No Whey Man says Robert Cheeke

Robert Cheeke 1 is a leading light in the area of vegan bodybuilding. His advice 2  on whether or not we should use whey powders in an attempt to build muscle should probably be adhered to or, at the least, listened to and carefully considered.

Robert Cheeke
  1. Who is Robert Cheeke? []
  2. No Whey, Man. I’ll Pass on the Protein Powder. By Robert Cheeke. November 7, 2014. []
  3. The Problem with Protein []
  4. Cow’s Milk – But It Looks So Innocent… []
  5. Eat Enough Food & You Eat Enough Protein []
  6. Animal Protein & Your Kidneys []
  7. Circ Heart Fail. 2018 Jun. Intake of Different Dietary Proteins and Risk of Heart Failure in Men: The Kuopio Ischaemic Heart Disease Risk Factor Study. Virtanen HEK, Voutilainen S, Koskinen TT, Mursu J, Tuomainen TP, Virtanen JK. []
  8. Independent: High protein diets like Atkin’s may increase risk of heart failure, finds study []
  9. PCRM: Milk and Prostate Cancer: The Evidence Mounts []
  10. Do Vegetarians Get Enough Protein? Michael Greger M.D. FACLM June 6th, 2014 Volume 19 []

Ginger Reduces Exercise-Induced Muscle Pain

Anything that can help recovery from vigorous exercise is a good thing – well, so long as 1. it’s of natural origin, 2. has no negative side effects, and 3. won’t cost you an arm and a leg. Well, it appears that there’s another great gift for us from Nature’s bounty that satisfies  all three criteria.

We’ve already looked  at some of the evidence that a WFPB diet in general is ideal for preventing sports injuries 1 before you even start to exercise, as well as for improving general sports performance during activity and recovery afterwards 2 . But a 2010 study 3 demonstrated that ginger, the readily-available and cheap spice, is proven to be effective in reducing exercise-induced muscle pain. And here’s what the study reported…

Ginger and rodents

Ginger had already been shown to exert anti-inflammatory 4 and hypoalgesic (pain-killing) 5 effects in rodents, but its effect on human muscle pain was uncertain before this 2010 study.

Ginger and human muscle pain

The research looked at the effects of 11 days of raw (study 1) and heat-treated (study 2) ginger supplementation on muscle pain. Raw ginger is the fresh rhizome and heat-treated is the dried powder that you usually buy in jars or packets. Both study 1 and 2 were identical double-blind, placebo controlled, randomised experiments with 34 and 40 volunteers, respectively.

The participants ate 2 grams (approximately a heaped teaspoon) of either raw (study 1) or heated (study 2) ginger or a placebo for 11 consecutive days.

They then performed 18 eccentric actions of the elbow flexors to induce pain and inflammation. The degree of pain was then measured and recorded – specifically, pain intensity, perceived effort, plasma prostaglandin E(2), arm volume, range-of-motion and isometric strength were assessed prior to and for 3 days after exercise.

Study results

As you will see from the chart below, the ginger (whether raw or dried) was better than the placebo at reducing the painful effects of exercise. The researchers concluded that “This study demonstrates that daily consumption of raw and heat-treated ginger resulted in moderate-to-large reductions in muscle pain following exercise-induced muscle injury. Our findings agree with those showing hypoalgesic effects of ginger in osteoarthritis patients and further demonstrate ginger’s effectiveness as a pain reliever.

And even by 2010, there were already plenty of other studies 6 which had concluded favourably on the health benefits of ginger – from its anti-inflammatory and pain-killing features to its ability to lower blood sugar levels.  This subject was also covered in a video 7  by Dr Greger.

Joe’s comment

It might be a good idea to get some dried or fresh ginger into your daily diet. I tend to add it to my list of ingredients in my huge breakfast8 muesli.  There are some good recipe ideas on One Green Planet 9 although it’s strongly advised that you cut out the added salt, sugar and oils mentioned in some of the recipes.


  1. WFPB Eating to Prevent Sports Injuries []
  2. Plant-Based Diet Improves All Aspects of Sports Performance & Recovery []
  3. J Pain. 2010 Sep;11(9):894-903. doi: 10.1016/j.jpain.2009.12.013. Epub 2010 Apr 24. Ginger (Zingiber officinale) reduces muscle pain caused by eccentric exercise. Black CD, Herring MP, Hurley DJ, O’Connor PJ. []
  4. Ojewole JA. Analgesic, antiinflammatory and hypoglycaemic effects of ethanol extract of Zingiber officinale (Roscoe) rhizomes (Zingiberaceae) in mice and rats. Phytother Res. 2006;20:764-772.  []
  5. Young HY, Luo YL, Cheng HY, Hsieh WC, Liao JC, Peng WH. Analgesic and antiinflammatory activities of [6]-gingerol. J Ethnopharmacol. 2005;96:207-210. []
  6. Other pre-2010 studies into the health benefits of ginger: 1. Lantz RC, Chen GJ, Sarihan M, Solyom AM, Jolad SD, Timmermann BN. The effect of extracts from ginger rhizome on inflammatory mediator production. Phytomedicine. 2007;14:123-128.   2. Nurtjahja-Tjendraputra E, Ammit AJ, Roufogalis BD, Tran VH, Duke CC. Effective anti-platelet and COX-1 enzyme inhibitors from pungent constituents of
    ginger. Thromb Res. 2003;111:259-265.    3. Tjendraputra E, Tran VH, Liu-Brennan D, Roufogalis BD, Duke CC. Effect of
    ginger constituents and synthetic analogues on cyclooxygenase-2 enzyme in intact cells. Bioorg Chem. 2001;29:156-163.   4. Tripathi S, Bruch D, Kittur DS. Ginger extract inhibits LPS induced macrophage activation and function. BMC Complement Altern Med. 2008;8:1.   5. Grzanna R, Phan P, Polotsky A, Lindmark L, Frondoza CG. Ginger extract inhibits beta-amyloid peptide-induced cytokine and chemokine expression in cultured THP-1 monocytes. J Altern Complement Med. 2004;10:1009-1013. []
  7. Ground Ginger to Reduce Muscle Pain. Michael Greger M.D. FACLM July 27th, 2018 Volume 43 []
  9. 10 Amazing Ginger-Based Recipes! []

WFPB Eating to Prevent Sports Injuries

When I was studying Dr T Colin Campbell’s eCornell Certificate in Plant-Based Nutrition 1 , the inspirational plant-based athlete Robert Cheeke presented a module entitled Eating to Prevent Sports Injuries. Its message was so simple and powerful that I thought it worth providing a quick overview of the points he raised. You can find lots more about his amazing story (and perhaps take a look at the books he’s written) by visiting his website 2 .

Focus on the whole diet, not just individual foods

As Robert says: “You will get all the ‘real’ nutrients you need from whole plant-based foods!

By following a whole food plant-based diet, we get real nutrients and we simply cannot get these from eating processed foods, or animal-based foods:

This means we get appropriate and and perfectly balanced levels of the following:

  • macronutrients
    • fat
    • complete protein – with total volume of amino acids 3
    • carbohydrates
  • vitamins
  • minerals
  • antioxidants
  • fatty acids

These are all in abundance in plant-based whole foods.

Naturally, certain foods will have superior nutrition than others, but micromanaging the diet is not something Robert thinks is either necessary or desirable. Rather, he suggests we get full nutrient density by eating a balanced whole food diet.

Optimal nutrition to prevent injury

With better overall nutrition, we’re going to help with muscle recovery and muscle repair, and it will, of course, also help provide the best amount of energy before a workout.

I’ve already covered some aspects of sports recovery in a previous blog 4 , but the subject of avoiding sports injuries in the first place, by eating a balanced plant-based diet, is worth stressing for its own sake.

Apart from anything else, avoiding injuries increases greatly the enjoyment of our training.

So what does a plant-based diet provide?

Certain plant-based whole foods have anti-inflammatory properties 5  and so reduce inflammation in our muscles. We know that processed foods 6 and animal-based foods 7 , on the other hand, are pro-inflammatory and are likely to undo some of the the gains we achieve through our efforts.

Plant foods (particularly leafy greens) are rich in nitric oxide, a vital chemical that we’ve already covered in previous blogs8 9 , and which Dr Greger further explains in relation to athletic performance 10 . It’s the nitric oxide that will “get that blood flowing better”.  Improved circulation during a workout, less sticky blood, better cell nutrition, and better movement and flexibility.

There are numerous plant based foods that will help in general, throughout our body – things like ginger root to help reduce inflammation, foods rich in omega 3 essential fatty acids (such as walnuts, flax, hemp, and chia11 . But, once again, the focus is not on specific individual foods, but just to show an example of certain foods that are great for injury prevention and muscle recovery.

Energy during a workout

Having adequate energy before a workout to make sure we get the best return on investment from the exercise session relies on eating foods that will provide both quick energy as well as long-lasting sustained energy.

Fruits are quickly absorbed and digested and will provide quick-release fuel for short energy bursts. Fruit is ideal to have just before exercise, since it will provide us with a better workout and better muscle growth stimulation as a result.

Complex carbs like potatoes, oats, brown rice, and quinoa are excellent for slower digestion and a longer lasting supply of energy. When we’re in it for the long haul, those foods are going to provide all the energy we need.

Don’t underestimate mood

Feeling positive and avoiding emotional ups and downs is one of the gifts provided free by eating a WFPB diet. Animal-based and processed foods are linked with inflammation and, in turn, inflammation is linked with depression 12 . A positive attitude helps us to maintain enthusiasm and commitment, as well as work harder.

“We are what we eat.”

Our bodies are made up of the food we eat. It’s as simple as that. By eating an optimally healthy WFPB diet, we are giving every cell in our bodies the perfect and ideal fuel that we have evolved to run on.

Eating complex carbohydrates replenishes the energy supplies that were lost through sweating. The ideal balance of amino acids in plant-foods (including beans, grains, green vegetables, nuts and seeds) will help to maintain flexibility and aid the muscle tissue repair that was put under stress during the workout.

Hydration Hydration Hydration

It’s not possible to overstate how important it is for optimum performance, injury-avoidance and after-exercise recovery to maintain high levels of hydration. Our muscles are 70% water. Our bodies are 70% water. Whole plant foods are really high in water, especially fruits and vegetables, and thus provide slow-release of the water contained within them.

Not only is hydration important in order to prevent cramping, but longer-term effects and injuries can be caused if we don’t maintain appropriate fluid levels.  Headaches and feelings of lethargy are only some of the effects that can prevent us from getting the most from our workouts.

Water can be often under-consumed, under-appreciated, overlooked, and it’s right there in perfect balance within plant-based whole foods to be consumed.

Document our progress

The best way to check whether our plant-based diet is able to repair faster, recover better, grow our muscle tissues more effectively and help us to perform better without suffering regular sports injuries is to keep a diet/exercise diary and let the facts speak for themselves.

Diet can injure – Diet can heal

You may be surprised to learn that 80% or more of all modern chronic diseases are thought to be avoidable with simple dietary and lifestyle changes 13 14 .  If food and other lifestyle changes (such as simply increasing daily exercise levels) can have such a profound effect on the development of chronic diseases like diabetes, cancer and heart disease, then it’s easy to appreciate the important impact that diet will have on our ability to avoid sports injuries, improve recovery, and enjoy enhanced performance.


  1. Dr T Colin Campbell’s eCornell Certificate in Plant-Based Nutrition []
  2. Robert Cheeke’s website []
  4. Plant-Based Diet Improves All Aspects of Sports Performance & Recovery []
  5. Inflammation. []
  6. Processed foods and inflammation. []
  7. How Does Meat Cause Inflammation? Written By Michael Greger M.D. FACLM on September 20th, 2012 []
  8. Nitric Oxide – The Most Powerful Anti-Oxidant. []
  9. Which Athlete Ate the Most Nitrates… []
  10. Vegetables Rate by Nitrate. Michael Greger M.D. FACLM February 22nd, 2012 Volume 7 []
  11. Non-Fish Sources of Omega-3 []
  12. Depression is Linked to Inflammation []
  13. The Independent: Healthy living ‘cuts chronic disease by up to 80 per cent’ []
  14. Eliminate Most of Your Chronic Disease Risk in Four Steps. Written By Michael Greger M.D. FACLM on September 22nd, 2015 []

Exercise vs Whole Food Plant-Based Diet

Which is more important for your health – exercise or diet? If you listen to the likes of Michelle Obama 1, then it would appear that exercise Trumps diet (pun intended and immediately regretted). This opinion appears to be shared by all those who have an interest in making money out of manufacturing/selling processed and junk food, those who want us to keep popping the pharmaceuticals and paying for mere management of our chronic illnesses rather than cure, and also by those who own gyms or sell home gym equipment and the plague of protein powders. But what do WFPB doctors and scientific research tell us?

WFPB doctors – exercise vs diet

I know that I go on and on about diet, devoting only a relatively small amount of blog space for exercise-related issues. Interestingly, it appears that I share this tendency with Dr Thomas Campbell: “…when I discuss lifestyle with my patients I spend almost all my time talking about food. My new book, The Campbell Plan 2 , contains just about a page on exercise. Am I delinquent? Perhaps I am. We know how crucial exercise is, but what I see more often than not is an overemphasis on exercise. I tend to see people focus their energies on getting to the gym as their primary strategy for weight control while leaving their diet largely the same. Perhaps they are trying to eat less, or just not snack on the junk in the house as often. Overall, this is a poor strategy.” 3 .

On the other hand, you’ll see Dr Michael Greger bounding along on his treadmill when doing his regular YouTube Q&A sessions, and he includes exercise as an integral part of his Daily Dozen 4 : “I advise one daily “serving” of exercise, which can be split up over the day. I recommend ninety minutes of moderate-intensity activity each day, such as brisk (four miles per hour) walking or, forty minutes of vigorous activity (such as jogging or active sports) each day. I explain my reasoning for that in my video, How Much Should You Exercise?” 5

Dr Joel Fuhrman considers 6 that exercise has a lot more value than simply helping us to lose weight by more quickly burning calories: “The calories burned during exercise, unless you’re a professional athlete, make up a very small portion of our total calories burned for the day; what we eat has a much greater influence on our body weight. So why should we bother to exercise? The answer is that burning calories is just one of the many benefits of exercise.

“For example, in the chapter titled “Nutritional Excellence, Not Drugs” in my book, The End of Heart Disease 7 , I discuss how exercise is an important component in attaining excellent health: ‘When you change to a Nutritarian diet-style, cut the salt out of your diet, exercise regularly, and lose weight, you remove inflammation, reduce atherosclerosis, and eliminate the inflammation of the endothelium. In other words, the causes of high blood pressure are eliminated, and the blood vessels begin to heal themselves.’ ”

Many other WFPB doctors extol the virtue of exercise, but they all consider that it must be within the context of a healthy plant-based diet.

Which does the science say is more important – diet or exercise?

In his book How Not To Die 8 , Dr Michael Greger makes it pretty clear that, whilst exercise is important, it’s diet that’s the biggie when it comes to warding off obesity and other chronic diseases:

“The food industries like to blame inactivity as the prime cause of obesity, not the promotion and consumption of their calorie-rich products 9 . On the contrary, however, research suggests that the level of physical activity may have actually increased in the United States over the past few decades 10 . We know that obesity is rising even in areas where people are exercising more 11 . This is likely explained by the fact that eating activity levels are outstripping physical activity levels 12 .

Surveys suggest that most people believe controlling diet and getting enough exercise are equally important for weight control 13 . Researchers who accept grants from the Coca-Cola Company 14 call physical inactivity “the biggest public health problem of the 21st century.” 15Actually, physical inactivity ranks down at number five in terms of risk factors for death in the United States and number six in terms of risk factors for disability 16 . And inactivity barely makes the top ten globally 17 .

“…diet is by far our greatest killer, followed by smoking 16 . Of course, that doesn’t mean you should sit on the couch all day. As we’ve seen in this book, in addition to helping you enjoy a healthy body weight, exercise can also ward off and possibly reverse mild cognitive decline, boost your immune system, prevent and treat high blood pressure, and improve your mood and quality of sleep, among many other benefits.” 18

Which is more effective – exercise or drugs?

A 2013 BMJ review 19 concluded that: “Although limited in quantity, existing randomised trial evidence on exercise interventions suggests that exercise and many drug interventions are often potentially similar in terms of their mortality benefits in the secondary prevention of coronary heart disease, rehabilitation after stroke, treatment of heart failure, and prevention of diabetes.

As pointed out by the PCRM website 20 this review, which analysed more than 305 trials with 339,274 participants, compared drug and exercise interventions and it found that: “…exercise proved similar to medications for heart disease prevention, heart failure treatment, and diabetes prevention. For those who had suffered a stroke, exercise was more effective than drug treatment. In addition, physical activity often provided patients with fewer side effects and injuries. The authors stress that these data provide health care professionals with a safe and effective alternative for their patients.

What are some of the benefits of exercise?

Dr Greger considers that: “…in addition to helping you enjoy a healthy body weight, exercise can also ward off and possibly reverse mild cognitive decline, boost your immune system, prevent and treat high blood pressure, and improve your mood and quality of sleep, among many other benefits.” 18

The science certainly seems to support the importance of physical exercise for preventing/treating a whole range of chronic diseases affecting all parts of the body, including:

  • the heart
    • regular physical activity reduces the risk of coronary heart disease and diabetes by 30-50% 21
    • when you exercise, the heart muscle gets a workout too. Over time, the heart becomes more efficient, allowing the resting heart rate to decrease—beneficial, since a high resting heart rate is a risk factor for cardiac mortality 22 23
    • regular exercise helps to increase production of nitric oxide, a key regulator of blood pressure. In addition to reduced blood pressure, resulting in improved blood flow to skeletal muscle and the heart 24 25
  • the brain
    • physical exercise is a natural mood elevator, and has been shown to be just as effective as (and, naturally, much safer than) anti-depressant drugs 26 27 28 29
    • physical activity has consistent and long links to cognitive abilities and mental alertness 30
    • for older adults, regular walking was shown to decrease the risk of cognitive impairment 31 , and strength training also produces cognitive benefits 32
  • the whole body
    • muscle strength is regarded as the best predictor of bone strength— exercise protects against osteoporosis 33 34 35
    • a decreased risk of colon, breast, and prostate cancers are associated with increased physical exercise, thought to partly due to the effects on the insulin-like growth factor 1 (IGF-1) system 36
    • the body’s antioxidant defences are built and maintained by regular physical exercise 24
    • sleep is enhanced by exercise 37 38
    • exercise protects against chronic inflammation 39

Final thoughts

So, which is most important, then – exercise or diet? I think it’s clear from the above that both are important. However, if I was to recommend one rather than the other, it would be diet every time. There’s some benefit in exercising while still eating the toxic SAD (Standard American Diet) full of excess animal protein, fat and cholesterol, processed junk, salt, sugar and oils; but the benefit would be minimal compared with doing relatively no exercise but simultaneously eating a WFPB diet.

You couldn’t go far wrong if you simply followed Dr Greger’s Daily Dozen – treat exercise as one of the daily components of your optimal diet and lifestyle – the best of both worlds…

  1. Let’s Move Campaign – Michelle Obama. []
  2. The Campbell Plan by Thomas Campbell, MD []
  3. Reasons You Should Include Exercise in Your Diet Plan. March 27, 2015. By Thomas Campbell, MD. []
  4. Dr. Greger’s Daily Dozen Checklist. Michael Greger M.D. FACLM September 11th, 2017 Volume 38 []
  5. How Much Should You Exercise? Michael Greger M.D. FACLM April 28th, 2017 Volume 35 []
  6. Exercise Has Surprising Benefits for Your Heart and Brain. May 21, 2016 by Joel Fuhrman, MD []
  7. The End of Heart Disease by Joel Fuhrman []
  8. How Not To Die by Dr Michael Greger []
  9. Freedhoff Y, Hébert PC. Partnerships between health organizations and the food industry risk derailing public health nutrition. CMAJ. 2011;183( 3): 291– 2. []
  10. Westerterp KR, Speakman JR. Physical activity energy expenditure has not declined since the 1980s and matches energy expenditures of wild mammals. Int J Obes (Lond). 2008;32( 8): 1256– 63. []
  11. Dwyer-Lindgren L, Freedman G, Engell RE, et al. Prevalence of physical activity and obesity in US counties, 2001– 2011: a road map for action. Popul Health Metr. 2013;11: 7. []
  12. Laskowski ER. The role of exercise in the treatment of obesity. PMR. 2012;4( 11): 840– 4. []
  13. Matthews J, International Food Information Council Foundation. Food & Health Survey: Consumer Attitudes Toward Food Safety, Nutrition & Health. August 31, 2011. []
  14. Archer E, Hand GA, Blair SN. Correction: Validity of U.S. Nutritional Surveillance: National Health and Nutrition Examination Survey Caloric Energy Intake Data, 1971– 2010. October 11, 2013. []
  15. Blair SN. Physical inactivity: the biggest public health problem of the 21st century. Br J Sports Med. 2009;43( 1): 1– 2. []
  16. Murray CJ, Atkinson C, Bhalla K, et al. The state of US health, 1990– 2010: burden of diseases, injuries, and risk factors. JAMA. 2013;310( 6): 591– 608. [] []
  17. Lim SS, Vos T, Flaxman AD, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990– 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380( 9859): 2224– 60. []
  18. Greger, Michael; Stone, Gene. How Not To Die: Discover the foods scientifically proven to prevent and reverse disease (Air Side Edt) (pp. 392-394). Pan Macmillan. Kindle Edition. [] []
  19. Naci H, Ioannidis JPA. Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study. BMJ. Published online October 1, 2013. []
  20. PCRM: Exercise as Effective as Drugs in Disease Treatment. October 3, 2013. []
  21. Bassuk SS, Manson JE. Epidemiological evidence for the role of physical activity in reducing risk of type 2 diabetes and cardiovascular disease. J Appl Physiol 2005;99:1193-1204. []
  22. Duncker DJ, Bache RJ. Regulation of coronary blood flow during exercise. Physiol Rev 2008;88:1009-1086. []
  23. Verrier RL, Tan A. Heart rate, autonomic markers, and cardiac mortality. Heart Rhythm 2009;6:S68-75. []
  24. Kojda G, Hambrecht R. Molecular mechanisms of vascular adaptations to exercise. Physical activity as an effective antioxidant therapy? Cardiovasc Res 2005;67:187-197. [] []
  25. Brown MD. Exercise and coronary vascular remodelling in the healthy heart. Exp Physiol 2003;88:645-658. []
  26. Medina J: brain rules. . Seattle, WA: Pear Press; 2008.))  ((Hyman M: The UltraMind Solution. New York, NY: Scribner; 2009. []
  27. Gill A, Womack R, Safranek S. Clinical Inquiries: Does exercise alleviate symptoms of depression? J Fam Pract2010;59:530-531. []
  28. Uebelacker LA, Epstein-Lubow G, Gaudiano BA, et al. Hatha yoga for depression: critical review of the evidence for efficacy, plausible mechanisms of action, and directions for future research. J Psychiatr Pract 2010;16:22-33. []
  29. Saeed SA, Antonacci DJ, Bloch RM. Exercise, yoga, and meditation for depressive and anxiety disorders. Am Fam Physician 2010;81:981-986. []
  30. Medina J: brain rules. . Seattle, WA: Pear Press; 2008.  []
  31. Erickson KI, Raji CA, Lopez OL, et al. Physical activity predicts gray matter volume in late adulthood: the Cardiovascular Health Study. Neurology 2010;75:1415-1422. []
  32. Davis JC, Marra CA, Beattie BL, et al. Sustained Cognitive and Economic Benefits of Resistance Training Among Community- Dwelling Senior Women: A 1-Year Follow-up Study of the Brain Power Study. Arch Intern Med2010;170:2036-2038. []
  33. Arq Bras Endocrinol Metabol. 2014 Jul;58(5):514-22. Physical exercise and osteoporosis: effects of different types of exercises on bone and physical function of postmenopausal women. Moreira LD, Oliveira ML, Lirani-Galvão AP, Marin-Mio RV, Santos RN, Lazaretti-Castro M. []
  34. Osteoporos Int. 2014 Aug;25(8):2017-25. doi: 10.1007/s00198-014-2724-3. Epub 2014 May 8. The effect of exercise and education on fear of falling in elderly women with osteoporosis and a history of vertebral fracture: results of a randomized controlled trial. Olsen CF1, Bergland A. []
  35. Osteoporos Int. 2015 Oct;26(10):2491-9. doi: 10.1007/s00198-015-3165-3. Epub 2015 May 12. Exercise and fractures in postmenopausal women. Final results of the controlled Erlangen Fitness and Osteoporosis Prevention Study (EFOPS). Kemmler W, Bebenek M, Kohl M, von Stengel S. []
  36. American Institute for Cancer Research: The Exercise Factor. []
  37. Atkinson G, Davenne D. Relationships between sleep, physical activity and human health. Physiol Behav2007;90:229-235. []
  38. Montgomery P, Dennis J. Physical exercise for sleep problems in adults aged 60+. Cochrane Database Syst Rev2002:CD003404. []
  39. Mathur N, Pedersen BK. Exercise as a mean to control low-grade systemic inflammation. Mediators Inflamm2008;2008:109502. []

Physical Activity for Disease Prevention & Healthy Gut Microbiome

A 2017 Czech study1 looked at the importance of exercise for maintaining optimal health, preventing/treating chronic diseases, and ensuring the well-being of our gut microbiota.

Effective & low-cost prescriptions

Movement is a basic factor of life and the importance of regular physical activity is both a very effective and cheap means of preventing and treating most non-communicable diseases.

When you go to visit your doctor, he or she should consider prescribing suitable physical activity as part of the first line of treatment.

How much exercise is enough?

The minimum* amount of physical activity with proven effects in primary prevention of chronic diseases is relatively low:

  • 150 minutes of moderate physical activity, or
  • 75 minutes of high intensity exercise per week, or
  • a combination of the two.

*See below for Dr Greger’s view on how much daily exercise we need.

What’s the simplest & safest form of exercise?

The simplest and safe way of physical activity is walking:

  • at least 10 000 steps/day, or
  • 6 000 steps/day on top of daily activities

Using FITT  to keep fit

The FITT model2  is a more sophisticated way of prescribing physical activity that already requires a stress test. A 2015 study3 looked at the use of FITT for stroke recovery.

Non-communicable diseases and exercise

People with the following physiological conditions have been seen to benefit from exercise:

  • those at risk of atherosclerosis4 or the following manifestations of atherosclerosis:
    • coronary artery disease5
    • post-stroke6
    • peripheral artery disease7
    • chronic heart failure8
  • lung disease:
    • COPD9
    • asthma10
  • metabolic diseases:
    • type 2 diabetes11
    • obesity12
    • osteoporosis13
    • rheumatologic diseases14
    • prostate cancer15 16

Psychological benefits of exercise

Regular exercise has been shown to improve outcomes/symptoms in the following ways:

  • improvement of cognitive function17
  • reduction of depression18
  • reduction of anxiety19
  • reduction of addictions20

Gut microbiome and exercise

Recently, it has been shown21 22 23 24 that exercise also changes the gut microbiome25 .

Myokine magic

One of the mechanisms thought to contribute to the beneficial effect of exercise is so-called “exercise factors”, namely myokines. These are one of several hundred cytokines (any of a number of substances, such as interferon, interleukin, and growth factors, which are secreted by certain cells of the immune system and have an effect on other cells). They are produced and released by muscle cells (myocytes) in response to muscular contractions.

A 2014 review26 looked at the current understanding of the positive effects of exercise-induced myokines on metabolic diseases. An earlier study27 discussed IL-6 (Interleukin 6 is an interleukin that acts as both a pro-inflammatory cytokine and an anti-inflammatory myokine, and in humans is encoded by the IL6 gene). This was the first myokine discovered, although many more have since been identified. The authors suggested that myokines may be involved in mediating the health-beneficial effects of exercise and that these in particular are involved in the protection against chronic diseases associated with low-grade inflammation such as diabetes and cardiovascular diseases. The gut microbiome is affected by exercise, being that it is linked to pretty much all systems within the body.

A February 2015 review28 looked at the proposal that physical exercise is able to modify gut microbiota, and thus that this could be another factor by which exercise promotes well-being, since gut microbiota appears to be closely related to health and disease. they review recent findings on gut microbiota modification by exercise, proposing several mechanisms by which physical exercise might cause changes in gut microbiota. Figures 1 and 2 are diagrams from their report.

A June 2017 study29 demonstrated that exercise-trained mice had altered gut microbiota compared with non-exercised mice. The exercise resulted in “…an attenuated response to chemical colitis, evidenced by reduced colon shortening, attenuated mucus depletion and augmented expression of cytokines involved in tissue regeneration.”  They concluded that: “…Exercise-induced modifications in the gut microbiota can mediate host-microbial interactions with potentially beneficial outcomes for the host.”  This study and a subsequent study on human subjects is discussed in more detail in a Natren article30 .


When properly prescribed, physical activity is an inexpensive and universal medication with minimal side effects, except feeling well and improving our health. And our gut microbiota benefits from it, ideally when combined with an optimally healthy diet.

The Czech authors refer to exercise as our “home pharmacy” that we always have with us. But, as with any medication, you have to use it in order to reap its benefits.

The last word goes to Dr Michael Greger. He has very clear views on how much exercise we should ideally have and recommends 90 minutes of moderate-intensity activity, such as brisk (four miles per hour) walking or 40 minutes of vigorous activity (such as jogging or active sports) each day.31

Below is a video32 where he explains why this is important.

He has also produced a podcast33 on the subject of exercise.


  1. [Physical activity – the Holy Grail of modern medicine?] Tuka V, Daňková M, Riegel K, Matoulek M. Vnitr Lek. Fall 2017;63(10):729-736. Review. Czech. PMID: 29127758. []
  2. The FITT Principle (model or formula) is a great way of monitoring your exercise program. The acronym FITT outlines the key components of an effective exercise program, and the initials F, I, T, T, stand for: Frequency, Intensity, Time and Type. … Time …refers to the time you spend exercising or how long you exercise for. []
  3. Does Aerobic Exercise and the FITT Principle Fit into Stroke Recovery? Sandra A. Billinger, Pierce Boyne, Eileen Coughenour, Kari Dunning, Anna Mattlage. Curr Neurol Neurosci Rep. Author manuscript; available in PMC 2016 Jan 1. Published in final edited form as: Curr Neurol Neurosci Rep. 2015; 15(2): 519. doi: 10.1007/s11910-014-0519-8 PMCID: PMC4560458. []
  4. Oman Med J. 2009 Jul; 24(3): 173–178. doi: 10.5001/omj.2009.34. PMCID: PMC3251175. PMID: 22224180. Atherosclerosis and Physical Activity. Ali Al-Mamari. []
  5. Effects of continuous vs interval exercise training on oxygen uptake efficiency slope in patients with coronary artery disease. D.M.L. Prado, E.A. Rocco, A.G. Silva, D.F. Rocco, M.T. Pacheco, P.F. Silva, V. Furlan. Braz J Med Biol Res. 2016; 49(2): e4890. Published online 2016 Feb 5. doi: 10.1590/1414-431X20154890. PMCID: PMC4742972. []
  6. The feasibility of an acute high-intensity exercise bout to promote locomotor learning after stroke. Charalambous CC, Helm EE, Lau KA, Morton SM, Reisman DS. Top Stroke Rehabil. 2018 Mar;25(2):83-89. doi: 10.1080/10749357.2017.1399527. Epub 2017 Nov 5. PMID: 29105605. []
  7. Clinical impact of exercise in patients with peripheral arterial disease. Novakovic M, Jug B, Lenasi H. Vascular. 2017 Aug;25(4):412-422. doi: 10.1177/1708538116678752. Epub 2016 Nov 9. Review. PMID: 28256934. []
  8. Curr Treat Options Cardiovasc Med. 2017 Oct 9;19(11):87. doi: 10.1007/s11936-017-0585-8. Therapeutic Targets for the Multi-system Pathophysiology of Heart Failure: Exercise Training.
    Van Iterson EH, Olson TP2. []
  9. Aerobic Exercise Training in Very Severe Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. Paneroni M, Simonelli C, Vitacca M, Ambrosino N. Am J Phys Med Rehabil. 2017 Aug;96(8):541-548. doi: 10.1097/PHM.0000000000000667. Review. PMID: 28099192. []
  10. Designing a physical activity intervention for children with asthma: a qualitative study of the views of healthcare professionals, parents and children with asthma
    Russell Jago, Aidan Searle, A John Henderson, Katrina M Turner
    BMJ Open. 2017; 7(3): e014020. Published online 2017 Mar 24. doi: 10.1136/bmjopen-2016-014020
    PMCID: PMC5372067. []
  11. Regular Physical Exercise as a Strategy to Improve Antioxidant and Anti-Inflammatory Status: Benefits in Type 2 Diabetes Mellitus. Edite Teixeira de Lemos, Jorge Oliveira, João Páscoa Pinheiro, Flávio Reis. Oxid Med Cell Longev. 2012; 2012: 741545. Published online 2012 Aug 13. doi: 10.1155/2012/741545 PMCID: PMC3425959. []
  12. The Effects of Exercise Training in Addition to Energy Restriction on Functional Capacities and Body Composition in Obese Adults during Weight Loss: A Systematic Review. Clint T. Miller, Steve F. Fraser, Itamar Levinger, Nora E. Straznicky, John B. Dixon, John Reynolds, Steve E. Selig. PLoS One. 2013; 8(11): e81692. Published online 2013 Nov 25. doi: 10.1371/journal.pone.0081692. PMCID: PMC3884087. []
  13. Too Fit To Fracture: outcomes of a Delphi consensus process on physical activity and exercise recommendations for adults with osteoporosis with or without vertebral fractures. L. M. Giangregorio, S. McGill, J. D. Wark, J. Laprade, A. Heinonen, M. C. Ashe, N. J. MacIntyre, A. M. Cheung, K. Shipp, H. Keller, R. Jain, A. Papaioannou. Osteoporos Int. Author manuscript; available in PMC 2016 Nov 8.
    Published in final edited form as: Osteoporos Int. 2015 Mar; 26(3): 891–910. Published online 2014 Dec 16. doi: 10.1007/s00198-014-2881-4. PMCID: PMC5101068. []
  14. Perceived Barriers, Facilitators and Benefits for Regular Physical Activity and Exercise in Patients with Rheumatoid Arthritis: A Review of the Literature. Jet J. C. S. Veldhuijzen van Zanten, Peter C. Rouse, Elizabeth D. Hale, Nikos Ntoumanis, George S. Metsios, Joan L. Duda, George D. Kitas. Sports Med. 2015; 45(10): 1401–1412. Published online 2015 Jul 29. doi: 10.1007/s40279-015-0363-2
    PMCID: PMC4579262. []
  15. Prostate Cancer []
  16. Physical Activity and Prostate Cancer: An Updated Review. Shephard RJ. Sports Med. 2017 Jun;47(6):1055-1073. doi: 10.1007/s40279-016-0648-0. Review. PMID: 27844337. []
  17. The Influence of Exercise on Cognitive Abilities. Fernando Gomez-Pinilla, Charles Hillman. Compr Physiol. Author manuscript; available in PMC 2014 Mar 13. Published in final edited form as: Compr Physiol. 2013 Jan; 3(1): 403–428. doi: 10.1002/cphy.c110063. PMCID: PMC3951958. []
  18. Exercise Leads to Better Clinical Outcomes in Those Receiving Medication Plus Cognitive Behavioral Therapy for Major Depressive Disorder. Joanne Gourgouvelis, Paul Yielder, Sandra T. Clarke, Hushyar Behbahani, Bernadette Ann Murphy. Front Psychiatry. 2018; 9: 37. Published online 2018 Mar 6. doi: 10.3389/fpsyt.2018.00037. PMCID: PMC5845641. []
  19. Exercise as Treatment for Anxiety: Systematic Review and Analysis. Gregory L. Stonerock, Benson M. Hoffman, Patrick J. Smith, James A. Blumenthal. Ann Behav Med. Author manuscript; available in PMC 2016 Aug 1. Published in final edited form as: Ann Behav Med. 2015 Aug; 49(4): 542–556. doi: 10.1007/s12160-014-9685-9. PMCID: PMC4498975. []
  20. Impact of Physical Exercise on Substance Use Disorders: A Meta-Analysis
    Dongshi Wang, Yanqiu Wang, Yingying Wang, Rena Li, Chenglin Zhou. PLoS One. 2014; 9(10): e110728. Published online 2014 Oct 16. doi: 10.1371/journal.pone.0110728. PMCID: PMC4199732. []
  21. Exercise-induced stress behavior, gut-microbiota-brain axis and diet: a systematic review for athletes. Allison Clark, Núria Mach. J Int Soc Sports Nutr. 2016; 13: 43. Published online 2016 Nov 24. doi: 10.1186/s12970-016-0155-6. PMCID: PMC5121944 []
  22. Gut Microbiota Modification: Another Piece in the Puzzle of the Benefits of Physical Exercise in Health? Begoña Cerdá, Margarita Pérez, Jennifer D. Pérez-Santiago, Jose F. Tornero-Aguilera, Rocío González-Soltero, Mar Larrosa. Front Physiol. 2016; 7: 51. Published online 2016 Feb 18. doi: 10.3389/fphys.2016.00051. PMCID: PMC4757670. []
  23. The Effect of Diet and Exercise on Intestinal Integrity and Microbial Diversity in Mice. Sara C. Campbell, Paul J. Wisniewski, Michael Noji, Lora R. McGuinness, Max M. Häggblom, Stanley A. Lightfoot, Laurie B. Joseph, Lee J. Kerkhof. PLoS One. 2016; 11(3): e0150502. Published online 2016 Mar 8. doi: 10.1371/journal.pone.0150502. PMCID: PMC4783017. []
  24. The Crosstalk between the Gut Microbiota and Mitochondria during Exercise. Allison Clark, Núria Mach. Front Physiol. 2017; 8: 319. Published online 2017 May 19. doi: 10.3389/fphys.2017.00319. PMCID: PMC5437217. []
  25. The difference between microbiome and microbiota can be a little confusing. Some researchers use the term ‘microbiota’ to mean the microbes found within a specific environment and the term ‘microbiome’ to mean the collection of microbial genomes in an environment. This is a useful differentiation since it can then indicate whether a paper has fully sequenced the genomes of the microbes it is examining or whether it has just identified them by 16S rRNA or culturing. However, over time many researchers have started to use these words interchangeably so it is not uncommon to see the word microbiome used in a paper where the author has identified the bacteria present in an environment but hasn’t sequenced their genomes. []
  26. Integr Med Res. 2014 Dec;3(4):172-179. doi: 10.1016/j.imr.2014.09.007. Epub 2014 Oct 5.
    Exercise-induced myokines in health and metabolic diseases. So B, Kim HJ, Kim J, Song W. []
  27. J Appl Physiol (1985). 2005 Apr;98(4):1154-62. The anti-inflammatory effect of exercise. Petersen AM1, Pedersen BK. []
  28. Front Physiol. 2016 Feb 18;7:51. doi: 10.3389/fphys.2016.00051. eCollection 2016. Gut Microbiota Modification: Another Piece in the Puzzle of the Benefits of Physical Exercise in Health?
    Cerdá B, Pérez M, Pérez-Santiago JD, Tornero-Aguilera JF, González-Soltero R, Larrosa M. []
  29. Exercise training-induced modification of the gut microbiota persists after microbiota colonization and attenuates the response to chemically-induced colitis in gnotobiotic mice. J. M. Allen, L. J. Mailing, J. Cohrs, C. Salmonson, J. D. Fryer, V. Nehra, V. L. Hale, P. Kashyap, B. A. White & J. A. Woods. Taylor & Francis Online. Received 05 Jun 2017, Accepted 23 Aug 2017, Accepted author version posted online: 01 Sep 2017, Published online: 22 Sep 2017. []
  30. Exercise May Positively Change the Makeup of Bacteria in Your Gut []
  31. Dr Greger on Exercise. []
  32. How Much Should You Exercise? []
  33. Dr Greger Podcast – How Much Exercise is Enough? []

EMS – Beneficial for Muscle-Building & Therapies?

There’s not a lot of peer-reviewed research on the effectiveness or safety of EMS (Electric Muscle Stimulation) either in relation to muscle-building for improved sports performance or for therapeutic uses, for instance in case of sarcopenia (muscle wastage) in the elderly. A quick review of all the current published research studies follows in an attempt to provide you with sufficient information to make up your own mind.

All bold/underlined highlights are my additions. The full study publications are available if you follow reference notes outlined at the bottom of this article.

EMS For Muscle-Building/Improved Sports Performance


Study 1

This study1 states that “…a whole-body suit equipped with an electrical muscle stimulation device may improve cardiopulmonary factors and psychophysiological indications. However, this form of exercise is not likely to be suitable for all individuals since many find EMS difficult to tolerate. Although most subjects of the WB-EMS group tolerated it quite well and there were no participants who dropped out from the experiment, five subjects in the WB-EMS group expressed tightness and discomfort in the chest area. Therefore, it is preferable to cut off the electrical stimuli to the chest area or to refrain from adding the chest area to the WB-EMS suit when it is developed later. Further research is required to confirm the most effective methods of using WB-EMS suits, to identify the populations in which it is most beneficial, and to ensure a greater degree of medical safety. In spite of these areas, this study was the first to investigate the safety of WB-EMS through applying GXT and analyzing the effects of WB-EMS on psychophysiological variables.”

Study 2

This study2 shows that “…common strength training and strength training with superimposed EMS both enhance strength of knee and hip extensors, as well as jumping and pendulum sprint performance without improvements in linear sprint performance. However, improvements of antagonistic hamstring strength in the S+E group suggest the potential of EMS to unloaded (antagonistic) muscle groups during training. Future research should seek to establish if superimposed EMS during complex movements like sprint and jump exercises could be a possible method to achieve positive effects for sport specific performance.”

Study 3

This study3 observed that “…comparable or at least similar increases of muscle parameters after 16 weeks of WB-EMS compared with the reference method “HIT.” Thus, WB-EMS can be considered as an attractive, time-efficient, and effective option to HIT-resistance exercise for people seeking to improve general strength and body composition. On the other hand, due to the close supervision of present WB-EMS applications, this exercise technology is much more expensive. However, taking into account the fact that WB-EMS technology will become more feasible and cost efficient over the next few years, the application of WB-EMS will be increasingly implemented in commercial and noncommercial fitness settings.”

Study 4

This study 4 concluded that”…an eight week training program (with just two days per week) of EMS combined with plyometric exercises has proven useful for the improvement of every kind of vertical jump ability required for sprint and hurdles disciplines in teenage athletes. A high-frequency (≥ 150 Hz) EMS and its simultaneous application with PT can significantly contribute to the improvement of the three different types of strength manifestations (explosive, explosive-elastic and explosive-elastic-reactive strength).”

EMS For Therapeutic Purposes


Study 5

Lower Back Pain

This study5 saw their results “…more as a preliminary finding than definitive evidence justifying a conclusion that WB-EMS has a favorable effect in the treatment of chronic, unspecific LBP [Lower Back Pain]. More dedicated WB-EMS RCTs with sufficient statistical power that focus on a homogeneous cohort of people with definite chronic and unspecific LBP and which incorporate generally accepted pain questionnaires that specifically focus on the low back region should be conducted to finally conclude this issue. Until then, WB-EMS should be regarded as a promising but still not adequately verified therapy for addressing chronic unspecific low back pain in the elderly.”

Study 6


This study6 clearly demonstrated that “…a whole-body EMS programme performed for 18 min/session, 3 sessions in 14 days, is effective for increasing muscle mass and is also safe and feasible, at least in an elderly cohort at risk for sarcopenia. Thus, we consider the application of this innovative exercise technology to be an appropriate option for elderly subjects looking to improve their body composition and muscular strength appropriately for independent and healthy aging. Taking into account that WB-EMS technology will become more feasible and cost effective over the next few years, the application of WB-EMS should be seriously considered as a means of exercise training that focuses primarily on body composition and strength parameters.”

Study 7

Sarcopenic Obesity7

This study8 pointed out that although “…our result might not be generalizable across all cohorts with sarcopenia or SO, it indicates at least the general effectiveness, safety, attractiveness, and feasibility of WB-EMS. However, taking into account the lower strain threshold of institutionalized women, we speculatively expected higher effects compared with our multimorbid but unexpectedly fit community dwelling cohort. Addressing the relevance of WB-EMS in older people with unfavorable body composition and functional limitation, we conclude that multimodal exercise protocol with endurance, resistance, and coordination would be definitely superior to WB-EMS application. However, as a matter of fact, the majority of older people are either no more capable or/and unexperienced to participate in intense and time-consuming exercise protocols. Thus, the take home message of this article is that WB-EMS can be considered as an appropriate training option for people unable or unwilling to exercise conventionally.”

Study 8

Muscle Mass/Abdominal Fat

This study9 clearly demonstrated “…WB-EMS [Whole Body-EMS] (at least combined with slight movements) applied for 18 minutes per session, on three sessions per 14 days over 12 months, has a beneficial impact on muscle mass and abdominal body fat, and is also safe and feasible, at least in this cohort of lean elderly females with limited interest in exercise. Although WB-EMS was unable to generate all the benefits of multipurpose exercise programs specifically designed for the multimorbid aged, it can be regarded as an option for subjects unwilling or unable to participate in conventional exercise programs but looking to improve their muscular fitness for independent and healthy aging.

Study 9


This study11 states that evidence “…supports the hypothesis that, neural supply to the veins provides direct antithrombic effects, a factor not included in Virchow’s triad. EMS appears to be one mechanism that, via neurogenic pathways, influences this 4th factor, thus suppressing thrombogenesis. As VTE remains one of the most preventable causes of in-hospital mortality, this hypothesis and factor as well as ways to affect it need to be explored. In addition, EMS needs to be investigated with well-designed RCTs for its possible additive effect on each thromboprophylactic measure, including the mechanical ones, as its implementation may save numerous lives.”

Study 10


In this study13 they found “…a borderline nonsignificant effect of WB-EMS on Bone Mineral Density at the lumbar spine and no effect at the hip. However, taking into account the high impact of this technology on muscle mass and strength, WB-EMS may be an option for musculoskeletal prevention/rehabilitation at least for (elderly) subjects unable or unwilling to exercise conventionally. Nevertheless, due to the higher impact of mixed exercise programs on BMD and their comprehensive effect on multiple risk factors and diseases of advanced age, classic exercise should be favored for elderly subjects.

Joe’s conclusion

The person who asked my opinion on EMS (the reason why I wrote this blog) has since decided that, in spite of the largely positive results coming out of the above research (and there isn’t much more that I could lay my hands on at this moment April 2018), he would still continue to use traditional weight-lifting exercises since the cost of EMS equipment was too high for him to be able to justify its use.

The peer-reviewed research data for and against EMS is outlined above. Of course, there are hundreds of websites that praise or condemn it, but I would suggest that you always check out the facts-based research before believing any anecdotal stories or sales pitches that might simply be trying to convince you to buy their products in order to line their pockets with profits – often without the least consideration about the true usefulness to you of the products or the possible negative health implications that can result for their short- or long-term use.




  1. J Exerc Rehabil. 2018 Feb; 14(1): 49–57. Published online 2018 Feb 26. doi: 10.12965/jer.1836022.011. PMCID: PMC5833968 PMID: 29511652. The efficacy and safety of whole-body electromyostimulation in applying to human body: based from graded exercise test. Yong-Seok Jee []
  2. J Sports Sci Med. 2016 Mar; 15(1): 26–33. Published online 2016 Feb 23. PMCID: PMC4763843. Effects of Loaded Squat Exercise with and without Application of Superimposed EMS on Physical Performance. Nicolas Wirtz, Christoph Zinner, Ulrike Doermann, Heinz Kleinoeder, and Joachim Mester. []
  3. Evid Based Complement Alternat Med. 2016; 2016: 9236809. Published online 2016 Feb 29. doi: 10.1155/2016/9236809 PMCID: PMC4789460 PMID: 27034699. Effects of Whole-Body Electromyostimulation versus High-Intensity Resistance Exercise on Body Composition and Strength: A Randomized Controlled Study. Wolfgang Kemmler,  , Marc Teschler,  Anja Weißenfels,  Michael Bebenek,  Michael Fröhlich, Matthias Kohl,  and Simon von Stengel []
  4. J Sports Sci Med. 2012 Dec; 11(4): 727–735. Published online 2012 Dec 1. Effects of Electrostimulation and Plyometric Training Program Combination on Jump Height in Teenage Athletes. Emilio J. Martínez-López, Elisa Benito-Martínez, Fidel Hita-Contreras, Amador Lara-Sánchez, and Antonio Martínez-Amat. []
  5. Evid Based Complement Alternat Med. 2017; 2017: 8480429. Published online 2017 Oct 18. doi: 10.1155/2017/8480429. Effects of Whole-Body Electromyostimulation on Low Back Pain in People with Chronic Unspecific Dorsal Pain: A Meta-Analysis of Individual Patient Data from Randomized Controlled WB-EMS Trials. Wolfgang Kemmler,  Anja Weissenfels,  Michael Bebenek,  Michael Fröhlich,  Heinz Kleinöder,  Matthias Kohl, and Simon von Stengel []
  6. Age (Dordr). 2014 Feb; 36(1): 395–406. Published online 2013 Aug 16. doi: 10.1007/s11357-013-9575-2. Impact of whole-body electromyostimulation on body composition in elderly women at risk for sarcopenia: the Training and ElectroStimulation Trial (TEST-III). Wolfgang Kemmler,corresponding author Michael Bebenek, Klaus Engelke, and Simon von Stengel. []
  7. Curr Opin Clin Nutr Metab Care. Author manuscript; available in PMC 2009 Jan 30. Published in final edited form as: Curr Opin Clin Nutr Metab Care. 2008 Nov; 11(6): 693–700. doi: 10.1097/MCO.0b013e328312c37d. Sarcopenic obesity – definition, etiology and consequences. Sari Stenholm, PhD, Tamara B. Harris, MD, MS, Taina Rantanen, PhD, Marjolein Visser, PhD, Stephen B. Kritchevsky, PhD, and Luigi Ferrucci, MD, PhD []
  8. Clin Interv Aging. 2016; 11: 1697–1706. Published online 2016 Nov 18. doi: 10.2147/CIA.S116430. Impact of whole body electromyostimulation on cardiometabolic risk factors in older women with sarcopenic obesity: the randomized controlled FORMOsA-sarcopenic obesity study. Katharina Wittmann, Cornel Sieber, Simon von Stengel, Matthias Kohl, Ellen Freiberger, Franz Jakob, Michael Lell, Klaus Engelke, and Wolfgang Kemmler []
  9. Clin Interv Aging. 2013; 8: 1353–1364. Published online 2013 Oct 7. doi: 10.2147/CIA.S52337. Whole-body electromyostimulation as a means to impact muscle mass and abdominal body fat in lean, sedentary, older female adults: subanalysis of the TEST-III trial. Wolfgang Kemmler and Simon von Stengel []
  10. Definition of thrombogenesis []
  11. Springerplus. 2016; 5(1): 884. Published online 2016 Jun 24. doi: 10.1186/s40064-016-2521-x. Electrical muscle stimulation in thomboprophylaxis: review and a derived hypothesis about thrombogenesis—the 4th factor. Christos Stefanou corresponding author []
  12. Definition of osteopenia []
  13. J Osteoporos. 2015; 2015: 643520. Published online 2015 Feb 15. doi: 10.1155/2015/643520. Whole-Body Electromyostimulation to Fight Osteopenia in Elderly Females: The Randomized Controlled Training and Electrostimulation Trial (TEST-III). Simon von Stengel, * Michael Bebenek, Klaus Engelke, and Wolfgang Kemmler []

Dr Kim Williams – Life’s Simple Seven

Dr Kim A Williams1, the first ever vegan president of the American College of Cardiology, gives2 his version of the American Heart Association’s simple rules for having a healthy heart, called “Life’s Simple Seven”. If we are really concerned about living long and healthy lives – both for ourselves and for our loved ones – why would anyone not use these as an essential lifestyle foundation?

1. Everyone should be on a plant-based diet.

The AHA don’t say “plant-based”, instead they talk about a “heart-healthy diet”:

“Eat Better – A healthy diet is one of your best weapons for fighting cardiovascular disease. When you eat a heart-healthy diet, you improve your chances for feeling good and staying healthy – for life!” 3

There’s a clear reason why Dr Williams modifies the AHA’s definition of what is “heart-healthy” when you look at the list of foods the AHA recommend as foods we should eat4:

” Eat an overall healthy dietary pattern that emphasizes:

This is not the place to go into the research showing the harmful effects of four of the items in the above list – dairy, poultry, fish and oils), so we’ll move on and just be thankful that the ex-president of the American College of Cardiology is up-to-date with –  and prepared to be honest about – the findings relating to plant-based vs meat-based diets in nutritional research literature.

2. Everyone should be at their ideal body weight.

  • If you’re overweight, you need to address it.
  • If you’re obese, you really need to deal with it now.
  • If you’re morbidly obese, you’re going to have to make some dramatic changes that are behavioural and not easy – but they have to be done.

3. Everyone should know their blood sugar and make sure it’s normal.

The health services of an ever-growing number of countries are increasingly under threat of being swamped by cases of diabetes. In addition to this, there is a worrying change in the CVD mortality figures.

For 40+ years, in the U.S., these figures have been dropping because of the pharmaceutical and surgical advances (stents, by-pass surgeries, etc) made in prolonging the lives of heart disease patients  – admittedly they still have restricted lives and are not being cured, unlike some of heart disease patients treated with WFPB lifestyle changes by the likes of Dr C B Esselstyn and Dr Dean Ornish.

But between 2014 and 2015, this downward trend came to an end. Some5 predict:

“The number of people with heart failure is expected to rise by 46 percent by 2030.” 

The rise could be partly due to the increase in obesity and diabetes, but also as a natural dropping of the curve as the average 10-year life expectancy increase of medical interventions in CVD catches up with those treated a decade or so ago.

For those who are diabetic, or at risk of becoming diabetic, losing weight is something that should be an immediate priority.

The obesity and diabetic epidemic is real.”

And transitioning to a WFPB diet is probably the healthiest and most sustainable way of doing this.

4. Everyone should know what their blood pressure is and it should be controlled.

It’s shocking how few people are even aware of what their blood pressure is. And of those who do know, only a relatively small proportion are doing anything to control it. Surely almost everyone should be able to justify either the small cost of purchasing a wrist or arm blood pressure monitor (also called a sphygmomanometer) or the short journey to the doctor’s surgery for a test.

5. Everyone needs to be getting some physical exercise every day.

Even aiming for a daily minimum of 30 minutes exercise would make a tremendous difference – whether it’s on a cross-trainer, walking briskly or playing a round of golf. Mixing the types of exercise is ideal, so that both aerobic and load-bearing exercises are involved.

Regardless of your age or level of fitness, there are exercises6 that will suit you and allow you to grow stronger and feel so much more alive.

6. Everyone should should know what their cholesterol is and that it is at a normal level.

If you have to normalise your cholesterol with medication, then do it. Ideally, of course, it’s best to achieve it by eating a WFPB diet, since then the only cholesterol you will have in your body is what your body (liver, intestines etc) is making for you. And an added benefit is that you then don’t have to pay for possibly expensive medications.

There’s so much invaluable advice7 – that can be found online about which foods lower cholesterol and how important it is to reduce, or better still, eliminate dietary cholesterol completely from your diet. Remember that dietary cholesterol only comes from animal foods, and because almost all animal foods come naturally pre-packed with corresponding amounts of saturated fat, this increases the damage that the cholesterol can do to your body.

7. Nobody should smoke.

Although the rate of tobacco smoking has reduced in the Western World, it’s still a major cause of a variety of diseases that are almost completely avoidable if you don’t smoke.


If you follow these 7 simple rules…

…there will be a dramatic change in your lifestyle, functional capacity and the influence you will have on your friends and family.

If we ignore these rules, it’s not just the future of our own health that’s at risk. The solvency of our national health service and the economic future of our country will also be casualties – victims of the unfortunate lifestyle and dietary choices made by its well-intentioned citizens.



  1. 1st Vegan President of the American College of Cardiology []
  2. Dr. Kim Williams And Jeremy Glogower Get Real About Going Plant-Based, Seven Rules We Can All Live By And More… []
  3. My Life Check – Life’s Simple 7. American Heart Association. []
  4. The American Heart Association: Diet and Lifestyle Recommendations. []
  5. CBS News: U.S. heart failure rates on the rise. []
  6. Physical Exercises for Beginners and Seniors []
  7. Cholesterol Advice from Dr Greger []

Does Prostate Cancer Screening Work?


As men age, they are likely to hear horror stories about someone that someone knows who died of prostate cancer. This often causes a fear-response that directs the person to ask their doctor for a PSA test. But do they cause more harm than good?


It seems intuitively sensible to have a test to make sure that you don’t have this cancer. But intuition would be misplaced in this instance.

The PSA test

The test that’s used in prostate cancer (PC) screening is called the PSA (prostate-specific antigen) test. PSA is a protein produced by cells (both normal and malignant) in the prostate gland. It is usually measured and reported in nanograms of PSA per millilitre of blood (ng/mL). If there is a high number as a result of the test, it could suggest a problem with your prostate – although not necessarily cancer.

Review of recent research

(My bold highlights)

A 2011 review of 5 RCT’s (randomised controlled trials) found the following:

“Prostate cancer screening did not significantly decrease all-cause or prostate cancer-specific mortality in a combined meta-analysis of five RCTs. Any benefits from prostate cancer screening may take > 10 years to accrue; therefore, men who have a life expectancy of < 10-15 years should be informed that screening for prostate cancer is not beneficial and has harms.”

A 2013 follow-up to the 2011 review confirmed the above findings:

“Pooled data currently demonstrates no significant reduction in prostate cancer-specific and overall mortality. Harms associated with PSA-based screening and subsequent diagnostic evaluations are frequent, and moderate in severity. Overdiagnosis and overtreatment are common and are associated with treatment-related harms. Men should be informed of this and the demonstrated adverse effects when they are deciding whether or not to undertake screening for prostate cancer. “

A 2018 study drew the same conclusions:

The Cancer Research UK CAP trial looked at whether a single PSA blood test would reduce the number of men dying of prostate cancer. This was a large UK study with over 400,000 men between the ages of 50 and 69 taking part. Around half the men had a PSA blood test the other half didn’t.

The results in early 2018 showed that the number of men dying from prostate cancer was the same in both groups. This was after 10 years of follow up. The researchers say that this trial doesn’t support PSA testing as a screening test for prostate cancer.”

Two anecdotal tales

  1. My father was diagnosed with PC several years before he died. However, he didn’t die of it – he died with it. His cause of death was pneumonia and COPD.
  2. Frank Zappa, the genius musician and one of my personal heroes, died of PC. He used to have regular PSA screening. His PC was not picked up!

So what’s to do?

As with all things, prevention is better than cure – and the WFPB diet combined with regular daily exercise have been shown to significantly reduce the risk of PC and of treating/reversing it once it has developed. Dr Greger presents plenty of convincing evidence that the fate of a man’s prostate is in his own hands – so to speak…

Mainstream media is catching up, too

It was refreshing to read a recent Times article that said pretty much everything outline above. And it was nice to see a range of plant food suggestions to fight PC. I mention them below, not so that people will concentrate on eating only these plant foods, but so that it might illustrate the variety of plant foods involved. I advocate the wholistic approach to nutrition – forget worrying getting specific micronutrients from a specific plant; rather, concentrate on eating as wide a range as possible of every whole plants as you can lay your hands on – I mention, in particular, Dr Joel Fuhrman’s G-BOMBS (greens, beans, onions, mushrooms, berries and seeds).

The Times they are a-changing

What to eat to beat prostate cancer (based on linked research):

There are literally thousands of research papers showing that plant foods can prevent, treat and reverse a vast array of chronic diseases.

But how often has your doctor written out a prescription for these humble life-savers?


BJU Int. 2011 Mar;107(6):882-91. doi: 10.1111/j.1464-410X.2010.10032.x. Screening for prostate cancer: an updated Cochrane systematic review. Ilic D, O’Connor D, Green S, Wilt TJ.

BMJ Open. 2013; 3(3): e002452. Published online 2013 Mar 1. doi: 10.1136/bmjopen-2012-002452
PMCID: PMC3612777. A cluster-randomised, parallel group, controlled intervention study of genetic prostate cancer risk assessment and use of PSA tests in general practice—the ProCaRis study: study protocol. Pia Kirkegaard, Peter Vedsted, Adrian Edwards, Morten Fenger-Grøn, and Flemming Bro.

The Cancer Research UK CAP trial. 2018. (

Prostate Cancer blog on 2018. (

Prostate Cancer blog on (

The Sunday Times March 10th 2018. What to eat to beat prostate cancer. (

Fighting prostate cancer with a tomato-rich diet. University of Bristol press release issued: 27 August 2014. (

Study: green tea prevents prostate cancer. UPI April 20, 2005. (

The Secret Power of Broccoli. Oregon State University. Summer 2016. (

A Meta-Analysis of Dietary Carotenoids and Prostate Cancer Incidence. Thesis. April 2014. DOI: 10.13140/RG.2.1.5074.7761. Thesis for: B.Sc. Human Health & Disease, Advisor: Dr. Katarina Bälter, Dr. Jennifer Protudjer, Dr. Arvid Sjölander (

Starving Prostate Cancer With What You Eat for Dinner. University of Texas at Austin News. June 6, 2017. (

Prostate Cancer Prostatic Dis. 2017 Sep; 20(3): 265–270. A Review of Pomegranate in Prostate Cancer. Channing J. Paller, MD, Allan Pantuck, MD, MS, FACS, and Michael A. Carducci, MD, FACP.

Reduction by Coffee Consumption of Prostate Cancer Risk: Evidence From the Moli-Sani Cohort and Cellular Models. G Pounis et al. Int J Cancer 141 (1), 72-82. 2017 Apr 24. (

J Med Food. 2014 Dec 1; 17(12): 1281–1286. PMCID: PMC4259176. TRAMP Prostate Tumor Growth Is Slowed by Walnut Diets Through Altered IGF-1 Levels, Energy Pathways, and Cholesterol Metabolism. Hyunsook Kim, Wallace Yokoyama, and Paul Andrew Davis.


10 Protein-Rich Plant Foods Your Muscles Will Love


There’s been a long-standing belief that plant-based diet might lack enough protein. This is simply not true.  Of course, some plant foods contain significantly more protein than others. But adopting a balanced and varied plant-based diet can promote muscle strength, endurance, performance and recovery for both top athletes and the occasional gym-goer.

Don’t ignore exercise

Regular daily exercise is not something that should be ignored simply because we are eating the optimal diet for human health and well-being.  All research indicates that there are huge health benefits when we regularly raise and maintain a higher heart rate and give our load-bearing muscles a good workout.

Let exercise exorcise those disease demons

It is amazing how many chronic diseases can be prevented and treated by regular exercise, including:

And this is just naming a few of the horrible health conditions that can benefit greatly from regular exercise.

How much exercise?

Dr Greger says “I recommend 90 minutes of moderate-intensity activity, such as brisk (four miles per hour) walking or 40 minutes of vigorous activity (such as jogging or active sports) each day.” 

And if we can’t manage this amount every day, we should ensure that we do as much as we possibly can – if possible, take the bike or walk rather than jump in the car; take the stairs rather than the lift; get up regularly from the chair and walk around the house – anything to increase the amount of daily physical movement. I use a Fit-bit wrist monitor to remind me when it’s time to get moving. There are many other products on the market like this to give us a timely tip-off that our muscles and joints would like to “go out and play”!

10 high-protein plant foods that muscles love

Tofu, tempeh and edamame

Tofu, tempeh and edamame all derive from soybeans. Soybeans are considered a whole source of protein. This means that they provide the body with all the essential amino acids it needs – which is important for workouts.

All three contain iron, calcium and 10-19 grams of protein per 3.5 ounces (100 grams).

Edamame are also rich in folate, vitamin K and fibre. Tempeh contains a good amount of probiotics, B vitamins and minerals such as magnesium and phosphorus.


At 18 grams of protein per cooked cup (240 ml), lentils are a beneficial source of protein.

Lentils also contain decent amounts of slowly digested carbs, and a single cup (240 ml) provides approximately 50% (14 grams) of our recommended daily fibre intake.

Further, the type of fibre found in lentils has been shown to feed the good bacteria in our colon, promoting a healthy gut. This type of detoxing allows for better workouts.

Lentils are rich in folate, manganese and iron. They also contain a decent amount of antioxidants and other health-promoting plant compounds.


Chickpeas, also known as garbanzo beans, are also high in protein.

Chickpeas contain about 15 grams of protein per cooked cup (240 ml). They are also excellent sources of complex carbs, fibre, iron, folate, phosphorus, potassium, manganese and several beneficial antioxidant compounds.

Nutritional yeast

Nutritional yeast is a deactivated strain of Saccharomyces cerevisiae yeast, usually sold as a yellow powder or flakes.

This complete source of plant protein provides the body with 14 grams of protein and 7 grams of fibre per ounce (28 grams).

And if you consider it is needed, fortified nutritional yeast is also an excellent source of zinc, magnesium, copper, manganese and all the B vitamins, including B12.

Hemp seeds

Hemp seeds contain 10 grams of complete, easily digestible protein per ounce (28 grams). That’s 50% more than chia seeds and flaxseeds.

Hemp seeds also contain a good amount of magnesium, iron, calcium, zinc and selenium. What’s more, they’re a good source of omega-3 and omega-6 fatty acids in the ratio considered optimal for human health.


1 cup (185 grams) of cooked quinoa provides us with 8 grams of complete protein, in addition to covering 30% of our daily requirements of iron, 50% manganese and 39% of our daily copper needs.

Quinoa also contains decent amounts of fibre (5.2 grams) , magnesium, thiamine, riboflavin, potassium and small amounts of most of the other nutrients our body needs, including essential fatty acids.

Oats and oatmeal

Half a cup (120 ml) of dry oats provides us with approximately 6 grams of protein and 4 grams of fibre. This portion also contains good amounts of magnesium, zinc, phosphorus and folate.

Oats are a good pre-workout snack.

For the best boost in energy before a hard workout, carbohydrates are easier and faster to digest than foods high in protein and fat.

Chia seeds

At 6 grams of protein and 13 grams of fibre per 1.25 ounces (35 grams), chia seeds contain a good amount of iron, calcium, selenium and magnesium, as well as omega-3 fatty acids, antioxidants and various other beneficial plant compounds.

Nuts, nut butters and other seeds

One ounce (28 grams) contains between 5–7 grams of protein, depending on the nut and seed variety.

Nuts and seeds are also great sources of fibre and healthy fats, in addition to iron, calcium, magnesium, selenium, phosphorus, vitamin E and certain B vitamins. They also contain antioxidants, amongst other beneficial plant compounds.

Add in a little bit of healthy fats before a workout. Try some clementine oranges with a few unsalted nuts. The combination of healthy fats and carbohydrates will help us stay fuelled without weighing us down.

Protein-rich fruits and vegetables


Fresh fruits have a lower protein content than vegetables.

Those containing the most are:

  • Guava
  • Mulberries
  • Blackberries
  • Nectarines
  • Bananas

They contain approximately 2–4 grams of protein per cup (150 grams).

These are great before a workout.

Fruit contains energy-boosting carbohydrates—not to mention satiating fibre and phytochemicals that are easy to digest.


Vegetables with the highest protein include:

  • Broccoli
  • Spinach
  • Asparagus
  • Artichokes
  • Kale
  • Sweet potatoes
  • Brussels sprouts

They contain about 4–5 grams of protein per cooked cup (approx. 150 grams).

Incorporating above-ground leafy vegetables (especially kale) after a workout will help neutralise the acid that’s released. We want to keep our bodies in a state of alkalinity, otherwise the body will leach calcium from the bones to neutralise blood acidity.

Two cornerstones of a healthy life are a WFPB diet and regular exercise. Enjoy them both every day…



Exercise – Nutritionfacts (

Physical activity and annual medical outlay in U.S. colorectal, breast and prostate cancer survivors. Yan AF, Wang Y, Ng AV. Prev Med Rep. 2018 Feb 2;9:118-123. doi: 10.1016/j.pmedr.2018.01.003. eCollection 2018 Mar.

Simultaneous Aerobic Exercise and Memory Training Program in Older Adults with Subjective Memory Impairments. McEwen SC, Siddarth P, Abedelsater B, Kim Y, Mui W, Wu P, Emerson ND, Lee J, Greenberg S, Shelton T, Kaiser S, Small GW, Merrill DA. J Alzheimers Dis. 2018;62(2):795-806. doi: 10.3233/JAD-170846.

Physical exercise prevents cognitive impairment by enhancing hippocampal neuroplasticity and mitochondrial function in doxorubicin-induced chemobrain. Park HS, Kim CJ, Kwak HB, No MH, Heo JW, Kim TW. Neuropharmacology. 2018 Mar 2;133:451-461. doi: 10.1016/j.neuropharm.2018.02.013. [Epub ahead of print] PMID: 29477301.

Aerobic Exercise: Evidence for a Direct Brain Effect to Slow Parkinson Disease Progression.Ahlskog JE. Mayo Clin Proc. 2018 Mar;93(3):360-372. doi: 10.1016/j.mayocp.2017.12.015. Review. PMID: 29502566.

Benefits of intensive treadmill exercise training on cardiorespiratory function and quality of life in patients with pulmonary hypertension. Chan L, Chin LMK, Kennedy M, Woolstenhulme JG, Nathan SD, Weinstein AA, Connors G, Weir NA, Drinkard B, Lamberti J, Keyser RE. Chest. 2013 Feb 1;143(2):333-343. doi: 10.1378/chest.12-0993. PMID: 22922554 Free PMC Article.

A review of lifestyle factors that contribute to important pathways associated with major depression: diet, sleep and exercise. Lopresti AL, Hood SD, Drummond PD. J Affect Disord. 2013 May 15;148(1):12-27. doi: 10.1016/j.jad.2013.01.014. Epub 2013 Feb 14. Review. PMID: 23415826.

The effects of exercise on vascular endothelial function in type 2 diabetes: a systematic review and meta-analysis. Lee JH, Lee R, Hwang MH, Hamilton MT, Park Y. Diabetol Metab Syndr. 2018 Mar 6;10:15. doi: 10.1186/s13098-018-0316-7. eCollection 2018. Review. PMID: 29541164 Free Article.

Exercise Training and Cardiovascular Health in Cancer Patients. Squires RW, Shultz AM, Herrmann J. Curr Oncol Rep. 2018 Mar 10;20(3):27. doi: 10.1007/s11912-018-0681-2. Review. PMID: 29525828.








What Will Your Last 10 Years Look Like?

Watching the life ebb out of my mother as she lies in hospital, I can’t help but wonder whether I will also end my days in such a painful, sad and ignominious manner. Decades of watching her health deteriorate, largely because of her atrocious diet and physical inactivity, was a major reason why I became so interested in nutrition. If only I could turn the clock back and change things for her, but she wouldn’t listen to me then and she can no longer hear me now.

Returning from the hospital, I noticed an email which coincidentally contained the following powerful short video (1.25 mins) from the True North Center in California, USA.

It poignantly reminds us that degenerative diseases are not inevitable. We all hold the ability, through the right lifestyle choices, to ensure we can maintain good health even right through into our latter years – not just for ourselves, but for our loved ones, too.

What will your choice be?