I wanted to address another thing I see questions about all the time.  How much protein shouid I eat?  How many carbs do I need?  Should I do 40/30/30?   There is no set number of calories or specific percentages for macros. It is all dependent on the persons goals, disease status, and workouts. 

First of all, you need to know how many calories you need.  You can look below to find out how to determine your Total Daily Energy Expenditure and go by that. If you want to lose body fat, eat no less then 80% of your TDEE. If you want to stay the same weight, eat at TDEE. If you want to gain lean mass, add about 85 calories per day from protein to gain about a pound of lean tissue per week. Unlike fat which is 3500 calories per pound, muscle is only 600 calories per pound so you don't have to increase your intake a whole lot to increase lean weight. Just remember that the initial gains will be glycogen and water stored in the muscle and then eventually the actual muscle gains will happen. 

Second, do you have any kind of issues with your kidneys, high blood pressure, diabetes, IBS, etc.? Those will effect your ranges of macronutrients based on the way the body processes the different macros.   If you have any of these issues, then we need to adjust your macros accordingly so you can't just go with the following recommendations or any other generic diet plan.  Ask your doctor for a referral to a dietitian.

Assuming you don't have any conditions that would effect your needs, then you can look at your workouts. If you are doing standard gym workouts or no exercise, then 0.8 grams of protein per kilogram of body weight is all that is needed. If you are a strength athlete (IE: someone who is training for body building or power lifting), then you need 1 to 1.5 grams per kilogram of body weight. If you are an endurance athlete (IE: someone training for a marathon or who does a lot of long workouts), then you need 1.5 to 2 grams per kilogram of body weight. Yes, I know this seems backwards, but endurance athletes actually need more protein then body builders because they are more likely to break down muscle and need the protein to rebuild and repair the muscle damage. Plus, body builders actually benefit from added carbohydrates because it leads to more glycogen storage in the muscles which will lead to the eventual gain of muscle fibers. 
Now, that you know how much protein per kilogram of body weight, you can determine your percentage from protein. First multiply your grams of protein by your kilograms of body weight. Then multiply by 4 to get calories from protein. Divide calories from protein from the total calories you want to eat to get the percentage from protein. 

For Carbohydrate, again, look at your workout status. If you are a strength or endurance athlete, then you need to get 6-8 grams per kilogram of body weight to fuel your workouts. The day before a marathon or other high endurance activity, then you can go up to 10 grams per kilogram of body weight as a one day carb load, or you can follow a more traditional 3 to 7 day carb load plan. If you aren't an athlete and have no medical reason to limit carbs, then you need 3-5 grams per kilogram of body weight. Again, multiply your gram number by your body weight in kilograms to get grams per day. Multiply your grams per day by 4 to get calories from carbs. Divide calories from carbs by total calories per day to get the percentage. Also, remember that the minimum grams of carbs recommended to maintain brain and red blood cell function is 120 grams per day. 

Now, you can take the 100% of your total daily intake and subtract the % from protein and the % from carbs to get the % from fat. Take that % and multiply it by your total daily intake to get calories from fat. Divide calories from fat by 9 to get the grams per day of fat. 

Okay, since I've seen a LOT of posts lately about how to figure your TDEE, I figured I would go through the steps for a simple estimate for everyone and post it on my blog so I don't have to type it over and over and over again. ;-)  I know it is confusing, but it's not really rocket science.  If you can do basic multiplication and division (or work a calculator), then you can figure your numbers.  Here's how:

BMR = 1 kcal x 24 hours per day x lean body mass in kg (You have to subtract out your body fat from your total weight to get lean body mass. Also make sure you are using kilograms and not pounds. Divide pounds by 2.2 to get kilograms. Multiply total body weight by body fat % to get pounds or kilos of fat. Subtract Fat pounds or kilos from total body weight pounds or kilos to get lean body mass.) 

Study of Additional Interventions on Cardiac Rehab Patients at Tift Regional Medical Center

March 2012

Tonya L. Davis-Miller

INTRODUCTION

The purpose of this study is to assess the need for further intervention with cardiac rehab patients, specifically as they would affect weight and body fat loss.  Initially, 6 patients were chosen to begin personalized interventions including both nutrition tracking with specific kilocalorie recommendations and additional exercise to be added outside of the cardiac rehab setting.  When one of the six patients had to leave the study within the first week an alternate was chosen.  A week later, the alternate left the cardiac rehab program due to financial reasons and therefore did not complete the study.  Four weeks into the study, another participant stopped coming to cardiac rehab due to financial issues, so she received the recommendations for kilocalorie intake and additional exercise at home but did not come back in for a final evaluation.  Therefore, the completed study information included only 4 participants, three in Phase IV and one in Phase II. 

METHODS

Each of the participants were given instructions for logging their daily food intake and exercise so that it could be tracked and correlated to their eventual weight loss or gain.  Two of the participants (Phase IV Patient 1 and Phase IV Patient 2) opted to log their food intake and exercise online using the www.myfitnesspal.com application.  The other two patients (Phase IV Patient 3 and Phase II Patient 1) opted to log their food and exercise manually and turn in their logs to have their food intake and exercise entered into the www.myfitnesspal.com application for them.  The www.myfitnesspal.com application allows for logging of food intake with the ability to manually enter the nutrition information from the package or restaurant or to choose preloaded nutritional information which makes it easy to estimate kilocalorie intake.  The application also allows for the entry of exercise with either a kilocalorie burn estimate from a heart rate monitor or using the program to estimate kilocalorie burns based on the weight of the participant and the estimated MET level of the activity.  Each participant was weighed and measured and their individual measurements entered into the body density and body fat percentage equations listed in the ACE Personal Trainer Manual.  <!--[if supportFields]><span style='mso-element: field-begin'></span><span style='mso-spacerun:yes'> </span>CITATION Ame03 \l 1033 <span style='mso-element:field-separator'></span><![endif]-->(American Council on Exercise, 2003)<!--[if supportFields]><span style='mso-no-proof:yes'><span style='mso-element:field-end'></span></span><![endif]-->  This method of body composition analysis was chosen because of the possibility of a patient having a pacemaker and being unable to use the Omron handheld bio-electrical impedance machine. Personalized nutritional recommendations were given to each participant based on their individual health status and the recommendations from Nutrition and Diet Therapy. <!--[if supportFields]><span style='mso-element:field-begin'></span><span style='mso-spacerun:yes'> </span>CITATION DeB08 \l 1033 <span style='mso-element:field-separator'></span><![endif]-->(DeBruyne, Pinna, & Whitney, 2008)<!--[if supportFields]><span style='mso-no-proof:yes'><span style='mso-element:field-end'></span></span><![endif]--> 

Specific kilocalorie per day recommendations were given based on the formula in Nutrition for Health, Fitness, and Sport <!--[if supportFields]><span style='mso-element:field-begin'></span><span style='mso-spacerun:yes'> </span>CITATION Wil10 \l 1033 <span style='mso-element:field-separator'></span><![endif]-->(Williams, 2010)<!--[if supportFields]><span style='mso-no-proof: yes'><span style='mso-element:field-end'></span></span><![endif]--> and a modification to that formula of using the lean body mass instead of total body mass as recommended by the dietitians on staff at Tift Regional Medical Center.  The participants were instructed to subtract no more than 20% of this estimation in order to create a kilocalorie deficit.  Therefore, their recommended range of kilocalorie intake was given as the formula estimate of kilocalorie need as the maximum recommended and 80% of that formula estimate as the minimum recommended.  Each participant was evaluated and given workout cards outlining exercises that they could do at home that would assist in meeting their needs based on specific exercise limitations and abilities.

The individual daily information was recorded for the participants weight, kilocalorie intake, carbohydrate intake in both grams and percentage of total kilocalories, protein intake in both grams and percentage of total kilocalories, fat intake in both grams and percentage of total kilocalorie intake, saturated fat in both grams and percentage of total kilocalorie intake, sodium intake, exercise kilocalorie expenditure, and a determination of whether they were in the recommended kilocalorie range, over the recommended kilocalorie range, or under the recommended kilocalorie range.  With the exception of the number of days in the recommended kilocalorie range, over the kilocalorie range, and under the kilocalorie range, this information was then averaged for each participant to be extrapolated into correlations of which component had the most effect on weight lost or gained, body fat percentage lost or gained, body fat in pounds lost or gained, and lean body mass in pounds lost or gained.   The number of days in, over, or under the recommended kilocalorie range was totaled to determine if there was a correlation between them and weight lost or gained, body fat percentage lost or gained, body fat in pounds lost or gained, and lean body mass lost or gained.  This information can be seen in the Breakdown by Patient table attached.

After the completion of the study, each participant was matched with another cardiac rehab patient who most closely matched their age and beginning weight.  These patients are considered the control group to see the difference in weight loss between those with the additional intervention and those using the standard cardiac rehab program.

DEMOGRAPHIC AND INDIVIDUAL INTERVENTION INFORMATION

Phase IV Patient 1 is a 78 year old male with a history of heart disease resulting in stent placement in 2001 and CABG in 2003.  Additional health issues include hypertension, hyperlipidemia, mitral regurgitation, and previous skin cancer.  Other surgical interventions he has had in the past include knee surgery and kidney surgery.  He is 5’9” tall and had a beginning weight of 236.4 pounds, waist measurement of 49”, iliac crest measurement of 46”, hip measurement of 44”, body fat of 42.9% which calculated to 101.5 pounds, and lean body mass of 134.9 pounds.   His recommended range of kilocalories was calculated to be between 1639 and 2049 kilocalories per day.   Throughout the course of the study, he was given informational handouts including his kilocalorie recommendations, percentage recommendations for total fat intake and saturated fat intake, recommendations for sodium intake, DASH diet information, and exercise cards for resistance bands, stretching, Pilates, Tai Chi, and other therapeutic body weight exercises.

He is being compared to Phase IV Control 1, who is a 75 year old male with a history of heart disease resulting in stent placement and CABG both in 2003.  Additional health issues include hypertension, hyperlipidemia, angina, anemia, pancytopenia, leucopenia, Barretts Esophagus, sleep apnea, and diabetes.  He is 6’ tall and had a beginning weight of 241.3 pounds.

Phase IV Patient 2 is a 47 year old male with a history of sudden cardiac death.  The patient is an avid runner who collapsed on the track for his first myocardial infarction and on the treadmill in the cardiac rehab department for his second.  His history includes PTCA, pacemaker, and heart valve repair, all in 2011.  The patient also has comorbidities of hypertension and hyperlipidemia.  He is 5’11” tall and had a beginning weight of 237.8 pounds, waist measurement of 42”, iliac crest measurement of 43”, hip measurement of 45.5”, body fat 30.2% which calculated to 71.9 pounds, and lean body mass of 165.9 pounds.   His recommended range of kilocalories was calculated to be between 2099 and 2624 kilocalories per day.   Throughout the course of the study, he was given informational handouts including his kilocalorie recommendations, percentage recommendations for total fat intake and saturated fat intake, recommendations for sodium intake, DASH diet information, and exercise cards for resistance bands, stretching, and resistance exercises using both machines and free weights.

He is being compared to Phase IV Control 2, who is a 59 year old male with a history of heart disease resulting in stent placement.  Additional health issues include hypertension, hyperlipidemia, and atrial fibrillation.  He is 6’ tall and had a beginning weight of 222 pounds.

Phase IV Patient 3 is an 85 year old female who is in cardiac rehab after a stent placement in 2004 and myocardial infarction in 2010.  Additional health issues include hypertension, hyperlipidemia, mild congestive heart failure, cardiomyopathy, carotid artery stenosis, colon polyps, diverticulosis, sleep apnea, and osteoarthritis.  She is 5’3.5” tall and had a beginning weight of 224.3 pounds, waist measurement of 42”, iliac crest measurement of 47”, hip measurement of 51.5”, body fat of 58.2% which calculated to 130.7 pounds, and lean body mass of 93.6 pounds.   Her recommended range of kilocalories was calculated to be between 1219 and 1523 kilocalories per day.   Throughout the course of the study, she was given informational handouts including her kilocalorie recommendations, percentage recommendations for total fat intake and saturated fat intake, recommendations for sodium intake, DASH diet information, and exercise cards for resistance bands, stretching, Pilates, Tai Chi, and other therapeutic body weight exercises.

She is being compared to Phase IV Control 3, who is a 74 year old female with a history of heart disease resulting in CABG.  Additional health issues include hypertension, hyperlipidemia, Meniere’s Disease, diverticulitis, hernia, and previous breast cancer.  She is 5’2” tall and had a beginning weight of 183.6 pounds.

Phase II Patient 1 is a 70 year old male with a history of heart disease resulting in CABG in 2002 and stent placement in 2002 and 2009.  Additional health issues include hypertension, hyperlipidemia, stable angina, COPD, and stroke.  He is 5’9.5” tall and had a beginning weight of 182.9 pounds, waist measurement of 40”, iliac crest measurement of 39”, hip measurement of 44.5”, body fat of 33.8% which calculated to 61.7 pounds, and lean body mass of 121.2 pounds.   His recommended range of kilocalories was calculated to be between 1618 and 2023 kilocalories per day.   Throughout the course of the study, he was given informational handouts including his kilocalorie recommendations, percentage recommendations for total fat intake and saturated fat intake, recommendations for sodium intake, DASH diet information, and exercise cards for resistance bands, stretching, and exercises for the wrist and hand to work on negating the effects of his stroke.  Because of the loss of function in his left hand after his stroke, his grip strength was also reviewed to be able to see any changes with the intervention.  He began the cardiac rehab program on January 9, 2012—3 weeks prior to beginning the study—with a right grip of 32 kilograms and a left grip of 24 kilograms.

He is being compared to Phase II Control 1, who is a 70 year old male with a history of heart disease resulting in CABG both in 2002 and 2011.  Additional health issues include hypertension, hyperlipidemia, stable angina, arthritis, hernia, and left eye blindness.  He is 5’6” tall.  As he is in Phase II, he had a full assessment at the beginning of his program which included bio-electrical impedance, waist measurement, and grip strength assessment on the 12^th of January.  He had a midpoint assessment for the cardiac rehab program on the 29^th of February, approximately 6 weeks from his beginning assessment, so those measurements are being used for his final measurements to compare to Phase II Patient 1.  His beginning measurements included a weight of 173.4 pounds, body fat of 28.8% which calculated to 50.98 pounds, lean body mass of 122.4 pounds, right grip strength of 35 kilograms, and left grip strength of 33 kilograms.

RESULTS

Phase IV Patient 1 saw a loss of 11.9 pounds total body weight, 2.7% body fat which calculates to 11.1 pounds of body fat loss, and 0.8 pounds of lean body mass loss.  He also lost 1.5 inches at the waist, 2.25 inches at the iliac crest, and 1.5 inches at the hips.  Phase IV Control 1 gained 3.8 pounds of total body weight. 

Phase IV Patient 2 saw a loss of 6 pounds total body weight, 6.15% body fat which calculates to 16 pounds of body fat, and a gain of 10 pounds of lean body mass.  He also lost 3 inches at the waist, 2.25 inches at the iliac crest, and 1.5 inches at the hips.  Phase IV Control 2 lost 2 pounds of total body weight.

Phase IV Patient 3 saw a gain of 4.7 pounds of total body weight and a loss of 0.32% body fat.  When calculated out, this equates to a gain of 2.69 pounds of body fat and a 2.01 pounds of lean body mass.  She also lost 2 inches at the waist and 3 inches at the iliac crest.  She gained 0.5 inch in the hips.  Phase IV Control 3 also saw a gain of 4.7 pounds.

Phase II Patient 1 saw a gain of 2.5 pounds of total body weight, 0.46% body fat which calculates to a 1.7 pound body fat gain, and a gain of 0.8 pounds of lean body mass.  He increased his grip strength by 2 kilograms on the left and had no change on the right.  His waist measurement remained the same while he gained 2.75 inches at the iliac crest and lost 1 inch in the hips.  Phase II Control 1 saw a loss of 0.8 pounds of total body weight, 0.6% body fat which calculates to a loss of 1.27 pounds of body fat, and a gain of 0.47 pounds of lean body mass.  He saw a decrease in grip strength on the right of 4 kilograms and an increase of grip strength on the left of 2 kilograms.

The Breakdown by Patient chart lists the data used to correlate changes in body weight, body fat, and lean body mass with intakes of kilocalories, carbohydrates, protein, fat, saturated fat, and sodium and with exercise expenditure and the number of days in, over, and under the recommended kilocalorie range.  The Correlations of Various Intakes and Expenditures on Weight Lost or Gained, Body Fat % Lost or Gained, Body Fat in Pounds Lost or Gained, and Lean Body Mass Lost or Gained chart shows all of the correlation coefficients (r) for the same information.

Based on these correlations, the strongest link was between the kilocalories expended through exercise and the number of pounds of body fat lost with r=0.99111.  This link is reinforced with a correlation of r=0.92282 for body fat percentage loss based on exercise kilocalorie expenditure. This shows a very strong, positive possibility of high kilocalorie expenditure through exercise increasing the amount of body fat lost.  The next strongest relationship was between grams of carbohydrate consumed and percentage of body fat lost with r=0.98434.  This shows a very strong, positive possibility of increased carbohydrate intake resulting in increased percentage of body fat lost.  The relationship between the number of days under the kilocalorie range showed the strongest correlation to total body weight lost with a correlation of r=0.98084.  This shows a very strong, positive possibility that a calorie deficit of more than 20% of kilocalorie need will result in greater total body weight loss.  However, when looking at the relationship between body fat loss and the number of days in, over, or under the recommended kilocalorie range, the days in the range had the strongest correlation with r=0.87868 for the body fat in pounds lost and r=0.86774 for body fat percentage lost.  This seems to indicate that if body fat loss is the goal it is more important to eat no less than 80% of the body’s kilocalorie need.  Exercise kilocalorie expenditure had the next strongest relationship to total body weight loss with r=0.85544.  The relationship between grams of protein consumed and lean body mass lost had a correlation of r=-0.98052.  This would show a very strong, negative correlation indicating that increased protein intake decreases the likelihood of losing lean body mass.

CONCLUSIONS

There was a dramatic difference between Phase IV Patient 1 and Phase IV Control 1 in total body weight change with Phase IV Patient 1 losing 11.9 pounds and Phase IV Control 1 gaining 3.8 pounds.    This would seem to indicate that the extra intervention with the patient was beneficial at least from a total body weight loss standpoint.  There was also a difference between Phase IV Patient 2 and Phase IV Control 2 in total body weight change with Phase IV Patient 2 losing 6 pounds and Phase IV Control 2 only losing 2 pounds.  Again, this seems to indicate that the extra interventions were beneficial.  It is important to note that Phase IV Patient 1 and Phase IV Patient 2 were the only participants who logged their food and exercise via the www.myfitnesspal.com application where they could see their intake values and kilocalorie expenditure through exercise.  Also of note are that these two patients are also the patients who logged the most exercise and highest exercise kilocalorie burns both in cardiac rehab and at home.

Both Phase IV Patient 3 and Phase IV Control 3 gained 4.7 pounds of total body weight.  While there appears to be no difference in the effects of the intervention on this patient, it is also of note that she had the most physical limitations with regard to adding additional exercise at home.  Also, while she logged her food and exercise, it was done manually without the benefit of actually seeing the breakdown of intake or expenditure.

It is more difficult at first glance to see the reasons for the differences in the 2.5 pound gain of total body weight in Phase II Patient 1 and the 0.8 pound loss of total body weight in Phase II Control 1.  While Phase II Patient 1 gained both body fat and lean body mass, his counterpart, Phase II Control 1, lost body fat and gained lean body mass.  These differences, however, could be accounted for by observing both men in the cardiac rehab setting as it is apparent that the control subject is progressing farther in his exercise abilities and has added resistance training to his program, whereas the study participant has only increased his exercise intensity by adding incline while walking on the treadmill.  This particular participant also had difficulty in adding in exercise at home due to a fear of causing another cardiac event.  He has only started doing his home exercises in the past couple of weeks, so hopefully, he will see results in the future from those added efforts.  Also of note is that this patient has drastically cut his alcohol consumption as a result of participating in the extra intervention.  When he first started logging his intake, he was consuming an average of 3 beers per night.  At the end of the study, he had cut that back to 1-2 beers and only consumes them a couple of nights a week.  This is a significant improvement that should also lead to better results in the future.

The correlations primarily show that exercise expenditure has a greater effect on body fat loss then dietary intake.  The fact that large deficits in kilocalorie intake had a greater impact on total body weight loss is not surprising, but this study highlights the need for additional exercise intervention in order to achieve greater losses in body fat which is more important in the long run.  The effects of carbohydrate and protein intake on the loss of body fat and lean mass were interesting.  Due to the small sample size, however, further research would be needed to see if those same trends are shown throughout a larger sample of people.

Based on these results, it is beneficial to incorporate additional interventions with cardiac rehab patients.  These interventions should include a way of monitoring both kilocalorie intake and expenditure by the patients where they can see the estimates of what they consuming and expending, as the only patients in this study who saw significant weight loss were using the www.myfitnesspal.com application where they were seeing if they were within their ranges or not.  The two participants who experienced significant weight and body fat loss were also both expending an average of over 300 kilocalories per day.  Therefore, finding ways for future cardiac rehab patients to burn more calories at home would be beneficial in helping them achieve greater overall kilocalorie expenditure and achieving better weight and body composition results.  Further research is needed to determine set points for kilocalorie expenditure per day for best results, as well as for populations with additional metabolic diseases.  All of the patients expressed the fact that this intervention has motivated them to attempt additional activities at home that they wouldn’t have tried otherwise.  These activities ranged from adding in exercise such as Tai Chi for Phase IV Patient 3 to building a shed at his home for Phase IV Patient 2.  Therefore, it is definitely beneficial for the patients belief in their own abilities to have additional intervention in providing home exercises that they are capable of doing in their daily lives.

Works Cited

<!--[if supportFields]><span style='mso-element:field-begin'></span><span style='mso-spacerun:yes'> </span>BIBLIOGRAPHY <span style='mso-element:field-separator'></span><![endif]-->American Council on Exercise. (2003). ACE Personal Trainer Manual (Third ed.). (P. Cedric X. Bryant, & D. J. Green, Eds.) San Diego, CA, USA: American Council on Exercise.

DeBruyne, L. K., Pinna, K., & Whitney, E. (2008). Nutrition and Diet Therapy (Seventh Edition ed.). Belmont, CA, USA: Wadsworth/Thomson Learning.

Williams, M. (2010). Nutrition for Health, Fitness, & Sport. New York: McGraw-Hill.

*****Sorry, I couldn't figure out how to add the tables from Excel into this post.  If anyone knows how to do that, please let me know so you can see the data too. 

If you've followed my blog since last year, then you know that I don't make resolutions, but I do set goals for the year around New Years.  I do this because resolutions always seem to get broken, but I'm pretty good about achieving goals.  LOL  Anyway, as a help to others who are planning their goals for the new year, I wanted ot explain a little about how I set my goals.  I use a format as if I was writing a story, because in a way I am writing the story of what my life will be for the next year.  When you write a story, you have to answer a few questions....Who? What? When? Where? How? and Why?  Well, it's obvious that the Who is me (or you if you're using this format).  Then I answer the other questions and write out the goal as a sort of mission statement for what I will achieve, when I will achieve it, where I will achieve it, how I will achieve it, and why I want to achieve it.  Failing to plan is planning to fail, afterall, so I make sure it is a good plan for achieving my goals.  Anyway, here are my goals for 2012.

I will bench press 200 pounds for 6 sets of 12 reps by December 31, 2012. I will achieve this goal by designing a monthly strength training program with proper progression that I can follow both in my home gym and at the gym. I am going to achieve this goal because increasing upper body strength helps decrease my back pain and risk for further injury. As an added benefit, this goal will help me with muscle building for future body building competition.

I will squat 300 pounds for 6 sets of 12 reps by December 31, 2012. I will achieve this goal by designing a monthly strength training program with proper progression that I can follow both in my home gym and at the gym. I am going to achieve this goal because improving lower body strength will improve my mobility as I age. Squats will also strengthen my spine through an axial load so I have less arthritis pain. As an added benefit, this goal will help me with muscle building for future body building competition.

I will pass the ACSM Clinical Exercise Specialist Certification by May 1, 2012. I will do this by setting up a study schedule for January through March while doing my internship and scheduling the test at their testing center for April. I am going to achieve this goal because it is one of the certifications that meets the graduation requirements for my bachelors program. It is also the highest level certification I am qualified to take and will allow me to work with people with injuries or illnesses in a fitness setting.

I will pass the NSCA Certified Strength and Conditioning Specialist test by May 1, 2012. I will do this by setting up a study schedule for January through March while doing my internship and scheduling the test at their testing center for April. I am going to achieve this goal because I want to fulfill this option for certification as part of my BSEP and it will allow me to work with collegiate and professional athletes.

I will complete the writing of my book by December 31, 2012. I will do this by planning the various chapters and scheduling time at home to write at least 1 chapter per month. I will achieve this goal because I want to help others on their journey to a healthier body and lifestyle.

I will volunteer at physical therapy offices in Fitzgerald, Tifton, and Adel by August 1, 2012. I will do this by meeting with the managers/owners of these locations and scheduling the times with them. I am going to achieve this goal because I need the volunteer hours in order to apply to PT school if I choose to in the future. This goal will also allow me to help those in need of new ideas for exercises while dealing with injury or disease.

I will start my masters in exercise science program at the University of South Florida in Tampa by August 31, 2012. I will achieve this goal by moving, finding a job, getting set up in a GA position, and setting up student loans. I am going to achieve this goal because I want to learn as much as I possibly can about the effects of exercise on the body, how to do different exercises with different populations, and how to do research on the effects of exercise on various diseases and populations.

I will maintain a maximum body fat % of 15% throughout 2012. I will do this by continuing with my healthy eating and exercise plans both at home and at the gym. I am going to achieve this goal because I am happy with where my body is now and feel that it is a healthy starting point for when I start preparing for body building competition in a few years.

I will do all 500+ of my video and DVD workouts by December 31, 2012. I will do this by finishing my inventory and making time at home to do at least 10 per week. I will achieve this goal so I don't feel guilty about buying more. This goal will also allow me to sort through what I have so that I know what I'm willing to part with to donate to others who may need them but can't afford them.

I will make at least 2 quilts by December 31, 2012. I will do this by spending part of my time at home cutting out quilt squares and putting them together. I will also spend a little of my school refund money on batting and backing for them. I am going to achieve this goal because I need to use the material I inherited from my Mom instead of leaving her things unused as a shrine to her and so I can accept the fact that she isn't coming back for them. And I need more quilts because I'm cold! 

Just updated my profile and stats and looked back at my progress for the last year.  I made my body fat % goal for the year!  As some of you know I set my goals for the year instead of making resolutions.  One of my goals was 15% body fat or less per the bioelectrical impedance scale and today I saw 14.5% on the scale!  When I look back at my progress, that's down from 29.5% on the first of the year, so I've literally cut my body fat in half this year.  That's like 30 pounds of fat loss, even with very little loss on the scale (9-ish pounds), so about 20 pounds of lean body mass gained (added muscle and glycogen stored in water).  Goes to show what focus on healthy eating and exercise can do!  For the past few years, I've been too focused on school and not on my eating and exercise.  I may have been ruled out of donating a kidney because of my endometriosis / adenomysosis, but going through the process of trying to donate has certainly focused me on what needs to be done to be healthier, which is why I've seen these results.  Now, it's on to the next goal--Olympia by 50!  Yep, I'm now planning to compete.  I figure I have 4 1/2 more years of school to focus on the right exercise and nutrition plan to get cut and add muscle so that by the time I graduate with my doctorate I'll be ready to start competing in the new physique division after it has passed the new phase and has more set standards.  Then after grad school, I'll have 5-6 years of competition to earn the pro card and make the Olympia by 2022 when I'm 50 years old.  Yeah, I know that sounds old for physique competition, but there were women that age in the Olympia figure division this year, so I'm sure I can do it, too, at that age.  

My new motto:  Dream Big, Achieve Bigger! 

......there is no secret.  High carb, low carb, high fat, low fat, clean eating, eating junk within calorie limits, with exercise, without exercise, whatever.  It all works for someone.  Unfortunately, too many people who find the combination that works for them, think they have found the secret and try to push it on everyone else regardless of whether it is right for them or not.  I've even been guilty of that earlier in my nutrition education.  As I've expanded my knowledge, however, I've realized just how dangerous this can be.  

Each person should evaluate their nutritional needs based on their own specific health issues and fitness needs.  We can't all follow the standard recommendations.  Take Irritable Bowel Syndrome for example.  Different spectrums of IBS will have different needs.  Someone with diarrhea or dumping (when you have to go to the bathroom within an hour of eating) issues can't have a high fiber (IE, lots of whole grains, fruits, and veggies) eating plan or it will make their issues worse. They will need to eat more processed foods so that the fiber has been removed to keep from having problems.  Yes, white bread and junk food is actually better for them then whole grains and fresh fruits and veggies.  Someone with constipation issues, however, will need to focus on the standard recommendations of high fiber (whole grains, fruits, and veggeis) and avoid excess protein (that takes longer to digest) so they should follow more of a vegetarian or low protein plan.  There are a lot of different issues that require the manipulation of nutrition in order to alleviate symptoms.  Diabetics have to watch their carbs and regulate them so that their blood sugar stays fairly even thoroughout the day.  Because they are hyperglycemic, they need to eat in the lower end of the carb range.  Someone with hypoglycemia, on the other hand, has a problem with their blood sugar going too low, so while they still need to manipulate their nutrition to keep their blood sugar up, they should eat more carbs and yes, even simple sugars are good for them.  People with kidney issues have to avoid excessive protein and may even need to be on a low protein (<15%) diet.  People with elevated cancer risk need to be on a low fat (<15%) diet.  Marathon runners need to plan their nutrition for fueling during their activities, which may mean a straight glucose supplement halfway through their race.  Body builders need more carbs (yes I said CARBS) to help them store extra glycogen in the muscles to fuel their lifts and to give the muscle a pumped look, and also to spare their protein intake for actual muscle growth instead of having to be used for energy production.  Small children, pregnant women, and those with nervous system injuries need to consume a higher fat (preferably mono and poly unsaturated fats) diet in order to provide the building blocks of the nervous system.  

Another thing to consider is that not everyone is in the same circumstances emotionally, financially, or culturally to be able to make what most would consider the healthiest choices in foods.  For someone who is going from a 3500 calorie a day diet to a 2000 calorie a day diet, just cutting the calories is a major life change.  Trying to eat perfect foods to live up to the standards of others may be overwhelming for them and a reason to quit making any healthier choices.  So, before offering nutrition advice, or trying to be helpful in saying, switch your processed foods for fresh foods, we should all step back and think about the individual.  Do they have nutritional needs that differ from your own?  Are they making the best choices they can for their circumstances?  Are they making better choices then they did prior to starting their journey?  If you can answer yes to any of those questions, offer encouragement but shut your yap with your advise about the "secret" to weight loss being your plan.  

So, for the past couple of days, I've been working on the next round of kidney donation testing.  First I had to collect my urine for 24 hours.  Yeah, that's sounds like fun, huh?  Would have been a lot easier if it weren't for the fact that apparently I GO more then the average person.  I had to go back to the hospital halfway through my 24 hours to get another collection jug.  They only give you a single 2 1/2 liter jug unless you ask for more.  So, if you are like me and drink a lot and pee a lot, be sure and ask for a second jug when you pick up the first one.  Oh, and ladies, ask for a hat too.  They don't give you one of those unless you ask either.  I thought they had just given me the male version of the collection kit, but no, they just don't give you the sit down part unless you ask.  Seems strange, but if you ever have to do a 24 hour urine collection, ask for a hat.   ;-)

Couple of really funny things at the registration.  When the lady asked me how I was feeling today as I walked in her office, I said, "Kinda strange carrying around a gallon of pee." and it seriously took her a minute to get the joke since I was literally carrying in the 24 hours of urine.  Then when she gave me the paperwork to sign, there's a form that asks if you are an organ donor.  I'm there to be tested to make sure I can donate a kidney, so being the smart ass I am when she asked if I was an organ donor, I said, "No, I'm just having them harvested for no apparent reason."  Took her a little longer to get that one.  Guess my sense of humor isn't funny to others.  Oh well, I thought I was hilarious, but it could have just been the lack of brain frunction from the 12 hours of fasting prior to going in there.    ;-)

So then I finally get back to the lab part, and the first thing I have to do is give a urine sample. Yeah, apparently the gallon I brought them wasn't enough.  Seemed strange to me, but okay.  Then about 12 vials of blood.  Then drink a 16 ounce bottle of glucose goop that tastes like orange Triaminic and wait 30 minutes.  8 more vials of blood.  30 more minutes of waiting, another vial of blood. An hour of waiting, another vial of blood.  4 total hours at the hospital, 22 vials of blood, and 16 ounces of goop all on an empty stomach.  Yeah, I feel like crap now!  I'm so sluggish from lack of fuel.  I've sucked down 2 different kinds of macaroni and cheese and a liter of Pepsi and I'm slightly better, but still need more fuel.  Unfortunately, my stomach says it has to empty before I can put more in.  LOL  So, in another hour, more food!  Still have to do a TB skin test but at least the worst of the testing is done, so I won't have to do that ridiculous fast again.  Until the next time they want to play Dracula, that is.    ;-)