Dealing with Delayed-Onset Muscle Soreness

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Muscle soreness generally occurs after a new workout routine, especially weight training. It generally involves eccentric contractions: the simplest way to explain it is the resistance to a movement. During a bicep curl, eccentric contractions would be resisting the lowering of the weight as you return to the starting position. But that’s not exactly what I mean. This is an overall fatigue and soreness that affects more than muscle. Let’s call it delayed-onset body soreness.

What Causes Delayed-Onset Body Soreness?

Movements that are repetitive, that last for hours, that aren’t part of your normal routine—those are the likely causes of delayed-onset soreness. It doesn’t matter how fit you are or how strong you are. While fitness and strength will help, it’s still going to happen occasionally. When you perform movements, even if they’re as simple as standing and answering questions like I did, there are stresses on the ligaments, tendons, and joints as well as the muscles, minute after minute, hour after hour. Micro-tears can occur in multiple types of tissue, and that can cause inflammation and pain.

What you feel the next day is actually the repair process in progress.

Can You Prevent DOBS?

Probably not because it’s caused by something you do infrequently: rake leaves, walk up and down arena steps, shovel snow, or help someone move. But stretching on a regular basis probably helps. Ever stand up, take a deep breath, and reach over your head to stretch just about every muscle in your body? Something as simple as that a few times a day will help keep you limber. Yoga would be great but whatever it is, it has to be consistent to be effective.

The Bottom Line

Infrequent events with repetitive movements are going to happen. I don’t think there’s a need to specifically train for them other than stretching on a regular basis. Taking nutrients such as glucosamine and vitamin C may help the repair process; you can take them in the days leading up to the event as well as after, along with whatever pain meds work best for you. No question that regular aerobic exercise and strength training will help, but most likely won’t prevent soreness. The good news is that this is a problem that should resolve itself quickly.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.acsm.org/docs/default-source/files-for-resource-library/delayed-onset-muscle-soreness-(doms).pdf?sfvrsn=8f430e18_2

What Did I Do?

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Fall is here and those wonderful multi-colored leaves everyone seems to love are making their appearance here in Michigan. While they can be stunning to look at, they will need to be raked and recycled. That’s going to lead to people waking up the next day (or days because they all don’t drop on the same day) feeling like they’ve been run over by a truck. Sore. Fatigued. Hard to move.

Recently Paula was on a mission to find a specific item so we went to six different big box stores in one afternoon, which is something we hadn’t done since before covid. She felt fine and made it through the day but was wiped out the next day. I just spent the weekend in St. Louis with a few thousand of my closest friends talking and answering questions. Both days I was wiped out and went to bed early. Ever help someone move? Remember how you felt the next day? You ask yourself, “What did I do?”

The technical term is delayed-onset muscle soreness. I think it’s really more than just muscles involved. The question is why? Raking leaves and walking through stores isn’t strenuous. Neither is standing and talking. What gives? Any time a task requires repetitive movements you’re not used to doing, you’re at risk for delayed-onset muscle soreness. I’ll talk about how to deal with it on Saturday.

What are you prepared to do today?

        Dr. Chet

How to Gain Weight Without Magic Pills

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How many of you took the time to look up the phytonutrient I gave you in Tuesday’s Memo? If you did, you know that it was one of the many phytonutrients in one of my favorite herbs: echinacea. The company that manufactures the weight gain pill called CB-1 claimed one of the ingredients was tested in a clinical trials and helped increase calorie intake for up to two hours.

I searched PubMed for every ingredient on the label, and the only studies I could find showed that some phytonutrients help add finishing weight to cows. There were no human trials related to body weight. Most of the research, especially on the phytonutrients, was related to improving the immune function in humans and animals.

My guess is that the 24-page booklet accompanying the supplement explains how to eat to gain weight: it comes with the purchase of a one-month supply of the product for just $70 plus shipping. So that’s it: no real research and booklet on how to eat. Such a deal!

Gaining Weight

There are some people who really want to gain weight, such as teen athletes and endurance athletes or people who’ve lost too much weight due to illness. Then there are those rare people who’ve always been thinner than they want to be. You might think my response would be to eat more and move less, but no. That course of action may help you get fatter, but it probably won’t be healthy. And the extra pounds may not go where you’d like them to go; how many of us wish for a bigger belly?

Here is the simplest approach. I’ll preface this by saying that anyone who has helped people gain weight probably has a different view, but after 35 years as an exercise physiologist, here’s my approach.

  • Increase protein intake by 20 to 40 grams per day. You can use food such as cooked chicken breast with about 10 grams protein per ounce or canned tuna in water at seven grams per ounce. That’s what we did before there were all the protein powders available today. You can measure the powders precisely and mix them in a smoothie or with milk for even more protein.
  • Use 10 to 30 grams of branch-chain amino acids (BCAA) and/or essential amino acids (EAA) every day, preferably after exercise. EAAs contain the BCAAs as well, so it’s your preference; both have shown an increase in muscle mass and strength when used in combination with a weight training program.
  • Incorporate weight training into your exercise program. There are a hundred different training regimens using everything from exercise tubes to weight training machines. The approach you use depends on your age and fitness level, but if you want to gain weight, you want to increase muscle as well as adding some fat.

That’s it. You already know how to get results based on the recent Memos: be consistent, week in, week out.

The Bottom Line

The focus in health always seems to be on losing weight and with 70% of the population overweight, there’s a reason for that. But if you need to add some weight, the simplest solution is often the correct one. Reasonably increase protein intake together with some of the right amino acids and start a weight training program. No need for magic pills because it’s the effort that gets results.

What are you prepared to do today?

        Dr. Chet

The Weight-Gain Pill

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I’m a self-proclaimed channel flipper—I always want to see what else is on when I have the remote. That’s why I did a double take when I saw the beginning of a commercial for weight gain. It wasn’t the typical approach, such as the product contains some formulation of branched chain amino acid, creatine, and other herbs that are supposedly associated with gaining muscle faster. Not this time.

The featured testimonial was a woman who was always “skinny” her entire life. The “before” picture was a very thin woman. Then she begins using this product with an herbal blend and some vitamins in it. She managed to gain 53 pounds! But it went with the product’s Facebook tag line: Curves are in—and we can help!

What was in this magnificent supplement? Vitamin D and zinc and the herbal blend. I’ll give you just one ingredient to give you a clue: dodeca-2E,4E,8Z,10Z-tetraenoic acid isobutylamide. I’ll tell you what I found in the research as well as describe a legitimate weight-gain program for those who might need it in Saturday’s Memo.

What are you prepared to do today?

        Dr. Chet

Why Are You Napping?

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I think people get frustrated with research because, just like I’ve described this week, one study says one thing while another comes to different conclusions. I hope that if you’ve been reading the Memo long enough you won’t be frustrated. In this case, why might studies that seem similar on the surface come up with different results?

First, while the studies seemed to ask the same questions, the studies actually had different objectives. In the Swedish study that showed a reduction in cardiovascular disease (CVD) events for those napping once or twice a week, the subjects were selected because they had not had any cardiac events or diagnosis of CVD. That means that any CVD that took place in the follow-up period was a primary event. In the other two studies, high-risk CVD events were excluded in one but other CVD factors were allowed such as hypertension.

Second, the purpose of the Swedish was designed to look at the development of CVD. The other two studies from Switzerland and the U.K. recruited over 500,000 subjects, but the research questions appeared to be decided after the studies began. There’s nothing wrong with that, but just because you have collected data on many variables, including genetics, doesn’t mean the data collected answer the research questions that were asked.

For example, the premise was that daytime napping causes CVD and hypertension. It seems likely that those conditions could cause fatigue, which would require daytime napping. Even if that were not the case, the subjects appeared to already have problems sleeping, which would impact hormone levels that contribute to CVD such as cortisol levels and many others.

The Bottom Line

These large studies attempted to make sense out of prior research that showed a link between daytime napping and CVD. What I think these studies demonstrate is that the cause of the nap is important. If it’s a planned nap designed to allow digestion or a pause in a long work day, it may not be hazardous to your heart health. However, if a person doesn’t sleep well or has sleep apnea and is fatigued because of that, being forced to nap during the day to recover can indicate a higher risk of developing CVD and hypertension.

Diet, body mass, lack of exercise, and other factors all have a role to play in sleep quality and CVD as well. If you plan your nap, you’re in control. If you’re forced to nap, time to look at your lifestyle and see what you can change.

What are you prepared to do today?

        Dr. Chet

P.S. Just for fun, these are a few of Riley’s more inventive napping positions. Oh, to be that flexible! Maybe the monkey blanket helps.

References:
1. Heart. 2019;105:1793–1798.
2. J Am Heart Assoc. 2022;11:e025969. DOI: 10.1161/JAHA.122.025969.
3. Hypertension. 2022;79:00–00. DOI: 10.1161/HYPERTENSIONAHA.122.19120.

To Nap or Not to Nap

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About 16 years ago, Paula and I spent several weeks (spread out from March to October) helping our son Matthew build his boat-building shop. The daily routine went something like this: start early, break for lunch, take a 30- to 45-minute nap, then work the rest of the day. Matthew and Kerri live near Charleston, SC, where summer temperatures aren’t really conducive to construction work, so napping during the hottest part of the day made a lot of sense, but we also found we got a lot more accomplished every day.

I’ve used that approach off and on ever since. Recently, a couple studies were published that called into question whether naps were a good idea as they might be related to cardiovascular disease (CVD).

The research news caught my attention because the last time I read a research paper about sleep and napping showed that there was no relationship between napping and cardiovascular disease. In fact, the risk over five years of follow-up was a 42% decrease in CVD events when a person took a nap once or twice a week and no risk if a person napped every day (1).

In the most recent research, there was a relationship between napping and hypertension and napping and CVD in two separate studies with thousands of subjects (2, 3). Why? We’ll delve into why there were different results on Saturday.

What are you prepared to do today?

        Dr. Chet

References:
1. Heart. 2019;105:1793–1798.
2. J Am Heart Assoc. 2022;11:e025969. DOI: 10.1161/JAHA.122.025969.
3. Hypertension. 2022;79:00–00. DOI: 10.1161/HYPERTENSIONAHA.122.19120.

The Secret to Prevention

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Consistency.

I thought I’d lead with the secret to disease prevention instead of making you wait. Whatever you want to accomplish in taking charge of your health, you have to be consistent. The polypill study proved it although the scientists, being conservative in their conclusions, don’t come out and say it—but I will. Here’s why.

Why the Polypill Was the Difference

The subjects taking the polypill were more consistent in taking their medications than the subjects who took the exact same medications as individual pills. They didn’t ask the subjects whether it was easier to remember to take one versus three pills; that could be a factor as the mean age of the subjects was over 75. It’s also easier to keep one medication refilled rather than three. Whatever the reason, the subjects just took their medication on a more regular basis and thus saw a decrease in recurrence of cardiovascular disease events.

While this was a study about medication, it applies to reducing or changing your foods to eat healthier, reducing the risk of cardiovascular disease and diabetes, or any other health goal: we have to be consistent. Even getting a health benefit from taking a supplement requires you to take it regularly for weeks or months to see a benefit.

Weight Loss: A Special Case

Losing weight and maintaining the weight loss is the single most difficult thing humans can do. I know. I’ve been trying for decades. I don’t weigh what I used to weigh, but I’m not where I want to be. I know many of you are in that spot as well.

It’s not the losing that’s the problem—it’s the maintaining. When you consider the simplicity of it, why is it so difficult to sustain a way of eating that keeps you at a healthy weight? Scientists and physicians have examined genetics, proteomics, hormones, and more. They have looked at every psychological issue they can think of to try to help people lose the weight and keep it off. No luck so far.

I’ll go out on a limb and predict there won’t be any one answer. It’s really up to each individual to find a way to eat that can sustain a normal body weight. It will probably be slightly different for each of us as to the types of foods and exercise we use, but our solution exists. We just have to find a way to be consistent and in the case of weight loss, it has to be for life.

The Bottom Line

We face plenty of obstacles in our path to health. We may not have the best genes. We may have had a poor lifestyle for many years that we have to compensate for. We may not have all the resources we need. But if we can pick a couple of things at a time and make them our habits for life, we can begin the process. We just have to be consistent, day in, day out. Where we end up may not be perfect, but it can be better than you are right now. That’s what aging with a vengeance is all about.

What are you prepared to do today?

        Dr. Chet

Reference: NEJM. 2022. DOI: 10.1056/NEJMoa2208275

Will the Polypill Reduce Second Heart Attacks?

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One of the issues with prevention is having people stick to a plan, even after an event as serious as a heart attack. Lifestyle changes are challenging to stick with, but so is something as simple as taking medications. Remember, this isn’t to prevent a heart attack; it’s to prevent a second one. That’s serious.

The concept of a polypill has been around for close to 15 years. The idea was to put medications together in one pill as a preventive that would reduce the risk of getting cardiovascular disease. For a long time, that idea never went anywhere, but recently researchers decided to resurrect the concept. This time, the objective was to monitor subjects with recent heart attacks. Would there be a difference in the rate of secondary events between subjects who took the polypill and those who took the same medications as individual pills? The medications used were aspirin, ace-inhibitor, and a statin. After three years of follow-up, the subjects in the polypill experienced significantly fewer secondary events, 9.5% versus 12.7%.

Can you figure out why the subjects who took the polypill did better than the subjects who took the same medications individually? I’ll tell you the secret to disease prevention on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: NEJM. 2022. DOI: 10.1056/NEJMoa2208275

What Is Secondary Prevention?

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Secondary prevention encompasses a wide range of health-related conditions. It includes people with risk factors such as high cholesterol and blood pressure, cigarette smoking, elevated HbA1c, atrial fibrillation, and more. It also includes people who may have had a heart attack, stroke, cancer, or were treated and now are trying to prevent a recurrence of another incident. This all falls under the umbrella of secondary prevention.

The problem, as I see it, is that we don’t take the risk factors seriously enough to prevent the occurrence of serious health events. For example, let’s say a person gets a reading of 5.9% in an HbA1c reading. That’s considered pre-diabetic and is definitely on the path to type 2 diabetes. The solution is pretty straightforward: reduce refined carbohydrate intake and total caloric intake if the person has weight to lose. Then start an exercise program and stick to it.

Did you know that within three days of beginning a walking or exercise bike program, your body will begin to utilize insulin better? That’s how quickly your body reduces insulin resistance and starts the path back to a lower HbA1c and thus reducing the risk of type 2 diabetes.

Aging with a vengeance is all about prevention—primary prevention to prevent serious diseases and conditions from occurring in the first place and secondary prevention to deal with them if they do occur. Aging is a risk factor in and of itself but not because of a calendar; it’s the changes that naturally occur as we age. What we do to resist or delay those changes is at least partly in our hands. That’s why I said aging with a vengeance begins in your 30s and maybe even younger.

It all begins with six simple words: Eat less. Eat better. Move more. I’ll continue to comb the research to find strategies to deal with other issues. Next week, I’ll review a research study that reveals the secret to getting results.

What are you prepared to do today?

        Dr. Chet

What Is Primary Prevention?

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The key to aging with a vengeance is prevention. One of the obvious goals is to prevent problems such as stroke or heart attack in healthy people and in people who have risk factors for disease. Today’s Memo will deal with primary prevention.

Primary prevention focuses on helping apparently healthy people prevent the onset of disease. Eating a healthy diet that focuses on plant-based sources of food would be an obvious preventive measure; so would a regular exercise program. Supplementation to fill in any gaps in the diet would also fit here.

But there are more steps that we don’t typically consider. Yearly physicals are important as we pass 30; I cringe every time people in their 60s say they’ve never had a physical. Something as simple as examining the skin for misshapen moles or measuring blood pressure regularly can be critical, because early treatment can prevent a disease such as skin cancer or hypertension that can cause life-threatening issues. Then add keeping your vaccinations up to date and flossing your teeth daily, and you’ve got a great start on primary prevention. I’ll elaborate in a new Straight Talk on Health available to Members and Insiders on Saturday. Then in Saturday’s Memo, I’ll talk about secondary prevention.

Tomorrow night at 9 ET is the Insiders Conference Call. The focus is on answering Insiders’ questions. I’m also going to address some of the latest research on artificial sweeteners to see whether they’re hazardous to our health or not. Become an Insider by 8 p.m. tomorrow and you can take part in the call.

What are you prepared to do today?

        Dr. Chet