I am honored to have won the 2018 Obesity Medicine Association Dr. Hal Seim Scholarship Fund Award! I had a wonderful time at the Obesity Medicine Association Summit in Washington DC. Looking forward to utilizing the tools that I've learned to help improve the health of my future patients.

   Recently a new study₁ "Supplemental Vitamins and Minerals for CVD Prevention and Treatment" was published in the Journal of the American College of Cardiology regarding the effect of vitamin and mineral supplementation on cardiovascular disease outcomes and all-cause mortality. Since its release, it has gotten a plethora of attention across a multitude of news channels with headlines claiming "Study: Vitamin Supplements Don’t Provide Health Benefits"₂ to "Scientists studying vitamin supplements warn that they’re a huge waste of money."₃ While this study is certainly valid and deserves attention, I believe that the takeaway message is getting skewed and taken out of proper context and misleading the public.

   I would like to take a moment to provide my personal opinion regarding this new study and some important points that we should consider when interpreting its conclusion. The generalized consensus from the study is that vitamin and mineral supplements seemed to provide no benefits in preventing cardiovascular disease or early death. 

Agreements:
1. I can agree with the general concept that popping a simple multivitamin or basic dose of a supplement will not magically extend your lifespan and prevent cardiovascular disease. Supplements are certainly advertised and marketed to a very high extent and often touted as a fix for many issues and consumers often spend more money on them than is necessary.

2. Food should be the primary source of our nutrients and the priority of a healthy lifestyle. A wholesome diet rich in fruits and veggies will provide most, if not all of the micronutrients necessary for optimal health and prevention of any nutrient deficiencies. They also provide nutrients that we often cannot get from a pill alone including polyphenols and fiber. 

3. Numerous studies have found that diets such as the Mediterranean Diet have significantly reduced the risk of cardiovascular disease and all-cause mortality.₄,₅,₆

4. In addition to a healthy diet, exercise is paramount for optimal well-being and is the closest you can get to consuming a "panacea miracle pill." Exercise has been proven time and time again to reduce all-cause and cardiovascular-related death, diabetes mellitus, cancer, osteoporosis, cognitive decline, and much more.₇ Exercise and proper nutrition are like two wheels on a bicycle: you need both working in order to progress forward.

With all that said, I do feel as though this new study is getting misinterpreted and falsely portraying that all supplements are useless and a complete waste of money.

Rebuttals:
1. This study was a meta-analysis comparing a variety of studies on specific supplements (folic acid, B-vitamins, multivitamins, vitamins C, D, β-carotene, calcium, selenium, antioxidant mixtures and niacin) and looking at their effects on cardiovascular disease outcomes and all-cause mortality. It did NOT state that all of these supplements are useless for any purpose. Headlines that are extrapolating the results of this study and proclaiming that all supplements are a waste of money are incorrectly interpreting this study. Each vitamin and mineral has specific roles in the body and may positively benefit individuals who are deficient or have a specific health condition. Just because a vitamin does not improve heart health or length of life, does not mean that it has no beneficial impacts on another aspect of health or quality of life.

2. Each person is unique and has specific vitamin and nutritional needs based on their diet, lifestyle, genetics, and more. We need to have a personalized approach to nutrition and supplements and understand that certain individuals have a greater need and benefit from certain supplements. Meta-analyses are great at providing a high sample size analysis of a large number of studies to help us see overall trends and effects. But we must remember that within each individual study, there is a wide range of outcomes, with some subjects noting a negligible effect or possibly negative effect due to a supplement, but others experiencing a highly beneficial impact. Also, the authors of the study are allowed to pick and choose the studies to include in the meta-analysis, thereby introducing the potential for bias. 
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3. There are many vitamin and mineral deficiencies in the US. This has been well-documented in a variety of studies. Here is a chart which displays the Prevalence of inadequacy (% of population below Estimated Average Requirement - EAR) for “underconsumed nutrients” identified in 2015–2020 Dietary Guidelines for Americans from food only and food + multi-vitamin/multi-mineral supplements (MVMS) among adults age 19 years and older reporting taking a MVMS. NHANES 2009–2012.₈​
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This is a delicious, protein packed recipe that is great for when you're rushed and need a wholesome meal or snack that is quick and easy to make. 

Ingredients:
1. Rolled Oats
2. Whey Protein Powder
3. Greek Yogurt
4. Frozen Berries
5. Creme cookies or nuts
6. Water

The beauty of the recipe is that it can be easily adjusted according to your tastes and available ingredients. You can try a variety of different protein powder flavors, different flavors of greek yogurt, and different frozen berries. You can also use graham cracker or nuts instead of the cookies for an alternative added crunch! You can also adjust the portion size according to your caloric needs.

Instructions:
1. Mix the water and oatmeal and cook according to your preference. 
2. Add a scoop of whey protein, cup of greek yogurt, frozen berries, and crushed cookie or nuts.
3. Mix and enjoy!

Here are the macros according to my recipe:
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Enjoy!

We’ve all heard it before: “Always use full range of motion.” We know it’s the right thing to do when weight lifting, but have we ever stopped and asked ourselves if we are enforcing it? Sure, we may think we’re using full range of motion with each exercise, but I want you to be honest with yourself and re-evaluate your form the next time you’re training in the gym. It’s easy to judge someone doing quarter reps when squatting and think to ourselves “I have much better form than that,” but “better” may not be good enough. Many of us may, in fact, be lifting with solid form, but I encourage you to test your boundaries and explore the potential benefits of increasing your range of motion during each exercise. Over the past month, I have done just that, and have already noticed the benefits.
 
Before I highlight some of the advantages, I would like to make a disclaimer that we all have different anatomical structures and joint mobility limitations so just do the best that you can and be sure to start with lighter weights to avoid injuries.
 
Advantages of Full ROM (Range of Motion)

1. Lifting a weight through a full range of motion places tension on the entire length of the muscle from origin to insertion. This is important for maximizing strength and hypertrophy. If you only lift through a partial range of motion, you’ll develop weak points during certain portions of each exercise. On the other hand, lifting through an entire range of motion allows for optimal strength throughout the exercise and leads to enhanced functional fitness. Additionally, the increased distance traveled leads to more tension on the muscle fibers.
2. Due to the increased distance traveled with each rep, this in turn leads to more overall volume with each set. For example, 10 reps completed with full ROM will take longer to complete than 10 partial reps. This increases time under tension as well as overall training volume which is closely correlated with increased muscle growth and strength.
3. The increased ROM also is beneficial for muscle and joint flexibility. By lifting through a deeper range, we are therefore stretching the muscles as well. Since many of us tend to neglect stretching, it certainly would be advantageous to get some stretching benefits within our actual training.
4. Stretching under load has actually been found to not only induce muscle hypertrophy (increase in muscle size), but also muscle hyperplasia, which is the increase in the number of muscle fibers.
5. Increased range of motion leads to increased recruitment of motor units which is vital for optimal strength and muscular development.
6. The increased time under tension for each set leads to more metabolic stress. This includes a variety of factors which all contribute to hypertrophy such as:
   - Occlusion of veins
   - Hypoxic muscular environment
   - Build-up of metabolic byproducts
   - Cell swelling (pump)
   - Important to note, mechanical tension, metabolic stress, and muscle damage are the three mechanisms of hypertrophy.
7. Lifting through a full range of motion, places the muscles under a combination of passive and active tension because they're being stretched while being activated. As previously mentioned, full ROM exercises stimulate muscle activity over the entire muscle’s length. They also stretch the muscle under high tension.
8. Since lifting a weight through the full ROM tends to be more difficult, you can use lighter weights. Rather than “ego-lifting” and doing partial reps with bad form, it is not only safer, but more effective to go lighter and do the full ROM. This is better for joint longevity as well. If you’re able to lift the weight through the entire ROM with proper form, then you know that you’re capable of handling that weight. You still should challenge yourself and aim to progressively increase weights over time, but it’s reassuring to know that if you’re able to lift a weight with full ROM for 6-12+ reps, then you certainly earned those reps.

   - Some may think that since shorter ROM movements allow for heavier weight, then the increased weight will lead to more muscle growth. But a 12 week study compared partial and long range of motion in squats and not only was strength and size of the muscle greater in the group with the longer range of motion, but additionally, the shorter range of motion group used 10-25% greater weight than the longer-range group and still didn’t do as well. The researchers also found that the load on the muscle in the longer range of motion was actually greater even though participants were lifting less weight.
   - Increased strength and hypertrophy were also found in the full ROM group in a different study analyzing upper limb muscular development using barbell preacher curls.             
   - Fat loss even improved in a longer range of motion training group compared to shorter range of motion.
 
Overall, the benefits speak for themselves, both from an anecdotal observation as well as a scientific evidence perspective. Next time you’re training, be cognizant of your range of motion and consider adjusting the weight to truly allow yourself to maximize range of motion. In turn, you will maximize muscle growth, strength, and flexibility.
 
Sources:
1.       https://www.ncbi.nlm.nih.gov/pubmed/23629583
2.       https://www.ncbi.nlm.nih.gov/pubmed/22027847
3.       https://www.ncbi.nlm.nih.gov/pubmed/7968431
4.       https://bretcontreras.com/partial-vs-full-reps-or-both/
5.      http://www.personaltraineroxford.com/blog/full-range-of-motion-vs-partial-range-of-motion-which-is-better-when-it-comes-to-muscle-size-and-str/
6.       https://www.facebook.com/michael.israetel/posts/10105394700379013
7.       https://breakingmuscle.com/strength-conditioning/science-says-full-range-of-motion-is-best

Take a look at the back of your supplements. Do you see a list filled with proprietary blends consisting of a multitude of ingredients, including artificial flavors, sweeteners, food dyes, preservatives, and fillers? It might be time to rethink about what you're actually putting into your body. As the world of fitness supplements has grown exponentially, so too has the amount of "junk" that has been additionally added in. Each day more and more research unveils the benefits to many of the supplements we take such as creatine, citrulline, beta-alanine, BCAAs, whey protein, etc. But we often don't realize that we tend to be taking in much more than just those ingredients in our pre-workouts and post-workout shakes. 

Just recently we heard about the potential carcinogenic effects of sucralose (aka Splenda) and the CSPI (Center for Science in the Public Interest) downgraded it's rating for sucralose from "Caution" to "Avoid."
See here for more info: http://www.cspinet.org/new/201602081.html

While occasional servings of sucralose are most likely safe, we may overlook the actual dosage of sucralose in some of the top preworkouts on the market. See this video from Kris Gethin for more info:

Since labels often don't list the actual dosage of inactive ingredients, we have no idea how much of these artificial sweeteners and colorings are in our supplements. 

As if one sweetener wasn't enough, most brands tend to add another sweetener as well, such as Acesulfame-Potassium. This also has been categorized as "Avoid" by CSPI:
http://www.cspinet.org/reports/chemcuisine.htm#acesulfamek

Beyond the sweeteners, many brands tend to value marketing gimmicks over your health and well-being and color their supplements with artificial food dyes such as Yellow 5, Yellow 6, and Red 40. These ingredients have been found to pose risks such as hyperactivity in children as well as a potential risk of cancer (like Red 3) and allergic reactions. See here for more info:
https://www.cspinet.org/fooddyes/

When we consider the fact that we often drink down our preworkouts in less than 10 seconds prior to heading to the gym, is it really necessary to be adding such high doses of sweeteners and colors? Especially considering we take these products day after day, in addition to other workout supplements such as BCAAs or post workout drinks which also contain another high dose of artificial sweeteners. 

​Being aware of all of the ingredients in your workout supplements allows you to make informed decisions about your health. It may be wise to consider opting for supplements that naturally sweeten their products with stevia and use natural food colorings such as beet root. Or, consider purchasing unflavored supplements with which you can rest assured that the contents are actually the active ingredients and not just fillers and flavorings.

I'm proud to support ​Do Vitamins and their wonderful line of supplements. 
PurePump Pre-Workout
PumpPulls
​PostPump
Wonder Whey Organic Whey Protein

I encourage you to look at all of their supplements and rest assured knowing that all of the ingredients are stated on the label with their dosages and there are no other fillers. Each supplement is crafted with scientifically proven effective ingredients and has the certifications to prove the quality and purity. Your health should be a top priority so choose good nutrition and supplement wisely. And follow the matra of Do Vitamins:

What if I were to tell you that over the weekend I had ravioli, popcorn, cookies, smoothies, crackers, dip, chocolate chip cookie dough bars, muffins, chocolate pudding, ice cream, chicken parmesan, and more and enjoyed it without feeling guilty AND actually felt as though I still stayed on track in terms of my nutrition? 
Am I crazy?
No - it's all possible to fit those foods into your life if you pick the right products and keep things in moderation. Those foods would all be typically classified as "dirty" or "unhealthy" but I'm posting this as an example that foods aren't inherently "good" or "bad" and that trying to "eat clean" 24/7 is not necessary or ideal. 
Now yes, it is true that the above foods are typically very high in calories and it would be hard to fit them into your daily macronutrient goals, but I'm here to show you that if you shop right, you can buy much healthier varieties of the same foods and stay on track.
Below I will compare the nutrition of my food choices vs. an alternative popular version:

It's pretty clear to see the vast amount of differences between the food choices in terms of their nutrition values. I hope this helps to highlight the point that if you put some effort into food planning and choices, you can still eat foods that are enjoyable and stay on track with your nutrition plan. And while this post is meant to serve as an example of how to incorporate delicious foods and snacks into a lifestyle, I also want to point out that my weekend also included "healthy" food options such as chicken, veggies, fruits, protein shakes, etc. I also went out for dinner and ordered Chicken Parmesan with angel hair pasta, but only had half my portion and a side salad so I could take home the rest. This saves 50% of the calories. And I also fit in a quick workout as well over the weekend. 

With the right preparation, you too can find the perfect balance and be able to enjoy your food choices and continue progressing toward your health and fitness goals.