Thursday, July 7, 2011

DrMirkin's eZine: Intense exercise benefits, lose belly fat, more . . .

Dr. Gabe Mirkin's Fitness and Health E-Zine
July 10, 2011

Intense Exercise for Heart Attack Patients?

Two years ago, researchers in Norway treated recovering
heart attack victims with the same intense training methods used
by competitive athletes (American Heart Journal, June 2009).
They supervised them as they ran on a treadmill very fast for a few
seconds, rested and then repeated their intense intervals. For
example, some of the patients ran fast for 30 seconds every five
minutes. The interval-training heart attack victims were able to
use more oxygen maximally (VO2max) and had their heart rates
returned toward normal faster than other heart attack victims who
did slower continuous training. This advantage persisted 30
months after the patients completed their 12-week rehabilitation
This same research group has now shown that high-
intensity interval training reduces high blood pressure more than
continuous exercise does (European Journal of Cardiovascular
Prevention & Rehabilitation, June 8, 2011).
Researchers at the Mayo Clinic have started to supervise
30-second bursts of exercise using faster speeds and steeper
inclines, gradually increasing the number of intervals and their
length to 120 seconds. I believe that They are the only center in
the U.S. using intense interval training to rehabilitate heart
attack victims. Certainly intense training is not accepted yet as
a treatment for heart attack victims, particularly those who have
chest pain with exercise or excessive shortness of breath.
Intense exercise can precipitate heart attacks in people with
blocked arteries. The exercise sessions are usually supervised by
trained technicians using electrocardiograms, at least in the
This study adds to the accumulating evidence that intense
exercise offers much greater health benefits than just exercising;
see my summary at the end of this newsletter (below).


Reports from

Irritable bowel syndrome

Iron deficiency impairs exercise

Overtraining syndrome


Dear Dr. Mirkin: Does snacking at night make you fatter than
daytime snacking?

A study presented June 14, at the 2011 annual meeting of
the American Academy of Sleep Medicine and the Sleep Research
Society in Minneapolis showed that people who snack at night are
fatter, even though they don't eat significantly more total daily
calories. Almost 40 years ago, Franz Halberg of the University of
Minnesota showed that food eaten in the evening is more fattening
than food eaten in the morning (1). After you eat, your body
temperature rises to burn extra calories because your body has to
break down the food by a series of chemical reactions that produce
heat (2). After you exercise, your body temperature also rises as
you supply extra calories to your muscles. When you are inactive
after eating, you burn fewer calories than when you are active
after eating, so eating at night is more fattening.
Mice fed only at night gained more than twice as much
weight as mice that ate during the day (3). Both groups were fed
the same high-fat food, and were equally active. By the end of the
six-week study, night-eaters had a 48 percent increase in body
weight compared to day-feeders who had a 20 percent gain.
Eating too much in the evening also increases risk for
diabetes. Contracting muscles remove sugar from the bloodstream
without needing insulin. Being active before eating lowers blood
sugar levels the next morning (4). Exercising after eating lowers
blood sugar levels after eating even more than exercising before
eating (5). A large meal in the evening is often followed by going
to bed or sitting around watching television, which can cause high
rises in blood sugar, diabetes and cell damage. Any type of
activity clears blood sugar far better than keeping your muscles
still. Most people are more likely to be active in the afternoon
(after lunch) than in the evening (after dinner). This suggests
that you should eat your main meal mid-day and have a light

1. J. Nutr 1989;119:333-43
2. Am J Clin Nutr 1993;37:476-8
3. Obesity, September 2009
4. Medicine and Science in Sports and Exercise, August 2009
5. Journal of the American Medical Directors Association, July


Dear Dr. Mirkin: How can I get rid of belly fat?

Eat more soluble fiber and exercise. Researchers
analyzed 1,114 black and Hispanic Americans who are at increased
risk for high blood pressure and diabetes. They showed that, over
five years, for every 10-gram increase in soluble fiber eaten per
day, visceral fat was reduced by 3.7 percent, and that 30 minutes
of vigorous exercise two to four times per week reduced belly fat
by 7.4 percent over the same time (Obesity, published online June
2011). You can get 10 grams of soluble fiber in two small
apples, one cup of green peas and one-half cup of pinto beans.
If you store fat primarily in your belly, you are at high
risk for diabetes, heart attacks, strokes, fatty liver, high blood
pressure, high cholesterol and premature death. Virtually every
person who has small hips and a fat belly has very high levels of
insulin because insulin causes fat to be deposited in the belly.
High levels of insulin are a sign that a person's cells cannot
respond to insulin. Then blood sugar levels rise even higher,
which causes the pancreas to release large amounts of insulin.
Everybody needs insulin to lower high blood sugar levels
by driving sugar from the bloodstream into cells. However, too
much insulin can kill you. It constricts the arteries that carry
blood to your heart to cause heart attacks. You can diagnose high
insulin levels by getting a blood test called C-peptide. Normal
values are 0.51-2.72 ng/mL or 0.17-0.90 nmol/L.
All foods that you eat contain carbohydrates, fats and
protein. Carbohydrates are made of combinations of sugars as
single, double, thousands and millions. Before any carbohydrate
can be absorbed into your body, it must first be broken down into
single sugars. Fiber cannot be absorbed in your intestinal tract
because the sugar molecules are bound together so tightly that the
human body cannot break them down.
Fiber is classified further into soluble and insoluble.
Insoluble fiber passes from your body without being absorbed.
However bacteria in the colon can break down soluble fiber into
short chain fatty acids that can be absorbed. Soluble fiber is
healthful because the short-chain fatty acids from it are absorbed
into the bloodstream and pass to the liver where they prevent the
liver from making cholesterol. Soluble fiber also helps to lower
levels of a fat called triglycerides in your liver. This prevents
the fatty liver that blocks insulin receptors and causes diabetes.
Exercise also helps to prevent a fatty liver by preventing
triglycerides from accumulating in the liver.
To get rid of belly fat, lose weight, avoid sugared
drinks and foods, exercise, eat huge amounts of fruits and
vegetables that are rich sources of soluble fiber, and make sure
that your blood levels of vitamin D3 are above 75 nmol/L.


Recipe of the Week:

Two-Bean Cabbage Slaw

You'll find lots of recipes and helpful tips in
The Good Food Book


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Summary of studies on the benefits of intense exercise:

Intense exercise is far more effective in reducing belly
fat than less intense exercise (Medicine & Science in Sports &
Exercise, November 2008. Metabolism 1991(May);40(5):545-551).
Storing fat primarily in your belly usually means that you have
very high insulin levels which increase risk for heart attacks,
strokes, diabetes, metabolic syndrome and even some cancers.
Insulin causes fat to be deposited in your belly.

Many people do not lose weight when they exercise because
they don't do it vigorously enough to raise their body temperatures and
increase their metabolisms (International Journal of Sport
Nutrition and Exercise Metabolism. January, 2001;11(1):1-14).
Intense exercise can raise body temperature enough to burn extra
calories for up to 18 hours afterwards (International Journal of
Sport Nutrition and Exercise Metabolism, 2001;11(1):15-31).
Most people cannot lose weight by swimming because water conducts
heat from the body so efficiently that it prevents their body
temperatures from rising.

Studies from Yale (Journal of Applied Physiology, January
2006) and Norway (Circulation, July 2008) show that intense
exercise is far more effective in preventing and controlling
diabetes than exercising at a leisurely pace. Intense exercising
diabetics have lower blood sugars levels, better contraction of
their arteries, better muscle growth, less cell damage, and lost
more fat than casually exercising diabetics.

Researchers in Homburg, Germany showed that 50-year-old
men who ran more than 50 miles per week at a fast pace had
telomeres (chromosome caps) that were almost the same length as
those of 20-year-old runners on the German National Team, and more
than 40 percent longer than those or inactive men of the same age
(Circulation, December 2009). This is astounding because shortened
telomeres represent aging.
The active ends of the genetic material (chromosomes) in
cells are covered with a layer of proteins called telomeres. If
they weren't, the exposed ends of the genetic material would stick
to anything nearby and the cells would die. However, each time a
cell divides to make two cells, a little bit of the telomere is
removed. Eventually the telomere is gone, the ends of genetic
material stick together and the cell can no longer divide so it
dies without replacing itself. Obviously, the longer the
telomeres, the longer it takes for the telomeres to be used up and
the longer a cell lives.

Intense exercise does not damage a healthy heart. To
improve for athletic competition, all athletes must suffer
skeletal muscle damage. Without this damage, their muscles will
not grow and they will not become stronger. So on one day, they
exercise very intensely by lifting very heavy weights, running
very fast, or competing on the basketball court very intensely.
They know that they have damaged their muscles with hard exercise
because their muscles feel sore on the next day. As the muscles
heal, they produce growth hormones that help the muscles to grow
larger and stronger.
However a normal heart cannot be damaged by exercise.
Post exercise electrocardiograms and echocardiograms are normal as
are blood levels of heart-specific enzymes, creatine kinase and
creatine kinase MB, and myoglobin (Medicine and Science in Sports
and Exercise October, 2003)

Before you start a program of cycling, running, tennis or
anything else, realize that exercising intensely is far more
likely to cause injuries and can cause heart attacks in people
with blocked arteries leading to their hearts. You may want to
check with your doctor before you start. Then get in shape
gradually by exercising at an easy pace three to six days a week
for at least six weeks.


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Gabe Mirkin, M.D.
10901 Connecticut Avenue, Kensington MD 20895, USA

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