Whole body cryotherapy (WBC) has become very popular over the last few years.  Celebrities and professional athletes are using this treatment for muscle recovery, to improve performance, to decrease soreness and even to help speed up metabolism for weight loss.  Some celebrities and athletes who have been known to use cryotherapy are Actress Jennifer Aniston, Basketball Player Lebron James, Actor Daniel Craig and Boxer Floyd Mayweather Jr.

Cryotherapy is defined as “super-cooling” of the body for therapeutic purposes. Cryotherapy can include the use of products such as ice packs on a localized portion of the body, such as the lower back.  Whole Body Cryotherapy is the use of a short but intense exposure to cold that triggers the body’s natural healing process. It involves exposing the entire body to temperatures colder than -200 degrees F.  

Whole body cryotherapy was originally developed in Japan in 1978 by Dr. Yamaguchi and the benefits have been studied and refined in Europe since that time.  Whole body cryotherapy was originally developed for the treatment of inflammation caused by rheumatoid arthritis.  Dr. Yamaguchi found he could significantly reduce the soreness and pain his patients felt during manipulation of their joints, because the rapid decrease of temperature of the outer layer of skin led to the immediate release of endorphins and therefore less sensitivity to pain.  His research led to the exposure of the entire body to these extreme temperatures with the development of cryogenic chambers. Further research in Europe and in Soviet Russia revealed the benefit of Whole Body Cryotherapy on patients suffering from chronic inflammatory conditions and on elite athlete’s training programs.​
​
During a WBC treatment you are enclosed in a relatively confined space for two to three minutes.  A person stands alone in a can-like enclosure that is open at the top. Your entire body, except for your head, is enclosed in the device. Your head remains at room temperature.  Your hands and feet are covered with gloves, shoes and socks respectively.  

I recently made a trip to Subzero Cryotherapy in Wellington, Florida.  Upon entering the studio I was greeted by Kim one of the owners.  She gave me a tour which included a WBC treatment and a localized cryotherapy session.  Prior to going into the whole body chamber, my blood pressure was taken and I was asked if I had any current health conditions or concerns.  After I was cleared to go into the cryotherapy device, I was instructed to remove any jewelry and all of my clothing.  I was then given insulated gloves for my hands and heavy socks and slippers for my feet.  I stepped into the chamber and closed the door.  The cryosauna was then turned on.  Nitrogen gas begins to flow through the device lowering the surface temperature of my skin.  My skin quickly became cold in about 30-45 seconds and then stayed at that temperature for the remaining 2 minutes and 30 seconds.  By the final 20-30 seconds I was pretty darn cold but I was able to move around a bit in the chamber which helped.  By the end of the treatment I felt energized and refreshed!  My muscles and joints felt relatively pain free which seemed to last for the next 2-3 days.  I was also given a spot treatment around my neck and TMJ area where I tend to get moderate soreness.  Kim measured my skin temperature regularly to make sure it was not getting too cold. A hose like device with nitrogen was utilized (see pic below).  Areas like the face, because there is less soft tissue and fat can become a lot cooler more quickly.  My neck and jaw felt less sore immediately after and for about another 24-48 hours.  

The theory is that during whole body cryotherapy, your skin reacts to the cold by sending messages to the brain that stimulates the body to go into survival mode by sending blood from your extremities to the core where the blood has higher amounts of oxygen, enzymes and nutrients.  As the body re-warms, this nutrient rich blood is pushed back to the extremities.  The idea is that the enriched blood promotes internal organ regeneration, detoxification, removal and elimination of damaged cells and decreases inflammation.  Basically, this helps the body heal, rejuvenate and recover.    A recent pilot study showed the substantial imbalance between human metabolism and thermolysis during WBC of which the explanation still remains an open question.  The relationship between skin temperature and thermolysis heat losses during this period is still unknown and have not been studied in the context of the human body.  Hopefully, there will be further studies showing this relationship and proving the benefits of WBC using evidence based medicine.  

According to the FDA, the healing benefits of whole body cryotherapy are unconfirmed and the potential risks are apparent.   Some risks include oxygen deficiency and hypoxia from the nitrogen vapors to a closed room leading to lose of consciousness.  You may also run the risk of frostbite, burns and eye injury from the extreme temperatures.  If you are going to try WBC or localized cryotherapy, please make sure that you go to a reputable establishment where the staff is well trained and qualified such as Subzero Cryotherapy in Wellington, Florida.  Also, please check with your physician prior to any treatments.  This is not meant for everyone and there are definitely possible risks associated with this type of treatment.  


Cheers to Your Health! 

I will continue where we left off from the last post on Prediabetes.  In order to reverse prediabetes, you must focus on decreasing body fat and improving your insulin sensitivity.  Before reading this post, I highly suggest you read the previous post Part I Prediabetes-A Reversible Disease.    I will discuss my recommendations on how to do this by using four categories;  diet, exercise, vitamins and supplements and stress reduction.   In this Part II section, I will discuss Diet and Exercise.  In Part III I will go over vitamins, supplements and stress reduction.  

Note: Please discuss with your physician or nutrition and training specialist, in regards to your particular medical conditions and health goals prior to making any changes in your current regimen.  

When patients are initially diagnosed with prediabetes or diabetes, their doctors may place them on medication to lower their blood sugar.  They will also discuss with them changing their diet and exercise habits or lack their of.  When patients come to me for an evaluation, I will ask them about their daily nutrition and exercise habits.  The extent of what most people know is that they need to lower their sugar and carbohydrate intake, lose weight and exercise more. This is a good start, however, many are confused and have no idea how to go about making these life altering changes.  

Diet 
​The last several decades have seen diet fads come and go.  A major diet craze, and one that is still quite popular, is the low fat and low calorie diet.  This diet is based on the old USDA food pyramid idea that every calorie and gram of fat is alike.  Ingrained in most Americans, is to eat less high fat foods regardless of the type of fat because it contains at least twice as many calories and eat more carbohydrates like cereals, breads and pasta because they contain less calories.  Recent research studies have proven that this is NOT true and in prediabetic and diabetic patients, higher carbohydrates are known to raise overall blood sugar levels.  

 In my experience, cutting calories and fat may help you lose weight in the short term but this type of restriction is usually short lived.  Many regain the weight and are back where they started again and again.  Studies have found that it is actually the type of fat, protein and carbohydrates as well as the ratio of each during meals and timing of meals that matters.  The most simple way to think about this is to focus on eating whole unprocessed foods.  Foods that are naturally found in nature such as fresh fish, meats, eggs, full fat dairy, vegetables and fruits.  Filling up on these at all of your meals will make you much less hungry and decrease cravings for sugary,high carbohydrate foods like breads, pastas and cakes.  Adding foods like nuts to eat as snacks and to use as flavor enhancers along with spices will also help you feel fuller and more satisfied.  

A great book to get you started is called Always Hungry? by Dr. David Ludwig.  Dr. Ludwig discusses how eating more good fats in a specific ratio to healthy proteins and carbohydrates can help sustain a healthy weight and lower insulin resistance.  This helps to reverse diseases like pre diabetes and obesity.  Dr. David Ludwig has written this book based on his clinical experience and research.  He is a practicing endocrinologist and leading Harvard Medical School expert and "obesity warrior"   Dr. Ludwig is said to have "rewritten the rules on weight loss, diet and health."  Always Hungry? includes a three-phase program that ignores calories and targets fat cells directly. The recipes and meal plan include satisfying and healthy high-fat foods (like nuts and nut butters, full-fat dairy, avocados, and dark chocolate), savory proteins, and natural carbohydrates. This is dieting without deprivation.   This is a great way to finally lose weight and help reverse prediabetes.  

Diet Tips:  
Skip artificial sweeteners.  Fake sugar can cause your blood sugar to rise just like real sugar.  In fact, anIsraeli study showed that ingesting artificial sweeteners might lead to obesity and related ailments such as diabetes.  The sweeteners appear to change the population of intestinal bacteria that direct metabolism, the conversion of food to energy or stored fuel.  Artificial sweeteners may favor the growth of bacteria that make more calories available to us, calories that can turn into belly fat and that dreaded muffin top! 

Don't eat directly before a workout.  If you ate within four hours of a workout you should skip that pre workout snack.  As I will discuss in the next section on exercise, when you workout your muscles use glucose from your bloodstream as fuel.  When you use up available blood sugar your body will burn fat for energy.  If you eat too much before you exercise your body will not need to burn as much subcutaneous fat.  Your body will instead use the glucose from the snack as energy and leave the belly fat behind.  

Sprinkle cinnamon on your food.  There is evidence to suggest thatcinnamon or cinnamaldehyde, increases fat burning potential and helps to normalize circulating levels of leptin/ghrelin ratio.  Leptin and ghrelin  help control appetite and energy.  This study also showed cinnamon reduced inflammation in mice fed a high fat diet, which augurs well for its anti-obesity role. 

Exercise
Go exercise!  This is easier said than done.  For most people it is hard enough just to get off the couch.  Figuring out what type of exercise works best for them is even more difficult.   There are several different types of exercise from walking, running, cycling or weight training just to name a few.  Recently, studies have shown that high-intensity interval training (HIIT) also called high-intensity interval exercise (HIIE), helps to lower blood glucose levels and improves insulin sensitivity.  

This type of training involved repeated bouts of high intensity effort followed by varied recovery times.  According to the American College of Sports Medicine (ACSM.org), the intense work periods may range from 5 seconds to 8 minutes long, and are performed at 80% to 95% of a person’s estimated maximal heart rate, the maximum number of times your heart will beat in a minute without overexerting yourself. The recovery periods may last equally as long as the work periods and are usually performed at 40% to 50% of a person’s estimated maximal heart rate. The workout continues with the alternating work and relief periods totaling 20 to 60 minutes.  HIIT training can easily be modified for people of all fitness levels and special conditions, such as those overweight or diabetic.

HIIT has been lab tested as a major component of fat loss around the belly.  As discussed in the previous post Part I Reversing Diabetes, belly fat or visceral fat can lead to diseases such as heart disease,cancer and diabetes.  According toa study from the University of New South Wales in Australia, women who did three HIIT workouts per week lost significantly more subcutaneous fat (the fat that you can see and pinch) then women who did only steady-state cardio. They also managed to improve insulin resistance.  
   
When developing a HIIT program, consider the duration, intensity, and frequency of the work intervals and the length of the recovery intervals. Intensity during the high intensity work interval should range ≥ 80% of your estimated maximal heart rate. As a good subjective indicator, the work interval should feel like you are exercising “hard” to “very hard”. Using the talk test as your guide, it would be like carrying on a conversation, with difficulty. The intensity of the recovery interval should be 40-50% of your estimate maximal heart rate. This would be a physical activity that felt very comfortable, in order to help you recover and prepare for your next work interval.  For more information on high-intensity interval training take a look here: ACSM.org.  

According to a study from November 2015 in the Obesity Review Journal; HIIT appears effective at improving metabolic health, particularly in those at risk of type 2 Diabetes.  High intensity interval training (HIIT) improves liver and adipose tissue insulin sensitivity.  HIIT lowers glucose levels by improving adipose and liver insulin sensitivity independently of changes in adiposity, adipose tissue inflammation or liver lipid content.   

Further evidence for high-intensity interval exercise effects on blood sugar control come from a study published in Metabolism from 2016.  This study showed that HIIT or HIIE is effective at lowering evening/fasting glycemic.  Exercise performed in the fasted state reduces postprandial glycemic (after eating a meal) increments to a greater extent than post-breakfast exercise does.  Basically, performing HIIT under fasted conditions may be very beneficial as it lowered most aspects of glycemia.  

Postprandial hyperglycemia (after eating a meal) is considered to be more strongly associated with insulin resistance at the level of muscles, whereas fasting glycemic reflects hepatic insulin resistance.  Therefore, some types of exercise may improve muscular insulin sensitivity but have little effects on hepatic insulin sensitivity.  Two exercise strategies to consider are high-intensity and fasted-state exercise.   We will mostly focus on HIIE.  

High-intensity interval training involves alternating between repetitions of high intensity exercise bits; ≥70% of maximum or peak oxygen consumption, or 80%–100% of maximal heart rate and lower-intensity recovery periods.  Brief bouts of high-intensity exercise allow for the breakdown of glycogen (glucose stored as energy in muscles) and increased uptake of glucose into muscles thus helping to lower overall blood glucose (blood sugar) levels and burn fat.  

Exercise Tips:
An easy do-it-yourself way to begin HIIT is by performing a combination of exercises including sprints and plyometrics such as burpees, squat jumps and jumping rope.  You must push yourself as hard as you can, recover and catch your breath, then push yourself as hard as you can again.  This is performed for multiple intervals.  For example go all out for 30-90 seconds then recover and catch your breath for about the same amount of time.  Repeat this sequence for approximately 20 minutes.  

A great way to decrease body fat around your belly is lifting weights while bracing your core.  Research published in the journal American College of Sports Medicine: Health and fitness showed compound exercises can elevate fat burn for up to 72 hours post workout and have a great effect on subcutaneous fat loss by increasing fat fighting hormones.  



Stay tuned to Part III-Prediabetes a Reversible Disease Coming Soon!