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Tag: osteoporosis

  • Bariatric Surgery: Risks in the OR and Beyond | NutritionFacts.org

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    The extent of risk from bariatric weight-loss surgery may depend on the skill of the surgeon.

    After sleeve gastrectomy and Roux-en-Y gastric bypass, the third most common bariatric procedure is a revision to fix a previous bariatric procedure, as you can see below and at 0:16 in my video The Complications of Bariatric Weight-Loss Surgery.

    Up to 25% of bariatric patients have to go back into the operating room for problems caused by their first bariatric surgery. Reoperations are even riskier, with up to 10 times the mortality rate, and there is “no guarantee of success.” Complications include leaks, fistulas, ulcers, strictures, erosions, obstructions, and severe acid reflux.

    The extent of risk may depend on the skill of the surgeon. In a study published in The New England Journal of Medicine, bariatric surgeons voluntarily submitted videos of themselves performing surgery to a panel of their peers for evaluation. Technical proficiency varied widely and was related to the rates of complications, hospital readmissions, reoperations, and death. Patients operated on by less competent surgeons suffered nearly three times the complications and five times the rate of death.

    “As with musicians or athletes, some surgeons may simply be more talented than others”—but practice may help make them perfect. Gastric bypass is such a complicated procedure that the learning curve may require 500 cases for a surgeon to master the procedure. Risk for complications appears to plateau after about 500 cases, with the lowest risk found among surgeons who had performed more than 600 bypasses. The odds of not making it out alive may be double under the knife of those who had performed less than 75 compared to more than 450, as seen below and at 1:47 in my video.

    So, if you do choose to undergo the operation, I’d recommend asking your surgeon how many procedures they’ve done, as well as choosing an accredited bariatric “Center of Excellence,” where surgical mortality appears to be two to three times lower than non-accredited institutions.

    It’s not always the surgeon’s fault, though. In a report entitled “The Dangers of Broccoli,” a surgeon described a case in which a woman went to an all-you-can-eat buffet three months after a gastric bypass operation. She chose really healthy foods—good for her!—but evidently forgot to chew. Her staples ruptured, and she ended up in the emergency room, then the operating room. They opened her up and found “full chunks of broccoli, whole lima beans, and other green leafy vegetables” inside her abdominal cavity. A cautionary tale to be sure, but perhaps one that’s less about chewing food better after surgery than about chewing better foods before surgery—to keep all your internal organs intact in the first place.

    Even if the surgical procedure goes perfectly, lifelong nutritional replacement and monitoring are required to avoid vitamin and mineral deficits. We’re talking about more than anemia, osteoporosis, or hair loss. Such deficits can cause full-blown cases of life-threatening deficiencies, such as beriberi, pellagra, kwashiorkor, and nerve damage that can manifest as vision loss years or even decades after surgery in the case of copper deficiency. Tragically, in reported cases of severe deficiency of a B vitamin called thiamine, nearly one in three patients progressed to permanent brain damage before the condition was caught.

    The malabsorption of nutrients is intentional for procedures like gastric bypass. By cutting out segments of the intestines, you can successfully impair the absorption of calories—at the expense of impairing the absorption of necessary nutrition. Even people who just undergo restrictive procedures like stomach stapling can be at risk for life-threatening nutrient deficiencies because of persistent vomiting. Vomiting is reported by up to 60% of patients after bariatric surgery due to “inappropriate eating behaviors.” (In other words, trying to eat normally.) The vomiting helps with weight loss, similar to the way a drug for alcoholics called Antabuse can be used to make them so violently ill after a drink that they eventually learn their lesson.

    “Dumping syndrome” can work the same way. A large percentage of gastric bypass patients can suffer from abdominal pain, diarrhea, nausea, bloating, fatigue, or palpitations after eating calorie-rich foods, as they bypass your stomach and dump straight into your intestines. As surgeons describe it, this is a feature, not a bug: “Dumping syndrome is an expected and desired part of the behavior modification caused by gastric bypass surgery; it can deter patients from consuming energy-dense food.

    Doctor’s Note

    This is the second in a four-part series on bariatric surgery. If you missed the first one, see The Mortality Rate of Bariatric Weight-Loss Surgery.

    Up next: Bariatric Surgery vs. Diet to Reverse Diabetes and How Sustainable Is the Weight Loss After Bariatric Surgery?.

    My book How Not to Diet is focused exclusively on sustainable weight loss. Check it out from your local library, or pick it up from wherever you get your books. (All proceeds from my books are donated to charity.)

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    Michael Greger M.D. FACLM

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  • Does Marijuana Affect Weight Gain or Bone Density?  | NutritionFacts.org

    Does Marijuana Affect Weight Gain or Bone Density?  | NutritionFacts.org

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    Are the apparent adverse effects of heavy cannabis use on the bone just due to users being thinner? 

    It’s been recognized for decades that cigarette smoking can have “a major effect” on bone health, “increasing the lifetime risk of hip fracture by about half.” It also appears to impair bone healing, so much so that surgeons ask if they should discriminate against smokers because their bone and wound-healing complication rates are so high. What about smoking marijuana?

    As I discuss in my video Effects of Marijuana on Weight Gain and Bone Density, “There is accumulating evidence to suggest that cannabinoids [cannabis compounds] and their receptors play important roles in bone metabolism by regulating bone mass, bone loss, and bone cell function.” Okay, but are they “friend or foe?” 

    “Results from research on cannabinoids and bone mineral density in rodent models have been inconsistent. Some studies show increased bone formation, others have demonstrated accelerated bone loss, and yet others have shown no association. This variation in results may be due [in part] to differences in the mouse strain, sex, age…” If you can’t even extrapolate from one mouse to another, how can you extrapolate from mice to human beings?

    What if you just measure cannabis use and bone mineral density in people? Researchers tested thousands of adults and asked them about their cannabis use. There did not appear to be any link between the two, which is a relief. However, in this study, “heavy” cannabis use was defined as just five or more days of use in the previous 30 days. The researchers didn’t ask beyond that, so, theoretically, someone who smoked just five joints in their entire life could be categorized as a “heavy user” if they happened to use it five times in the last four weeks.

    How about cannabis use on 5,000 separate occasions over a lifetime? Now that’s a heavy user—decades of regular use. In that case, heavy use was “associated with low bone mineral density and an increased risk of fractures”—about double the fracture rate presumably due to lower bone density in the hip and spine, although heavy cannabis users were also thinner on average, and thinner people have lighter bones.

    Hip fracture risk goes down as our weight goes up. Nearly half of underweight women have osteoporosis, but less than 1 percent of obese women do, which makes total sense. Being obese forces our body to make our bones stronger to carry around all of that extra weight. That’s why weight-bearing exercise is so important to constantly put stress on our skeleton. When it comes to our bones, it’s use it or lose it. That’s why astronauts can lose a percent of their bone mass every month in “long-duration spaceflight.” Their bodies aren’t stupid. Why waste all that energy making a strong skeleton if you aren’t going to put any weight on it? 

    So, maybe the reason heavy cannabis users have frailer bones is because they tend to be about 15 pounds lighter. Wait a second. Marijuana users are slimmer? What about the munchies? “The lower BMI that was observed in heavy cannabis users at first sight seems counterintuitive,” given marijuana’s appetite stimulation, but this isn’t the first time this has been noted. 

    “Popular culture commonly depicts marijuana users as a sluggish, lethargic, and unproductive subculture of compulsive snackers,” and marijuana has indeed been found to increase food intake. A single hit can increase appetite, so you’d expect obesity rates to rise in states that legalized it. But, if anything, the rise in obesity appeared to slow after medical marijuana laws were passed, whereas it appeared to just keep rising in other states, as you can see in the graph below and at 3:45 in my video. 

    The reason pot smokers may be slimmer is because of the effect of smoked marijuana on metabolism. We’ve known for more than nearly 40 years that within 15 minutes of lighting up, our metabolic rate goes up by about 25 percent and stays there for at least an hour, as you can see below and at 4:04 in my video. So, that may be playing a role. 

    Is that why heavy cannabis use is associated with lower bone mineral density and increased risk of fractures? Because users just aren’t as overweight? No. Even when taking BMI into account, heavy cannabis use appears to be “an independent predictor” of weaker bones.

    I originally released a series of marijuana videos in a webinar and downloadable digital DVD. There are still a few videos coming out over the next year, but if you missed any of the already published ones, see the related posts below. 

    For more on bone health, check out the related posts below. 

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    Michael Greger M.D. FACLM

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  • Bone Health Technologies Announces FDA Clearance of OsteoboostTM, the First Prescription Medical Device to Treat Low Bone Density

    Bone Health Technologies Announces FDA Clearance of OsteoboostTM, the First Prescription Medical Device to Treat Low Bone Density

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    • Osteoboost is the first and only non-pharmacological prescription treatment to demonstrate reduced loss of bone strength in postmenopausal women
    • Represents the first therapeutic mechanism specifically designed and cleared for intervention during the osteopenia stage


    REDWOOD CITY, Calif., January 18, 2024 (Newswire.com)
    –
    Bone Health Technologies today announced that the U.S. Food and Drug Administration (FDA) has granted clearance for OsteoboostTM, the first non-pharmacological device-based prescription treatment for postmenopausal women diagnosed with osteopenia (low bone density). 

    Osteoboost is a wearable belt device, worn on the hips, that delivers targeted, calibrated vibration to the lumbar spine and hips. Osteoboost is indicated to reduce bone strength and density decline in postmenopausal women and is the first and only solution specifically designed to improve bone health during osteopenia. This breakthrough technology is safe, medication-free, and easy to use at home, making it suitable for a wide variety of patients with bone density loss. 

    An estimated 52 million Americans have osteopenia, the precursor to osteoporosis, driving an addressable market of over $30 billion in the U.S. and $100 billion globally. Half of all women suffer from fractures during their lifetime, and most of these fractures occur during the osteopenia stage. 

    “Today’s groundbreaking decision represents the first non-pharmacological therapy approved to treat this widespread and serious condition. With Osteoboost, we have a new treatment option — free of serious adverse events — that taps into the body’s natural mechanism to stimulate bone growth,” said Laura Yecies, CEO of Bone Health Technologies. “Women’s health has been underserved for too long, making this a huge step forward for older women who have lacked effective treatment options and are seeking an effective way to protect their bone health.”

    Osteoboost was reviewed through the FDA’s De Novo classification process and received Breakthrough Device Designation. The Osteoboost clearance creates an entirely new class of therapeutics for low bone density outside of pharmacological intervention. Notably, Osteoboost also represents the first therapeutic mechanism specifically designed and cleared for intervention during the osteopenia stage. Until now, patients with osteopenia have lacked effective therapeutic options. Before Osteoboost, the standard of care for osteopenia focused on regular weight-bearing exercise and calcium supplementation — neither of which have been proven to significantly slow the loss of bone density. 

    “There are millions of American women with low bone density or osteopenia. This is often the precursor to osteoporosis. We have little to offer those women other than calcium and vitamin D supplements,” said David B. Karpf, MD, Adjunct Clinical Professor of Endocrinology, Gerontology & Metabolism, Stanford University School of Medicine and attending in the Osteoporosis & Metabolic Bone Disease Clinic. “The field of bone health right now is missing innovative approaches — there are no new agents in clinical trials for osteoporosis and nothing for women who have osteopenia. With the aging of our population, we need new ways to effectively prevent the decline in bone mass and strength that affects all women in the peri-menopause or post-menopausal stage.”

    Osteoboost was granted clearance based on data from an NIH-funded double-blinded, sham-controlled study conducted at the University of Nebraska Medical Center. The data, which were shared at the 2023 ENDO and ASBR conferences, demonstrate the efficacy of Osteoboost in directly stimulating bone growth and preserving bone mineral density and strength by sending low-frequency vibrations directly to the lumbar spine and hips.  

    The primary outcome measurement was the change in vertebral strength measured by CT scan. Per Protocol (PP) — subjects (those who used the device a minimum of three times per week) in the Active Treatment group lost, on average, 0.48% bone strength while those in the Sham group lost 2.84%, with a relative difference of 2.36% (P=0.014). Additionally, CT measurement of vertebral bone density was conducted and showed a 1.68% relative benefit for those using the Osteoboost (P=0.008). These results represent a dramatic reduction in the loss of bone strength and density. Zero serious adverse events were reported.

    “The well-being and ability of postmenopausal women to maintain an active lifestyle is threatened when loss of estrogen causes rapid loss of bone,” said Laura Bilek, Ph.D., Associate Dean for Research and Associate Professor at the University of Nebraska and principal investigator for this study. “Although lifestyle interventions such as exercise and diet are beneficial to bone, the effect is small. The Osteoboost shows promise in slowing the loss of bone density and strength and may fill the treatment gap.”

    About Bone Health Technologies

    Bone Health Technologies (BHT) is a Redwood City-based company that applies science and medical expertise to create better health outcomes for women and men at risk of developing osteoporosis and associated bone fractures. The company’s first FDA-approved device, Osteoboost, is poised to become the new standard of care in treating post-menopausal osteopenia. BHT is backed by leading investors, including Esplanade Ventures, Ambit Health Ventures, Good Growth Capital, Portfolia, Astia Angels, and Golden Seeds. For more information about BHT and Osteoboost, including the full Indications for Use, please visit www.bonehealthtech.com.

    Source: Bone Health Technologies

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  • Any Pitfalls with Restricting Calories?  | NutritionFacts.org

    Any Pitfalls with Restricting Calories?  | NutritionFacts.org

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    How may we preserve bone and mass on a low-calorie diet? 
     
    One of the most consistent benefits of calorie restriction is that blood pressure improves in as little as one or two weeks. Blood pressure may even be normalized in a matter of weeks and blood pressure pills discontinued. Unfortunately, this can work a little too well and cause orthostatic intolerance, which can manifest as lightheadedness or dizziness upon standing and, in severe cases, may cause fainting, though staying hydrated can help. 
     
    What about loss of muscle mass? In the CALERIE trial, which I profile in my video Potential Pitfalls of Calorie Restriction, 70 percent of the body weight the subjects lost was fat and 30 percent was lean body mass. So, they ended up with an improved body composition of about 72 percent lean mass compared to 66 percent in the control group, as you can see at 0:51 in my video. And, even though leg muscle mass and strength declined in absolute terms, relative to their new body size, they generally got stronger. 

    Is there any way to preserve even more lean mass, particularly among older individuals who naturally tend to lose muscle mass with age? Increased protein intakes are commonly suggested, but most studies fail to find a beneficial effect on preserving muscle strength or function whether you’re young or old, active or sedentary. For example, during a 25 percent calorie restriction, researchers randomized overweight older men and women to either a normal-protein diet with 4 grams for every ten pounds of body weight or a high-protein diet with about 8 grams per ten pounds. That doubling of protein intake had no discernible effect on lean body mass, muscle strength, or physical performance. As you can see below and at 1:48 in my video, most such studies found the same lack of benefit, but when they’re all put together, one can tease out a small advantage of about one or two pounds of lean mass over an average of six months. 

    Unfortunately, high protein intake during weight loss has also been found to have “profound” negative metabolic effects, including undermining the benefits of weight loss on insulin sensitivity. As you can see in the graph below and at 2:14 in my video, if you lose 20 pounds, you can dramatically improve your body’s ability to handle blood sugars, compared to subjects in a control group who maintained their weight. But, if you lose the exact same amount of weight on a high-protein diet, getting about an extra 30 grams a day, it’s like you never lost any weight at all. 


    Though you can always bulk back up after weight loss, the best way to preserve muscle mass during weight loss is to exercise. The CALERIE study had no structured exercise component, and, similar to bariatric surgery, about 30 percent of the weight loss was lean mass. In contrast, that proportion was only about 16 percent of The Biggest Loser contestants, chalked up to their “vigorous exercise program.” Resistance training even just three times a week can prevent more than 90 percent of lean body mass loss during calorie restriction. 
     
    The same may be true of bone loss. Lose weight through calorie restriction alone, and you experience a decline in bone mineral density in fracture risk sites, such as the hip and spine. In the same study, though, those randomized to lose weight with exercise did not suffer any bone loss. The researchers concluded: “Our results suggest that regular EX [exercise] should be included as part of a comprehensive weight loss program to offset the adverse effects of CR [caloric restriction] on bone.” 
     
    It’s hard to argue with calls for increased physical activity, but even without an exercise regimen, the “very small” drop in bone mineral density in the CALERIE trial might only increase a ten-year risk of osteoporotic fracture by about 0.2 percent. The benefits of calorie restriction revealed by the study included improvements in blood pressure and cholesterol, as you can see in the graph below and at 3:54 in my video, as well as improved mood, libido, and sleep. These would seem to far outweigh any potential risks. The fact that a reduction in calories seemed to have such wide-ranging benefits on quality of life led commentators in the AMA’s internal medicine journal to write: “The findings of this well-designed study suggest that intake of excess calories is not only a burden to our physical homeostasis [or equilibrium], but also on our psychological well-being.” 
     


    Check out my other videos on calorie restriction, fasting, intermittent fasting, and time-restricted eating in the related videos below. 

     

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    Michael Greger M.D. FACLM

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  • Muscle Shrinkage and Bone Loss on Keto Diets?  | NutritionFacts.org

    Muscle Shrinkage and Bone Loss on Keto Diets?  | NutritionFacts.org

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    Ketogenic diets have been found to undermine exercise efforts and lead to muscle shrinkage and bone loss. 
     
    An official International Society of Sports Nutrition position paper covering keto diets notes the “ergolytic effect” of keto diets on both high- and low-intensity workouts. Ergolytic is the opposite of ergogenic. Ergogenic means performance-boosting, whereas ergolytic means performance-impairing. 
     
    For nonathletes, ketosis may also undermine exercise efforts. Ketosis was correlated with increased feelings of “perceived exercise effort” and “also significantly correlated to feelings of ‘fatigue’ and to ‘total mood disturbance,’” during physical activity. “Together, these data suggest that the ability and desire to maintain sustained exercise might be adversely impacted in individuals adhering to ketogenic diets for weight loss.” 
     
    You may recall that I’ve previously discussed that shrinkage of measured muscle mass among CrossFit trainees has been reported. So, a ketogenic diet may not just blunt the performance of endurance athletes, but their strength training as well. As I discuss in my video Keto Diets: Muscle Growth and Bone Density, study participants performed eight weeks of the battery of standard upper and lower body training protocols, like bench presses, pull-ups, squats, and deadlifts, and there was no surprise. You boost muscle mass—unless you’re on a keto diet, in which case there was no significant change in muscle mass after all that effort. Those randomized to a non-ketogenic diet added about three pounds of muscle mass, whereas the same amount of weight lifting on the keto diet tended to subtract muscle mass by about 3.5 ounces on average. How else could you do eight weeks of weight training and not gain a single ounce of muscle on a ketogenic diet? Even keto diet advocates call bodybuilding on a ketogenic diet an “oxymoron.” 
     
    What about bone loss? Sadly, bone fractures are one of the side effects that disproportionately plague children placed on ketogenic diets, along with slowed growth and kidney stones. Ketogenic diets may cause a steady rate of bone loss as measured in the spine, presumed to be because ketones are acidic, so keto diets can put people in what’s called a “chronic acidotic state.” 
     
    Some of the case reports of children on keto diets are truly heart-wrenching. One nine-year-old girl seemed to get it all, including osteoporosis, bone fractures, and kidney stones, then she got pancreatitis and died. Pancreatitis can be triggered by having too much fat in your blood. As you can see in the graph below and at 2:48 in my video, a single high-fat meal can cause a quintupling of the spike in triglycerides in your bloodstream within hours of consumption, which can put you at risk for inflammation of the pancreas.  

    The young girl had a rare genetic disorder called glucose transporter deficiency syndrome. She was born with a defect in ferrying blood sugar into her brain. That can result in daily seizures starting in infancy, but a ketogenic diet can be used as a way to sneak fuel into the brain, which makes a keto diet a godsend for the 1 in 90,000 families stricken with this disorder.

    As with anything in medicine, it’s all about risks versus benefits. As many as 30 percent of patients with epilepsy don’t respond to anti-seizure drugs. Unfortunately, the alternatives aren’t pretty and can include brain surgery that implants deep electrodes through the skull or even removes a lobe of your brain. This can obviously lead to serious side effects, but so can having seizures every day. If a ketogenic diet can help with seizures, the pros can far outweigh the cons. For those just choosing a diet to lose weight, though, the cost-benefit analysis would really seem to go the other way. Thankfully, you don’t need to mortgage your long-term health for short-term weight loss. We can get the best of both worlds by choosing a healthy diet, as I discussed in my video Flashback Friday: The Weight Loss Program That Got Better with Time.
     
    Remember the study that showed the weight loss was nearly identical in those who had been told to eat the low-carb Atkins diet for a year and those told to eat the low-fat Ornish diet, as seen below and at 4:18 in my video? The authors concluded, “This supports the practice of recommending any diet that a patient will adhere to in order to lose weight.” That seems like terrible advice. 

    There are regimens out there like “The Last Chance Diet which consisted of a low-calorie liquid formula made from leftover byproducts from a slaughterhouse [that] was linked to approximately 60 deaths from cardiovascular-related events.” An ensuing failed lawsuit from one widower laid the precedent for the First Amendment protection for those who produce deadly diet books. 

    It’s possible to construct a healthy low-carb diet or an unhealthy low-fat one—a diet of cotton candy would be zero fat—but the health effects of a typical low-carb ketogenic diet like Atkins are vastly different from a low-fat plant-based diet like Ornish’s. As you can see in the graph below and at 5:26 in my video, they would have diametrically opposed effects on cardiovascular risk factors in theory, based on the fiber, saturated fat, and cholesterol contents of their representative meal plans. 

    And when actually put to the test, low-carb diets were found to impair artery function. Over time, blood flow to the heart muscle itself is improved on an Ornish-style diet and diminished on a low-carb one, as shown below and at 5:44 in my video. Heart disease tends to progress on typical weight-loss diets and actively worsens on low-carb diets, but it may be reversed by an Ornish-style diet. Given that heart disease is the number one killer of men and women, “recommending any diet that a patient will adhere to in order to lose weight” seems irresponsible. Why not tell people to smoke? Cigarettes can cause weight loss, too, as can tuberculosis and a meth habit. The goal of weight loss is not to lighten the load for your pallbearers. 

     
    For more on keto diets, see my videos on the topic. Interested in enhancing athletic performance? Check out the related videos below. 

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    Michael Greger M.D. FACLM

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  • Older Men More at Risk as Dangerous Falls Rise for All Seniors

    Older Men More at Risk as Dangerous Falls Rise for All Seniors

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    March 17, 2023 — When Senate Minority Leader Mitch McConnell (R-KY) fell recently at a dinner event in Washington, D.C., he unfortunately joined a large group of his senior citizen peers. 

    This wasn’t the first tumble the 81-year-old has taken. In 2019, he fell in his home, fracturing his shoulder. This time, he got a concussion and was recently released to an in-patient rehabilitation facility. While McConnell didn’t fracture his skull, in falling and hitting his head, McConnell became part of an emerging statistic: one that reveals falls are more dangerous for senior men than senior women. 

    This new research, which appeared in the American Journal of Emergency Medicine, came as a surprise to lead researcher Scott Alter, MD, associate professor of emergency medicine at the Florida Atlantic University College of Medicine. 

    “We always hear about lower bone density rates among females, so we didn’t expect to see males with more skull fractures,” he said. 

    Alter said that as a clinician in a southern Florida facility, his ER department was the perfect study grounds to evaluate incoming geriatric patients due to falls. Older “patients are at higher risk of skull fractures and intercranial bleeding, and we wanted to look at any patient presenting with a head injury. Some 80% were fall related, however.” 

    The statistics bear out the fact that falls of all types are incredibly common among the elderly: some 800,000 seniors wind up in the hospital each year due to falls.

    The numbers show death rates from falls are on the rise in the senior citizen age group, too, up 30% from 2007 to 2016. Falls account for 70% of accidental deaths in people 75 and older. They are the leading cause of injury-related visits to emergency departments in the country, too. 

    Jennifer Stevens, MD, a gerontologist and executive director at Florida-based Abbey Delray South, is aware of the dire numbers and sees their consequences regularly. “The reasons seniors are at a high fall risk are many,” she said. “They include balance issues, declining strength, diseases like Parkinson’s and Alzheimer’s, side effects of their medications, and more.”

    In addition, many seniors live in spaces that are not necessarily equipped for their limitations, and hazards exist all over their homes. Put together, and the risks for falls are everywhere. But there are steps seniors, their families, and even middle-aged people can take to mitigate and hopefully prevent dangerous falls.  

    Staring Early

    While in many cases the journey to lessen fall risks begins after a fall, the time to begin addressing the issue is long before you hit your senior years. Mary Therese Cole, a physical therapist and certified dementia practitioner at Manual Edge Physical Therapy in Colorado Springs, CO, says that age 50 is a good time to start paying attention and addressing physical declines. 

    “This is an age where your vision might begin deteriorating,” she said. “It’s a big reason why elderly people trip and fall.” 

    Additionally, as our brains begin to age in our middle years, the neural pathways from brain to extremities start to decline, too. The result is that many people stop picking up their feet as well as they used to do, making them more likely to trip. 

    “You’re not elderly yet, but you’re not a spring chicken, either,” Cole said. “Any issues you have now will only get worse if you’re not working on them.” 

    A good starting point in middle age, then, is to work on both strength training and balance exercises. A certified personal trainer or physical therapist can help get you on a program to ward off many of these declines.

    If you’ve reached your later years, however, and are experiencing physical declines, it’s smart to check in with your primary care doctor for an assessment. “He or she can get your started on regular PT to evaluate any shortcomings and then address them,” Cole said. 

    Cole said when she’s working with a senior patient, she’ll test their strength getting into and out of a chair, do a manual strength test to check on lower extremities, check their walking stride, and ask about conditions like diabetes, former surgeries, and other conditions. 

    From there, Cole said she can write up a plan for the patient. Likewise, Stevens uses a program called Be Active that allows her to test seniors on a variety of measurements, including flexibility, balance, hand strength, and more. 

    “Then we match them with classes to address their shortcomings,” she said. “It’s critical that seniors have the ability to recover and not fall if they get knocked off balance.”

    Beyond working on your physical limitations, taking a good look at your home is essential, too. “You can have an occupational therapist come to your home and do an evaluation,” Stevens said. “They can help you rearrange and reorganize for a safer environment.” 

    Big, common household fall hazards include throw rugs, lack of nightlights for middle-of-the-night visits to the bathroom, a lack of grab bars in the shower/bathtub, and furniture that blocks pathways. 

    For his part, Alter likes to point seniors and their doctors to the CDC’s STEADI program, which is aimed at stopping elderly accidents, deaths, and injuries. 

    “It includes screening for fall risk, assessing factors you can modify or improve, and more tools,” he said. 

    Alter also recommended seniors talk to their doctor about medications, particularly blood thinners. 

    “At a certain point, you need to weigh the benefits of disease prevention with the risk of injury if you fall,” he said. “The bleeding risk might be too high if the patient is at a high risk of falls.” 

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  • Top Benefits of Exercise (and How Much to Do)

    Top Benefits of Exercise (and How Much to Do)

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    PHOTO CREDIT: FatCamera / Getty Images

     

    SOURCES:

    Mark Hutchinson, MD, FACSM, professor of orthopedics and sports medicine and head team physician, University of Illinois Chicago; president, ACSM Foundation, Chicago.

    Gene Shirokobrod, DPT, co-founder, Recharge, Ellicott City, MD.

    CDC: “How much physical activity do adults need?” 

    OrthoInfo: “Healthy Bones at Every Age.”

    ChoosePT: “Physical Therapy Guide to Osteoporosis.”

    Archives of Physical Medicine and Rehabilitation: “The Erlangen Fitness Osteoporosis Prevention Study: a controlled exercise trial in early postmenopausal women with low bone density-first-year results.”

    Harvard Health Publishing, Harvard Medical School: “Declining muscle mass is part of aging, but that does not mean you are helpless to stop it.” 

    International Journal of Environmental Research and Public Health: “The Effects of High-Intensity Interval Training vs. Moderate-Intensity Continuous Training on Heart Rate Variability in Physically Inactive Adults.”

    European Journal of Cardiovascular Prevention and Rehabilitation: “Association of physical activity with all-cause and cardiovascular mortality: a systematic review and meta-analysis.”

    American Journal of Epidemiology: “Does Strength-Promoting Exercise Confer Unique Health Benefits? A Pooled Analysis of Data on 11 Population Cohorts With All-Cause, Cancer, and Cardiovascular Mortality Endpoints.”

    British Journal of Sports Medicine: “The dose-response effect of physical activity on cancer mortality: findings from 71 prospective cohort studies.”

    Physiological Reviews: “Role of Inactivity in Chronic Diseases: Evolutionary Insight and Pathophysiological Mechanisms.”

    Cannabis and Cannabinoid Research: “A Systematic Review and Meta-Analysis on the Effects of Exercise on the Endocannabinoid System.”

    Medicine & Science in Sport & Exercise: “Endocannabinoid and Mood Responses to Exercise in Adults with Varying Activity Levels.”

    The Conversation: “The ‘runner’s high’ may result from molecules called cannabinoids—the body’s own version of THC and CBD.”

    JAMA Psychiatry: “Association of Efficacy of Resistance Exercise Training With Depressive Symptoms: Meta-analysis and Meta-regression Analysis of Randomized Clinical Trials.”

    Sports Medicine: “The Effects of Resistance Exercise Training on Anxiety: A Meta-Analysis and Meta-Regression Analysis of Randomized Controlled Trials.”

    Scandinavian Journal of Medicine & Science in Sports: “Increased insulin-stimulated glucose uptake in both leg and arm muscles after sprint interval and moderate-intensity training in subjects with type 2 diabetes or prediabetes.”

    British Journal of Sports Medicine: “Exercise interventions for cognitive function in adults older than 50: a systematic review with meta-analysis.”

    Preventive Medicine Reports: “Sprint-based exercise and cognitive function in adolescents.”

    Brain Plasticity: “The Effects of Acute Exercise on Mood, Cognition, Neurophysiology, and Neurochemical Pathways: A Review.”

    National Library of Medicine: “Neuroanatomy, Parasympathetic Nervous System.”

    The Journal of Alternative and Complementary Medicine: “Effects of Yoga on Heart Rate Variability and Depressive Symptoms in Women” A Randomized Controlled Trial.”

    Evidence-Based Complementary and Alternative Medicine: “Medical Students’ Stress Levels and Sense of Well Being After Six Weeks of Yoga and Meditation.”

     CDC: “Facts About Falls.”

    Medicine and Science in Sports and Exercise: “Physical Activity, Injurious Falls, and Physical Function in Aging: An Umbrella Review.”

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