Michael Toscani, Pharm.D
Project Director
Jefferson School of Population Health
Obesity rates in the United States have reached epidemic proportions. The impact on our healthcare system in terms of type 2 diabetes and related cardiovascular disease will cost us billions in the next 10 years. One solution to this multi-factorial issue involves physical activity and exercise. However, there is a lack of consistent adherence to recommended physical activity guidelines.
Guidelines issued by the American College of Sports Medicine (ACSM) recommend 20 to 60 minutes of continuous aerobic activity three to five times a week, at 60% to 90% of your maximum heart rate. The ACSM also recommends doing resistance training two to three days a week. One set of eight to 10 exercises for major muscle groups (eight to 12 repetitions of each exercise) is ideal.
The second set of guidelines, from the U.S. Surgeon General, recommends that you accumulate 30 minutes of "moderate intensity" physical activity (such as walking, vacuuming, climbing stairs, and yard work) on most days – in two 15-minute bouts, three 10-minute bouts, or one 30-minute bout.
I’ve had the pleasure of being involved in a “Bootcamp” Fitness Class for the past 5 years. The creator of the program was a retired Major in the Marine Corps. His vision was to structure a variety of workouts that encompass the requirements of the guidelines but can be tailored for a wide group of participants at all levels of fitness. The group meets each day (M-F) from 6-7 AM at a local high school. All the workouts are outside, beginning with a 10-15 min warm up and ending with a cool down period. They are designed to offer a variety of training experiences and leadership opportunities for the participants. Participants work out at the level they are comfortable with.
A typical week is outlined below:
• Monday- Walk /run alternating speeds followed by abdominal core exercises
• Tuesday- Use a deck of cards (each suit corresponds to a different exercise designed to work large muscle groups, 2-14 reps each), 52 exercises
• Wednesday- Bike ride, run/walk or swim
• Thursday-Aerobic training and calisthenics/weight training using 4 corners of the workout area and fitness stations alternating periodically with a yoga class several months of the year.
• Friday- Leg exercises (squats, etc) combined with push ups, abdominal exercises and others selected by the group
Some of the results I have observed have been extraordinary for participants, who range in age from 35-65 years old. Some participants have many chronic medical conditions, including a renal transplant recipient and donor, lymphoma survivor, type 1 diabetes, hypertension, and dyslipidemias. Anecdotal results have included blood sugar and blood pressure reductions, normalized lipid profiles, weight loss, and improved cardiovascular fitness and a general sense of well being and confidence with continued participation for many months and years.
This approach and regimen is certainly not for all; however, the importance of having a “team fitness” approach undoubtedly improves attendance, adherence to fitness and dietary guidelines and could be a valuable piece of the complex puzzle of our health care system. Participants should always seek medical advice before engaging in these programs.
It would be great to see more randomized studies to test these observations and help provide more evidence to support individuals to achieve greater levels of fitness.
Hoo Rah !!!
Wednesday, October 27, 2010
Moisturizing Spritz Recipes
The moisturizing spritz is ideal for those with fine hair or those who prefer a lighter alternative to thick butters. Additionally, it may be used to revive twists or another style that has gotten dry over time. Below are a couple of quick, easy recipes. Feel free to tweak to your own liking!
H2O Spritz
- water
- few drops of essential oil (your favorite)
ROSE-GLYCERIN Spritz
- 4 parts rosewater
- 1-2 parts glycerin
LEAVE-IN Spritz
- 5 parts water
- 1 part conditioner (your favorite)
THE WORKS Spritz
- 3-4 parts water
- 2 parts aloe vera juice
- 2 parts glycerin
- 1 part coconut oil
- 1 part olive oil
- few drops essential oil (your favorite)
NOTE: Some of these spritzes have a short shelf life (few days to a few weeks), so be sure not to create too much in one sitting. Refrigeration may extend the shelf life a bit.
- water
- few drops of essential oil (your favorite)
ROSE-GLYCERIN Spritz
- 4 parts rosewater
- 1-2 parts glycerin
LEAVE-IN Spritz
- 5 parts water
- 1 part conditioner (your favorite)
THE WORKS Spritz
- 3-4 parts water
- 2 parts aloe vera juice
- 2 parts glycerin
- 1 part coconut oil
- 1 part olive oil
- few drops essential oil (your favorite)
NOTE: Some of these spritzes have a short shelf life (few days to a few weeks), so be sure not to create too much in one sitting. Refrigeration may extend the shelf life a bit.
Twist Series: The Method I
More replies coming soon ... :o)
1. After washing, deep conditioning, and detangling, I plop my hair (while in 10-12 jumbo twists) in a towel. (Time: 1-2 hrs.)
2. After plopping, I undo each jumbo twist and apply a half-dollar-sized amount of whipped shea butter to each section. Then I redo each jumbo twist and airdry (in a satin scarf) until 80-90% dry. (Time: several hours.) I suggest applying enough butter to seal your hair and not so much to coat it.
3. Once airdried 80-90% of the way, I begin to twist my hair. I take down a jumbo twist and begin parting. I find it easiest to part a horizontal section and then grab-and-go within that section. I make smaller parts along the perimeter ... larger parts within the perimeter. (Twist time: 1-3 hrs, depending on size.) If needed, a small amount of whipped shea butter is reapplied to the ends of the twists only.
4. When I reapply the whipped shea butter weekly (after a quick spritz with water), I just rub the butter along the twisted hair from the mid-shaft to the ends. Afterwards, I immediately put my twists in 1-2 frenchbraids and wrap with a satin scarf to combat frizz formation. Once the hair has "set", I take off the satin scarf. (Time: 30 minutes - 1hr.)
- When you put in your shea butter mixture can you indicate how much exactly you put, because I find that when I do my hair I can't lean up on anything afterwards...lol Should it be a dime sized amount or should I not worry about the oil slick!
- Can you show a picture to give any indication to how you part the twists?
- When you say that you "reapply the whipped shea butter" weekly.. do you just rub the butter along the twisted hair? Or untwist, apply shea butter, and then retwist?
- I find when I go to remoisturize my twists, whether I re-wet my hair and apply moisturizer or just apply the moisturizer alone, my twists are sooo frizzy and fuzzy afterwards. How can I prevent this? I have about 6 inches of hair just to give you an idea.
1. After washing, deep conditioning, and detangling, I plop my hair (while in 10-12 jumbo twists) in a towel. (Time: 1-2 hrs.)
2. After plopping, I undo each jumbo twist and apply a half-dollar-sized amount of whipped shea butter to each section. Then I redo each jumbo twist and airdry (in a satin scarf) until 80-90% dry. (Time: several hours.) I suggest applying enough butter to seal your hair and not so much to coat it.
 |
| Plop, moisturize, then airdry in jumbo twists under scarf. |
3. Once airdried 80-90% of the way, I begin to twist my hair. I take down a jumbo twist and begin parting. I find it easiest to part a horizontal section and then grab-and-go within that section. I make smaller parts along the perimeter ... larger parts within the perimeter. (Twist time: 1-3 hrs, depending on size.) If needed, a small amount of whipped shea butter is reapplied to the ends of the twists only.
 |
| Part horizontally, then grab and go. |
 |
| Smaller parts near nape. (Not too small though.) |
 |
| Long, slender parts along hairline. (Too small = bad for my edges.) |
Monday, October 25, 2010
The amounts of water, carbohydrates, fat, and protein lost during a 30-day fast
When it comes to losing fat and maintaining muscle, at the same time, there are no shortcuts. The process generally has to be slow to be healthy. When one loses a lot of weight in a few days, most of what is being lost is water, followed by carbohydrates. (Carbohydrates are stored as liver and muscle glycogen.) Smaller amounts of fat and protein are also lost. The figure below, from Wilmore et al. (2007), shows the weights in grams of stored water, carbohydrates (glycogen), fat, and protein lost during a 30-day water fast.
On the first few days of the fast a massive amount of water is lost, even though drinking water is allowed in this type of fast. A significant amount of glycogen is lost as well. This is no surprise. About 2.6 g of water are lost for each 1 g of glycogen lost. That is, water is stored by the body proportionally to the amount of glycogen stored. People who do strength training on a regular basis tend to store more glycogen, particular in muscle tissue; this is a compensatory adaptation. Those folks also tend to store more water.
Not many people will try a 30-day fast. Still, the figure above has implications for almost everybody.
One implication is that if you use a bioimpedance scale to measure your body fat, you can bet that it will give you fairly misleading results if your glycogen stores are depleted. Your body fat percentage will be overestimated, because water and glycogen are lean body mass. This will happen with low carbohydrate dieters who regularly engage in intense physical exercise, aerobic or anaerobic. The physical exercise will deplete glycogen stores, which will typically not be fully replenished due to the low intake of carbohydrates.
Light endurance exercise (e.g., walking) is normally easier to maintain with a depleted “glycogen tank” than strength training, because light endurance exercise relies heavily on fat oxidation. It uses glycogen, but more slowly. Strength training, on the other hand, relies much more heavily on glycogen while it is being conducted (significant fat oxidation occurs after the exercise session), and is difficult to do effectively with a depleted “glycogen tank”.
Strength training practitioners often will feel fatigued, and will probably be unable to generate supercompensation, if their “glycogen tank” is constantly depleted. Still, compensatory adaptation can work its “magic” if one persists, and lead to long term adaptations that make athletes rely much more heavily on fat than the average person as a fuel for strength training and other types of anaerobic exercise. Some people seem to be naturally more likely to achieve this type of compensatory adaptation; others may never do so, no matter how hard they try.
Another implication is that you should not worry about short-term weight variations if your focus is on losing body fat. Losing stored water and glycogen may give you an illusion of body fat loss, but it will be only that – an illusion. You may recall this post, where body fat loss coupled with muscle gain led to some weight gain and yet to a much improved body composition. That is, the participants ended up leaner, even though they also weighed more.
The figure above also gives us some hints as to what happens with very low carbohydrate dieting (i.e., daily consumption of less than 20 grams of carbohydrates); at least at the beginning, before long term compensatory adaptation. This type of dieting mimics fasting as far as glycogen depletion is concerned, especially if protein intake is low, and has many positive short term health benefits. The depletion is not as quick as in a fast because a high fat and/or protein diet promotes higher rates of fat/protein oxidation and ketosis than fasting, which spare glycogen. (Yes, dietary fat spares glycogen. It also spares muscle tissue.) Still, the related loss of stored water is analogous to that of fasting, over a slightly longer period. The result is a marked weight loss at the beginning of the diet. This is an illusion as far as body fat loss is concerned.
Dietary protein cannot be used directly for glycogenesis; i.e., for replenishing glycogen stores. Dietary protein must first be used to generate glucose, through a process called gluconeogenesis. The glucose is then used for liver and muscle glycogenesis, among other things. This process is less efficient than glycogenesis based on carbohydrate sources (particularly carbohydrate sources that combine fructose and glucose), which is why for quite a few people (but not all) it is difficult to replenish glycogen stores and stimulate muscle growth on very low carbohydrate diets.
Glycogen depletion appears to be very healthy, but most of the empirical evidence seems to suggest that it is the depletion that creates a hormonal mix that is particularly health-promoting, not being permanently in the depleted state. In this sense, the extent of the glycogen depletion that is happening should be positively associated with the health benefits. And significant glycogen depletion can only happen if glycogen stores are at least half full to start with.
Reference
Wilmore, J.H., Costill, D.L., & Kenney, W.L. (2007). Physiology of sport and exercise. Champaign, IL: Human Kinetics.
On the first few days of the fast a massive amount of water is lost, even though drinking water is allowed in this type of fast. A significant amount of glycogen is lost as well. This is no surprise. About 2.6 g of water are lost for each 1 g of glycogen lost. That is, water is stored by the body proportionally to the amount of glycogen stored. People who do strength training on a regular basis tend to store more glycogen, particular in muscle tissue; this is a compensatory adaptation. Those folks also tend to store more water.
Not many people will try a 30-day fast. Still, the figure above has implications for almost everybody.
One implication is that if you use a bioimpedance scale to measure your body fat, you can bet that it will give you fairly misleading results if your glycogen stores are depleted. Your body fat percentage will be overestimated, because water and glycogen are lean body mass. This will happen with low carbohydrate dieters who regularly engage in intense physical exercise, aerobic or anaerobic. The physical exercise will deplete glycogen stores, which will typically not be fully replenished due to the low intake of carbohydrates.
Light endurance exercise (e.g., walking) is normally easier to maintain with a depleted “glycogen tank” than strength training, because light endurance exercise relies heavily on fat oxidation. It uses glycogen, but more slowly. Strength training, on the other hand, relies much more heavily on glycogen while it is being conducted (significant fat oxidation occurs after the exercise session), and is difficult to do effectively with a depleted “glycogen tank”.
Strength training practitioners often will feel fatigued, and will probably be unable to generate supercompensation, if their “glycogen tank” is constantly depleted. Still, compensatory adaptation can work its “magic” if one persists, and lead to long term adaptations that make athletes rely much more heavily on fat than the average person as a fuel for strength training and other types of anaerobic exercise. Some people seem to be naturally more likely to achieve this type of compensatory adaptation; others may never do so, no matter how hard they try.
Another implication is that you should not worry about short-term weight variations if your focus is on losing body fat. Losing stored water and glycogen may give you an illusion of body fat loss, but it will be only that – an illusion. You may recall this post, where body fat loss coupled with muscle gain led to some weight gain and yet to a much improved body composition. That is, the participants ended up leaner, even though they also weighed more.
The figure above also gives us some hints as to what happens with very low carbohydrate dieting (i.e., daily consumption of less than 20 grams of carbohydrates); at least at the beginning, before long term compensatory adaptation. This type of dieting mimics fasting as far as glycogen depletion is concerned, especially if protein intake is low, and has many positive short term health benefits. The depletion is not as quick as in a fast because a high fat and/or protein diet promotes higher rates of fat/protein oxidation and ketosis than fasting, which spare glycogen. (Yes, dietary fat spares glycogen. It also spares muscle tissue.) Still, the related loss of stored water is analogous to that of fasting, over a slightly longer period. The result is a marked weight loss at the beginning of the diet. This is an illusion as far as body fat loss is concerned.
Dietary protein cannot be used directly for glycogenesis; i.e., for replenishing glycogen stores. Dietary protein must first be used to generate glucose, through a process called gluconeogenesis. The glucose is then used for liver and muscle glycogenesis, among other things. This process is less efficient than glycogenesis based on carbohydrate sources (particularly carbohydrate sources that combine fructose and glucose), which is why for quite a few people (but not all) it is difficult to replenish glycogen stores and stimulate muscle growth on very low carbohydrate diets.
Glycogen depletion appears to be very healthy, but most of the empirical evidence seems to suggest that it is the depletion that creates a hormonal mix that is particularly health-promoting, not being permanently in the depleted state. In this sense, the extent of the glycogen depletion that is happening should be positively associated with the health benefits. And significant glycogen depletion can only happen if glycogen stores are at least half full to start with.
Reference
Wilmore, J.H., Costill, D.L., & Kenney, W.L. (2007). Physiology of sport and exercise. Champaign, IL: Human Kinetics.
Thursday, October 21, 2010
Twist Series: More to Come!
After two weeks of bunning, I'll be twisting again this weekend. Answers to the following are on the way:
If you have more questions, feel free to leave a comment with this post. Until next week!
- When you put in your shea butter mixture can you indicate how much exactly you put, because I find that when I do my hair I can't lean up on anything afterwards...lol Should it be a dime sized amount or should I not worry about the oil slick!
- Can you show a picture to give any indication to how you part the twists?
- When you say that you "reapply the whipped shea butter" weekly.. do you just rub the butter along the twisted hair? Or untwist, apply shea butter, and then retwist?
- Do you have alot of shorter strands of hair that contribute to the frizzy look? I noticed that I have alot at the top and middle of my head and was wondering if that is natural or if something is wrong since to me it seems to be increasing in number!
- Second, does having alot of single strand knots at the ends of my hair mean its definitely time for a trim?
If you have more questions, feel free to leave a comment with this post. Until next week!
REVIEW #8: Jane Carter Nourish & Shine
Purpose: To moisturize dry hair, scalp, and/or skin.
Ingredients: shea, illipe, mango, kokum butters, grapefruit and pear essential oils, vitamins A, D, & E.
Number of trials: Multiple (80% of the container)
How I used it:
• Seal my hair after washing or spritzing with water
• Create a braidout
• Create a braidout
• Moisturize dry elbows, knees, ankles, and lips
_____________
THE REVIEW:
My favorite characteristics about this product are the natural ingredients, mango-like smell, thickness, moisturizing capability, and versatility. For me, Jane Carter Nourish & Shine was most effective as a sealing agent after washing or wetting my hair ... AND on my skin (particularly, on my elbows, knees, and ankles) after bathing.
My not-so-favorite characteristic is the $22 price for the 4 oz. This pricing may be due to the ingredients being all natural and shea butter being high on the list (number one to be exact). Thus, one is paying for ingredient richness when purchasing this product. Additionally, a little bit of Jane Carter Nourish & Shine goes a long, long way.
Will I purchase it again? If it were cheaper and weren't a mixologist, then yes. At the moment, I'm just fine whipping my own butters for less than half the price. However, I do recommend Jane Carter Nourish & Shine to those desiring to purchase a thick, moisturizing, all-natural, rich, butter-based product that actually works. Here's a less expensive finding including more reviews on Amazon:
_____________
PROS: moisturizing, thick, versatile (use on skin, scalp, and hair), a little goes a long way, nice scent (if you like mango), shea butter as #1 ingredient
CONS: expensive, has a scent (if you're not a fan of mango or fragrances, in general)
RATING: Overall, I give the Jane Carter Nourish & Shine 4 out of 5 stars. If it were inexpensive, I'd probably give it a full 5 stars.
Ideal for those with: thick hair prone to dryness
Not ideal for those with: fine hair, or hair prone to oiliness
Ideal for those with: thick hair prone to dryness
Not ideal for those with: fine hair, or hair prone to oiliness
Wednesday, October 20, 2010
Guest Commentary: Highlights from The Academy of Managed Care Pharmacy 2010 Educational Conference
Kellie Dudash, PharmD
Health Economics & Outcomes Research Fellow
Jefferson School of Population Health
The Academy of Managed Care Pharmacy (AMCP) 2010 Educational Conference was held last week in St. Louis, MO. The educational programming clearly reflected key contemporary issues in healthcare reform.
One of the most exciting presentations at the conference was an overview of a project that aims to demonstrate improved medication adherence for health plan members through pharmacy performance reporting and quality metric–focused interventions. The project is a collaboration between Highmark BlueCross BlueShield, Rite Aid Pharmacy, The Pharmacy Quality Alliance (PQA), CECity, and The University of Pittsburgh School of Pharmacy.
The literature indicates that poor medication adherence directly relates to increases in healthcare utilization and costs. Health plans usually tackle this issue by providing physicians with adherence reports for their patients at the population level. This study offers a novel approach by utilizing pharmacists at the point-of-dispensing to target non-adherent patients at the patient level.
The first phase of the project (2008) was rolled out in 50 Rite Aid Pharmacies in Western Pennsylvania. PQA-endorsed adherence measures for certain chronic conditions (heart disease, diabetes) were calculated for health plan members using Highmark claims data. CECity’s Lifetime™ platform translated the data into user-friendly electronic performance reports for Rite Aid pharmacists. The pharmacists could then compare the members’ adherence rates over time to those in their region and in all participating pharmacies.
Now that a system is in place to measure adherence in health plan members, phase two of the project (2010) will measure the impact of a psychosocial intervention on member adherence. Pharmacists in the intervention group will be trained in motivational interviewing techniques that will be used to motivate the non-adherent members. The primary outcome measured will be an increase in member adherence as measured by the PQA-endorsed adherence measures. Secondary outcomes include overall healthcare utilization calculated using member pharmacy and medical claims as well as member satisfaction with pharmacy services. The outcomes measured will be compared to health plan members in a control group in Central Pennsylvania who did not receive the intervention.
Currently, the data is only available at the pharmacy level. If they are able to measure data at the individual pharmacist level, exciting future directions for this project could include consumer reporting of pharmacist services and incentive reimbursement programs (pay-for-performance) for pharmacists.
As a profession, pharmacists have traditionally struggled with demonstrating the value of the cognitive services we offer. Retail pharmacists in particular are primarily rewarded based on prescription volume. It seems inappropriate to equate our professional value with hitting a target number that does not adequately account for the patient care services that go into each prescription.
I think most store managers would be open to rewarding pharmacists for cognitive services; but without easy to understand measures, the value of these services is consequently ignored. By creating a system to concretely measure the impact of pharmacists on improving patient outcomes, this pilot project is a step in the right direction.
Health Economics & Outcomes Research Fellow
Jefferson School of Population Health
The Academy of Managed Care Pharmacy (AMCP) 2010 Educational Conference was held last week in St. Louis, MO. The educational programming clearly reflected key contemporary issues in healthcare reform.
One of the most exciting presentations at the conference was an overview of a project that aims to demonstrate improved medication adherence for health plan members through pharmacy performance reporting and quality metric–focused interventions. The project is a collaboration between Highmark BlueCross BlueShield, Rite Aid Pharmacy, The Pharmacy Quality Alliance (PQA), CECity, and The University of Pittsburgh School of Pharmacy.
The literature indicates that poor medication adherence directly relates to increases in healthcare utilization and costs. Health plans usually tackle this issue by providing physicians with adherence reports for their patients at the population level. This study offers a novel approach by utilizing pharmacists at the point-of-dispensing to target non-adherent patients at the patient level.
The first phase of the project (2008) was rolled out in 50 Rite Aid Pharmacies in Western Pennsylvania. PQA-endorsed adherence measures for certain chronic conditions (heart disease, diabetes) were calculated for health plan members using Highmark claims data. CECity’s Lifetime™ platform translated the data into user-friendly electronic performance reports for Rite Aid pharmacists. The pharmacists could then compare the members’ adherence rates over time to those in their region and in all participating pharmacies.
Now that a system is in place to measure adherence in health plan members, phase two of the project (2010) will measure the impact of a psychosocial intervention on member adherence. Pharmacists in the intervention group will be trained in motivational interviewing techniques that will be used to motivate the non-adherent members. The primary outcome measured will be an increase in member adherence as measured by the PQA-endorsed adherence measures. Secondary outcomes include overall healthcare utilization calculated using member pharmacy and medical claims as well as member satisfaction with pharmacy services. The outcomes measured will be compared to health plan members in a control group in Central Pennsylvania who did not receive the intervention.
Currently, the data is only available at the pharmacy level. If they are able to measure data at the individual pharmacist level, exciting future directions for this project could include consumer reporting of pharmacist services and incentive reimbursement programs (pay-for-performance) for pharmacists.
As a profession, pharmacists have traditionally struggled with demonstrating the value of the cognitive services we offer. Retail pharmacists in particular are primarily rewarded based on prescription volume. It seems inappropriate to equate our professional value with hitting a target number that does not adequately account for the patient care services that go into each prescription.
I think most store managers would be open to rewarding pharmacists for cognitive services; but without easy to understand measures, the value of these services is consequently ignored. By creating a system to concretely measure the impact of pharmacists on improving patient outcomes, this pilot project is a step in the right direction.
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