80% of NWCR members report eating breakfast every day. This habit may help control hunger and prevent them from overeating later in the day.

6. High dietary restraint and awareness. NWCR members maintain control over what they eat. They don’t eat something in response to their emotions, or just because it’s there.

7. Self-track. More than half of NWCR members weigh themselves at least weekly and track their daily food intake. They also tend to monitor their calories and/or fat grams.

Do you track? What method do you use? Have you tried an app, or the online USDA SuperTracker?

The successful losers combine physical activity and diet. They use their leisure time wisely, engaging in physical activity instead of sedentary activities, such as TV watching. They exhibit restraint. And they stay on track with self-tracking.

What works (or doesn’t work) for you?
If you are a successful loser, you are invited to join the study:  http://www.nwcr.ws/

Related posts

• Childhood Obesity By The (Big) Numbers 
• Twelve Everyday Health Rules–From 1908
• Kids and Media Use: Letting their fingers do the walking?
• Self-tracking, Sensors, and mHealth: Trends and Opportunities
• 12 real foods for real results: Insider tips from top sports nutritionists
• Self-Tracking Meets Ready-To-Wear: Make Room in Your Closet for Smart Clothes

Photos

• Two women: istockphoto
• V a u h d i k a s [bike] courtesy of Pörrö at Flickr
• Remote courtesy of kevinthoule at Flickr
• Banana courtesy of the USDA Fruit Food Gallery
• Zero Gravity [scale] courtesy of mrjorgen at Flickr

Reference
Graham, T.J., Bond, D.S., Hill, J.O., Wing, Rena R. The National Weight Control Registry: A Study of “Successful Losers.” ACSM’S Health & Fitness Journal, 15 (2) pgs 8-12, 2011.
doi: 10.1249/FIT.0b013e31820b72b5

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©2012 Kinetics. All Rights Reserved.

“Research reveals new secret weapon for Le Tour,” read the press release headline, referring to the Tour de France. “Now there could be a new, completely legal and rather surprising weapon for riders aiming to shave vital seconds off their time – beetroot juice.”

Beetroot juice? Within 24 hours my local bike club forum was buzzing about the news. The research, published in Medicine & Science in Sports & Exercise (June 2011), is the latest in a series of studies on beetroot juice and exercise conducted by Dr. Andy Jones and crew at the University of Exeter (the University put out the press release).

The study found that men who consumed 0.5 liters (~17 ounces) of beetroot juice improved simulated 4 km and 16.1 km cycling time trial performance by 2.8 percent (11 seconds) and 2.7 percent (45 seconds), respectively, as compared to when they completed the rides after drinking a placebo. Power output increased while oxygen consumption was not changed, indicating cycling economy was improved. The participants drank the juice 2.5 hours before completing the rides, which were conducted on stationary bikes.

The nine competitive male cyclists (average age 21 years) who participated in this study were asked to avoid strenuous activity and refrain from caffeine and alcohol consumption prior to coming to the lab to ride. This is standard. But a subsequent step in the protocol is not standard:

“The subjects also abstained from using antibacterial mouthwash and chewing gum during the supplementation periods because these are known to eradicate the oral bacteria that are necessary for the conversion of nitrate to nitrite.”

Huh? It turns out beetroot juice is just the tip of the iceberg for an exciting and rather amazing area of research that also involves bacteria and spit. You’ll be hearing a lot more about this work and its implications for sports performance and health, so it’s worth a closer look.

Why beetroot juice?
Beetroot juice is chock full of inorganic nitrate. The nitrate (NO₃^-) gets converted to nitrite (NO₂^-), which is then converted to nitrogen oxides, such as nitric oxide (NO). Nitric oxide is a powerful signaling molecule that is thought to be responsible for the majority of the physiological benefits. [Nitrate is not the same as nitrite. See  the section on risks below.]

Beetroot juice contains lots of nutrients, including antioxidants and polyphenols. To make sure the effects were due to nitrate, the researchers selectively removed  just the nitrate from the juice. When participants were given this altered juice, they exhibited no improvements in cycling performance. (Thus the nitrate-depleted juice served as the perfect placebo for comparison against the regular juice.)

What’s with the mouthwash?
Humans lack the necessary enzyme to convert nitrate to nitrite and get the whole chain of events going. But it turns out there are bacteria that lounge in the back of our mouths that are pros at this. The nitrate we eat goes through a rather strange and wonderful journey:

1. When we consume a source of nitrate, such as beetroot juice, the nitrate is rapidly absorbed by our small intestine. Nitrate levels subsequently rise in our blood stream and remain elevated for hours.
2. Our salivary glands suck up about 25 percent of this circulating nitrate, concentrating it in our saliva (the balance of the nitrate ends up in our urine). Saliva levels of nitrate become 10-20 fold higher than blood levels, and can peak 30 minutes after ingesting nitrate.
3. This salivary nitrate is then converted to nitrite by bacteria that hang out on the back of our tongues.
4. When we swallow, our saliva, now full of nitrite, goes to our stomach, where the nitrite is converted to nitric oxide and other nitrogen oxides. Some of the nitrite also makes its way from our stomach back into our circulation.

If we use an antiseptic mouthwash, we stop the bacteria from working. If we spit (or don’t swallow), we deny our gut the nitrite-enriched saliva.

Bacteria? Seriously?
Yes, bacteria. Communities of bacteria reside in our mouths, our nasal passages, on our skin, in our gastrointestinal tract, in our urogenital tract, and in many other places where light doesn’t shine. For each single human cell we have, we have ten (10!) microbial cells.

We have a symbiotic relationship with these microbes. As the beetroot juice research illustrates, bacteria possess enzymes we don’t have but that we need in order to digest certain foods.

We each possess a unique set of bacteria; the lint in our belly button, the dirt under our fingernails, and the bacteria in our gut help define who we are, and may affect our health. If you’ve ever consumed foods that contain probiotics, such as yogurt or tempeh, than you’ve influenced your microbial community. This is a very hot field of research and product development.

How big of a boost to athletic performance does beetroot juice/nitrate cause?
Surprisingly big. In this study average power output was increased by 5 percent during the 4 km time trial and  6 percent during the 16.1 km time trial. There were no changes in oxygen consumption, indicating cycling economy was improved.

Several studies have now shown that dietary nitrate supplementation causes an improvement in exercise efficiency and an improved tolerance for high-intensity exercise. In essence, your muscles are getting better gas mileage from oxygen.

Bear in mind this research was conducted on very small numbers (usually less than 12 participants in each study) of mostly male, college-age participants. All the research was carried out in laboratory settings. Whether the benefits extend to real-world settings has not been examined.

Geek speak:

To date, dietary nitrate supplementation has been shown to improve a number of exercise performance variables in several small studies:

• reduce the oxygen cost of submaximal cycling
• reduce the oxygen cost of low and high intensity knee extensor exercise
• reduce the oxygen cost of treadmill walking and running
• extend time-to-exhaustion during high intensity exercise

How does it work? Dietary nitrate supplementation appears to reduce the metabolic perturbation in contracting muscle cells (muscles at rest are not affected). There is a reduced rate of muscle ATP turnover at a given work rate. The mechanisms responsible for this reduced oxygen cost include increased mitochondrial efficiency (Larsen, 2011), and perhaps increased energetic efficiency of calcium transport by the sarcoplasmic reticulum Ca2+ ATPases (SERCA) (Ferreira, 2011).

The effects of dietary nitrate are not limited to athletic performance. Nitric oxide can widen (dilate) blood vessels, reducing blood pressure and increasing blood flow. Much of the current research on dietary nitrate supplementation is focusing on the prevention and treatment of conditions such as heart attacks and peripheral arterial disease (PAD). Scientists are also starting to examine the effects of nitrate on brain health.

Beetroot juice? Yuck. What other foods have high levels of nitrate?
Beetroot juice was used for the experiments because it offers a quick and easy way for research participants to consume a substantial amount of nitrate. But beetroot juice is something of an acquired taste, and it can, ahem, result in red urine and red stools.

Luckily, beetroots are just one of many vegetables and herbs that are high in nitrate. Leafy green vegetables tend to be the top sources of nitrate:

• Very high nitrate levels (> 250 mg/100 g*): arugula (rocket or rucola), bok choy, celery, chervil, collard greens, cress, lettuce, radish, red beetroot, rhubarb, spinach, Swiss chard.
• High nitrate levels (~100-250 mg/100 g): basil, celeriac, Chinese cabbage, chard, coriander, endive, fennel, kohlrabi, leek, mustard greens, parsley.

*Numbers are nitrate content, expressed as milligrams per 100 grams fresh weight, and are compiled from a variety of U.S. and European sources. Nitrate levels in vegetables can vary considerably depending on many factors, such as growing conditions.

The amount of nitrate utilized in the research studies to reduce the oxygen cost of exercise ranges from about 300-500 mg. These are levels that are readily obtained by eating a diet rich in fruits and vegetables. Here’s how some of the numbers compare:

500 ml (~17 ounces) beetroot juice          500 mg nitrate*
1 cup raw spinach                                              926 mg nitrate**
1/2 cup cooked collard greens                    198 mg nitrate**
1 cup raw leaf lettuce                                       103 mg nitrate**

* The beetroot juice used in several of the experiments was supplied by James White Drinks Ltd (Ipswich, U.K.). According to the company website, approximately 2.5 beetroots are in each 250 ml serving and the juice contains 0.1 g of nitrate per 100 ml.

** These numbers are adapted from Hord, 2009. Remember that nitrate concentrations in vegetables can vary considerably.

Participants in almost all the research studies were asked to avoid foods high in nitrate, and/or performed the exercise tests after a 3 hour (or overnight) fast. Thus they started off with low levels of plasma nitrate in their systems.

What would happen if you conducted the research on participants who consumed a diet of nitrate-rich vegetables and thus would presumably have high plasma nitrate levels to begin with? Would you see improvements in athletic performance following additional dietary supplementation? It seems unlikely as there is no evidence that higher doses of dietary nitrate increase the beneficial effects (no dose-response studies have been published).

What about hot dogs?
Nitrate and nitrite are also present in very low levels (too low to impact athletic performance) in cured and processed meats such as hot dogs, bologna, corned beef, luncheon meats, sausages and ham. They are added to enhance flavor, stabilize color, and serve as antimicrobial and antioxidant agents.

Nitrate and nitrite are considered potentially harmful at high concentrations, and their levels are regulated in food and drinking water. This regulation is the source of much debate. Researchers note that the traditional Japanese diet, the heart-healthy Mediterranean diet, and the research-based Dietary Approaches to Stopping Hypertension (DASH) eating plan all emphasize fruits and vegetables, and thus are abundant in nitrate. This has led to speculation that these diets might help protect against heart disease, high blood pressure, and type 2 diabetes in part because of their high nitrate levels. For a good discussion of the dietary issues, as well as lists of nitrate levels in foods, see Hord, 2009.

What are the risks?
The nitrate-nitrite-nitric oxide pathways can be confusing. There is a big difference between the biological effects and toxicity of nitrate and nitrite. And there is a big difference between the biological effects of inorganic nitrate, found in dietary sources such as beetroot juice and vegetables, and organic nitrate, found in drugs such as nitroglycerin.

Nitrate supplementation to enhance sports performance has become a hot topic in online forums, but unfortunately there are some misconceptions. This has raised concern among leading researchers in the field, prompting them to address potential hazards (see the Journal of Applied Physiology, August 2011 ‘Letters to the Editor’ section). Recommendations include:

• Don’t use nitrate salts and nitrite salts as dietary supplements to enhance sports performance.
• Be aware that nitrite, used intentionally or unintentionally, can have harmful effects.
• Nitrate-containing vegetable juice presents a potential risk if stored incorrectly. If the juice gets contaminated by bacteria that can convert nitrate to nitrite, high levels of nitrite could accumulate over time which could potentially be harmful.
• Nitrate ingestion from dietary sources, such as vegetables, is safe.

In addition, several medications may adversely interact with a high nitrate diet. These include nitroglycerin or nitrate preparations used for angina, and PDE-5 inhibitors such as Viagra, Cialis and Levitra. Anyone with risk factors for or diagnosed with heart disease, or with low blood pressure (hypotension), may wish to consult their healthcare professional before starting a high nitrate diet. Individuals with kidney stones should bear in mind that several vegetables that are high in nitrate are also high in oxalate (rhubarb, beetroot, Swiss chard, spinach).

The bottom line: You are what you – and your microbes – eat
It’s tempting to interpret this exciting research as suggesting that a particular substance, such as beetroot juice, provides a “new secret weapon” akin to an ergogenic aid. But all the evidence points to the slightly less sexy conclusion that the true ‘secret weapon’ to sports performance resides in your vegetable crisper. (Popeye was right all along!)

Eating a diet abundant in nitrate-rich vegetables may improve your athletic performance (as well as your cardiovascular health). Conversely, consuming a diet low in nitrate-rich vegetables may adversely affect your athletic performance (and your cardiovascular health).

To improve your performance during day-to-day training and competition:

• Aim for a serving of fruits and a serving of vegetables at each meal (If you don’t know where to start, take a look at ChooseMyPlate.gov, the DASH Eating Plan and the Mediterranean diet)
• To up your odds of improving performance for a specific event, try consuming nitrate-rich foods approximately 3 hours before the event
• Ditch the mouthwash (and don’t obsess over belly button lint or dirt under your fingernails – they probably harbor friendly, helpful microbes)
• Don’t forget the big picture. Stay well hydrated and get plenty of sleep (see Twelve Everyday Health Rules from 1908)
• Consider keeping a training log so you can look for patterns among these variables and determine what works best for you.

Recipes
See how easy it is to incorporate greens into your diet with these awesome recipes (and stunning photos) from around the food blogosphere:

• From Smitten Kitchen: Spinach Quiche (freezer friendly) and Arugula, Potato and Green Bean Salad
• From Kiss My Spatula: Wild Arugula-Quinoa Salad with Cherries and Thyme Roasted Baby Beets with Mint Vinaigrette
• From Love & Olive Oil: Fig, Prosciutto, and Arugula Pizza and Pizza Bianca with Goat Cheese and Greens
• From Food Blogga: Spinach and Apple Salad with Warm Cranberry-Maple Dressing and Arugula, Baby Spinach and Blueberry Summertime Salad
• From 5 Second Rule: Creamy Spinach Cashew Spread and Roasted Beet Salad with Goat Cheese and Walnuts

Also try:

• Start with Dr. Allen Lim’s Rice Cakes (a favorite snack of pro cyclists) and add in chopped spinach or other greens (fresh or frozen)
• Do your own riff on the classic Joe’s Special (try rolling in tortillas and freezing) or add spinach to Freezer Breakfast Burritos (my standby is to omit the sausage, add frozen hash browns, make several dozen and freeze)

What’s your favorite recipe that uses leafy green vegetables?

Hungry for more information?

• L F Ferreira, BJ Behnke. A toast to health and performance! Beetroot juice lowers blood pressure and the O2 cost of exercise. Journal of Applied Physiology, 110:585-586, 2011. doi: 10.1152/japplphysiol.01457.2010
• NG Hord, Y Tang, NS Bryan. Food sources of nitrates and nitrites: the physiologic context for potential health benefits. American Journal of Clinical Nutrition, 90 (1):1-10, July 2009. doi: 10.3945/ajcn.2008.27131
• KE Lansley, et al. Acute dietary nitrate supplementation improves cycling time trial performance. Medicine & Science in Sports & Exercise, 43(6):1125-1131, June 2011. doi: 10.1249/MSS.0b013e31821597b4
• FJ Larsen, et al., Dietary inorganic nitrate improves mitochondrial efficiency in humans, Cell Metabolism, 13(2):149-159, February 2011. doi: 10.1016/j.cmet.2011.01.004
• JO Lundberg, et al. Roles of dietary inorganic nitrate in cardiovascular health and disease.  Cardiovascular Research, 89 (3):525-532, 2011. doi: 10.1093/cvr/cvq325
• A A Kenjale, et al. Dietary nitrate supplementation enhances exercise performance in peripheral arterial disease. Journal of Applied Physiology, 110(6):1582-1591, 2011. doi: 10.1152/japplphysiol.00071.2011

The Human Microbiome Project seeks to characterize the various microbes and their DNA that reside in and on our bodies. The project is examining the connections among these microbial communities, our health, and various conditions including psoriasis, Crohn’s Disease, acne, asthma, and obesity.  Also check out Belly Button Biodiversity.

Related posts

• Carbohydrates and sports performance: rinse, repeat, win?
• 12 real foods for real results: Insider tips from top sports nutritionists
• Are humans designed to be endurance runners?
• What can pro cyclists teach us about pain?

Photos
Shorewood Criterium courtesy of Michael Newman at Flickr
1k-7649 spinach courtesy of Creativity+ Timothy K Hamilton at Flickr

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©2012 Kinetics. All Rights Reserved.

Do you weigh yourself regularly?  Do you make note of your  blood pressure or menstrual cycle? Do you note when your waist size or dress size changes? If so, you’re a self-tracker.

Self-tracking is extremely widespread. In addition to all the organized tracking communities, there’s a growing number of organic self-tracking communities. For examples, take a look at the diabetes made visible community on Flickr, or the more than 20,000 videos on YouTube tagged weight loss journey.

At the same time, sensor technology is advancing at an astounding pace. New materials and fabrication techniques, many at the nanoscale level, are leading to a host of amazing sensors that can be woven into clothes or permanently implanted into our bodies.

Mobile health (mHealth) offers the perfect platform to merge the tracking communities and sensor technologies. Toss in the power of social networking capabilities, and you’ve put the trifecta of instant ‘track, share, and compare’ at people’s fingertips.

This presentation was given by invitation at the 2011 mHealth Networking Conference to review the current status of self-tracking and sensors, and to highlight just a few of the many exciting opportunities that lay ahead.

Resources cited in the presentation are listed below.

What do you track? What opportunities do you envision?

Communities, organizations

• 23andMe
• Asthmapolis
• Cure Together
• MedHelp
• PatientsLikeMe
• Quantified Self
• TuDiabetes
• Tweetwhatyoueat!

Tracking tools

• MedHelp – Health tools
• Personal Informatics – tools
• iTunes app store, popular apps, Healthcare & Fitness, Medical

Sensors

• BodyMedia
• cardiomems
• Fitbit
• IDEAL LIFE
• iHealth
• Polar
• Sleeptracker
• Under Armour
• Withings
• Zeo

Reports & publications

• Healthcare unwired: New business models delivering care anywhere. PricewaterhouseCoopers, September, 2010
• Peer-to-peer healthcare, Susannah Fox, Pew Internet, Feb 28, 2011
• Ingestible thermometer pill aids athletes in beating the heat, NASA Spinoff, 2006
• Innovations in health literacy research, workshop summary. Institute of Medicine, The National Academies Press, 2011
• Boomers, technology & health: Consumers taking charge! MIT Enterprise Forum Northwest, January, 2011 (pdf)
• 2008-2013 Action plan for the global strategy for the prevention and control of noncommunicable diseases, World Health Organization, 2009
• Yang , Yang-Li et al., Thick-film textile-based amperometric sensors and biosensors . Analyst, 135:1230-1234, 2010
• Abraham, WT, et al., Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial. The Lancet, 377:658-666, 2011
• Frost, J. et al., Patient-reported outcomes as a source of evidence in off-label prescribing: Analysis of data From PatientsLikeMe. Journal of Medical Internet Research, 13( 1), 2011
• Baicker, K. et al., Workplace wellness programs can generate savings, Health Affairs, 29(2): 304-311,2010

Miscellaneous

• Salt-o-meter, The Globe and Mail
• Finally: Self-tracking is cool enough for viral advertising. information aesthetics, Feb 15, 2011
• Push Snowboarding, Nokia x Burton

Related posts

• Self-Tracking Meets Ready-To-Wear: Make Room in Your Closet for Smart Clothes
  
• Self-tracking: Checking under the hood
• mHealth: Health where you live, work, and play
• mHealth Summit 2010: A context check list
• Utilizing mobile technology and new media to encourage mobile lifestyles

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©2012 Kinetics. All Rights Reserved.

The world of Health 2.0 has so many moving parts that are spinning so fast, that it’s tempting to gaze into a crystal ball and predict what will collide and where it will land. As we move from Health 2.0 to Health Squared, here are 7 trends I see on the horizon.

1.  Nutrigenomics & Nutrigenetics
We’re moving toward the $100 genome, and Direct-to-Consumer (DTC) genetic testing from companies such as 23andMe is on the rise. While we’re gradually learning more about the connection between our genes and our risk factors and our responses to drugs, there’s an intriguing area that has received little attention: the link between our genes and what we eat.

Nutrigenomics examines how what we eat affects our genes, proteins and metabolism. On the flip side, nutrigenetics looks at how our genetic sequence affects our responses to what we eat. Also to watch, nutraceuticals (nutrition + pharmaceuticals), which are foods and food products that provide health and medical benefits. It’s about linking the world of “-omics” with what we put in our mouths, and it will bring a whole new spin to “Eat this, not that!”

2.  Ready-to-Wear Biosensors
Advances in biosensor technology will result in clothing that monitors our every move  and mental state. The information will be automatically downloaded to our mobile devices. This advance will revolutionize health, as the ‘right place, right time’ biofeedback will lead a shift from reactive to proactive health care. Designers will compete to create self-tracking garments for pregnant women on Project Runway.

3.  Groupon Health for Baby Boomers
On January 1, 2011, ten thousand baby boomers turned 65. Each day 10,000 more will turn 65. This will continue for the next 19 years.

Groupon, Living Social, and numerous other sites that harness collective buying power will offer deals based on age, and will target the more than 75 million baby-boomers. This “silver tsunami” is concerned with healthy living and longevity, and they love getting and sharing deals. They already routinely hop online to access email, research health information, buy products, and make travel reservations (Pew Generations report, Dec 2010).

Groupon Health for boomers will focus on anti-aging options (yoga retreats, vitamin packs, golf packages, cholesterol screenings, brain exercise gadgets, pilates classes), and skip unhealthy deals (tanning salons). Boomers will be hired to find the deals for their classmates.

4.  Lies, Damned Lies, and Statistics
Given the exponential increase in biological data (take a spin around NCBI), we’ll need robust stats that help us separate the signal from the noise, tease out trends, and dissect potential cause and effect vs. random correlations.

Bioinformatics will become a trendy buzz word, number crunching will become a contact sport, and entirely new statistical models will be created.

5.  Infographics :: Data Visualization
What was once the domain of a small corner of the USA Today newspaper has gone mainstream. Daily newspapers now feature word clouds, and Hans Rosling’s talks on visualizations of global health have become TED and YouTube phenomenona.

We’re inundated with data that beg to be made into visual stories. The data stem from self-tracking (Quantified Self) and crowd sourcing (Cure Together), and from gene mapping and global mapping.

We will see even more data artfully displayed. Utilizing graphics to convey health information will increase health literacy and will consistently prove a picture is worth several thousand words.

6.  3D mHealth
New technologies are enabling 3D displays on mobile devices that don’t require the use of glasses. These are created by altering our sense of depth, using auto-stereoscopic 3D technology. This imaging will greatly enhance mobile health applications; visualize the possibilities of 3D for everything from anatomy textbooks to yoga poses. How about a 3D Pillbox?

7.  Transgenerational Social Networking
Many of our risks for diseases may be due to stretches of DNA that are not along our own chromosomes, but rather, are along the chromosomes of our parents or grandparents. This is the crux of the paradigm shifting field of  “transgenerational” genetics.

Research is mounting that suggests the genes our ancestors carried, but that were not passed down to us, can influence the traits and diseases we get. In addition, the foods that our mother ate while she was pregnant with us, and our parents environmental exposures (e.g., pesticides), may influence the traits we have, and that our children and grandchildren will have.

This throws a monkey wrench in classical genetics and merits close watch. While you don’t have to Friend your mom on Facebook, you will want to ‘friend’ her PHR – and your grandmothers – and learn everything you can about your parents health and habits.  And you’ll also want to closely track your own diet for the sake of your health (see #1), and for the health of your grandchildren.

When you look into your crystal ball, what trends do you see as we move from Health 2.0 to Health Squared?

Related posts

• Self-tracking: Checking under the hood
• mHealth Summit 2010: A context check list
• Health 2.0 goes to Washington: Aretha Franklin would be proud
• Utilizing Mobile Technology and New Media to Encourage Mobile Lifestyles

Photo credits

• Crystal ball:  Frozen Bubble, courtesy of sparkleice on Flickr
• Chocolate: Want one? courtesy of MarcelGermain on Flickr
• Yoga: yoga_signed courtesy of shunpikie on Flickr
• Hans Rosling: Courtesy of Gapfinder
• Pills: flickr pills – you should check how many you need … courtesy of eagleglide on Flickr
• Mother & Daughter: Silhouetted Mother & Daughter courtesy of Jerome Rothermund on Flickr

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©2012 Kinetics. All Rights Reserved.

Der Mensch als Industriepalast (Man as Industrial Palace), Fritz Kahn, 1926. (See full description below.)

Our bodies are exquisite self-tracking machines. We’re artfully engineered with rheostats and feedback loops and switches. The number of times our heart beats in a minute, the temperature of our body, the pH of our blood, the sodium concentration inside our cells, and the turning on and off of our genes are all tightly regulated.

Unfortunately, we don’t come equipped with external tachometers. We don’t have a fuel gauge that points a needle to ‘full’ to signify when we should stop eating, or a temperature gauge to indicate when we are overheating. There is no factory-installed ‘check engine’ light.

In order to make sense of what’s going on under our hoods, we can turn to a variety of tracking tools. Sensors, probes and analyzers help us detect the electrical, chemical and mechanical signals emanating from within. We can measure, track and display with respect to time and space, episode and intervention. And best of all, we get to serve as our own control: N=1.

From lab bench to park bench
As a physiologist, my life has revolved around self-tracking. In grad school, we routinely used ourselves to calibrate equipment, develop techniques, and generally see ‘what would happen if….’  We documented our lives in lab notebooks and every day was ‘show and tell.’

Self-tracking is moving out of the lab and into living rooms and bedrooms, gyms and diners. There’s a rapidly growing community, Quantified Self, that is “a collaboration of users and tool makers who share an interest in self-knowledge through self-tracking.” The site originated with gurus Kevin Kelly and Gary Wolf, and an expanding community is overseen by them, along with Alexandra Carmichael, cofounder of CureTogether. There are more than a dozen meet-up groups around the world, as well as an active Twitter community (#quantifiedself).

Long the province of elite athletes and astronauts at one end of the spectrum, and individuals living with chronic diseases (and ICU patients) at the other end of the spectrum, tracking is moving from the fringes inward. Now the bright, shiny gadgets we ordered from scientific equipment catalogs (lactate analyzers, heart rate monitors, pulse oximeters) can be picked up on Amazon.

Should you check under your hood?
Suffering from insomnia? Want to get pregnant? Training for your first 10K? Measuring any number of parameters can reveal trends and provide clues as to what makes you tick. Self-tracking can help you make a connection between what you’re feeling or sensing and how your body is doing.

You can track physiological parameters such as heart rate, blood pressure, body temperature, and blood glucose. You can track mental health parameters such as mood and self-esteem. You can track behaviors such as foods eaten, hours spent sitting at a computer, songs listened to, minutes spent exercising, and hours spent sleeping. You can track environmental influences such as outside temperature and pollen count, commuting time, number of friends on Facebook, number of neighbors on your street you know by first name.

The data provide a glimpse of what’s going on under your hood. The measures are all exquisitely intertwined and although they might not represent true cause and effect, when grouped in combination they can reveal wonderful patterns. The patterns tell a story that can provide you with insights and awareness, which may in turn lead to behavior change, thus creating a feedback loop much like your internal circuits.

Self-tracking lets you build a personal dashboard to create a narrative of yourself. It can empower you to better understand how you are functioning, and thereby put you in better control of what’s going on under your hood. And as you self-track, at some point you will cross a threshold where you view your body not only as a machine full of data points, but as an engineered piece of living art.

Great self-tracking resources

• Quantified Self
• What if Self-Tracking Goes Mainstream?, Alexandra Carmichael, The Future Now Blog
• The data-driven life, Gary Wolf, The New York Times
• Know thyself: Tracking every facet of life, from sleep to mood to pain, 24/7/365, Gary Wolf, Wired

Related posts

• Self-tracking, Sensors, and mHealth: Trends and Opportunities
• Self-Tracking Meets Ready-To-Wear: Make Room in Your Closet for Smart Clothes
• mHealth: Health where you live, work, and play
• Twelve Everyday Health Rules–From 1908
• Are humans designed to be endurance runners?

The image
The image above is a cropped view of  Der Mensch als Industriepalast (Man as Industrial Palace) by Fritz Kahn (1888-1968). It is a chromolithograph frpm 1926, and is courtesy of the National Library of Medicine, as part of their amazing Dream Anatomy exhibit. “Kahn’s modernist visualization of the digestive and respiratory system as ‘industrial palace,’ really a chemical plant, was conceived in a period when the German chemical industry was the world’s most advanced.”

Inspired by the art, Henning M. Lederer created this video in 2009:

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Do you have a pantry full of gels, bars, powders, and neon-colored fluids? Sports fuels (engineered foods) can have a valuable place in training and racing, and are a mainstay of professional athletes and weekend warriors alike.

Slurping down ooze from a foil pouch, however, can never match the joy of nibbling on a soft peanut butter and jelly sandwich. And why gnaw your way through an engineered bar when you can bite into a juicy orange or potassium-rich banana which are nature’s versions of prepackaged sports fuels.

If your sports nutrition is in a rut or if your training is suffering, perhaps it’s time for you to give your taste buds a break. Here are 12 top food choices from sports nutrition experts who practice what they preach. Try these real foods for snacks, during an event, or for recovery, and maybe you’ll see some real results!

1. Whole grain fig bars, whole grain crackers, graham crackers: Enjoy with peanut butter for a filling snack.
2. Apples, oranges, bananas: Portable, available all year.
3. Cereal or granola bars: Less expensive than sports bars.
4. Trail mix: Tailor a blend of nuts, dried fruit, and cereal to fit your personal preferences.
5. Instant oatmeal: Make with low-fat milk for a quick, inexpensive, and healthy snack.
6. Watermelon and cantaloupe: Nutrient dense, available at most salad bars.
7. Candy such as Tootsie Rolls, Jolly Ranchers, Gummi Bears, Swedish Fish, and jelly beans: Treats to savor in your mouth during long events.
8. De-fizzed soft drinks: Inexpensive source of caffeine and carbohydrate during long events.
9. Sweet potatoes: Pop them in the microwave for a quick pre-exercise or post-exercise snack.
10. Fruit smoothies: Great for recovery, cheaper than canned shakes.
11. Chocolate milk: Great recovery beverage, available in single serving boxes that don’t require refrigeration.
12. Peanut butter and jelly sandwiches: Cult favorite, perfect for a snack, during some events, and as a recovery food.

Try incorporating some of these real foods into your training regimen. But keep in mind that just as you train your muscles, you may need to train your digestive system. If you have a big event coming up, test potential new foods ahead of time. Don’t make the common mistake of picking up food samples at an Expo the day before a key race and then trying them the next day.  (Would you lace up a brand new pair of running shoes the day of a marathon?)

Additional tips from the experts:

• “Pros develop a plan weeks or months ahead of priority races. They then experiment in a less important ‘B grade’ race under the same intensity and environmental conditions as their target race.” – Ellen Coleman, MA, MPH, RD, CSSD, author of Ultimate Sports Nutrition and Eating for Endurance; 2-time finisher of the Ironman Triathlon.
• “The goal of consuming foods during your training or racing is to minimize dehydration and carbohydrate depletion. To accomplish this, carbohydrates should be consumed every 15 to 20 minutes. You should never wait until you are hungry or thirsty before you eat or drink.”  – Kathy Zadwadzki, MS, contributing author, Food for Fitness: Eat Right to Train Right; USAC Level I Coach; Licensed Sports Nutritionist, National Association of Sports Nutrition.
• “You haven’t finished your training until you’ve refueled.” – Nancy Clark, MS, RD, CSSD, nutrition columnist and author of numerous books, including Sports Nutrition Guidebook.
• “Don’t overlook classic foods, such as PB & J, which has the perfect ratio of carbohydrate to protein.” – Lynn Umbreit, MS, RD, LD, Past-Chair of the WM (Weight Management) and SCAN (Sports, Cardiovascular & Wellness Nutritionists) dietetic practice groups of the American Dietetic Association; finisher of over 50 marathons.

The field of sports nutrition is continually evolving based on scientific research and ‘field testing.’ There are numerous books, formulas, and philosophies. Pro athletes spend an enormous amount of time and energy adjusting and readjusting their nutritional regimens.

The foods that work best for you may not come in a package with an expiration date three years from now. These top notch sports nutritionists confess to having favorite real foods that they indulge in before or after big events. Some of their “off-the-record” splurges? Baked potato chips, beef jerky, and pizza and beer.

What’s your favorite training food? What’s your favorite splurge?

Learn more:

• Boosting athletic performance with beetroot juice, nitrate and spit. Research shows beetroot juice consumption can improve athletic performance. Learn why it works, what foods have a similar effect, and what the potential drawbacks are.
• Carbohydrates and sports performance: rinse, repeat, win? Mounting evidence suggests we have receptors (both sweet and non-sweet) in our mouths that are sensitive to carbohydrates, and that when triggered, activate areas in our brains associated with reward. Thus swishing a carbohydrate-containing solution around in your mouth may improve exercise performance.
• Are humans designed to be endurance runners? Yes! Learn about key features that enable humans to excel at running.
• 10 Tips for exercising in the heat. It’s important to keep an eye on the color of your urine, as well as listen to your body and keep an eye on your friends. Stay in the game with these ten tips to beat the heat.

Photo credits

• Oranges, courtesy of WGyuri at Flickr
• PB & J, courtesy of tamdotcom at Flickr
• Beer, courtesy of Libraryman at Flickr

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©2012 Kinetics. All Rights Reserved.

Childhood obesity is epidemic. We see evidence of it every day – at mall food courts, in video arcades, at school bus stops. But just how bad is it and how much is it costing us?

‘Child Obesity: The Way Forward’ is the theme of the March 2010 issue of Health Affairs, a leading health policy journal. In a special briefing held in Washington, D.C. to highlight the journal issue, authors summarized their work, policy briefs were circulated, and passionate individuals shared questions and experiences. Here are some key numbers from the meeting and journal papers to quantify the magnitude and implications of what we see every day. (Full references are below.)

How bad is the childhood obesity epidemic?

• Nearly one in three U.S. children and adolescents aged 2 through 19 years are overweight or obese (more than 23 million youth). [Odgen 2010]
• About one in six children (16.4%) ages 10 to 17 are obese. [Bethell, Singh]
• Nearly one in three very young children who enroll in Head Start programs are overweight or obese. [Tarullo]
• Over the past 40 years the rates of overweight and obesity have more than quadrupled among children ages 6 to 11, and have more than tripled for adolescents ages 12 to 19. [Data spanning from 1963 to 2004; Ogden 2002, 2006]

Disparities, and disparities within disparities

• Across states, there is a wide range in the prevalence of overweight and obesity among children ages 10-17, ranging from 23.1% in Utah and Minnesota to 44.4% in Mississippi. [Bethell]
• Between 2003 and 2007, the disparity in the prevalence of overweight and obesity in U.S. children ages 10-17 grew wider between publicly and privately insured children, lower-and higher-income children, and Hispanic and non-Hispanic children. [Bethell]
• Nationally, in 2007, 44.8% of children in poverty were overweight or obese, compared to 22.2% of children living in households with incomes above 400% of poverty. The disparities based on poverty vary two- to threefold across states. [Bethell]
• Illustrative of the substantial disparities that exist within states as well as among states, Minnesota had the highest disparity ratio (2.61) between children with private vs. public health insurance, despite having one of the lowest overall overweight/obesity rates nationally.  [Bethell]

Food and drink

• Sugar-sweetened beverages and 100% fruit juice comprise 10-15% of the total calorie consumption of children and adolescents (ages 2-19).  [Frieden, Wang]
• Americans’ average daily calorie intake in 2007 was 400 calories higher than in 1985, and 600 calories higher than in 1970. [Wallinga]
• The inflation-adjusted price of carbonated soft drinks decreased ~24% from 1985 to 2000, while the prices of fresh fruit and vegetables rose 39% (based on USDA data). [Wallinga]
• Less than one in ten Americans meet the levels of fruit and vegetable consumption recommended in the 2005 Dietary Guidelines for Americans. [Wallinga]

Physical activity

• Only 42% of children ages 6-11 years, and only 8% of adolescents’ ages 12-19 years, obtain the recommended 60 min/day of physical activity.  [Troiano]
• A quarter of high school students do not meet recommended levels of physical activity (60 minutes of moderate-to-vigorous activity per day) on any day. [Frieden, Eaton]
• Less than 4% of adults engage in enough physical activity to improve health, although approximately 40% of adults claim they do. [Frieden, Troiano]
• The odds are 1.21 times greater for a child to be overweight or obese if they do not participate in sports and other activities outside of school. [Bethell]
• The odds are 1.21 times greater for a child to be overweight or obese if they do not have local access to a park or recreation center. [Bethell]

Lifestyle & environment

• Children who have a TV in their bedroom or watch more than 2 hours of TV on average per day are more than 1.5 times likely to be overweight or obese. (This relationship holds when socioeconomic and other factors are adjusted for). [Bethell]
• For U.S. children ages 10-17, 35.0% have no access to recreation or community centers; 26.7% have no neighborhood access to sidewalks or walking paths; and 19.2% have no access to parks or playgrounds (as reported by their parents). [Singh]
• Children living in neighborhoods with the most unfavorable social conditions are 50% more likely to be physically inactive; 52% more likely to watch TV more than 2 hours a day; and 65% more likely to engage in recreational computer use of more than 2 hrs/day, as compared to children living in most favorable social conditions (based on 2007 data).  [Singh]
• Children living in unsafe neighborhoods have 61% higher odds of being obese and 43% higher odds of being overweight than children living in safe neighborhoods (after adjusting for age and sex).  [Singh]
• Children living in neighborhoods with no access to sidewalks or walking paths, parks or playgrounds, and recreation or community centers, have 32%, 26% and 20% higher adjusted odds of obesity than children in neighborhoods with access to these amenities, respectively.  [Singh]

Health

• Approximately 70% of obese youth have at least one additional risk factor for cardiovascular disease, such as high blood pressure or high cholesterol. Nearly 40% have at least two additional risk factors.  [Frieden]
• Children who are obese after age 6 have greater than a 50% chance of being obese as adults, even if their parents are not obese. [Frieden]

School achievement

• The odds are 1.32 times greater for an overweight or obese child to repeat a grade in school. [Bethell]
• The odds are 1.59 times greater for an overweight or obese child to miss more than 2 weeks of school during the school year. (These data do not include children who have special health care needs.)  [Bethell]

How much does obesity cost?

• Almost 10% of all medical costs in 2008 were attributable to obesity. [Finkelstein]
• The estimated cost of treating obesity-related illness was $147 billion/year in 2008. [Finkelstein]
• The direct costs of childhood obesity include annual prescription drug, emergency room, and outpatient costs of $14.1 billion, as well as inpatient costs of $237.6 million. [Cawley]
• Obesity-related job absenteeism costs $4.3 billion annually. [Cawley]
• The decrease in productivity in obese individuals while at work (presenteeism) totals $506 per obese worker per year. [Cawley]
• Obesity-related illnesses cost Medicare $19.7 billion and Medicaid $8 billion in 2008. [Cawley]
• Private health insurance plans paid $49 billion to treat obesity-related illness in 2008. [Cawley]
• According to mathematical modeling, U.S. children who were age twelve in 2005 will incur an estimated $2.77 billion in attributable medical expenditures over their lifetime. The twelve-year-olds who were overweight and obese and become obese adults will incur an estimated additional $3.47 billion in medical expenditures. Further mathematical modeling indicates a one-percentage point reduction in obesity (from 16.3% to 15.3%) in children who were age 12 in 2005 would save $260.4 million in total medical expenditures. [Trasande]

What numbers do you find the most frightening?
What numbers are you going to change?

Definition of child overweight and obesity
Child overweight and obesity are based on body mass index, or BMI, which is based on height and weight measurements. Overweight is defined as the 85th through 94th percentiles of age- and sex- specific BMI; obese is defined as the 95th or greater percentile of age- and sex- specific BMI.  The CDC has information on BMI for children and teens, including a Child and Teen BMI Calculator.

References

• Bethell, C., et al. National, state, and local disparities in childhood obesity. Health Affairs, 29(3): 347-356, 2010. doi: 10.1377/hlthaff.2009.0762
• Cawley, J. The economics of childhood obesity. Health Affairs, 29(3): 364-371, 2010. doi: 10.1377/hlthaff.2009.0721
• Eaton, D. K., et al. Youth risk behavior surveillance — United States, 2007. MMWR Surveillance Summaries 57(4): 1-131, 2008.
• Finkelstein, E. A., et al. Annual medical spending attributable to obesity: Payer-and service-specific estimates. Health Affairs, 28(5): 357-363, 2009.  doi: 10.1377/hlthaff.28.5.w822
• Frieden, T., et al. Reducing childhood obesity through policy change: acting now to prevent obesity. Health Affairs, 29(3): 357-363, 2010. doi: 10.1377/hlthaff.2010.0039
• Odgen, C. L., et al. Prevalence of high body mass index in US children and adolescents, 2007-2008. JAMA 303(3):242-249, 2010. doi:10.1001/jama.2009.2012
• Ogden C. L., et al. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA 295(13):1549-55, 2006.
• Ogden C. L., et al. Prevalence and trends in overweight among US children and adolescents, 1999-2000. JAMA 288(14):1728-32, 2002.
• Singh, G. K., et al. Neighborhood socioeconomic conditions, built environments, and childhood obesity. Health Affairs, 29(3): 503-512, 2010.  doi: 10.1377/hlthaff.2009.0730
• Tarullo, L., et al. Beginning Head Start: Children, families and programs in fall 2006 (PDF). FACES 2006 baseline report, Mathematica Policy Research, Inc., December 2008. (Available at www.acf.hhs.gov/)
• Trasande, L. How much should we invest in preventing childhood obesity? Health Affairs, 29(3): 372-378, 2010. doi: 10.1377/hlthaff.2009.0691
• Troiano, R. P., et al. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc, 40(1): 181-188, 2008. doi: 10.1249/mss.0b013e31815a51b3
• Wallinga, D. Agricultural policy and childhood obesity: a food systems and public health commentary. Health Affairs, 29(3): 405-410, 2010. doi: 10.1377/hlthaff.2010.0102
• Wang, Y. C., et al. Increasing caloric contribution from sugar-sweetened beverages and 100% fruit juices among US children and adolescents, 1988–2004. Pediatrics, 121(6): e1604-e1614, 2008. doi: 10.1542/peds.2007-2834

Health Affairs

• Table of contents from ‘Child Obesity: The Way Forward’ thematic issue (This issue is made possible with support from the Robert Wood Johnson Foundation)
• Child Obesity Policy Briefs
• Video and slides from the March 2, 2010 briefing

Related posts

• Kids and media use: Letting their fingers do the walking?
• 7 Simple tips to grow active, playful kids
• 12 Everyday Health Rules – From 1908

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Dr. Marshall Nirenburg in his office with molecular models. He shared the 1968 Nobel Prize in Physiology or Medicine for his work on deciphering the genetic code. (I had the honor of working in the Laboratory of Biochemical Genetics at the National Institutes of Health, where Marshall is laboratory chief.) Photo courtesy of National Library of Medicine Profiles in Science.

Here’s a roundup of recent thought-provoking, amazing, and/or just plain cool items that are worth a look. In this week’s Nobel edition we celebrate the awarding of the 2009 Nobel Prizes.

Can you hear me now?
“Hello, you’ve won the Nobel.” A chat with Gunnar Öquist, the man who makes The Phone Call. From Seed Magazine.
“Then, the phone really started ringing. It was a reporter from The A.P. who said she was in front of our apartment and wanted to get a picture of me. I said, ‘I’m in my pajamas.’ She said, ‘That’s exactly the photo I want.’ I said, ‘But you’re not going to get it.’”  A brilliant interview with Martin Chalfie, 2008 winner of the Nobel Prize in Chemistry, who slept through The Phone Call. From The New York Times.

Sidewiki
Are you familiar with Sidewiki? If not, brush up with these thought-provoking posts.
Been Avoiding Social Media? It Just Kicked In Your Door, The Scholarly Kitchen
Google SideWiki: How to Brace Yourself for a Communications Bitch Slap, Phil Bauman
A Google colonial sideswipe, Andrew Keen of the UK Telegraph
Martin Frank, Executive Director of the American Physiological Society, points out via Twitter that Sidewiki could allow for commentary along side research articles. (@ExecDirectorAPS)
Make sure to watch the demo video and ponder the implications. What are your thoughts?

Stick figures
Watching life unfold as a social network where every link is a human relationship and every circle is a waistline. “The Buddy System: How Medical Data Revealed Secret to Health and Happiness,” from Wired. Includes stunning data visualizations.

4 billion served
“More than 4 billion [cell phones] are now in use worldwide, three-quarters of them in the developing world.” From The Economist special report on “The power of mobile money.”
4.1 billion SMS messages are sent daily, according to the latest Semi-Annual Wireless Industry Survey results from CTIA-The Wireless Association®

Art imitating life
Anatomical illustrations by Fernando Vicente that merge science and art and add a dash of fashion. They are reminiscent of Andreas Vesalius’s classic 1543 De Humani Corporis Fabrica (this link is to an amazing ‘touch and turn’ version of the book.)

Fat body = skinny wallet
NPR interview with Safeway Inc. CEO Steve Burd, about the company’s wellness incentive program. Employees receive a discount on their health insurance if their body mass index is below 30, the number over which people are considered obese. (Here’s a BMI calculator so you can see if you qualify for a discount.)

Don’t bother with the CliffsNotes
“There was no rule book, we just did what we thought was interesting and might prove fruitful. You can’t write a book on how to do that.” Dr. George Smith, 2009 winner of the Nobel Prize in Chemistry, in “‘Masters of Light’ Get Nobel,” a wonderful article in The Wall Street Journal.

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Hand off – Courtesy of Anna.Hawaii at Flickr

Can simply swishing a carbohydrate-containing solution around in your mouth improve short-duration exercise performance? Yes, according to intriguing new research.

It’s been well documented that ingesting carbohydrates during exercise can improve athletic performance in events lasting for several hours or more. But in events lasting for only an hour, the carbohydrates you suck down aren’t needed by your muscles for fuel.

Surprisingly, however, consuming carbohydrates has been found to improve short, intense exercise performance. Since the carbs aren’t needed for energy by the working muscles, physiologists have been left scratching their heads. A key insight appears to be in how the carbohydrates are consumed.

From the lips to the hips
If individuals perform a simulated one-hour cycling time trial in a lab and are given glucose intravenously, bypassing the mouth and gut, their bloodstreams will fill with the energy-supplying sugar. Yet the subjects will show no improvement in cycling performance as compared to when they complete the time trial with an infusion of only saline.

However, if individuals perform a stationary cycling time trial in the lab and do nothing more than rinse their mouths with a maltodextrin solution, they’ll show an improvement in their exercise performance. Maltodextrin is a type of sugar that is not sweet — which offers another clue to this crazy paradox.

This evidence suggests it’s the mouth, not the muscles, that is happy to see carbohydrates. These results hint that there are taste receptors in the mouth that are sensitive to carbohydrates, even non-sweet ones such as maltodextrin. The theory is that once the receptors are activated, signals are sent to the brain that ultimately result in improved exercise performance.

A real tongue twister
As you might recall from science class, our tongues have taste buds for sweet, salty, sour and bitter. Our mouths now appear to also contain receptors that respond to carbohydrates. New evidence is provided in a nice set of experiments done by Drs. Ed S. Chambers, Matt W. Bridge and David A. Jones from the University of Birmingham and published in Journal of Physiology.

The researchers asked cyclists to perform a simulated time trial in which they completed a set amount of work in the shortest time possible. The participants were given a solution of 6.4 percent glucose, 6.4 percent maltodextrin, or water, which was the placebo. (As a reference, Gatorade is 6 percent carbohydrate, and regular Coke is 11 percent carbohydrate.) All three solutions included a noncaloric artificial sweetener (containing aspartame and saccharin) to make them indistinguishable from each other. The cyclists rinsed their mouths with one of the solutions at the start of the time trial and then approximately every seven minutes during the ride.

The cyclists completed the time trial 2 to 3 percent faster when they rinsed their mouths with the glucose or maltodextrin solution than with the placebo (60.4 minutes with glucose vs. 61.6 minutes with placebo in one experiment, and 62.6 minutes with maltodextrin vs. 64.6 minutes with placebo in a second experiment). There was a corresponding increase in power output during the faster ride, with no change in perceived exertion or heart rate. This indicates the sugar swishing lowered the participants’ perception of how hard they were working.

Your brain on carbs
The researchers next had individuals swish a carbohydrate solution in their mouths while undergoing functional magnetic resonance imaging (fMRI). The technology, which monitors the anatomical detail of brain activity, revealed that oral exposure to carbohydrates, both sweet and non-sweet, activates regions of the brain associated with reward. The areas include the striatum, the anterior cingulate cortex and the orbitofrontal cortex.

Before you start using Sprite as a mouthwash, there are several caveats to this research worth noting. The cyclists all performed the time trial following a six-hour or overnight fast, which is not how most of us start a bike ride or race. The concentration of some of the glucose and maltodextrin solutions used for the brain-imaging studies was almost three times greater (18 percent) than the one used during the exercise studies. The exact concentrations, types (glucose, fructose, maltodextrin, etc.) and forms (liquid, gel, solid) of carbs that are most effective in activating the brain to create more brawn are not known. These results also don’t reveal whether ingesting protein or other nutrients along with the carbs in a drink might alter the effects.

Elwood Gatorade Race. Courtesy of Alistair 35 at Flickr

The bottom line
Mounting evidence suggests we have receptors (both sweet and non-sweet) in our mouths that are sensitive to carbohydrates, and that when triggered, they activate areas in our brains associated with reward. This has implications for exercise performance and for the food industry. The research raises the intriguing question of whether other undiscovered receptors are lurking in our mouths as well.

By swishing a carbohydrate-containing drink in your mouth, you may be able to improve your exercise performance. If you are running a 5k or 10k race, or competing in a cycling time trial or other short-duration, high-intensity event, it may be worth your while to reach for a drink that contains carbs and to swish it around in your mouth. A potential 2 to 3 percent improvement in time is substantial. But if you need to slow your pace in order to swill, you may negate the improvement in time. And if you’re exercising in hot weather, be sure to swirl and then swallow the liquid in order to help stay hydrated.

Resources

• Carbohydrate sensing in the human mouth: effects on exercise performance and brain activity. Chambers ES, Bridge MW, Jones DA. The Journal of Physiology, Apr 15;587(Pt 8):1779-94, 2009.
• Historical Perspective of Biomedical Imaging: From MRI to fMRI

Related posts

• Boosting athletic performance with beetroot juice, nitrate and spit
• Are humans designed to be endurance runners?
• What can pro cyclists teach us about pain?
• 12 real foods for real results: Insider tips from top sports nutritionists

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©2012 Kinetics. All Rights Reserved.

Do you have a garage full of ThighMasters, Ab Flyers, Ab Circles, Ab Coasters and Ab Rockers? Are you concerned about thunder thighs, love handles, man boobs, saddlebags, potbellies or cankles?

Everyone has his or her problem area (or areas). Thanks to the concept of spot reduction, we’ve witnessed decades of fabulous (or should that be flabulous?) gizmos such as the Astro-Trimmer, Abflex and, of course, those classic vibrating belts.

What can you do about those flabby arms or muffin tops? Does spot reduction work? Here are answers to the top six most common questions.

1. What is spot reduction?
Spot reduction is the idea that you can lose fat from a specific part of your body, especially if you exercise the area. Some people think spot reduction means that when you exercise a particular area, the fat in that area will turn to muscle. Unfortunately this is not medically possible — it would be like turning oranges into apples.

The concept of spot reduction also implies that the muscle tissue and fat tissue in a particular part of your body engage in some sort of metabolic pillow talk with each other. For example, if you do sit-ups, then ideally, your abdominal muscles would selectively use the fat that blankets them for energy. Although many cells communicate with each other in numerous intimate ways, there’s still a language barrier in this regard.

2. Can you spot-reduce?
No. If spot reduction worked, there would be a lot of lopsided people walking around. Think of anyone who uses one side of his or her body or one limb much more than the other side. Pitchers, quarterbacks and trombone players come to mind. If spot reduction worked, a player’s dominant arm would have much less fat than his or her opposite arm.

Tennis players are a perfect example. In a classic study, researchers examined the arms of players. Although the dominant arm had a greater girth due to more muscle mass than the opposite arm, there was no difference in skinfold fat thickness between the arms. For further proof, researchers asked a group of individuals to do a total of 5,000 sit-ups over 27 days. (That’s about 185 sit-ups a day.) Fat biopsies were taken from the participants’ abs, buttocks and upper backs before and after the exercise program. The fat decreased the same amount in all three areas, demonstrating that no spot reduction occurred.

3. What is fat and what is it good for?
Fat is made up of individual fat cells called adipocytes. They are just one type of cell, along with muscle cells, nerve cells, bone cells, liver cells and numerous others. A person’s total number of fat cells is thought to be determined by puberty. After that, as you gain and lose weight, the size of these cells swells or shrinks.

Some fat is good. Odds are you are either sitting on fat (your tush) or standing on it (padding in your feet) as you read this. Fat protects your internal organs, serves as an energy warehouse, insulates and helps regulate body temperature. Fat cells secrete numerous proteins and hormones that can influence blood pressure, immune function and blood sugar (glucose) levels.

4. Can you control the location of your fat?
Fat is like real estate — we’re all concerned with location, location, location. And location is mainly determined by the two G’s: gender and genes. To verify this, take a good long look at your parents and siblings, and then take a good long look at yourself in the mirror. Scary, isn’t it?

5. Does location matter?
Ab-solutely. There’s a growing body of scientific evidence that links the location of your fat to your health. Fat tends to be located either around the middle or center of the body (the classic apple shape) or peripherally on the arms, hips, and thighs (pear shape). Studies continually show that people with apple shapes are at much greater risk than those with pear shapes for numerous conditions, such as heart disease, type 2 diabetes and liver disease.

6. Can anything be done about thunder thighs and beer bellies?
The great news is yes, you may be able to shore up an area. And if you can reduce belly fat, you may decrease your risk of associated health problems. But it’s not as simple as using products that you’ve ordered on late-night TV for eight minutes a day. It takes a little bit of sweat combined with good nutritional habits. Repeat after me this mantra we all know by heart (and need to take to heart): Move more, eat less.

The first step is to engage in regular physical activity, especially as outlined in the new Physical Activity Guidelines. Engage in some type of strength training two or more days a week. You’ll tone up your muscles, strengthen your bones and burn calories. Buffing up your muscles, however, won’t help if you still have a layer of fat providing a cloak of invisibility over them.

So the companion step is to divest yourself of your extra pounds by also engaging in regular moderate-to-vigorous endurance (aerobic) activity at least 60 to 75 minutes a week. Lastly, keep an eye on what you eat. You know the drill: Burn more calories than you consume.

Your muscles require fuel to work, and fat is a great source. When you exercise, chemicals are released in your bloodstream that travel to fat cells and trigger them to break down units of fat to be burned for energy. Unfortunately, we can’t control which fat cells respond to the chemical signals. However, a general rule of thumb seems to be “last in, first out.” That is, wherever you’ve most recently added the insulation is generally the first place it’s lost. Then eat in moderation so that you aren’t refilling your fat cells to overflow.

What gizmos do you have in your garage? What late-night infomercials made you pick up the phone? Did you use any of the gadgets more than once? Some of these items can legitimately be incorporated into your exercise routine, while others probably need to be sprung during spring cleaning, sold at a yard sale or put up for adoption on eBay.

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