WARNING: This blog is very geeked out, so it is NOT for the casual reader.

The health and fitness industry has grown to become a multi-billion dollar industry. A large part of this growth has been through selling supplements to the “busy” consumer who just does not have time to eat healthy. Or, these products target the average American who has the aspirations to have the body like their favorite athlete. This has led to an explosion of various products confusing the consumer as to what is really necessary to take. 

The goals of this post are:
1. Understand basic human physiology of muscle contraction and all the micronutrients that are involved
2. Educate regarding these micronutrients and how supplements aim to help, assist, or replace them
3. Learn about various supplements, including pre-workout drinks, branched chain amino acids (BCAAs), creatine, B vitamins, and much more!
4. Touch on the topic of probiotics and fiber. What's my colon got to do with all this? 
5. Touch on "detox" programs, juicing, and fasting. Which is better and do I really need to do this?

Throughout this discussion, there is one proven fact that cannot be dismissed: all the nutrients your body needs already exist in your environment. To eat and live healthy, all we have to do is be willing to learn, make healthy eating a priority, and surround ourselves with people who will support eating healthy. Easy as that. To learn more, check out Dr. Sommer White, a board certified physician who is a great resource for you to learn about how food can heal and facilitate healthy living. http://www.sommerwhitemd.com

Also consider reviewing my previous blog about the 7 essentials to live healthy.

Basic physiology of energy
We all need energy to do anything. This is a law of physics where energy that is kinetic (motion) is dependent on the weight of the object and its speed. So the faster it moves and heavier it is, the more kinetic energy it develops. 

                                                                     Energy = weight (kg) x velocity (m/s2)
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In food, we measure energy in calories. Our sources of energy come from proteins and carbohydrates. 
1 calorie = 4.1868 Joules (measurement of energy in an object) 

There is international debate as to how much calories we should consume. But here is a general recommendation: 

Men = 2500 daily calories 
Women = 2000 daily calories

​Those who are sedentary, certainly these requirements will suffice. But, what about those who are active. Meaning, those who are working out 150 minutes per week or more? Active individuals have a higher demand for micronutrients and calories, especially if they want to maintain their weight and/or muscle mass. 

This means, that the more you exercise, the more you expend energy, then the more you need to invest in the recovery phase. 

The recovery phase means:

1. getting 7-8 hours of restful sleep per night
2. optimizing nutrition 
3. balancing workout with stressful and non stressful routines
4. stretching, yoga, and meditation to allow muscle fibers to heal

It is the recovery phase where you build muscle, not when you are working out in the gym. 
Remember, before a single muscle fiber moves, it needs to get a signal from the nervous system. This is called an action potential. This process involves sodium and potassium channels. This is why micronutrients are so important!

Basic muscle physiology

​Our muscles are important structures as they not only give us strength, make us look “buff”, but also strengthen joints and improve our balance as we age. To learn what an action potential is watch this video. I love this guy because this is what I probably would be doing if I didn't become a doctor.

Now that you understand the basic muscle physiology and realize all the micronutrients that are involved in the contraction, the following sections will make more sense. 
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What about these pre-workout drinks? 
There are various drinks on the market. At the gym, I see few people still use Monster energy drinks and the like. More commonly, I see 5-Hour energy. The main component in many of these drinks is caffeine. 

*Depending on the brew, an 8oz serving of coffee contains anywhere from 60-120mg of caffeine. Tea averages about 20-90mg per 8oz cup. Soft drinks average 20-40mg per can. 

How much caffeine is too much?
According to the Mayo Clinic, up to 400mg of caffeine a day is safe in healthy adults. However, in adolescents and children, they should limit to no more than 100mg of caffeine per day. 

So, taking a pre-workout drink will get an adult close to or meet that maximum daily requirement. Remember, these recommendations are for healthy adults. If you have heart disease, high blood pressure, anxiety, high cholesterol, arrythmias, and many other health conditions, then these recommendations DO NOT apply to you. 
Here is where having a good primary care doctor can help. Have a good conversation about your workout goals and work together to reach those goals in a healthy way. If your current primary care doctor is not comfortable with this conversation or doesn't even workout…well, then give Dr. Ahmed a call! 

​Many energy drinks and pre-workout drinks are packed with B vitamins. Ever wonder why? 
​Check this out:

What about whey protein and branched chain amino acids (BCAAs)? Or, creatine and glutamine so I can look like those fitness models? Because clearly, if I take all those, I will look like them right? 
Um, no you will not look like those fitness models just by taking these supplements. It takes a good balanced diet and exercise. More specifically, 80% - 90% is diet and the rest is exercise. You read that right: diet is more important than your exercise regimen. 

​How about juicing, fasting, and all these “detox” programs?
Majority of these programs are sketchy and very dangerous. Regardless of which program you are following, you need to be followed by a physician. This idea of “detox” should be an ongoing program where you eat foods that help clear any toxins by allowing normal bowel movements, increasing the efficiency of our cellular enzymes and reactions to digest all the toxins we are exposed to in our foods, water, air, etc. 
Check out www.sommerwhitemd.com. Watch her videos and her explanation of detoxification approach through food. We had her at our clinic and support what she offers. 
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Short intervals of fasting are healthy, but must be monitored by a physician. Juicing has similar advantages for detoxification with elimination of inflammatory markers and provide antioxidants. Again, this should not be a one time thing and must be monitored by a physician. The bottom line is, get a doctor to monitor and assure that whatever you choose to do, follow it up with eating a healthy balanced diet and exercising daily. At the end of the day, diet and exercise is what is going to give you the benefits. If a fast or a juice helps you transition or get you to diet and exercise, then do it I guess. 
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Here is a breakdown of the most popular ingredients the average athlete is curious about?

How much protein do I really need?
The average person needs about 1g/kg of protein per day. Those who are not as active can probably be ok eating a little less than that. However, if you are trying to add muscle mass, then the usual recommendation is 1.5g/kg. Remember, muscle building happens at night when you are sleeping or when you are resting, not at the gym. Balance this with about 30g of fiber to prevent constipation and certainly anyone with kidney disease, high blood pressure, or the medical conditions must be monitored by a physician. 

To give you some idea of how much protein some common foods have:

• 3 oz meat = 21g protein
• 1 cup milk = 8g protein 
• 8 oz yogurt = 11g protein 
• 1 cup dry beans = 16g protein 

So, the point is, before you run to the store to get containers of whey protein and bottles of BCAAs, think about how much protein you already consume and if there is a deficit, THEN consider possibly supplement. Remember, many if not all supplement products are NOT FDA approved. This means, these supplements are not benign or harm free. We just do not know the long term effects of some of these supplements. That is why I recommend use supplements to help you fill in gaps and hopefully you can replace those supplements with actual food. Long term supplements are not a good idea since we do not have the data to support their absolute need for the average human being. Professionals athletes are a different category in this discussion. 

Probiotics and colon health
There has been more enthusiasm about probiotics recently without the support of much scientific evidence. All the trials that are done on probiotics are inconsistent with methodology or are small studies. The intestinal tract is a host to any bacteria and any change in these colonies can affect your health. In a sense our intestine has its own ecosystem with bacteria regulating certain toxin elimination and protecting the intestine from inflammation and other processes that can damage its lining. 

By definition, probiotics are microorganisms that have beneficial properties for the human being. Many of the bacteria in these tablets are available in foods, such as non-pasteurized yogurt and milk. Some of the benefits include suppression of growth or epithelial binding/invasion by pathogenic bacteria, improvement of intestinal barrier function, modulation of the immune system, and modulation of pain perception.  Reports for benefit have been seen in the following conditions:

1. infectious diarrhea
2. Clostridium deficile infection 
3. preventing antibiotic associated diarrhea
4. Possible benefit with IBS 
*Again, the data is limited here. As you can see, there are only a few things have shown moderate evidence of benefit

Fiber is a stool bulking agent that helps people stay regular. It is important to have one bowel movement per day. The bulking agent facilitates peristalsis, which is contraction of the intestinal tract to help move stool along to facilitate a bowel movement. You need to take in about 20-25g of Fiber daily. I usually recommend 30g given the poor American diet. You can get fiber in a balanced diet or supplement with any affordable over the counter powders. 

Colon health is important to eliminate toxins from our body. If you think about it, our body eliminates waste by sweating through our skin, urination, and stool elimination. The average American does not stay hydrated and nor do they stay regular with their fiber intake. So the body is left with only sweat as a mechanism to eliminate waste. There is something to be said as these toxins accumulate and are not released, this can lead to poor health outcomes. More evidence is needed for this statement to be completely accurate, but the basic physiology suggests this possibility. 

                                                                       What is the bottom line on supplements?
I take supplements to help with muscle development and recovery. However, supplements are there to do just that - supplement your diet! A majority of supplements I think are unnecessary long term. If you are working out for a competition or a sport, then short intervals are reasonable. The more I learn about various vegetables that I had no idea about: daikon, miso, wakame, dried shiitake, and the benefits of brown rice, I am starting to realize how silly supplements seem. 

​Every supplement, whether they claim to be “all natural” or not, need to be monitored by a physician who is comfortable with these products. 

I have tried many supplements and do so with the intent to taste what my patients or future patients are likely trying. I also read about these products, because for me, it is important to have a knowledgable discussion about these products in the right medical setting. Consumers who take these products are likely very in tune with their bodies and would appreciate a physiologic lesson as to why they should continue, adjust their dose, or maybe even stop what they are taking. 

So, bottom line, focus on your diet. Get a team together that will help you not only understand but hold you accountable to a good balanced diet. Food should be entertaining, enjoyed with company, and diverse to facilitate curiosity and enjoyment. The supplement industry makes billions off the human behavior of not sticking to a plan or climbing on and off the wagon. Save yourself money and put together a good team for yourself to help you take what you need and stick to a program for life. Finally, combine your healthy diet and supplements with the right exercise program. You do not need to work out 6 days a week and spend hours at the gym. 

After 1 hour in the gym of active working out, any more time is just increasing your risk for injury. Athletes are different in that they know how to recover in between training sessions during the day with the right nutrition to allow healing of those injured muscles. 

Don’t be swayed by these new years resolution gimmicks. Stick to what you know - great diet with 150 minutes of activity per week is all you need to see results. Finally, be patient and positive. Feed your soul with a good book, meditate, do yoga, and laugh. 

Please do no hesitate to ask any questions you may have. Better yet, if you don't have a primary care doctor, please consider joining my practice. 
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To a great year full of happiness, health, and blessings,

​Dr. Ahmed 

Recently, there has been much discussion regarding concussion and sudden cardiac death (SCD) in young athletes. Although this is rare in children and adolescents, they are so devastating when it happens. There has been a growing effort in finding evidence-based strategies that will prevent this in a cost-effective manner. 

How common is this?
The incidence for SCD ranges 0.5 to 20 per 100,000 persons-years. Interestingly, when we compare studies from 1980s to 2009 show a rise in survival, which is attributed to improvements in community-based EMS and changes in resuscitation protocols. 

What is the cause?

• Coronary artery disease (29%)
• Primary arrhythmia like Wolff-parkinson-White syndrome (WPW) and conduction defects (22%)
• Cardiomyopathy like dilated, hypertrophic, and myocarditis (20%)
• Congenital cardiac disease like tetralogy of ballot, hypo plastic left heart syndrome and transposition of the great arteries (15%)
• Other cardiac disorders like coronary arteritis, anomalous origin of coronary arteries, aortic dissection, and mitral valve prolapse (8%)
• Unspecified disease (7%)

Interestingly:
2 years old and younger - cause of death congenital heart disease (84%)
3-13 years old - No dominant cause - congenital (21%), hypertrophic cardiomyopathy (18%), long QT 
                                    Syndrome (14%)
14-24 years old - No dominant cause - Primary arrhythmia (23%), congenital (23%), and dilated 
                                       hypertrophic cardiomyopathy (14%)
25-35 years old - Coronary artery disease 

When should I be concerned?

• chest pain
• fatigue
• passing out or lightheadedness 

What is the role for screening?
The American Heart Association (AHA) and the American Academy of Pediatrics (AAP) recommend that the most cost-effective initial screening for children and adolescents for cardiac disease is a detailed history and physical examination - ALONE. That is right, no need for unnecessary expensive testing no matter how some of these organizations market their services. 

There NO evidence that a ECG or any other cardiovascular screening program would reduce the incidence of SCD in the United States. 

Even for young athletes, there is NO evidence for routine use of ECG, echocardiography, or exercise stress testing. However, athletes older than 35 years old, some experts recommend ECG. If the athlete who is 35 years and older has moderate-to-high risk of coronary heart disease, then some experts would recommend exercise stress testing. 

Bottom line: Be careful out there as consumers are inundated with advertisements for services that can prevent cardiac disease. The truth is that unnecessary testing not only is costly, but also leads to false-positives that lead to further unnecessary testing. As with every health care topic - have a GOOD PRIMARY CARE DOCTOR to discuss issues like this and build a relationship with them so that you protect yourself from unnecessary testing that can be costly or lead to further unnecessary procedures that might expose you to harmful agents like radiation. 

To your health my friends, 
- Dr. Ahmed