In the majority of individuals, type 2 diabetes occurs related to metabolic syndrome, i.e., in the context of overweight/obesity, ectopic fat accumulation, metabolic inflammation, and insulin resistance [1]. However, alternative pathophysiologic processes, unrelated to metabolic syndrome, can also lead to this disease [1-4].

Historically, type 2 diabetes was viewed as irreversible and progressive. However, recent research showed the opposite, at least for type 2 diabetes related to metabolic syndrome. As first demonstrated after bariatric surgery, this disease subtype can be brought into remission by substantial weight loss [5,6]. As shown later, such weight loss can also be achieved through lifestyle intervention. The Counterpoint study, for example, demonstrated that short-term caloric restriction leads to rapid metabolic improvement in subjects with type 2 diabetes related to metabolic syndrome [7]. Furthermore, theDiRECT study applied a similar approach in a routine care setting. In that trial, a 46% remission rate of type 2 diabetes related to metabolic syndrome was achieved after 12months of a lifestyle intervention that started with a period of a very-low-calorie formula diet [8].

In the DiRECT study, remission of type 2 diabetes was defined asglycosylated hemoglobin (HbA1c) of less than 48 mmol/mol (6.5%) in the absence of glucose-lowering medication. Reaching this target of partial remission in a large percentage of study participants was a great success. Nevertheless, this remission target falls short of normalization of plasma glucose in real life and thus of a state in which glucotoxicity and beta cell stress would be minimized. Such a normalized state, however, seems necessary for the long-term maintenance of metabolic health. In contrast, partial remission to a prediabetic state is probably set up for failure and rapid reoccurrence of type 2 diabetes [9].

Currently, different devices permit obtaining a real-life glucose profile. Some transmit data continuously, while others rely on intermittent scanning. All, however, measure subcutaneous, interstitial glucose levels in short intervals. These devices are already established as valuable tools to guide insulin therapy. They provide detailed insights into glycemia that go beyond the information obtained by punctual plasma glucose measurements or HbA1c [10]. Additionally, a normal range for real-life glucose profiles has now been established through the study of healthy populations [11].

Given this level of development of continuous monitoring, real-life glucose profiling could be an ideal tool to evaluate the extent of type 2 diabetes remission. In this pilot trial, we, therefore, attempted to provide proof of concept that complete remission of type 2 diabetes related to metabolic syndrome to the point of a normalized real-life glucose profile can be achieved.

The monocenter lifestyle intervention study PiREM (Pilot study for individualized REMission induction of type 2 diabetes) was conducted at the diabetes center of the University Hospital, Ludwig-Maximilians-Universitt (LMU) Munich, Germany. Participants were recruited between January and June 2020 through the local diabetes outpatient clinic as well as through advertisements on public transport and online diabetes information portals.

Eligible participants were 18 to 64 years old, had been diagnosed with type 2 diabetes within the previous sixyears, suffered from metabolic syndrome, and were motivated to participate in the lifestyle intervention. The diabetes diagnosis had to be confirmed by an HbA1c 48 mmol/mol (6.5%) plus one elevated blood glucose value (fasting glucose 7.0 mmol/l, random blood glucose 11.1mmol/l, or 2-hour glucose in an oral glucose tolerance test 11.1 mmol/l). Furthermore, the glucose profile at baseline had to be diabetic (at least two time points with fasting sensor glucose 7mmol/l or any sensor glucose value 11.1 mmol/l).

Exclusion criteria were autoantibodies to glutamic acid decarboxylase 65 (GAD 65), tyrosine phosphatase 2 (IA-2)or zinc transporter 8 (ZnT8) >1.1 times the upper reference limit, fasting c-peptide<0.27 nmol/l, recent on-record estimated glomerular filtration rate less than 30 ml/min per 1.732 m2, current or planned pregnancy within the following 12 months, scheduled surgery within the following 12 months, myocardial infarction or stroke within the previous six months, known malignancy, severe or unstable heart failure ( New York Heart Association classII), previous bariatric surgery, hospital admission for depression within the previous 12months, substance abuse, or participation in another clinical trial. The current use of anti-diabetic medication, including insulin therapy, was not an exclusion criterion.

Written informed consent was obtained from all participants and the protocol was approved by the Ethics Committee of the Ludwig-Maximilians-Universitt (project number: 19-182). The study was preregistered at the German Clinical Trials Register (drks.de; study ID: DRKS00020453).

The study was designed as a single-arm pilot trial to test the feasibility of complete diabetes remission, defined as a normalized real-life glucose profile, after lifestyle intervention. The intervention period lasted six months. In one case, it was prolonged to nine months due to study interruption and in one case, it was concluded after five months due to personal reasons.

The primary study endpoint was the degree of improvement of glucose metabolism at the post-intervention visit. Complete remission was defined as normalization of the real-life glucose profile without glucose-lowering medication over at least five days (see below for further details). In case no real-life glucose profile could be obtained, an HbA1c value of less than 39 mmol/mol (5.7%) plus a fasting plasma glucose less than 5.6mmol/l without glucose-lowering medication were accepted as an alternative definition. However, this alternative definition of complete remission did not have to be applied.Partial remission was defined as an above-normal real-life glucose profile but an HbA1c in the prediabetic range of 39-47 mmol/mol (5.7-6.4%) without glucose-lowering medication.

Secondary endpoints were changes in body weight, BMI, waist and hip circumference, insulin resistance (calculated as homeostatic model assessment of insulin resistance (HOMA-IR)), insulin secretory reserve, whole-body, liver and pancreatic fat, systolic and diastolic blood pressure, serum lipids (triglycerides, cholesterol, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) cholesterol), and changes in the prescribed medication.

The three main study visits were a screening visit, a pre-intervention visit, and a post-intervention visit that included measures of fasting plasma glucose, HbA1c, and serum lipids (triglycerides, cholesterol, HDL, and LDL cholesterol). Further, a real-life glucose profile, anthropometric measurements, MRI, and an arginine stimulation test were obtained during the pre- and post-intervention visits.

In weekly in-person visits during the first two weeks of the intervention, a study physician assessed the participants motivation, adherence to the diet, blood glucose profile, weight, exercise patterns, and possible side effects. After that, contacts were every other week in person or via telephone.

For participants with type 2 diabetes related to metabolic syndrome, all with a BMI25kg/m2, the lifestyle intervention started with a very-low-calorie formula diet (Optifast 800 or Optifast Professional, Nestl Health Science, Vevey, Switzerland, respectively; 815-865 kcal per day, distributed over five ratios of 163-173 kcal per day, 34-46%carbohydrates, 32-36% protein, 7-11% fat, and 5-7% fiber) for one to three months, depending on the individual progress. Only vegetables with negligible calorie content were permitted in addition to the formula diet. Participants were also advised to drink at least two liters of water or unsweetened tea per day to prevent constipation, which had been described previously in similar trials [8,12]. Further, participants were asked to monitor their plasma glucose and blood pressure. Glucose-lowering and blood pressure-lowering medications were reduced as indicated.

After a maximum period of three months, regular food was reintroduced, accompanied by regular nutrition counseling. The aim was to reach a maintenance diet that permitted further gradual weight loss or was at least isocaloric with an approximate composition of 25% carbohydrates,25%protein/fat, 40% vegetables, and 10% fruits [13]. Besides nutrition counseling, participants were coached regarding physical activity, exercise, psychology, and behavior change. To support physical activity, pedometers were distributed. The exercise target was at least 150minutes of moderate-intensity activity per week, preferably combined with muscle-strengthening activities [14].

Height, waistcircumference, and hip circumference were measured using a measuring tape to the nearest 0.5 cm. Body weight and body fat percentage were determined by bioelectrical impedance analysis (Tanita BC-418, Tanita Corporation, Tokyo, Japan). Resting systolic and diastolic blood pressures were obtained on both arms in a seated position and the mean out of two measurements on the arm with the higher systolic pressure was recorded.

Study participants were invited to participate in a whole-body MRI to determine pancreatic and hepatic fat levels via a low-fat fraction map technique (3 Tesla System, Ingenia or Achieva, Philips Health Care, Best, Netherlands). The MRI study protocol has been described in detail previously [15]. For two participants, baseline MRI data were missing due to scheduling conflicts.

Insulin secretory reserve was tested in an arginine stimulation test. The test protocol was adapted from Teuscher et al. [16] and Robertson [17]. Subjects with glucose-lowering medication were asked to pause their pharmacological treatment from the evening before testing. The stimulation test started after an overnight fast of at least eight hours. Fasting samples of plasma glucose and insulin were drawn, before a bolus of arginine (5g arginine HCl, given as a 0.29 mol/l solution; B. Braun Melsungen AG, Melsungen, Germany) was injected over 60seconds with time 0 set at the beginning of the injection. Further blood samples for insulin measurements were drawn at 2, 3, 4, 5, 6, 8, 10, and 15 minutes. The acute insulin response to arginine (AIRArg) was calculated as the mean of the three highest insulin levels obtained within five minutes after the start of arginine injection minus the pre-stimulus insulin level [18,19].

To obtain a real-life glucose profile, a FreeStyle Libre 2 device (Abbott Diabetes Care, Alameda, CA, USA) was used for 2-14 days at a time. The sensor was inserted into the upper arm adipose tissue.

Interstitial glucose values were measured every minute and stored in the sensor memory every 15 minutes. For validation, occasional capillary plasma glucose measurements were implemented. Participants were advised to scan their sensor at least every eight hours to avoid losing any values stored in the sensors temporary memory. However, they were not supposed to use the sensor values to guide any lifestyle decisions.

A real-life glucose profile was obtained at least twice during the study, at the pre- and the post-intervention visit. An additional profile was obtained during the intervention period as needed to guide the intervention or to decide about medication.

Reference values for a normal real-life glucose profile have been published previously by Shahetal.[11]. According to this publication, we classified a profile as normal when glucose concentrations remained between 3.9 and 7.8 mmol/l at least 96% of the time. To display and analyze the real-life glucose profiles, we used the web-based diabetes management system LibreView (Abbott Diabetes Care, Alameda, CA, USA), and the glucose values were stored in the sensor memory every 15 minutes.

Plasma glucose was determined by the hexokinase method (Glucose HK Gen. 3, Roche Diagnostics, Mannheim, Germany), serum insulin by chemiluminescent immunoassay (DiaSorin LIAISON Systems, Saluggia, Italy), plasma HbA1c by high-performance liquid chromatography (HPLC) (VARIANT II TURBO HbA1c Kit, Bio-Rad Laboratories, Hercules, CA, USA), and serum blood lipids (HDL cholesterol and triglycerides) by enzymatic caloric test (Roche Diagnostics, Mannheim, Germany). LDL cholesterol was calculated by the Friedewald equation. For antibody determination, enzyme immunoassays were conducted (ZnT8: Medizym Anti-ZnT8, Medipan GmbH, Dahlewitz/Berlin, Germany; GAD65: Anti-GAD-ELISA (IgG), Euroimmun Medizinische Labordiagnostika AG, Lbeck, Germany; IA-2: Anti-IA2-ELISA (IgG), Euroimmun Medizinische Labordiagnostika AG, Lbeck, Germany). The HOMA-IR was calculated from fasting samples according to Matthews et al. [20]: HOMA-IR =glucose0(mg/dl)*insulin0*(IU/ml)/405.

Due to the small group size, variables were treated as non-normally distributed and are presented as median (first quartile-third quartile). To compare pre- and post-intervention measurements, the Wilcoxon signed-rank test was used. Fishers exact test was used for the comparison of categorical variables between visits. Two-sided p-values < 0.05 were considered statistically significant. Statistical calculations were performed using the statistical software program IBM SPSS Statistics (IBM SPSS Statistics for Windows, version 25.0, IBM Corp., Armonk, NY, USA). For graphic representation, GraphPad Prism was applied (GraphPad Prism version 6.0 for Mac, GraphPad Software, La Jolla, CA, USA).

Ten participants with type 2 diabetes related to metabolic syndrome were included in this study. The participants' median age was 52 (43-56) years, they had a median BMI of 33.1 (32.1-37.7) kg/m2, and the median time since diagnosis was 1.5 (1.1-5.3) years (Table 1).Of these 10 participants, seven completed the study. Two dropped out due to unwillingness to follow through with the nutritional program and one because of a long-term stay abroad.

At the end of the study, one participant reached complete remission, three achieved partial remission, and three displayed improved glucose control still in the diabetic range (Table 2 and Figure 1). Additionally, body weight, BMI, waist circumference, hip circumference, body fat percentage, and HbA1c decreased significantly in the whole group. Fasting plasma glucose, fasting insulin, HOMA-IR, liver fat, pancreas fat, systolic and diastolic blood pressures, triglycerides, and total cholesterol depicted non-significant downward trends. LDL and HDL cholesterol, as well as the AIRArg, remained unchanged (Table 3 and Figures2-5).

This pilot trial demonstrates that complete remission of type 2 diabetes related to metabolic syndrome to the point of a normalized real-life glucose profile is, in principle, possible through lifestyle intervention. However, this trial also illustrates that fully effective lifestyle change is difficult to achieve.

We consider the trial results a sufficient proof of concept for our hypothesis despite the fact that only one out of 10 participants reached the set remission target. This participant had been diagnosed with type 2 diabetes 1.4 years before study entry and had a baseline HbA1c of 51 mmol/mol (6.8 %) while taking metformin as glucose-lowering medication. Therefore, we believe that truly complete remission of established type 2 diabetes occurred in this case. Furthermore, three other trial participants reached partial remission with real-life glucose profiles in the normal range of 60-85% of the time.

As in previous studies, glycemic improvement in our trial was linked to weight loss,a reduction in hip and waist circumference, and whole-body, liver, and pancreas fat [7,21,22]. Due to the small sample size, not all of these changes were statistically significant, but the trends nevertheless appeared clear. Additionally, we observed other expected benefits of weight loss and lifestyle change, such as trends toward lower blood pressure and reduced serum triglycerides.

To avoid hyperglycemia after glucose administration, we conducted simple arginine stimulation tests to determine the insulin secretory reserve [18,19]. The median AIRArg remained stable over the study period, indicating unchanged stimulated insulin release. However, a more differentiated assessment of beta cell function may provide additional insights in future trials.

As in most lifestyle intervention trials, success in weight loss and glycemic improvement was variable between participants, despite intensive and individualized counseling [23]. This observation highlights the need for further improvements in intervention protocols for the induction of type 2 diabetes remission. We also want to reiterate that our findings and those of previous trials [7,8,21,24] only concern type 2 diabetes related to metabolic syndrome, not unrelated type 2 diabetes subtypes [1]. In those subtypes, remission by lifestyle change may be illusive or, at least, effective approaches have not been found yet.

The main limitation of our study was its small sample size. Nonetheless, we could demonstrate that complete remission of type 2 diabetes to the point of a normalized real-life glucose profile is possible in principle. Moreover, every participant completing our intervention improved his or her glycemic status and gained health benefits. Another limitation of our study was that we could not obtain baseline MRI data from two participants. Given the already small sample size, this missing data are probably responsible for the non-significant results regarding ectopic fat in the liver and pancreas despite the importance of these fat depots, which has been demonstrated in previous remission trials [7,21,22].

Excerpt from:
A Normalized Real-Life Glucose Profile After Diet-Induced Remission of Type 2 Diabetes: A Pilot Trial - Cureus

Its one thing to play Superman on screen, but its another thing entirely to walk around looking like a Kryptonian in your everyday life. And the first thing youre likely to notice when staring at Henry Cavill on Zoom are his shouldersnot even his Clark Kent jawline can distract from the small mountain range erupting from his humerus and clavicle. None of this is exactly news, given the multiple high-profile roles in which Cavill has transformed his body forThe DC universe, The Witcher, extremely buff Sherlock in Enola Holmesbut you truly cannot prepare for how mesmerizing those deltoids are.

Which is why Cavills latest role, as an ambassador for the supplement company MuscleTech is perhaps the most natural line on his resume. GQ caught up with the 38-year-old actor to find out how supplements influence his diet, his thoughts on pre-workout, and just how many meals a day you need to eat if you ever want shoulders like his.

GQ: Supplements are such a huge part of the fitness world, but I think something that can often be misunderstood, especially when youre first starting out. What was your journey with using supplements like?

Henry Cavill: It's an interesting thing, because I've been very fortunate over my career to have pros guiding me. As useful as that has been when it comes to physical results and how the body looks when I'm taking my shirt off on camera or whatever the case may be, it does certainly hinder my growth in knowledge. And so over the past couple of years, I've been trying to quiz my trainer, Dave Rienzi, more and more about the why of everything. Why is that going in? Why this rather than that? Aren't they both carbohydrates? Why this protein versus that protein? What does it mean when you do this before or afterwards? And so my journey is still very much in process.

Once you started asking those questions, was there anything that you were surprised to learn?

So I have a protein shake before bed, and there would be times where Id go, you know what, I want to lose a few more pounds, so I'm just going to cut the pre-bed shake out and not tell my trainer Dave. And itll be fine, because I'll be losing a few pounds and then I'll get back to showing progress photos and people will be like, Oh wow, look at the progress you made! But if I took three weeks off, when I would send Dave a progress photo, he would go, Okay, cool. So are you still taking the pre-bed shake? And I go, No, because I wanted to lose a few pounds.

That's when I started asking these questions because he then informed me that the problem with that logic is that, yes, you do have fewer calories going into your body, but you also go into a catabolic state with how hard you're training and how hard you're working. So actually what you're doing is you're losing muscularity while you sleep. So your body won't be looking as good. And almost immediately when I went back to the pre-bed shake, I was like, Yeah, the body looks better already. And for me, that was a massive learning point and a real shock. I thought, I need to start asking more questions and stop thinking that I can pull a fast one and pull the wool over his eyes.

I love that Dave instantly knew, too. Like, Hey, are you skipping that? But I think that's the preconceived notion, right? Don't eat before bed.

Absolutely. The protein shakes before bed, they are a real lifesaver for me. Especially with the amount of work, with the amount of output I have. It's important to make sure that all the right stuff is getting in at the right time so you don't lose anything and you're not wasting any time at the gym.

So youve got the protein shake right before bed, but what does a typical day of eating look like?

Read the original:
Henry Cavill Is Happy to Eat the Same Thing Every Day - GQ

For those who work out, protein supplements are a part of their life. Protein intake may vary from person to person, but a diet is incomplete without it.

Medical researchers advise against protein supplements for an average person, because the amount of protein every person requires depends on factors like age, sex, health and activity level. Ideally, your daily food should provide you with the required protein, say Dr Sanjay Shah, general physician, Fortis Hospital, Mulund and Shweta Mahadik, clinical nutritionist, Fortis Hospital Kalyan.

But many sports trainers continue to push them on amateur athletes.

The question then arises of whether you need protein when you exercise, particularly when you try to build muscle through weightlifting or other forms of resistance training. The doctors answer in the affirmative. The process of building muscle involves causing damage to muscle filaments and then rebuilding them, and this requires more protein, they say.

Why do we need proteins?

Protein is an essential macronutrient made up of amino acids. These chain-like compounds can be broken apart and put back together in a nearly endless variety of patterns which are used to create different kinds of cells.

Your body can make some of these amino acids on its own, but not all of them. The complete proteins found in animal products are your best sources of the essential amino acids that your body cannot produce.

But keep in mind that you shouldnt consume extra protein. Dairy products are also high in protein, as are certain green leafy vegetables and legumes. Too much protein can put a strain on your kidneys, so if youre using protein supplements to lose or maintain weight without working out, you need to balance your diet with fresh fruits, vegetables, whole grains, healthy fats and 1-2 litres of water per day. Tofu, soya milk, lentils, chickpeas, pinto beans, almond milk, nuts and oil seeds like sunflower, pumpkin seeds, sesame seeds etc., are rich sources of protein for vegetarians and vegans, they explain.

Consuming proteins in the right way

A healthy individual needs 1g protein per kg body weight per day. When training, however, they need about a half gram of protein per pound of body weight.

If you want to slim down or need more protein in your diet, feel free to have a protein shake on your off-training days. For example, if you skip breakfast or have a meeting to rush to in the morning, drinking a protein shake can provide you with the energy needed to function optimally. These, however, cannot replace meals; their role is to supplement your diet only, the experts say.

The risk factor is that all food and beverages provide calories. Protein supplements in the form of shakes and bars are no exception. They work best when used as part of a training program since they fuel your muscles into growth and increase fat burning.

Keep in mind

The doctors say that incorporating protein supplements in your diet with no workout at all is not recommended. If you go overboard, you may end up gaining weight especially if you have a sedentary lifestyle. You may also develop hyperaminoacidemia (excess of amino acid in the bloodstream) with nausea and diarrhoea symptoms; other health concerns may include kidney problems. Extra intake will slow down the kidneys metabolism.

If you need to consume more protein, but you do not exercise, it is best to have natural sources of the macronutrient as mentioned above coupled with minimum exercising. Remember to keep the nutrition factor high, and the calorie counts low if you arent exercising to burn off extra calories.

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The protein count: Do you need supplements even if you dont work out? - The Indian Express

Sometimes your body notices things before your mind does: you might think youre so far away from the menopause that a hot flush is just a thing you can fake to get out of a boring situation, but your midriff knows better. Lucinda Meade, 57, is a physiotherapist and personal trainer. She has trained many clients through the menopause and says it tends to start with surreptitious weight gain around the middle, which they then cant shift. It may be accompanied by aches and pains in smaller joints, and an unappetising smrgsbord of mood changes, sleep changes, annoying visits to the GP to be given antidepressants.

All this makes perfect sense from a hormonal perspective, as another trainer, Sarah Overall, 51, describes: Oestrogen governs so many of your bodily processes, and one of the things its involved in is water regulation. Its a lot easier for tendons and ligaments and joints to become dehydrated. And that can also lead to a resurgence of old injuries. Plus, when your female hormones decrease, you go from having a gynoid shape, carrying fat on your hips and thighs, to android obesity, abdominal fat, which is a male shape.

But what are you supposed to do, fitness-wise? Should you power through the aches, pains and lethargy, or just give up on being fit until you are out the other side? Are there adjustments you can make to the way you exercise and eat? Can you make it any better by working up to it beforehand? Finally, are there any upsides to the menopause, or is it just an irksome creep towards death, only ameliorated by the fact that it happens to (half of) everyone?

Arj Thiruchelvam, a personal trainer who coaches elite athletes, says of this power-through or take-a-break dilemma: Always make the decision on a macro, rather than a micro, level. In macro terms, to give up exercise during your menopause would be a disaster as your muscle mass decreases with age at the rate of about 1% a year. For menopausal women, its much more substantial than that. You need muscle mass to protect your bones, not to mention, as Meade says, the fact that it decreases cell death, increases stem cells and decreases fat cells, which are a secretor of inflammatory markers. Ageing is all about chronic, low-level inflammation.

On a micro level, though, Thiruchelvam says, if youve had hot flushes throughout the night and not slept, its probably worth listening to your body and giving yourself a rest. Overall has a 10-minute rule: If I wake up and I dont feel like a workout, I think, Ill do 10 minutes and if I still feel rubbish, Im going to stop. Thats the biggest piece of advice I can give anyone 95% of the time youll feel fine after 10 minutes.

Its also important to have weekly rather than daily goals, and be flexible (mentally as well as physically): use your energy when you have it, rather than beating yourself up about the times you dont. This will mean prioritising yourself and flaking out of other obligations, but thats fine your oestrogens dropping, so hopefully youll be less of a people-pleaser, too.

Now all you have to do is completely change your perception of what kind of exercise you need and enjoy. Meade explains: A lot of women have done a lot of yoga and running and they really need to be coaxed into weight training. This will probably be different once millennials are menopausal, since they have a huge iron woman culture and are all over calisthenics (building strength using your own bodyweight). But women now in their late 40s and 50s will have had their formative years in the 1980s, when exercise was all about looking skinny and weight-training was unpopular. Younger readers may not believe it, but magazines were absolutely full of the perils of muscle-building, and how once youd given yourself huge beefy shoulders, thered be no going back.

But there is more than one way to skin this cat. Dancing, rock climbing, climbing trees, anything: find the thing that works for you, says Meade. But there must be some strength element. Elite athletes, being so body-literate, often notice sooner than the rest of us that something has to change. Jenny Stoute, 56, represented the UK in the Olympics in Seoul and Barcelona, taking bronze in the 4 x 400m relay, before she became Rebel, the Gladiator, in 1996. Her menopause started two years ago, and now she says she cant even jog. If I went out on the road, springing up and down, my hamstrings would be history. I know my lower back doesnt like too much impact. So Ill do weights and body-bearing stuff, go on the rower, go on the cross-trainer. To be fair, I dont really want to run 100 metres. I had my time. All I want to do is look after my body to the best of my abilities.

Its a really good idea to get ahead of this if possible. People go into the menopause like some ghastly blind date where you know its going to happen but you hope its going to be OK, Meade says. Everyone in their 40s should be thinking about getting themselves in tip-top shape so that when it happens, its as fine as it can be. Dont treat it like a lottery and dont wait until youre feeling crap and then try to make decisions in that state.

Besides strength training, what does this actually look like? Work on your diet, so that your blood sugar isnt fluctuating too much: this can stave off the worst of the hot flushes, and will also help with mood swings. Dont try a ketogenic diet but do use a protein calculator, as protein-rich meals can help in maintaining muscle mass. You might want to adjust your portion size to suit your reduced basal metabolic rate (this is the amount of energy you use at rest, doing basic tasks like breathing and keeping warm) or you might think, sod it, one thing at a time. Take vitamin D and calcium supplements, and omega-3s the first two for bone health, since the loss of oestrogen often causes osteoporosis, the third for mood.

Work on the dehydration, not just by gulping water when you remember but by learning to recognise your personal signs of being dehydrated, and figure out when in the day its at its worst. A lot of menopausal women say they suddenly have no tolerance for alcohol and start to see wine, especially, as a kind of kryptonite. But its essentially just that the concentration of alcohol in your blood is higher. Im not saying you have to drink just that, if you stay really well hydrated, maybe you can.

If you havent got a sympathetic GP, see a pelvic health physiotherapist. Your pelvic floor muscles weaken regardless of whether youve had children or not, so bladder control becomes an issue as well, Overall says. Trampolining is a famous no-no for the menopausal, but running can also highlight bladder-control issues. I personally wouldnt sweat it. Youre probably going to have a shower when you get home anyway. And thats not even the worst of it: A lot of women will have had untreated issues from childbirth and then the menopause hits, on top of maybe a tiny little prolapse vaginal atrophy is a nightmare, Meade says. Pilates, generally, and Kegels in particular will help. In addition, its a good idea to find out what your family history is, particularly with osteoporosis. The more likely you are to get it, the more important it is that you do the strength-building work that will protect your bones.

Everybody I speak to is of one mind on HRT: if it works for you, do it, and start as soon as you get symptoms dont wait until they are unbearable. There is a certain reticence about starting HRT, a misplaced stoicism, a sense that you only need it because youre weak. Most of the perceived risks of HRT are historical and have been substantially reduced by developments to the drug regimen; there is a negligible rise in the risk of breast cancer, for instance, with oestrogen-only HRT.

Menopause symptoms interact with one another in unhelpful ways: sleep deprivation because youre too hot doesnt help with the mood swings, and a low mood makes things look worse than they are. So many menopausal people, including fitness experts, take a harsh view of their changing bodies. The bloating is terrible, Overall says. People are looking at me for their fitness and I look like a Michelin man. Stoute says her own athletic past has made her more of a wreck. Anyone who used to be top of the tree in the sporting world is thinking, My whole body feels like its falling apart. Its almost like the fitter you are at your peak, the worse the other end becomes. I look her up on Instagram (@gorgeousfifties), and find she still looks incredible. Be kind to yourself sounds like a cliche, but its worth doing anyway.

And finally, is there anything good to be said for the experience? Meade delivers this rousing statement: Its a wake-up call. Youre likely to live until youre nearly 90. How do you want it to be? How do you want to feel? Make a plan for that. Its a reminder that you can make choices and change your life for the better. Dont be a victim; you can fix it. Im much fitter than I was before.

Overall agrees: Im not there yet, but friends whove come out the other side say its absolutely brilliant. You dont have to worry about periods any more, you dont have hormonal fluctuations, you feel great. Nobody has ever said to me, This is rubbish. I miss periods.

See the article here:
Work your muscles and rethink your diet: how fitness can help you through the menopause - The Guardian

The height of a childs biological parents can be a good indicator of how tall a child will be, as genetics play a prominent role in determining height. However, this can vary, and siblings with the same parents may all reach different heights. Other factors, such as biological sex, overall health, nutrition, sleep, and exercise, during developmental years all factor into height and growth.

The height a person reaches by adulthood can depend on the genes they inherit from their biological parents, although some factors may mean a child does not reach their full potential height.

Nutrition and overall health during childhood and adolescence also affect human growth and height. Over hundreds of years, the average human height has increased due to improved nourishment in children and a reduction in illness and infections.

This article explores methods people may use to predict height, factors that affect growth in children and adolescents, and when to speak with a doctor if growth becomes a concern.

A combination of genetics and external factors can affect how tall a child will grow.

Health experts believe that 80% of a persons height is genetic. This means the height of biological parents can be an indicator of a childs height, although this is not always a reliable predictor.

Siblings with the same parents can vary in height, and one child in the family may be taller or shorter compared to the rest of the family.

Other factors, such as nutrition, illness, or premature birth, can also play a part in height and growth and may prevent a child from reaching their full potential height.

Learn more about which factors can influence a persons height.

According to Johns Hopkins Medicine, people may wish to try the following formula for predicting how tall a child will be:

However, note that predictive methods such as these are not concrete, and a childs adult height could change depending on different factors.

Learn how to measure height accurately.

According to the Society for Endocrinology, people can usually expect the following average growth patterns in children and adolescents:

Learn about the signs and stages of puberty.

Most females will have a growth spurt in the year before they start their first menstrual period. Their feet and hands will likely increase in size first, followed by the rest of the body.

Female growth slows down after their first menstrual period, but females will usually still grow 12 in after this time.

According to health experts, males usually have a growth spurt in puberty 2 years after most females. The peak time of growth is before sperm develops, and males will grow about 9 cm a year. Males also usually have longer growth spurts than females.

According to the Society for Endocrinology, there is no set age for when males and females will stop growing. Once a person has gone through all the stages of puberty to reach adult development, their growth will slow down and stop.

Additionally, growth plates in the bones fuse together at this stage, meaning individuals will not grow any taller.

Learn about when male children might stop growing.

Learn about when female children might stop growing.

Adolescents go through puberty at different stages, so variations in growth spurts can be normal. In some cases, going through puberty at a slower rate can be due to an inherited pattern, known as constitutional delay.

If there is too much variation, such as a growth spurt not occurring or females not menstruating by the age of 16 years, then it is important to speak with a doctor for a checkup.

In some cases, unusual growth or development in a young person may be the result of an underlying medical condition, such as:

Treating the underlying condition may help improve growth. In the case of a growth hormone deficiency, people may need treatment with artificial growth hormone.

Although genetics largely determine a persons height, proper nutrition is an important factor in healthy growth and development for children and adolescents.

According to the Academy of Nutrition and Dietetics, a balanced and nutritious diet for healthy growth and development includes:

According to a 2018 study, both exercise and good sleep can help increase height, as they elevate the release of growth hormones.

Sometimes, children or adolescents may face peer pressure or bullying for being a different height than those around them. This can lead to feelings of inadequacy, anxiety, or depression.

The American Academy of Child and Adolescent Psychiatry provides the following advice for parents and caregivers to help young people deal with peer pressure:

Learn more about teen anxiety and depression.

How tall a child or teenager will grow largely depends on the genes they inherit from their biological parents.

Good nutrition, exercise, and sleep also all play an important role in healthy growth and development. Illness, infection, or premature birth may all affect whether a child reaches their potential full height or not.

In most cases, young people will not be able to have much impact on their height other than living a healthy and balanced lifestyle. In some cases, children or adolescents may have a deficiency in growth hormone, which may require medical treatment to resolve.

If a child or adolescent is not growing or developing as expected for their age and biological sex, misses a growth spurt, or females do not have their first period by 16 years, then individuals can consult with their doctor for a checkup.

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How tall will I be? A guide for parents and children - Medical News Today

When it comes to longevity, much of the focus has been on the foods you eat and the best types of exercise. For good reason too - regular exercise and eating well can slash your risk of chronic disease, namely heart disease, which claims millions of lives each year. However, there are other lifestyle habits that contribute to longevity and research suggests they should not be overlooked.

Specifically, the researchers sought to determine the extent to which social relationships influence risk for mortality, which aspects of social relationships are most highly predictive, and which factors may moderate the risk.

Data were extracted on several participant characteristics, including cause of mortality, initial health status, and pre-existing health conditions, as well as on study characteristics, including length of follow-up and type of assessment of social relationships.

Drawing on 148 studies, the researchers put a 50 percent increased likelihood of survival for participants with stronger social relationships.

This finding remained consistent across age, sex, initial health status, cause of death, and follow-up period.

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Significant differences were found across the type of social dynamic evaluated.

For example, the association was strongest for complex measures of social integration.

In contrast, the outcomes were poorest for those living alone.

The result is not entirely surprising.

Although its hard to measure social isolation and loneliness precisely, there is strong evidence that many adults aged 50 and older are socially isolated or lonely in ways that put their health at risk.

The Centres for Disease Control and Prevention (CDC), cite a number of studies found that tie social isolation to poorer health outcomes.

In one study, social isolation significantly increased a persons risk of premature death from all causes, a risk that may rival those of smoking, obesity, and physical inactivity.

In another, social isolation was associated with about a 50 percent increased risk of dementia.

What's more, poor social relationships (characterised by social isolation or loneliness) was associated with a 29 percent increased risk of heart disease and a 32 percent increased risk of stroke.

Other evidence suggests loneliness is associated with higher rates of depression, anxiety, and suicide.

Furthermore, loneliness among heart failure patients was associated with a nearly four times increased risk of death, 68 percent increased risk of hospitalisation, and 57 percent increased risk of emergency department visits in one study.

"Your doctor can assess your risk for loneliness and social isolation and get you connected to community resources for help, if needed," notes the CDC.

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The habit that may increase your chances of longevity by 50% - its not exercise or diet - Express

That's even though many cheap and easy treatments exist -- from healthier diet and exercise to pills that safely lower blood pressure using a variety of mechanisms.

"We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment," the global team, led by Majid Ezzati, a global health specialist at Imperial College London, wrote.

"We defined hypertension as having systolic blood pressure (the top number of a blood pressure reading) 140 mm Hg or greater, diastolic blood pressure (the bottom number of a reading) 90 mm Hg or greater, or taking medication for hypertension."

The researchers looked at data covering 184 countries. The number of people with high blood pressure doubled from 648 million in 1990 to nearly 1.3 billion by 2019, they found.

"Policies that enable people in the poorest countries to access healthier foodsparticularly reducing salt intake and making fruit and vegetables more affordable and accessiblealongside improving detection by expanding universal health coverage and primary care, and ensuring uninterrupted access to effective drugs, must be financed and implemented to slow the growing epidemic of high blood pressure in low- and middle-income countries," Ezzati said in a statement.

Many high-income countries, including Canada, Switzerland, the UK and Spain reported their numbers of people with hypertension at all-time lows, but low- and middle-income countries such as Paraguay and central European countries including Hungary, Poland, and Croatia had high rates. Canada and Peru had the lowest rates of high blood pressure. "Hypertension prevalence was highest throughout central and eastern Europe, central Asia, Oceania, southern Africa, and some countries in Latin America and the Caribbean," the team wrote.

Overall, just under a third of men and women globally ages 30 to 79 had high blood pressure, the study found.

"The pandemic of cardiovascular disease has received less attention in the last 18 months but reflects concerning worldwide trends in unhealthy lifestyle choices such as high fat, sugar, salt and alcohol intake, sedentary lifestyles with avoidance of exercise, and smoking, all of which lead to higher blood pressure and bad cholesterol levels that cause damage to the blood vessels that supply the heart and brain," said Robert Storey, a professor of cardiology at the University of Sheffield who was not involved in the study.

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Number of people with high blood pressure has doubled globally, large study finds - CNN

Whether she's lighting up the stage as a member of the Pussycat Dolls or bringing her signature enthusiasm to The Masked Singer, Nicole Scherzinger has a seemingly endless font of energy. It's not just her dedication to her craft that keeps her in such good spirits (and great shape), howeverthe star relies on a tough workout routine to ensure she's ready to always bring her A-game to her devoted fans. In a new video, a bikini-clad Scherzinger reveals the exercise routine that keeps her so fit. Read on to discover the star's exact workout. And for more on how your favorite stars stay in amazing shape, Khloe Kardashian Reveals Her Exact Butt and Abs Workout.

On August 21, Scherzinger showed off her grueling workout routine to fans in a new Instagram video. In the clip, a bikini-clad Scherzinger can be seen doing a series of lunges and overhead dumbbell presses. She follows this with a quick workout on a stationary bike, after which she completes a series of yoga-inspired moves on a weight bench. A dancer at heart, Scherzinger rounds out her routine with some twerking on all fours. "I don't danceI WERK," she captioned the clip.

For more on how A-listers really shape up, These Are the Exact Foods Ciara Ate to Lose 39 Pounds.

Intense weight-bearing workouts aren't the only way Scherzinger stays fit, however.

In June, the multihyphenate star revealed that she makes dance-based workouts a priority, too. In a clip posted to her Instagram, Scherzinger showed off some Latin dance-inspired movesand once again, ended things with a little twerking. "I mean, I heard that dancing and laughing gives you better abs than crunches anyway?" she captioned the video.

It's not her commitment to exercise alone that keeps Scherzinger in such amazing shape. The Masked Singer judge revealed that when she's trying to shed a few pounds, she incorporates intermittent fasting into her routine.

"When I'm really watching my weight, I refrain from eating late at night," she revealed to People.

While Scherzinger admitted in her People interview that her diet is largely healthy and plant-based, she doesn't deprive herself of treats, either.

"When I'm going to indulge, I love pasta, pizza, I love Mexican with lots of cheese. I love French fries, or [chips]," she revealed in a 2019 interview with Women's Health. For more on how your favorite stars stay fit, Chris Hemsworth's Trainer Reveals His Exact Workout Plan, and for the latest celebrity health and fitness news delivered to your inbox, sign up for our newsletter!

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Nicole Scherzinger Reveals Her Exact Workout Routine in New Bikini Video | Eat This Not That - Eat This, Not That

The COVID-19 pandemic forced many of us to isolate and disrupted our usual routinesespecially those related to exercise. If you haven't resumed regular physical activity, a new study might make you want to get back on the horse (or bike, as it were). It found that being inactive has a potentially very serious consequence. Read on to find out moreand to ensure your health and the health of others, don't miss these Sure Signs You Have "Long" COVID and May Not Even Know It.

According to the study published in the journal Stroke, people younger than 60 who reported sitting for eight or more hours dailyand not being otherwise physically activewere seven times more likely to have a stroke than people who were sedentary for less than four hours and got at least 10 minutes of exercise every day.

Researchers looked at the health data of 143,000 adults registered with the Canadian Community Health Survey, which tracked participantsall 40 years and older, with no prior history of strokefor an average of 9.4 years.

"Sedentary time is increasing in the United States and Canada," said lead study author Dr. Raed Joundi of the University of Calgary. "Sedentary time is the duration of awake activities that are done sitting or lying down. Leisure sedentary time is specific to the sedentary activities done while not at work. It is important to understand whether high amounts of sedentary time can lead to stroke in young individuals, as a stroke can cause premature death or significantly impair function and quality of life."

"Sedentary time is thought to impair glucose, lipid metabolism and blood flow, and increase inflammation in the body," Joundi told CNN. "These changes, over time, may have adverse effects on the blood vessels and increase the risk of heart attack and stroke."

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"Physical activity has a very important role in that it reduces the actual time spent sedentary, and it also seems to diminish the negative impact of excess sedentary time," said Joundi.

The American Heart Association recommends that adults should get at least 150 minutes of moderate-intensity physical activity, or 75 minutes of vigorous activity, each week.

Joundi told CNN that ideally, that activity is done for more than 10 minutes at a time. "Activities are considered moderate intensity when you are exercising enough to raise your heart rate and break a sweat, such as brisk walking or biking." Examples of vigorous activity include running, rowing or swimming.

RELATED: The #1 Cause of Alzheimer's, According to Science

Other studies have found that 10 risk factors are associated with 90% of strokes, Joundi said, so "90% of strokes could in theory be avoided if all of these risk factors were removed in a population." They are:

"Improving physical activity is only one important component of stroke risk reduction, together with a nutritious diet, smoking cessation, and diagnosing and treating conditions like high blood pressure and diabetes," said Joundi. And to get through this pandemic at your healthiest, don't miss these 35 Places You're Most Likely to Catch COVID.

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Never Do This or Risk a Stroke, Says New Study | Eat This Not That - Eat This, Not That

Written by Jane E. Brody

The childhood admonition to refrain from swimming for an hour after eating, ostensibly to avoid cramp, is not nearly long enough for me anymore. I now have to wait at least two hours before attempting any vigorous activity, or chores that involve bending over, to avoid the miserable sensation of acid reflux, commonly recognized by its frequent symptom of heartburn.

Ive also found that a favorite breakfast food peanut butter is especially troublesome, along with smoked fish, pickled herring or brewed coffee on an empty stomach.

How common is acid reflux?

Acid reflux is among the most frequent health complaints of American adults, and may have become even more common in the wake of pandemic-related stress and weight gain. Late last year, pharmacies reported an unprecedented run on antacids by people described as having a pandemic stomach, leaving those with serious ailments that required such products often out of luck.

Even before the pandemic, an online survey from 2019 of more than 71,000 adults found that nearly a third reported that they were affected at least weekly by the discomforting symptoms of acid reflux, in which a small amount of stomach contents reverses course and backs up into the esophagus.

What are the symptoms?

Common symptoms include a burning feeling in the chest, a sensation of a lump in the throat, belching and bloating, and regurgitation into the mouth of highly acidic, partially digested food from the stomach. Reflux can also affect the respiratory tract, resulting in hoarseness, wheezing, postnasal drip, cough or asthma.

But persistent acid reflux is more than just annoying. If it occurs too often and persists for too long, it can erode the lining of the esophagus and increase the risk of developing a deadly cancer called esophageal adenocarcinoma.

5 ways to reduce your reflux risk?

A Harvard research team recently reported that many people could avoid this misery by adhering to an anti-reflux lifestyle. The researchers analyzed periodic health surveys over 12 years from more than 40,000 nurses and identified five lifestyle characteristics that helped keep acid reflux at bay.

The more of these behaviors the nurses adhered to, the lower their risk of developing GERD, the popular acronym for gastroesophageal reflux disease, the most persistent and potentially serious form of acid reflux. Following all five behaviors reduced the overall risk of developing GERD symptoms by 37 percent.

1. MAINTAIN A HEALTHY BODY WEIGHT: An analysis of the medical literature led by Dr. Jesper Lagergren of the Karolinska Institute in Stockholm found that GERD affected about 22 percent of people who were classified as obese, compared with about 14 percent of those who were not obese. After you eat, a muscular sphincter at the bottom of the esophagus opens to let food enter the stomach, and then closes to keep it from reversing direction. An oversized abdomen can put excess pressure on this sphincter and may prevent it from closing when it should, allowing contents from the acidic stomach to leach into the esophagus.

2. DONT SMOKE: Dr. Lagergrens team found that tobacco can extend the time it takes for acidic foods to leave the esophagus. In an analysis of 30 studies, GERD affected about 20 percent of smokers, compared with about 16 percent of nonsmokers.

3. EXERCISE: Those who engaged in moderate to vigorous physical activity for at least 30 minutes per day were less likely to develop symptoms of GERD, the Harvard team reported.

4. CUT DOWN ON COFFEE, TEA AND SODA: The risk of GERD was reduced among those who consumed no more than two cups of coffee, tea or soda each day.

5. FOLLOW A HEART-HEALTHY DIET: Those who followed a Mediterranean-style diet, for example, featuring fruits and vegetables, legumes, fish, poultry and whole grains, but little or no red meat and other sources of saturated fats, were less likely to develop acid reflux.

Genetics can also affect ones risk of developing acid reflux, so people with a family history of the problem would do best to avoid the risks highlighted above. Doing so will also help protect against leading killers like heart disease, diabetes and many forms of cancer.

How to manage symptoms

If you already have acid reflux, theres much you can do to minimize symptoms and perhaps avoid them entirely. Instead of consuming large meals, eat smaller ones more often. Minimize fatty foods and skip fried and fast foods entirely. A friend uses an air fryer to achieve a crispy skin on chicken, but I prefer grilled chicken and skip the skin. Choose lean meats (if you eat meat) and low-fat or nonfat dairy products, and avoid eating within three hours of bedtime. Also, try sleeping as if on a recliner, with the head of the bed propped higher than the foot.

Foods that many people with GERD find most irritating include tomatoes and citrus (like oranges and grapefruit) and their juices, coffee (even decaf for some people), alcoholic and carbonated beverages, spicy foods, garlic, chocolate and peppermint. I long ago switched to low-acid orange juice, consuming only a few ounces a day to dissolve a fiber supplement. Ive also found instant coffee to be less irritating than brewed, and drink the latter only with food to help protect my digestive tract.

To counter an occasional unexpected attack of heartburn, many people use a quick-acting antacid like Tums (calcium carbonate) to help neutralize stomach acid. A more modern remedy, an H2 receptor blocker like Pepcid (famotidine), can relieve symptoms within about 20 minutes by blocking the histamine receptors in the stomach that trigger acid production.

But chronic reflux sufferers may find the most effective relief with medications called proton pump inhibitors, or P.P.I.s, that shut down acid production in the stomach. Popular brands, sold over-the-counter and in higher doses by prescription, include Nexium (esomeprazole), Prevacid (lansoprazole) and Prilosec (omeprazole). Theyre among the countrys top-selling drugs.

However, like any medication, drugs that fight reflux can have side effects, so trial-and-error may be needed to find a product that works best for you. Also, the drugs should be used only as long as needed to control symptoms. Taken long-term, the P.P.I.s have been linked to a small increased risk of developing serious complications, including kidney disease, osteoporosis, stomach cancer, C. difficile infection and pneumonia.

Thus, your best bet in avoiding or controlling acid reflux might be to combine the lifestyle factors described above with a course of doctor-prescribed medication for as short a time as needed.

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5 diet and lifestyle measures to ward off heartburn - The Indian Express