Antioxidants: who needs 'em?

The name antioxidants implies that they are against oxidants. But why would you be anti-oxidant? Is there anyone out there who is pro-oxidant?


Let's start with the basics:


As your body works and metabolizes fuel (makes energy) it also produces reactive oxygen species, or ROS. Not to be confused with ROUS's (I don't even believe they exist). You may have also heard of them as Free Radicals. Your body makes them all the time during metabolism and when your metabolic needs increase when you are more active your ROS production increases too. Whatever the name is, most people agree that it is good to keep them in check. You see, generally your body oxidizes metabolites in order to break them down. Oxygen, as you may have inferred by the theme in naming here, is really good at oxidizing. The problem is when you have ROS attacking things in your body that they shouldn't attack...like your cells.


An antioxidant, then, is something that gets oxidized to stop your body from being damaged by getting oxidized. Some common simple antioxidants include Vitamin C and Vitamin E but there are many more that the body uses. In some ways it makes an antioxidant like a bodyguard taking a bullet for you.


The theory behind supplementing antioxidants is pretty sound, try and stop the dangerous ROS flying around by upping the number of body guards (antioxidants) in the system. But the proof is a bit lacking.


If we move on to the current evidence we see:


One study in Spain (M.E. Munoz et al. / Toxicology 278 (2010) 101–111) published recently, showed that there was a benefit for elderly exercisers whose body's natural defense mechanisms were a little worn out. But then again these participants were sedentary to begin with and the study was sponsored by the antioxidant drink that the participants were taking during the study.


Another study done by University of Wisconsin-Madison said the opposite, that perhaps helping your body deal with antioxidants stops your body from making other good adaptations to exercise. Most benefits from exercise actually come from stressing your body which includes the production of ROS. When you let your body recover from this stress, your body generally rebuilds itself as strong or stronger than before which is what allows for increased performance. Yet another more recent study in Germany echoed these findings by showing that exercisers who supplemented with antioxidants had less of an increase in insulin sensitivity than exercisers who did not take antioxidants. That means that antioxidant supplementation could actually decrease the effectiveness of exercise for managing Type 2 diabetes.


Finally, the idea of taking antioxidants as a daily supplement or in your multivitamin has lost a little bit of its credence since an article in JAMA came out that showed daily doses of antioxidant substances ranging from beta-carotene to Vitamin E may actually do more harm than good as a preventative measure.


The conclusion:


...a bit fuzzy. Antioxidants have reached craze status, this is confirmed by the fact that the word antioxidants has become a marketing catch phrase and is plastered all over everything from breakfast cereal to green tea. The science behind them is convincing, but as it turns out your body is pretty good at managing on its own.


Even in an event like an Ironman Triathlon, where there is a very significant increase in ROS production, healthy well trained athletes "experience no adverse health risks regarding oxidative stress" (Toxicology. 2010 Dec 5;278(2):211-6. Epub 2009 Sep 18). So for all of you endurance athletes out there who see Lance Armstrong drinking FRS in the commercials, don't be too quick to join the antioxidant party.


As with all fitness fads, it's best to give it a little time before following the crowd. That allows the scientists some time to straighten out the theory from the practice. And don't think the decision here is final. I'm sure it will be some time before this all really gets figured out and we stop going back and forth on what we think is best. Until then I'd say it's best to stick with what has lasted the test of time. Let your body do what it's been made to do by training regularly. It'll give you the jump on ROS you're looking for instead of dumping in extra unnecessary antioxidant supplements and relying on those to do the work for you. Then again, that's just my opinion and I'm no professional... at least not yet.

Making Plans

Whew, just in time for the new year. I can't think of any other time of year that this might be more appropriate than just before everyone is making their New Year Resolutions. Before you scoff and tell me you think it's cliche or that resolutions are just good intentions without anything to back them up think about it for just a moment.

While there is nothing special about the New Year as far as a health or fitness perspective it's not a bad thing to take the chance to make some goals for the upcoming 12 months. The important thing is to distinguish between goals and dreams.

Goals are specific. They have a plan of action to bring them to fruition and a way to measure if they have actually been attained. Dreams on the other hand are unattainable, unrealistic and if you really take the time to think about it are not something that you would ever even expect to happen.

Let's give an example. One of my goals two years ago was to run a 45 min 10k race. To do this I prepared for several months. I planned my weekly runs and set up a schedule to follow so that I would be ready for my big run. On the day of the race I knew how to measure my success. If the clock was over 45 minutes when I crossed the line I had failed and if it was under 45 minutes then I had succeeded. My plan was specific and my goal was measurable. I had some experience running prior to this. It wasn't like I was just trying to start as someone who never ran or only jogged a 12 min/mile pace before this, so I knew that this was within my reach. Thankfully, I attained my goal. I made it to the finish with less than 5 seconds to spare.

Now a dream of mine has always been to be in the Tour de France. This obviously is not going to happen. No matter how much I train, it's just not a possibility. I'm in my mid 20's, I have raced my bike for one year so far and am only a Cat 4 racer. Riding in Le Tour just is not an option for me. But I can dream, can't I?

Another important part of setting reasonable goals is using the right scale to measure them. You would never measure the growth of a tree in seconds. It would be absurd. The same is true for fitness or nutrition goals, you need to measure with a calendar, not a clock.

So even if you are adverse to making a New Year's Resolution, think about all this the next time you make plans for life whether they are in your work or play. Aim high, but have a plan for how to achieve it and measure it when you get there so that you don't spend all of your energy towards something you discover to be just a dream.

Simple Garlic Hummus

A tasty snack with good fat and a good price too.

1 can of chick peas (14 oz)

1/4 cup of yogurt

2 Tbsp Lemon Juice

2 Tsp minced garlic

1.5 Tbsp olive oil

Salt- to taste

1 Tbsp Tahini (optional)

Combine all ingredients in your blender or food processor and mix until smooth. Mix less if you like your hummus a little coarser.

Serve with Pita bread, fresh vegetables, pretzels or any of your other favorite dipping delicacies.

You need fat too!

I realize this is something that is hard to swallow, but it's true. You need fat too. Before you blow me off and keep "fat" on your black list read a little further.



You're body is made up of cells. A couple hundred years ago you might have looked at me and just said, "huh?" But thanks to the microscope and some advances in science (as well as public education) I feel pretty confident you can track with me here. Now where were we...ah yes, cells. You're body is made up of cells. Skin cells, stomach cells, hair cells, muscle cells, fat cells and more. Despite the fact that these cells all are part of different organs and systems, they have more in common than you may think. One of the things that all these cells have in common is their outer layer.



Cells have what is called a membrane which is composed of a lipid bilayer. What that basically means is that each cell is encased in a double layer of fat molecules. That's right fat molecules (aka lipids). And an important source for those cell walls is the fat that you eat. The fat you eat and cholesterol that you eat and that your body makes are mostly responsible for making the walls of your cells. The combination of those two components helps to determine how hard or soft those walls are. In the ideal world it would be the perfect combination of not too soft and not too hard, but every person is a little different based on their diet and their genetics.



This is part of the reason that trans fats are such a big deal. Initially when trans fats were invented we thought they were a great cheap solution to always needing plant or animal products, but as we quickly found out it's hard to beat nature at it's own game. By now it is impossible to go into a store without seeing bags of anything and everything labeled "0 Grams of Trans Fat" or "Trans Fat Free." That's because we learned that when trans fat gets included into our cell walls it tends to pack very tightly together. This means rigid cell walls (among other problems). Fats made by people and animals are almost exclusively cis-fats. While trans fats generally make straight linear molecules, cis-fats have some twists and bends in them. They create little extra spaces for molecules to move around and your cell membrane stays "softer" so to speak. Because of all of these problems trans fats are one item I would say are okay to put on the official "bad" list.

Another fat to avoid in excess is saturated fat. Saturated fats have similar properties in your cell to trans fats, but are naturally occuring in animal products and still not as bad as trans fats. This makes intuitive sense because we all are aware that eating a stick of butter or having bacon with every meal (both of which have a large amount of saturated fat) is not a good idea. Saturated fat, though, is not necessarily something to completely eliminate from your diet. For one, it would mean eating almost no animal products which is not a truly healthy or realistic option. In addition, your body can handle saturated fat and deal with it without too much difficulty, but just like any other nutrient if you eat too much of it you will not be happy with the outcome.

Now there are a couple of fats that are good for you. Namely unsaturated fats as well as omega-3 and omega-6 fatty acids. Unsaturated fats are found in nuts, seeds and other plant products and they are generally liquid at room temperature when they are isolated (as compared to saturated fats which are typically solid at room temperature-this is another good indicator of the quality of fat you are eating. Have the solids sparingly and enjoy the liquids). These unsaturated fats are the kinds that will leave your cells' walls soft and happy instead of rigid. Omega-3 and omega-6 fatty acids are important for multiple uses in the body, but they can't be made by humans, so they need to be eaten instead to be included in our bodies.

But now I've been babbling long enough, let's get to the payoff.

If you had to distill all of this information into a quick application it would be this. Don't avoid fat because you think "fat is bad." Fat has twice as many calories/gram as carbohydrate or protein so it's important to eat less of it if you want to avoid packing extra supplies of it on your body. However, it's not necessary to avoid it altogether and isn't good for you to do so either. Try enjoying some almonds instead of potato chips or using olive oil in place of butter. These are good ways to make sure that you get the fat you need without overdosing on the fat you don't need.

I know it's complicated, but you can do it. If you are just tuning in, check out more of this series on the three main nutrients under the Nutrition tags.

BMI is a baseline measure, but also a helpful one

Lots of people put tons of emphasis on BMI. It's a good baseline test for figuring out what kind of shape your body is in. The US Department of Health and Human Services National Institutes for Health (NIH) have composed guidelines for healthy BMI and are what physicians use in the initial assessment of whether or not a person is underweight, healthy weight, overweight or obese. BMI is somewhat limited in that it does not take into account a person's body composition, but the majority of the population (not elite athletes) this isn't too big of a problem. When you consider athletes BMI hits a little bit of a wall because athletes tend to have less body fat which means more of their weight is from muscle. This does not mean that BMI is invaluable, it simply needs to be used carefully. For this reason I have often given BMI less credence than perhaps it deserves.

The NIH recently released information regarding a study published in the New England Journal of Medicine on BMI and it's predictive power concerning longevity. It turns out that your BMI is a little bit bigger deal than I have thought in the past. The study pooled 19 other investigations that examined BMI and the probability of mortality (dying). This study actually allowed them to look at data concerning 1.5 million people which is 0.5% of the total population in the US (not bad considering the number of people in the US). What it found was that overweight people had significantly increased mortality rates and that obese people were even more at risk. This was also examined with other possible concurrent risk factors for death and found that an increased BMI by itself increases the likelihood of death within 10 years compared to an individual with a health BMI (defined as between 20 and 25).

Interestingly, a BMI that is too low is also bad for you (there is such a thing as being too skinny). But before you go pounding down twinkies to try and protect yourself from a low BMI, consider this. The increased risk to your health begins around a BMI of 18 which would be a 5' 6" tall person who weighed less than 118 lbs or a 6' tall person under 140 lbs.

If you're curious you can go to the NIH's BMI Caculator and see for yourself what your BMI is. If that's not enough for you, the next step to finding out more about what kind of shape you're in would be to find out your body composition or % body fat, but that's a conversation for another time.

What's the big deal about protein?

Having just finished the Thanksgiving week and heading into the Christmas season, I thought it might be an appropriate time to return to some of my previous nutrition topics. After downing more bird than I care to admit during the last several days , protein seems like the best place to start.

If Zubaz were a definitive mark of 90's fashion, high protein diets are a definitive mark of our current decade's attempt to trim the fat. Most of these are fads aimed at dropping weight quickly without much care for the other associated health risks (i.e. Atkin's). I recently reviewed an article during my evidence based medicine class that especially highlighted the increased risks of heart disease in middle aged women who ate a high protein-low carbohydrate diet.

This isn't to say that protein is bad for you. An appropriate view of nutrition means that you need to make your eating choices based on balance and your personal circumstances will dictate your need for different nutrients. Lean protein, for instance, has been shown to help with muscle building and recovery from strenuous exercise. Another perk and perhaps more important to those who care to lose weight is that it helps with satiety. However, like all good things, there is a limit to it's effectiveness and benefits. As I talked about before, if you eat too much of anything your body will store it as fat for later.

So how much protein is enough and how much is too much. Let's take a look at what the experts have to say. In 2007 the Journal of the International Society of Sports Nutrition wrote an article regarding their stand on "protein and exercise." If you'd like to view the entire article for yourself, just follow the hyperlink. I'll highlight some of the most important parts:

1) "Vast amounts of research" have been done that support the increased protein needs of exercising individuals. This means that, yes, you do need more protein when you work your body more. (warning: sciencey language ahead) This is because proteins are made up of amino acids which are used to build other proteins in your body including enzymes that perform metabolic processes. An athlete's increased metabolism and stresses therefore dictate the need for increased protein intake.

2) Protein intake levels ranging from 1.4-2.0 g/kg/day in exercising individuals are not only safe but may also help improve adaptations to exercise training. That's pretty self explanatory. It means that for a guy like me who weighs ~79 kg, I can eat between 110 and 158 g of protein each day in hopes of improving my athletic performance. That comes out to between 400 and 600 calories a day from protein which would be only 13-20% of my caloric intake on a day that I eat 3000 calories (which is normal or less than normal when I am in full swing with bike racing).

3) Eating protein after exercise can aid in recovery, specifically it aids in maintenance of lean muscle mass and muscular hypertrophy when consumed following resistance exercise . This is a complicated topic, and one that I think I will highlight again another time, so for more info you'll have to tune in later.

Another interesting topic on protein is how much is too much? Generally your body breaks down and reuses a set amount of its own proteins each day. This means that there is a plateau effect in supplementing protein. Amounts higher than 2.0 g/kg/day generally offer only limited increase in benefit if any increase at all. It also just so happens that eating 2.0 g/kg/day is actually rather difficult if you aren't intentional about it. A whole egg only has about 7 g of protein (I would need to eat 22 eggs to eat my 158 g of protein) or 600+ g of lean chicken...that's about 1.32 pounds.

The bottom line is that protein is an essential part of your diet whether you are an athlete or not. If you aspire to live an active lifestyle, protein becomes a more important part of your diet. Nevertheless, all things must be taken in moderation and balance must be your guiding principle. I'll leave you with the following from Mayoclinic.com:

"Remember, the healthiest diet is based on fruits, vegetables, whole grains and lean sources of protein — not rigid lists of 'good' and 'bad' foods. "

Be Thankful

So much of exercise and fitness is about moving forward, getting better, improving on what you have and leaving the old obsolete version of you behind. But if that was the only message that I ever offered you here it would be incomplete.

When I write, I am very progress minded, and this is a lot of what fitness is about. Improving so that you get faster, stronger etc. However, there comes a point where you need to reflect on what you have gained and where you are. If you don't it will only lead to discontentment.

Today is Thanksgiving, so what better time to take pause and be thankful for whatever you have to be thankful for in life and in the theme of this blog here are a few things that I am thankful for...

...a healthy body to run, bike, swim, yoga (I don't know if I can use that as a verb), jump, row, and just plain play.

...my lovely wife who supports my crazy endeavors and family who backs me up.

...the privilege of being in medical school where I can learn all about the human body and how it works.

...friends and riding partners who like to do some of the same crazy stuff that I do

...Hey Cow

...A beautiful world to explore in so many different ways

...A safe place to live and sometimes to rest and recover when I need to

...Good food to eat and fuel my adventures

...A trusty steed to take me wherever my little heart desires

God has blessed me with all of these things and it just wouldn't make sense not to be grateful for them. I hope you take the time to stop and reflect on the good things in your life from time to time and not just when we have a holiday designed for it. Happy Thanksgiving!

Carbohydrates are not evil

Carbohydrates are the main source of energy that your body needs. That's right needs. Without carbs your body generally doesn't get enough high quality energy for your daily activities. Eating only protein leaves your body to starve in between meals (and especially overnight) because you cannot store protein and eating only fat in place of carbohydrate leads to LOTS of other problems.

If you want to do any kind of physical activity, carbohydrates are a necessity. They directly feed your muscle glycogen stores which are the primary source of energy for your muscles. Also, carbohydrates are the main way that your body feeds your brain the glucose that it needs. So fruits and veggies really are brain foods.

So why do carbohydrates get such a bad wrap? Mostly because our society has become so sedentary. It is easy to eat a lot of carbohydrates without even thinking about it, and when you eat too much at one time you wind up storing it as fat because you have more than you need for the time being. Also, diets like Atkins and South Beach have said "no carbohydrates = weight loss." Most people can't see through that to see that "no carbohydrates = water weight loss." When you have carbohydrates stored in your body you are also storing a significant amount of water with them, but when you cut out carbohydrate for long enough you also lose a lot of water resulting in a chronically dehydrated and lighter body. I think we can all agree that being well hydrated is a good thing, so if you are really wanting to be fit and healthy, cutting carbs out is not a sensible option (although cutting back may not be a bad idea).

Furthermore, your body knows what it needs, so the next time a carbohydrate deficient body gets any carbohydrates it latches on to them to store for later because it has been starving for carb. It may result in dropping some weight, but initially that weight is water weight and in the long term a significant amount of the weight that is lost is muscle. Additionally, the first carbohydrates it gets after starving for days weeks or months get stored right away and sometimes as fat. I don't know about you, but I'm most interested in losing fat, not storing it up to lose water or muscle.

Carbohydrates come in all sorts of different foods. Whole unprocessed foods like fruits, vegetables and grains are the best sources because they include other important vitamins and minerals with them, but there's nothing wrong with satisfying your sweet tooth from time to time with a chocolate bar. Whenever possible it's important to include some fiber or protein with carbs because carbohydrates do not trigger your "satiety switch" quite the same way as other nutrients. Satiety has to do with feeling full and satisfied and it takes longer for your body to realize this with carbohydrate than it does with fat or protein. Including enough fiber and staying well hydrated can help too.

The bottom line, carbohydrates are an essential part of your daily diet (and the FDA generally recommends that you get around 50-60% of your daily caloric intake from carbs). Not only that, but if you have even the slightest desire to live an active lifestyle you are going to need carbohydrates to fuel your fun.

Portion size, why it is that a super-sized portion means a super-sized you.

Everyone has heard about the movie "Super Size Me" by now and has seen how a sustained period of terrible eating can do terrible things to your body. The protagonist in the documentary was up against a lot more than just lots of calories, but that was the primary contributor to his 24.5 lb weight gain over the 30 days of his experiment. He was a 6'2" guy who weighed 185 lbs to start. During the 30 days of his experiement he ate around 5000 calories a day. His BMR based on those figures is right around 2000 calories/day, which means that he was eating in excess of 2500+ calories/day assuming that he was minimally active (which was another constraint of his experiment).

So what?

Before we answer the "so what?" let's start by laying some baseline information. Calories are a measurement of energy. Calorie with a capital "C" is actually a kilocalorie, but we use Calories to talk about food because measuring in calories like physicists would give us giganticer numbers than we want to deal with. Your body needs a certain number of calories per day which it gets from food. Food is your fuel. There are three main pathways that those fuels take when you eat them. They get used for 1)energy now, 2)they get stored as energy specifically for muscle in glycogen or 3) they get stored away as fat.

Now let's answer the "so what?" question.

If I only need around 2000 calories per day to do everything that my body needs to do what does it do with the extra? It stores it! Let me introduce you to your friend, the liver. The liver organizes most all of this fuel. It's first job is to maintain your blood sugar. If you don't have enough glucose in your blood the liver will move glucose into your blood. If you have too much glucose in your blood, the liver will take it out and send it where it can be stored. Pretty handy organ to have, eh? The liver also does a lot to direct the storage of extra fuel as both glycogen and fat. But here's the deal, you're body can only store so much glycogen before it's full. Fat cells on the other hand just keep getting bigger and bigger the more you stuff in them. It's not such a bad system when you don't know when your next meal will be, but living a developed nation we can usually count on eating every day. Which means that if you don't want to store food as fat you need to control your caloric intake.

There are two really important ways to do this. First, keeping an eye on your daily caloric intake vs. output. If you are using 2600 calories a day and eating 3000 you are going to have 400 extra calories a day that the body wants to hang on to, which means more fat. This explains the well known idea that if calories in > calories out you will gain weight.

Let's get more specific though and talk about how much you eat at one time. Would you believe me if I told you that eating 5 times a day is better for your body composition than eating 3 times a day? What if I explained that you would be eating the same number of calories, but in smaller portions spread throughout the day? Think about the liver's priorities..1)blood sugar, 2) glycogen, 3) fat. All right, so now imagine you ate 2500 calories in 5 portions. That means that you would eat around 500 calories each time you ate. Not too bad. That's a big PB&J sandwich. But it also means that your portions are small enough that you are primarily addressing liver priorities #1 and #2. Once the food is used to balance your blood sugar and fill up your glycogen tank there may not be any left for your fat stores. Now that's pretty cool!

Try it and see how it works for you. The worst part is the inconvenience of eating outside of the normal Breakfast-Lunch-Dinner window. However, eating small portions several times a day, will help your body to store less fat and use more of the energy it is consuming when it enters the body.

Food is Fuel

...and you're body is a power plant. Think of it a lot like a steam engine when you fuel the fire in a steam engine there is more heat to create more steam and thus more power from the engine. The engine doesn't work unless there is fuel to burn. (for those of you who need a refresher on steam engines check out How Stuff Works)

The difference is that our bodies also have batteries. The problem being that the batteries for our body tend to come in the form of love-handles rather than the nice copper tops. That's right, fat is the human battery. It's the primary way that we store energy for using later and it's pretty stinking good at storing a lot of energy (we can talk more later about how fat really isn't a bad thing unless you have too much of it).

Food is fuel. Sounds great, but what does it really mean. It means that what you eat lets your body do what it needs to do. There are three main nutrients that give energy to your body, protein, fat and carbohydrate. There is potential energy stored up in all of the chemical bonds that exist in the foods you eat. When you eat, your body breaks those bonds and transfers the energy in them to make other molecules your body can use, primarily ATP. Don't worry that's about the end of the sciencey discussion for now. The bottom line being that if you don't eat, you don't get the energy you need to do the things you like to do like running, biking, swimming etc.

There are three main plans that your body has for the fuel you put into it: 1) turn it into glucose right away to maintain your blood sugar levels and feed your brain, 2) store some energy in small energy stores for muscles called glycogen so that your muscles have the immediate energy they need to do things like walk, jump, sit, stand, etc. and 3) store whatever is left as fat.

Your body's goal is always to use the fuel you give it, even if you give it too much. Now the trick is finding out how much fuel you need and to give yourself the right amount. A good place to start is by doing a simple calculation of a basal metabolic rate. There are lots of calculators on the internet that you can find which will help you do this. The basal metabolic rate really is just a starting point though, because this is the absolute minimum number of calories you need in a day. Which means that even someone who has a sedentary job will burn more calories than their BMR...albeit not a lot more. The more active you are the more calories you burn because your muscles are using more fuel. Makes enough sense, right? If you drove your car 100 miles a day it would need more gas than if you drove it 10 miles a day. It's the same idea. Some calculators will try to compensate for this by giving you an opportunity to estimate activity level, like this one I found or the Livestrong.com calorie calculator. These are only estimates, but they work fairly well.

Not all fuels are created equally, either because you are never getting just one nutrient from what you eat. This is a good thing too. Interestingly enough it is often found that natural whole foods frequently have a combination of nutrients and vitamins that complement each other in such a way to benefit your body. For instance, eating an orange or a bell pepper is a more efficient way for your body to obtain vitamin C than taking supplements...but now we're getting into vitamins and other add ons. They aren't really fuel, but they help your body do what it needs to do with the fuel. We'll leave that for later.

Ultimately you need to choose your fuel carefully. Most people would be quick to agree that eating all fat is no good, but eating all protein is also no good. Foods need to be balanced between nutrients (fat, protein and carbohydrate) and they need to be enough to meet your needs. A caloric deficit--which is what you usually aim for whenever you go on a diet--will make your body lose weight, but it will also stress your body. Remembering that food is fuel will help you realize that when you eat you should be considering the amount of energy you have used or will need to use. The key being balance and establishing a beneficial average quantity.

Until next time, fuel up!

An exercise in discipline

I recently gave a presentation at Wauwatosa East High School to a 10th grade health class about obesity in America and about childhood obesity in particular. The presentation ended with a challenge to the class to make a change in their lifestyle for 30 days that will help to keep them fit and healthy. Some of the options included: Eating smaller portions, walking/bike riding to school, doubling your water intake, sleeping 8-9 hours per night, not drinking soda etc.

I left thinking it was funny to challenge them and then not accept a similar challenge on my part. Studies have shown the impact that a community or social network have on the health of individuals in that network. It means that if two people in a group of 10 friends decide to quit smoking, the other 8 are more likely to quit smoking. Likewise if you are in a high school and 30 people in a class decide to stop drinking soda at lunch, the rest of the class is more likely to stop drinking soda. The opposite is true as well. It means that our community has profound effects on our health.

I decided that it would be silly to challenge them to improve their health and community's health without contributing to my own. So I chose two changes to make as well. The first is to drink 2 L of water a day. After the first couple days, during which I am sure I took at least 10 different trips to the bathroom, my body has gotten a little more used to it and it's going well. I actually noticed that I get less hungry during the day when I manage to reasonably space my portions out through the day. Additionally--and this may be pure coincidence--I am two pounds lighter than when I started this a week and a half ago or so. I've heard that staying hydrated actually keeps your body from storing excess water weight. It makes sense, but I didn't know if I actually believed it. So far, that seems to be true.

The other challenge I decided to accept was keeping a food journal. Talk about a Challenge with a capital 'C.' I did this for two months at the beginning of the year and counted calories in order to try and drop 5 pounds before starting the cycling season. And having done it once, I can honestly say that it is a very rewarding exercise no matter how demanding. You have the opportunity to go back and shine a light on your habits which can be a little embarrassing, but helpful regardless. For instance, I am learning right now that I have started eating dessert a bit more often than I used to (I wonder why...). However, I haven't been riding or exercising as much. Hmmm.... In my first journal I discovered that I don't eat veggies nearly as much as I should. It didn't have as much to do with my eating preferences as much as it did with when and where I would eat. Working in the evenings left me with fewer opportunities to cook dinner and in turn I ate fewer vegetables. Oops.

All this to say that we talk a lot about being healthy without ever taking the steps to become more healthy. As an amateur athlete and a future physician I would hate to be one talking about all the great strategies to be healthy without ever trying or employing them. So for now, I'm on the 30 day challenge along with several Milwaukee County high schoolers. Here's to making a positive change!

What you eat and what your body does with it...

Just a few weeks in a medical biochemistry class and it's hard not to think about what's going on inside of me and with my metabolism every time I sit down to eat. Better yet, though, it's hard not to think about how to better fuel myself when I ride/race/exercise.

With that said, I think that you will be in for some Biochemistry lessons over the course of the next several posts. I'll try to address carb metabolism, lipids (fats), a bit about protein and any other golden nuggets that I come along...and if you thought of McDonald's chicken nuggets when I said that, you might just want to tune in for more.

Nutrition science is pretty cool and I'll be sharing as I learn. Hopefully it's as cool to anyone who feels like reading as it is to me.

我喜歡喝茶

Yeah, I'm surprised too.

It turns out I have to admit, 我喜歡喝茶 or "I like drinking tea" for those of you wondering.

In particular I like green tea (绿茶) especially with lemon. Maybe it's just a phase and will pass now that my sore throat and headache are gone, but I don't think so. And to my delight, green tea is actually quite good for you. The citrus from lemons supposedly even enhances the bioavailability of the catechins in green tea. That's technobabble for citrus makes it even better for you.

There are all sorts of anecdotal benefits of tea that have been around as long as tea itself. Which is pretty long since the experts at Wikipedia claim that tea is about as old as Chinese history (4000-5000 years give or take a century or two). Nowadays the big label on the box has to do with lots of antioxidants. The jury here is still out on the whole antioxidant craze, so for now I'm content to enjoy the anecdotes and--believe it or not--the scientific literature discussing the benefits of tea.

Perhaps more to come on the current antioxidant obsession in a later post, but for now it's tea time.

Green tea and varieties of green tea are the most common in China and is generally their beverage of choice over the black tea which has gained the most popularity among the tea people in the West (i.e. almost everywhere besides Asia). Although, Oolong (烏龍) tea which means "black dragon" tea, is also rather prominent. Let's face it all kinds of tea are popular in Asia. The phrase "all the tea in China" didn't just appear out of nowhere.

***A brief tea lesson. White Tea, Green Tea, Oolong and Black Tea are all technically the same thing. Sort of. They all come from the same plant, Camelia sinensis. They just represent different levels of processing or oxidation. The least processed being White Tea which is actually often made from buds of the tea plant and the most processed being Black Tea which is used in English Breakfast tea, Earl Gray etc.***

For me, though, I'm content to stay with the green stuff for now. Surprising, even to me, considering that some of my first experiences with green tea had me convinced that I was being fed grass clippings from the last time the lawn was mowed.

Green tea is a good middle of the road tea. It has half the caffeine of black tea and the most beneficial components because the level of processing is enough to bring them out without destroying them. Some of the purported benefits of green tea include: increased metabolic rate, a boost in mental alertness, a boost in the immune system, decreased cognitive decline in the elderly, and even an antidepressant effect. All of this coupled with the fact that a little caffeine comes in handy on study days makes it brain food that I can enjoy.

Now, obviously I don't know if all of that is true, BUT when it comes down to it tea isn't going to hurt me (unless it gives me kidney stones...which would hurt...a lot...). Regardless, it could help, so why not give it a try? It's an easy drink to make at home, costs about 12 cents per tea bag which can be used 1-3 times and has no calories. Except for the 15 calories that come from a tsp of sugar to sweeten it I'm not adding lots of extra fluff to my daily intake. Cool, huh?

That's my cup of tea. Enjoy!

The new kid

Yep, that's me again. The new kid. Well, sort of. I'm the new kid along with 203 other incoming M1 students at Medical College of Wisconsin. M-1 is the equivalent of a medical school freshman, in case you were wondering. It's a funny feeling after being away from the academic world for the last 2 years. The different part here is that life is not like it was for any other schooling up until now.

Up until now, every class I've been in has been populated primarily with people more like me. We've all lived closer together (except college maybe), we were all closer in age and generally closer in background. Here we all have some things in common. We all want to be doctors, we all went to college (at least I think so), we all eat and breathe and sleep and study... A LOT. And we're all bored with orientation and ready to hit the books, sort of, I guess. Regardless of what we have in common it all feels a bit different than anything before this. Which is probably a good thing. I mean, no one wants medical school to feel like kindergarten, right? Just imagine what our health care system would look like then. Oof.

Even though it's orientation, we still get a bit of a feel for what it will be like time wise. It's going to be really hard to do a lot more than go to school, eat and sleep, but it's definitely doable. The prospect of minimal free time makes me value my summer that much more. It was awesome. I'm going to miss riding my bike 8+ hours a week.

However, in an effort to stay sane and not squishy I have resolved to take steps to be involved in "non-studious" activities and "good lifekeeping" habits.

1. Eat good food and at home whenever possible. (note: good food)

2. Play.

3. Get involved with classmates outside of the classroom. Because if I don't, my only social interactions will sound something like this...

- What did you think of that last test?

~ It was hard.

- Yeah, I thought so too

~ Do you remember the answer to that one question about that stuff?

- Maybe. Do you mean the one about the thingy that does whatever.

~ Yeah

- Yeah, that was hard

~ Yeah, really hard....

...ad infinitum

Hopefully our conversations will be a little more intelligent than that, given that we are going to be doctors and all, but after our brains have been pulverized it may take a little recovery time.

I figure if I eat well, play anything I can whenever I get the chance and interact with people outside of the classroom, I won't turn into a blob that's just full of smart stuff and maybe it will feel at least a little like a normal life.

A little.

Maybe?

maybe not.

I can pretend, right? :)

Eat at Home

That's right, eat at home. In a world full of restaurants and fast food joints it's easy to convince yourself that it's easier to eat out and faster. But it's so much better for you to make your own food and share a meal with your family!

First let's evaluate this strictly on a convenience factor. While it may seem like you save a lot of time by going out to dinner, that's hardly ever true (unless you only visit McDonald's, Burger King, Wendy's, Taco Bell etc.) Let's say that dinner takes an hour to prepare and you spend 30 minutes eating. I'd say that's a fairly generous time allotment considering the number of families who dine and dash off to sporting events, school plays, PTA meetings, Wednesday night church and such. That's 1.5 hours of your evening.

Now let's take a look at a night out. Most people are willing to drive at least 20 minutes to go out to eat at a place that they like, often even more than that. There's 40 minutes right there. Not including the 15-20 minutes that it takes to be seated, order your food and have it brought to your table. Suddenly there's the hour that it took to make dinner and that's assuming that there was no traffic, you are the only one at the restaurant and you instantly knew which place to go for dinner without any delay in decision making. Not so fast and convenient now, is it?

Granted it's nice not to do the dishes, but is it worth paying $10 a plate or more just to have the dishes done when you could prepare the same meal for less than half the cost at home? And face it, $10 a plate these days is relatively moderate when you include taxes and tip (I doubt your tipping the server at home, although, maybe you should be).

Besides the time and money factors there is also the health factor. When you cook at home you know exactly what goes into your food and how much you are eating. Plus you rarely feel as obligated to stuff yourself and "get your money's worth" when you are eating at home instead of at a restaurant.

To illustrate, try this on for size: This winter I took my wife to dinner at a nearby restaurant as a special night out. I had a roasted red pepper stuffed chicken breast with mashed potatoes. Sounds tasty, no? I was curious about the nutrition facts for the meal and was shocked to find that the meal I had just eaten was around 1500 calories, not including my two large glasses of lemonade. I did not feel like I had stuffed myself despite eating over half a day's worth of calories. Admittedly, I was full, but not to the point of bursting or to the point at which I felt like I really shouldn't eat anything else that evening. In comparison, I had cooked a similar meal of stuffed chicken breasts at home during the spring and had an equally tasty dinner that was approximately half the calories of eating out.

Another danger to your health of eating out is feeling that you need to get your "money's worth" as I previously mentioned. The unfortunate American definition of this generally means More = Better. We opt for quantity over quality. Which leads to all sorts of problems that I will have to address at a later date.

All this to say that there are many benefits to eating at home, and you don't have to sacrifice flavor or quality. Not that eating out once in awhile is a bad thing. All things in moderation, right? Including moderation itself...hmmm...chew on that all you philosophers out there. But for now, try dining in a little more often. Make it a game and see what you can save by eating at home. Whether it's dollars or pounds it'll all add up in the end.

In case you need any other encouragement, have a taste of this...

Yummm... Smoothies

Craig's Strawberry Banana Smoothie

-1 cup Orange Juice

-1 Banana

-1 1/2 cups Frozen Strawberries

-1 cup Plain Yogurt

-add Sugar to taste (1-2 Tbsp)

Serves 2 large smoothies (20 oz); ~275 cal/20 oz smoothie

Bon Appetit!

Sometimes it's hard to eat enough.

Yeah, that's right. No one is going to want to hear me say this but sometimes it's hard to eat enough. Especially when you have to eat 4000-5000 calories in one day. Okay, so maybe it's not really super difficult to eat that much considering how many ways our US cuisine has invented for us to overindulge, but eating well and eating that much is a serious challenge. After all, food is fuel, and if you want to run like a Ferrari and not like a Yugo you have to use premium, you know? Now try eating almost double that while 4-6 hours of your day are spent riding your bike across the country.


Some of the riders at the Tour share telemetric information with the media just for fun. Jens Voigt is frequently one of those riders. He often shares his real time heart rate, power output and speed so that they can show the data while airing the Tour. It's cool, but humbling when you see that he's just cruising along around 30 MPH with a heart rate in the low 130's. In addition, two days ago, Jens was working like a madman to get Andy Schleck in Yellow and reported to journalists that he burned 6000 calories during his ride up and over the Col de la Madeleine. That's only in one day. Doing work like that, riders sometimes have to eat as much as 9000 calories per day. Yikes!



I found this article last year by Joel Stein about trying to eat that much. Here it is for your reading pleasure. In the meantime, while I prepare for my day in the mountains tomorrow I think I'm going to have a snack...



"What's Tougher, Riding or Eating" by Joel Stein

As much as I'd like to experience the Tour de France, I don't enjoy being on a bike for more than 90 minutes or going uphill. So after years of longing as an obsessive fan, I came up with another, more American way to experience the thrill of the Tour.

I would eat everything the riders do.

After all, as impressive as riding 125 miles up the Pyrenees in five hours is, eating 9,000 calories in a day is far better. And it's a goal that, through training, determination and possibly vomiting, I figured I could attain.

So I called Team Columbia and asked for its menu from one of the hardest days of the 2008 Tour, which included the insane climbs up Col du Tourmalet and Hautacam. Looking at the six meals -- the caloric equivalent of nearly five days of food for a normal adult male -- was the gastronomical equivalent of staring up at a cloud-covered mountain as you approached it (or what I assume it would feel like to stare up at a cloud-covered mountain as you approached it). Apparently these guys needed so many calories that day that Team Columbia's professional nutritionist required them to drink two Coca-Colas. I kept rechecking the list to make sure there were no Twinkies on it.

I soon decided that if I were to be true to myself and my American heritage, I'd have to attempt this feat while sitting on my couch, watching live cycling coverage. It would be all calories in and no calories out -- at least not through sweating. (Unless I was sweating over a toilet bowl.)
Also, in camaraderie with the Tour, which is trying to eliminate performance-enhancing drugs, I vowed not to smoke any marijuana.

TEAM COLUMBIA MENU

STAGE 17, TOUR DE FRANCE 2008

Breakfast
• Banana (1)
• Muesli (150 gr)
• Pasta (150 gr -- weight is non-cooked)
• Croissant with chocolate (1)
• Coffee (250 ml)
• Soy milk (300 gr)
• Mixed fruits (200 gr)
• Orange juice (300 ml)

Pre-race
• Pasta (150 gr)
• Water (500 ml)

Race
• PowerBar (4)
• Fruit cake (100 gr)
• PowerBar carbo drink (4000 ml)
• PowerBar energy gels (4)
• Coca-Cola (400 ml)
• Turkey sandwich (2)
• Water (1000 ml)

Post-race
• Recovery drink (500 ml)
• Turkey sandwich (1)
• PowerBar (1)
• Coca-Cola (330 ml)
• Fruit cake (100 gr)
• Water (400 ml)

Dinner
• Mixed vegetables (200 gr)
• Pasta (200 gr)
• Chicken breast (250 gr)
• Sauce (100 gr)
• Plain yogurt (350 gr)
• Mixed fruits (150 gr)
• Water (800 ml)

Pre-sleep
• Gum/sweets (100 gr)
• Chocolate (25 gr)
• Water (500 ml)

Before any record-shattering athletic feat is attempted, it's always best to check with a medical professional. My longtime doctor, Robert Samuelson, gave it some thought and concluded, "It would not hurt you at all" and "You'll gain weight." He also said it wouldn't be much different than eating a couple of Big Macs in a day. Let me just say that while Dr. Samuelson is a great doctor and a smart guy, he clearly knows very little about the McDonald's menu. I would have to eat 17 Big Macs to equal the Team Columbia daily caloric intake.

On the morning of my attempt, I woke up extra early just to start eating, which felt rather weird. Unfortunately, it took me almost an hour to prepare breakfast, so I didn't actually start consuming food until about 9 a.m., putting me behind schedule from the start. In front of me, I saw what looked like one of those expensive hotel Sunday brunch buffets that includes breakfast, lunch, dessert and a meal not yet invented.

I enjoyed the fruit, and a half-pound of pasta with olive oil is never a bad thing. But I do not know what the Swiss do all day that requires muesli to be the densest food ever made in non-bar form. The only way I could get through my bowl of it was to revive myself occasionally with little bites of the chocolate croissant.

I felt so full afterward, I broke my own rule and went out for a walk, which turned into a hike. Even Tour riders don't cheat during breakfast.

Before the race starts, there is another meal -- for which I was not yet hungry at all, having eaten an hour ealier. I plowed through the other half of the box of pasta and downed it all with two pitchers of bright pink PowerBar carbo drink, which made me imagine a summer camp for kids who are too skinny. But halfway through I broke down, sweating, with stomach pains. I have no idea how you can eat this much and then feel like getting on a bike. Or how you can eat this much when you're nervous about racing. Or how you can eat this much if you're an adult elephant.

As I watched the race on TV, I alternated between two turkey sandwiches, four peanut butter PowerBars, four PowerBar energy gels and two Cokes. I looked at the riders' grimacing faces and knew I was suffering more. As I sipped my second Coke, my eyes started watering and I desperately wanted to barf. But then, thankfully, the race ended. I was a whole lot of carbo drink, one PowerBar, three gels and a piece of fruit cake behind schedule. Cadel Evans, who'd won the day's race, was smiling and talking on TV, not enduring anything close to what I was. I kept wondering what would happen if those two women on the podium with him tried to kiss me. It could be ugly.

An hour later, as I sat down for my postrace meal, I'd recovered impressively -- I downed another turkey sandwich, my fourth PowerBar of the day and another Coke. The PowerBar made my jaw ache, but mostly, I was just dealing with the clichéd self-recriminations of an athlete after a loss. I could have dealt with the jaw fatigue and had another PowerBar, but I held off. I vowed to make up for it later that night.

I had to head out to a movie screening in the early evening, but I took my predinner snacks with me. I was gnawing on a giant piece of fruit cake 30 minutes into the film when, suddenly, my face turned red and I felt feverish, as if that last little bit of food had activated all the other food still inside me. I made it about 10 feet out of the theater before I saw that I was following none other than Larry King into the men's room. And I immediately felt very, very bad for him.
I'll spare you the gory details on that portion of the evening. Suffice it to say I went to the bathroom six times that day. I'm not a scientist, and this was not a real experiment, but I learned at least one thing from all of this: You give the human body enough calories in a short enough period of time, and it doesn't have time to turn it all into fat. One way or another, those calories get turned to waste.

I also learned I'm an idiot who does idiotic things.

At 11 p.m., with just an hour to go, I stared at the uncooked chicken breast, vegetables, fruit, yogurt, chocolate and (unbelievably) more pasta I had left to tackle -- and I dropped out. I fell short by more than 2,000 calories. And I marveled, more than ever, about how different I am from professional athletes.

I guess I will never know what it's like, on any level, to be a Tour de France rider. Which fills me with the kind of shame only known by people who fail in an attempt to do something stupid that no one cares about.

The shame of Robbie Knievel.

The philanthropist and humanitarian Joel Stein is based in Los Angeles and a Time magazine columnist.

Turn off the TV

I read an interesting article on Time.com today about the foods that get advertised on TV and what your diet would look like if you ate only things advertised in TV commercials.

Think about it a little. If you watch TV much and pay attention to the commercials instead of just skipping over them with Tivo (if you have that option), what are the most important things in life? Cars, Beer, new clothes, perfume, fast food, fine dining and weight loss...to name a few. Hmmm...fine dining, fast food and weight loss. A bit of a paradox eh?

The research team from Armstrong Atlantic State University in Savannah, GA watched 84 hours of prime time television and 12 hours of Saturday morning cartoons. Then they formulated a 2000 calorie a day diet based only on the things that they saw advertised on TV. Here's a taste:

"When the research team calculated the nutritional content of a 2,000-calorie-a-day diet containing only foods that were advertised on television, they found that it exceeded the government's recommended daily amount of fat by 20 times and had 25 times the recommended daily intake of sugar. "That's almost a month's worth of sugar in one day," notes study leader Michael Mink."

Yuck! Not only that, but the daily intake was significantly deficient of important vitamins and minerals like potassium, calcium, Vitamins D and E for example. Not that this should really be surprising to anyone who thinks about the food they are putting in their mouths, but still, that's disgusting.

To quote your mother "Turn off the TV and go play outside." You'll be happy you did.