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Can you really improve your immunity in 21 days? – Evening Standard

Posted: August 27, 2020 at 2:57 pm

The latest lifestyle, fashion and travel trends

The links are undeniable: having underlying health conditions and being overweight put us at a significantly greater risk of COVID-19.

Countless research studies have proven it. Boris is on a mission to tackle it. And now a new book sets out guidelines for exactly how you can improve your health and protect yourself in just 21 days.

It is understood that eighty per cent of chronic disease is attributable to lifestyle and linked to environmental factors. That is to say, that eighty percent of common diseases like diabetes and cardiovascular disease can be prevented with healthier diet and lifestyle choices.

We know that losing weight and improving our health can help us prevent these diseases, but how can it help us fight Covid?

In his book, The 21-Day Immunity Plan, Aseem Malhotra details the strong link between poor metabolic health and its impact on our immune health. In simple terms, metabolic can be explained as the state of balance the body maintains between storing fat and burning it for energy. Once this balance is disrupted it impacts negatively on our health in a variety of ways.

Poor metabolic health is directly linked to the development of heart disease, type 2 diabetes and stroke and has also linked to the development of cancer and dementia. It is assessed using five markers: blood glucose (sugar) levels, blood pressure, waist circumference and cholesterol profile.

Poor metabolic health and our weight are closely linked. Excess body fat has a negative effect on our immune function in a number of different ways but primarily through a process known as chronic inflammation. When we suffer an infection, a healthy functioning immune and inflammatory response protects us. But carrying excess body fat is known to result in chronic inflammation a constant low-grade inflammation that has many negative impacts on health. Underlying chronic inflammation means that when we are exposed to a virus the cells that are responsible for mounting an attack do not function as effectively as they should and are less able to protect us.

Its known that diabetes (both type 1 and type 2) is associated with more frequent and more severe infections. In the UK it was noted that compared to non-diabetics those with type 2 diabetes who contracted coronavirus had a threefold increased risk in death and those with type 1 diabetes had a fourfold increase. One study in China revealed that type 2 diabetics with poor glucose control had a 10-fold increases risk of death in comparison with those with better glucose control.

Life after lockdown: the new habits to keep and those to leave behind

Unlike Type 1 diabetes, which is diagnosed early in life, our chances of developing Type 2 diabetes are significantly impacted by our diet. Its now known we can reverse it through dietary intervention, something I have witnessed first hand on multiple occasions in my own clinical practice.

Relying on medical intervention alone to save us is a risky business, whether thats a vaccine to protect us from Covid or medications to manage chronic diseases. In his book, Aseem highlights the fact that obesity appears to reduce the response to vaccination and increase the risk of viruses mutating. This happens because viruses stay in the body for longer as a result of an inability to produce the full immune response, which allows the virus to replicate for longer and produce a new strain. On the other hand, several studies have revealed that exercise can significantly increase the antibody response to influenza vaccine. This goes to show the extent to which medical treatment can be significantly enhanced by improving our diet and lifestyle.

We cannot ignore the impact of ageing on immunity, particularly with coronavirus given that its by far the biggest risk factor for death. Those aged over 65 account for 80 per cent of hospitalisation compared to those under 65, and are 23 times more likely to die.

But Aseem points to the fact that the overwhelming majority of those that died from COVID-19 in older age groups had at least one underlying condition, predominantly rooted in poor metabolic health. While we cant slow down the speed at which the years pass, we can impact the speed at which our body ages through our diet and lifestyle choices.

A low carb Mediterranean diet is considered one of the healthiest in the world (Unsplash)

An individuals immune system is the result of a number of factors and some of them cannot be changed, such as age and genetics. But many of them can, such as diet, exercise, weight, alcohol and stress. As the saying goes genes load the gun, environment pulls the trigger.

Four steps to better metabolic (and immune) health:

So what can we do to support our metabolic health in order to support our immune defences? The 21-Day Immunity Plan highlights four key areas to address.

1. A low carb Mediterranean Diet

Poor diet is the most significant contributor to metabolic health disorders and is now responsible for more disease and death than physical inactivity, smoking and alcohol combined. Aseem describes ultra-processed foods and drink as the number one enemy in our western diets, making up more than a staggering 50 per cent of calories consumed on average in the UK. He highlights the major dietary culprits including a diet low in whole fruit and vegetables, inadequate intake of nuts and seeds, not enough omega 3 fats, not enough fibre, too much sugar, and a high intake of processed meat.

5 food mistakes to avoid if you're trying to lose weight

In The 21 Day Immunity Plan he explains how to identify and eliminate ultra-processed foods from your diet and outlines a clear strategy for how to eat to support metabolic and immune health. These principles are based on a nutrient dense, low carb Mediterranean diet approach.

2. Key nutrients

Theres been a lot of publicity around the link between vitamin D deficiency and worse outcomes from coronavirus. A study from Indonesia revealed a ten-fold difference in death rates between those with the lowest levels versus those with normal levels. Its therefore vital to ensure your vitamin D levels are always optimised. In his book, Aseem discusses the importance of vitamin D and other immuneessential nutrients, along with how to establish your levels and what to do to make sure youre getting enough.

A BMJ paper on Nutrition, Prevention and Health is quoted as saying: What is clear is that conditions of nutrient deficiency impair the functioning of the immune system and increase susceptibility to infection. Ensuring optimal intake of key nutrients is an important step in supporting immune system health.

3. Exercise

The immune system is significantly influenced by physical activity. Just a single bout of moderate to vigorous exercise has been shown to enhance the immune systems ability to function and fight infection more effectively. Over time, with regular exercise, these effects build up to strengthen immune defences. Moderate activity has an anti-inflammatory effect and is well known to improve metabolic health.

However, overly intense and prolonged bouts of exercise can have a negative impact on immune function, especially if the individual is not well rested or nourished. As with so many things, moderation is key. The Chief Medical Officers guidelines for adults state that we should be engaging in at least 150 minutes of moderate activity per week and/or 75 minutes of vigorous-intensity activity per week, as well as some form of strength building exercise on at least two days per week.

4. Stress management

Chronic stress plays a significant role in the development of most chronic metabolic diseases. In the 21-day plan Aseem shares simple guidance and techniques for how to reduce stress which has proven to be a powerful tool in managing patients with heart disease.

There are three main reasons for a 21 day plan. The first is that for most people it takes three weeks to break any habit, in this case a sugar and ultra-processed food habit.

The second is that most people with adverse metabolic health will start to see marked improvements to their health and/or shape within three weeks. Aseem points to a number of different trials outlining the significant changes that can be made in a short period of time.

The third reason is the need to change the narrative around the impact of lifestyle changes and show that their effect on health can be rapid and substantial. We should use this to motivate ourselves to continue to reap the benefits of improved health for life.

This reflects what I have seen in my own clinical practice. Many of the clients I work with are amazed at how quickly nutrition and lifestyle optimisation can result in significant fat loss, increased energy and improved health markers. Of course, health improvement is a journey and not a quick fix, but it is witnessing the fruits of our labour so to speak that keeps us motivated to continue.

Like me, Aseem is a passionate advocate for lifestyle medicine. We share the fundamental belief that, when taken good care of, our body possesses an innate ability to heal itself. An ability far greater than that of many modern medical practices. We also share the belief that prevention is better than cure and that much can be done to protect ourselves from ill health - way beyond mask wearing and hand sanitising.

This valuable and timely book is a must read for anyone who wants to empower themselves with the practical knowledge of how they can improve their health and protect themself from disease of all kinds - Covid included. If there was ever a time to prioritise taking care of your health, now is it.

Kim Pearson is a qualified nutritionist and runs a weight loss clinic on Londons Harley Street. Kim and her team consult clients in London and internationally via her virtual clinic. For more information about the weight loss solutions Kim offers, visit kim-pearson.com.

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Can you really improve your immunity in 21 days? - Evening Standard

North Carolinas top football prospects for 2021: 41-50 – The Topsail Advertiser

Posted: August 27, 2020 at 2:57 pm

USA TODAY Network sports writer Sammy Batten has produced a ranking of North Carolinas top college football prospects since 1994. Batten ranks the players based on many factors, including scholarship offers, conversations with recruiting analysts and football coaches, and his own observations after reviewing video of each prospect.

Included in this year's rankings is an in-depth look at each prospect where they rank in major networks, their statistics and honors, where their recruitment stands and Sammy's personal evaluation.

Due to the COVID-19 outbreak, which has postponed the North Carolina high school football season until next spring, some of these athletes have elected not to play as seniors. Instead, they will graduate from high school in December to get an early start on their college careers in January. We have indicated, where known, the players that are exercising that option in their individual bios.

The countdown of top in-state prospects will run in groups of 10 through Sunday. Here are Nos. 41-50:

41. TYMIR BROWN

Position: Cornerback

Height, weight: 6-0, 170

Hometown: Jacksonville

High school: Jacksonville

College choice: North Carolina

In the rankings

ESPN.com: 4 stars, No. 13 cornerback nationally, No. 204 in ESPN300 nationally.

Rivals.com: 3 stars, Unranked nationally.

247Sports.com: 3 stars, No. 42 athlete nationally.

Notes & numbers: A three-year varsity starter already who beat out an upperclassman as a freshman to land a job at cornerback. Brown made 33 tackles and an interception during his rookie campaign. Played offense and defense as a sophomore. Rushed 18 times for 111 yards and two touchdowns, while making four interceptions on defense. Returned two of those picks for scores. Became Jacksonvilles starting quarterback as a junior. Completed 30 of 100 passes for 635 yards and four touchdowns, and rushed 94 times for 713 yards and 11 scores. Was named to the Jacksonville Daily New All-Area squad as a junior. A 7.7 scorer in basketball as a junior. Has been timed at 11.04 seconds in the 100-meter dash.

Recruiting trail: An impressive list of schools, including Duke, Georgia Tech, N.C. State, South Carolina, Tennessee, Virginia Tech, Wake Forest and West Virginia, offered Brown scholarships. But it was the opportunity to learn the cornerback position under former NFL All-Pro Dre Bly at North Carolina that swayed him toward becoming a Tar Heel on March 17, 2020.

Sammy's take: Brown is a bit of a project because his experience at cornerback was limited during his junior season while he was playing quarterback in Jacksonvilles veer-option attack. But his athletic ability is clear. Hes a guy with speed, showed the ability to flip his hips as a ball carrier and is stronger than his size might indicate. Those will translate well when he becomes to being a full-time corner at UNC.

More: Tymir Brown highlight video

42. JALEEL DAVIS

Position: Offensive tackle

Height, weight: 6-6, 300

Hometown: Rockingham

High school: Richmond Senior

College choice: N.C. State

In the rankings

ESPN.com: 3 stars, No. 95 offensive tackle nationally.

Rivals.com: 3 stars, No. 54 offensive tackle nationally.

247Sports.com: 3 stars, No. 63 offensive tackle nationally.

Notes & numbers: A product of the 4-A powerhouse Richmond program, Davis was a key contributor to one of the states top offenses as a junior. The Raiders averaged 39.8 points and 224.8 yards rushing en route to a 13-1 finish. They scored 51 touchdowns on the ground to reach the state semifinals before falling to eventual champion Charlotte Vance. Davis earned first-team All-Sandhills 4-A Conference honors and was named to the All-East squad as selected by HighSchoolOT.com. Started on an 11-2 squad as a sophomore when he also earned All-Sandhills 4-A honors. Teammate of N.C. State receiver commit Jakolbe Baldwin.

Recruiting trail: Davis spent time at Tennessee, attending a Junior Day function there in January 2020. But hed already established a strong connection with N.C. State after participating in summer camp there in 2019. The Wolfpack offered a scholarship when he was on campus for a Junior Day in January, then on May 26 Davis decided to join Richmond wide receiver teammate Jakolbe Baldwin in States recruiting class.

Sammy's take: Davis has held his own against some of the best competition in our state, whether its in the Sandhills Conference or state playoffs. Hes long and lean physically doesnt look like he weighs 300 pounds. He gets off the ball fast, gets into the chest of defenders quickly and stays low as he drives them to the ground. The best thing about Davis is that hes equally effective blocking for the pass or run.

More: Jaleel Davis highlight video

43. NICHOLAS BARRETT

Position: Defensive tackle

Height, weight: 6-4, 320

Hometown: Goldsboro

High school: Eastern Wayne

College choice: South Carolina

In the rankings

ESPN.com: 3 stars, No. 40 defensive tackle nationally.

Rivals.com: 3 stars, Unranked nationally.

247Sports.com: 3 stars, No. 51 defensive tackle nationally.

Notes & numbers: Barrett was named the Eastern Carolina 3-A/4-A Conference Defensive Player of the Year as a junior after collecting 70 tackles, 15 tackles for loss and 15 sacks. He had five tackles for loss and four sacks among his nine tackles in a late-season game against D.H. Conley. Also had three quarterback hurries in that game. Played in seven games for the Warriors as a freshman, making 12 tackles. Became a full-time starter as a sophomore when he had 32 tackles, six tackles for loss and two sacks. Has been timed at 5.4 seconds in the 40-yard dash. Earned an invitation to the Blue-Gray All-American game in January.

Recruiting trail: A big junior season put Barrett on the recruiting radar of schools such as Coastal Carolina, Duke, East Carolina, Mississippi, Penn State, Tennessee and Virginia, all of whom offered scholarships. But Will Muschamps reputation for developing defensive players drew Barrett to South Carolina, where he verbally committed on April 8, 2020.

Sammy's take: Barrett is a tall, powerful athlete who already has the size to handle the demands of FBS football. Hes an immovable force in the middle of the defensive front and consistently forces offenses to run away from him in high school. Beats double teams to blow up a lot of plays in the backfield. The Gamecocks pulled off a real recruiting coup in luring Barrett out of state.

More: Nicholas Barrett highlight video

44. AARON HALL

Position: Defensive end

Height, weight: 6-5, 220

Hometown: Durham

High school: Southern Durham

College choice: Duke

In the rankings

ESPN.com: 3 stars, No. 108 defensive end nationally.

Rivals.com: 3 stars, Unranked nationally.

247Sports.com: 3 stars, No. 37 weakside defensive end nationally.

Notes & numbers: One of the most productive years among defenders in the Research Triangle area as a junior. Recorded 97 tackles, 27.5 sacks in 11 games. Had a season-high 12 tackles twice. Posted four sacks in a single game against rival Hillside and had 3.5 sacks against Vance County. Also made 12 catches for 276 yards and four touchdowns as a wide receiver on offense. Selected first-team All-Big 8 4-A Conference for his efforts. Appeared in seven games for Southern Durham as a sophomore, making 21 tackles, seven tackles for loss and two sacks. Averaged 8.0 points and 6.2 rebounds in 22 basketball games as a junior.

Recruiting trail: After receiving his first scholarship offer from Duke in November 2019, Hall then had Arizona State, Syracuse, Virginia and Virginia Tech follow suit. He took an unofficial visit to Virginia in late November, but by Jan. 21, 2020, had decided to play for his hometown Blue Devils. Hall was the first member of Dukes recruiting Class of 2021.

Sammy's take: Its impressive to see a guy Halls size line up wide as a receiver in high school. Hes already a physical mismatch for most defensive backs, but then surprises them with his speed. And the body control he exhibits in making a one-handed grab on his highlight reel is equally impressive. Of course, hell need to add some significant weight before hes ready to step on the field and compete with the Blue Devils. But, in addition to his speed and quickness, I like the way Hall uses his hands and leverage to maneuver blockers out of position.

More: Aaron Hall highlight video

45. JACOB GILL

Position: Wide receiver

Height, weight: 6-0, 173

Hometown: Raleigh

High school: Cardinal Gibbons (Gill has opted to graduate early and skip his senior season)

College choice: Northwestern

In the rankings

ESPN.com: 3 stars, No. 161 wide receiver nationally.

Rivals.com: 3 stars, Unranked nationally.

247Sports.com: 3 stars, No. 153 wide receiver nationally.

Notes & numbers: After making three catches for 64 yards in two varsity games as a freshman, Gill blossomed into an All-Cap 7 4-A Conference performer as a sophomore. He corralled 74 catches for 1,170 yards and 18 touchdowns that season along with 204 yards on kickoff returns. Returned one kickoff 93 yards against Raleigh Athens Drive for a touchdown. Appeared in 15 games as a junior, making 64 catches for 794 yards and nine scores. Had seven receptions for 122 yards and a touchdown against Leesville Road. Produced 235 yards on six kickoff returns.

Recruiting trail: Gill seemed headed for a college career with his hometown N.C. State squad. The Wolfpack was the first to offer in January 2019 and he made several unofficial visits to the State campus over the last year. But when Northwestern stepped in with an offer in June 2020, the Wildcats jumped ahead of the pack and claimed his commitment on July 8.

Sammy's take: Long arms, good hands, the ability to change directions on a dime and sharp route-running make Gill a consistent threat in the passing game. He doesnt blow you away with any one skill, but is just really good at them all. Gill has a lot of shake-and-bake in him, too, which allows him to make extra yards after the catch.

More: Jacob Gill highlight video

46. ISAIAH POTTS

Position: Defensive tackle

Height, weight: 6-2, 290

Hometown: Fayetteville

High school: Pine Forest

College choice: Undecided.

In the rankings

ESPN.com: Unranked.

Rivals.com: Unranked.

247Sports.com: Unranked.

Notes & numbers: Potts established himself as one of the top defenders in the Cape Fear region as a freshman and sophomore at Pine Forest. He registered 68 tackles, seven tackles for loss and four sacks in 11 games as a varsity rookie in 2017, then produced 94 tackles, 19 tackles for loss and six sacks in 12 outings in 2018. ... The latter earned him a place on the All-Patriot Athletic 4-A/3-A Conference second team and a berth on the Best of 910Preps All-Area squad as selected by The Fayetteville Observer. ...A desire to improve his recruiting stock led Potts to The Peddie School in Highstown, New Jersey, last fall, where he reclassified academically as a sophomore. Helped Peddie to an 8-0 finish and the Mid-Atlantic Prep League championship before deciding to return to Pine Forest in January. Returned to original class and is a senior this year.

Recruiting trail: The year away from Pine Forest didnt really help Potts that much on the recruiting front, so hes been playing catch-up since returning to Fayetteville. Missing out on summer camps and combines have hurt, but he still holds FBS offers from Central Michigan, Charlotte, Coastal Carolina, Temple and Vanderbilt.

Sammy's take: Potts is quick off the ball and has the lateral movement to run down plays from behind. Hes a tad shorter than the prototypical defensive tackle, but makes up for it with a hearty work ethic and aggressive nature. Potts is also versatile enough to play any position on the front line, depending on the defensive alignment.

More: Isaiah Potts highlight video

47. MICHAEL GONZALEZ

Position: Offensive guard

Height, weight: 6-4, 280

Hometown: Monroe

High school: Sun Valley

College choice: Louisville

In the rankings

ESPN.com: 4 stars, No. 19 offensive guard nationally.

Rivals.com: 3 stars, No. 58 offensive tackle nationally.

247Sports.com: 3 stars, No. 49 offensive guard nationally.

Notes & numbers: A two-year starter for Sun Valley, including a sophomore season in which he helped protect North Carolina quarterback Sam Howell. Howell passed for 3,240 yards and 36 touchdowns as Sun Valley went 10-3 that season. Gonzalez has played guard and tackle for the Spartans. He earned All-Southern Carolina 3-A Conference and All-State honors from MaxPreps as a junior. Also a prep teammate of UNC wide receiver commit Gavin Blackwell.

Recruiting trail: No doubt former N.C. State offensive line coach Dwayne Ledford had a hand in enticing Gonzalez to Louisville, where he committed on June 18, 2020. Ledford, the offensive coordinator now for the Cardinals, helped secure Gonzalez over a list of finalists that included Duke, N.C. State, Wake Forest and Virginia Tech.

Originally posted here:
North Carolinas top football prospects for 2021: 41-50 - The Topsail Advertiser

4 Hanging Band Exercises That Can Improve Your Powerlifts – BarBend

Posted: August 27, 2020 at 2:57 pm

Remember the functional training craze when people were squatting and pressing on all kinds of unstable surfaces? Barbell squats on Swiss balls? The thought was they achieved better muscle activation and being unstable was more functional.

The idea of adding instability to lifts is sound, but in some cases it is poorly executed and dangerous. Some of these attempts at instability training belonged more in the circus than the gym.

But there is a better way. A way that gives you all the instability you can handle while improving your strength and technique at the powerlifts.

Its the hanging band technique.

The hanging band technique is hanging plates or kettlebells from a barbell using looped bands. The hanging weights create instability due to the weight bouncing and moving around while lifting.

This method works for most barbell exercises except for the Olympic lifts.

Why would you consider such a ridiculous exercise? First off, look, its not ridiculous. Be nice. Also,

Spreading the same load between more bands will cause smaller and more frequent movements back and forth. Loading the same weight onto a single band creates fewer yet larger movements back and forth.

The more on point your form is, the less the bar will move, allowing you to handle greater resistance with more control.

You should be able to handle 80-90% of the load you can normally handle on a given lift (for the prescribed reps, of course, not your 1RM). But dont overdo this method, as it is taxing on the nervous system. For instance, if you squat twice per week, then consider doing HBT once every two weeks.

This is an advanced technique, but it is effective for reinforcing better form to beginners. Lightening the load and doing more reps is advisable here. There is no need for fancy programming with HBT, anywhere from 3-5 sets and 4-8 reps as part of your accessory routine works well.

Incorporate these four exercises into your accessory routine to build more strength and reinforce technique. Brush off the weird looks youre going to get when people are wondering what youre doing.

To get stronger at squatting you need to put some serious weight on the bar and grind. Sometimes the grind makes your lower back and knees wear down. Plus, at times good technique goes by the wayside when chasing more weight. (I know youre guilty of this, dont pretend.)

The hanging bar back squat lightens your load on your spine and knees but there is no loss of intensity due to the instability of the barbell and the increased time under tension.

Youre forced to use strict and controlled squat mechanics and to keep the weights from moving in an uncontrollable fashion. This gives you a challenging stimulus to your lower body at a lighter weight. A win-win for your back, knees, and gains.

The big 3 require hip, ankle, and shoulder mobility as well as plenty of core and shoulder stability. If you have problems in any of these areas, this exercise will help.

The tall kneeling improves hip mobility and core stability, while isometrically holding the hanging kettlebells over head gives you a large dose of shoulder stability while increasing your proprioception demands.

If you have any shoulder issues that dont require surgery this can be an excellent injury rehab exercise for problems related to shoulder instability and its a great balance exercise. (But check with your doctor or physical therapist before trying new exercises.)

Holding for 30-60 seconds will be a challenge youll enjoy.

[Related:Why You Should Try Lifting Weights from a Kneeling Position More Often]

Tightness, tension, strength, and control are always required for powerlifting and the HBT technique can proide this in spades. The HBT bench press can do great things to improve your technique, stability, strength, and joint health.

Like the squat and deadlift, you cannot always add more weight and reps to your bench without repercussions. The HBT is another method to improve your technique and strength without losing any intensity.

HBT bench press helps improve your body positioning and movement mechanics by making you more aware of deviations in form due to the movement of the weights. Plus, the increased time under tension does wonders for your pump.

For this exercise to be effective, you should perform it on an elevated surface.

The Romanian deadlift is a fantastic accessory exercise to improve your hip mobility, upper back strength, grip strength, and the strength and size of your hamstrings. The HBT takes this to a new level for reasons already explained.

Any slight deviations in your hip hinge technique and youll receive instant feedback because when hinging, sometimes you are not aware you are favoring one side over the other, or youre going too quickly, or youre losing upper back tightness. Think of HBT as a trainer, making sure youre doing it right.

Hanging band technique is one more tool in your toolbox to help improve your powerlifts. Reducing the weight while maintaining intensity gives your joints a break and makes you more aware of any flaws in your technique.

Plus, youll be the coolest powerlifter in the gym.

Featured image via Dr. Joel Seedman on YouTube.

Originally posted here:
4 Hanging Band Exercises That Can Improve Your Powerlifts - BarBend

How long does it take to build muscle? – CNET

Posted: August 27, 2020 at 2:57 pm

Building muscle is a slow but worthwhile process.

Many people start workout routines to look toned or lean. Lifting weights can help you achieve those goals, but it's important to start a new workout plan with the right expectations.

Building muscle takes much longer than most people realize. It's a slow -- almost excruciatingly slow -- process that can feel discouraging when you don't see the muscle definition you want.

Here you'll learn how long it takes to build muscle and what factors influence your ability to get stronger, leaner and fitter from weight training.

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Each muscle is made up of muscle fibers, which are cylindrical cells. Weight training breaks them down and recovery helps them grow.

Building muscle involves the repair of microtraumas in your muscle fibers. Here's a breakdown of this extremely complex process:

1. Each muscle is made up of thousands of tiny muscle fibers.

2. When you lift weights (or do body weight exercises), your muscles endure tiny injuries throughout their fibers.

3. Then, when you rest your muscles, your body begins repairing your damaged muscle cells.

4. The repair process involves fusing torn muscle fibers back together, as well as laying down new proteins within each muscle cell.

5. Your muscles become bigger and stronger as a result of the repair process.

Keep in mind that the above is a tremendously simplified version of what actually happens in your body after a weight training workout. In reality, the process includes more than just your muscles -- your nervous system, circulatory system and endocrine system all contribute to muscle repair and growth.

Building muscle is super hard. If it was easy, we'd all be ripped.

There's no one muscle-building timeline, because several factors affect your ability to build muscle mass, including:

Your protein intake: While all macronutrients have their roles, protein is king when it comes to building muscle. Your muscles need adequate protein to repair themselves after the stress of weight training. Without enough protein, muscle growth stagnates.

Your calorie intake: If you don't eat enough calories on a daily basis, you won't build muscle even if you eat a lot of protein. To build muscle, your body must create new tissue, and it can't create something from nothing. Extra fuel from extra calories expedites muscle recovery and growth. This is one reason many people never reach their muscle growth goals -- they aren't willing to deal with the extra body fat that comes along with a muscle-building phase.

Your sleep schedule: Lifting weights while sleep-deprived isn't a smart strategy. You might see some gains, but you definitely can't optimize muscle growth when you don't give your body a fighting chance to recover.

Your lifting routine: If you're trying to build muscle, you should know about two key strength training concepts: frequency and volume. Frequency refers to how often you train a muscle or muscle group, while volume refers to the total load you stress a muscle with.

For example, if you perform three sets of 10 reps on squats using 100 pounds, your total volume is 3,000 pounds. More volume and higher frequency typically equate to more muscle, unless you reach the point of overtraining.

Your training age: The more advanced you are, the less muscle growth you'll see (yeah, that sounds backward). Everyone has a maximum genetic potential for muscle growth, and the closer you get to yours, the harder it gets to build more muscle.

Your actual age: Like a lot of things, building muscle gets harder as you get older. Sarcopenia, or loss of muscle mass and function, is actually a big problem in older adults. That's one reason why it's so important to stay active as you get older.

Other major factors include your genetic potential for building muscle (which is impossible to quantify without lab testing, and even then, kind of wishy-washy) and your testosterone levels -- which is why men typically have more muscle than women. Other hormones, including human growth hormone and insulin growth factor also play a role in muscle growth.

All that said, the muscle-building process starts the moment you challenge your muscles to do something. True beginners might see muscle growth within six weeks of starting a resistance training program, and advanced lifters may see results within six to eight weeks of switching up their usual strength training regimen.

Regardless of fitness level, building muscle takes several weeks, even when your diet, sleep and training regimen are all dialed in to optimize muscle growth.

Cardio that involves high-volume weight training can help you build muscle.

This depends on your definition of cardio and your training age. Most people won't build much muscle from traditional cardio, such as walking or jogging, and people who've been training for a long time definitely won't build new muscle through traditional cardio. It doesn't recruit your muscles in a way that sends a muscle-building signal to your body.

However, cardio that involves high-intensity exercises like plyometrics (think jump squats) or high-volume weight training can help you build muscle to an extent. Sprinting hills, hiking, skiing and other outdoor cardio can also contribute a small amount to muscle mass, especially for beginners. People with a long training history may not see as much success with cardio.

Although cardio can improve your overall fitness and help build muscle in select scenarios, strength training remains the best way to build muscle mass.

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.

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How long does it take to build muscle? - CNET

Testosterone Replacement Therapy market to Grow at a Whopping 4.4% from 2019 to 2027 – The Daily Chronicle

Posted: August 27, 2020 at 2:56 pm

Transparency Market Research (TMR)has published a new report titled, Testosterone Replacement Therapy Market Global Industry Analysis, Size, Share, Growth, Trends, and Forecast, 20192027.According to the report, the globalTestosterone Replacement Therapy marketwas valued atUS$ 1,613.7 Mnin2018and is projected to expand at a CAGR of4.4%from2019to2027.

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Transparency Market Research is a global market intelligence company providing global business information reports and services. Our exclusive blend of quantitative forecasting and trends analysis provides forward-looking insight for several decision makers. Our experienced team of analysts, researchers, and consultants use proprietary data sources and various tools and techniques to gather and analyze information.

Our data repository is continuously updated and revised by a team of research experts so that it always reflects latest trends and information. With a broad research and analysis capability, Transparency Market Research employs rigorous primary and secondary research techniques in developing distinctive data sets and research material for business reports.

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Testosterone Replacement Therapy market to Grow at a Whopping 4.4% from 2019 to 2027 - The Daily Chronicle

Testosterone Replacement Therapy Sales Market Still Has Room to Grow With Emerging Players 2027 – The Daily Chronicle

Posted: August 27, 2020 at 2:56 pm

(Augest 2020) SMI published a business research report on Testosterone Replacement Therapy Sales Market: Global Industry Analysis, Size, Share, Growth,Trends, and Forecasts 20202027. Research reportwith 110+ pages on market data Tables, Pie Chat, Graphs & Figures spread through Pages and easy to understand detailed analysis. The information is gathered based on modern floats and requests identified with the administrations and items.

Key players are expected to enhance their marketing capabilities over the forecast period owing to certain market conditions. The report presents certain elements that will reflect whats and hows of such changes in the market. Further, the report studies various aspects of the global market such as upstream raw materials, downstream demand, and production value of leading players subject to market growth.

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Geographical segmentation of the Testosterone Replacement Therapy Sales Market involves the regional outlook which further covers the United States, China, Europe, Japan, Southeast Asia and Middle East & Africa. This report categorizes the market based on manufacturers, regions, type and applications.

Testosterone Replacement Therapy Sales Market: Competitive Landscape

Leading players operating in the global Testosterone Replacement Therapy Sales market include AbbVie, Endo International, Eli lilly, Pfizer, Actavis (Allergan), Bayer, Novartis, Teva, Mylan, Upsher-Smith, Ferring Pharmaceuticals, Kyowa Kirin, Acerus Pharmaceuticals.

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Testosterone Replacement Therapy Sales Market is growing at a High CAGR during the forecast period 2020-2026. The increasing interest of the individuals in this industry is the major reason for the expansion of this market.

As the report proceeds further, it covers the analysis of key market participants paired with development plans and policies, production techniques, price structure of the market. The report also identifies the other essential elements such as product overview, supply chain relationship, raw material supply and demand statistics, expected developments, profit and consumption ratio.

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Important Data Available In This Report:

An Overview of the Impact of COVID-19 on this Market:

The pandemic of COVID-19 continues to expand and impact over 175 countries and territories. Although the outbreak appears to have slowed in China, COVID-19 has impacted globally. The pandemic could affect three main aspects of the global economy: production, supply chain, and firms, and financial markets. National governments have announced largely uncoordinated, country-specific responses to the virus.

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The study offers an in-depth assessment of various customers journeys pertinent to the market and its segments. It offers various customer impressions about products and service use. The analysis takes a closer look at their pain points and fears across various customer touchpoints. The consultation and business intelligence solutions will help interested stakeholders, including CXOs, define customer experience maps tailored to their needs. This will help them aim at boosting customer engagement with their brands.

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Testosterone Replacement Therapy Sales Market Still Has Room to Grow With Emerging Players 2027 - The Daily Chronicle

Testosterone Replacement Therapy Market Size, Analysis, and Forecast Report 2019-2025 – StartupNG

Posted: August 27, 2020 at 2:56 pm

The report is an all-inclusive research study of the global Testosterone Replacement Therapy market taking into account the growth factors, recent trends, developments, opportunities, and competitive landscape. The market analysts and researchers have done extensive analysis of the global Testosterone Replacement Therapy market with the help of research methodologies such as PESTLE and Porters Five Forces analysis. They have provided accurate and reliable market data and useful recommendations with an aim to help the players gain an insight into the overall present and future market scenario. The Testosterone Replacement Therapy report comprises in-depth study of the potential segments including product type, application, and end user and their contribution to the overall market size.

The Testosterone Replacement Therapy Market carries out financial changes that occur year by years in market, with information about upcoming opportunities and risk to keeps you ahead of competitors. The report also describes top company profiles that present in market with trends worldwide. This research guided you for extending business.

The Testosterone Replacement Therapy Market research report presents a comprehensive assessment of the market and contains thoughtful insights, facts, historical data and statistically-supported and industry-validated market data and projections with a suitable set of assumptions and methodology. It provides analysis and information by categories such as market segments, regions, and product type and distribution channels.

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Segment by Type, the Testosterone Replacement Therapy market is segmented intoGelsInjectionsPatchesOther

Segment by Application, the Testosterone Replacement Therapy market is segmented intoHospitalsClinicsOthers

Regional and Country-level Analysis:North AmericaUnited StatesCanadaAsia-PacificChinaJapanSouth KoreaIndiaSoutheast AsiaAustraliaRest of Asia-PacificEuropeGermanyFranceU.K.ItalyRussiaNordic CountriesRest of EuropeLatin AmericaMexicoBrazilRest of Latin AmericaMiddle East & AfricaTurkeySaudi ArabiaUAERest of MEA

Competitive Landscape and Testosterone Replacement Therapy Market Share AnalysisTestosterone Replacement Therapy market competitive landscape provides details and data information by companies. The report offers comprehensive analysis and accurate statistics on revenue by the player for the period 2015-2020. It also offers detailed analysis supported by reliable statistics on sale and revenue by players for the period 2015-2020. Details included are company description, major business, Testosterone Replacement Therapy product introduction, recent developments, Testosterone Replacement Therapy sales by region, type, application and by sales channel.

The major companies include:AbbVieEndo InternationalEli lillyPfizerActavis (Allergan)BayerNovartisTevaMylanUpsher-SmithFerring PharmaceuticalsKyowa KirinAcerus Pharmaceuticals

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Market Segmentation based On Type, Application and Region:

The global Testosterone Replacement Therapy is analyzed for different segments to arrive at an insightful analysis. Such segmentation has been done based on type, application and Region.

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Testosterone Replacement Therapy Market Size, Analysis, and Forecast Report 2019-2025 - StartupNG

LPCN: Tlando: Target Action Date This Friday – Zacks Small Cap Research

Posted: August 27, 2020 at 2:56 pm

By John Vandermosten

NASDAQ:LPCN

READ THE FULL LPCN RESEARCH REPORT

Up and Coming Milestones

Tlando PDUFA date August 28, 2020

Primary endpoint results for LiFT (LPCN 1144) 4Q:20

Patent Infringement trial February 2021

Complete Phase II LiFT (LPCN 1144) 2Q:21

Second Quarter 2020 Operational and Financial Results

On August 6, 2020 Lipocine (NASDAQ:LPCN) filed its second quarter 2020 10-Q and posted its earnings release for the three month period ending June 30, 2020. The company reported zero revenues and a net loss per share of ($0.13) compared to prior year revenues of zero and loss of ($0.14) per share. Activity during the second quarter revolved around several items including presentation at the American Urological Association (AUA) conference, demonstration of treatment potential for LPCN 1144, investigational new drug clearance for LPCN 1148, affirmation of the USPTO decision and the dismissal of a shareholder lawsuit. The companys shares also exceeded $1.00 in June, and have remained above this level, allowing Lipocine to regain compliance with NASDAQ minimum bid requirements. The most important item on the calendar is the FDAs response to Tlandos NDA submission, which is expected on or before August 28th.

We anticipate that upon approval, Lipocine will find a partner to commercialize Tlando and use associated upfront and milestone payments to further develop the existing portfolio, especially LPCN 1144 and LPCN 1148. Potential licensees are waiting until approval is granted before performing their due diligence. This suggests that a deal would be announced in the fourth quarter of 2020 rather than in the weeks following an assumed approval.

Operational expenses for 2Q:20 were $4.2 million, up 26% and net loss totaled ($6.4) million or ($0.13) per share. Research and development expenses totaled $2.5 million. The 16% rise over prior year amounts reflects increased costs related to the LiFT study and higher personnel expenditures offset by a decrease in amounts related to the ABPM study, lower spend on the Tlando XR program and a fall in manufacturing costs for LPCN 1107. General and administrative costs rose 41% over last years second quarter to $2.0 million on an expansion in legal expenditures related to the Clarus dispute and an increase in personnel costs offset by lower marketing expenses, administrative travel and other expenses. A rise in the share price increased the warrant liability and required the recognition of a $2.1 million non-cash loss in other income.

Cash and marketable securities balance was $18.2 million as of June 30, 2020. There is another $5 million of restricted1 cash which will remain on hold until Tlando is approved. Current and non-current debt is carried on the balance sheet at $6.3 million. Cash burn for 2Q:20 was approximately ($4.1) million and net cash provided by financing was $11.7 million representing a stock offering and warrant proceeds partially offset by a small amount of debt repayment.

Tlando

On November 11 of last year, Lipocine announced that it had received a complete response letter (CRL) for Tlando. The CRL identified one deficiency stating that the trial did not meet one of the three secondary endpoints for maximal testosterone concentrations (Cmax). No deficiencies related to chemistry, manufacturing and controls were noted. FDA guidelines call for 85% of subjects to achieve a Cmax below 1500 ng/dL and no more than 5% of subjects presenting a Cmax between 1800 ng/dL and 2500 ng/dL and 0% above 2500 ng/dL. In the most recent dosing validation (DV) study, 85% of subjects were below 1500 ng/dL and 7% were between 1800 ng/dL and 2500 ng/dL. Although there were small variations from the FDA guidelines in the original SOAR study for subjects above 2500 ng/dL, the FDA did not identify these as a deficiency during the original New Drug Application (NDA) submission.

Following the Post Action meeting with the FDA, Lipocine was advised to address the outstanding deficiencies with a reanalysis of existing data. This recommendation relieved Lipocine of the time and cost of an additional trial and also allowed the resubmission of the Tlando NDA in February. A target action date of August 28th was provided. While the resubmission is a positive, Tlando has faced significant hurdles gaining the favor of the FDA. We published a note on February 25th that discussed details regarding the resubmission.

LPCN 1144

Lipocine announced in August 2018 the pursuit of a new indication in nonalcoholic steatohepatitis (NASH). We discuss the indication and Lipocines efforts in an earlier piece that can be accessed here. Full enrollment of 36 subjects was achieved in November 2018.

In January 2019, Lipocine announced meaningful liver fat reduction in patients participating in its Liver Fat Study and informed investors that the company had filed an investigational new drug (IND) application to begin a Phase II study for NASH. Since LPCN 1144 is the same molecule as TLANDO, for which there were numerous safety studies completed, LPCN was allowed to perform a proof of concept (POC) clinical study under the original IND to assess liver fat changes. This 36-person study was conducted in hypogonadal men at risk of developing non-alcoholic steatohepatitis (NASH) and results were measured using the magnetic resonance imaging proton density fat fraction (MRI-PDFF) technique. Topline results were announced in 1Q:19 demonstrating a 4.0% to 8.2% percentage point reduction in liver fat depending on baseline liver fat category. We discussed the results in further detail in our NASH Topline article.

Lipocine launched its Phase II clinical study for LPCN 1144 and dosed its first patient last September. Prior to the start of the trial, Lipocine announced that the FDA would allow the Phase II LiFT trial to enroll eugonadal patients in addition to the NASH patients that were initially targeted. This expansion was based on research that we discussed in a July 29th note. The study is anticipated to last for 18 months and cost approximately $8 million.

LiFT, an acronym of Liver Fat intervention with oral Testosterone, is a paired biopsy Phase II study in NASH subjects. The study design will employ a three-arm, double-blind, placebo-controlled structure and enroll approximately 75 biopsy confirmed male NASH subjects with a NAS2 score of greater or equal to four. The primary endpoint for the study is 12-week MRI-PDFF liver fat reduction and the first patient was enrolled in 3Q:19. As for the anticipated timeline, Lipocine expects top line liver fat reduction data in 4Q:20 as measured by MRI-PDFF at 12 weeks. Biopsy data at 36 weeks is expected to be available in the second quarter of 2021.

Exhibit I LiFT Study Timeline3

NASH Environment

A lot has happened in the NASH space in 2020. Genfit (GNFT) announced that it will halt development of elafibranor after it failed to distinguish itself compared to placebo earlier this year. CymaBay (CBAY) announced that the FDA had lifted the hold on seladelpars Phase II study last month. No evidence was found for liver injury for the drug and the trial is expected to resume. Intercepts (ICPT) OCA received a complete response letter from the FDA in late June noting that the agency remains uncertain that the benefits of the drug outweigh the risks. Viking (VKTX) is conducting the Phase IIb VOYAGE trial for VK2809 which is still ongoing. A bright spot in the space has been results from Akeros (AKRO) Phase IIb trial for efruxifermin in NASH which were announced June 30. The study found that 48% of patients had fibrosis improvement of at least one stage with a 62% response rate. Fibrosis improved by at least two stages for 28% of the group with a 38% response rate and 48% experienced NASH resolution without worsening of fibrosis across all dose groups.

LPCN 1148

Lipocine is preparing to develop its testosterone molecule to treat NASH cirrhosis patients. While the target market is smaller than that of pre-cirrhotic NASH, there are no other FDA approved products available. The inverse relationship between testosterone and sarcopenia and the increased risks of advancing NASH cirrhosis validates this pursuit. Pending funding, Lipocine plans to initiate a proof of concept trial to evaluate the potential of this candidate. The companys Investigational New Drug (IND) application was cleared by the FDA in May 2020. We anticipate Lipocine will launch the Phase II trial after the start of commercialization of Tlando and upon availability of sufficient capital to fund it. Management has guided to a 4Q:20 or 1Q:21 start.

Exhibit II Lipocine Pipeline4

Markman Hearing

On March 26th, Lipocine announced the outcome of the Markman Hearing, also known as a claim construction hearing. This meeting is an important precursor to a patent infringement lawsuit and provides the definitions of terms critical for a jurys determination on whether or not a patent has value. A patent should not be too specific, as it provides insufficient protection to an invention, or too broad, in which case a court may rule it indefinite. In the hearing order5, Judge Bryson did not agree with most of Clarus claims and sided with Lipocine on the majority of definitions and clarifications. While the terms and definitions are subject to an evolving construction, the order is favorable to Lipocines dispute against Clarus. While this order could be appealed again, it is unlikely in the opinion of Lipocines counsel. Lipocine and Clarus are currently engaged in the fact discovery phase of the lawsuit and the jury trial is anticipated to take place in February 2021. Lipocine need only prevail on one claim to merit damages, which places them in a strong position to succeed in the trial or provide incentive for Clarus to settle.

USPTO Decision Affirmed

The US Court of Appeals affirmed the decision of the USPTO in April 2020 to grant Lipocines Priority Motion in the interference case that cancelled Clarus claims to the 428 patent in January 2019. The USPTO, through its Patent Trial and Appeal Board (PTAB), had granted Lipocines priority motion in the related interference case and entered adverse judgment against Clarus. As we have previously shared, this outcome was expected as it is rare for a federal court to overturn a USPTO ruling. As a reminder, in 2Q:19 Lipocinefiled suitagainst Clarus alleging that Jatenzo infringed on six of Lipocines patents. The injunction filing may slow down commercialization of Jatenzo and force Clarus to come to the table to negotiate a settlement. While the cost of pursuing such legal action could be high, we anticipate by the time the case works its way through the courts, cash flow from Tlando could be sufficient to support the legal efforts.

Publications and Abstracts

Results from Lipocines Liver Fat Study were published in Hepatology Communications in an article entitled LPCN 1144 Resolves Non-Alcoholic Fatty Liver Disease In Hypogonadal Males." The study served to identify the prevalence of non-alcoholic fatty liver disease (NAFLD) in hypogonadal males and quantify the beneficial impact of LPCN 1144 on hypogonadism. 36 hypogonadal males were evaluated using MRI-PDFF measurements for liver fat. 81% of those with baseline liver fat equal to or greater than 5% showed improvement in liver fat content and NAFLD resolved in one-third of the group at six weeks and 48% after 16 weeks. The paper concluded that treatment with LPCN 1144 resolved NAFLD in about half of affected patients without any safety signals.

Lipocine submitted several abstracts to the American Urological Association (AUA) Virtual Experience, which took place from May 15 to 17, 2020. Three titles were presented.

Impact of a new oral testosterone undecanoate on blood pressure and cardiovascular risk was presented by Dr. Mohit Khera which investigated the chronic use of testosterone replacement therapy (TRT) on cardiovascular risk. Jatenzo, Xyosted and Tlando were assessed in their impact on blood pressure and cardiovascular risk in hypogonadal men. Marginal increases in blood pressure were observed and no meaningful impact on cardiovascular risk was noted.

A novel oral testosterone therapy restores testosterone to eugonadal levels without dose titration was presented by Dr. Martin Miner and highlights the shortcomings of dose titration when prescribing TRT. The abstract concluded that fixed dose Tlando normalizes testosterone levels in hypogonadal patients while avoiding the potential problems associated with titrated TRT.

Effects of a new oral testosterone undecanoate (TLANDO) therapy on liver was presented by Dr. Irwin Goldstein and compares oral methyltestosterone (MT) with TRT in males deficient in endogenous testosterone. The study results suggested that unlike MT, Tlando has no adverse effects on liver and can be used for an extended period to potentially reduce liver fat.

Milestones

Tlando CRL November 9, 2019

Tlando FDA post action meeting January 2020

Resubmission of Tlando NDA February 2020

Investigational New Drug (IND) clearance for LPCN 1148 May 2020

Wajda v. Patel shareholder suit dismissed July 2020

Tlando PDUFA date August 28, 2020

Primary endpoint results for LiFT (LPCN 1144) 4Q:20

Patent Infringement trial February 2021

Complete Phase II LiFT (LPCN 1144) 2Q:21

Summary

Since our previous update, Lipocine has participated in scientific conferences, published an article in the journal Hepatology Communications and advanced several months towards the upcoming August 28 PDUFA date for Tlando. Assuming a favorable outcome for the application, Lipocine will seek a commercialization partner and should receive upfront and milestone proceeds in conjunction with a deal. The Phase II LiFT trial continues to be a bright spot for the company and is potentially able to address a large unmet need in NASH patients in contrast to other programs which have met with difficulty. Management has guided towards a year-end readout of LiFT trial results. Lipocine is also developing LPCN 1148 for cirrhosis patients which was recently given clearance to begin a Phase II study. While we do not see this program entering the clinic until sufficient capital is available, we do think it will advance if Phase II data for LPCN 1144 are positive.

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DISCLOSURE: Zacks SCR has received compensation from the issuer directly, from an investment manager, or from an investor relations consulting firm, engaged by the issuer, for providing research coverage for a period of no less than one year. Research articles, as seen here, are part of the service Zacks provides and Zacks receives quarterly payments totaling a maximum fee of $40,000 annually for these services. Full Disclaimer HERE.

________________________

1. Tlando was not approved by the FDA by May 31, 2018, and therefore Lipocine is required to maintain $5.0 million of cash collateral at Silicon Valley Bank (the lender) until such time as it is approved by the FDA.

2. NAS: NAFLD (Non-alcoholic fatty liver disease) Activity Score. Discussion of the metric can be found here.

3. Source: Lipocine Corporate Presentation May 2020.

4. Source: Lipocine Corporate Presentation July 2020.

5. A link to the Markman Hearing Order can be found on this page: https://ir.lipocine.com/presentations

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LPCN: Tlando: Target Action Date This Friday - Zacks Small Cap Research

Doctors find testicles in woman’s stomach that are in early stages of cancer – Mirror Online

Posted: August 27, 2020 at 2:56 pm

A woman was 'devastated' when she found out the reason she'd never had a period is because she's intersex - after doctors discovered she was missing a womb and had testicles inside her stomach.

Content creator and activist, Dani Coyle, 25, from Swindon, grew up suspecting that something made her different. As a young teen, Dani's voice suddenly dropped and whilst her peers began to get their first periods, Dani only developed terrible stomach cramps.

After seeking medical advice, Dani was sent to specialists who at age 14, diagnosed her as being intersex. This means that Dani has a deviation in her gender characteristics that does not match the 'traditional' understanding of the female body.

Dani was told she had a 17 beta-hydroxysteroid dehydrogenase three deficiency. Whilst she'd always appeared to be female, Dani didn't have the female hormones she required once she reached puberty and 'should have' been born as a cisgender male. This is when a person's gender identification matches their birth sex.

The doctors discovered that Dani had XY chromosomes usually found in men and no female reproductive organs such as a womb. A further scan revealed that she has testicles inside her stomach which were in the early stages of cancer.

Doctors told Dani that they could 'normalise' her 'medical defect' through surgery and hormone replacement therapy. In 2009, the suspected cancerous testes were removed and Dani underwent external cosmetic surgery to alter the appearance of her vulva.

Dani thought that the ordeal was over, but she later felt coerced into the surgery after quickly learning that intersex bodies aren't accepted by society.

At school, Dani began to experience transphobic comments as her peers would deem her to be a 'lady boy' and a 'tranny,' due to a lack of understanding on what it means to be intersex. Whilst Dani uses both female and gender-neutral pronouns, she identifies as female.

"When I was told that I'm intersex, in truth, I was devastated although not surprised," Dani said.

"I'd wished for words to explain and understand my differences for a long time. I was relieved but scared to finally have them.

"When I was ten, I noticed things changing in my body that were more typical of what happens in male development. My voice lowered in tone and my period never came. It was an extremely confusing and lonely time.

"At fourteen, I was told I had 'seventeen beta-hydroxysteroid dehydrogenase three' deficiency.

"My body didn't respond 'normally' to the testosterone my testes produced which is why I was born, looked like, and was raised as a girl which is lucky as I've always identified as female.

"I was scared no one was going to love me when I found out. I was angry at the odds why me? I was told and believed it to be a secret that no one needed to know so I quickly underwent the surgery to remove my testes and normalise my external appearance just as the doctors and surgeons recommended.

"I also had hormone replacement therapy which is essentially a menopause oestrogen pill and I thought I'd be back to being a normal girl. Now, I feel like these surgeries were presented as the only viable option like I was robbed by biased doctors who work within a biased system which has caused an immeasurable amount of mental trauma."

Dani is a keen activist and she hopes to raise awareness around intersex surgery particularly surgery performed on young children without their consent. She believes raising awareness in society through extended education in schools could be a part of the solution.

"We are robbed of bodily autonomy in the name of gender binary," said Dani. "For many, the idea there are only two sexes and genders is way more convenient disregarding those of us who don't fit in to 'either' and 'or.' If I had known then what I do know, I wonder if I would have chosen the surgeries or harboured as much and shame and disgust for myself, as I did for so long.

"I used to think being intersex was a curse but now I see that's a blessing. I am free from the confines of gender expectations. I'm a part of the sanctuary of the LGBTQIA+ community and I'm literally one in a million.

"These surgeries are forced upon intersex babies every day, many of whom end up with a gender identity that doesn't align with their body's presentation because it was chosen for them by someone else.

"Even now, I have intimacy issues and body dysmorphia due to the trauma of being poked and prodded so much as a child ` it was incredibly traumatic.

"I want to see representative education in schools that covers the whole spectrum of human biology. I want to see the end of non-consensual, cosmetic intersex genital surgeries on babies and children.

"I want to promote and see the world become more aware, accepting, and inclusive of intersex, trans, and gender non-conforming people and our use of language. Hopefully, I can play a small part in that.

"The differences in our bodies, identities, and cultures are things to celebrate. Let's all be kinder to people who are different from ourselves."

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Doctors find testicles in woman's stomach that are in early stages of cancer - Mirror Online

Fasting Safely with Diabetes | NIDDK – National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Posted: August 27, 2020 at 2:55 pm

People with diabetes may wish to fast for dietary, medical, or religious reasons. Advance planning with a health care professional may reduce complications.

When Martin M. Grajower, MD, encountered patients with diabetes through his clinical practice who were committed to fasting for religious and other reasons, he was inspired to support them in finding ways to fast safely. Here, he discusses strategies that can help people with diabetes avoid health complications while fasting.

Q: What is a fast?

A: A fast is any defined period of time in which someone chooses not to eat. That could be six hours, eight hours, or 24 hours or more. A fast can mean no intake of food, or it can mean nothing at all by mouth, including no liquids.

Q: Why do people with diabetes fast?

A: People with diabetes fast for a variety of reasons, just like people without diabetes do. Most commonly today, people fast for dietary reasons. They want to lose weight, and so they may engage in calorie restriction by means of intermittent fasting.

People also fast for spiritual or religious reasons. For example, various religious practices call for fasting over a 24-hour period, over a certain number of hours per day for an entire month, or for one day a month throughout the year, or on some other schedule.

People may also fast because they have been told to do so before going into surgery. For example, sometimes people are told to eat nothing after midnight, but their surgery may not be until 3 oclock in the afternoon the next day, so thats a 15-hour fast. Some people going in for procedures, such as a bowel procedure, may be told to consume only liquids for 24 hours, which is also a form of fasting.

Q: What are the risks from fasting for people with diabetes?

A: Hypoglycemia is the number one risk. Hyperglycemia can also become an issue because people will cut back on their diabetes medicine, especially if theyre on insulin, to avoid hypoglycemia. But if they cut back too much, then their blood glucose will go too high and theyre at risk of hyperglycemia, and even potentially diabetic ketoacidosis.

Dehydration is another risk and depends on the nature of the fast. If its a complete fast where the person fasting cant take in liquids or has been instructed not to take anything orally to prepare for surgery, then dehydration becomes a major risk. The dehydration could be due to not drinking or because some diabetes medicines, such as the SGLT-2 inhibitors and diuretic medicines, induce diuresis. Furthermore, hyperglycemia induces diuresis.

Q: How do the different types of diabetes affect fasting risks?

A: People with type 1 diabetes are at greater risk when fasting compared to people with type 2 diabetes, because they are on insulin. The amount of insulin they take when fasting needs to be adjusted. If they dont cut back enough, they risk hypoglycemia, but if it is cut back too much, they can develop hyperglycemia. People with type 1 diabetes also face increased risk of dehydration and diabetic ketoacidosis, compared to people with type 2 diabetes. However, there are more people with type 2 diabetes, so at the population level there are more people at risk when fasting.

For women with gestational diabetes, if theyre not on medicine, especially if theyre not on insulin, fasting is the best insulin sensitizer that we have. So, I never hesitate to let women with gestational diabetes restrict calories for a short period. Pregnant women do have to factor in the risk of dehydration, taking into consideration their blood pressure and any edema.For women with gestational diabetes who wish to partake in the longer fasting regimen of certain religious practices, thats a separate discussion.

Q: What challenges does intermittent fasting pose for people with diabetes?

A: There are two types of intermittent fasting. Theres the type that you do every dayfor example, every day you eat for only eight hours during the day. I don't necessarily recommend it, but I have no problem with a person with diabetes following this eating pattern, because they're doing the same thing every day and you can just adjust their medications accordingly. The intermittent fasting where you fast two days a week or every other day is more problematic because it can become very complicated to adjust the medication. It can be done, but it requires the time and the expertise of the physician and it requires the compliance of the patient. So, I don't recommend patients do it on their own, but it can be done safely under medical supervision.

Q: What is your approach with patients who wish to fast for religious or spiritual reasons?

A: I became interested in this subject because of a couple of patients. A member of my religious community went to the rabbi and said, Last year my doctor said anyone with diabetes shouldnt fast, but I did anyway, on my own, and my sugar dropped low. So, what do I do this year? The rabbi called me up and asked what I should tell him. I found out that the only medicine this person was taking was a sulfonylurea, so I told him to stop taking his medicine 36 hours before Yom Kippur, and he did fine.

I also had an elderly Orthodox Jewish woman as my patient. I said to her, I dont think you should fast on Yom Kippur because youre elderly, youre on heart medicines, and youre on a complicated insulin regimen of three shots a day. She looked me straight in the eye and said, Doctor, I fasted on Yom Kippur in the concentration camps, so dont tell me not to fast now. Im going to fast with or without your help, but Im going to fast.

This was a powerful lesson. The determination to fast is found not just in the Jewish religion, but also in the Muslim faith. People hold Ramadan to be a very holy time, and theyre going to fast either with or without their doctors help. People of other faiths or who adhere to other spiritual or meditative traditions fast as well. Thats why I've become a very big proponent of allowing people with diabetes to fast, but under medical supervision.

Its our obligation as health care professionals to adapt diabetes to our patients religious beliefs. I did my fellowship under Dr. Harold Rifkin, who co-wrote the first textbook on diabetes. He taught me that you need to adjust the management of diabetes to the patients lifestyle, not the other way around.

I really think nurse practitioners and nutritionists could take the lead on this, because doctors unfortunately dont always have the time. If you have patients who are Jewish, Muslim, or a member of the Church of the Latter-day Saints, you can ask, Do you fast for religious reasons? And if they do, talk with them about how theyre going to manage it. Because if you dont ask the question, patients will do it on their own, and thats when theyre going to run into problems.

Q: What are the concerns when people must fast prior to surgery?

A: The major concerns are hypoglycemia and dehydration, both of which can be avoided by adjustment of medication and scheduling the surgery, for early in the day when possible.

Q: How do you help manage the patient who wants to fast?

A: Health care professionals need to consider the pharmacodynamics (mechanism of action) and pharmacokinetics (the onset and duration of action) of the diabetes medicine a patient is on. How long does the medicine work? How long does it stay in the system? Does the medicine increase hypoglycemia risk or is its action glucose dependent?

Sulfonylureas, the short-acting meglitinides, and insulin, are associated with hypoglycemia. The sulfonylureas have a 24- or 36-hour duration of action, so those need to be stopped at least 24 and preferably 36 hours before the patient is going to fast. Meglitinide and Nateglinide generally are taken three times a day before each meal because it has a duration of action of only 4-6 hours. Patients should not take a glinide medicine if theyre not eating or if theyre not going to eat carbohydrates.

Insulin requires a major adjustment, so the health care professional should understand the duration of action for the kind of insulin that the patient is on. For example, certain long-acting insulins are taken every day and have a duration of action of 36 to 42 hours. If a patient takes insulin on Monday, the effect is going to last until Wednesday. If I have a patient with this kind of insulin going in for a medical procedure on Tuesday, I advise him or her to reduce their dose of insulin on Sunday, two days prior, as well as on Monday, one day prior. I provide detailed instructions on how much to reduce the dosage, as described in the article on medication adjustment referenced below.

The older NPH (isophane) insulin has a duration of action of about 12 to 16 hours, and other forms of long-acting insulins have a duration of between 16 and 24 hours. For these medicines, you would have to help the patient adjust dosages mostly the day before the procedure.

Metformin, pioglitazone, and DPP-4 inhibitors rarely cause hypoglycemia, so health care professionals dont have to adjust them. But the patient should not take it on the day of fasting if its a 24-hour fast. With patients doing intermittent fasting, where they are eating during 8 hours of the day and going on a 16-hour fast, I dont tell them to stop taking the medicine, because they rarely cause hypoglycemia, and the medicine should be in their system for those 6 or 8 hours while they are eating to prevent hyperglycemia.

Q: What about dehydration concerns?

A: As far as dehydration goes, it really depends on the kind of fast. With intermittent fasting, fluid intake is never restricted; just calories are restricted. So, people with diabetes can drink water, diet soda, tea, or black coffee without hesitating, and dehydration should generally not be an issue. However, patients who normally get a lot of their liquids from foods like soups, shakes, jello, and yogurt may not realize that three-quarters of their fluid intake is really coming through food. Even if they drink as much while fasting as they do at other times, they will not be consuming enough liquid and they could run into a problem with dehydration.

Health care professionals also need to keep in mind that the SGLT-2s, besides lowering blood sugar, have a diuretic effect. Both aspects of the medicine must be considered when adjusting the dosages. I generally will stop the SGLT-2 two days before a patient begins a fast because of the dehydration aspect.

Health care professionals should also consider other medicines the patient is on, especially diuretics. These may also require adjusting. We also keep in mind the patients other medical conditions. A patient who has had a heart attack or a stroke within the last three months is at increased risk from dehydration and the resultant drop in blood pressure. If the patient becomes hypotensive from dehydration, this could lead to another heart attack or another stroke.

If A1C is not controlled, the patient is also at increased risk for dehydration, because glucose in the urine acts as a diuretic. If a patient has an A1C of 9 or greater, I will strongly discourage fasting due to the risk of dehydration from the high blood sugar or, if the patient has type 1 diabetes, the risk of going into diabetic ketoacidosis.

A patient who is running any fever in the last week or so should not be fasting, again because of the risk of dehydration resulting from fluid loss due to sweating. Health care professionals need to be conscious of these other issues before going ahead and giving a blanket recommendation regarding fasting.

Q: How do you advise patients regarding glucose monitoring during a fast?

A: Patients who are on insulin and fasting should do even more frequent glucose monitoring than usual until they get a sense of the safety of their revised insulin regimen. For example, the patient on a long-acting insulin who decides to intermittently fast two days a week, with the help of a health care professional, should adjust the insulin the day before the start of the fast. Then over the first two or three fasting periods, the patient should check glucose levels even more frequently than normal, until it can be established that the lower dose of insulin is correct. Subsequently, the normal frequency of testing can be resumed.

Someone whos not on a sulfonylurea or insulin doesnt have to test any more frequently than normal because the risk of hypoglycemia is extremely low.

Note: For detailed guidelines on medication adjustment and other considerations while fasting with diabetes, see the articles listed at the end of this interview.

Q: Do you have any other tips for helping patients with diabetes manage fasting?

A: At the time of a patients pre-fast visit, I write down all my instructions. I hand the patient a copy (to avoid misunderstandings), and I keep a copy in the patients chart. In the instructions, I put down medication adjustments, how often to check blood glucose readings, and what to do if the blood glucose reading goes above or below a certain specific number (individualized for the patient depending on age, the presence of hypoglycemia unawareness, and comorbid conditions). Soon after the fast, either at the next visit or via a follow-up telephone call, I ask the patient how he or she did. I make a note of that in the chart. The next time the fasting observance comes around, I look back at my previous note in the chart. If the patient did well, I simply make a photocopy and say, Here are your instructions. And for me, instead of spending 10 minutes, now it takes only 30 seconds.

Also, on the occasion when Ive told patients that I dont think they should be fasting, I ask permission to discuss it with their clergy. Youd be surprised how often a patient will let me do that. And then when their religious advisor tells them not to fast, they feel much more comfortable about it.

Guidance on fasting with diabetes by Dr. Grajower and others:

How do you address the subject of fasting with your patients who have diabetes?

More here:
Fasting Safely with Diabetes | NIDDK - National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)


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