Type 3 Diabetes, Growing body of evidence

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There is a recent emergence in scientific research regarding an association between insulin and Alzheimer’s disease: it has been termed Type 3 Diabetes (Ahmed, Mahmood, & Zahid, 2015). Alzheimer’s disease is a progressive neurodegenerative disorder that is age-related and characterized by intracellular neurofibrillary tangles (NFT) and amyloid-beta plaques. Common findings in the brains of afflicted individuals show impairments of energy metabolism and glucose utilization, as well as insulin receptor, insulin, and IGF deficiency (Ahmed et al., 2015).

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Insulin plays a role in regulating energy homeostasis in the hypothalamus, and insulin receptors are widely distributed throughout the brain, especially in the hippocampus, amygdala, and septum (Ahmed et al., 2015). The hippocampus, of note, regulates acquisition and consolidation of memory, and there may be a role of insulin in potentiating memory. Non-diabetic Alzheimer’s patients have manifested increased levels of peripheral insulin resistance biomarkers in their hippocampi. A potential mechanism suggested is that progressive insulin resistance in the brain may increase expression of cerebral inflammatory mediators leading to oxidative stress and mitochondrial dysfunction and a self-propagating cycle of neurotoxicity from oxidative stress and amyloid-beta deposits.

Growing evidence associating Alzheimer’s disease with insulin resistance further highlights the importance of maintaining a healthy body weight and not consuming excessive amounts of sugars and fats in our diets.

To learn more about insulin check out my article: Be More Sensitive…To Insulin!

Reference

Ahmed, S., Mahmood, Z., & Zahid, S. (2015). Linking insulin with Alzheimer’s disease: Emergence as type III diabetes. Neurological Sciences, 36, 1763-1769.

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Motivation

Intrinsic motivation describes one’s internal drive to participate, exert effort, and be persistent when engaging in an activity. Intrinsically motivated individuals partake in an activity simply due to the pleasure and satisfaction derived from the activity itself (Hunter, 2008).  Not surprising, it is a huge factor in long-term exercise program adherence. As a person who takes on clients working toward specific fitness goals, it is part of my job to keep them committed to their goals so they are successful. Cultivating a client’s intrinsic motivation is an important part of this.

Hunter (2008) identifies three facets of intrinsic motivation: autonomy, competence, and relatedness. Autonomy means that a client has some control over his or her workout. One way I like to give clients autonomy is by letting them choose the weight they want to lift during exercises, within my parameters (i.e., they can lift the weight with good technique, they are not risking injury, the weight corresponds to my desired intensity, etc.). I also ask clients or the kids in my group classes for feedback on exercises. For example, I’ll ask the kids if any of the exercises are too easy or too hard, or which exercise is their favorite or least favorite of the exercises in a circuit. These choices involve my clients in the decision-making aspects of their workouts while keeping them on track to meet their goals.

Competence describes a client’s belief in his or her ability to perform a task. Hunter (2008) suggests providing ample opportunities for clients to practice performing quality skills. I start many of my youth strength and conditioning classes with 5-10 minutes of jumping rope, and many kids do not do this well, at first. I provide the beginners with lots of positive feedback and encouragement in their first classes. In just a few weeks of practice, at the start of every class, kids will master the basics of jumping rope. For many, improving so much in such a short time is a big confidence booster.

Relatedness is the third component of intrinsic motivation that refers to an individual’s connection or sense of belongingness to a group (Hunter, 2008). I actually had a shocking moment yesterday when, after teaching my gym’s level 1 strength and conditioning class to two boys of similar size and age, I asked them if they knew each other’s name and neither did! A lot of kids develop relationships with the coaches at the gym, which fosters some relatedness, but I could definitely do more to develop connections between the kids in my classes.

A study by Evans, Cooke, Murray, and Wilson (2014) explored how the temporal proximity of anticipated positive outcomes affected intrinsic motivation. Proximal outcomes were defined as the benefits that occur immediately during or within a few hours of a single exercise bout, whereas distal outcomes occur after days, months or years of consistent physical activity. This study demonstrated that the intrinsic motivation of subjects with lower levels of past physical activity significantly increased when they were exposed to proximal outcomes compared to distal.

As a coach and trainer, I’ve always understood the importance of motivating others (and myself) with the positive benefits of consistent exercise, but my temporal outcome differentiation was between short-term outcomes (in the next month or two) and long-term outcomes (in 6 months to a year). The idea of focusing on immediate outcomes from single workouts is fantastic. I may not be the greatest example because I generally enjoy exercise, but reading through the list of proximal positive outcomes from the study has really motivated me to workout tonight. I may even print it out and post it by my desk. I love the idea of encouraging clients to make lists of proximal positive outcomes or reference the one from this study, and I think it could go a long way in developing intrinsic motivation with exercise.

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Previous studies have reported the effect motivational climate has on an athlete. The perception of a mastery motivational climate, emphasizing “learning, effort, improvement, and success determined by self-reference criteria,” has been demonstrated to increase intrinsic motivation (Brinkman-Majewski & Weiss, 2015).  This is opposite of a performance motivational climate, where success is determined in competition to others, leading to increased anxiety and less satisfaction (Brinkman-Majewski & Weiss, 2015). Creating mastery motivational climates with fitness clients could be done as a coach by not comparing clients to each other and highlighting personal PRs and improvements. Especially when working with kids whose sense of self is in a more formative stage, emphasizing task-involved goal orientations could increase the perception of the motivational climate, thereby influencing intrinsic motivation.

References

Brinkman-Majewski, R. E. & Weiss, W. M. (2015). Examination of the motivational climate in the athletic training room. Journal of Sports Behavior, 38(2), 143-160.

Evans, M. B., Cooke, L. M., Murray, R. A., & Wilson, A. E. (2014). The sooner, the better: Exercise outcome proximity and intrinsic motivation. Applied Psychology: Health and Well-being, 6 (3), 347-361. doi:10.1111/aphw.12032

Hunter, S. D. (2008). Promoting intrinsic motivation in clients. Strength and Conditioning Journal, 30(1), 52-54.

Will Power and Healthy Habits

Psychological deterrents to exercise and healthy eating adherence are of great interest to me. We’ve previously discussed that people who are more skillful may be more likely to be active, and self-efficacy research reveals that an individual’s belief in his or her ability to successfully do an activity is a large determinant of if he or she will actually do it (Clarke, 2015; Jongen et al., 2016). Other psychological factors contributing to adherence are support and willpower.

A meta-analysis by Burke, Carron, Eys, Ntoumanis, and Estabrooks (2006) demonstrated the value of contact and/or social support in exercise. The more contact and social support available, the greater the adherence was as well as the beneficial effects of the exercise (Burke et al., 2006). I believe this is the reason activities such as Crossfit and spin classes have such loyal patrons. The group or team dynamics increase members’ consistency and, therefore, their results.

Willpower, synonymous with the concepts of self-control and active volition, is another psychological component of diet and exercise adherence. The Fell article (2011) mentions that willpower is a limited resource that gets depleted throughout the day, therefore, the morning is the best time for one to make the decision to exercise. Baumeister, Bratslavsky, Muraven, and Tice (1998) further demonstrated that one’s willpower is limited and one’s willpower in a certain task (for example, exercise) can be depleted by unrelated acts (such as willpower at work) that share this common resource.

Willpower is important for anyone who is trying to change habits, especially those involving diet or exercise, to understand, as relying solely on will power may not be the most effective method. One of my favorite fitness bloggers, Sohee Lee, writes a lot about how willpower comes into play with diet goals. She discusses how restrained eating (when an individual must resist the urge to eat particular “forbidden” foods) draws more on one’s willpower reserves than unrestrained eating (no food is off-limits), and, often, counter-regulatory eating (overeating “forbidden” foods) results from a period of high restraint (Lee, 2016). Because of this, she recommends a no-food-off-limits approach to healthy eating, and that one should make small changes week by week toward healthier eating as opposed to drastic ones. The less willpower required the more likely the healthy habits will last.

References

Baumeister, R., Bratslavsky, E., Muraven, M., & Tice, D.M. (1998). Ego depletion: Is the active self a limited resource [Abstract]? Journal of Personality and Social Psychology. 74(5):1252-65.

Burke, S. M., Carron, A. V., Eys, M. A., Ntoumanis, N., & Estabrooks, P. A. (2006). Group versus individual approach? A meta-analysis of the effectiveness of interventions to promote physical activity. Sport & Exercise Psychology Review, 2(1), 19-35.

Clark, J. E. (1995). On becoming skillful: Patterns and constraints. Research Quarterly for Exercise and Sport, 66(3), 173-183.

Fell, J. S. (2011, April 4). For best exercise, don’t be lonely or late. Los Angeles Times. Retrieved from http://www.latimes.com/health/la-he-fitness-exercise-adherence-20110404,0,746272.story

Jongen, P. J., Heerings, M., Ruimschotel, R., Hussaarts, A., Duyverman, L., van der Zande, A., & … Visser, L. H. (2016). Intensive social cognitive treatment (can do treatment) with participation of support partners in persons with relapsing remitting Multiple Sclerosis: Observation of improved self-efficacy, quality of life, anxiety and depression 1 year later. BMC Research Notes, 91-8. doi:10.1186/s13104-016-2173-5

Lee, S. (2016) Why can’t I stick to my diet: The what-the-hell effect explained. Sohee Fit. Retrieved from http://www.soheefit.com/what-the-hell/

Be More Sensitive…To Insulin!

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What is insulin?

  • Hormone: a signaling molecule produced by the body or synthetically to control or regulate the activity of certain cells or organs
  • Peptide: a small protein, a chain of amino acids (110 to be specific).
    • Peptide hormones cannot pass easily through cell membranes (like steroid hormones can) and must bind to receptors on the surface of cell membranes to create the desired action.
  • Anabolic: responsible for building (synthesizing) in the body, not breaking things down (which would be catabolic).
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Where does insulin come from?

  • The Pancreas

    In an area of the pancreas called the Islet of Langerhans (I didn’t name it).
    DAD2.pngFrom Beta Cells in this area.
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What causes insulin to be released from β-cells?

During digestion, nutrients from food, including fats, proteins, carbohydrates, and micronutrients, are broken down to their most basic forms and absorbed into the blood.
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Ingestion of carbohydrates causes blood glucose levels to rise, and this is the primary trigger for insulin to be secreted from the pancreas into the blood stream.

Ingestion of certain amino acids can also trigger insulin release, but this is to a much smaller degree.

What does insulin do?

  • Without insulin, glucose cannot get from the bloodstream into cells of the body. Insulin attaches to receptors on cell membranes and enables the transport of glucose into cells. Glucose gets transported mainly into skeletal muscle cells and fat tissue.
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  • Prioritizes the body’s use of carbohydrates as energy instead of fat or muscle.
  • Insulin also causes cells to be more permeable to amino acids, creatine, and some minerals. In muscles, this helps with growth, repair, and energy.
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  • When insulin attaches to skeletal muscle it increases muscle protein synthesis (i.e. the building of muscle tissue from entering amino acids).
  • Insulin causes blood vessels to dilate, increasing the amount of nutrients (glucose/amino acids) delivered to muscle cells.

What does the glycemic index have to do with insulin?

Foods are digested at various speeds, meaning their nutrients are absorbed into the bloodstream at different rates. The glycemic index (GI) is a reflection of digestion rate for carbohydrate sources. Higher GI numbers reflect faster digestion than lower GI numbers. High GI carbs arrive in the bloodstream quickly, driving blood glucose levels up high. Insulin spikes to make use of that glucose, but afterward blood glucose may crash to low levels causing fatigue (i.e. food coma). Low GI carbs gradually enter the blood stream, so insulin levels are more consistent.
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Things that raise a carbohydrate’s digestion rate (higher GI): sugar

Things that lower a carbohydrate’s digestion rate (lower GI): fiber, protein

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It’s generally suggested that at most times, one should consume lower GI carbohydrates. However, there are other times, such as after a strength training workout, where eating high-GI carbs with a whey protein shake (also quickly digested by the body) is optimal for increasing nutrient uptake into muscle tissue.

Why is insulin necessary?

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There are a couple reasons insulin is important:

  1. Too much sugar (glucose) in the blood is toxic to the body. Blood glucose must remain within normal levels of 75-120ml/dl.
    ->As a side note: too little blood glucose is also problematic, but that’s an issue for another pancreatic hormone called glucagon.
  2. Glucose is an important energy source for our bodies’ daily processes. Without insulin, glucose can’t get into the cells to be used as energy. The body will deplete it’s glycogen stores and then break down muscle tissue for energy.
  3. Let’s not forget the brain. In the brain, insulin receptors are present in areas that control nutrient homeostasis (keeping nutrient levels constant), reproduction, cognition, memory, neural development, executive functioning, learning, and memory.
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    • I recall discussing the importance of glucose in the functioning of the hippocampus (a memory center in the brain) in my Psychology of Learning class at UCLA. My professor’s hypothesis (which he was testing on military members at Camp Pendleton) was that some symptoms of PTSD (inappropriate memory flashes) arise when, due to extreme emotional stress, the hippocampus depletes it’s glucose stores and cannot properly store memories.

Insulin Sensitivity vs. Resistance

These terms describe how sensitive the body is to the effects of insulin. When one is insulin sensitive, his or her cells respond properly to the presence of insulin. In cases of insulin resistance, cells fail to respond to the presence of insulin, blood glucose remains elevated, the pancreas releases more insulin, so blood insulin levels are also abnormally high.

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Insulin resistance can be developed from diets that are chronically high in High-GI carbohydrates, and it can lead to the body’s inability to regulate blood glucose (Type 2 Diabetes).

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Insulin sensitivity is considered a desired trait for good health, and it can be increased by both aerobic and anaerobic exercise. Maintaining insulin sensitivity can help with workout goals in a couple ways:

  1. More carbohydrates can get into the muscles during exercise allowing for better workout performance (because more energy!).
  2. Elevated insulin from eating or drinking carbohydrates post-workout increases amino acid uptake (building blocks for new muscle or muscle repair). It also enables faster recovery from workouts since muscle can quickly absorb glucose from the blood instead of the slow process of getting it from fat stores.

Further Reading

Sugar the Sweet Truth by Bret Contreras

Insulin by Rehan Jalali

The Muscle Building Messenger Complete Guide to Insulin by Jim Stoppani

Insulin in the Brain: Its Pathophysiological Implications for States Related with Central Insulin Resistance, Type 2 Diabetes and Alzheimer’s Disease

References

[1] Goulet, E.D., Melancon, M.O., Aubertin-Leheudre, M., Dionne, I.J. (2005). Aerobic training improves insulin sensitivity 72-120h after the last exercise session in younger but not in older women. Eur J Appl Physiol., 95(2-3):146-52.

[2] Van Der Heijden, G.J., Wang, Z.J., Chu, Z., Toffolo, G., Manesso, E., Sauer, P.J., Sunehag, A.L. (2010). Strength exercise improves muscle mass and hepatic insulin sensitivity in obese youth. Med Sci Sports Exerc., 42(11):1973-80.


 

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How Food Is More Than Fuel

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Food is a complex issue.

There’s a reason that our society struggles with weight management, and it’s not necessarily because we don’t know how to eat well. I’m sure many of us understand we’d be a whole lot healthier if we ate more whole foods and less sugar, avoided fried or processed things, drank less alcohol, and limited our soda consumption. So, why don’t we?

I’m the biggest culprit of it all– I really know a lot about how to eat well. So why isn’t my diet better?

The way we eat is not just a physical, biological process–it’s highly psychological! When we eat we are not only fulfilling our bodys’ fuel needs, but often, other emotional or psychological needs as well.
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In honor of Eating Disorder Awareness Week this week, I’m writing this article to share some insight into the complexity of eating behavior.

Adaptive Roles of One’s Diet

  1. Identity
    A person uses the way they eat to define who they are. “The skinny one,” “the fat one,” and “the health nut” are all identities that people take on having to do with the way they eat. Personally, I’ve been “the health-conscious” person to the point where I felt embarrassed to eat a food that was unhealthy or in a large portion in front of others. Coworkers would remark,”Look at Kait’s lunch, it’s always so healthy.” I’d only eat candy or burritos or fried food when I was alone, because heaven forbid someone see me eat something unhealthy and I lose that identity of being the health-conscious person.
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  2.  Distraction or Numbing Emotions
    Eating becomes a way of distracting from life’s problems when one is unable to cope. Instead of being unhappy, stressed, or burdened from the life problem, the central focus becomes one’s diet and the goal of losing weight. Sometimes people eat to “stuff” down uncomfortable feelings. In concentrating on eating, one can space out instead of focusing on the problem. I have some crazy mental association between relaxing and binge eating. If I’m stressed I need to relax so I binge…which is actually counterproductive considering that binging causes more discomfort and anxiety (i.e. more stress).
  3. Control
    When life feels out of control, eating becomes the one area that no one else can control. Sometimes our bodies become the battleground for self-assertion.
  4. Social Habits
    If you are female and you break up with your boyfriend, what do you do? Grab that pint of ice cream!
    Unknown-1Rough, stressful day at work? You need a drink….or 5.
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What characterizes an eating disorder?

There are a variety of eating disorders that exist, some more well-known than others: anorexia, bulimia, binge eating, orthorexia, purging, night eating syndrome, body dysmorphia. Do you feel immense guilt after drinking an In-N-Out milkshake? Would you still love yourself 5 pounds heavier? Do you opt out of a family dinner just because the meal isn’t the healthiest? Do you feel like certain foods have control over you or cause you to lose control?

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Eating disorders involve extreme emotions, attitudes, and behaviors surrounding weight and food issues.

Research suggests that up to 50% of the general population demonstrates problematic or disordered relationships with exercise, body, and/or food, but clinical eating disorders only occur in 1-3% of the population. The difference lies in the degree of symptoms one experiences and how much they interfere with one’s life, health, and ability to function day to day. There are some common symptoms of eating disorders like food restriction, binge eating, purging, excessive exercise, and use of diet pills and/or laxatives. Symptoms that are not as well known include basing one’s self worth or self esteem highly or exclusively on weight or body shape, or having an obsession with or high amount of anxiety surrounding certain foods, calories, or food groups.

Keep your food/body relationships healthy:

  • Avoid classifying foods as good or bad. Food doesn’t have morality; you are not good because you eat broccoli or bad because you eat pizza. There is a time and a place for all foods.
  • Limit social media time. It’s easy to get caught up in comparisons, but when most people share pictures on social media, they are sharing pictures that reflect the best versions of themselves. These posts don’t tell the whole story–the struggles, the vulnerabilities–these pictures are the highlight reel. Check out Sohee Lee’s short article called Don’t Be Fooled By Photos.
  • Be as objective as possible about physical assessments. It’s been said that one should view his or her scale weight with as much emotion as he or she would count the number of white cars in a parking lot.
  • Don’t make a habit of “punishment” workouts or diets. “I ate X so now I need to do an extra workout this week.” “I binged last night, so I’m not eating any carbs today.” Be consistent with your diet and workouts and the results will come.
  • Make a list of all your amazing qualities that are not related to your body or diet. (I’m really organized, I listen well to others, My dog loves me)
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  • Be aware and respond to your own red flags. (Isolating yourself from others, becoming secretive about food, anxiety, depression, giving a lot of emotional weight to things like your scale weight, binge eating episodes)
  • Set realistic goals and focus on your system to make progress day to day. If your goal is to lose 20 pounds in the next 4 months, focus on your plan of going to the gym 4 days a week and eating enough protein each day. I like focusing on the small steps because it allows more opportunities for success every day instead of just one big moment for ultimate success or failure 4 months from now. Read my article on goal setting to learn more.
  • Forgive yourself!
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Further Reading

Body Dysmorphia in the Fitness Industry

Why Can’t I Stick to My Diet? The What-The-Hell Effect Explained

How to Break Free From Binge Eating

The Candy’s Not Going Anywhere

Ban No Foods

How to Stop at One Cookie

When Good Fitness Habits Go Bad

What are your thoughts? Let me know!

Confessions from a Recovering Perfectionist

My name is a Kait, and I’m a recovering perfectionist.

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It’s something I’ve struggled with my entire life. All or nothing. Black and white. Best or worst. No cookies or all the cookies. Kale or Cheetos. Clean eating or dirty eating. 100%. A or F. Good food and bad food. I was once insulted when someone accused me of not having a Type-A personality.

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To be honest, though, trying to be perfect has caused me a lot of stress, anxiety, exhaustion, embarrassment, shame, and guilt, and it has lead to an eating disorder and bouts of low self-esteem. When one aims for perfection, failure is unavoidable, because perfect doesn’t exist.

I am not perfect.
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I am. Not perfect.

I. Am. Not. Perfect…and I never will be!

But, TODAY I am better than I was yesterday.

Here are some areas of my life I’ve learned to appreciate not being perfect.

  1. My diet is not perfectly healthy

    I’ve fallen in love with the flexible dieting or the “if it fits your macros” mentality where no foods are off limits. I can occasionally incorporate imperfect foods into my diet without feeling guilty or like I’ve completely sabotaged all my fitness goals. I actually eat more whole foods because I choose to, not because I have to.

    My diet is still not perfect in these regards. I struggle to track my food, eat enough protein, and not succumb to emotional eating in times of stress, but I’m getting better at it. My relationship with food is much better now than it was at this time last year.
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  2. I don’t know everything there is to know about fitness.

    There is so much to know and to learn as a personal trainer, a fitness enthusiast, and a coach. No one knows it all. I certainly don’t know it all. Sometimes, the amount I don’t know overwhelms me, but for the most part, what I don’t know drives me to keep learning. It creates my passion. I’m so glad I don’t know everything because I actually love learning about training, nutrition, motivation, etc.. Half the reason I started this website is so I have a reason to learn and study more aspects of the fitness field in depth while I write articles.

  3. I’m not a perfect coach or personal trainer.

    Blasphemy, I know. I have so much room for improvement, but there are 2 things I’m certain of: 1) With my education and experience, I know a lot more than your average gym go-er (and many personal trainers) and 2) every day I do my best move my clients safely toward their goals. I am content knowing that every day I am working to be a better coach and if 3 years from now I coach the same way I coach today, I’ll know I’ve done something wrong.
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  4. I’m not a perfect writer.

    I don’t quite understand how to use effect and affect or semicolons vs. colons. I’m not bursting at the seams with words of wisdom each time I sit down and write. I’m not sure what “my voice” sounds like or if people even want to read what I’m writing about. I enjoy it, though, and I trust that in time I’ll figure it out. Plus, if i didn’t publish posts until I deemed them perfect, I wouldn’t have a blog…or a life.

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Are you a recovering perfectionist? Where do you embrace imperfections?

Meatballs and Muffintops

Meatballs

Buffalo Meatballs. They aren’t too spicy either–just enough! I’ve been using this recipe so long that I don’t know where I found it, so I apologize to whomever I’m unable to give credit to. Anyway, here’s what you’ll need to make these delicious, protein-filled….balls.

  • 2 eggs
  • 1/2 cup diced celery
  • 1 sweet onion diced
  • 4oz Frank’s Red Hot Sauce
  • 1/2 cup oats
  • 1 package (16-20oz) ground meat (I used ground turkey, but you could easily use another ground meat variety)

Mix all ingredients together. Form into meatballs of desired size on a cookie tray. Bake 450 degrees for about 25 minutes.

Serving ideas:

  • Meatballs + Rice
  • Meatballs + Salad
  • Meatballs + Celery and lite Ranch
  • Meatballs in a baggy in your purse… I can’t be the only one =P

Let me know if you try ’em!

Muffintops

Weight Gain Jean Girl

Well, to be more precise, this is the cardio element to get rid of them.

Parts of my fitness goals this year include losing fat and challenging my heart regularly, so in addition to my 4 day lifting split each week, I’ve started with 1 day of cardio every week. This way, if my results ever plateau or my body doesn’t feel challenged with this small amount of cardio, I can always add more.

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While there are many ways to do cardio (i.e. exercise that gets your heart rate up for health and calorie burning), my favorite way is short, sweet, and takes only 20 minutes.

Zombie Sprints

This can be done in any cardio modality, but is best done in a way that doesn’t limit speed (not treadmill or step mill). I like sprints on flat ground, hill sprints, spin bike sprints, or elliptical sprints (as a last resort).

  • Warmup: 5 minute (light to moderate intensity). You may want to incorporate dynamic stretches such as high knees, butt-kicks, lunges, etc to stretch out a bit.
  • Sprints: 10 minutes
    1:40 at 50% effort
    20 seconds at 105% effort (life-or-death-speed sprints, like zombies are chasing you)
    Repeat 5 times.

    • If you feel like you can do another sprint after those 5, you didn’t push hard enough
  • Cool down: 5 minutes (moderate to light intensity)
  • You’re done! Go home (or stretch a bit)

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This is a type of training known as HIIT, or high-intensity interval training. The benefit to this type of cardio is it improves your anaerobic and aerobic capacities, speeds up your metabolism for the next 12-24 hours (more calorie burn), and preserves muscle tissue which can be catabolized from long-duration cardio.