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Clarence Bass by Guy Appelman


FAQ 12 (Scroll for all articles)

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Does Extra Protein Help Older Men?

A: Apparently not.

People ask me what protein supplement I recommend. I tell them that a healthy balanced diet is all we need to maintain and promote lean body mass; that excess calories in the form of protein are deposited as fat. But they keep asking about protein supplements.

"In the US we get more than enough protein," said Dr. Alice Lichtenstein, executive editor of Tufts Health & Nutrition Letter (August 2018). "Yet people seem to be trying to add even more protein to their diets, and there are more and more protein supplements and protein-fortified foods to tempt them."

A clinical trial in the April JAMA Internal Medicine tested this issue, with and without testosterone injections, on the most vulnerable group: older men with physical limitations. The design also alleviated a major problem with nutritional studies which are based of self-reporting, by providing participants with foods carefully prepared to meet their individual protein and energy requirements and by monitoring adherence to the protocol.

While testosterone had the desired effect, protein beyond the current RDA (0.8 grams per kg of bodyweight) had no effect. One kilogram equals approximately 2.2 pounds, so the RDA calls for .36 grams of protein for each pound of bodyweight. You'd be hard pressed to find an American who doesn't consume that amount or more.

Researchers from Brighams and Women's Hospital in Boston and the Boston Medical Center, assigned 92 older men with physical functional limitations (mean age 73) to one of four groups:

1: 0.8 gm protein/kgm + testosterone injections. 2: 1.3 gm protein/kgm + testosterone injections. 3: 0.8 gm protein/kgm and no testosterone. 4: 1.3 gm protein/kgm and no testosterone.

The primary target of the study was lean body mass, determined using DEXA. Secondary outcomes were muscle strength, power, physical function, health-related quality of life, fatigue, balance, and well-being.

The bottom line is that consuming almost twice the recommended amount of protein had no effect on lean body mass or the secondary outcomes--with or without testosterone injections.

"Protein intake exceeding the RDA did not increase LBM, muscle performance, physical function, or well-being measures or augment anabolic response to testosterone in older men with functional limitations whose usual protein intakes were within the RDA. The RDA for protein is sufficient to maintain LBM, and protein intake exceeding the RDA does not promote LBM [buildup] or augment anabolic response to testosterone," the researchers concluded.

Let's be clear. The men in this study were functionally limited; they were not able to meet physical activity guidelines. They need all the help they can get. Those able to exercise effectively don't need extra protein--or testosterone. We do need adequate protein, but more is not better. Have some high quality protein in each meal and you'll be fine. For someone weighing 175 pounds, the RDA works out to 63 grams of protein a day. Four ounces of poultry, 8 ounces of yogurt, an egg, and a half cup of beans would supply that much. (Tufts Health & Nutrition Letter, September 2018)

November 1, 2018

Coffee and Health?

A: Yes. A lot has happened since I wrote about the pros and cons of coffee almost a decade ago (FAQ 8, Item 4).

At that time it was thought that observational studies were the only feasible option; that randomized controlled trials involving coffee were too risky. The good and bad were about evenly balanced. Long-term observational studies had found lower rates of advanced prostate cancer, Alzheimer's, Parkinson's, strokes, diabetes, and more. But there was also evidence that coffee can be harmful for people with high blood pressure, low bone density, insomnia, and pregnant women. While all of that is probably still true, the balance seems to have shifted in favor of coffee. We even have a mouse study from Germany showing a mechanism by which coffee can lower the risk of dying of a heart attack. That the caffeine in coffee gives cells energy to fight off damage.

An "umbrella" review of 218 studies found that people who drink 3 to 4 cups a day of coffee are at lower risk of a range of diseases and conditions. (BMJ January 12, 2018) Importantly, this study of studies included 17 randomized clinical trials, "with nine unique outcomes." They go beyond association to prove cause and effect.

The big study of studies found that coffee is associated with lower risk of several cancers, cardiovascular disease, neurological (brain, spine and connecting nerves) and liver conditions, and death from any cause. Most of the evidence, however, comes from observational studies.

The authors call for more randomized controlled trials "to understand whether the observed associations are causal." Outside of pregnancy, they say that such research is "more likely to benefit health than harm." They warn that women at risk for fracture should probably be excluded from such trails.

It appears that the gates are open for more clinical trials on the benefits of coffee. Coffee is taking center stage for its health benefits.

*  *  *

My coffee consumption has also changed, in two ways I consider positive. First, I now have my coffee with whole rather than skimmed milk: two thirds whole milk and a teaspoon of canola oil. Coffee tastes better with whole milk and absorbs more slowly and evenly. As before, I usually have my coffee with food, and never black. I'm careful not to drink coffee late in the day when it would keep me awake.

Three cups are my limit.

Being 10 years older, I am more convinced that coffee stimulates my brain and helps me concentrate. (I also get up and walk around to stimulate my brain.) I have coffee before I sit down to work in the morning and again in the afternoon. I also have double strength coffee before my main workouts on Tuesday and Saturday. Ten years ago my coffee consumption was pretty much take it or leave it. Now I consider it an important factor in my day-to-day productivity.

The new research suggests that I may be getting even more benefit than I realized.

Carol still does not drink coffee. (Interestingly, her parents drank coffee in the home and mine didn't.)  If you feel no need for coffee (like Carol) there is probably no good reason to start--unless your doctor suggests otherwise.

(See below for more on benefits of whole milk.)

September 1, 2018

Still Drinking Organic Whole Milk?

A: Absolutely! I'm enjoying my daily consumption of whole milk more than ever. It's far more satisfying than skimmed milk. Plus, we have good news.

New research adds support for my switch to whole milk. Researchers from the University of Texas Health Science Center at Houston found no connection between dairy fat and mortality or cardiovascular disease. Moreover, they found evidence that dairy foods guard against heart disease and stroke.

"Our findings not only support, but also significantly strengthen, the growing body of evidence which suggests that dairy fat, contrary to popular belief, does not increase risk of heart disease or overall mortality in older adults. In addition to not contributing to death, the results suggest that one fatty acid present in dairy may lower risk of death from cardiovascular disease, particularly from stroke," first researcher Marcia Otto, PhD, told UT Health Media Relations. (July 11, 2018)

Tufts University's Dariush Mozaffarian, MD, a leader in the movement to re-evaluate dietary fat, including whole-fat dairy products, was senior author of the new study. (See my Time to Lift the Limit on Dietary Fat https://www.cbass.com/dietaryfatlimit.htm )

The study looked at how fatty acids found in dairy fat are related to heart disease and all-cause mortality over a 22-year period. This gave the study accuracy not found in the more commonly used self-reported consumption of dairy fat.

Nearly 3000 adults 65 year and older were included in the study, which measured plasma levels of three different fatty acids found in diary products at the beginning of the study, in 1992 and again at six and 13 years later.

None of the fatty acids were significantly associated with total mortality. One type, in fact, was linked to lower cardiovascular disease deaths. People with higher fatty acid levels, suggesting higher consumption of whole-fat dairy products, had a 42 percent lower risk of dying from stroke.

"Consistent with previous findings, our results highlight the need to revisit current dietary guidelines on whole fat dairy foods, which are rich sources of nutrients such as calcium and potassium. These are essential for health not only during childhood but throughout life, particularly also in later years when undernourishment and conditions like osteoporosis are more common," Otto added.

You can read the entire study online: https://academic.oup.com/ajcn/advance-article/doi/10.1093/ajcn/nqy117/5052139?guestAccessKey=c18b1acf-2778-42b9-8d72-878c0e86cdbf

August 1, 2018

What's Normal Cognitive Aging and What's Cause for Concern?

A: When I told my doctor that I'm having more trouble remembering names (names have never been my strong suite) he responded by telling me about the problem he had remembering the names of people he and his wife spent time with on a recent cruise. He simply could not remember their names. It was embarrassing. He finally solved the problem by keeping their names on a note in his shirt pocket.

He said it's normal to have memory problems at my age. Not to worry unless it starts to affect my quality of life, especially if other people have to tell me about it. If Carol says I've got a problem, it's probably time to worry.

Looking back, I've come to appreciate my doctor's "note pad" solution. As our memory fades with age, our understanding of how our mind works grows. We get smarter. When we can't remember where we left our glasses or car keys, we solve the problem by making a habit of always putting them in the same place. (I have a special bowl for my keys.) The problem is solved. It works every time.

My grandmother--who passed at 98 with her mind intact--used to "sleep on problems." I didn't understand what she meant, until I found the solution to problems coming to me over night. (Key elements of this FAQ came to me during the night.) Walking has the same effect. "Never trust any idea that comes to you sitting down," has merit. Both sleep and walking put our mind in creative mode--making us smarter with age.

Gerontologists tell us that starting as early as 30, everyone develops subtle declines in memory, thinking speed and concentration. Usually, they occur so gradually that you don't notice until you're in your 60s or 70s. Some call them "senior moments." (A phase that's banned in our house. We see it as equating age with incompetence.)

Let's look at what's normal and what's not, based on information from the Cleveland Clinic and a few things from me.

Retroactive inhibition, the tendency of later learning to hinder the memory of previously learned material, is a concept I remember from psychology, my college major. It's the number one cause of forgetting, for young and old. Men generally have poorer memory than women, but time is the enemy of memory for both sexes. If you don't routinely retrieve a piece of information, you're likely to have more trouble remembering it with the passage of time.

Carol's memory is definitely better than mine, but sometimes I retrieve information before she does. She's better on some things and I'm better on others. We move on and, all the sudden, the information finds it's way into our consciousness. She's far better on details and I'm a little better on big picture thinking. She can read a book and then tell you about it in great detail. I can't do that, but what I can do is connect ideas.

So people are different, not better or worse, just different.

Some memory lapses are part of normal cognitive aging, while others suggest a more serious problem.

Just because your memory has slipped slightly doesn't mean that you're on a downward slide toward Alzheimer's disease or some other form of dementia. You are more likely to be experiencing normal changes in memory that occur with aging. If you find that your memory problems are a lot worse than others your age, you might want to have it checked. Your spouse may notice it before you do.

Any concerns you have are likely to be put to rest by this list of slippage considered normal:

Trouble remembering a phone number--Forgetting where you left your car keys--Taking longer to perform basic math--Forgetting why you entered a room--Momentarily forgetting the next step in a process--Forgetting the name of a public figure or person you haven't seen for a while--Taking longer to come up with the right word.

Feel better?

"What shouldn't change," according to the Cleveland Clinic's Center for Geriatric Medicine, "is how you remember occurrences in your life, as well as your ability to respond in an emotionally appropriate manner in certain situations. Also, take note if you or your loved ones notice more permanent cognitive problems that affect your ability to enjoy hobbies, manage your finances, understand how to take your medications properly, drive or follow directions."

You can, of course, fight back and lower your risk of falling into the abnormal category.

Ways to maintain your brain are essentially the same as those to keep your heart going strong. Beyond regular exercise and a healthy diet you can participate in mentally challenging activities. Stay socially engaged and do things you enjoy and do well.

Start right away. Don't wait until you begin having problems. See our latest new article on boosting brain function:  GO

July 1, 2018

Can Exercise Help Overcome a Family History of Heart Disease?

A: Surely it can, although couch potatoes might argue that genes are destiny. I've often wondered about it. My father battled high cholesterol for years and died after suffering a silent heart attack and later a stroke.

An observational study published April 9, 2018, in the journal Circulation suggests that exercise may actually have a greater impact on those with the worst genes.

One of the largest studies of fitness and heart disease, it examined data collected from nearly a half-million people in the UK Biobank database. They found that people with high levels of fitness had reduced risks of heart attack and stroke--even if they had an elevated genetic susceptibility to these diseases.

Among those with an intermediate genetic risk, those with the strongest grips were 36% less likely to develop coronary heart disease and 46% less likely to develop atrial fibrillation (AF) than those with the same genetic risk and the weakest grips.

Among those with the highest genetic risk, the highest level of cardiorespiratory fitness was associated with a 49% lower risk for heart disease and a 60% lower risk for AF.

"People should not just give up on exercise because they have a high genetic risk for heart disease," explained senior researcher Erik Ingelsson, MD, PhD, professor of medicine at Stanford University School of Medicine. "And vice versa: Even if you have a low genetic risk, you should still get exercise. It all ties back to what we have known all along: It's a mix of genes and environment that influence health."

For more details--and there are many--you'll find the entire study online. 10.1161/CIRCULATIONAHA.117.032432

Another study, published October 31, 2017, in the American Journal of Epidemiology, investigated the unique benefits of strength exercise, aerobic exercise, and a combination of the two forms of exercise on all-cause mortality, cardiovascular disease, and cancer.

Researchers from the University of Sydney analyzed data from 80,306 adults over a span 14 years in health surveys in England and Scotland. They found strength training to be associated with a reduction in premature death from all causes, and may be even more beneficial than aerobic exercise when it comes to cancer.

Those doing strength training showed a 23% reduced risk of all-cause mortality, and a 31% reduction in cancer related death. Those doing both cardiovascular and strength training were shown to have a greater risk reduction than those doing cardio training only. Strength training alone, however, did not appear to reduce the risk of death from cardiovascular disease.

"In terms of mortality risk reduction, adherence to the strength promoting guideline on physical activity appears to be at least as important as adherence to the aerobic guideline," the researchers concluded. "Our results support the value of specifically promoting adherence to the strength exercise guideline over and above the generic physical activity targets."

Once again you'll find the entire study on line: https://academic.oup.com/aje/article-abstract/187/5/1102/4582884

*  *  *

A well rounded exercise routine including both strength and aerobic exercise will help tremendously to overcome a family history of illness and early death. Find a balanced exercise routine that you enjoy and keep doing it as long as you can. Our friend Judge Dan Sawyer, now in his 90s and having outlived almost all of his peers, vows to stop off at the gym for a final workout on the way to the cemetery. 


June 1, 2018

What's the Best Way to Avoid Back Pain?

A: Trinity College Dublin Associate Professor & Chartered Physiotherapist Fiona Wilson wrote April 5, 2018, in The Conversation that the best way to avoid back pain is to "lift heavy things." That would probably come as a surprise to most adults suffering from lower-back pain. Not me, however. With some qualifications, I'm inclined to agree. I've been managing a gimpy lower back for years by lifting and rowing hard. I no longer do squats or deadlifts, but I challenge the muscles of my lower back and body in many other ways. I warm-up thoroughly and avoid movements that hurt.

Wouldn't works for everyone, of course. Those with bad backs should talk with their doctor or physical therapist before making major changes.

The fact that so many people have back problems suggests that a different approach is needed. Avoiding heavy lifting whenever possible doesn't seem to be working.

Professor Wilson reminds us that human tissue needs to be exposed to loads to become strong. The spine is no exception. "Regular loading prepares the joints, muscle, and ligaments for normal tasks," she explains. "Nobody would expect to run a marathon without preparing the body for such loading, so it seems logical that to be able to lift a weight requires exposure to that activity."

Weight trainers are no doubt nodding in agreement. Weak backs are more likely to complain than strong backs.

Wilson references studies of astronauts showing that prolonged weightlessness in space caused back pain when they returned to earth. "Prolonged unloading caused an unstable or weak spine leading to back pain."

Research on elite rowers--who fully flex and load their lower backs hundreds of times every time they train--provides a model for building a strong and pain free back.

Wilson says there appears to be a loading sweet spot--progressive loading and adequate recovery--where the lower back is gradually trained to cope with the load. "Rapid increases in training load with poor recovery is associated with the onset of back pain in rowers," she warns.

Take your time building back strength and allow time for recovery--and growth--between training sessions.

Another lesson from rowers is that engaging the hips and thighs along with the back makes you less likely to develop back pain. "The emphasis should be on strengthening these muscles," Wilson writes.

"Rather than advise people to avoid lifting, they should be taught to make regular lifting part of their everyday routine," Professor Wilson concludes. "Emphasis should be on creating a fit workforce rather than providing them with lifting equipment. After all our spines can handle it."

My Take

Elite rowers row five or more days a week--and I row once every two weeks. For most people, one is probably too much and the other too little. Rowers mainly row, while I add many other forms of exercise for my back and the surrounding muscles. The photos below show me using the Glute-Ham Developer to strengthen my lower back, hips, and leg biceps--without compressing my spine. The only muscles aiding the back it doesn't work are the quads on the front of the thighs. I do the leg press to work my thighs, lower back, and hips. My rowing, of course, works my legs, lower back, traps, arms, and rear deltoids.

I tells you this to illustrate a way to strengthen your lower back and the surrounding muscles, without doing more harm than good. Few people want to row every day or do exactly what I do. If you can squat and deadlift, by all means includes these proven movements in your routine. I prefer the Trap-Bar deadlift, because it allows a more upright position. It's up to you to find what you enjoy and works for you--and then keep doing it. 

Listen to Professor Wilson. Avoid the crowd with low-back pain. Make back training part of your lifestyle. Better yet, make total-body fitness your goal.

Once again, avoid movements that hurt. If it hurts don't do it!



Photos by Laszlo

June 1, 2018

Steps to Avoid Dementia?

Q: You've written about steps to cope with aging and keep arteries flexible. Are there similar steps to lower the risk of dementia?

A: Interestingly, there are two avenues (one long and the other short and focused) to combat the gradual decline of the brain and its abilities--a growing and costly problem worldwide. Both are telling and instructive.

Conferences in London and elsewhere have brought together experts to review existing dementia research and recommend ways to lower the risk of this devastating condition. A recent report published in The Lancet identified nine modifiable risk factors:

          1: Low levels of education

          2: Midlife hearing loss

          3: Physical inactivity

          4: High blood pressure

          5: Type 2 diabetes

          6: Obesity

          7: Smoking

          8: Depression

          9: Social isolation

About 35 percent of dementia cases are attributable to these factors, according the report. The majority of them are the same as those for slowing aging and preventing arterial stiffening. Like the others, the four new ones can be modified for dementia prevention.

The first one can be modified by increasing education in early life, which the report estimates could reduce the total number of dementia cases by 8 percent. Continued education and other mentally stimulating tasks are believed to help the brain strengthen its networks so it can continue to function at a higher level even if it starts to decline later in life.

Never stop learning and challenging your mind.

For the first time, the researchers identified hearing loss as a major risk factor for dementia. They estimated that treating hearing loss in mid-life could reduce the number of dementia cases by 9 percent.

Hearing loss contributes to the other new risk factors, social isolation and depression. "They may work in similar ways as they reduce the chance of interactions and conversations, which are like exercise for the brain and enrich it and predispose to depression," commission member Lon Schneider, MD, a professor of psychiatry and behavioral sciences at the Keck School of Medicine of USC, said in a statement.

While it is not clear whether depression is a cause or a symptom of dementia, it was found to be responsible for 4% of the risk of developing dementia.

Social isolation is increasingly thought to be a risk factor for dementia as it also increases the risk of hypertension, heart conditions and depression. However, like depression, it remains unclear whether social isolation is a result of the development of dementia. It was found to be responsible for 2.3% of dementia.

Noting that modifying all nine risk factors could reduce risk by 35 percent, Professor Schneider observed that lifestyle modification is inexpensive and that a 35 percent reduction of risk is "far larger than anything you can ever expect for drugs." (Lifestyle trumps drugs once again.)

Another report, by the National Academies of Sciences, Engineering and Medicine, using different methodologies than The Lancet report, found that just three types of intervention offered "encouraging but inconclusive" evidence: cognitive training, blood pressure management for hypertension, and increased physical exercise.

According to The Washington Post, similar studies are underway in this country, in Singapore, and in Australia.

While the war against dementia will be with us for a very long time, lifestyle modification can stem the tide.

*  *  *

Once again, we find that we can do more for ourselves than any drug can do for us. Lifestyle is the most powerful tool we have. Whether--and how--to use it is up to each one of us.

December 1, 2017

Heavy Weights Build Stronger Nerves?

Q: You've written before that light weights and heavy weights lifted to failure are equally effective for building muscle mass, but that heavy weights have the edge for building strength; to lift heavy weights you must lift heavy weights. Anything new on how this works?

A: Yes, we have an interesting new study from the University of Nebraska-Lincoln examine how lifting 30 and 80 percent of one-rep maximum to failure influence neuromuscular adaptation--signals from the brain to the muscles. The unique contribution of the study is measuring the difference in neural adaptation. Let's look at what they found and then discuss the practical application.

Readers might want to begin by reviewing our earlier piece on the effect of low- and high-loads on building muscle and strength: http://www.cbass.com/LightWeights2.htm  Specificity comes more into play in building strength. As you say, to lift heavy weights you must lift heavy weights. You have to challenge your nervous system to lift heavier and heavier weights.

Muscles contract when they receive electrical signals from the brain. The signals speed through the spinal column to the motor neurons that trigger the muscle fibers involved.

Nathaniel Jenkins, now an assistant professor of exercise physiology at Oklahoma State University, conducted the research for his dissertation at Nebraska-Lincoln. His team randomly assigned 26 men to train for six weeks on a leg-extension machine loaded with either 30 or 80 percent of their one-rep maximum. Three times a week they lifted until they couldn't complete another repetition. As in earlier studies, the groups saw similar growth in muscle mass but a larger strength gain (about 10 pounds) in the high-load group.

To understand the role nerves play in building strength, the researchers supplied an electrical current to the nerves that stimulate the quadriceps muscle. This allowed participants to work at 100 percent of capacity, which cannot be achieved voluntarily. They then compared maximum force production with and without help from an electrical current.

By doing this, they were able to determine how close each participant's nerve cells were to achieving 100 percent activation, a measure known as voluntary activation.

After repeating this test at baseline, 3 and 6 weeks, they found that the low-load group increased their nerve capacity from 90.07% to 90.22%, or 0.15%. Low-load training barely moved the dial.

The high-load group on the other hand saw their voluntary activation jump from 90.94 to 93.29 percent, a rise of 2.35 percent. Almost 16 times more than the low-load group.

Jenkins acknowledged that low-load training remains a viable option for those looking to simply build muscle mass or avoid putting too much stress on joints. Still, he said, when it comes to building strength--heavier is better.

"I don't think anybody would argue (with the idea) that high-load training is more efficient," Professor Jenkins said. "It's more time-efficient. We're seeing greater adaptation. And now we're seeing greater neural [nerve cell] adaptation."

"The unique contributions of this study were robust measurements...used to elucidate any potential underlying neural factors," the researchers wrote in concluding their report.

Reported July 10, 2017, in the journal Frontiers in Physiology, you can read the entire study online. http://www.readcube.com/articles/10.3389/fphys.2017.00331

My Take

I beg to differ with Professor Jenkins. While he is correct that heavier is better for building nerve force and strength, that doesn't mean training heavy all the time is a good idea. It seems to me that a practical take away would be to train in the middle of the two extremes, using 50 or 60 percent of maximum, getting the best of both worlds in a more user friendly manner. Both low- and high-load training can be oppressive.

Another approach would be to cycle between the two extremes. Topping out at 40%, 60% and 80%  (high reps to low reps) and then starting over would be more interesting--and keep you progressing.

Competitive lifters would, of course, want to spend most of their time in the high-load area. Still, Tommy Kono America's greatest weightlifter did low-load training from time to time. He also won four international bodybuilding titles.

Professor Jenkins' efficient might very well be another person's agony.

The key for long term success is to lift in ways that keeps you interested and motivated.

Understand the principle illustrated in the Jenkins study and put it to use in a manner that suits you.


Get Ripped on Whole Milk & Yogurt?

Q: Will full-fat dairy foods make you fat? Are they good for you?

A: The latest findings challenge the current dietary guidelines, which recommend limiting saturated fat and and skim over whole milk: http://www.cbass.com/dietaryguidelines.htm 

A new study from Ireland found that full-fat dairy foods were associated with lower body fat and blood pressure, while reduced-fat milk and yogurt were associated with higher triglyceride levels and LDL-cholesterol.

The researchers confirmed that people who regularly consume low-fat milk and yogurt tended to have a higher intake of carbohydrate, which can elevate blood sugar.

Cheese was found to be neutral, not associated, negatively or positively, with cholesterol, body fat, or various markers of metabolic health.

Here's how Dr. Emma Feeney and her team of researchers from the University of Dublin arrived at those conclusions.

Using results from the National Adult Nutrition Survey, they divided 1,500 healthy Irish adults aged 18-90 years into patterns of dairy consumption, including whole milk, and reduced fat milks and yogurt. They also considered the overall diet in which the dairy foods were consumed. Finally, they then collected blood samples and measured body composition, blood pressure, and other markers of metabolic health.

Interestingly, the reduced-fat and yogurt group had the highest score on the Healthy Eating Index (fruit, vegetables, nuts, whole grain, vegetable fat, less red meat, and no trans fat), but higher triglycerides levels and total cholesterol. Those eating full-fat dairy rated lower on the Healthy Eating Index, but had less body fat and lower blood pressure.

“We have to consider not just the nutrients themselves but also the matrix in which we are eating them in and what the overall dietary pattern is, so not just about the food then, but the pattern of other foods we eat with them as well," Dr. Feeney told University College Dublin News and Opinion: http://www.ucd.ie/newsandopinion/news/2017/mar/13/eatinglotsofcheesedoesnotraisecholesterol/

Whole milk and yogurt in an overall healthy diet pattern would seem to be best. Unfortunately, few if any of the participants fit that pattern. It appears that skim milk drinkers were paying more attention to the dietary guidelines than those drinking whole milk. Time for a change in both groups?

The researchers summarized their conclusions:

This study applies the concept of dietary pattern analysis to understanding dairy food intakes and allows for the exploration of patterns of dairy food intakes with differing fat contents. Here we show that clear and robust patterns of dairy food intake exist in the Irish population. The results of the tertile analysis suggest that dairy foods overall may offer potential for weight management, particularly milk and yogurt. Dairy foods, principally milk, may also have a role in the control of blood pressure, and potentially in the management of blood glucose. Cheese consumption was not associated with adverse lipid profiles, measures of body fatness or other markers of metabolic health in this cohort. Although greater overall dairy food consumption, driven mainly by milk and yogurt, was associated with more favourable body weight status, no single pattern of dairy food consumption stood out as having an overall healthier profile in this reportedly healthy population sample, when actual patterns of intake were examined. In fact, a ‘Reduced fat milks and yogurt’ pattern was associated with higher triglycerides. As this cluster consumed a lower percentage energy from fat, and a higher percentage energy from grains, this suggests that the food intake pattern associated with low fat high carbohydrate may be less healthy than other patterns. More research is needed to better understand this result.

The results presented here demonstrate the importance of considering not only intakes of discrete foods, but also the patterns in which they are consumed in the diet, particularly in relation to dairy food intake patterns. Due to the current debate over dietary sources of SFA, the application of this concept to larger data sets, including ‘at-risk’ cohorts, is warranted.

The study was published February 20, 2017, in the journal Nutrition & Diabetes and can be read online: http://www.nature.com/nutd/journal/v7/n2/full/nutd201654a.html?foxtrotcallback=true

Time to Decide

The weaknesses of the Irish study are that association does not prove causation and that food diaries leave no way to tell if foods were missed or excluded. Be that as it may, the evidence presented is likely to be the best we are going to get. There is no practical way to control what people eat over an extended period of time.

For what it's worth, I am an example of the benefits of consuming organic whole milk in the matrix of a balanced whole food diet. Except for the whole milk, I would score high on the Healthy Eating Index used in the study. I rarely eat junk food.

Switching to whole milk after decades of skimmed milk consumption had little or effect on my body fat level--but did push my HDL "good" cholesterol level off the chart, into the 80s for the first time. My other blood lipids and triglycerides remained low. My overall numbers were and are ideal.

For more details, see the results of my first visit to the Cooper Clinic after switching to whole milk: http://www.cbass.com/ClarenceBassCooperClinic14.htm and More HDL is Better: http://www.cbass.com/HDLCholesterolMax.htm

Finally, see Milk in the Middle: http://www.cbass.com/milk.htm (Note that butter, red and processed meats fall into the "harm" category. The green light on whole milk and yogurt does not extend to fatty and cured meats.)

If we wait for the experts to agree on the dairy fat issue, we are likely to be waiting a very long time. Many are heavy invested in low fat eating and are not likely to change their mind.

It's time to decide what's best for you.

October 1, 2017

Fat But Fit?

Q: Where do we stand on those who are fat but fit? Is there a price to be paid for being overweight if you are otherwise fit and healthy?

A: A new study from the University of Birmingham in the UK, followed 3.5 million people for 20 years, and found "fat but fit" to be a pipe dream for most people.

This dispute dates back to 1999, when Dr. Steven Blair, director of research at the Cooper Institute in Dallas, opined that being fat appears to be okay if you are also fit. "In the men who are overweight or obese, but also moderately or high-fit, we don't see much increase in the risk of dying," he told everyone willing to listen. I believe it would be fair to say that this became his signature issue.

Continuing to explore this controversial topic, Professor Blair appears to have refined his position. “Our data support the idea that interventions might be more urgently needed in metabolically unhealthy and unfit obese people, since they are at a higher risk," he reported from his perch at the University of South Carolina. "This research highlights once again the important role of physical fitness as a health marker,” he continued.  http://www.sc.edu/news/newsarticle.php?nid=4574#.WTrm-NE2ycw

While the UK researchers would probably agree on the importance of physical fitness, they provide strong evidence that ignoring obesity is a bad bet.

Refining "fat but fit" to mean "metabolically healthy obese," the researchers classed any one who did not have coronary heart disease, diabetes, high blood pressure, or high cholesterol at the beginning of the study as "metabolically healthy obese." Taken from a large UK general practice database, the data did not include level of exercise or physical fitness. It stands to reason, however, that physically fit subjects are more likely to be among the metabolically healthy obese.

The UK researchers found that "metabolically healthy obese" individuals are 50% more likely to suffer heart disease than those of normal weight.

There are, of course, exceptions. There will always be people who remain healthy in spite of being obese. Being physically fit probably ups the odds.

Susannah Brown, senior scientist at the World Cancer Research Fund, told the European Congress on Obesity in Porto, Portugal, where the new study was reported, that being overweight or obese can increase the risk of 11 common cancers, including prostate and liver.

Dr. Rishi Caleyachetty, who led the new study, said that "the priority of health professionals should be to promote and facilitate weight loss among obese persons, regardless of the presence or absence of metabolic abnormalities."

The British Heart Foundation, the UK's biggest funder of cardiovascular research, said that the research helps to dispel an "age-old myth."

"The big bottom line is that you can't be fat and healthy forever - it's a ticking time bomb, and sooner or later it will lead to a disease or medical condition that is almost entirely preventable," Jacqueline Hooton wrote in The Independent on May 17, 2017. http://www.independent.co.uk/voices/fat-but-fit-myth-diet-fitness-obesity-complications-inclusive-a7741126.html

For many more details, read the coverage of the new study in The Guardian: https://www.theguardian.com/society/2017/may/17/obesity-health-no-such-thing-as-fat-but-fit-major-study

July 1, 2017

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Step Up Exercise in Mid-Life?

Q: What’s the basis for your claim that exercise becomes more important with each passing year?

A: Until now, the basis was primarily my own experience. I see people younger than me who can barely pick up their feet and struggle to get out of a chair. Makes me thankful that I started exercising in my teens and never stopped trying to improve. A recent study in the Journal of Gerontology: Medical Sciences backs up my experience with hard evidence.

Researchers from Duke University gave 775 people, ages 30 to 100, simple tests of strength, endurance, and balance. They found that physical performance was worse with each decade. The decrement was about the same for men and women. Worsening physical performance was observed as early as the fifties for chair stands and balance and in the sixties for gait speed and aerobic endurance.

The association between performance and physical activity increased with age. As I've said many times, exercise became more important with each passing year.

“More physical activity was associated with better physical function.” Use it and you won’t lose it.

A good test is to see if you can stand on one leg for a minute. The researchers found that the average person in their 30s or 40s came close to the minute mark. People in their 50s made it just 45 seconds. For people in their 60s, it was 40 seconds; for those in their 70s, it was 27 seconds, and for over 80, it was 12 seconds.

“Typically, functional tests are conducted on people in their 70s and 80s, and by then you’ve missed 40 years of opportunities to remedy problems,” senior author Miriam C. Morey, PhD, told Duke Health.

“Our research reinforces a life-span approach to maintaining physical ability—don’t wait until you are 80 years old and can’t get out of a chair,” lead author Katherine S. Hall, PhD, added. “The good news is, with proper attention and effort, the ability to function independently can be preserved with regular exercise.”

*  *  *

If you aren’t exercising regularly, you might begin by putting movement into your day. Simply get up and move around every hour or so; you'll be surprised how much better you'll feel and perform. See my article Get Up and Move: http://www.cbass.com/getupandmove.htm

In that article I refer to my “Morning Motion” routine. You might want to give that a try. I start my day by moving every part of my body, beginning by opening and closing my hands, and moving on to my wrists, elbows, shoulders, and then my torso and lower body. Nothing complicated; I make changes regularly as new moves occur to me. I pay particular attention to my lower back and knees, starting out by moving without resistance and moving on free squats, and then rapidly thrusting upward on my toes. I always include a series of balancing movements on one leg and then the other.

The whole routine takes about 10 minutes. Use your imagination and move your body in ways you enjoys. See my article on balance http://cbass.com/Balance.htm 

For tips on gradually introducing exercise into your life, see my FAQ on New Year’s resolutions: http://www.cbass.com/Faq(8).htm (scroll down)

The key is to find forms of exercise you would enjoy doing regularly. The possibilities are practically endless. See my book Take Charge http://www.cbass.com/PROD08.htm

Stay active and thrive.

June 1, 2017

Comment on this FAQ: FEEDBACK

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