So what is NEAT you ask? It is all the energy used that is secondary to planned exercise and weight training activities.

Last week I talked a little bit about incorporating NEAT (non-exercise thermogenesis) into a weight loss program. So today I will be expanding upon what exactly that means, and what it can do for you. The information for today’s post come from a study published in April of 2015.
So what is NEAT you ask? It is all the energy used that is secondary to planned exercise and weight training activities. For instance fidgeting, singing, walking, laughing, cleaning, standing, and any other movements throughout the day count towards NEAT (also see table at the bottom*). Individually these activities don’t use many calories, however, when combined the NEAT activities can generate a great deal burned calories. In fact, it is estimated that those who are lean and active burn and additional 350 calories DAILY compared to those who are sedentary. For such small changes in what you do on a daily basis those are some big results.
Here are some more highlights taken from the paper that I think you will find interesting:
– NEAT variability can explain the caloric expenditure differences in individuals with similar body types. Variances in work and leisure-time activities in individuals play a fundamental role in NEAT differences.
– By just doing simple daily manual task activities, NEAT can be enhanced throughout the workday and at home.
– NEAT decreases cardiovascular disease mortality and improves metabolic parameters.
– NEAT has good long-term adherence, with positive impact.
Check out the rest of the article at the link below, and I highly encourage you to take a look at the table at the end of this email to see what steps you can take to increase your activity. I think it is also important to remember that the ultimate goal is to create a sustainable healthy practices. There is no need to try and do all of these things at once, but to focus on creating one healthy habit at a time.
TableDaily Activities According to the Amount of Nonexercise Activity Thermogenesis (NEAT)
Activity Calories Burned per Hour
0-50 >50-100 >100-200
NEAT home activity
 Barbecuing/grilling X
 Cleaning X
 Clearing out storage space/garage X
 Cooking dinner X
 Grocery shopping X
 Hanging pictures X
 Ironing X
 Laundry X
 Organizing closets X
 Painting walls X
 Redecorating X
 Sweeping X
 Vacuuming X
General NEAT movements
 Climbing stairs X
 Pacing X
 Pushing a stroller X
 Riding in an automobile X
 Standing X
 Stretch band exercises X
 Stretching X
 Walking (strolling pace) X
 Walking and talking (briskly) X
 Walking around the home/office X
 Walking the dog X
 Walking to work X
NEAT yard activity
 Playing fetch with dog X
 Gardening X
 Mowing lawn X
 Planting flowers X
 Pruning shrubs X
 Raking leaves X
 Shoveling snow X
 Trimming hedges X
 Washing automobile X
 Watering plants X
 Weeding X
Hobbies and other recreational NEAT activity
 Baking X
 Bicycling X
 Bird watching X
 Playing board/card games X
 Bowling X
 Dancing X
 Fishing X
 Playing Frisbee or other outdoor games X
 Hiking X
 Journaling (while strolling) X
 Knitting/sewing X
 Kayaking X
 Playing the piano or another musical instrument X
 Reading (lounging) X
 Reading (standing) X
 Skiing (water or snow) X
 Surfing the Web (sitting) X
 Surfing the Web (standing) X
 Swimming X
 Practicing Tai Chi X
 Playing tennis X
 Watching TV X
 Watching TV on an elliptical trainer X
 Watching TV on a stationary bike X
 Watching TV on a treadmill X
 Playing video games (seated) X
 Playing video games (while moving) X
 Doing volunteer work (setting up/serving meals) X
 Window shopping X
 Practicing yoga X

TV = television.

*Mayo Clin Proc. n April 2015;90(4):509-519 n


The Real Reasons You’re Not Losing Weight

Using the secret awesome supplements, fat burners, shakes, and other “scientifically proven” stuff that your trainer/TV doctor said to use. But for some strange reason, you just can’t seem to lose any weight?

Your app says you’re eating 1200 calories a day. The online metabolism calculator says that you’re burning 2000 calories a day. You’re even using the secret awesome supplements, fat burners, shakes, and other “scientifically proven” stuff that your trainer/TV doctor said to use. But for some strange reason, you just can’t seem to lose any weight. How can this possibly be?!?! Well, let me tell you a dirty little secret. Most of that stuff can be summed up in one word. Crap. Because if any of this sounds familiar to you, you’re not losing body fat because in one way or another, whether you realize it or not, you’re eating more than you think are even when you think you aren’t.
Calories In
Nutrition tracking is great because it can give you a sense of how many calories you’re eating within a given food, meal, day, etc. However, when it comes to tracking nutrition, the energetic content of food has been completely divorced from the energetic cost of food. Meaning, the tracker won’t take into account how many calories will be burned preparing the food and/or digesting the food. Additionally, your tracker may not always be counting correctly. For instance, I have seen examples on my tracker where the calorie count is identical for 4oz and 8oz portions of the same foods. So even if you use a scale to weigh and meticulously record you food stuffs, you could still end up being way off. In fact, on average people, even after being well educated on how to track their food, will under estimate their intake by 429 calories per day (1).That’s about 3,000 calories per week! That’s not to say tracking calories is not worth your while. Because when you’re not paying attention to calorie intake, you leave yourself open to all the environmental and cognitive factors that have you eating more and more without even realizing it. For the most part, your brain is to blame for all of this. So, set your brain up for success to decrease the amount you eat.
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Calories Out
You take out your phone at the end of a long day and see that you have walked almost 10.000 steps. You say to yourself, “not a bad day’s work! No need for the gym tonight.” But, of course this is a huge mistake. For starters, everyone should be exercising in some fashion just about everyday. Regardless of age, gender, or health concerns, there are guidelines that you should follow for your exercise routine. The operative word being routine. Not a “when I feel like it” mentality. Secondly, there really is no great way to measure your steps, or for that matter, your calorie output. Even the most expensive and popular brands of trackers routinely under-estimate your steps while over-estimating your calorie expenditure (2). If you truly want to know how many calories you’re using in a day, you will need to be hooked up to some expensive machinery (see picture bellow for details). But you better not plan on using that number forever. Your calorie usage changes on a daily basis for many reasons. And as you lose weight, your body will almost cruelly reduce the number of calories it burns. Because as you become leaner, this ‘leanness’ means your body doesn’t require as many calories to keep you alive.
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Beware The Guru
By now most of you know that I don’t enjoy the works of certain health and fitness “gurus.” Not only that, but I don’t really believe that the works of many supplement companies are quite ethical. With everyone craving instant results, the immoral take advantage of this fact despite knowing there is no way they can deliver. They make fads something to profit off of rather than actually help people and guide them to success in their goals. They try to get you to buy into their way of thinking, so it makes it harder for you to dig yourself out of their profit pit. They use fear mongering to get their way and make your pocketbook lighter. And while it certainly is commendable that you want to do something to make yourself healthier, I would like to share with you some money saving and health enhancing factsFat burning supplements won’t help you lose weight but can be dangerous (3). Vitamin supplements and detoxes are a waste of money (4). And cutting fat is just as effective as cutting carbs to lose fat mass (5). Diet soda is actually a good tool to help you lose weight and to that end, there are no negative side effects of consuming artificial sweeteners (6). And the likes of TV doctors and Men’s Health magazine leave much to be desired when it comes to good advice (7,8)
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Instead of focusing on instant gratification, remember that anything worth having is going to take time, hard work, and persistence. Instead of searching for motivation all the time, learn why motivation is unreliable and what you should do instead. Remember that any diet suggesting you remove entire food groups, or slash your calories drastically doesn’t have your best interests in mind. There’s no long-term play here. Finally, ask yourself “are there any beliefs you hold that you might need to let go in order to attain better results?”
1. Champagne, C. M., Bray, G. A., Kurtz, A. A., Monteiro, J. B. R., Tucker, E., Volaufova, J., & Delany, J. P. (2002). Energy intake and energy expenditure: A controlled study comparing dietitians and non-dietitians. Journal of the American Dietetic Association, 102(10), 1428-1432. doi:10.1016/S0002-8223(02)90316-0
2. NELSON, M. B., KAMINSKY, L. A., DICKIN, D. C., & MONTOYE, A. H. K. (2016). Validity of consumer-based physical activity monitors for specific activity types. Medicine & Science in Sports & Exercise, 48(8), 1619-1628. doi:10.1249/MSS.0000000000000933
3. Dara, L., Hewett, J., & Lim, J. K. (2008). Hydroxycut hepatotoxicity: A case series and review of liver toxicity from herbal weight loss supplements. China: The WJG Press and Baishideng. doi:10.3748/wjg.14.6999
4. Guallar, E., Stranges, S., Mulrow, C., Appel, L. J., & Miller, 3., Edgar R. (2013). Enough is enough: Stop wasting money on vitamin and mineral supplements. Annals of Internal Medicine, 159(12), 850.
5. Hall, K. D., Bemis, T., Brychta, R., Chen, K. Y., Courville, A., Crayner, E. J., . . . Yannai, L. (2015). Calorie for calorie, dietary fat restriction results in more body fat loss than carbohydrate restriction in people with obesity. Cell Metabolism, 22(3), 427. doi:10.1016/j.cmet.2015.07.021
6. Peters, J. C., Wyatt, H. R., Foster, G. D., Pan, Z., Wojtanowski, A. C., Vander Veur, S. S., . . . Hill, J. O. (2014). The effects of water and non‐nutritive sweetened beverages on weight loss during a 12‐week weight loss treatment program. Obesity, 22(6), 1415-1421. doi:10.1002/oby.20737
7. Korownyk, C., Kolber, M. R., McCormack, J., Lam, V., Overbo, K., Cotton, C.. . Allan, G. M. (2014). Televised medical talk shows–what they recommend and the evidence to support their recommendations: A prospective observational study. BMJ (Clinical Research Ed.), 349(dec17 11), g7346-g7346. doi:10.1136/bmj.g7346
8. Cook, T. M., Russell, J. M., & Barker, M. E. (2014). Dietary advice for muscularity, leanness and weight control in men’s health magazine: A content analysis. BMC Public Health, 14(1), 1062-1062. doi:10.1186/1471-2458-14-1062

Getting Grilled

“5 reasons why grilling will kill you”… What?

Some time back I stumbled upon a blog condemning the grill saying something along the lines of “5 reasons why grilling will kill you”. Naturally my mind went to using too much lighter fluid causing an explosion so I clicked the link to see what fun ways I could hurt myself this weekend. However, to my dismay the article was about how grilling can cause cancer, and that anyone who uses a grill is at harm and would be better off throwing out their cooking device.
Well I can say that as a lifelong lover of anything bacon, steak, and BBQ related I quickly made it my mission to find out if I should consult an oncologist, or if Memorial Day weekend plans were safe (grilling, home made beer, and Frisbee btw). Well I can safely say that I will be spending my afternoon savoring the sweet sweet smell of venison and Mae farm pork sausage.
I found most of the information on the subject in peer reviewed literature, but today’s post mostly comes from the fine folks at Precision Nutrition. Here is what you need to know:
– Grilling meat does produce a couple of chemicals that may increase risk of cancer (HCA & PAH
– Heterocyclic amines (HCAs) form when meat is overcooked or charbroiled
-Four factors influence HCA formation: 1. Type of food 2. How it’s cooked 3. Temperature 4. How long it’s cooked
– Polycyclic aromatic hydrocarbons (PAHs) form when meat is charred or blackened, or when fat from the meat drips onto the hot surface of the grill.
– PAH creation is influenced by: 1. Temperature of cooking 2. How long food is cooked 3. Type of fuel used in heating 4. Distance from heat source 5. Fat content of the food
– How to make grilling healthier: 
1. Use herbs and spices
2. Acid-based marinades Beer marinades work, too!!!
3. Don’t overcook HCAs and PAHs depend on temperature plus time.
4. Choose meat wisely. Highly-processed meats have a much stronger link to cancer than less-processed meats.
5. Include lots of fruits and veggies
6. Strategize while cooking i.e. Cut your meat into smaller pieces, Flip meat frequently, Cook meat on medium to medium-high heat, Cover the grill with foil.
7. And my FAVORITE drinking a beer with your grilled meat can significantly lower the mutagenic activity of the HCAs that formed.
The author of the PN article, Brian St. Pierre, sums things up extremely well when he says “Keep the risks in perspective. Overall, HCAs and PAHs make a minor contribution to your cancer risk. Being sedentary, having excess body fat, and eating a diet rich in highly processed foods are much greater risk factors. If you have some slow-cooked, pit-roasted ribs in your life once in a while, you’ll probably survive. (And likely be happier overall. Don’t be afraid of your food.)” Have a fun and safe holiday weekend, and say a prayer (or take a moment of silence) in remembrance of those who have fallen for our nation.

The Best Signs Of Progress Don’t Include Your Weight!

Physical and mental signs of improvement that make the scale irrelevant!

I can get anyone to lose 5 pounds with one simple trick. I put them in a steam room for an hour and don’t allow them to drink anything! But of course, for most people, that’s not  the point of losing weight. This simple fact begs the question, if losing water weight isn’t the end goal, then does what the scale says even matter? Our weight fluctuates to a dramatic degree throughout the day based on all sorts of things. Are you hydrated?  Did you use the bathroom recently? Have you eaten yet? Are you sick? Are you stressed? Even your sleep can play a roll in weight fluctuation. That’s why I want to talk about the physical and mental signs of improvement that make the scale irrelevant! 
First Things First
For the most part, people want to see two things happen. They want to see themselves lose fat, and gain muscle. But there are so many more benefits to exercise than that. So I encourage everyone to take a few minutes to write down exactly what their goals are. Once you have a goal/goals in mind, you can start to take action and monitor the outcomes of your efforts. I don’t want to get too side-tracked here, so here are some easy steps to start taking action today.
Write down one outcome you want. Don’t over-think it. Just name the desired outcome you want most right now.
Write down some of the skills you think you’ll need to get that outcome. If you’re just starting out, focus on foundation skills. What are the basics that make everything else possible? (For instance, if you want to manage your time, you need to learn to use a calendar.)
Related to each skill, write down a behavior or two you can do today that’ll help build those skills. This can be really easy, like walking through the gym doors or even packing your gym bag for tomorrow morning.
Do the behavior today, and tomorrow, and so on. And, keep in mind, if you don’t follow through on a given day, don’t let it derail you. Each day is a clean slate.
By The Numbers
Some of the best physical markers of success are easy to see, while others take some time and equipment to measure. So for each marker, I will give you the scientific way to go about reaching it, and the DIY version.
Body Composition – This is perhaps the most revealing assessment (1). Your body composition is the ration of fat mass to lean mass (muscle, bone, water, etc.). There are loads of ways to measure this marker from the gold standard Bod Pod and X-rays, to skin fold measures, to the less accurate bio-electrical impermanence (BIA). For all intents and purposes, the BIA does a good enough job for most people and is a cheep option via a smart scale or hand held device. Seeing your body fat percentage go down and muscle mass go up is always a great feeling!
Waist Line – Using a hip to waist ratio is an easy way to self assess your overall health ( Seeing your waist line go down is an even easier way to see improvement because your clothes will begin to fit better! It’s hard not to take notice of improvement when you’re having to buy smaller pant sizes after all.
Labs – It will certainly make your doctor happy to see lower blood pressure, blood cholesterol and blood sugar. These measurements can assess risk for chronic illnesses like heart disease, Type 2 diabetes, and cancer. For the most part, these need to be measured at your doctor’s office, but most pharmacies have free equipment for measuring blood pressure (3).
Heart Rate – This is a twofer because both your resting heart rate and working heart rate are important health markers. Watching your resting heart rate decrease over time means that you are becoming more cardio-vascularly fit (4). Having your heart rate stay stable while exercising means that your body is accustomed to doing work, which is a great sign! Testing this is simple. You can count how many times your heart beats in a minute by taking your pulse, or simply buy a heart rate monitor.
Better, Faster, Stronger – One of the most gratifying indicators of improvement is seeing your body change. You are able to see your muscles in the mirror and witness your strength increase. It always feels good to add an extra weight plate to your barbell!
State of Mind
Signs of progress also happen in the form of mental health. How you feel throughout the day and during a workout can be great indicators of improvement. So take mental note or keep a journal to document your improvement in these indicators of success.
Exercise Excitement – Okay, so not everyone enjoys exercising. In fact, most people loath going to the gym. But everyone can agree that we feel better after a workout. That’s why dreading going to the gym less and making exercise a part of your identity over time is a great indicator of improvement.
Energizer – While everyone has an off day here or there, having an off week or month can be downright frustrating. That’s why keeping note of your day-to-day energy & stress levels is an exhilarating way to experience positive changes from your efforts.
Zzzzzzz – Your sleep can be influenced by stress, aging, hormonal changes, being a new parent, getting too much light late at night, jet lag, and so on. But nutrition and exercise can play a role as well. A regular sleep schedule can be a great way to monitor your improvement as well as improve your performance at the gym and in life (5)!
Mood – Stability and improvement in your mood are also fun ways to mark your improvement. Feeling confident, clearer-headed, happier and more positive, motivated, and more open to trying new things can be subtle but very meaningful markers of improvement.
1. Gale, C. R., Martyn, C. N., Cooper, C., & Sayer, A. A. (2007;2006;). Grip strength, body composition, and mortality. International Journal of Epidemiology, 36(1), 228-235. doi:10.1093/ije/dyl224
2. Czernichow, S., Kengne, A. ‐., Stamatakis, E., Hamer, M., & Batty, G. D. (2011). Body mass index, waist circumference and waist–hip ratio: Which is the better discriminator of cardiovascular disease mortality risk? evidence from an individual‐participant meta‐analysis of 82 864 participants from nine cohort studies. Obesity Reviews, 12(9), 680-687. doi:10.1111/j.1467-789X.2011.00879.x
3. Nagaya, T., Yoshida, H., Takahashi, H., & Kawai, M. (2010). Resting heart rate and blood pressure, independent of each other, proportionally raise the risk for type-2 diabetes mellitus. International Journal of Epidemiology, 39(1), 215-222. doi:10.1093/ije/dyp229
4. Fox, K., Borer, J. S., Camm, A. J., Danchin, N., Ferrari, R., Lopez Sendon, J. L., . . . Heart Rate Working Group. (2007). Resting heart rate in cardiovascular disease. Journal of the American College of Cardiology, 50(9), 823-830. doi:10.1016/j.jacc.2007.04.079
5. JACKOWSKA, M., DOCKRAY, S., ENDRIGHI, R., HENDRICKX, H., & STEPTOE, A. (2012). Sleep problems and heart rate variability over the working day. Journal of Sleep Research, 21(4), 434-440. doi:10.1111/j.1365-2869.2012.00996.x

Nutrition Simplified

I want to give you all an idea of what the foundation of a good nutrition plan looks like.

Some things never go out of fashion: blue jeans, Corvettes, and Pokemon. But for some reason, people try to make nutrition out to be a never-ending crap storm of “must do’s/don’ts.”Don’t eat fat, don’t eat carbs, salt will kill you, sugar will bring Cthulhu from the watery depths to rule the world.” Whatever happened to the notion that simple is better? Why bother to eat the expensive organic, GMO free, local foods that cost an arm and a leg when you’re trying to build them up and lose the belly instead? Well, today I want to give you all an idea of what the foundation of a good nutrition plan looks like. Even if it isn’t the scariest scenario or the sexiest diet around.
It’s No Secret
Since I’m not a dietitian, I don’t provide specific meal plans. That being said, by now, everyone by knows that what you eat effects not only your overall health, but also your training results. This is why simple guidelines are the best advice any coach or trainer can legally give. On top of that, anyone who says there is an “absolute” nutrition recommendation is suggesting that his or her plan is the “only way of doing things.” Which, of course, is craziness and is probably worth dismissing. The only “absolute” worth noting is that you need to be in a consistent calorie deficit in order to drop body fat, plain and simple. So, don’t get all bent out of shape when someone says you shouldn’t eat a specific food because of some ingredient or chemical it has.
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Becoming Simplified
Here is a beautiful way to sum it all up in 3 easy steps.
1. Eat mostly meals consisting of fruits and vegetables and  high-quality meats, eggs, and fish (or protein substitutes, for vegetarians and vegans).
2. Limit your intake of refined foods, simple sugars, hydrogenated oil, and alcohol.
3. And don’t overeat.
Is your mind blown?!?!?! Yes, these are the same recommendations that have been given to us for years. And yet, how many of us follow them? What’s the point of starting a new diet or taking a fist-full of supplements if you haven’t tried to lay a solid foundation? You should start by focusing on the quality of the foods you eat (emphasizing fruits, vegetables, high-quality proteins). You’ll likely end up taking in fewer calories without even counting them. Before we move on to the next section, we are going to get into the three soft “don’ts.”
Don’t crash diet. When you create massive caloric deficits, there can be issues with metabolic slowdown. But even worse is the hormonal response that causes appetite to run amok, and you end up gaining back all the weight you lost, and then some.
Don’t drink a doughnut. I don’t mean this literally, but what I’m trying to say is limit the calories you drink. This, of course, means cutting back on the booze, sodas, and the ever-so-ridiculous trend of putting fat in your coffee.
Avoid added sugar, fat and salt. The most important word here is ADDED. Cut back on the extras, and your waist line will show some love.
Instead of Subtracting, Add
When you focus on bringing the good stuff in, the bad stuff finds its own way out. For the most part, this statement is true. So here are a few things that you should consider adding:
1. A regular meal pattern – Three decent sized meals each day will decrease the need for preparation and keep you feeling full.
2. The grocery store – Eating out should be a rare treat. This is because each meal you don’t make yourself is almost guaranteed to be a bucket full of unneeded calories.
3. Veg out –  Eat your vegetables. Not slathered with butter or covered up with cheese, but with a sprinkle of salt and pepper.
4. Protein power – Protein will help you feel full and increase your metabolism (1). Don’t over estimate this because it can be a downfall. Like everything else, moderation is needed.
5. The dinner table – When you eat every meal at the dinner table, you create a psychological environment that lends itself to healthier eating. No one eats a bag of chips at the table, I hope.
One Thing Leads To The Next
When you create one good habit, another is sure to follow. This domino effect can be profound over time. Choose a healthier eating style that’s realistic for you to stick with, and gradually implement it by making small changes in your eating behaviors and turning them into positive habits before changing other eating behaviors. Of course there are loads of other ways to create the caloric deficit needed to create fat loss. Here is a great reference for those ready for the next steps. But for now, keep it simple and build upon your good habits.
Don’t forget to like me on Facebook!
1. Acheson, K. J., Blondel-Lubrano, A., Oguey-Araymon, S., Beaumont, M., Emady-Azar, S., Ammon-Zufferey, C.. . Bovetto, L. (2011). Protein choices targeting thermogenesis and metabolism. The American Journal of Clinical Nutrition, 93(3), 525-534. doi:10.3945/ajcn.110.005850

All About Sugar; Disease, Inflammation, Insulin, & Fat Gain

So what really happens when you eat sugar?

You eat sugar, your insulin spikes, you get fat, end of story. That’s how the story goes for people who are trying to sell you their products. But, because you are reading this, you must already know that the likes of food babe and “Dr.” Mercola are full of crap. So what really happens when you eat sugar? Well let’s take a look at what the science says and dispel some myths and ease the fear caused by those only looking to line their wallets.
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Low Carb Diets
I’ll start by saying low carb diets work (1). They work because they force you to eat fewer calories than you use throughout the day. The same way that any weight loss program works. But it’s not due to some magical insulin pixie. When you cut out a ton of calories, you are going to lose weight. It may seem obvious, but too many people mix up the message. A big part of why cutting carbs lowers your weight is due to water. Switching to a low carb diet will cause an initial sharp increase  in total weight loss, but this is due to the drop in water weight that accompanies carb restriction (2). Of course this means that as soon as you start eating carbs again, you will regain the weight rapidly. Finally, many are successful on a low carb diet because it automatically increases protein, which helps to curb appetite (3). They also typically eliminate all junk foods, which is where our excess calories come from. Bottom line, if it works, it works.
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About Insulin
I have written about this twice before (Part 1Part 2), but the more internet garbage I read, the more I want to write about it. Here’s a good way think about insulin’s roll in weight gain “Insulin is like workers in a warehouse. Calories are the boxes that the workers have to stack on shelves. If there’s lots of workers (high levels of insulin) and lots of boxes (a calorie surplus) then the boxes are packed quickly, and you get a build up of calories, i.e. fat gain. If, however, you’re in a calorie deficitthere are no boxes for the workers to store, so no matter how much insulin is present, there’s nothing to be stacked, and no fat mass to be added.” In other words, the only time carbs actually contribute to fat gain is in the context of a calorie surplus. It is also important to note that insulin sensitivity issues are most likely a result of obesity than it is a cause (4). Bottom line, it’s not the insulin.
Fructose & High Fructose Corn Syrup
For some crazy reason, there are people on the internet who are ranting on about how bad fruit is for you because it has fructose in it. In short, fruit is good for you for many reasons, and fructose is not bad. Moderate levels of fructose consumption do not adversely effect body weight or blood chemistry. However, obscenely high levels of intake (>150 grams per day) may have undesirable health effects (5). High fructose corn syrup (HFCS) has been blamed for the rise in obesity over the years. But the reality is that HFCS is the same as any other sugar and has nothing to do with the rise in obesity (6). Bottom line, HFCS and fructose are sugar and nothing more. Keep your consumption in check and you will be fine.
Sugar Addiction
Not so long ago, I can remember news outlets around the US saying that sugar is as addictive as narcotics. The thought was that sugars would impact the pleasure center of your brain as well as energy-regulating hormones including insulin, leptin, and ghrelin. This issue was popular because it would mean that our addiction would lead us to eat more sugar, which would make us eat more calories, and therefore make us fat. These stories got lots of views and clicksso the media kept em comin for a while. The problem is that the stories were based on terrible studies. In reality, the “addiction” seen in animals (and possibly in humans) is due to intermittent access to sweet tasting or highly palatable foods, not the neurochemical effects of sugar (7). Bottom line, no one has ever needed to do a line of sugar because they got the shakes.
Inflammation, Diabetes, Heart Health & More
People from around the world, throughout history and today, have lived long, obesity-free and disease-free, lives while consuming carbs as much as 70% of their diets (8,9). If carbs themselves are fattening, these populations would not have had lean bodies and good health overall, regardless of how active they were. I’ve also heard talk around the gym lately that carbs, sugar in particular, cause inflammation and are therefore bad. Don’t get me wrong, chronic low grade inflammation is a real thing, and it is bad, but it’s not caused by fructose, high-fructose corn syrup, or glucose in normal-weight to obese adults. Not even when consumed in high amounts (10). There’s also little support for a relationship between sugar consumption and diabetes, increases in blood pressure, non-alcoholic fatty liver disease, or cardiovascular disease (11). Bottom line, there’s no link between sugar consumption at normal levels within the human diet and various adverse metabolic and health-related effects.
Night Time Carbs
You will never guess what I’m about to say. Carbs at night… are not bad! They can help you sleep, help fuel training performance the next day, and carbs at night will have absolutely no negative effect on fat loss (12). Consuming food at night has no effect on overall metabolism either. Bottom line, be happy with your meals and don’t sweat that night time snack.
Final Thoughts
Low carb diets are good and bad. As mentioned before, going low carb or ketogenic means your diet is higher in protein, which helps to curb appetite and eliminates junk foods, which is where our excess calories come from. But in the long term, it means you have to sacrifice a lot. You will have a harder time going out and eating with friends, preparing meals will become far less convenient (especially for sandwich lovers like myself). You might feel worse, and have lower energy and overall mood. If anything, it will make it harder to lose fat in the long run due to a (slightly) lowered metabolism (13). Some may say “if it works, it works” but is it really worth the sacrifice? That’s up to you. The bottom line however, is that carbs don’t make you fat. So the next time someone says that sugar is making the world fat, tell them “it’s because of junk food as a whole – the total calories – and not just the carbs.”
1. Westman, E. C., Yancy, J., William S, Mavropoulos, J. C., Marquart, M., & McDuffie, J. R. (2008). The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutrition & Metabolism, 5(1), 36-36. doi:10.1186/1743-7075-5-36
2. Kreitzman, S. N., Coxon, A. Y., & Szaz, K. F. (1992). Glycogen storage: Illusions of easy weight loss, excessive weight regain, and distortions in estimates of body composition. The American Journal of Clinical Nutrition, 56(1 Suppl), 292S.
3. Westerterp-Plantenga, M. S., Lemmens, S. G., & Westerterp, K. R. (2012). Dietary protein – its role in satiety, energetics, weight loss and health. The British Journal of Nutrition, 108 Suppl 2(S2), S105. doi:10.1017/S0007114512002589
4. Kahn, S. E., Prigeon, R. L., McCulloch, D. K., Boyko, E. J., Bergman, R. N., Schwartz, M. W.. . Palmer, J. P. (1993). Quantification of the relationship between insulin sensitivity and beta-cell function in human subjects. evidence for a hyperbolic function. Diabetes, 42(11), 1663.
5. Madero, M., Arriaga, J. C., Jalal, D., Rivard, C., McFann, K., Pérez-Méndez, O.. . Lozada, L. S. (2011). The effect of two energy-restricted diets, a low-fructose diet versus a moderate natural fructose diet, on weight loss and metabolic syndrome parameters: A randomized controlled trial. Metabolism: Clinical and Experimental, 60(11), 1551-1559. doi:10.1016/j.metabol.2011.04.001
6. White, J. S. (2008). Straight talk about high-fructose corn syrup: What it is and what it ain’t. United States: American Society for Clinical Nutrition, Inc. doi:10.3945/ajcn.2008.25825B
7. Westwater, M. L., Fletcher, P. C., & Ziauddeen, H. (2016). Sugar addiction: The state of the science. European Journal of Nutrition, doi:10.1007/s00394-016-1229-6
8. Lindeberg, S., Eliasson, M., Lindahl, B., & Ahrén, B. (1999). Low serum insulin in traditional pacific islanders—The kitava study. Metabolism, 48(10), 1216-1219. doi:10.1016/S0026-0495(99)90258-5
9. Zhou, B. F., Stamler, J., Dennis, B., Moag-Stahlberg, A., Okuda, N., Robertson, C.. . INTERMAP Research Group. (2003). Nutrient intakes of middle-aged men and women in china, japan, united kingdom, and united states in the late 1990s: The INTERMAP study. Journal of Human Hypertension, 17(9), 623-630. doi:10.1038/sj.jhh.1001605
10. Kuzma JN et al. (2016).No differential effect of beverages sweetened with fructose, high-fructose corn syrup, or glucose on systemic or adipose tissue inflammation in normal-weight to obese adults: a randomized controlled trial. Am J Clin Nutr.
11. Rippe, J. M., & Angelopoulos, T. J. (2016). Sugars, obesity, and cardiovascular disease: Results from recent randomized control trials. European Journal of Nutrition, doi:10.1007/s00394-016-1257-2
12. Afaghi, A., O’Connor, H., & Chow, C. M. (2007). High-glycemic-index carbohydrate meals shorten sleep onset 1,2,3. The American Journal of Clinical Nutrition, 85(2), 426.
13. Johnston, C. S., Tjonn, S. L., Swan, P. D., White, A., Hutchins, H., & Sears, B. (2006). Ketogenic low-carbohydrate diets have no metabolic advantage over nonketogenic low-carbohydrate diets. The American Journal of Clinical Nutrition, 83(5), 1055.

How Much Should You Rest Between Sets?

In today’s post is I’m talking about doing nothing.

In today’s post is I’m talking about doing nothing. Well really I’m talking about how much time should you wait between your sets. As you could imagine, it depends on what your goals are. But for most of us the answer is “as little as possible.”
Well the following information is for those of you looking to lose weight and gain muscle. If these aren’t your goals then this information may not be for you. So here are some reasons why 1 minute is the target rest time for most of us.
 – Compared to a 3m rest, 1m rest intervals cost 36% higher energy expenditure!!!
 – The smaller rest time stimulates greater muscle growth which of course is needed to look toned and trim
 – You shorten your overall time training… and who wouldn’t want to do that?!?!
 – This short rest time, and other forms of HIIT have been shown to be way better than spending hours on the treadmill in the “fat burning zone”.

Cutting Through Crap & Real Solutions For Nutrition, Health, & Life

The truth is that the health and fitness industry is so rife with crap because, well, we buy it. Let’s take a look at what can be done, how to educate yourself so you don’t waste money, and how simple it is to really be healthy and happy with your body.

What if I told you I had THE ONE SIMPLE TRICK to get you to lose weight and gain muscle fast? All it takes is… laser treatmentssuper shakes,eating for your body typeweight loss wraps, or some other bald faced lie. The truth is that the health and fitness industry is so rife with crap because, well, we buy it. We are all looking for the magic bullet to get us to where we want to be. Admittedly, most people, including myself, think it would be nice right? But in reality, you can’t alter your height, limb or torso length, and most other characteristics determined by your genetics. It’s not about trying to look like “her/him”;  it’s about being the best version of yourself. So let’s take a look at what can be done, how to educate yourself so you don’t waste money, and how simple it is to really be healthy and happy with your body.

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My Redundant Plea

I have written on several occasions about where to go for good advice/where bad info comes fromhow to spot bad swindlers/bad science, and why you need to think critically about your investment in your health and fitness goals. But, after another week of fielding questions about “which shake should I be drinking” and “how many carbs should I have”, I wanted to pick on a few more mind boggling BS claims. The powdered unicorn fart capsules known as shakeology, detox/cleanse, super supplements, and Gwyneth Paltrow continue to make people lose weight by making their wallets lighter. And it’s not just your local 20 something trainer caught up in a multilevel marketing scheme, it’s people who have credentials who are getting in on the action. Take “Dr.” Joseph Mercola seen below who continues to blur the lines between business and medicine.

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These folks, and those who claim that you have to sacrifice, suffer, and deprive yourself to build a better looking body and that eating well and working out has to become your entire life, suck. They may make claims that their workout program will make you a battle-ready warrior or superior specimen of the human race, and that their diet will make you bulletproof. They may speak in absolutes stating “women should always do A, B, and C”, or “women should never do X, Y, and Z.” They use words like “groundbreaking” and “revolutionary” frequently when describing quick-fix fads and gimmicks. You may encounter entire groups that put down other people who don’t work out or eat the way they do. For the record, any group claiming to be better than others because of their health and fitness lifestyle has eaten too many of their own poop sandwiches. Speaking of poop sandwiches, just because someone had success with a particular diet or workout program doesn’t mean it’s the best option for you. Anything promising to make your muscles “long and lean” or says you can look like someone else is, once again, a turdy bacon club sandwich. Diets that blame a macronutrient (e.g., fat, protein, carbohydrates) or food group (e.g., dairy) for hindering your fat loss efforts are, you guessed it, crap.CARBS WILL NOT MAKE YOU FAT!!!!! Science (1). A low-fat diet isn’t a benefit because eating fat doesn’t cause disease. NOT eating it probably does, and we now know the body even needs some saturated fat to function optimally (2). Salt won’t kill you or drive up blood pressure if you’re generally healthy (3). And gluten… well what can be said other than food marketers have simply found another way to convince you that their bag or box of garbage is healthy (4).

Find the people who know their stuff, and learn from them. You can, again, check out my favorite “go to” resources here, but in short, Alan Aragon,Precision Nutrition, and Brad Schoenfeld will always be on my short list of trusted information sources.


Simple, Practical, Crap Free Advice

Now that we have bravely made it past the organic corn fill BM that is much of the fitness industry, let’s take a look at some info that will actually help.

-First up, short cuts don’t exist. Like many other aspects of life, if you truly want to achieve a goal, you must put in some effort.

-Strict diets are not sustainable long-term and exercise is not punishment. Your best bet is to eat real food with ample amounts of fruits and vegetables, and you’ll reap far greater results by consistently doing exercises you like (e.g. hiking, take a group fitness class, start learning martial arts, or anything that sounds fun to you) rather than haphazardly doing something deemed perfect. Find out what you like for both nutrition and exercise, and you will see results and be much happier in the long run. Isn’t that what it’s all about in the end anyways?

-Know that gimmicks prey on your insecurities (and even create new ones). You don’t have to be miserable or deprived. Stick to the basics: eat mostly real, minimally processed foods, and strength train 2-4 days per week, and get enough sleep. These should be done according to your preferences and time availability.

-If you make a mistake, or even fail completely, don’t beat yourself up. Practice some self-compassion and then move on and do something positive when possible.


I am going to talk about looking and feeling confident because if you want that shredded, 6 pack abs, glistening muscles, ripped look, you may want to think about what it takes to get there. First of all, it’s tough to get and stay lean enough to look like Khal Drogo. It takes dedication, knowledge, and a win of the genetics lottery. But from disease risk to brain function and physical performance, a healthy diet is vital for every aspect of life. So to feel confident enough to take off your shirt at a pool party or feel like you can take on the world (or a last minute 5k you get invited to), then you will want to look into these rational steps.

  1. Know that total calorie intake is key (5). If you put in more calories than you burn, you will store them as new muscle or body fat. If you consume fewer calories than you burn every day, you will lose weight (6).
  2. Know what macro nutrients are. Carbs4 calories per gram. All starchy foods like bread, pasta and potatoes. Also includes fruit, legumes, juice, sugar and some dairy products.

Protein 4 calories per gram. Main sources include meat and fish, dairy, eggs, legumes and vegetarian alternatives like tofu.

Fats 9 calories per gram. Main sources include nuts, seeds, oils, butter, cheese, oily fish and fatty meat.

  1. Know what whole foods are. Basing your diet on whole foods is an extremely effective but simple strategy to improve health and lose weight. They are the unprocessed foods containing only one ingredientthat should be eaten at least 80-90% of the time. So if the product looks like it was made in a factory, then it’s probably not a whole food.
  2. Know that no food is strictly off limits. However, overeating certain foods like processed low-fatproducts and refined carbscan increase disease risk and lead to weight gain (7).
  3. Know that by controlling your portions, you are more likely to avoid consuming too many calories. To avoid portion distortion, you can use smaller plates and take a smaller-than-average first serving, then wait 20 minutes before you return for more. You can also use the hand method.
  4. Know how to assess your calorie needs. You can use a calorie calculatorfree calorie/nutrienttrackers, or simply consider increasing protein intake. Protein shakes can be very helpful, but know that what type you buyis also based on your goals.
  5. Know that most people regain all the weight they lost soon after attempting a weight loss diet (8). To avoid being a statistic, follow the rule that if you can’t see yourself on this diet in one, two or three years, then it’s not right for you. Making a sustainable diet means that you can enjoy and stick with it for the long term. If you want unhealthy foods, save them for an occasional treat.



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  1. Kreitzman, S. N., Coxon, A. Y., & Szaz, K. F. (1992). Glycogen storage: Illusions of easy weight loss, excessive weight regain, and distortions in estimates of body composition. The American Journal of Clinical Nutrition, 56(1 Suppl), 292S.
  2. Skeaff, C. M., & Miller, J. (2009). Dietary fat and coronary heart disease: Summary of evidence from prospective cohort and randomised controlled trials. Annals of Nutrition and Metabolism, 55(1-3), 173. doi:10.1159/000229002
  3. Cohen, H. W., Hailpern, S. M., Fang, J., & Alderman, M. H. (2006). Sodium intake and mortality in the NHANES II follow-up study. The American Journal of Medicine, 119(3), 275.e7-275.e14. doi:10.1016/j.amjmed.2005.10.042
  4. Reilly, NR. (2016) The Gluten-Free Diet: Recognizing Fact, Fiction, and Fad. The Journal of Pediatrics. , Volume 0 , Issue 0 ,DOI:
  5. Swinburn, B. A., Sacks, G., Lo, S. K., Westerterp, K. R., Rush, E. C., Rosenbaum, M.. . Ravussin, E. (2009). Estimating the changes in energy flux that characterize the rise in obesity prevalence. The American Journal of Clinical Nutrition, 89(6), 1723.
  6. Hall, K. D., Heymsfield, S. B., Kemnitz, J. W., Klein, S., Schoeller, D. A., & Speakman, J. R. (2012). Energy balance and its components: Implications for body weight regulation. The American Journal of Clinical Nutrition, 95(4), 989.
  7. Gross, L. S., Li, L., Ford, E. S., & Liu, S. (2004). Increased consumption of refined carbohydrates and the epidemic of type 2 diabetes in the united states: An ecologic assessment. The American Journal of Clinical Nutrition, 79(5), 774.
  8. Dulloo, A. G., & Montani, J. ‐. (2015). Pathways from dieting to weight regain, to obesity and to the metabolic syndrome: An overview. Obesity Reviews, 16(S1), 1-6. doi:10.1111/obr.12250

Carbs Are Not The Enemy! Part 2

To see the big picture lets focus back in on what else is driving the obesity epidemic.

I had such a great response to last weeks post that I decided to do a part 2 on carbohydrates (CHO) and its relationship to obesity! So once again the focus will be on insulin, and like last week the information is not all inclusive and does not cover everyone with a special need, disease, or condition. Of course before I dive in I want to remind everyone that for healthy individuals, insulin is very tightly controlled by the body and there is no reason at all to fear it. And as a refresher on what insulin does I’ll remind you that one of insulin’s main roles is to maintain glucose homeostasis.
So this week I am going to start by saying why CHO’s are bad according to a couple of sources.
 – Increased sugar consumption has significantly contributed to the rise in obesity and metabolic diseases
 – There is an association between risk of overweight and obesity and fructose-containing sugars consumed as sugar-sweetened beverages
 – High intakes of highly palatable foods like refined grains, processed meats, red meats, French fries, and potato products play a role in weight gain
 – Insulin levels are typically increased in obese individuals
At this point you may be asking yourself “wait what? I thought this was about how carbs aren’t bad for me?” I will say first and foremost thatassociation is not causation. This means that the previously mentioned issues are only part of the problem. To see the big picture lets focus back in on what else is driving the obesity epidemic.
 – Physical inactivity!!!!!!!!!! (as I sit in front of a screen I realize that I’m a hypocrite… I’m doing 10 squats before I write more and so should you!)
 – Over consumption of all foods is associated with overweight and obesity
 – Western dietary pattern and lifestyle in general is just a culture of poor decisions
I say this because I really dislike absolutes. As in CHO’s are the reason why we have an obesity crisis. To me it doesn’t make sense. We have been eating the stuff forever without issue so why all of a sudden is it becoming a problem? Why are so many people blaming sugar and insulin to be the issue? Well the first, and most obvious, answer to this is that individuals want to make a quick buck off of a product, book, or alternative health care product. The second answer is that some individual just don’t understand whats really the issue. So here are some bullet point’s on why an increased insulin response to CHO consumption leading to lipogenesis (energy stored as fat) is not likely the mechanistic cause of the obesity problem.
 – The supportive data for insulin being the bad guy are largely supported by ecological observations, rodent models of overfeeding (humans are not rats), and select human trials (all are poor evidence)
 – There have been no high quality studies showing that fructose-containing sugars behave differently from any other forms of energy intake
 – Although the food mentioned earlier are associated with increased levels of obesity, total sugars or other important sources of added sugars such as cakes, pastries and sweets have not
 – If insulin was the true problem, we would observe increased insulin in all cases of obesity
 – While there is increased insulin in obese people (in most cases), it appears its action is reduced (i.e. its action of lipogenesis and reducinglipolysis on fat tissue is decreased)
 – Insulin can have short-term effects on how nutrients are stored in the body for things like muscle glycogen synthesis and muscle protein synthesis
So what the hell does this all mean? Well to sum it all up I can say that CHO’s do not cause obesity. They do however, play an important roll. It is way to easy to consume CHO’s in large quantities so it’s important to know how much energy you are taking in. Insulin is a substrate conductor that tells your cells what to use for fuel and can be manipulated to optimize fuel portioning to promote fat oxidation and recovery from workouts. What this all means is that obesity is likely the cause of insulin resistance, and NOT the driving factor behind it.
For more information I recommend you read the three fantastic articles. Additionally check out this TED talk for more thoughts on insulin resistance.

The Happy Healthy Traveler

Traveling will always throw you in a funk when it comes to your health and fitness habits. So today I wanted to go over some tips to help you stay on track with your goals.

It’s inevitable. During the summer we will all likely be doing some traveling for vacation, sports, or a friend who selfishly demanded to do a destination wedding. Of course these events are special, but they will always throw you in a funk when it comes to your health and fitness habits. So today I wanted to go over some tips to help you stay on track with your goals, but more importantly, I want to hear about your favorite tips and tricks for staying on target.

Health Before Fun, Food, or Fitness

Before we dive into the fitness and nutrition side of things, I think it’s important to address the health needs of the traveler. Depending on where you’re going, it’s important to keep a few things in mind. First, if you’re going outside of the country (or to Michigan), make sure you are aware of the water situation. If the tap water isn’t good for drinking, then you will need to game plan for buying bottled water, brushing your teeth, and to keep your mouth shut when you take a shower or hop in a swimming in a pool. Nothing’s worse than running a trip short due to the runs. Speaking of which, consider taking bismuth subsalicylate (sold as Pepto-Bismol and various store brands) before every meal to decrease your chances of developing diarrhea (1). Never eat undercooked foods — eggs, meat, fish or poultry — or any food sold by street vendors, and wash your hands before and after meals to ensure you have a pleasant trip. Finally, make sure you are all up-to-date on routine vaccines (measles-mumps-rubella, varicella (chickenpox), diphtheria-tetanus-pertussis, hepatitis A, typhoid, polio, an annual flu shot, and, if needed, a prescription for generic Malarone (atovaquone proguanil) to prevent malaria. Check out this link to know exactly what vaccinations you need depending on your destination. Be sure to pack an ample supply of sunscreen, insect repellent with 20 percent or more of DEET, and a first-aid kit of hydrocortisone cream, antibiotic ointment and a variety of bandages. When flying, be sure to get up and walk around to avoid blood clots especially if you’re over 40, obese or pregnant, or have limited mobility (for example, because of a leg cast) or have a personal or family history of clots. Although rare, blood clots can be a very serious problem that everyone should be aware of.

Nutrition No Brainers

When I think about traveling and nutrition, I think about how speed is the key. You want to get in and out fast so you can just get to where you’re going. Of course, this means stopping at a fast food place. To avoid the junk at fast food places, I have a few tips that may seem like no-brainers, but actually going through with them is key.

#1 Pre Travel Game Plan – My wife spends hours planning her outfits for any trip. She writes down what she will need for each day of the trip, lays out the clothes, and then makes sure they will all fit in her bag. This same technique should be applied to your nutritional needs for any trip! Make a game plan by writing down how many times you/your family will need to eat, make a note of whether it will be on the road, hotel, or at the destination, and pack a cooler accordingly. The food you make yourself will almost surely be healthier than a number 8 with a soda at a fast food joint. This is especially true if you or your kids will be on the road for sports competitions.

#2 On The Road Game Plan – If you know your travels will take you on the road/air for multiple meals, there Here are a few things you can do to help keep yourself fueled with the good stuff: ask the airline ahead of time for a special meal, request a room with a small fridge for healthy food storage, and pack foods that don’t need to be immediately refrigerated.

#3 The Destination – Wherever you go, there is no excuse for not eating well. There are grocery stores, local markets, and healthy restaurant options everywhere. With a few taps of the smart phone, you can find these locations with ease. Because most of us will opt for the restaurant option, you will want to look for healthy choices online ahead of time;

* Protein (grilled chicken breast, lean beef, shrimp tuna, beans, etc)

* Veggies

* Side dishes because you can make pretty good meal from a few side orders, such as a single egg or a cup of fruit

* Appetizers because ordering a small item or two instead of a table-crushing platter of ribs is always better option

* The classic soup and salad options are filling and familiar

* Eat slowly, put your fork down and take long sips of water between bites so that you aren’t rushing through your meal and filling up before you even notice you’re satisfied

#4 Snacks – I love to snack on long drives because it helps keep me focused. Naturally, there are better options out there than chips and soda to snack on. So here are a few thoughts on what to pack, or what to look for at the gas station, when on the move.

* Focus on portion control when packing your own food. You will eat more if you put everything in one big container rather than many small ones

* Fresh produce such as apples, bananas, oranges, grapes, clementines, celery sticks, edamame and carrot sticks

* Hard-boiled eggs are perfect for any time of the day, but are particularly better for you than a hotel waffle or muffin at breakfast

* Dried fruit/jerky because fruits are packed with potassium and fiber and jerky is an excellent snack that’s low in calories and high in protein.(just make sure they both are unsweetened)

* DIY trail mix with unsweetened dried fruit, nuts, whole-grain cereal and seeds packed them in little snack baggies with cinnamon, pumpkin pie spice or smoked paprika to kick it up a notch

* And my personal favorite, snack sized pickles. No calories (that’s right… 0) and the salt in them will help you retain a little water so you don’t have to make quite so many potty breaks

Exercise & Sleep

When it comes to your health, exercise and sleep are crucial. And traveling will always throw a wrench in the works for both of these. Click this link to learn everything you need to know about sleep and how to keep a regular healthy pattern while traveling. And when it comes to exercise, you should always be able to make time for a quick workout. Those 30 to 45 minutes in the gym during the week doesn’t make up for all the time on your rear. Crunched for time? Well then do a cool 15 minute core workout like this one. Outdoor workouts like a scenic walk or run from the hotel work wonders. In-room workouts offer challenges, but doing dips on a chair, push ups, resistance bands, tennis ball for self-myofascial release, a bag filled with water for resistance exercise, and even a towel can easily be used for a yoga mat. Heck, if you have a wall, you can have a workout! Bottom line, don’t make excuses, just get it done!


  1. DuPont, H. L., Ericsson, C. D., Johnson, P. C., Bitsura, J. A. M., DuPont, M. W., & de la Cabada, Francisco Javier. (1987). Prevention of travelers’ diarrhea by the tablet formulation of bismuth subsalicylate. Jama, 257(10), 1347-1350. doi:10.1001/jama.1987.03390100085031