Category Archives for Clinical Excellence

mature couple smiling at phone while standing outside of tropical hotel

4 Dos and Don’ts for Eating Healthy While Traveling

The habits that took years to build,  

do not take a day to change.

Susan Powter



Joshua D’Alessandro MS, CSCS, CISSN
Nutrition & Exercise Counselor at Cenegenics New York City


As a resident of New York, it is no surprise that I need to get away from the stone torture tube that is the subway and the hustle and bustle of New York. I have always been a huge fan of traveling and have done so with my family since I was 2 years old. Over the last 5 or 6 years, I have found a balance when on vacation between fun and health and I actually enjoy vacation more because of it.

I just came back from Costa Rica and feel no different than when I left, in terms of motivation. I was able to have my fun, while also keeping in mind that going all out all the time can have some pretty immediate effects. Here is a list of do’s and don’ts when on vacation to help you enjoy but also stay on track:

Dos and Don'ts of a Healthy Vacation

While trying not to fall too heavily off the tracks during a vacation, incorporate the following tips:

  • DO something active
  • DO drink plenty of water
  • DO make healthy choices as often as possible
  • DO get good quality sleep
  • DON'T overindulge on unhealthy food
  • DON'T consume alcohol with every meal
  • DON'T oversleep
  • DON'T be physically inactive

Vacation Don’ts


This has a bit of a negative connotation. Drinking, eating, and excessive relaxation are all part of a great trip away from the norm. However, in excess, they can cause problems and even bring great frustration.

DON’T make every meal your last meal on Earth

Believe me, I have been on vacation and have gone to restaurants where my mentality is, “They may have to carry me after this one.” This type of meal will happen, and that is okay.

However, treating every meal like this, especially over the course of many days, can pile on the calories, reduce your energy levels, and even disrupt your metabolism. Try to limit this type of meal as often as you can.

 Don’t be afraid to eat the things you enjoy, but maybe limit to once a day and not in massive quantities.

DON’T drink alcohol at every meal

mature group of friends drinking alcohol in a bar

Breakfast is awesome, and I love bacon and eggs. However, adding a cocktail to this meal, at 8:30 in the morning, is unnecessary.

 Try to consume more water and low-calorie beverages at meals like breakfast and lunch, and save the alcohol for meals that are low in carbohydrates as well.

DON’T sleep too much

Once again, I have slept in so much on vacation that someone had to remind me what day it is. Not only can you actually oversleep, but your entire rhythm will be completely thrown off.

Oversleeping can cause you to feel groggier throughout the day and less motivated to make the right decisions. Try to get a deep 8 hours or so, and wake up feeling refreshed, not like a zombie! 

DON’T do absolutely nothing physically

Some people will find a beach chair, pull it up, and sit for hours on end (I personally lose my mind sitting there for 30 minutes). Try to plan events that encourage you to be active, such as:

  • Hiking
  • Walking around historic destinations
  • Biking

These types of activities will allow you to see the most of your vacation destination, and keep you moving as well!

Vacation Do’s


There are a few of these that may seem contrary to what you want to do on vacation. These are mere guidelines that will take up a fraction of your time while helping you stay on point.

DO exercise

Mature couple hiking while on vacation

I am a crazy person who will literally “workout” for hours on vacation. I love playing sports, lifting weights, and doing outdoor activities. However, for you non-crazy people out there, this does not have to be the case.

Working out in the morning when you first wake up is a great idea. A morning workout can help you:

  • Feel more refreshed to start the day
  • Make better food and beverage choices
  • Lessen the overall impact of poor calorie choices
You do not have to work out every day or for very long, but try to get at least 30-45 minutes a day of resistance training with cardio every other day

DO drink lots of water

man pouring water into glass cup while sitting in clean kitchen

Forgetting to hydrate is one of the biggest mistakes people make when on vacation. It is safe to say you may partake in some dehydration type activities, so maintaining consistent fluid intake will help.

Here are some basic hydration tips:

  • Try drinking water with every alcoholic beverage
  • Avoid sugary drinks and mixers as often as possible
  • Fruit juices, sodas, cream based coffee drinks, and overly sweet frozen drinks should also be avoided

DO choose healthy options as often as possible

mature gentlemen eating salads after playing golf during vacation

Believe it or not, there are almost always tons of healthy options when on vacation. Whenever I have gone on a cruise, or to an all-inclusive, there have been loads of fresh fruits, vegetables, lean protein, and healthy fats.

Granted, they are surrounded by fried, doughy madness, but your ability to sift through these unhealthy options is part of the learning process of balance. Try when possible to stick to the lower glycemic side of the scale, while occasionally tossing in a treat snack or meal.

DO get good sleep

mature couple sleeping in robes in hotel room

Sleeping too little is just as big a problem as sleeping too much on vacation. Go out and have your fun, but also know that too many days of back to back poor sleep can set you up for quite the difficult return trip.

Try your best to get 8 solid hours of sleep while on vacation (but remember, not too much either).

ENJOY! You’re on Vacation


Mature couple checking into hotel on vacation

When we travel, it is usually to a place nothing like where we are from. Take in all the culture has to offer, and enjoy immersing yourself in an unfamiliar place. Overeating and moving very little may seem appealing but can actually hinder your ability to explore and enjoy.

Find the balance, and you will make the most of your trip!

Vacation Control: How to Enjoy While Staying on Track – In Conclusion


The key to eating healthy and not falling off track while traveling is balance. Understanding that it is important to step away from our busy lives and live in the moment, while also not over indulging, is a hard lesson to master.

Tips such as getting in a morning workout so you feel more motivated to make additional healthy choices, and getting enough sleep in order to not have unhealthy cravings are great steps to take in order to not feel too guilty while on vacation.

At Cenegenics, your clinical team is only an email or phone call away. If you are unsure of what steps to take while on vacation, your clinical team is your greatest tool!

Next Steps to Learning Vacation Control

FREE Consultation

Our world class physicians create a personalized plan to help you feel 10+ years younger. You'll be more energetic, lose weight, sleep better, have more libido, and think more clearly. Click below to schedule a free consultation with one of our physicians. It's quick + easy. 

About the Author

Joshua D’Alessandro MS, CSCS, CISSN

My name is Joshua D'Alessandro and I am an Exercise and Nutrition Counselor for Cenegenics in NY. My passion for fitness began at a very young age and has manifested into a career filled with possibilities. The countries largest epidemic, and quite possibly the root cause of most issues, is diminishing health. In my career, I hope to do everything and anything I can to improve the well being and lives of the people around me! 

Key Resources

This guide was produced with contributions from the following key resources: 

The Cenegenics Education and Research Foundation  

The Textbook of Age Management Medicine Volume 1: Mastering Healthy Aging Nutrition, Exercise and Hormone Replacement Therapy

Click to purchase

The Cenegenics Education and Research Foundation  

The Textbook of Age Management Medicine Volume 2: Mastering Healthy Aging Nutrition, Exercise and Hormone Replacement Therapy

Click to purchase

Textbook Authors:

Jeffrey Park Leake, M.D., CPT

Dr. Jeffrey Park Leake is a Partner and Director of Education at Cenegenics Elite Health specializing in age management and wellness. Having trained hundreds of physicians worldwide, Dr. Leake is also the Director of Education for the Clinical Strategies for Healthy Aging course at AMM Educational Foundation.

Todd David Greenberg, M.D., CSCS

Dr. Todd Greenberg is a practicing physician with a broad range of expertise, including wellness, exercise, sports injuries, and MRI of sports injuries. He is a Radiology Clinical Associate Professor at the University of Washington.

dual energy x-ray absorptiometry scan, DEXA machine in doctor’s office

DEXA Scan: How Cenegenics Accurately Measures Body Composition

There is no secrets to success. It is the result of preparation,

hard work and learning from failure.

Collin Powell

With roughly 50% of U.S. adults actively trying to lose weight [1] and more than 70% considered overweight or obese, [2] its no surprise that everywhere we look we’re inundated with weight loss solutions. From supplements to diet and exercise programs, there are countless options designed specifically to elicit weight loss, many of which promise quick results. The industry for diet products and plans is valued at a staggering $70.3 billion, [3] while the $30 billion fitness industry has shown 3-4% annual growth for the last ten years. [4]

Indeed, being overweight continues to be an epidemic that demands attention from the population, intervention from health care providers, and practical approaches to manage a healthier lifestyle. Yet, there are inherent flaws with the way it’s currently being approached. Aside from the unrealistic promises made by many of these weight loss “solutions,” another issue surrounding weight loss is the fact that the vast majority of individuals pursuing loss of body fat are dictating their efforts based solely on one narrow measure: body weight.

What’s the problem with focusing on the number on the scale? After all, isn’t it called weight loss? Here, we debunk the weight loss myth and unveil the real measures of health, which can be used as guiding points to help you create a fuller picture of your wellness. We’ll also cover the powerful solutions for measuring these values and how having this knowledge can set the foundation for a more comprehensive approach to achieving and maintaining a healthy body composition.

Weight: Only One Piece of the Puzzle


In their quest to reduce body fat, most people use the scale as the guiding factor to determine their starting point and progress. They may also use weight as the basis for framing their goals; often we hear people struggling in their quest to lose “the last ten pounds.”

Yet, weight alone doesn’t provide a good marker for overall health. In fact, it’s just an arbitrary number used to measure the body’s relative mass. It’s the composition of that mass that matters, including how much of the body is made up of fat mass, lean mass, organs, bones, and other tissues. For this reason, evaluating weight alone can be very misleading.

For instance, an individual may actually weigh a lot but have little fat mass and a lot of muscle mass. While they would appear and feel healthy, by clinical standards, they could be deemed overweight. Often, this calculation is represented by Body Mass Index (BMI), which brings us to our next point.

The Shortcomings of Body Mass Index (BMI)


BMI is a calculation of a person’s weight relative to their height and is used to categorize individuals into groups such as healthy, overweight, obese, and morbidly obese. It’s a straightforward and free way to calculate body mass and can be routinely measured with reasonable accuracy. Below are two methods for calculating your BMI:

BMI Calculation 1:

Weight (lbs)

               --------------------  x 703     

Height (in)2

BMI Calculation 2:

Weight (kg)

-------------------------------

Height (m) x Height (m)

Classification of BMI is as follows:

  • Underweight: <18.5
  • Normal: 18.5 – 24.9
  • Overweight: 25.0 – 29.9
  • Obese: 30.0-34.9
  • Extremely Obese: >35
Body mass index medical infographic chart


BMI has been used for decades and, in fact, was developed by a mathematician in the early 19th century. Yet, therein lies one of the first issues with the metric: it was not created by a physician and, moreover, the creator himself explicitly said that it should not be used to indicate the level of body fat in an individual.

Rather, the formula was developed to provide a quick overview of obesity among the general population to aid in government resource allocation. In other words, this flawed measure has been used to do the exact thing it was intended not to do for more than 200 years. [5]

Even the CDC has issued BMI considerations for practitioners, stating, “It is a surrogate measure of body fat because it measures excess weight rather than excess fat.” [6] While perhaps a useful tool for doctors and physicians who do not have other means of measuring body fat readily available, BMI doesn’t show the whole picture. And, to perform a comprehensive assessment of an individual’s health, you will ultimately need to see that whole picture.

BMI – Not the Whole Picture

Specifically, BMI falls short when it comes to addressing key values, such as body fat percentage (BF%), lean body mass, and fat mass. Body fat percentage is a representation of the percentage of the body that is made up of fat mass and is a better indicator of health status than overall weight.

Unfortunately, BMI is simply too narrow a measurement to determine body fat percentage. One of its key flaws is the fact that BMI doesn’t discriminate between types of fat. For example, a person with a high BMI carrying a fair amount of subcutaneous fat in the hips and buttocks won’t face the same risk factors as an individual with the same BMI, but who stores most fat in the abdominal region.

Visceral fat, or that which is located deep in the abdominal cavity, is inflammatory, and can release compounds that trigger disease. Contrast this with subcutaneous fat, or the pinchable type located just beneath the skin: this kind isn’t linked as readily to serious disease. [7]

Unresponsive or Inaccurate – Limitations of BMI

Moreover, there are certain instances in which BMI simply gets it wrong. As mentioned above, it fails to account for muscle. Lean body builders may weigh more for their height than what BMI standards would consider healthy, but these individuals do not have an unhealthy body fat composition and are likely not at an increased risk for disease based on body fat.

On the flip side, BMI can also overlook what’s considered “normal weight obesity.” People who are considered to be at a normal weight for their height may still carry excess body fat and, while they may appear thin, their excess fat could still make them vulnerable to issues like type 2 diabetes and heart disease. [8]

Finally, a frustrating scenario many individuals run into is finding BMI to be unresponsive. Through diet and exercise, people seeking to lose weight may find that the scale won’t budge. They may have successfully reduced their body fat percentage and increased lean muscle mass, but BMI calculations won’t reflect that.

This will lead people to perceive failures or stalled progress when in reality they have indeed made strides towards bettering their health; increased physical activity is linked to reductions in heart disease and mortality related to the condition, regardless of an individual’s size. [9] Yet, a reduction in body fat and gain in muscle mass can cause the net change in gross weight to stay the same, even while the body composition is much healthier.

Clearly, BMI has some major shortcomings and is by no means the most effective way to measure body fat. If that’s the case, however, the question still remains: what is the best way to determine body composition?

Methods for Testing Body Composition


There are currently a variety of methods available for testing body composition. The most common methods include the use of skin calipers, hydrostatic weighing, bioelectrical impedance, and finally, dual energy X-ray absorptiometry (DEXA). We’ll go through each of these briefly, with a greater focus on DEXA, as it is considered the gold standard for body composition analysis.

Skinfold Calipers

Woman measure man’s body composition with skinfold calipers

Skinfold calipers are easily accessible and inexpensive, which is why they are among the most common methods used to measure subcutaneous fat. The process involves pulling out a fold of skin from either three or seven parts of the body, such as the back of the arm, front of the arm, or the shoulder blade, and placing the skin between the calipers. The measures should then be added up and can be entered into an equation to provide a body fat percentage reading.

The benefits of this method are that they don’t require a lot of space and can be used by anyone. Yet, this method does leave room for human error and variability. One person may not use the calipers the same way as the next. Caliper technique, precise measurement location, and accuracy of estimations are all factors which can diminish the reliability of this method.

Hydrostatic Weighing

Once considered the gold standard of body composition measurement, hydrostatic weighing is rarely used nowadays. Also referred to as underwater weighing, this method is based on the Archimedes principle which states that upward buoyant force exerted on a body immersed in a liquid is equal to the weight of the fluid that the body displaces.

Muscle and bone are denser than water, but fat floats. Thus, a person with a larger percentage of free fat mass will weigh more in the water and have a lower body fat percentage. Conversely, a large amount of fat mass will make the body lighter in water. [10]

When performed properly, hydrostatic weighing is considered accurate and only has a +/- 1.5% error margin. Nonetheless, one potential barrier to achieving accurate results is the fact that the test relies on the patient’s ability to blow the air out of their lungs completely, both prior to the test and during it, using a spirometer. If the air is not completely expelled, it could create a miscalculation of body fat percentage, since air makes the body float. [11]

While this method was once hailed for its accuracy, it also presents some additional inherent issues. For one, it’s time-consuming, complex, and requires a significant amount of equipment and space. In-depth knowledge is also required to administer the tests and accurately calculate body fat. Moreover, it can also present challenges for the test subject as some people may find it difficult or unsettling to stay under water for the duration of the test.

Bioelectrical Impedance Analysis

Bioelectrical impedance analysis (BIA) is another method used to assess body composition. Modern BIA devices are noninvasive and have become more readily available and affordable. These solutions can be used to calculate body fat percentage, lean body mass, and overall mass.

BIA devices require the subject to place two electrodes on their right hand and/or foot. A low level current, undetectable to the subject, is sent through the body. The flow of this current is influenced by the amount of water inside the body and can measure how the signal is impeded by different types of tissue.

Blood, for example, is characterized by high amounts of electrolytes and fluid and therefore has high conductivity. Likewise, lean tissue, including muscle mass, is composed of roughly 70% water. Fat and bone, on the other hand, will slow the current. By determining the resistance of this flow, it can form estimates of body water to calculate body fat using specific formulas.

Factors That May Skew BIA Results

Man in doctor’s office standing on BIA device to measure body composition

Variations of BIA devices may be used differently. Some models require hand to hand, foot to foot, or foot to hand placement. The units that encompass a full body measurement may yield the most accurate value, while hand to hand units may not produce enough current through the lower body. Conversely, the foot to foot systems may not obtain an accurate picture of body composition in the torso and arms.

While BIA is generally considered to be a feasible tool for accurately measuring body composition, there are a few additional factors that can lead to skewed results. One major influencer is the test subject’s level of hydration. As mentioned above, body water plays an essential role in the conduction of the electrical current.

Thus, the more hydrated an individual is, the faster the current will travel, leading to more accurate results. On the other hand, if the subject is dehydrated, the results may not be accurate due to the slower conduction rate. Therefore, to yield accurate results, it’s important that test administrators ensure the subject has consumed ample fluids beforehand.

DEXA Scan: Gold Standard of Body Composition Testing


Finally, we have the DEXA, the gold standard in body composition analysis. Coincidentally, it was originally developed to analyze bone mineral density, but medical professionals soon caught on to its powerful ability to be used as a body composition analysis tool. Like the aforementioned approaches, DEXA is a noninvasive test. It involves the use of two X-ray beams sent through the body at different energy levels.

X-ray of skeletal bone density from DEXA scan

It can measure changes in bone density as small as one percent and is therefore extremely sensitive and accurate. [12] This helps to determine risk and progression of osteoporosis, which is important for at-risk populations such as elderly individuals. The DEXA has the ability to scan specific areas in the body as well as the whole body. Perhaps the two most critical areas to assess for bone mineral density are the lumbar spine and the femoral neck (hips).

X-ray of spinal bone density from DEXA scan

As we age, not only does our bone mineral density decrease, but we may lose balance and are at a much greater risk for falls. With that increased risk, we also are more likely to sustain fractures.

DualFemur Bone Density from DEXA Scan, x-ray of hips and top portion of legs

A hip fracture can double the risk of dying within a year in elderly populations. [13] The lumbar spine and femoral neck tests are ideal for determining bone mineral density and assessing fracture risks. For this reason, these tests are an essential part of the Cenegenics Elite Health assessment.

Densitometry reference chart from DEXA differentiating between normal and osteoporosis scores

Yet, beyond the ability to accurately measure bone density, the DEXA is the most powerful means of providing data for body composition available today. Unlike the BIA which can be manipulated by water intake or the skinfold calipers which can be altered by the user’s technique, the DEXA is nearly impossible to fool.

Looking Beyond Bone Density

Not only does DEXA tell you the accurate composition of body fat and lean mass, but it also determines how it is distributed across the body. It is the only method that can reveal the precise amount of dangerous fat located around your vital organs which puts you at risk for serious disease.

The DEXA can even provide segmented data to indicate the amounts of lean mass on the arms, trunk, and legs on either side. This is beneficial for helping us understand the distribution of fat mass, as well as the specific diseases for which we may be at risk.

DEXA provides two fat distribution measurements: android and gynoid fat. While android is commonly seen in men and stored around the trunk and upper body (commonly associated with the infamous “beer belly”), gynoid fat is often seen in women and is stored in the lower body, including the hips and thighs. Android fat is commonly associated with hypertension, insulin resistance, type 2 diabetes, and heart disease.

DEXA Measurements Quick Navigation

The DEXA Scan measures

  • AP Spine Bone Density Trend
  • Densitometry Reference
  • Total Body Bone Density Trend
  • Total Body Tissue Quantitation
  • Fat Mass Ratio
  • Total Body Fat Percentage
  • DualFemur Bone Density Trend

The ability to tap into this previously inaccessible data on body composition does much more than uncover disease risk, however. More importantly, it gives us a reliable baseline on which we can set realistic goals to make specific improvements towards optimal health. For example, visceral fat responds best to certain exercises, including high-intensity interval training, while subcutaneous fat may be best approached using other methods. [14] Without an accurate understanding of which type impacts you, however, you’ll be missing a key piece of the puzzle needed to create sustainable improvements to your health. 

Premier Standard of Body Composition Measurement – In Conclusion


As the leader in age management medicine, Cenegenics provides its patients with the resources, tools, and services needed to take an all-encompassing yet targeted approach to improving their health and quality of life. Our clinical team leverages modern technology like the DEXA scan to uncover key indicators of health, which are then used to provide an individualized framework for treatment.

While benefits like improved body composition are a natural byproduct of these efforts, the more important achievements made include better overall health and longevity, and decreased disease risk.

If you’re interested in having your body composition assessed using the DEXA scan, contact Cenegenics today to schedule an assessment and go over your results with a physician.

Next Steps in Scheduling Your DEXA Scan

FREE Consultation

Our world class physicians create a personalized plan to help you feel 10+ years younger. You'll be more energetic, lose weight, sleep better, have more libido, and think more clearly. Click below to schedule a free consultation with one of our physicians. It's quick + easy. 

Key Resources

This guide was produced with contributions from the following key resources: 

The Cenegenics Education and Research Foundation  

The Textbook of Age Management Medicine Volume 1: Mastering Healthy Aging Nutrition, Exercise and Hormone Replacement Therapy

Click to purchase

The Cenegenics Education and Research Foundation  

The Textbook of Age Management Medicine Volume 2: Mastering Healthy Aging Nutrition, Exercise and Hormone Replacement Therapy

Click to purchase

Textbook Authors:

Jeffrey Park Leake, M.D., CPT

Dr. Jeffrey Park Leake is a Partner and Director of Education at Cenegenics Elite Health specializing in age management and wellness. Having trained hundreds of physicians worldwide, Dr. Leake is also the Director of Education for the Clinical Strategies for Healthy Aging course at AMM Educational Foundation.

Todd David Greenberg, M.D., CSCS

Dr. Todd Greenberg is a practicing physician with a broad range of expertise, including wellness, exercise, sports injuries, and MRI of sports injuries. He is a Radiology Clinical Associate Professor at the University of Washington.

References

[1] Ducharme, Jamie. “About Half of Americans Say They’re Trying to Lose Weight.” Time. 12 Jul. 2018. Retrieved from URL: http://time.com/5334532/weight-loss-americans/

[2] “Obesity and Overweight.” Centers for Disease Control and Prevention. 3 May 2017. Retrieved from URL: https://www.cdc.gov/nchs/fastats/obesity-overweight.htm

[3] Roepe, Lisa Rabasca. “The Diet Industry.” BusinessResearcher. 05 March 2018. Retrieved from URL: http://businessresearcher.sagepub.com/sbr-1946-105904-2881576/20180305/the-diet-industry

[4] Midgley, Ben. “The Six Reasons the Fitness Industry is Booming.” Forbes. 26 Sept. 2018. Retrieved from URL: https://www.forbes.com/sites/benmidgley/2018/09/26/the-six-reasons-the-fitness-industry-is-booming/#10d88ca0506d

[5] Devlin, Keith. “Top 10 Reasons Why the BMI Is Bogus.” 4 Jul. 2009. NPR. Retrieved from URL: https://www.npr.org/templates/story/story.php?storyId=106268439

[6] “Body Mass Index: Considerations for Practitioners.” Department of Health and Human Services Centers for Disease Control and Prevention. Retrieved from URL: https://www.cdc.gov/obesity/downloads/bmiforpactitioners.pdf

[7] Cespedes, Andrea. “Problems With BMI.” Livestrong. Retrieved from URL: https://www.livestrong.com/article/93472-problems-bmi/

[8] Cespedes, Andrea. See above.

[9] Janiszewski, Peter M., PhD., and Ross, Robert, PhD. “Effects of Weight Loss Among Metabolically Healthy Obese Men and Women. Diabetes Care. Sept. 2010. Retrieved from URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2928342/

[10] “Body Composition.” Georgia State University Department of Kinesiology and Health. Retrieved from URL: http://www2.gsu.edu/~wwwfit/bodycomp.html

[11] Georgia State University, see above.

[12] Eustice, Carol. “What Is a DEXA Scan?” Very Well Health. 26 Nov. 2018. Retrieved from URL: https://www.verywellhealth.com/what-is-a-dexa-scan-190167

[13] “Elderly Women Who Break a Hip at Increased Risk of Dying Within a Year.” Kaiser Permanente. 26 Sept. 2011. Retrieved from URL : https://share.kaiserpermanente.org/article/elderly-women-who-break-a-hip-at-increased-risk-of-dying-within-a-year/

[14] B.A. Irving et al. “Effect of exercise training intensity on abdominal visceral fat and body composition.” Medicine & Science in Sports & Exercise. Nov. 2008. Retrieved from URL: https://www.ncbi.nlm.nih.gov/pubmed/18845966

Man in windbreaker standing on top of mountain staring out at mountainous green landscape as sun is rising

Getting Back on Track with Diet & Exercise: Staying Motivated

When I lost all my excuses, I found all my results.

Unknown



Joshua D’Alessandro MS, CSCS, CISSN
Nutrition & Exercise Counselor at Cenegenics New York City


After a long, strenuous week, it’s Friday! The work week is over, and it is time to relax and leave some of the stress behind. During the week, you remained focused and diligent, not just on work, but on yourself. Your nutrition was spot on, and you hit the gym 3 out of 5 days. You are feeling great and motivated, and there is nothing that can slow you down!

Saturday comes along, and your friends invite you to a party. No big deal; socializing is part of a healthy lifestyle. When you get there, you are feeling confident that you have found balance and can enjoy yourself while maintaining the moderation that has gotten you here.

Immediately, the smell hits you. All of your favorite snacks are there along with pizza, subs, and all types of alcohol, like the world ends tomorrow. You try your best, but you give in, and 3 glasses of wine, 2 slices of pizza, and 2 cookies later, you’re on the couch in an immovable heap of a food coma. Now, there are a few scenarios that follow this.

  • You wake up the next morning, feeling guilty about your decisions the previous day, and decide to continue down that path. You figure, “I will just start again Monday,” and add pancakes to the mix the next morning.
  • You overreact and eat little to nothing the next day. You think this will help but, on Monday, you feel even worse than before, and your workout goes terribly.
  • You acknowledge that it was one meal and that it has little to no effect on all of the hard work you put in. You wake up the next morning, hydrate (you all know why), and you kick it back into gear.

Getting Back on Track with Diet & Exercise


Blonde woman handing pizza to a smiling mature man at dinner table

When we hear the phrase “falling off track,” many of us see this as an insurmountable mistake. Not only have we fallen off track, but the train is cascading down a hill that creates a new uphill battle.

The reality of the situation is that one meal did not knock you off a cliff. One meal merely tilted you off one wheel for a small fraction of time. The only way for the train to fall completely off the tracks is for you, as the conductor, to allow this to happen.

Acknowledging that it was one meal, or a single night out, and not allowing yourself to use this as an excuse to continue down your current path makes a large difference. Tilt the balance back by waking up and eating a high quality, nutritious breakfast, and hit the gym for a satisfying workout!

Staying Motivated on a Diet & Exercise Program


Staying motivated and keeping on track can be difficult, but it is not remotely impossible. Much like anything in life, there will be bumps along the way that provide immense challenges. Having a plan going into these situations will turn this so-called disaster into an enjoyable and necessary social experience. Here are some tips to not only stay on track but to also keep moving forward!

Staying Motivated

Here are some tips to help you stay motivated & stay on track:

  • Workout Before Going Out
  • Eat & Hydrate Before Going Out
  • Workout Afterwards or the Following Day
  • Have a Motivation or Workout Buddy
  • Have Healthy Meals Planned for After a Social Event
  • Enjoy & Live in the Moment 

Workout Before Going Out and Socializing

  • Most of the time when we go out, it is not until at the very least the early afternoon
  • Take the time to wake up in the morning, eat well, hydrate a lot, and toss in a great workout
  • Working out before these events will increase your metabolism, increasing muscular demand for those potentially bad calories, and even reduce your cravings for them
  • Make good use of the calories to come, and start the day with activity and good decisions!

Eat and Hydrate Before You Go

Woman drinking water while exercising with mature male partner
  • Most of the time when we go to social events, we typically plan to eat until it hurts
  • This is a huge mistake, because going into a social event hungry will increase cravings and the possibility of binging
  • On top of your morning workout, try to have as much high quality nutrition as you can before you go, including:
    • Lean protein such as chicken, fish, eggs and egg whites
    • Lots of vegetables
    • Healthy fats like avocado and nuts
    • Some fruit or low glycemic carbs such as quinoa or sweet potato
    • Lots of water
  • The more satisfied you feel going into the social event, the less likely you are to go all out

Workout Afterwards, or the Next Day

  • Working out as soon as you can, after a cheat meal or event, can help you immediately make use of the calories and steer you in the right direction
  • Instead of slamming down more bad food the next morning, get up and go to the gym
  • Even a light workout will help you release endorphins that help you think positively of the food you had, and allow you to carry on with your nutrition and exercise regimen right away

Have a Motivation Buddy

silhouetted man helping partner climb large boulders
  • Having someone with the same mentality as you can be very helpful
  • If you are going to a party or event with a spouse, friend, or family member, have each other’s back
  • Try to support one another by making realistic goals going in and sticking to them as best you can
  • Make plans together to go to the gym in the morning before or the morning after the event
  • Keep each other accountable, and you will succeed!

Have Healthy Meals Planned out for After the Social Event

ENJOY!

  • Life is about taking in these fun, slightly glutinous moments and appreciating them
  • Living in the moment is key here
  • By living in the moment, you can get what you need out of these less healthy decisions, and make them fit well into your lifestyle

All in all, enjoy life and maintain a balanced approach. No one can push you off the tracks. Staying on path is up to you, and these tools will make it much easier.

Finding Motivation – In Conclusion


We all live busy lives and aren’t always able to say no to socializing with friends and family, but “don’t’ get so busy making a life that you forget to live it”. Enjoy life, but remember to maintain a healthy balance.

If you are going out, be sure to plan ahead:

  • Enjoy a morning workout and a healthy breakfast
  • Keep hydrated
  • Have healthy meals ready for after
  • Always have a motivation partner
  • Don’t guilt yourself the next day

Having a healthy mindset and being able to recognize that one night does not ruin all of your progress is the best way to keep yourself on track and motivated. Your Cenegenics Nutrition & Exercise Counselor is also a great source of motivation when you are feeling overwhelmed by your choices from a night out.

Our customized nutrition and exercise programs are designed to help optimize your health & wellness, taking into account your current lifestyle. Your Cenegenics team is here to help you every step of the way. To learn more, contact your nearest Cenegenics location.

Next Steps to Staying Motivated with Cenegenics

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About the Author

Joshua D’Alessandro MS, CSCS, CISSN

My name is Joshua D'Alessandro and I am an Exercise and Nutrition Counselor for Cenegenics in NY. My passion for fitness began at a very young age and has manifested into a career filled with possibilities. The countries largest epidemic, and quite possibly the root cause of most issues, is diminishing health. In my career, I hope to do everything and anything I can to improve the well being and lives of the people around me! 

Key Resources

This guide was produced with contributions from the following key resources: 

The Cenegenics Education and Research Foundation  

The Textbook of Age Management Medicine Volume 1: Mastering Healthy Aging Nutrition, Exercise and Hormone Replacement Therapy

Click to purchase

The Cenegenics Education and Research Foundation  

The Textbook of Age Management Medicine Volume 2: Mastering Healthy Aging Nutrition, Exercise and Hormone Replacement Therapy

Click to purchase

Textbook Authors:

Jeffrey Park Leake, M.D., CPT

Dr. Jeffrey Park Leake is a Partner and Director of Education at Cenegenics Elite Health specializing in age management and wellness. Having trained hundreds of physicians worldwide, Dr. Leake is also the Director of Education for the Clinical Strategies for Healthy Aging course at AMM Educational Foundation.

Todd David Greenberg, M.D., CSCS

Dr. Todd Greenberg is a practicing physician with a broad range of expertise, including wellness, exercise, sports injuries, and MRI of sports injuries. He is a Radiology Clinical Associate Professor at the University of Washington.

Pick one day to prep your food for the week, Following healthy meal prepping ideas can help you avoid eating processed foods and take-out when short on time, The following meal prep guide provides you with tips and recommendations to make the most of your time and make your meal prep effective & efficient

Healthy Meal Prepping Ideas

By failing to prepare, you are preparing to fail.

Benjamin Franklin


One of the main reasons people struggle to maintain success with a nutrition plan is lack of preparation. Although there are healthy options to be had on the go, it is very tough to tell exactly which options provide what we truly need. Many foods at restaurants, pharmacies, etc., tend to have additives to increase flavor, such as sugar, salt, and other preservatives. The best way to know for sure you are getting what you need is to take matters into your own hands.


Preparation is the key aspect on any solid plan, nutrition based or not. Going into an endeavor without planning is the first step to feeling overwhelmed and falling off track. In order to make sure this does not happen, the effort needs to be put in before our hectic schedules get the best of us.

Meal prepping sounds challenging. Not many people want to waste their hard earned free time cooking loads of protein. However, there are many benefits to meal prepping that people do not typically acknowledge including:

These are just a few of the many benefits to getting ready for the week. Here are some suggestions on how to meal prep effectively to fit a busy lifestyle! I will also provide examples of meal prepping that go by specific nutrition requirements (vegan, low carb, etc.)

Meal Prep Guide & Tips


Healthy Meal Prep Tips

Here are a few suggestions to help you meal prep effectively, even with a busy lifestyle:

  • Pick one day to meal prep for the week
  • Prepare a shopping list
  • Buy food that you can store in the freezer in bulk
  • Buy large containers of healthy snacks
  • Purchase various container sizes
  • Stock up on spices
  • Get others involved!

Choose a Day to Prep That You Can Stick To 

  • Typically, meal prep will take a few hours
  • Choosing a day during the weekend or a day where you are off from work during the week is a great time to get the shopping done and prep as well
  • Use the time wisely, because this will also save you time preparing lunches, dinners, and snacks throughout the week
  • This is precious time that adds up, even if you don't notice it immediately
Choosing one day to meal prep is a healthy meal prep tip that can help make the most of your time

Make a List Before Going to the Store  

  • Having a list before going in will save you time and even money
  • By focusing in on the things you need and keeping out the things you don't, you will navigate the supermarket more efficiently and buy less "craving" food
Healthy Meal Prep Tips include making a list before going to the store, Having a list prevents you from hungry shopping

Buy Food in Bulk That You Can Keep in the Freezer

  • Certain foods you will have to buy 2-3 times a week, including fruits, vegetable, and other perishable foods
  •  With protein, frozen veggies, and other freezer friendly items, try to stock up. Being able to take this food right out of the freezer and defrost while at work is a great way to save trips to the grocery store

Buy Large Containers of Healthy Snacks

  • Investing in a large bag of healthy snacks can make eating throughout the day manageable
  • Healthy fats to buy in bulk
    • Almonds, walnuts, pistachios, cashews
    • These foods maintain well, have good fat and fiber, and will keep you full
    • CHECK SERVING SIZE! These foods are calorically dense and need to be measured out
  • Healthy protein snacks in bulk
    • Low sugar beef jerky
    • Wild caught tuna packets
    • Vegan/whey protein tubs
    • Low sodium cheese sticks
  • Healthy carb snacks
    • Some whole fruits (apples, oranges, pears)
    • Steel cut oats packets

Buy Container Sizes

  • Buy various containers for lunches, dinners, and snacks
  • Portion out your meals and snacks in their respective containers
  • Label them as "lunch, dinner, snacks" to make them easy to grab
  •  Ziploc bags help quite a bit as well for packing snacks like fresh vegetables, nuts, and fruit

Buy Loads of Spices!

  • Load up on garlic salt, adobo, cumin, paprika, Himalayan sea salt, pepper corn, or whatever flavors you enjoy!
  •  This will help keep your food flavorful and help you avoid monotony

Make It a Family Thing!

  • Family time, or time with a spouse or friends, cannot be overstated
  • Get the whole family involved
  • Not only will it save you time, but it can also get everyone on-board with this very necessary, healthy habit!

Healthy Meal Prepping Ideas & Recommendations


General Guidelines: Low Glycemic Meal Prep

a great healthy meal prep is a low-glycemic option, lean protein and fresh vegetables are great options for a low-glycemic meal prep
  • 5-7 pounds of lean protein
    • Skinless chicken, lean ground turkey or chicken, whole roasted turkey, fish (salmon, mackerel, cod, tuna, WILD CAUGHT)
    • Ground chicken and turkey can be made into meatballs, burgers, meatloaf, or for Mexican style bowls (lettuce, guacamole, fresh pico de gallo, black beans)
  • 1-2 pounds of 3 different fresh vegetables
    • Squash, zucchini, broccoli, asparagus, cabbage, Brussel sprouts
    • Be sure to cook down the cruciferous vegetables such as broccoli and cabbage to avoid GI distress
    • Large bags of organic spinach, kale, arugula, cabbage mix, and spring mix
  • Healthy fats (choose 2-3)
    • 4-6 avocados
    • 1 large bottle of olive oil
    • 1 large package of unsalted nuts (almonds, walnuts, etc.)
    • 1 jar of natural, no sugar added peanut or almond butter
  • Breakfast/miscellaneous
    • 1-2 dozen free range organic eggs
    • Turkey sausage (all natural)
  • Seasonings and additions
    • Himalayan salt, pepper, paprika, adobo, mint, etc.
    • Garlic
    • 5-6 lemons or limes (great for adding flavor to chicken and vegetables, use rinds as well)
    • Red wine vinegar
    • Stone ground mustard
    •  Hummus and guacamole (good for dipping)

Additional Guidelines for Whole Food Nutrition (Moderate Glycemic)

taking advantage of spices is a great tip from this meal prep guide, using spices to add flavor to meals can keep meals exciting vs eating the same meal daily.

For those consuming energy dense, moderate to low glycemic diets, the following recommendations can be followed in addition to the general guidelines listed above:

    • Moderate to low glycemic index carbohydrates (1 or 2 to keep variety)
      • ​​​​​​​2-4 pounds of sweet potatoes
      • 1 bag of organic quinoa (1 cup usually makes 2 to 3 servings)
      • 1 large bag organic brown or wild rice
    • 2-4 pounds of fresh fruit
      • ​​​​​​​Apples, oranges/clementine's, bananas, berries
    • Breakfast/miscellaneous
      • ​​​​​​​1 package of certified organic, certified gluten-free steel cut oats
      • 1 tub plain Greek yogurt

Additional Guidelines for Keto Style Meal Prep

Keto style meal prep includes less lean protein compared to a low- to medium-glycemic diet

If following a keto plan, limit your lean protein to 3-4 pounds, compared to the recommended 5-7 pounds for low and moderate glycemic plans. Try to limit to no less than 50 grams of carbs from vegetable sources a day to maintain ketosis.

Additionally, you can choose 3-4 healthy fats, instead of limiting it to 2-3 as the low and moderate glycemic plans do. Organic coconut oil and unsalted ghee/butter can be used as additional sources of healthy fats within the keto style meal prep.

Low-Glycemic vs Whole Food vs Keto – Which One Should I Choose?  


Low-glycemic plans is ideal for individuals trying to lose weight, manage prediabetes or type 2 diabetes, as well as prevent chronic diseases such as obesity and heart disease [1].

Whole foods (moderate glycemic) plans follow most of the same guidelines as a low-glycemic plan, but allows for a little more flexibility of additional carbs such as sweet potatoes, quinoa, and organic brown or wild rice. It eliminates the risk of processed foods, and helps you feel full longer.

Keto meal plans are often used for individuals trying to bulk up. It has been found to be effective in weight loss, since it forces the body to use fat instead of carbs are a source of energy. There is evidence that a low-carb keto diet can reduce body mass without the negative impact on strength and power [2].

The above guidelines are based on general recommendations of popular meal plans. For custom, individualized meal plans contact your nearest Cenegenics location to discover how Cenegenics can help you live well, longer.

Choosing The Right Meal Plan For You – In Conclusion


Choosing the right nutritional plan is truly dependent upon your individual goals, medical history and current lifestyle. Cenegenics is focused on treating the individual and helping to optimize overall health and wellness.

Our physician and clinical team will perform a comprehensive health evaluation, including analyzing key biomarkers to determine if any deficiencies exist. Customized nutrition plans are then formed to help ensure your body receives the nutrients it needs to function optimally, both now and in the long term.

If you are interested in learning about nutrition and meal prepping beyond the basics, contact your nearest location today.

Next Steps to Receive Individualized Nutritional Plan

Key Resources

This guide was produced with contributions from the following key resources: 

Joshua D’Alessandro MS, CSCS, CISSN 

Nutrition & Exercise Counselor at Cenegenics New York City 

The Cenegenics Education and Research Foundation  

The Textbook of Age Management Medicine Volume 1: Mastering Healthy Aging Nutrition, Exercise and Hormone Replacement Therapy

Click to purchase

The Cenegenics Education and Research Foundation  

The Textbook of Age Management Medicine Volume 2: Mastering Healthy Aging Nutrition, Exercise and Hormone Replacement Therapy

Click to purchase

Textbook Authors:

Jeffrey Park Leake, M.D., CPT

Dr. Jeffrey Park Leake is a Partner and Director of Education at Cenegenics Elite Health specializing in age management and wellness. Having trained hundreds of physicians worldwide, Dr. Leake is also the Director of Education for the Clinical Strategies for Healthy Aging course at AMM Educational Foundation.

Todd David Greenberg, M.D., CSCS

Dr. Todd Greenberg is a practicing physician with a broad range of expertise, including wellness, exercise, sports injuries, and MRI of sports injuries. He is a Radiology Clinical Associate Professor at the University of Washington.

References

[1] Augustin, L. S., Kendall, C. W., Jenkins, D. J., Willett, W. C., Astrup, A., Barclay, A. W., . . . Poli, A. (2015, September). Glycemic index, glycemic load and glycemic response: An International Scientific Consensus Summit from the International Carbohydrate Quality Consortium (ICQC). Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26160327

[2] Greene, D. A., Varley, B. J., Hartwig, T. B., Chapman, P., & Rigney, M. (2018, December). A Low-Carbohydrate Ketogenic Diet Reduces Body Mass Without Compromising Performance in Powerlifting and Olympic Weightlifting Athletes. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/30335720

* Disclaimer: These are general recommendations based on popular nutrition plans. If you are interested in plans specific to your goals, please contact Cenegenics to learn more about our individualized programs.

(Leafy greens are a good source of vitamin K, the role of vitamin K includes proper blood clotting and accumulation of calcium within the bones

Learn About Vitamin K – Including Beneficial Foods with Vitamin K

When we talk about important vitamins and minerals, oftentimes vitamins like B, C, and D tend to get the most attention. Yet, the body needs more than two dozen vitamins and minerals every day to function optimally. While there are certainly some which are more critical to important bodily functions than others, the roles of many less frequently discussed vitamins are largely overlooked.

In particular, vitamin K is a vitamin which tends to go under the radar. The reason it’s so underrated may stem from the fact that vitamin K deficiencies are relatively rare. With that said, taking in anything lower than an optimal amount of vitamin K could impair your health in the long run and might even contribute to a higher risk of developing heart disease. [1]

Below, discover just how important vitamin K is in keeping you healthy and what you can do to prevent a deficiency in this essential nutrient.

The Role of Vitamin K


The major role of vitamin K is to assist with proper blood clotting, vitamin K deficiency can lead to risk of excessive bleeding

Although its role is understated compared to that of other vitamins, and while it is seldom discussed, vitamin K also supports many crucial functions throughout the body. For one, this vitamin is necessary for proper blood clotting. For another, it contributes to calcium accumulation within the bones alongside vitamin D. While vitamin D is responsible for improving the absorption from the calcium we take in via diet, it can also take calcium from the bones as needed when dietary calcium is inadequate.

Role of Vitamin K

Vitamin K tends to be underrated since a deficiency of this vitamin is rare. However, it does play an important role in: 

  • Bone health
  • Cognitive health
  • Heart health
  • Blood clotting
  • Protects against hypercalcemia

This is where vitamin K comes in: the nutrient can activate osteocalcin to promote the accumulation of calcium in bones and teeth to prevent against loss. In fact, the NHS shows a 30% reduction in hip fractures in women who take 110 micrograms of vitamin K or more per day, and women who ate one serving of leafy greens per day (a rich source of vitamin K) had a 50% reduction in hip fractures compared with those who consumed one serving per week. [2]

Additionally, vitamin K prevents calcium buildup in the kidneys and blood vessels. It can also protect against hypercalcemia, a condition in which the blood’s calcium levels are above normal. This presents serious health hazards like excessive calcium; too much of the nutrient can weaken bones. It may also lead to kidney stones and interfere with organ functionality, including that of the heart and brain. [3]

Vitamin K Deficiency


A vitamin K deficiency, although rare, can have serious implications. Deficiencies in this vitamin have been linked to blood vessel calcification, in which calcium builds up in the arteries causing them to become stiffer. This poses a significant risk for cardiovascular health. Vitamin K deficiency can also prevent the body from producing proteins needed to help the blood clot. When this happens, the risk of excessive bleeding increases.

A vitamin K deficiency is most likely to occur in infants and adults who take medications or have medical conditions which inhibit absorption. The RDI for K2 is 120 micrograms in males and 90 micrograms in females. This may be difficult to achieve through diet alone and, for this reason, it’s recommended to take K2 with D3 to promote proper calcium levels within the body.

Foods with Vitamin K


Foods with vitamin K include leafy greens and even some garnishing, Some fruits and cruciferous vegetables are foods with vitamin K

Vitamin K1 is found mostly in dietary sources and is converted into K2 within the body. Vegetable sources of vitamin K include:

  • Leafy greens:
    • Kale
    • Spinach
    • Mustard greens
    • Others
  • Leeks and cruciferous vegetables:
    • Broccoli
    • Cauliflower
    • Brussels sprouts
    • Others
  • Even certain types of garnishing and herbs can be used for vitamin K intake:
    • Capers
    • Parsley
    • black peppercorns
    • Others
  • Fruit sources include:
    • Blueberries
    • Kiwi

Why is Vitamin K Important – In Conclusion


Until now, you may not have paid much mind to vitamin K. Yet, this is just one of the many vitamins for which deficiencies could pose serious health consequences. Unfortunately, optimizing nutrient intake can quickly become overwhelming, and even the healthiest diets may still leave nutritional gaps. 

At Cenegenics, our expert-led nutrition team will work with you to develop eating habits that are healthy yet sustainable. Our team will also perform a comprehensive health screening, including analyzing key biomarkers to determine where any deficiencies may exist. If needed, our expert clinicians can prescribe high-quality nutraceuticals made exclusively for Cenegenics patients. This helps to ensure your body receives all of the nutrients it needs to perform its best, both now and into the future.

If you’re interested in learning how the Cenegenics program can help you optimize your wellness through improved nutrition, among many other benefits, contact your nearest location today.

Next Steps in Understanding the Role of Vitamin K

Key Resources

This guide was produced with contributions from the following key resources: 

The Cenegenics Education and Research Foundation  

The Textbook of Age Management Medicine Volume 1: Mastering Healthy Aging Nutrition, Exercise and Hormone Replacement Therapy

Click to purchase

The Cenegenics Education and Research Foundation  

The Textbook of Age Management Medicine Volume 2: Mastering Healthy Aging Nutrition, Exercise and Hormone Replacement Therapy

Click to purchase

Textbook Authors:

Jeffrey Park Leake, M.D., CPT

Dr. Jeffrey Park Leake is a Partner and Director of Education at Cenegenics Elite Health specializing in age management and wellness. Having trained hundreds of physicians worldwide, Dr. Leake is also the Director of Education for the Clinical Strategies for Healthy Aging course at AMM Educational Foundation.

Todd David Greenberg, M.D., CSCS

Dr. Todd Greenberg is a practicing physician with a broad range of expertise, including wellness, exercise, sports injuries, and MRI of sports injuries. He is a Radiology Clinical Associate Professor at the University of Washington.

References

[1] Vermeer, C. “Vitamin K: the effect on health beyond coagulation – an overview.” Food & Nutritional Research. 02 Apr. 2012. Retrieved from URL: https://www.ncbi.nlm.nih.gov/pubmed/22489224

[2] Leake, Jeffery Park, M.D., CPT, see above.

[3] Mayo Clinic. “Hypercalcemia.” 06 Mar. 2018. Retrieved from URL: https://www.mayoclinic.org/diseases-conditions/hypercalcemia/symptoms-causes/syc-20355523

A large portion of teens and adults in the U.S. are deficient in vitamin D, People who have less exposure to the sun are at higher risk of low vitamin D

Are You Experiencing Low Vitamin D?

To perform its best, the body needs at least 30 different vitamins and minerals every day. [1] While each plays an essential role in keeping us healthy, some are more critical than others. To add further complexity to the mix, there are some nutrients which we are most likely to be deficient in, due to dietary gaps and other lifestyle factors. Moreover, our bodies’ nutritional needs evolve with age.

One critical vitamin in which many individuals are deficient is vitamin D. Failure to take in adequate amounts of this vitamin can produce widespread effects, and we may notice symptoms ranging from sluggishness to more alarming consequences, including bone loss.

Below, we’ll take a deeper look how this powerful nutrient helps to support optimal health. We’ll also discuss appropriate values to help you determine whether you’re a good candidate for supplementing vitamin D with nutraceuticals.

Role of Vitamin D


Vitamin D can be absorbed through exposure to sunlight, the role of vitamin D is multifaceted and can include regulation of calcium and phosphorus

The body can take in vitamin D in two ways: through exposure to sunlight and through supplements. It is found naturally in very few foods, and even the foods it is found in contain only small amounts of the nutrient. [2]

Some fish and dairy products do contain minimal amounts of the vitamin, but not nearly enough to meet the recommended daily intake. For these reasons, many individuals aren’t getting enough vitamin D – when coupled with dietary gaps, lack of sunlight increases deficiency risk significantly.

When we don’t get enough vitamin D, it may have some impacts on our mood and how we feel, but there are also underlying effects taking place which may not be readily observable. Vitamin D is produced by the body when a person’s bare skin is exposed to UV rays from sunlight. It is synthesized from cholesterol when this exposure takes place. Thereafter, the role of vitamin D takes many forms.

Role of Vitamin D

The role of vitamin D takes on many forms including: 

  • Impact mood and how we feel
  • Regulates absorption of calcium and phosphorus
  • Promotes bone health
  • Reduces risk of fractures
  • Promotes neuromuscular and immune function
  • Influences cell growth
  • Reduces inflammation

Vitamin D Function as a Hormone

Vitamin D is involved in many important functions inside the body that support optimal health. It functions like a hormone, and every cell has a receptor for it. One job of vitamin D is to regulate the absorption of calcium and phosphorus.

Specifically, calcium absorption increases through calbindin (a calcium binding protein) in the small intestine with the assistance of calcitriol, the hormonally active metabolite of vitamin D.

The role of vitamin D in calcium absorption is so essential because together, these nutrients promote bone health – an extremely important factor for older women, who face a greater risk of osteoporosis. Without ample vitamin D, bones can become brittle, thin, or misshapen.

The risk of falls among the elderly is reduced by 20% with vitamin D supplementation, and the risk of hip and vertebral body fractures are also reduced. [3] Sufficient levels of the vitamin can also prevent osteomalacia in children, also known as rickets – a condition characterized by the softening and weakening of bones. [4]

Vitamin D and Inflammation Reduction

Vitamin D also has other critical functions in the body outside of bone health. It makes itself available to tissues all over the body and is turned into a chemical, a process which is called hydroxylation. As such, it supports a broad range of bodily activities including neuromuscular and immune function, modulation of cell growth, and reduction of inflammation. [5]

The link between vitamin D and immune system health is so strong that researchers have even observed an association between increased susceptibility to infection and vitamin D deficiency. [6]

Moreover, low levels of vitamin D in populations across the globe have been associated with autoimmune disease including type 1 diabetes, Crohn’s disease, and multiple sclerosis, while more recent studies indicate infections such as tuberculosis may also be linked to low vitamin D. [7]

In terms of combatting inflammation, the vitamin-D receptor appears to bind directly to DNA to activate a specific gene inhibiting inflammatory responses. This suggests that vitamin D could contribute to the control of immune and inflammatory conditions. [8]

Yet, despite the many powerful ways in which vitamin D contributes to optimal health and perhaps even aids in disease prevention, there continues to be an epidemic deficiency of the nutrient. Just how widespread is the vitamin D issue, and what are the consequences of not getting enough?

Low Vitamin D


Research suggested that the shift toward safe sun practice and the use of sunscreen may be decreasing vitamin D absorption, people with less sun exposure are also at risk of low vitamin D

Research suggests a staggering portion of the population is deficient in vitamin D. Low vitamin D was observed in three-quarters of U.S. teens and adults, and compared to results measured just a decade earlier, the trend is continuing to worsen.

While 45% of more than 18,000 people examined in 1994 had 30 nanograms per milliliter or more of vitamin D, the level physicians consider sufficient for wellness, ten years later that figure dropped to 23%. [9] With that being said, slightly more recent findings show some improvement: in 2011, 42% of the population exhibited low vitamin D levels, with the greatest deficiencies appearing in minority groups. The number increases to 69.2% in Hispanics and 82.1% in African-Americans. [10]

Nevertheless, the numbers are still concerning. Beyond dietary insufficiencies, what’s to blame for this sharp decline? For one, it is suspected that the shift towards safe sun practices have contributed to declining vitamin D levels. Even SPF 15 cuts the body’s vitamin D production by 99%. [11] We also see increases in deficiencies in some areas further north of the equator, where winter weather can inhibit sun exposure.

Specifically, people living at latitudes above 40 degrees are at a particular risk of a deficiency, because even if they do choose to venture outdoors during the wintertime, sunlight during that time of year is ineffective at stimulating the conversion of pre-vitamin D to vitamin D. [12] 

Symptoms of Low Vitamin D


Impaired wound healing and bone loss are concrete symptoms of low vitamin D, muscle aches and bone pain are symptoms of low vitamin D and may also be associated with a number of other culprits

With low vitamin D becoming such a widespread phenomenon, you might think the majority of the population would be ailing. While there are indeed some noticeable signs and symptoms of a vitamin D deficiency, these can often be attributed to other factors such as the aging process.

These symptoms of low vitamin D may also have a number of other culprits. Impaired wound healing and bone loss, on the other hand, may be more concrete signs of a deficiency.

Symptoms of Low Vitamin D

Symptoms of a vitamin D deficiency include:

  • Bone and back pain
  • Increased fatigue and tiredness
  • Muscle aches
  • Depression
  • Becoming sick more often
  • Impaired wound healing
  • Bone loss

Populations with Increased Risk of Vitamin D Deficiency

Business people who spend the majority of their time in doors may have an increased risk of low vitamin D, Individuals who wear total skin covers are also at an increased risk of being vitamin deficient

While the best way to increase vitamin D levels is by pursuing more sunlight exposure, this simply isn’t feasible for everyone – especially those living in areas further from the equator. Therefore, taking supplemental vitamin D is usually advised to help individuals reach their recommended daily intake. It is also critically important for certain populations to have their vitamin D levels checked.

Are You at Risk of Low Vitamin D?

Populations of increased risk of a vitamin D deficiency include: 

  • Perimenopausal women
  • People with dark skin
  • People with reduced bone density or other skeletal disorders
  • Individuals who wear total skin coverings
  • People with less exposure to sunlight [13]

Currently, the Reference Daily Intake (or RDI, the level of a nutrient considered sufficient to meet the requirements of most healthy individuals) of vitamin D for teens and adults up to 70 years old is 600 international units (IU). People over the age of 70 need a bit more and are advised to take in 800 IU. It is important to note that vitamin D is fat-soluble, meaning that it is absorbed by the body instead of being processed out via urine as is the case with water soluble vitamins.

Thus, it is critically important to take only trusted nutraceuticals, as toxicity is possible with fat-soluble vitamins. Also, be mindful of the form of vitamin D you take. It is available in both D2 and D3. The latter is the form that is synthesized in humans and the most effective form to take to increase vitamin D levels throughout the body.

Understanding the Role of Vitamin D – In Conclusion


For most people, it seems daunting to satisfy so many different dietary requirements each day. Not only are there calories and macronutrients to consider, but also micronutrients such as vitamin D. If you feel overwhelmed by these guidelines, you’re not alone.

At Cenegenics, our expert-led nutrition panel will help you optimize your eating habits in a way that is manageable and sustainable for the long-term. Moreover, we’ll perform a comprehensive assessment of your health by measuring and monitoring biomarkers to determine where any deficiencies may lie. Our nutraceuticals are made from the highest quality ingredients without any harmful additives to ensure your body receives all of the nutrients it needs to function at its best, both now and into the future.

If you’re interested in learning how the Cenegenics program can help you optimize your wellness through improved nutrition, among many other benefits, contact your nearest location today.

Next Steps in Combatting Low Vitamin D

Key Resources

This guide was produced with contributions from the following key resources: 

The Cenegenics Education and Research Foundation  

The Textbook of Age Management Medicine Volume 1: Mastering Healthy Aging Nutrition, Exercise and Hormone Replacement Therapy

Click to purchase

The Cenegenics Education and Research Foundation  

The Textbook of Age Management Medicine Volume 2: Mastering Healthy Aging Nutrition, Exercise and Hormone Replacement Therapy

Click to purchase

Textbook Authors:

Jeffrey Park Leake, M.D., CPT

Dr. Jeffrey Park Leake is a Partner and Director of Education at Cenegenics Elite Health specializing in age management and wellness. Having trained hundreds of physicians worldwide, Dr. Leake is also the Director of Education for the Clinical Strategies for Healthy Aging course at AMM Educational Foundation.

Todd David Greenberg, M.D., CSCS

Dr. Todd Greenberg is a practicing physician with a broad range of expertise, including wellness, exercise, sports injuries, and MRI of sports injuries. He is a Radiology Clinical Associate Professor at the University of Washington.

References

[1] “Listing of vitamins.” Harvard Health Publishing. 14 Aug. 2017. Retrieved from URL: https://www.health.harvard.edu/staying-healthy/listing_of_vitamins

[2] “Vitamin D Fact Sheet for Health Professionals.” National Institutes of Health (NIH). 09 Nov. 2018. Retrieved from URL: https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/

[3] Leake, Jeffery Park, M.D., CPT and Todd David Greenberg, M.D., CSCS. The Textbook of Age Management Medicine: Volume 1. Leake-Greenberg Ventures, LLC. 2015.

[4] NIH, see above.

[5] NIH, see above.

[6] Aranow, Cynthia, MD. “Vitamin D and the Immune System.” Journal of Investigative Medicine. 01 Aug. 2012. Retrieved from URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3166406/

[7] Hewison M. “Vitamin D and immune function: an overview.” Proceedings of the Nutrition Society. Feb. 2012. Retrieved from URL: https://www.ncbi.nlm.nih.gov/pubmed/21849106

[8] National Jewish Health. “How vitamin D inhibits inflammation.” ScienceDaily. 23 Feb. 2012. Retrieved from URL: https://www.sciencedaily.com/releases/2012/02/120223103920.htm

[9] Adit A. Ginde, MD, MPH et al. “Demographic differences and Trends of Vitamin D Insufficiency in the Us Population, 1988-2004.” Archives of Internal Medicine. 2009.

[10] Forrest KY and Stuhldreher WL. “Prevalence and correlates of vitamin D deficiency in US adults.” Nutritional Research. Jan. 2011.

[11] Adit A. Ginde, see above.

[12] Leake, Jeffery Park, M.D., CPT, see above.

[13] Tello, Monique, MD, MPH. “Vitamin D: What’s the ‘right’ level?” Harvard Health Publishing. 19 Dec. 2016. Retrieved from URL: https://www.health.harvard.edu/blog/vitamin-d-whats-right-level-2016121910893

Insulin resistance occurs when the body does not respond to insulin as it should, Causes of insulin resistance include genetics and obesity, insulin resistance treatment options include weight management and medications to manage high blood pressure or high cholesterol levels

Could You Be at Risk of Developing Insulin Resistance?

Insulin is a hormone produced by the pancreas which helps glucose, or blood sugar, make its way into cells throughout the body’s muscle, fat, and liver to be used for energy. Glucose is found in various amounts in different types of food. Blood sugar levels spike after you eat, prompting the pancreas to release insulin. Thereafter, insulin regulates blood sugar levels.

When the cells in your body no longer respond to insulin as they should, it impedes their ability to take glucose from the blood. As a result, glucose builds up in the blood. The pancreas goes into overdrive, producing even more insulin in response. This phenomenon is known as insulin resistance.

Insulin sensitivity is one of the most important markers of overall wellness. Insulin resistance is the hallmark of type 2 diabetes and is ultimately associated with the cascade of events that can cause metabolic syndrome, a cluster of disorders that increase the risk for stroke and heart disease, as well as premature cardiovascular-related deaths. [1]

Here, we take a closer look at insulin resistance to help you determine your risk and actively prevent against this serious condition. Additionally, patients who have already been diagnosed with insulin resistance will find treatment options below. 

How is Insulin Resistance Diagnosed?


Insulin resistance is often tested with a blood test or HOMA-IR score

If the pancreas is able to produce enough insulin to combat the cells’ weakened insulin response, blood glucose levels will stay within a healthy range. Thus, while diagnosing prediabetes and type 2 diabetes is fairly straightforward, testing for insulin resistance isn’t always as simple.

Laboratory tools such as the Homeostatic Model Assessment of Insulin Resistance, or HOMA-IR score, can be used to detect insulin sensitivity. A HOMA-IR score of less than 1.0 indicates healthy insulin sensitivity, whereas a score between 1.7 and 2.4 suggests insulin resistance.

A score of 2.6 is the cutoff for prediabetes. [2] A series of other diagnostic tests, combined with a review of the patient’s medical history and symptoms, may also be used to help doctors diagnose insulin sensitivity.

When the blood glucose levels are elevated but not high enough to be considered type 2 diabetes, patients are diagnosed with prediabetes. This occurs when patients have some insulin resistance or the pancreas isn’t producing enough insulin to keep blood sugar at a normal level.

Excess glucose therefore builds up in the bloodstream instead of being used by the cells, and 15-30% of people with prediabetes will be diagnosed with type 2 diabetes within 5 years. [3]

The good news is that with both insulin resistance and prediabetes, it’s possible to make lifestyle changes to prevent or delay diabetes and other serious health conditions. We’ll discuss insulin resistance treatments in an upcoming section, but first let’s examine the causes of insulin resistance.

What Are the Causes of Insulin Resistance?


one of the major causes of insulin resistance is being overweight or obese, Storage of excess body fat in the abdomen can cause chronic inflammation and factors into insulin resistance

Experts have yet to develop an exact understanding of the mechanisms behind insulin resistance and prediabetes, but a few major factors have been established as playing a role in the conditions.

Being overweight or obese, for example, is an important cause of insulin resistance. Storing excess fat around the abdomen, known as visceral fat, is an especially noteworthy contributing factor. For men, a waist measurement of 40 inches or more has been linked to insulin resistance, whereas 35 inches or more becomes concerning for women.

This is likely due to the fact that abdominal fat can produce hormones which contribute to chronic inflammation. [4] Inflammatory factors parallel insulin sensitivity. [5]

In addition, insulin resistance has been attributed to leading a sedentary lifestyle, as it’s suspected that exercise spurs bodily changes which help to maintain healthy blood sugar levels. Physical activity has been shown to decrease insulin resistance in previously sedentary adults. [6]

Risk Factors

Beyond physical inactivity and having excess visceral fat, populations with certain genetic or lifestyle risk factors may face an elevated risk for developing insulin resistance. 

Risk Factors of Insulin Resistance

Excess abdominal fat and lack of physical activity largely contribute to insulin resistance. Additional factors include:

  • Being over the age of 45
  • Having a parent or sibling with diabetes
  • Elevated cholesterol or blood pressure levels
  • A history of heart disease or stroke
  • Polycystic ovary syndrome
  • Certain medications, including antipsychotics and drugs for HIV
  • Hormonal disorders, including Cushing’s syndrome
  • Sleep disorders, such as sleep apnea

With these risk factors in mind, let’s explore some of the possible symptoms of insulin resistance.

What Are the Symptoms of Insulin Resistance?


Diagnosing insulin resistance becomes further complicated by the fact that patients typically exhibit no symptoms. When the condition progresses to the point of prediabetes, patients may notice darkening of the skin in certain areas, such as the armpit or neck. Skin tags may also develop.

In some cases, patients may experience fatigue, weight gain, excessive thirst, and excessive urination. Nonetheless, these symptoms typically don’t manifest until the condition has surpassed the levels of insulin resistance and prediabetes or type 2 diabetes have developed.

The absence of symptoms can indeed complicate the ability to diagnose and treat insulin resistance. Nonetheless, whether you suspect you could be at risk for insulin resistance or you’ve already been diagnosed, the following lifestyle changes can benefit everyone.

Insulin Resistance Treatment Options


The most effective insulin resistance treatment is weight management, the incorporation of a heathy diet and regular exercise may decrease risk of insulin resistance and type 2 diabetes

One of the most effective insulin resistance treatments is for overweight or obese patients to reach a healthy weight. This can be achieved both through diet and exercise.

Although low-fat diets were advised for weight loss in the past, experts now recommend the modernized and more effective approach of incorporating healthy fats into the diet, along with nutritionally dense yet low-calorie foods such as vegetables and lean protein.

Most importantly, minimizing intake of processed foods and increasing foods with a low glycemic index can make positive changes towards a healthier insulin sensitivity. [8] Glycemic index measures the ways in which the blood glucose levels are impacted by the food product. Foods such as white breads and pastas tend to have the highest glycemic index scores.

Exercising regularly can also spur weight loss, and is believed to support the metabolism which may help to control or prevent insulin resistance. [9] Certain types of exercise, such as high-intensity interval training (HIIT), tend to reduce visceral fat specifically. [10]

Finally, controlling any other risk factors, such as high blood pressure or cholesterol, may help to prevent the development of prediabetes or type 2 diabetes.

Insulin Sensitivity as an Indicator of Overall Wellness – In Conclusion


Without an in-depth analysis of a patient’s biomarkers, conditions such as insulin resistance can be easily overlooked. Yet, like many other precursors for serious disease, insulin resistance is most effectively addressed in its early stages. It’s therefore critical that at-risk populations, including adults over the age of 40, overweight or inactive individuals, and people with a family history of type 2 diabetes, have their insulin sensitivity routinely tested.

At Cenegenics, our clinicians remain focused on disease prevention by addressing any current warning signs while also giving patients the tools they need to optimize their health moving forward. T

hrough comprehensive lab work, patient-oriented treatment approaches encompassing individualized meal and exercise plans and ongoing vigilance, our specialists help patients navigate conditions such as insulin resistance and prediabetes successfully. The end result is better health and vitality, both now and into the future.

If you’re interested in discovering how Cenegenics can help you unlock the healthiest version of yourself, contact your nearest location today.

Next Steps in Understanding Insulin Resistance

Key Resources

This guide was produced with contributions from the following key resources: 

The Cenegenics Education and Research Foundation  

The Textbook of Age Management Medicine Volume 1: Mastering Healthy Aging Nutrition, Exercise and Hormone Replacement Therapy

Click to purchase

The Cenegenics Education and Research Foundation  

The Textbook of Age Management Medicine Volume 2: Mastering Healthy Aging Nutrition, Exercise and Hormone Replacement Therapy

Click to purchase

Textbook Authors:

Jeffrey Park Leake, M.D., CPT

Dr. Jeffrey Park Leake is a Partner and Director of Education at Cenegenics Elite Health specializing in age management and wellness. Having trained hundreds of physicians worldwide, Dr. Leake is also the Director of Education for the Clinical Strategies for Healthy Aging course at AMM Educational Foundation.

Todd David Greenberg, M.D., CSCS

Dr. Todd Greenberg is a practicing physician with a broad range of expertise, including wellness, exercise, sports injuries, and MRI of sports injuries. He is a Radiology Clinical Associate Professor at the University of Washington.

References

[1] Leake, Jeffrey Park, M.D., CPT, and Greenberg, Todd David, M.D., CSCS. Textbook of Age Management Medicine: Volume 1. Leake-Greenberg Ventures, 2015. p.43

[2] Leake, Jeffrey Park, M.D., CPT, and Greenberg, Todd David, M.D., CSCS; see above.

[3] Pletcher, Peggy MS, RD, LD, CDE. “What’s to know about insulin resistance?” MedicalNewsToday. 17 Feb. 2017. Retrieved from URL: https://www.medicalnewstoday.com/articles/305567.php

[4] National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). “Insulin Resistance & Prediabetes.” Retrieved from URL: https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance

[5] Leake, Jeffrey Park, M.D., CPT, and Greenberg, Todd David, M.D., CSCS; see above; p. 29.

[6] Leake, Jeffrey Park, M.D., CPT, and Greenberg, Todd David, M.D., CSCS; see above; p. 313.

[7] NIDDK; see above.

[8] Leake, Jeffrey Park, M.D., CPT, and Greenberg, Todd David, M.D., CSCS; see above; p. 29.

[9] Donson, Laura. “Insulin Resistance Symptoms, Causes, and Treatment.” VeryWell Health. 03 Jan. 2019. Retrieved from URL: https://www.verywellhealth.com/what-is-insulin-resistance-2242260

[10] Leake, Jeffrey Park, M.D., CPT, and Greenberg, Todd David, M.D., CSCS; see above; p. 136

VO2 Max Testing is one of the most significant tests when analyzing a patient’s ability to utilize oxygen, The results of the VO2 Max will help your Cenegenics clinical team determine the best fitness program for you

The Importance of VO2 Max Testing: How to Read Your Results


One of the unique advantages of Cenegenics’ Age Management program is the comprehensive testing performed by our clinical team. With a full panel of age management experts, we thoroughly screen each patient to achieve as robust a measurement of overall wellness as possible. While each test we perform holds tremendous value in terms of directing our physicians in developing an individualized program, one of the most significant parameters analyzed is a patient’s ability to utilize oxygen during exercise. This is measured through VO2 max testing.

Importance of VO2 Max Testing at Cenegenics


VO2 max testing assesses the maximal oxygen consumption of an individual during periods of intense, strenuous exercise. It is currently considered to be the gold standard of measuring cardiovascular fitness among medical experts and is hailed for its ability to accurately assess cardiorespiratory functioning.

Not only does this test indicate aerobic fitness levels of a specific individual, it also provides a wealth of useful information on which specific directions can be provided for training purposes. Additionally, VO2 max testing unlocks powerful insights into overall wellness, including warnings of potential cardiac or respiratory disease symptoms.

At Cenegenics, VO2 max testing is a primary component of each Elite Health Evaluation, and our clinical team uses the results of this test to create your individualized program for optimal results.

What is VO2 Max Testing? 

VO2 Max Testing at Cenegenics, Exercise room with VO2Max Test cycling equipment

There are various ways to perform a VO2 max test, the most common including use of a treadmill or cycle ergometer, both of which measure energy expenditure. Through the treadmill method, the participant begins by walking on a treadmill at a 10% grade.

Every two minutes, both the treadmill’s speed and grade will increase until a maximal work output or volitional failure is achieved. While this is considered to be the most thorough means of testing, as it requires the use of the entire body, it also presents significant risk of injury.

This is a maximal exercise test that is intended to push participants to reach levels of exhaustion, which, on a treadmill, can lead to the risk of falling. The proper precautions must therefore be implemented to ensure the safety of participants.

As an alternative to the treadmill test, the cycle ergometer is used as a safer option. At Cenegenics, we perform VO2 max tests via cycle as it is a much more efficient and less dangerous method for our clients. Additionally, it still provides valid, valuable results and information.

How Does a VO2 Max Test Measure?

A VO2 max test employs the use of a mask, which is worn by the participant during the exercise and connected to a metabolic cart where biometric measurements are recorded. As the participants breathe, the air is collected in a mixing chamber where the gas is analyzed.

When the air enters the chamber, both the volume of air and the ratio of carbon dioxide to oxygen are measured. The testing system uses specialized software, which can determine the energy expenditure of the exercise.

As the level of exercise intensity increases, the amount of carbon dioxide expelled while breathing also increases. These readings allow physicians to determine which fuel sources are being used in the body, (fats or carbohydrates) during a given point of time throughout the test. This proves to be beneficial for assigning customized training values for patients.

How to Read VO2 Max Test Results

Our cutting-edge VO2 max software provides a host of extremely useful information. Here, we will discuss the practicality and application of the data derived from the testing.

One of the most outstanding qualities of this test is its ability to track all of the following data in 15-second intervals for the duration of the entire test, allowing our physicians to observe not only the changes that occur but also how quickly physiologic markers shift as the exercise intensity increases.

Relative and Absolute VO2 Max

Absolute VO2 max (L/min) is a total value, while relative VO2 max (ml/kg/min) takes body weight into consideration. The relative value is therefore a more precise indicator of overall health than the absolute value.

For example, an individual may have a high absolute value, but when factoring in body weight, it is determined that they have a very low relative value which indicates less than ideal health. See the below chart for Relative VO2 Max Norms from the American College of Sports Medicine.

METS identify the amount of oxygen consumed at rest, graph of metabolic equivalent ranges for men and women

Metabolic Equivalents (METS)

Also known as metabolic equivalents, METS identify the amount of oxygen consumed at rest. One MET is defined as 3.5 ml/kg/hour, which is equivalent to the energy cost of sitting idly. This measurement provides a simple and straightforward means of measuring exercise intensity via oxygen consumption, and may be particularly beneficial for training.

Most treadmills now have a feature that will display the METS of a certain intensity level. An exercise physiologist or similar professional may prescribe an exercise plan using METS as a frame of reference for appropriate levels of intensity during physical activity.

Carbon Dioxide Expelled (VCO2)

VCO2 (L/min) is a value that goes hand-in-hand with VO2. As exercise intensity increases, so too does oxygen consumption (VO2). Thus, as more oxygen is consumed, more CO2 is created and expired through breathing.

The volume of carbon dioxide expelled after transporting oxygen throughout the body is measured by VCO2. CO2 is also created as a byproduct of energy production inside the body during rigorous exercise; we will cover that in greater detail in an upcoming section.

Ventilation (VE)

VE (L/min) refers to ventilation. In simpler terms, VE defines the movement of air via breathing. Ventilation therefore increases with exercise intensity, as the need to supply the body with oxygen and remove carbon dioxide increases. VE can also be correlated with the ventilatory threshold (described below) and used for training purposes

Tidal Volume (VT)

VT (L) is tidal volume. It is the volume of air that is transported into and out of the lungs with each respiratory cycle or breath. As exercise intensity increases, a larger oxygen demand is placed on the working tissue, demanding a larger volume of air per breath, more breaths per minute and an increased heart rate.

Respiratory Rate (RR)

Respiratory rate, or RR, is measured in breaths per minute. At rest, an adult averages 12 to 20 breaths per minute. As activity intensifies, respiratory rate will increase. With that said, elite athletes have the ability to maintain a lower RR even while performing high-intensity exercise, due to optimal cardiovascular conditioning.

Heart Rate (HR)

Heart rate (HR) is measured in beats per minute (bpm). Increased exercise intensity requires an increased oxygen demand to the body. In order to meet that demand, heart rate must increase to facilitate the transportation of oxygen to the working muscles. Both resting and exercising heart rate can be influenced by factors such as medication, stress levels, hormones, weight, and fitness level.

Most individuals have a resting heart rate between 60 and 100 bpm, but trained athletes may have a resting HR as low as 40 bpm. In general, physicians tend to recommend a target heart rate during moderate exercise of roughly 50-70% of maximum HR, or 70-80% of maximum HR during vigorous exercise. Keep in mind that maximum heart rate may vary by age and other factors, so physician oversight is essential to ensuring patients are exercising within safe HR zones [1].

Respiratory Exchange Ratio (RER)

RER stands for respiratory exchange ratio. It is among the most valuable pieces of information derived from a VO2 max test. RER determines the ratio of CO2 to O2 used, and it is indicative of the fuel source being used by the body. RER operates on a scale of 0.7 to upwards of 1.0, with 0.7 indicating utilization of fats for fuel and a measure of 1.0 or higher designating use of carbohydrates. This can be determined by the amount of CO2 in the air exhaled by the subject.

During periods of rest, we utilize fats as a fuel source and would therefore have an RER of 0.7. This is because breaking fat down for fuel requires oxygen and time. It is a slow process, so while at rest or during low-intensity exercise, our bodies are able to get enough oxygen to break down fats for fuel.

As exercise intensity increases, however, the body is no longer able to break down fats quickly enough to provide energy. It therefore needs to pull from carbohydrates stored in the muscles, known as glycogen stores. Carbohydrates require little oxygen to be broken down as fuel, and compared to breaking down fats, the process is completed fairly quickly.

As more carbohydrates are utilized to keep up with energy demands, however, fewer fats are used. The RER will then begin to shift up to 1.0. Typically, around the 1.0 mark the individual is anaerobic, meaning energy production depends fully on carbohydrates and there is a lack of oxygen to create energy.

Why Do a VO2 Max Test?


Man cycling for cardiovascular health, Vo2 Max Testing is the most effective predictor of long term health

With all of the aforementioned data points provided by a VO2 max test, participants are provided with a better understanding of their overall health, potential disease risk factors, and fitness levels. The VO2 max test is one of the most effective predictor methods of long-term health and significant disease risk – so much so, in fact, that the American Heart Association (AHA) has released a statement on the reliability of cardiorespiratory fitness (synonymous with VO2 max) as an effective indicator of health risk factors.

Additionally, emerging evidence is increasingly linking low VO2 max values with high risk of cardiovascular disease and all-cause mortality. It is even proving to be a more dependable indicator than other risk factors, including smoking, hypertension, diabetes, and high cholesterol.

When evaluating overall health, the relative VO2 max and METS are the values of most importance. The relative value provides an accurate determination with oxygen consumption levels with regards to weight, which provides greater insight into an individual’s overall wellness. Meanwhile, per the AHA, METS can be used as an indicator of high-risk mortality, with a measure of less than five indicating high risk, and a METS of 8 to 10 associated with a better chance of survival.

woman running to improve her cardiovascular health, Vo2 Max Test helping woman shape her training plan to further improve fitness and health

Not only does VO2 testing accurately assess health, but it also measures overall fitness levels and provides practical information, in order to prescribe precise training plans to further improve fitness and health. While not all exercise equipment or fitness trackers have the ability to analyze VO2, one of the best ways to apply this data to an individualized training program is by using a common, accessible value such as heart rate (HR).

Most modern exercise equipment, fitness trackers, and smartphones have the ability to measure heart rate and provide the user with instant feedback. By using heart rate as a method of prescribing exercise, patients can match a heart rate zone to a desired intensity to elicit a specific result.

How, precisely, is this done? If a lower training intensity or steady-state cardiovascular exercise is ideal for the patient’s need, the physician would match the RER of roughly 0.85 to the patient’s respective heart rate value and recommend that they stay in that range.

Likewise, if high-intensity interval training (HIIT) would best support the patient’s goals, the physician would recommend a heart rate value that could be achieved in accordance with an RER of 1.1. (If not 1.1., the patient might aim for the highest value over 1.0 prior to cooling down). That heart rate value is the target HR to shoot for when doing HIIT to achieve an anaerobic state, which ensures the full benefits of this style of training are realized. If the heart rate is too low, on the other hand, there may be insufficient stimulus to truly achieve the benefits of HIIT training.

Maximizing Results at Cenegenics with VO2


At Cenegenics, we do not simply use VO2 max testing as a means of assessing health; we also use the data derived from the test to continuously support a demanding, comprehensive program to potentiate real results and minimize risk factors for age-related disease. After completing a VO2 max assessment at a Cenegenics facility, the patient’s data is then analyzed by an age management physician, as well as a qualified exercise and nutrition counselor, and used to assess risk and develop a training program created exclusively for that individual.

Using the aforementioned process and associating heart rate values with target RERs, a target heart rate zone will be prescribed as a goal to reach during exercise. By working within this target range, the patient will achieve anaerobic exercise and stimulate the EPOC response.

EPOC stands for excess post-exercise oxygen consumption, which refers to the period of time following physical activity during which the body uses oxygen to generate adenosine triphosphate (ATP), clear out lactate, return normal oxygen flow to the rest of the body, and restore the body temperature to a normal level. During this time frame, the body will be more metabolically active and continue to burn additional calories as a result. HIIT training is the most effective way to achieve EPOC, whether through running, rowing, biking, or using resistance exercise.

Man performing HIIT training on track, Man sprinting during HIIT training workout

HIIT training involves short bursts of exercise performed at an all-out intensity level, typically lasting from 10 to 30 seconds, followed by a short 45 to 60 second rest period. These durations vary based on fitness level. For instance, after a five-minute warmup, a HIIT routine might involve a 15-second max sprint followed by a 45-second rest, repeated for a total of ten minutes and followed by a five-minute cool down.

In just 20 minutes, the amount of work done and caloric expenditure can exceed that of a 30 to 45 minute low-intensity steady state workout. It is for this reason that HIIT is widely recommended by Cenegenics physicians and favored by Cenegenics patients.

The results of using VO2 max testing to prescribe exercise programs and implement wellness measures to lower disease risk speak for themselves. Cenegenics patients are not only better able to achieve their weight loss goals and maintain their results; they are also more energized, alert, and healthier overall. If you are interested in discovering the power of VO2 max testing firsthand, contact your nearest Cenegenics location today.

Key Resources

This guide was produced with contributions from the following key resources: 

The Cenegenics Education and Research Foundation  

The Textbook of Age Management Medicine Volume 1: Mastering Healthy Aging Nutrition, Exercise and Hormone Replacement Therapy

Click to purchase

The Cenegenics Education and Research Foundation  

The Textbook of Age Management Medicine Volume 2: Mastering Healthy Aging Nutrition, Exercise and Hormone Replacement Therapy

Click to purchase

Textbook Authors:

Jeffrey Park Leake, M.D., CPT

Dr. Jeffrey Park Leake is a Partner and Director of Education at Cenegenics Elite Health specializing in age management and wellness. Having trained hundreds of physicians worldwide, Dr. Leake is also the Director of Education for the Clinical Strategies for Healthy Aging course at AMM Educational Foundation.

Todd David Greenberg, M.D., CSCS

Dr. Todd Greenberg is a practicing physician with a broad range of expertise, including wellness, exercise, sports injuries, and MRI of sports injuries. He is a Radiology Clinical Associate Professor at the University of Washington.

References

[1] “Know Your Target Heart Rates for Exercise, Losing Weight and Health.” American Heart Association, Inc. 2018. Retrieved from URL: http://www.heart.org/en/healthy-living/fitness/fitness-basics/target-heart-rates


Cenegenics alternatives are often in the form of a low-T center, A low-T center focuses on low testosterone but does not focus on the causation of low-T symptoms

Traditional Low-T Centers May Be Causing You To Miss Out On Weight Loss

Article at a Glance

  • A low-T center focuses on low testosterone and bringing it within normal range. Sufficient monitoring is necessary to minimize side effects and risk, which is often lacking in most low-t centers.
  • Cenegenics all-encompassing approach is superior to a low-T clinic. Age management physicians focus on treating the hormone imbalance and the symptoms, but also investigate the root cause of the imbalance.
  • Cenegenics focuses on boosting energy, losing weight, enhancing libido, improving mental acuity, and achieving better sleep.

A Google search for “Cenegenics alternatives” yields roughly 35,600 results, and it is no surprise why. The world of age management medicine has exploded since the inception of our physician-founded program in 1997. From Ehormones to HealthGAINS, Andrologix to Royal Medical Centers, many hormone therapy services have emerged in response to the growing number of adults seeking out solutions for low hormone levels. Yet, as more and more individuals continue to prioritize their health through their middle ages and beyond, many continue to ask: How do Cenegenics alternatives compare to the original age management program?

As with many trailblazers, Cenegenics is superior in a number of ways. We are considered the “Gold Standard” in the industry, and beyond offering the best services for hormone treatment , our program extends far beyond hormone replacement therapy (HRT) and age management alone. If you are exploring your options for achieving optimal health and are wondering whether you might be able to attain the same results from a Cenegenics alternative, take the time to read through the following guide. From our comprehensive age management solutions that address all facets of adult wellness to our team of industry-leading specialists, we have cultivated a program for which, simply put, there is no viable alternative.

Going Beyond the Scope of a Low-T Center: Cenegenics Age Management


While there are indeed plenty of low-testosterone clinics to choose from, none compares to the robust age management solutions available through Cenegenics. Yet, many patients considering an alternative to Cenegenics might wonder whether such a comprehensive age management program is necessary. After all, if many of the issues associated with aging can be traced to hormonal changes, isn’t HRT enough? Not quite.

It is important to note that while hormone regulation is a critical element in a robust wellness program, for many adults, it is only one piece of the puzzle. Changing hormones can produce widespread effects, from impacting sleep duration and quality to posing ongoing weight challenges. Thus, while treating hormone imbalances themselves is a logical starting point for patients suffering from estrogen and testosterone deficiencies, a better approach is to treat not only the imbalance itself, but also the many frustrating symptoms it may produce, in concurrence.

physicians at a low-T center only focus on your testosterone levels, Cenegenics physicians focus on the root cause of your low testosterone, Cenegenics alternatives cannot compare to the all-encompassing Cenegenics Elite Health program

The Cenegenics difference lies in our commitment to helping you overcome all of the challenges associated with aging. We address health in the areas of sleep, cognition, weight management, libido, and energy levels, providing well-rounded yet individualized treatment to achieve real results. Our team excels in enhancing health across these five pillars through evidence-based, physician-developed strategies. Moreover, our approach is proactive: instead of waiting for the signs of serious age-related diseases to appear, we mitigate risk factors and facilitate optimal health. Our focus is not to simply bring patients within the “normal” ranges found in traditional medicine. In many cases, these readings are not actually healthy at all, and are based on the overall U.S. adult population which encompasses the 32% of people who are obese. We therefore target accurate representations of optimal health, going far beyond age management medicine.

For example, we adhere to the highest standards in heart disease prevention with the understanding that 1 in 4 fatalities are caused by heart events. [1] More alarmingly, 50% of people who experience a heart event were classified as “low risk” by the measures employed in traditional medicine. [2] We use carotid artery testing to detect risk of heart attack or stroke by measuring the thickness of artery walls. In addition to this and other forms of sophisticated heart health testing which are not used in traditional medicine, we perform an abundance of additional exhaustive testing and diagnostics, including 86 comprehensive labs. This allows our physicians to drill down and identify core conditions causing health issues such as low energy or inability to lose weight. Even expert physicians who are highly trained in optimal health cannot properly diagnose a patient without this extensive testing, which also includes neurocognitive testing, VO2 max, DEXA scans, and more to precisely measure all biologic and physiologic biomarkers, as well as physical performance and mental acuity.

Additionally, it must be noted that age-related factors such as hormonal decline are not the only issues responsible for causing sub-optimal health. Exercise and sleep, for example, are cornerstones for reducing the risk of age-related problems including:

  • Obesity
  • Frailty
  • Dementia
  • Heart disease
  • Cancer
  • Osteoporosis

With the addition of hormone regulation, the effectiveness of nutrition, exercise, and sleep prescriptions can produce tangible results for motivated patients. Cenegenics patients therefore experience the benefits of hormonal health along with many more. Burning fat and building muscle, optimizing cognitive function, achieving quality sleep, and improving both physical and sexual energy are just a few of the lasting advantages of program participation. Ultimately, patients who choose Cenegenics understand that hormone replacement is of little value without establishing good overall health.

Clinics that offer hormone replacement therapy alone give patients only a small glimpse into their overall health. Yet, Cenegenics clinicians understand how each hormone has a specific job, but overlaps the others to create a synergistic environment for improved wellness.

Our team also realizes that hormone imbalances can encroach on job performance– especially in a 21st century business landscape where poor lifestyle choices, diminished endocrine system, and ongoing career-related stress can collide. Because hormones perceptively alter sexual, physical, and cognitive functions, which often lead to psychological complications, our team takes a sophisticated approach to wellness optimization instead of narrowly addressing a single parameter of age management. In doing so, we guide our patients into an improved lifestyle, maximizing health potential to enjoy a more youthful way of life with the following benefits:

Improved Energy

Cenegenics addresses the addition of exercise to a person’s regimen as research suggests that obesity is strongly linked to low testosterone, Cenegenics alternatives do not address exercise as their main focus is low testosterone and not the root causes of the issue

By the age of 70, roughly 30% of muscle mass individuals had at the age of 20 is gone [4]. This often contributes to decreased strength, fatigue, and energy depletion. Our age management doctors specialize in determining whether lifestyle changes alone are enough to address declining energy levels associated with aging, or whether a more aggressive approach is needed to target an underlying cause of the symptom.

Better Sleep

A low-T center does not focus on sleep, Cenegenics focuses on patients getting better sleep as poor sleep quality can attribute to hormonal changes, Cenegenics alternatives may not address sleep issues such as sleep apnea or disordered breathing as a cause of low testosterone

Untreated sleep disorders increase the risk of death from any cause in older adults [5]. More than a third of Americans are poorly rested for more days out of the week than not, and nearly half the population (46%) is unable to achieve the recommended seven to eight hours of sleep every night [6].

While poor sleep is in certain cases attributed to hormonal changes, there are many other potential culprits. Specifically, there is a proven interplay between sleep and inflammation, especially in the cardiovascular system. Sleep-disordered breathing and obstructive sleep apnea, in particular, can be attributed to sleep issues for at least 24% of the population. By addressing sleep disorders, in addition to any contributing factors, Cenegenics physicians make the greatest possible improvement on both long- and short-term health in their patients.

Mental Acuity

It is in irrefutable fact that the mind changes with age. Yet, neural and cognitive functions are complex, and age-related changes to brain structure and function are not the same in all individuals. Moreover, age alone isn’t the only factor impacting focus, memory, and other cognitive functions. Lifestyle factors such as exercise, sleep, diet, alcohol consumption, and even caffeine intake can all influence brain health. Understanding the ways in which these factors affect the mind demands an extensive look into an individual’s current measures of health, medical history, and lifestyle. Through approaches such as nutraceuticals and prescriptive lifestyle adjustments, Cenegenics clinicians advise tailored preventive treatment programs to help patients minimize age-related cognitive decline.

Weight Loss

Cenegenics focuses on weight loss for obese patients as it can be a large contributor of low T, Cenegenics alternatives do not often focus on weight loss as part of their treatment plan of low T

Metabolic rate drops by 2% or more per decade after the age of 25 [7], making weight loss and weight regulation more challenging with age. However, it is important to understand that aging, and the fluctuations in hormone levels that go with it, cannot be solely blamed for the obesity epidemic. It is instead eating patterns that contribute to obesity, which is directly linked to morbidity from heart disease, cancer, diabetes, and high blood pressure [7]. Thus, any indication that a single hormone supplement will accomplish weight loss in itself is a falsehood, as there is no way to achieve sustainable weight loss without compliance to a healthy eating program.

Cenegenics physicians take into consideration the lifestyle factors, preferences, and nutritional needs of their patients to design a detailed dietary plan. In doing so, they help their patients make the transition towards mindful, healthy eating habits that will last, instead of dieting. The results are not only reductions in body fat, but also decreased risk of life-threatening conditions such as cardiovascular disease.

Increased Libido

A declining sex drive can take a toll on overall wellbeing, as well as the quality of a relationship. Low sexual interest can stem from a multitude of factors, including fatigue. Like weight management and sleep, addressing variances in libido necessitates a patient-centric approach. Our physicians therefore perform a comprehensive analysis into overall physical and mental health to determine the best course of action for each patient.

Cenegenics alternatives focus on increasing testosterone in order to increase libido, Cenegenics focuses on additional factors like weight management and sleep as low libido may stem from a multitude of factors

Overall, the comprehensive approach taken by Cenegenics is vastly different from those of most low-T clinics, many of which promise results with a few simple steps. True health optimization requires compliance with a demanding and comprehensive program. Low-testosterone clinics, conversely, advertise services such as medications shipped to you after a brief analysis. Unfortunately, these quick and easy approaches may overlook some significant indicators of health – which could have serious consequences.

How Cenegenics Differs from a Low-T Center: Unwavering Attention to Detail


Cenegenics clinical team take an all-encompassing approach compared to Cenegenics alternatives, The Cenegenics team ranges from phlebotomists to physicians in order to give the highest quality of patient care

Cenegenics’ comprehensive approach to health encompasses patient care from multiple sources, including wellness optimization physicians, exercise physiologists, phlebotomists, and nutrition & nutraceutical experts. They also look at the entire picture of patient health by taking into consideration key factors such as carbohydrate metabolism to observe the ways in which bioidentical hormones are impacting critical bodily functions.

Individualized Treatment

One important difference among Cenegenics and its competitors is our commitment to prioritizing the individual needs analysis. Our care providers treat each patient based on the specific nuances and combined circumstances impacting their health. While we understand that symptoms associated with low hormone levels may be one of the primary reasons why patients seek us out, our physicians also understand that a “one size fits all” modality is ineffective for treating these conditions. Instead, the complex interplay among nutrition, exercise, sleep, and genetic factors, among others, must all be considered and accounted for when developing a robust and effective health optimization plan.

To administer such a plan, Cenegenics collects in-depth, comprehensive lab values on patients at specific intervals. Contrast this with low-T centers, many of which boast a simple and easy three-step process. After the patient contacts the center, physicians from these low-cost options typically only perform a review of the patient’s sex hormone panel before prescribing medications. Yet, this significantly limits the physician’s understanding of how hormones are directly affecting carbohydrate and lipid metabolism, inflammatory markers, and kidney and liver function. More alarmingly, they may fail to address the treatment’s potential influence on prostate health. While low-T centers may perform lab work when subjective symptoms arise, Cenegenics is proactive in measuring the impact of bioidentical hormone use on prostate, kidney, and liver health, as well as other biomarkers.

By processing this information and regularly observing patients and patients’ biomarkers, our clinical team dynamically shifts and adjusts nutrition, exercise, and supplement goals and efforts, as needed, as patients respond and adapt over time. This allows us to make recommendations based on the individual’s needs analysis and prescribe only what will impact their biomarkers.

The Biomarkers of Aging

Only trained age management specialists can perform a comprehensive analysis of an individual’s biomarkers of age and provide individualized treatment based on these factors. Unlike our chronological age, the biomarkers of aging tell a different story. Made up of parameters such as muscle strength, cardiovascular performance, bone density, immunology, and mental acuity, they give age management specialists the most comprehensive overview of wellness when combined. Using this information, Cenegenics clinicians are able to develop customized exercise, nutrition, and supplementation programs – in addition to bioidentical hormone treatment fitting the precise needs of the individual.

Industry-Leading Specialists


age management medical practice, Cenegenics physicians differ from low-t center centers

Many low-cost clinics operate under one physician, while Cenegenics boasts 20 centers across the country supported by Cenegenics Partners, Center Physicians and Fellows trained in Age Management Medicine by the AMM Education Foundation. As our Partner and Director of Education for the Clinical Strategies for Healthy Aging course, Dr. Jeffrey Park Leake also co-wrote the Textbook of Age Management Medicine, available on Amazon. We pioneered the world’s largest age management practice, and with a focus on preventive care, have helped more than 35,000 patients worldwide dramatically improve their health and vitality. With optimal health as our primary focus, we bridge the gap between medicine and scientifically-based prevention, going far beyond addressing hormonal imbalances and achieving maintenance, not just repair.

We also hold our physicians against the highest set of standards to ensure the utmost quality of care for our patients. These specialists are highly trained in Cenegenics clinical tactics to aging, and only 1% of trainees meet the requirements needed to become a Cenegenics Physician Partner. Our physicians collaborate on complex patient health issues and are continually receiving clinical updates as proven, evidence-based science evolves to ensure each patient’s program remains cutting-edge and effective. Patients can therefore remain confident in the fact that health issues which arise can be detected early for preventive treatment, and that continuous monitoring will ensure their individualized Program is consistently updated to reflect emerging science and evolving goals.

The value of having a full team of health optimization specialists oversee your needs and progress through the program is beyond measure: it ensures every aspect of your health is being enriched to its fullest potential. Additionally, with a complete panel of specialists, we do not outsource:

  • lab services
  • diagnostic testing
  • clinical support
  • pharmacy items
  • nutraceuticals

This means all of the components of your wellness program will be overseen by Cenegenics and managed internally. Instead of waiting in a lab office, you will receive prompt and professional service through our phlebotomy network. Instead of going to multiple locations for testing, diagnostics are performed onsite for your convenience. We also have employed, onsite support staff, versus call center or remote health coaches. Finally, our patients receive custom pharmacy items, and efficaciously dosed, pharmaceutically tested, nutraceuticals with patented raw materials – instead of low-cost, generic retail supplements. In other words, Cenegenics believes that the quality of what goes into the body directly influences the quality of health outcomes.

A Better Patient Experience Over Cenegenics Alternatives


Cenegenics patients often have a better overall patient experience as compared to a low-T center, Cenegenics unwavering attention to detail helps patients combat low testosterone and its symptoms

While the attention to detail within Cenegenics program versus its alternatives is perhaps the most noteworthy difference, one final factor to bear in mind is the patient experience. While there is nothing wrong with seeking treatment elsewhere, lower-cost alternatives typically require more effort on the patient end. As a concierge, proactive medical service, the Cenegenics team takes significant measures to ensure compliance with a demanding, comprehensive program to potentiate real results and manage age-related disease risk. Through timely follow-ups, patient-focused care from day one, and an unwavering commitment to your precise wellness needs, our team ensures a positive experience in your journey towards optimal health.

Why a Low-T Center Is Not an Alternative to Cenegenics


A search for “Cenegenics alternatives” yields thousands of results, ranging from Ehormones to HealthGAINS, Andrologix to Royal Medical Centers, and it is no surprise why. The world of age management medicine has exploded since the inception of our physician-founded program in 1997. Many hormone therapy services have emerged in response to the growing number of adults seeking out solutions for low hormone levels, promising a low-cost few step solution. However none compare to the original Age Management Medical Practice, Cenegenics.

Cenegenics focuses on attention to detail, taking significant measures to ensure compliance with a demanding, comprehensive program to potentiate real results and manage age-related diseases. The accessibility to the Cenegenics clinical team – physician, nutrition expert, exercise physiologist and phlebotomist, allows timely follow-up in patient focused care to guarantee you are receiving an individualized plan designed specifically to accommodate your needs; Cenegenics is not a “one-size-fits-all” program.

Next Steps to Prioritizing Your Health with Cenegenics


Register for your complimentary phone consultation.

We hope the information above assisted you in your research process.

Key Resources


This guide was produced with contributions from the following key resources:

[1] Centers for Disease Control and Prevention. “Heart Disease Facts”. Retrieved from https://www.cdc.gov/heartdisease/facts.htm

[2] From Vulnerable Plaque to Vulnerable Patient—Part III: Executive Summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force Report. The American Journal of Cardiology. 2006.

[3] Boston, Gabriella. “Basal metabolic rate changes as you age.” Washington Post. 05 March 2013.

[4] Dennis, Helen. “Successful Aging: Causes of energy loss in older adults.” Los Angeles Daily News. 29 June 2015.

[5] Paudel et al. “Rest/Activity Rhythms and Mortality Rates in Older Men: MrOS Sleep Study.” Chronobiology International. 06 Apr. 2010.

[6] Sleep and tiredness survey. YouGov. 02 June 2015. https://today.yougov.com/topics/lifestyle/articles-reports/2015/06/02/sleep-and-dreams

[7] Stanford Health Care. Retrieved from URL: https://stanfordhealthcare.org/medical-conditions/healthy-living/obesity.html

Additional Information For Cenegenics Age Management Program 


What is Cenegenics?

What is Age Management Medicine?

What Does Cenegenics Cost?

Cenegenics Elite Health Program: Why You Should Consider Age Management Your Next Investment

Anti-Aging vs. Age Management

Weight Loss on the Cenegenics Age Management Program

Defy Your Age™ with Cenegenics

What is Testosterone Replacement Therapy (TRT)?

Cenegenics is the clinical leader in age management medicine, Cenegenics uses preventive care which begins with a comprehensive elite health evaluation, additional testing such as telomere or heart attack and stroke prevention program can be added for an additional cost, the cost of Cenegenics can vary based on location

Youth is a Feeling – Not a Number

Start with a Highly Comprehensive Full-Day Assessment

Custom Designed Cenegenics Age Management Program

Cenegenics Weight Loss Programs: Better Understanding the Role of Nutrition and Exercise

A Pillar of Cenegenics Success: Close Monitoring and Consultation

Does Cenegenics Work?

Are You Ready to Live a Healthier, More Active Life?

About the Senior Cenegenics Physician, Dr. Leake

Aging is Aging, Right?

Conventional wisdom might say so.

From lower energy levels to chronic pain and loss of muscle tone, there are many symptoms older adults experience that are considered to be “just a part of aging.” Declining libido and weight management challenges are a few additional conditions people witness with age, and the common sentiment is that there isn’t much we can do about it.

Not True

There is something you can do to take control of your health as you age: proactive age management. Based on science and proven by medical research, modern anti-aging solutions are powerful treatments used to improve the quality of life for individuals as they enter their later years.

Optimal health takes your wellness beyond the “normal ranges” found in traditional medicine – which, in many cases, aren’t very healthy at all – empowering you to become the healthiest version of yourself. After all, ranges considered normal by the US population are commonly not ideal, or even acceptable, as 39% of the US adult population being overweight or obese.

Moreover, optimal health encompasses exhaustive testing and diagnostics which enables expert physicians to drill down and identify underlying conditions which could be contributing to persistent health issues, such as low energy or inability to lose weight. At Cenegenics, this approach is at the heart of what we do.

Cenegenics is the Defining Clinical Leader in Health Optimization Medicine

Founded in 1997, Cenegenics is recognized in the medical community for its pioneering work in age management medicine. Its physicians are the leading authorities in the field, with Jeffrey P. Leake, M.D., Senior Physician and Director of Education for Cenegenics having co-authored the Textbook of Age Management Medicine. This guide serves as the foundation for clinical practice and was written based on Dr. Leake’s decade of experience at Cenegenics.

The entire Cenegenics team is passionate about helping individuals overcome the challenges of aging, enabling you to reclaim your glory days™. Here are some compelling statistics to note:

  • 1 in 3 adults suffers from high blood pressure, while only 54% of these individuals are actively controlling it
  • 70% of adults are overweight, while 34% have obesity
  • 80% of adults have at least one chronic health condition, while 50% have two or more [2]

While these conditions are not exclusive to older adults alone, we do know that aging can exacerbate symptoms or make an individual more prone to developing them. We are living longer now and, as such, there is an increasing demand to provide older adults with the specialized care they need and deserve.

This is precisely what Cenegenics aims to do. We take age management a step further by providing personalized, physician-developed optimal health programs to Defy Your Age™, taking an all-encompassing approach to improving wellness. Read on to find out how our programs work, and to learn what our services can do for you.

Start with a Highly Comprehensive Full-Day Assessment

A highly trained expert physician in optimal health cannot properly diagnose a patient without extensive diagnostic testing. This should include not only lab panels and physical exams, but also more robust assessments including carotid artery, neurocognitive, VO2 max testing, body composition, and bone mineral density testing.

The starting point of the Cenegenics program is the most comprehensive preventive health evaluation in the industry. It goes far beyond many well-known “Executive Health” evaluations, digging deep to establish as thorough a representation of a person’s health as possible. Our rigorous testing precisely measures all biologic and physiologic biomarkers, as well as physical and neurocognitive functioning, and includes:

1. Medical History and Lifestyle Assessment

Are you always tired? Have you struggled to lose weight and tone as aging progresses? Perhaps you’re experiencing hormone problems or seeking ways to improve sex drive. No matter which health issues you’re facing, the Cenegenics team wants to hear about it.

During the lifestyle assessment, you’ll provide information about your day-to-day living habits, including activity levels and eating patterns. You will also be asked to provide details about any noteworthy health issues, procedures, or other experiences you have to formulate a well-rounded overview of your medical history. This information will help the specialists shape a highly personalized program according to your unique needs.

2. Comprehensive Labs

The extensive lab panel measures a broad range of health indicators, including: CBC (complete blood count), evaluations on hormone levels, cardiac disease risks, lipid panels, homocysteine levels, potential prostate issues (in men), and urine analysis, among others. The results will reveal markers for disease risk and low hormone levels below the healthy range, which our programs can restore. It will also provide the opportunity to address any underlying conditions, if needed.

3. Physical Evaluation

When is the last time you received a full physical exam? Fewer than a quarter of all visits to family physicians are from older adults [1], which suggests that seniors aren’t seeking out preventive health care services as often as they should be. The ability to catch potentially life-threatening illnesses early on lies in routine physical examinations. The Cenegenics staff is adept at performing comprehensive, efficient exams.

Beyond drawing attention to serious health issues, physicals also provide medical experts the opportunity to take vital signs and spot any abnormalities which may have otherwise gone unnoticed. The findings from your physical will also factor into your comprehensive optimal health plan.

4. Dual Energy X-Ray Absorptiometry (DEXA)

The number we see on the scale only tells us one thing about our bodies. Calculating body composition, however, is far more involved than that. A number of complex factors contribute to our bodily makeup, which is why we use state-of- the-art DEXA scanning to measure:

  • Lean muscle mass
  • Body fat percentage
  • Bone mineral density

DXA, DXA scan, DEXA scan, physician, doctor consultation, physician consultation, physician consulting patient, patient testing, body fat test, doctor’s office

Each Cenegenics center offers a series of comprehensive scans that provide the most accurate measurements of bone and cardiometabolic health to help specialists develop a data-driven approach to clinical treatment. If you have a condition such as poor bone health, for instance, it can be analyzed quickly, allowing you to receive an initial treatment plan tailored specifically for you upon your first physician visit. Additional risk factors are assessed that correlate with visceral body fat levels, including diabetes, cardiovascular disease, and metabolic syndrome.

5. Cardiopulmonary Exercise Testing – CPET

VO2 Max Test, oxygen consumption test, exercise consultant, physiology, exercise physiology, bike, training, male trainer, exercise consultation, consultation

If you’re suffering from a lack of energy, this test could yield significant insights as to why. A VO2 Max test will measure your volume of oxygen consumption by assessing your ability to perform sustained exercise at maximum exertion. If there is an obstacle getting in your way of pursuing a weight loss program through fitness, this may be the test to help uncover it. It is generally considered the best indicator of cardiovascular fitness and aerobic endurance.

VO2 Max Results allow us to design a program that will help:

  • Maximize fat burning potential based on the best way to lose weight for your body type
  • Condition the heart to become stronger both during physical activity and periods of rest
  • Improve exercise efficiency to help you achieve powerful results

6. Carotid Artery Ultrasonography – Carotid Intima-Media Thickness (CIMT) Exam

woman in doctor’s office, doctor consultation, doctor’s appointment, CIMT, ultrasound evaluation, ultrasound, carotid artery, carotid artery ultrasonography, carotid intima-media thickness exam, ultrasonography

Heart health is among the most important areas of focus within the Cenegenics program. One in four fatalities are caused by heart events [3], and traditional medicine mischaracterized 50% of patients as “low risk” who later went on to experience a heart event [4]. We aim to change these statistics with a more accurate assessment of heart attack risk, and by preventing heart events in at-risk populations with effective, proactive interventions.

The carotid arteries (there are actually two – one on either side of the neck) supply blood to the brain, making this artery branch one of the most important systems in the body. A clinical examination of the arteries can uncover important evidence of conditions, leading to diagnosis and treatment. Inflammation of the artery, for instance, could point to an autoimmune disorder or previously undetected infection. Weakness and bulging in the artery can also indicate a number of ailments, which upon further investigation, may be treated effectively.

The CIMT Test is an FDA-approved, noninvasive advanced ultrasound evaluation of the carotid arteries. This evaluation allows for detection of existing plaque and provides a highly precise measurement of the thickness of the artery wall. Thickening of the artery wall is an early sign of vascular disease and relates to your risk of heart attack as well as stroke. Early detection allows for the formulation of proactive strategies to reduce your risk for these catastrophic events.

Both this test and the other sophisticated heart health testing provided by Cenegenics provide powerful insights into cardiovascular health, but are not commonly practiced within traditional medicine.

7. Neurocognitive Assessment

neurocognitive assessment, neuro exam, brain function, memory, cognitive exam, CNS Vital Signs

One critical aspect of optimizing health as you age is maintaining – and in some cases, even strengthening – cognitive abilities. We begin to experience cognitive decline as early as our mid-twenties, with the decline in thinking and reasoning skills, memory impairment, and a decreased ability to maintain focus and solve problems becoming more pronounced thereafter [5].

While cognitive decline is indeed a scientifically proven aspect of aging, that isn’t to say that there’s nothing that can be done about it. Through our computerized cognitive assessment, CNS Vital Signs, we are able to evaluate important brain functions including memory, processing speed, executive function, and many other vital activities. Once on the Cenegenics program, patients often witness a significant improvement in cognitive performance. This is because our optimal health solutions are not focused on one area of wellness exclusively; instead, we firmly believe that supporting both the mental and physical aspects of well-being are essential to overcoming age-related challenges.

8. Core strength and flexibility assessment

If you’ve ever embarked on a weight loss program, you know that eating a balanced diet and maintaining physical fitness are the best ways to lose weight. While strength and flexibility are not the only markers of vitality, they are considered important measures of fitness. By assessing your current fitness levels, the Cenegenics team will be able to forge a comprehensive strategy to help you reach your goals.

9. Comprehensive exercise and nutrition assessment

Many individuals who enter the Cenegenics program want to know how to lose weight quickly. A better question would be: How can I lose weight in a way that’s sustainable for my lifestyle? With an in-depth assessment, we will unlock the answers to this question. With that said, the program will still provide enough challenge, forcing the body to adapt, spurring noticeable results.

10. Food Allergy & Immunology Testing*

An analysis of diet-induced sensitivity pathways provides individual insights into inflammation-provoking foods and food chemicals specific to your body’s own response, which could be interfering with your health goals. Food sensitivities and allergies are commonly perceived as initiating minor, temporary symptoms. Unfortunately, not all symptoms are recognizable and, more frustratingly, many symptoms associated with food allergies can be attributed to other issues.

Something as seemingly innocent as gluten could be creating a chronic inflammatory reaction within your body, causing you to experience persistent discomfort and acting as a barrier against your wellness goals. More specifically, a spike in white cells caused by an allergy can have a pro-inflammatory and pro-algesic mediator release. It is the interplay between these pro-algesic mediators (cytokines, histamines, and prostaglandins) and analgesic mediators that causes inflammatory pain. Left untreated, high levels of pro-algesic mediators can have a chronic inflammatory response which can develop into both short-term conditions and long-term disease. Our specialized diagnostics are used to assess these levels, helping our clinical team derive data-driven insights that can factor into your wellness strategy.

11. Micronutrient Analysis*

Although needed only in small amounts, micronutrients play a vital role in a number of key bodily functions, including: hormone production, immune function, enzymatic function, and metabolism of glucose, fatty acids, and amino acids. Micronutrients are also needed to support general cell replication and repair – two factors which are critical to fighting the effects of aging. By understanding micronutrient imbalances within your system, we can identify any risk factors that could contribute to degenerative diseases, balance deficiencies that could otherwise hinder anti-aging treatment, and gain further insights into common complaints related to specific diseases.

12. Genomic Testing*

Have you ever wondered why some people seem more susceptible to health conditions than others? Many risk factors have a lot to do with our genetics. Our comprehensive exome sequencing measures all 22,000 genes of your DNA and cross-references them with more than 100,000 health-related findings on cancer, cardiovascular disease, cognitive function, potential prescription drug complications, and various chronic diseases. In doing so, we can determine which types of treatments will be safest and most effective based on your genetic profile. Measurements of this degree outperform traditional genome sequencing tests, which only look at partial snippets of your DNA and cannot pinpoint the rare genetic mutations that 10% of Americans have [6].

13. Telomerase Testing*

man playing with son, kid with football, summer, healthy aging, telomere testing

Telomeres are an essential part of human cells that affect cellular aging. They also protect critical information of our DNA. When telomeres are abnormally short, they are linked to premature cellular aging. By understanding your percentage of short telomeres, we are able to prioritize critical lifestyle changes, as well as nutraceutical selection, to improve the telomerase enzyme for healthier, longer telomeres.

14. Genetic Inflammatory Biometric Testing*

Biometric testing sounds complex, but it can be broken down rather simply. Since “bio” refers to living things and “metrics” is simply another word for measurements, genetic inflammatory biometric testing is just a phrase that describes the measurement of your inflammatory reactions based on genetic factors. Here are three of the main testing types we use to uncover these insights:

  • KIF6: Genotype that determines if specific cardiovascular medications are useful to the individual
  • ApoE: Genotype that determines response to dietary fat
  • 9p21: Genotype that determines risk of early onset heart attack, abdominal aortic aneurysm, and total heart disease risk

15. Cardiovascular Biomarkers*

When the heart is damaged or stressed, it releases substances called cardiac biomarkers into the bloodstream. Measuring these markers can help determine whether or not there is sufficient blood flow to the heart, among other critical functions. Here are some of the biomarkers Cenegenics can test:

  • Myeloperoxidase: Potential inflammatory precursor to myocardial infarction
  • High-sensitivity C-reactive protein: Measure for systemic inflammation
  • Microalbumin:creatinine ratio: Data suggests subjects with elevated microalbumin levels have a 3x greater risk of developing heart disease [7]
    • F2-isoprostane:creatinine ratio – Gold Standard in measuring oxidative stress

Watch this video to learn more about the comprehensive evaluation:

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Custom Designed Cenegenics Age Management Program

What Can I Expect from the Cenegenics Program?

Each patient consults with their Cenegenics physician for several hours to develop an in-depth understanding of health issues and risks based on the results of their lab and diagnostic analysis, medical history, and lifestyle assessment. The patient will then work collaboratively with their Cenegenics physician to develop an individualized, goal-oriented plan that suits their lifestyle and food and exercise preferences. All nutraceutical supplements and, if medically indicated, hormone supplementation will be prescribed by the Cenegenics physician. The patient will be closely monitored during follow-up lab analysis to ensure optimal dosages, as each patient’s body will absorb supplements at different rates, and adjustments can be made to reach optimal levels.

The Cenegenics Difference: Personalized Care

Each patient is different, and that is why a “one-size-fits-all” or “take this supplement” approach will routinely fail. Some patients prefer playing tennis over going to the gym to work out, for instance. For these individuals, we custom-design exercise programs to supplement tennis playing. This maximizes efforts and eliminates redundancies, thereby delivering a comprehensive result for healthy aging.

Likewise, nutrition is highly complex and medically different for each individual (we’ll explore this in greater detail in an upcoming section). There is no such thing as a patient who eats a “perfect” diet.

With this in mind, the Cenegenics team works with patients to develop a customized nutrition plan that works for them which they can implement with ease into their lifestyle. Many of our patients are busy executives who travel often and do not have optimal food choices available, so we create a workable system. One simple Cenegenics weight loss tactic is to swap a starch for two sides of vegetables when dining out. Of course, this is just one example to showcase the level of personalization each patient receives when pursuing their wellness journey; there are many more physician-approved weight loss strategies that can be leveraged by individuals across all circumstances. These strategies can also be coupled with tactics like individualized fitness programs and nutraceuticals, if needed.

Cenegenics Weight Loss Programs: Better Understanding the Role of Nutrition and Exercise

ginger, lemons, kale, oranges, cranberries, fruits, veggies, vegetables, healthy eating, nutrition

Nutrition and exercise are integral components of our robust age management programs. Here, we’ll take a look at why Cenegenics gets results when other weight loss alternatives you may have tried fell short.

Nutrition & Weight Loss Programs: More than Just Calories 

Nutrition is a very important modifiable element in optimizing health as we age. It sounds simple but it is not. Nutrition is a complex, polyvalent system encompassing an interplay of hormones, genomics, hedonics, energy balance, and macronutrients. Understandably, it can become very overwhelming for an individual to conceptualize the relationship between all of these moving parts, and how mastering this balance can help them lose weight.

The nutritional prescription, therefore, should be written like any other treatment for conditions such as heart disease or diabetes: based on individual needs analysis. The interplay referred to above is patient-specific, and the nutrition plan must recognize this. By carefully reviewing the nutrition-related biomarkers via blood and genomic testing, Cenegenics prioritizes which markers are playing the most detrimental role in your health, and then develops a plan of attack based on these factors.

In some individuals, for example, carbohydrate metabolism and the ability to utilize the body’s primary source of fuel can decline over many years. In certain cases, this could be a result of poor nutritional choices. Others may learn that they have genetic markers that prevent them from breaking down seemingly healthy foods appropriately, and instead their bodies respond via inflammation. Identifying these issues and developing a nutritional strategy that progresses and changes as the individual reduces their risk factors and becomes healthier is critical to long-term success.

Lose Weight & Tone with the Cenegenics Approach to Exercise

Now, let’s talk about exercise. Unfortunately, it’s impossible to exercise your way to significant fat reductions alone. However, when combined with an optimized eating program, exercise is key to aging well. Like diet, exercise must be patient-specific, comprising the proper mix of aerobic, resistance, flexibility, and balance training.

Too often, we get caught in the moment, seeking short-term solutions on how to lose weight quickly. We may succumb to fitness and exercise trends that are promoted in magazines, on television, and across social media. These programs are often presented as fail-proof and as the “ideal” form of exercise. Oftentimes, the lack of results that eventually ensues can create a perpetual sense of failure.

It is therefore critically important to understand that there is no “one-size-fits-all” approach to exercise, either. However, by incorporating metabolic testing and measuring the body’s ability to deliver oxygen to all of its working muscles, Cenegenics identifies your body’s most ideal starting point and pushes you to the appropriate intensities that you are physically capable of achieving, while also allowing for sufficient recovery. The use of scientific, evidence-based exercise allows you to see results from month-to-month, building your confidence and motivation while preventing injury.

Moreover, our program properly balances all biologics with nutraceutical and hormone supplementation, ensuring the patient’s body is able to most effectively address any underlying health conditions with powerful nutritional dietary modifications and time-efficient exercise regimens.

A Pillar of Cenegenics Success: Close Monitoring and Consultation

While the evidence-based science and the experience of specialized Cenegenics physicians remains unmatched, another key difference of the Cenegenics program that delivers results for our patients is our close monitoring and consultation. Patients receive unlimited access to their full Cenegenics clinical team, including a Cenegenics age management doctor and clinical specialists in nutrition and exercise.

Our physicians are highly trained in the Cenegenics science, and only 1% of trainees ultimately meet the requirements needed to become a Cenegenics Physician Partner. These medical experts collaborate extensively on complex patient health issues, and are continuously receiving clinical updates as proven, evidence-based science evolves. In doing so, they ensure each patient’s program is appropriately optimized for their individual needs, while also remaining cutting-edge.

New patients often engage in a weekly dialogue with their clinical team to discuss progress, experience, and how they are feeling so modifications can be made, as needed, to optimize the program. The Cenegenics physician will prescribe ongoing lab work to closely monitor the body’s response to the custom-prescribed nutraceuticals and hormone supplementation, if needed, and make adjustments accordingly.

Patients will have multiple labs ran throughout the year and annual reevaluations so that we can closely monitor and manage their progress towards their wellness optimization goals and identify any emerging risk factors for proactive intervention. Additionally, it allows our treatments to dynamically adjust when clinically indicated.

Does Cenegenics Work?

Proven Results 

Cenegenics has had over 35,000 patients on its programs. We are highly trusted within the medical community, as 25% of our patients are physicians and their families.

Based on an internal study, our average patient reduced their body fat index by 30% in the first year on the Cenegenics program**.

Of course, the benefits of Cenegenics extend far beyond weight loss alone. Patients who choose Cenegenics can be confident in the fact that any health issues that arise will be detected early for preventive treatment, and that the Cenegenics Physician Leadership will continuously monitor all evidence-based scientific developments to ensure their fully-customized program is advanced and in line with emerging best practices.

You can see what our patients are saying about their Cenegenics experience:

Cenegenics – Patient Testimonial – Look at the ResultsAnthony Maffei, MD, FACS, Cenegenics Patient

Anthony Maffei, Dr. Maffei, Cenegenics Patient, Cenegenics Patient Review, patient review, program results

Cenegenics – Patient TestimonialJonny Bowden, PhD, CNS, Cenegenics Patient

Jonny Bowden, Dr. Bowden, Cenegenics Patient, Cenegenics Patient Review, patient review, program results

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We hope the information above assisted you in your research process.

About the Senior Cenegenics Physician, Dr. Leake

Dr. Jeffrey P. Leake, Dr. Leake, Cenegenics Physician, Cenegenics Director of Education, Cenegenics Partner

Dr. Leake, a board-certified anesthesiologist, educated at Ohio State University, held a 23-year tenure at Washington’s Harrison Medical Center Bremerton as Chief of Anesthesiology and Medical Director of Surgical Services.

An expert in nutrition and physiology, Dr. Jeffrey Park Leake has long been known for guiding patients in a preventive health approach. As course instructor for the Age Management Medicine Education Foundation (AMMEF), he demonstrates the established Cenegenics model for achieving optimal health and youthful aging.

He is a certified personal trainer and avidly pursues backcountry/extreme skiing, equestrian sports, weight, plyometric and yoga training. He is a member of the Endocrine Society, North American Menopause Society, International Menopause Society, American College of Sports Medicine, American Society for Nutrition and the National Strength and Conditioning Association.

He is the author of the Textbook of Age Management Medicine and was the recipient of the Alan P. Mintz Award for Excellence in Age Management Medicine in 2015.

*Available at additional charge

**Based on internal study of the last 200 Cenegenics patients completing their first annual re-evaluation, the average body fat percentage declined 30% from the initial extensive evaluation when joining the Cenegenics program.

Key Resources

This guide was produced with contributions from the following key resources:

The Cenegenics Education and Research Foundation

The Textbook of Age Management Medicine Volume 1: Mastering Healthy Aging Nutrition, Exercise and Hormone Replacement Therapy

Available for purchase here

The Textbook of Age Management Medicine Volume 2: Mastering Healthy Aging Nutrition, Exercise and Hormone Replacement Therapy

Available for purchase here

Textbook Authors:

Jeffrey Park Leake, M.D., CPT

Dr. Jeffrey Park Leake is a Partner and Director of Education at Cenegenics Elite Health specializing in age management and wellness. Having trained hundreds of physicians worldwide, Dr. Leake is also the Director of Education for the Clinical Strategies for Healthy Aging course at AMM Education Foundation.

Todd David Greenberg, M.D., CSCS

Dr. Todd Greenberg is a practicing physician with a broad range of expertise, including wellness, exercise, sports injuries, and MRI of sports injuries. He is a Radiology Clinical Associate Professor at the University of Washington.

Additional Information

What is Cenegenics?

What is Age Management Medicine?

Cenegenics Elite Health Program: Why You Should Consider Age Management Your Next Investment

Anti-Aging vs. Age Management

Healthy Heart: What is Heart Disease? Preventative Steps and Recognizing Symptoms

Cenegenics Elite Health Now Offers State-of-the-Art Genetic Testing

Weight Loss on the Cenegenics Age Management Program

Nutrition for Weight Loss

Weight Loss: Role of Exercise

Sources

[1] American Family Physician, aafp.org, 2018.

[2] Centers for Disease Control, cdc.gov, 2018.

[3] Heart Disease Facts, Centers for Disease Control and Prevention, n.d.

[4] From Vulnerable Plaque to Vulnerable Patient—Part III: Executive Summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force Report, The American Journal of Cardiology, 2006.

[5] Deformation Field Morphometry Reveals Age-Related Structural Differences between the Brains of Adults up to 51 years, The Journal of Neuroscience, 2008.

[6] Global Genes®, globalgenes.org, 2015.

[7] Urinary albumin excretion in a population based sample of 1011 middle aged non-diabetic subjects, Scandinavian Journal of Clinical and Laboratory Investigation, 1993.

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