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Ketosis is a metabolic state that can help you shed fat fast here’s how to reach it – Insider – INSIDER

Posted: June 4, 2020 at 12:45 pm

The ketogenic diet, or keto for short, may seem like just another fad, but scroll through social media and you'll see many showing off their weight loss success. The keto diet works by literally changing the way your body uses energy.

Normally, the body converts carbohydrates, or sugar, into glycogen for energy. But on the ketogenic diet, carbs are drastically reduced so that the body can enter a metabolic state called ketosis where you burn fat for energy instead of glycogen.

However, it's not always easy to enter ketosis. And your body won't immediately reach this fat-burning state after a day of cutting carbohydrates. It takes time, and it may be difficult to know when you've reached that point. Here are some tips to help you know when you've reached ketosis and how to get there a little faster.

To reach ketosis, you must first reduce your body's glycogen reserves. The keto diet helps you do that by limiting carbohydrates to less than 50 grams per day. That's about the equivalent amount of carbs in two large apples.

After about two days to a week of restricting carbs, your body should start tapping into fat reserves for energy. But this can vary person to person and may take slightly longer. Some ways you can speed up the process is:

Common symptoms of the keto diet include:

These symptoms are often called the keto flu, and are a side effect of your body's transition to a constant state of ketosis. After four to six weeks your body will adapt and these side effects should resolve.

Other ways to check that you're in ketosis is with urine test strips or at-home blood and breath tests. These tests measure the ketone levels in your system. Ketones are the byproduct of fatty acids the body breaks down when you're in ketosis.

A blood test is the most accurate way to measure ketones and is used in doctor's offices, but involves a needle prick. However, urine strips and breath meters are also accurate and less invasive. According to one small 2016 study, urine strips offer the most accurate readings early in the morning and right after dinner.

The keto diet was developed in the 1920s as an effective treatment for children with epilepsy who were not responding to drugs that were available at the time.

Today it's also used as a medical diet to treat other diseases, like type 2 diabetes and obesity. Studies show that ketones provide energy without elevating blood sugar levels, which reduces the need for insulin. In one clinical trial, people with type 2 diabetes were able to decrease their medication dosage after 12 months of a ketogenic diet.

There are also hints this diet may be good for brain health. In 2019, a small study showed a low-carb diet may improve memory in adults who have mild cognitive problems, potentially an early sign of Alzheimer's disease. One possible explanation is that brains of people with Alzheimer's disease don't use glucose as efficiently, and ketones may be an easier source of energy for overall brain function.

But beyond low blood sugar levels and possible brain health, the keto diet's recent claim to fame is for weight and fat loss. Low carbohydrate diets, in general, have been shown to lead to more rapid weight loss compared to other diets, but not necessarily more weight loss long-term.

For example, in one trial, lasting six months, obese women following a low-carb diet lost nearly 10 pounds more than participants following a low-fat diet. They also lost significantly more body fat 10.5 pounds versus 4.4 pounds.

Researchers note, though, that most weight loss studies have been short term, so it is unclear how this diet performs for long-term weight loss.

Despite the weight loss and other potential health benefits, Lorraine Turcotte, a metabolism researcher at the University of Southern California says she would not recommend this extreme diet over a more moderate approach to eating.

"There is a potential benefit [for weight loss] but I would never recommend it unless you are clinically managed," she says.

One reason she would not recommend the diet, especially to athletes, is because it can lead to a breakdown of musclesthe body cannot operate optimally without carbohydrates, so it may resort to using muscle stores instead.

"The body breaks down muscle protein into amino acids and then uses the amino acids to make glucose," says Turcotte. It is not clear if consuming so much fat, especially if the diet is heavy in saturated fat, is good for cardiovascular health long term either cardiologists say the diet could lead to high cholesterol. In addition, over time, ketosis can cause side effects like kidney stones and constipation in children following the diet for epilepsy treatment.

Turcotte also says that leaving out carbohydrate-rich food groups like fruits, whole grains, and legumes can also lead to a nutritionally-deficient diet lacking many vitamins, minerals and phytochemicals, which are essential to overall health. Besides that, she says, it is just a very strict regime to stay on for a long period of time even for the most "die-hard keto dieters."

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Ketosis is a metabolic state that can help you shed fat fast here's how to reach it - Insider - INSIDER

How to exercise and diet correctly as per your body type? – PINKVILLA

Posted: June 4, 2020 at 12:45 pm

Many people don't know their body type and that's why they fail to achieve their weight gain or loss targets among others. Read on to know about the same.

Many of us don't know what our body type is and eating and exercising in the wrong way. To determine the right type of diet and exercise, one should know first know their body type. What is your body type? Typically there 3 main body times: Ectomorphs will have long and slim limbs, Endomorphs will have wide hips/ fat accumulation around the belly area and mesomorphs have sporty aka muscular body. Genetics play a huge role when it comes to body type, however, you can achieve the body goals with the right food and training.

The first step is to understand your body type so that you can start eating the right diet and do exercises that will work for you and help you to set realistic goals. Read on to know about the characteristics that will help to determine your body type and next read on to know about the diet and workout as per each type.

ALSO READ:Weight Loss: Nutritionist Rujuta Diwekar REVEALS the right way to shed fat

Are you an Ectomorph?

You can call them lucky, as they can eat whatever they want and never gain weight because they have a fast and high metabolism. They are usually lanky and have a small bone structure. Their shoulders are usually narrower than the hip. And their goal is to gain weight.

Are you a Mesomorph?

They have medium bone structure, athletic body, good metabolism (means you can gain muscle and easily lose fat). They can maintain weight if they have an active and healthy lifestyle. They can gain weight and lose as well easily. Their goal is to have a lean body.

Are you an Endomorph?

They have a soft and rounded body, larger midsection and hips. They can easily pile up fats, struggle to lose weight and metabolism is naturally slow. They should pay attention to what they eat.The goal is to lose weight.

If you don't fit in any of the three? Maybe you are Ecto-Meso- Lean and muscular, Meso- endo- Strong but muscles are not well defined or Endo-Meso- Skinny fat. Naturally thin, gain weight due to lack of exercise and poor diet.

Ectomorphs Diet and Workout

The focus should be on resistance training (strength and hypertrophy) and less cardio. Make sure to lift heavy weights, add more compound movements (works on several muscles at once) with minimal isolation movements for muscle mass and for quickest strength. You can do squats, lunges, bench press, pushup, deadlift and pull-ups.

You can do them 3-4 times a week on alternative days and include short cardio sessions. Your diet should be mass gained focused, higher carb, moderate protein and low fat. And make sure to eat frequently.

Mesomorph Diet and Workout

You are lucky, naturally strong and respond quickly to exercises. It is easy for you to gain mass and lose weight.You should focus on strength, endurance and size. Make sure to have 3-4 times resistance training and 2-3 times HIIT. For diet, you can equal amounts of fats, protein and carbs. You can change the quantity as per workout.

If you are doing strength and conditioning, then reduce carbs and increase protein intake. On HIIT days, you can have high carb foods post-training to fuel your body.

Endomorph Diet and Workout

Don't blame your genetics, instead eat the right food to fire metabolism and incorporate the right exercises.You should include 3-4 days of resistance training and other days for cardio. Ideally, have 2 days of low-intensity conditioning for 30-60 minutes. Include inclined walk, light jog, cycling, swimming, hiking and HITT once a week.

Make sure to have short periods of rest and lift moderate weights. Interval and circuit training are also very effective. Endomorphs are more insulin resistant and have lower carb tolerance. So, limit your carb intake, include diet which is high in protein, high in fats and low in carbs.

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How to exercise and diet correctly as per your body type? - PINKVILLA

Androgen Replacement Therapy Market potential growth, share, demand and analysis of key players – research… – Azizsalon News

Posted: June 3, 2020 at 2:52 pm

This detailed market study covers androgen replacement therapy market growth potentials which can assist the stake holders to understand key trends and prospects in androgen replacement therapy market identifying the growth opportunities and competitive scenarios. The report also focuses on data from different primary and secondary sources, and is analyzed using various tools. It helps to gain insights into the markets growth potential, which can help investors identify scope and opportunities. The analysis also provides details of each segment in the global androgen replacement therapy market

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According to the report, the androgen replacement therapy market report points out national and global business prospects and competitive conditions for androgen replacement therapy. Market size estimation and forecasts were given based on a detailed research methodology tailored to the conditions of the demand for androgen replacement therapy. The androgen replacement therapy market has been segmented by product type (creams/gels, patches, injections, implants, and oral tablets/capsules/gums), by active ingredient type (testosterone, methyl testosterone, testosterone undecanoate, testosterone enanthate, and testosterone cypionate), by distribution channel (hospitals pharmacies, retail pharmacies, and online pharmacies). Historical background for the demand of androgen replacement therapy has been studied according to organic and inorganic innovations in order to provide accurate estimates of the market size. Primary factors influencing the growth of the demand androgen replacement therapy have also been established with potential gravity.

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The market has been segmented in major regions to understand the global development and demand patterns of this market.

North America, Europe, and Asia Pacific by region are estimated to dominate the androgen replacement therapy market during the forecast period. These regions have been market leaders for the overall healthcare sector in terms of technological developments and advanced medical treatments. Moreover, the government policies have been favourable for the growth of the healthcare infrastructure in these regions. North America and Europe have an established healthcare infrastructure for product innovations and early adaptations. This is expected to drive the demand for androgen replacement therapy market during the forecast period.

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With an emphasis on strategies there have been several primary developments done by major companies such as AbbVie, Inc., Allergan Plc, Bayer AG, Endo Pharmaceuticals, Inc., Eli Lilly and Company, Kyowa Kirin International Plc, Mylan N.V., Novartis International AG, Pfizer, Inc., Clarus Therapeutics, Ferring Holding SA, Perrigo Company Plc, Acerus Pharmaceuticals Corporation.

Market Segmentation:

By Product Type:o Creams/Gelso Patcheso Injectionso Implantso Oral Tablets/Capsules/Gums.

By Active Ingredient Type:o Hospitals Pharmacieso Retail Pharmacieso Online Pharmacies

By Distribution Channel:o Testosteroneo Methyl Testosteroneo Testosterone Undecanoateo Testosterone Enanthateo Testosterone Cypionate

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North America Androgen Replacement Therapy Marketo North America, by CountryUSCanadaMexicoo North America, by Product Typeo North America, by Modalityo North America, by Distribution Channel

Europe Androgen Replacement Therapy Marketo Europe, by CountryGermanyRussiaUKFranceItalySpainThe NetherlandsRest of Europeo Europe, by Product Typeo Europe, by Modalityo Europe, by Distribution Channel

Asia Pacific Androgen Replacement Therapy Marketo Asia Pacific, by CountryChinaIndiaJapanSouth KoreaAustraliaIndonesiaRest of Asia Pacifico Asia Pacific, by Product Typeo Asia Pacific, by Modalityo Asia Pacific, by Distribution Channel

Middle East & Africa Androgen Replacement Therapy Marketo Middle East & Africa, by CountryUAESaudi ArabiaQatarSouth AfricaRest of Middle East & Africao Middle East & Africa, by Product Typeo Middle East & Africa, by Modalityo Middle East & Africa, by Distribution Channel

South America Androgen Replacement Therapy Marketo South America, by CountryBrazilArgentinaColombiaRest of South Americao South America, by Product Typeo South America, by Modalityo South America, by Distribution Channel

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Androgen Replacement Therapy Market potential growth, share, demand and analysis of key players - research... - Azizsalon News

Is There a Peak ‘Fat-Burning Zone’? Exercise Scientists Explain How It Really Works – ScienceAlert

Posted: June 3, 2020 at 2:50 pm

When it comes to losing weight, people often want know the best way to shed excess pounds and there's no shortage of fad diets or fitness crazes claiming to have the "secret" to fat loss.

One theory even suggests that exercising at around 60 percent of your maximum heart rate will bring our bodies into a so-called "fat burning zone", optimal for losing weight.

But does this "fat burning zone" even exist?

First, it's important to understand a little about our metabolism. Even if we were to sit at our desk all day, our body still needs "fuel" to meet energy demands. This energy comes from carbohydrates, proteins, fats and phosphates.

However, the rate at which we use them, and how much we have available, varies between people. It depends on a number of factors, such as dietary intake, age, sex and how hard or often we exercise.

Generally, exercising at lower intensities such as sustained walking or light jogging doesn't require as much effort by our muscles as sprinting, for example. This means the amount of energy needed by the body is lower, so energy supply predominantly comes from fats.

But as exercise intensity increases, fat can't be metabolised fast enough to meet increased energy demand. So the body will use carbohydrates, as these can be metabolised more rapidly. This means there is indeed an exercise intensity where fat is the predominant energy source.

At the lower end of this spectrum is our resting state. Here, the number of calories our body needs to function is considerably low, so the body primarily metabolises fat to use for energy.

This means the potential "zone" for metabolising fat is between the rested state and the level of exercise intensity where carbohydrates become the dominant energy source (in terms of percent contribution to energy demand).

But this is a wide range, which lies between a resting heart rate of around 70 beats per minute to around 160 beats per minute during moderate effort exercise (such as cycling at a constant speed where holding a conversation becomes challenging), where the crossover from using fat to carbohydrates for energy occurs.

The issue with such a wide zone is that the person exercising wouldn't necessarily be optimising their ability to metabolise fat, because as the exercise intensity increases there's a gradual change in the balance of fat and carbohydrates your body uses for energy.

So how can we know at which point our body will switch from using fat to other fuels for energy? One approach researchers take is assessing how much fat is being used for energy during different exercise intensities.

By measuring how much air a person expels during an exercise test which gets progressively harder, physiologists have been able to calculate the relative contributions of fat and carbohydrates to meet the exercise demand at different intensities.

The highest amount of fat burned is called the "maximal fat oxidation rate" (or MFO), and the intensity this occurs at is termed "FATmax".

Since this method was first used by researchers, studies have shown that as the intensity rises from around 40-70 percent of a person's VO max which is the maximum amount of oxygen a person can use during exercise there's an increase in the rate of carbohydrates and fats being used. The rate of fat being burned starts to decline at higher intensities as the body requires energy more rapidly.

The so-called "fat burning zone" has been shown to occur anywhere between about 50-72 percent of a person's VO max. However, the ability to burn fat is also based on genetics, with studies showing that this fat burning zone is likely to be lower in overweight or obese people around 24-46 percentof their VO max and higher in endurance athletes.

Another point to consider is how much fat we actually burn during exercise (if we express it in grams per minute). The answer is: surprisingly little. Even in studies with athletes, at FATmax, participants only burned on average a mere 0.5 grams of fat per minute. This would equate to around 30 grams of fat per hour.

In the average person, this appears to be even lower, ranging between 0.1 and 0.4 grams of fat per minute. To put it in perspective, one pound of fat weighs around 454 grams. So, though training in this fat burning zone will help with fat loss, this might also help explain why it takes some people longer to lose fat through exercise.

But there is evidence that following certain diets (such as intermittent fasting or a ketogenic, high fat diet) and longer exercise can increase the actual amount of fat we burn.

Perhaps it's time to no longer consider "burning fat" to have a "zone", but rather an individualised "sweet spot" which can be used to optimise our exercise regimes to lose weight.

Regular physical activity around this "sweet spot" (which typically occurs at a low to moderate feeling of effort, for example 30-60 percent of your maximal effort, or a perceived exertion level of one to four out of ten) will likely improve our body's efficiency in using fat for energy and translate to a lower overall body fat percentage.

Justin Roberts, Principal Lecturer, Anglia Ruskin University; Ash Willmott, Lecturer in Sport and Exercise Science, Anglia Ruskin University, and Dan Gordon, Principal Lecturer Sport and Exercise Sciences, Anglia Ruskin University.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Is There a Peak 'Fat-Burning Zone'? Exercise Scientists Explain How It Really Works - ScienceAlert

‘Fat burning zone’? The best way to exercise to burn fat – Jakarta Post

Posted: June 3, 2020 at 2:50 pm

When it comes to losing weight, people often want know the best way to shed excess pounds and theres no shortage of fad diets or fitness crazes claiming to have the secret to fat loss. One theory even suggests that exercising at around 60% of your maximum heart rate will bring our bodies into a so-called fat burning zone, optimal for losing weight.

But does this fat burning zone even exist?

First, its important to understand a little about our metabolism. Even if we were to sit at our desk all day, our body still needs fuel to meet energy demands. This energy comes from carbohydrates, proteins, fats and phosphates. However, the rate at which we use them, and how much we have available, varies between people. It depends on a number of factors, such as dietary intake, age, sex and how hard or often we exercise.

Generally, exercising at lower intensities such as sustained walking or light jogging doesnt require as much effort by our muscles as sprinting, for example. This means the amount of energy needed by the body is lower, so energy supply predominantly comes from fats.

But as exercise intensity increases, fat cant be metabolized fast enough to meet increased energy demand. So the body will use carbohydrates, as these can be metabolized more rapidly. This means there is indeed an exercise intensity where fat is the predominant energy source.

At the lower end of this spectrum is our resting state. Here, the number of calories our body needs to function is considerably low, so the body primarily metabolizes fat to use for energy. This means the potential zone for metabolizing fat is between the rested state and the level of exercise intensity where carbohydrates become the dominant energy source (in terms of percent contribution to energy demand).

But this is a wide range, which lies between a resting heart rate of around 70 beats per minute to around 160 beats per minute during moderate effort exercise (such as cycling at a constant speed where holding a conversation becomes challenging), where the crossover from using fat to carbohydrates for energy occurs.

The issue with such a wide zone is that the person exercising wouldnt necessarily be optimizing their ability to metabolize fat, because as the exercise intensity increases theres a gradual change in the balance of fat and carbohydrates your body uses for energy.

Fat burning zone

So how can we know at which point our body will switch from using fat to other fuels for energy? One approach researchers take is assessing how much fat is being used for energy during different exercise intensities.

By measuring how much air a person expels during an exercise test which gets progressively harder, physiologists have been able to calculate the relative contributions of fat and carbohydrates to meet the exercise demand at different intensities. The highest amount of fat burned is called the maximal fat oxidation rate (or MFO), and the intensity this occurs at is termed FATmax.

Since this method was first used by researchers, studies have shown that as the intensity rises from around 40-70% of a persons VO max which is the maximum amount of oxygen a person can use during exercise theres an increase in the rate of carbohydrates and fats being used. The rate of fat being burned starts to decline at higher intensities as the body requires energy more rapidly.

The so-called fat burning zone has been shown to occur anywhere between about 50-72% of a persons VO max. However, the ability to burn fat is also based on genetics, with studies showing that this fat burning zone is likely to be lower in overweight or obese people around 24-46% of their VO max and higher in endurance athletes.

Another point to consider is how much fat we actually burn during exercise (if we express it in grams per minute). The answer is: surprisingly little. Even in studies with athletes, at FATmax, participants only burned on average a mere 0.5 grams of fat per minute. This would equate to around 30 grams of fat per hour.

In the average person, this appears to be even lower, ranging between 0.1 and 0.4 grams of fat per minute. To put it in perspective, one pound of fat weighs around 454 grams. So, though training in this fat burning zone will help with fat loss, this might also help explain why it takes some people longer to lose fat through exercise.

But there is evidence that following certain diets (such as intermittent fasting or a ketogenic, high fat diet) and longer exercise can increase the actual amount of fat we burn.

Perhaps its time to no longer consider burning fat to have a zone, but rather an individualized sweet spot which can be used to optimize our exercise regimes to lose weight. Regular physical activity around this sweet spot (which typically occurs at a low to moderate feeling of effort, for example 30-60% of your maximal effort, or a perceived exertion level of one to four out of ten) will likely improve our bodys efficiency in using fat for energy and translate to a lower overall body fat percentage.

---

Justin Roberts, Principal Lecturer, Anglia Ruskin University; Ash Willmott, Lecturer in Sport and Exercise Science, Anglia Ruskin University, and Dan Gordon, Principal Lecturer Sport and Exercise Sciences, Anglia Ruskin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Disclaimer: The opinions expressed in this article are those of the author and do not reflect the official stance of The Jakarta Post.

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'Fat burning zone'? The best way to exercise to burn fat - Jakarta Post

Fact or fiction: does the ‘fat-burning zone’ really exist? – The Independent

Posted: June 3, 2020 at 2:50 pm

When it comes to losing weight, people often want to know the best way to shed excess pounds and theres no shortage of fad diets or fitness crazes claiming to have the secret to fat loss. One theory even suggests that exercising at around 60 per cent of your maximum heart rate will bring our bodies into a so-called fat-burning zone, optimal for losing weight. But does this fat-burning zone even exist?

First, its important to understand a little about our metabolism. Even if we were to sit at our desk all day, our body still needs fuel to meet energy demands. This energy comes from carbohydrates, proteins, fats and phosphates. However, the rate at which we use them, and how much we have available, varies between people. It depends on a number of factors, such as dietary intake, age, sex and how hard or often we exercise.

Generally, exercising at lower intensities such as sustained walking or light jogging doesnt require as much effort by our muscles as sprinting, for example. This means the amount of energy needed by the body is lower, so energy supply predominantly comes from fats.

Sharing the full story, not just the headlines

But as exercise intensity increases, fat cant be metabolised fast enough to meet increased energy demand. So the body will use carbohydrates, as these can be metabolised more rapidly. This means there is indeed an exercise intensity where fat is the predominant energy source.

At the lower end of this spectrum is our resting state. Here, the number of calories our body needs to function is considerably low, so the body primarily metabolises fat to use for energy. This means the potential zone for metabolising fat is between the rested state and the level of exercise intensity where carbohydrates become the dominant energy source (in terms of per cent contribution to energy demand).

But this is a wide range, which lies between a resting heart rate of around 70 beats per minute to around 160 beats per minute during moderate effort exercise (such as cycling at a constant speed where holding a conversation becomes challenging), where the crossover from using fat to carbohydrates for energy occurs.

The issue with such a wide zone is that the person exercising wouldnt necessarily be optimising their ability to metabolise fat, because as the exercise intensity increases theres a gradual change in the balance of fat and carbohydrates your body uses for energy.

So how can we know at which point our body will switch from using fat to other fuels for energy? One approach researchers take is assessing how much fat is being used for energy during different exercise intensities.

By measuring how much air a person expels during an exercise test which gets progressively harder, physiologists have been able to calculate the relative contributions of fat and carbohydrates to meet the exercise demand at different intensities. The highest amount of fat burnt is called the maximal fat oxidation rate (or MFO), and the intensity this occurs at is termed FATmax.

Since this method was first used by researchers, studies have shown that as the intensity rises from around 40-70 per cent of a persons VO2 max which is the maximum amount of oxygen a person can use during exercise theres an increase in the rate of carbohydrates and fats being used. The rate of fat being burnt starts to decline at higher intensities as the body requires energy more rapidly.

No hype, just the advice and analysis you need

The average person only burns between 0.1 and 0.4 grams of fat per minute (AFP/Getty)

The so-called fat-burning zone has been shown to occur anywhere between about 50-72 per cent of a persons VO2 max. However, the ability to burn fat is also based on genetics, with studies showing that this fat-burning zone is likely to be lower in overweight or obese people around 24-46 per cent of their VO2 max and higher in endurance athletes.

Another point to consider is how much fat we actually burn during exercise (if we express it in grams per minute). The answer is: surprisingly little. Even in studies with athletes, at FATmax, participants only burnt on average a mere 0.5 grams of fat per minute. This would equate to around 30 grams of fat per hour.

In the average person, this appears to be even lower, ranging between 0.1 and 0.4 grams of fat per minute. To put it in perspective, one pound of fat weighs around 454 grams. So, while training in this fat-burning zone will help with fat loss, this might also help explain why it takes some people longer to lose fat through exercise.

But there is evidence that following certain diets (such as intermittent fasting or a ketogenic, high-fat diet) and longer exercise can increase the actual amount of fat we burn.

Perhaps its time to no longer consider burning fat to have a zone, but rather an individualised sweet spot which can be used to optimise our exercise regimes to lose weight. Regular physical activity around this sweet spot (which typically occurs at a low to moderate feeling of effort, for example, 30-60 per cent of your maximal effort, or a perceived exertion level of one to four out of ten) will likely improve our bodys efficiency in using fat for energy and translate to a lower overall body fat percentage.

Justin Roberts is a principal lecturer at Anglia Ruskin University. Ash Willmott is a lecturer in sport and exercise science at Anglia Ruskin University. And Dan Gordon is a principal lecturer in sport and exercise sciences at Anglia Ruskin University. This article first appeared on The Conversation

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Fact or fiction: does the 'fat-burning zone' really exist? - The Independent

A year after Anthony Joshua upset, what happened to Andy Ruiz Jr.? – ESPN

Posted: June 3, 2020 at 2:50 pm

THE ASSIGNMENT WAS simple: Catch up with Andy Ruiz Jr. ahead of the anniversary of his stunning upset over Anthony Joshua last June. Maybe relive that fight, and the spiritless loss to Joshua in the December rematch. Pretty wild year, right? His arrival as the first Mexican-American heavyweight champion and his departure as a cautionary tale felt nearly simultaneous. Maybe see if he has come to terms with the twists fortune sent his way and find out what might come next. Standard stuff.

Then it got weird.

Numerous calls to his father and manager, Andy Sr., went unreturned. His attorney, David Garcia, answered two calls, said he was jogging and would call back both times, and never did. A spokesman for Ruiz's promoter, Premier Boxing Champions, said he didn't expect to be able to reach the fighter; PBC had recently set up an Instagram Live event for Ruiz's followers, and Ruiz had failed to show up. Manny Robles, Ruiz's former trainer who was fired in January by Andy Sr., said the only communication he has received from his ex-fighter since December was a single text message.

To be clear: Ruiz hasn't disappeared. He occasionally posts what can only be described as pseudo-workout video clips online -- "How many crunches till I get a six-pack?" he asks in one -- that fail as both information and inspiration. But even amid a pandemic, this level of seclusion felt different. Suddenly and without warning, this had turned into a mystery: What's going on with Andy Ruiz Jr.?

I told Robles, the man who helped guide Ruiz to his shocking title moment, that I was on a quest to find out what's happening with his former fighter.

"If you find out," he replied, "let me know. I'm wondering the same thing."

THE SAME PHOTOGRAPH appeared in almost every story of Ruiz's win over Joshua on June 1, 2019. Ruiz and Robles are in the middle of the Madison Square Garden ring, hugging. Ruiz's head is tilted back slightly, a gold glove raised at the end of his left arm, eyes closed, a blend of astonishment and bliss engulfing his face like a sinkhole. Robles, wearing a Mexican-flag bandanna, has a tenuous hold on Ruiz's formidable midsection, a normal-sized man trying to hold on to a tree during a storm. In the background, Joshua stands in his corner, arms at his sides, his face a knot of confusion.

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In a hotel suite in New York later that night, Team Ruiz celebrated the win. "We cried, of course," Robles says. "We sang and screamed and we embraced." Andy sat on a couch, a dumbstruck look on his face, repeatedly saying, "I can't f---ing believe I won." At some point, Andy Sr. made an announcement: "This is going to be our team forever, and we're going to conquer the world."

Anything seemed possible. The win over Joshua -- who, in a convenient plot point, is built like a stock photo for the perfect human form -- felt like alchemy. Ruiz had revealed himself to be a repository of hidden talents: Despite his girth, his hands are incredibly fast, his feet delicate. When it's all moving in concert, when he's controlling the ring as if he designed it himself, it creates the impression of a dancing barrel.

He was the best story in sports, and the story got better as the layers got peeled back. Months before he became champion, Ruiz was despondent, unhappy with his career, evicted from an apartment in Norwalk, near Robles' Southern California gym. He was out of shape and severely overweight, close to walking away from boxing.

And then, in a kaleidoscopic series of events, he moved in with Alonso Flores, a chef who regularly provides housing for Robles' fighters. He left Top Rank and signed with Al Haymon's PBC. He got in shape and beat Alexander Dimitrenko, and nine weeks later -- not enough time to get out of shape, it should be noted -- he was dropping Joshua in Madison Square Garden and hopping into Robles' arms in the middle of the ring.

But even in his best moment, Ruiz seemed a bit out of place. He possesses a sort of artless charm: round face sweet as birthday cake; soft, almost warbly voice that seems to belong in a different body; just enough self-consciousness to be endearing.

"He made you believe you didn't have to look like Anthony Joshua," Robles says. "[Most of us] have more in common with Andy. We see him, and it's like we're looking in the mirror."

Ruiz became the first heavyweight champion of Mexican descent. His hometown, the tiny California border town of Imperial, held a parade in his honor. He went to Mexico City to visit with President Andres Manuel Lopez Obrador. He went on Jimmy Kimmel. He found himself in the unlikely position of being hounded in public wherever he went.

He was supposed to take a month off before getting back in the gym, training for the rematch. He took three. "He just quit and checked out, I guess," Robles says. "Starting June 1, the day he beat Joshua, I didn't have the same fighter."

THE STORY OF Ruiz's six-month rise and fall isn't unique to boxing, but it feels remarkably specific to it. Through the first decade of his professional career, Ruiz faced mostly journeyman fighters and battled to keep his weight under control. And then, in a compressed period of time, he made close to $20 million. Doors opened. The shy fat kid -- a lifelong underdog who was bullied as a child -- suddenly found himself surrounded by admirers. He bought a mansion in San Diego and a Rolls-Royce, all from money he rightfully earned. He then fell back into his bad nutritional habits and treated trips to the gym as strictly optional. The work ethic atrophied. It's nothing new; lottery winners often quit their jobs. A good percentage of them also go broke.

"I had control when he was there, but I don't live with the guy," Robles says. "I can show up at the track, but if he's not there, what can I do? Sometimes people say, 'It's your fighter; how come he's not being disciplined?' Hey, I'm his coach, not his dad."

When it became clear Ruiz wasn't serious about training, Robles moved the camp to Mexico City for a month to distance the fighter from his family and what Robles terms "his new friends." He played up Ruiz's responsibility as the first Mexican heavyweight champ. He appealed to his pride. Nothing worked.

"I was always trying to get him to look at the bigger picture," Robles says. "I would say, 'You need to be a good role model for all the kids who look up to you.'"

When those entreaties went unheeded, Robles changed his approach. "If money's what motivates you," he told Ruiz, "then let's go make that money. But you've got to work hard. That money's out there if that's what motivates you." Robles pauses and emits a groan that sounds like pain. "That didn't work either," he says. "Apparently, he was content. It was like he said, 'I know I'm going to make so much for this fight, and I'm good.'

"I still scratch my head. I can't figure any of this out. You're the first Mexican heavyweight champ, right? You got to go see the president of Mexico, right? What other motivation do you need than the responsibility you have to the Mexican people -- and really everybody? Because this went way beyond being the first Mexican champ. This transcended borders and reached people across the world. He made people believe. He was the feel-good story of the year. I did everything I could to convince him to look at the bigger picture and leave a legacy, but not everybody has the same drive or the same priorities."

Ruiz weighed 268 for the first fight, 283 six months later for the rematch in Riyadh, Saudi Arabia. Nobody really knows Ruiz's ideal fighting weight -- Flores, the chef, suggests 250 to 255 -- but there's universal agreement that it's not 283. Those 15 pounds he gathered from June to December all seemed to land in the same spot: his belly. He lasted 12 rounds but never posed a threat.

Flores waited for Ruiz to leave the ring as security ushered the rest of the team to the dressing room. When Ruiz saw him, he hugged him and said, "I'm sorry, dude. I let people down." In stark contrast to that celebratory night in New York, Ruiz sat forlornly at the lectern in the postfight news conference and admitted he didn't train properly. He apologized to his team and the promoters. He begged for a third fight.

"It was so hard for me to sit there," says Robles, who felt Ruiz should have simply congratulated Joshua and relinquished the stage. He mimics Ruiz, adopting a whining tone: "'I didn't train. I didn't prepare.' The way he handled it, it was embarrassing."

A month later, Andy Ruiz Sr. requested a meeting with Robles. The team would not stay together; it would not conquer the world.

"I knew what was coming," Robles says. "They needed a villain. But I'll be honest with you: I'm better now. I don't want to be a part of something like that. I want to be able to sleep at night. There was a lot of stress -- with the dad, with David [Garcia, the lawyer], with Andy. It's not worth my health."

Will Ruiz become lost to history, just another remember-that-guy from boxing's dustbin? Robles sighs through the phone. "I wish Andy nothing but the best," he says. "I want to see him succeed. I care about him. How could I not? We made history together. I believed in him, and I still do -- I just don't know what's going on with him. I worry about him -- absolutely. I just know money isn't everything, and I don't want to see him end up in a dark place."

Robles tells his fighters, "Remember where you came from," but not out of perceived loyalty to the folks left to bob in the wake of fame. "The moment you forget where you came from, you lose direction," he says. "How do you know where you're going if you forget where you've been?"

THE CALL INTRIGUED Teddy Atlas. Train Andy Ruiz Jr.? The idea was tempting. "If he was in better shape, he'd be the best damned heavyweight in the world," Atlas says. "He'd beat everybody." So sure, the man who used to train Mike Tyson and now handpicks his fighters with utmost care was interested.

But Atlas wanted everyone on the phone -- Ruiz, his father, Garcia -- to know that there were conditions. Atlas, an ESPN commentator, needed Ruiz to make a trip to his gym in New York and train for a weekend to see if the two were compatible. Ruiz would also have to check himself into an inpatient weight loss facility because, as Atlas says, "if you just want me for weight loss, call Jenny Craig."

"I can make a guy lose 30 pounds with my eyes closed, but he needs to make sure it becomes a condition of life," Atlas says. "I think [Ruiz] is subconsciously undermining himself with the weight. It's about his relationship with food, what he depends on food for and how he uses it sometimes as a way to hide from something. If you're heavy, no one expects you to win, so you're protected a little bit. It's a subconscious-level excuse."

Atlas cautioned Ruiz's team that he had not yet agreed to train him, and both sides agreed to a follow-up call to firm up the details. In the meantime, Atlas studied film of Ruiz's fights and put together an eight-page list of suggestions to bring the fighter back to prominence.

There was no second call, no intensive weight-loss program, no trip to New York to judge compatibility. "It was a test," says a close friend of Atlas. "I think Teddy just wanted to see if he'd get his ass on a plane." Atlas doesn't know whether Ruiz was insulted by his demands or simply uninterested in carrying them out. He never got to share his eight-page list with Ruiz or his team. He never got to tell them he believed the win over Joshua didn't feel sustainable, that -- in Atlas' words -- "it felt temporary. It didn't feel like he arrived through great preparation and a readiness to stay." He never got to outline his reasons for demanding a comprehensive lifestyle approach to training.

"It's potentially going to be a sad ending," Atlas says, "and I'm careful with my thoughts on those things. I hope I'm wrong."

MORE THAN A month after my first contact with the Ruiz camp, and only after I gave Garcia a drop-dead deadline and emphasized the need to include Andy's voice -- or one close to him -- a call is arranged with Andy Ruiz Sr. He says Andy is enjoying life with his five children and training at home. He has gone nearly six months without any formal training but is almost ready to begin working with new trainer Eddy Reynoso, who trains Canelo Alvarez. The idea is to fight Chris Arreola -- not ranked among The Ring magazine's top 10 heavyweight contenders -- in November.

"Andy's the same person," his father says. "He's never stressed about money because I've always backed Andy. He was driving a 2006 [Dodge] Hemi Charger and now he's driving a Rolls-Royce, but he's the same person."

I ask him why Andy has been so silent lately, at a time when he has a new trainer and supposedly a new outlook. Wouldn't it make sense for him to be more public as he attempts to rehabilitate his image and career? His father says that part of his son's problem after becoming champion was "too much publicity." And the break with Robles was "nothing personal," necessitated by the lack of communication between fighter and trainer.

"I think Manny should have been more strict with Andy," he says. "It shouldn't be about what the fighter wants. You can't let them get on top of you. It has to be, 'We're going to do this, and this is the way to do it.' Manny learned something, and we learned something too. Eddy Reynoso is going to say, 'This is the way we're going to train, like it or don't like it.' That's what Manny needed to do."

Robles says, "I didn't give up on Andy. He gave up on himself."

On the phone with Ruiz Sr., I mention Robles' frustration with Andy, a 30-year-old professional, and the trainer's contention that he can't train a fighter who doesn't show up to the gym. "What would you say is Andy's responsibility in all of this?" I ask.

I wait for an answer that never comes. The phone goes dead. Subsequent calls immediately clicked to voicemail. The mailbox was full.

BACK IN DECEMBER, two days after Ruiz lost his belt, a TMZ reporter interviewed him as he walked through baggage claim at Los Angeles International Airport after returning from Saudi Arabia. The reporter is a classic of the tabloid genre, egging Ruiz on with flattery while coaxing him to answer questions about his failure to train. It's a master class in passive-aggressive manipulation.

"It could have happened to anybody," Ruiz says. "You know, I was having so much fun. ... Celebrating too much, a few too many Coronas."

Here the interviewer laughs hyenically, and Ruiz joins in, clearly believing he has found someone -- finally -- who understands. "What was your favorite meal while you were training?" he is asked.

"Oh, I think I pretty much ate everything," Ruiz says, and the hyena goes turbo. Flores stands slightly behind Ruiz's right shoulder, the look on his face indicating he has reservations about the prudence of this interview.

Ruiz soldiers on.

"Even out of shape, even the way I was training, I did pretty good, dude," he says. "I did pretty good."

The interviewer agrees with a vigor not often found in human interaction. "You're a legend," the TMZ guy tells Ruiz, who smiles and nods and heads across the street toward a black Suburban. A man in a black suit is waiting, holding the door open to whatever comes next.

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A year after Anthony Joshua upset, what happened to Andy Ruiz Jr.? - ESPN

Ketosis is a metabolic state that can help you shed fat fast here’s how to reach it – Business Insider Australia

Posted: June 3, 2020 at 2:49 pm

The ketogenic diet, or keto for short, may seem like just another fad, but scroll through social media and youll see many showing off their weight loss success. The keto diet works by literally changing the way your body uses energy.

Normally, the body converts carbohydrates, or sugar, into glycogen for energy. But on the ketogenic diet, carbs are drastically reduced so that the body can enter a metabolic state called ketosis where you burn fat for energy instead of glycogen.

However, its not always easy to enter ketosis. And your body wont immediately reach this fat-burning state after a day of cutting carbohydrates. It takes time, and it may be difficult to know when youve reached that point. Here are some tips to help you know when youve reached ketosis and how to get there a little faster.

To reach ketosis, you must first reduce your bodys glycogen reserves. The keto diet helps you do that by limiting carbohydrates to less than 50 grams per day. Thats about the equivalent amount of carbs in two large apples.

After about two days to a week of restricting carbs, your body should start tapping into fat reserves for energy. But this can vary person to person and may take slightly longer. Some ways you can speed up the process is:

Common symptoms of the keto diet include:

These symptoms are often called the keto flu, and are a side effect of your bodys transition to a constant state of ketosis. After four to six weeks your body will adapt and these side effects should resolve.

Other ways to check that youre in ketosis is with urine test strips or at-home blood and breath tests. These tests measure the ketone levels in your system. Ketones are the byproduct of fatty acids the body breaks down when youre in ketosis.

A blood test is the most accurate way to measure ketones and is used in doctors offices, but involves a needle prick. However, urine strips and breath meters are also accurate and less invasive. According to one small 2016 study, urine strips offer the most accurate readings early in the morning and right after dinner.

The keto diet was developed in the 1920s as an effective treatment for children with epilepsy who were not responding to drugs that were available at the time.

Today its also used as a medical diet to treat other diseases, like type 2 diabetes and obesity. Studies show that ketones provide energy without elevating blood sugar levels, which reduces the need for insulin. In one clinical trial, people with type 2 diabetes were able to decrease their medication dosage after 12 months of a ketogenic diet.

There are also hints this diet may be good for brain health. In 2019, a small study showed a low-carb diet may improve memory in adults who have mild cognitive problems, potentially an early sign of Alzheimers disease. One possible explanation is that brains of people with Alzheimers disease dont use glucose as efficiently, and ketones may be an easier source of energy for overall brain function.

But beyond low blood sugar levels and possible brain health, the keto diets recent claim to fame is for weight and fat loss. Low carbohydrate diets, in general, have been shown to lead to more rapid weight loss compared to other diets, but not necessarily more weight loss long-term.

For example, in one trial, lasting six months, obese women following a low-carb diet lost nearly 10 pounds more than participants following a low-fat diet. They also lost significantly more body fat 10.5 pounds versus 4.4 pounds.

Researchers note, though, that most weight loss studies have been short term, so it is unclear how this diet performs for long-term weight loss.

Despite the weight loss and other potential health benefits,Lorraine Turcotte, a metabolism researcher at the University of Southern California says she would not recommend this extreme diet over a more moderate approach to eating.

There is a potential benefit [for weight loss] but I would never recommend it unless you are clinically managed, she says.

One reason she would not recommend the diet, especially to athletes, is because it can lead to a breakdown of muscles-the body cannot operate optimally without carbohydrates, so it may resort to using muscle stores instead.

The body breaks down muscle protein into amino acids and then uses the amino acids to make glucose, says Turcotte. It is not clear if consuming so much fat, especially if the diet is heavy in saturated fat, is good for cardiovascular health long term either cardiologists say the diet could lead to high cholesterol. In addition, over time, ketosis can cause side effects like kidney stones and constipation in children following the diet for epilepsy treatment.

Turcotte also says that leaving out carbohydrate-rich food groups like fruits, whole grains, and legumes can also lead to a nutritionally-deficient diet lacking many vitamins, minerals and phytochemicals, which are essential to overall health. Besides that, she says, it is just a very strict regime to stay on for a long period of time even for the most die-hard keto dieters.

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Ketosis is a metabolic state that can help you shed fat fast here's how to reach it - Business Insider Australia

Felicia Spencer reflects on fast track to UFC title fight: Ive earned my spot here – MMA Fighting

Posted: June 3, 2020 at 2:49 pm

On Saturday, Felicia Spencer competes in her first pay-per-view main event. It wont be the first time shes squared off with a woman considered to be one of the greatest of all-time.

When Spencer fought Cris Cyborg this past summer, the Brazilian star was one fight removed from her first loss in 13 years. The bout carried considerable weight, not only because of the scrutiny Cyborg was facing following a stunning setback against Amanda Nunes, but because it would also provide insight into how far along Spencer was as a featherweight prospect.

Though Spencer lost a unanimous decision, she earned praise for going the distance with the more experienced Cyborg and bounced back from that loss with a first-round TKO of Zarah Fairn in February. That win moved Spencer to the top of the contender rankings and next for her is a shot at Nuness championship at UFC 250 at the UFC APEX in Las Vegas.

Spencer learned a lot from the 15 minutes she spent battling Cyborg and shes bringing that to the octagon with her as she attempts to be more than just another name in the legendary run that Nunes is currently on.

I definitely see the resemblance, Spencer told MMA Fighting, in regards to the hype surrounding the Cyborg and Nunes fights. [The Cyborg fight] did feel like a title fight and I think even some of the commentators made comments about it being a title fight or a five-round fight, something like that was said during the actual event. Media, even afterwards, were like, losing to the champion or mentioned that it was five rounds and I had to remind them it wasnt a championship fight, it was only three rounds.

I think that the experience just adds to the repertoire. Ive been through some of the buildup and now its actually a little bit less because of the restrictions with media and stuff. Its less invasive, less stuff going on. I feel like I was so lucky and happy to be given the opportunity to have such a high placement on the card last summer with Cyborg, having the big stage, and now its kind of all happening again but this time in the main event, which was super unexpected at first because we were third down initially and then co-main and now were the main. I just kind of take the news and then move on. My number one focus is just beating Amanda and then everything that comes after will come after and Ill enjoy it then.

Spencer has had plenty to celebrate already. Aside from booking the Nunes fight, the 29-year-old was married in December. Her husband Todd Coppinger, also a fighter, competed for the first time as a pro in February after dealing with injuries for the past two years. He won by first-round knockout.

Coppinger wasnt cornered by Spencer as she instead watched from the seats, describing herself as jittery and grateful to be in the background on fight night for once. Just five years ago, Spencer made her own pro debut with Invicta FC, rattling off six straight wins to start her career capped off by a submission of Pam Sorenson that won her a vacant featherweight title. Less than two years later, shes fighting for UFC gold.

The rapid ascent is not lost on Spencer.

Especially since I turned pro, but even before then, the opportunities just escalate quickly, Spencer said. My amateur career started off slow, it was really tough to get fights, then all of a sudden I had a few wins and I got called to Vegas to fight in the Tuff-N-Uff tournament, which was a huge deal and such a big thing back then. And then Invicta.

Really, every year I look back its milestones. People are just saying the same thing, Wow, its crazy, youve done this and this, its a crazy year. Yeah, every year I look back and its a crazy year so its kind of the same as usual. The opportunities are incredible and mind-blowing but I feel like this every year, so well see what happens next year.

Born in Montreal and raised in Florida, Spencer looks forward to taking the UFC belt on a tour of both Canada and the United States should she defeat Nunes. Spencer is the first Canadian to challenge for a UFC title since Georges St-Pierre returned from retirement and beat middleweight champion Michael Bisping in November 2017.

Its an opportunity that Spencer was confident she would get after defeating Fairn, though shes aware that the more established Megan Anderson who knocked out Norma Dumont Viana the same night as Spencers win over Fairn was in consideration as well. Spencer submitted Anderson in May 2019 and wouldnt be surprised if they rematch somewhere down the road.

It was definitely presented after like it could be [Anderson] too, that both were being considered, Spencer said. I honestly figured that I would get the first call and if they wanted to make it happen, it would happen. If I didnt get the first call then so be it. Just the way that they positioned us [with Spencer in the co-main event] on the card also not that they wanted me to win and not her but in the situation that happened where we both had great performances, it seemed like I would be the first one. I know Megan and I will probably fight again in the future.

Spencer is aware shes still not a household name and that there are fans viewing her as little more than a mandatory challenger for Nunes. When she steps into the octagon at UFC 250, it will be just her 10th pro appearance. Add to that the fact that her fight with Nunes had to be rescheduled due to the COVID-19 pandemic throwing the UFC schedule into disarray and their hasnt been much time to properly build up their bout.

Regardless of how many are watching and how some may choose to view her contender credentials, Spencer is proud of the hill shes climbed to get here. And if she has to keep climbing to earn respect, shes ready to dig in.

Ive earned my spot here, Spencer said. I understand where people come from especially if theyre not following the sport. I understand the division that Im in is different and unique. All I stress about is what I can control, which is putting on a great performance and making people want to see me fight. Thats what I always try to do.

Two out of the three fights Ive had so far in the UFC have been first-round finishes. The other one was a decision that a lot of people were happy with as far as my performance, other people werent, but whatever. All I can do is put my best foot forward and hope the people want to see me again. If not, Ill keep winning and take my spot.

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Felicia Spencer reflects on fast track to UFC title fight: Ive earned my spot here - MMA Fighting

Cultivated by physician investors, Fruit Street Health’s evolution as a telehealth business – MedCity News

Posted: June 3, 2020 at 2:49 pm

Laurence Girard, Fruit Street Health CEO

Like many healthcare startups, Fruit Street Health has experienced many twists and turns in its evolution as a telemedicine company with multiple products. In an interview with MedCity News, CEO and co-founder Laurence Girard discussed the companys product offerings, business model and its focus on building a community of physician investors, as opposed to seeking funding from venture capitalists, all of which are reflective of the companys mission and journey.

After perceiving a growing need for digital health tools to manage chronic conditions, Girard founded Fruit Street Health in 2014. While serving as an ER volunteer, Girard took a course in nutrition epidemiology at the Harvard Extension School with a Harvard School of Public Health professor, which changed his initial plans of attending medical school.

I realized that we can prevent chronic conditions like heart disease, diabetes and stroke through diet and lifestyle. I also started reading about physicians like Dr. Dean Ornish who proved you could reverse heart disease through diet and lifestyle modification. It made me think I could have a bigger social impact through a combination of technology and entrepreneurship in the field of public health.

In its first phase of business development, Fruit Street created a telemedicine software platform that would eventually be licensed to physicians and dietitians. For the first three years the company was developing telemedicine software and striving to find product market fit. It ultimately succeeded with strategic developments and the formation of critical relationships. Fruit Street found success when it pivoted its business model from telehealth software to delivering the CDCs Diabetes Prevention Program.

In 2017, Girard successfully registered the company for the CDC diabetes prevention program based on advice from a Fitbit executive. Fruit Street eventually got a stamp of approval from the CDC when it achieved full recognition. In order to achieve the full recognition designation from the CDC, diabetes prevention programs must achieve outcomes such as 5% average weight loss for participants that take part for at least nine months.

Fruit Streets flagship product is delivery of the CDCs diabetes prevention program via telehealth and live group video conferencing with registered dietitians. The program is designed to help patients with pre-diabetes lose 5% to 7% of their weight to reduce their risk for developing Type 2 diabetes. The program is based on research CMS funded that was published in the New England Journal of Medicine which proved that the diabetes prevention program helped patients with prediabetes reduce their risk for Type 2 diabetes by 58%.

It involves screening patients via a Type 2 diabetes risk assessment. If the results indicate the patient is at risk for the disease, they will be entered into a weekly telehealth program aimed at managing health and preventing the chronic condition. Members not only participate in the weekly group classes, but also share photos of their meals with dietitians providing feedback. They also use a wireless scale and Fitbit to track their physical activity.

When asked about the impact of the current public health crisis on Fruit Streets business, Girard said Medicares loosening of telehealth regulations has helped attract more customers. He noted that the CDC promoted Fruit Streets software as a solution for in-person diabetes prevention programs to switch to delivery of the program online via telemedicine during the pandemic.

Weve seen a big shift from these in-person diabetes prevention programs to adopting telemedicine relatively quickly, he said.

Rachel Neifeld, a registered dietitian, is among Fruit Streets recent hires who have helped thrust the company into pole position. She leads the digital diabetes prevention program. Previously, Rachel served as an inpatient dietitian at Montefiore Medical Center and New York Presbyterian Hospital, then as an outpatient diabetes educator at Beth Israel Mt. Sinai Endocrine Center.

In late April, Fruit Street hired Chief Technology Officer Ian McFarland, who served in a similar role at Pear Therapeutics, a digital therapeutics business. In fact, it was McFarland who persuaded Girard to expand Fruit Streets offering to include a service aimed at preventing and treating the coronavirus.

Fruit Street Health launched CovidMD at the height of the public health crisis, during which the countrys struggle regarding the need to address public health and the need to restore the economy was at its peak. The risk assessment, triage, and telemedicine platform, built on the Salesforce Service Cloud and Zoom, tracks sources of domestic exposure and pre-existing chronic conditions as part of a proprietary risk scoring system. This system generates both an exposure risk score and a health risk score for each person. Then, users are provided with personalized information about next steps, based on their risk scores and the latest CDC guidelines. Theyre also given the option to connect with a healthcare provider via live video, who will be able to take actions such as write a prescription or order an at-home test for Covid-19.

Eventually, Fruit Street plans to develop a more holistic telemedicine solution that will include behavioral health with psychiatrists and psychologists via live video, virtual primary care, and dietitian-based services which Fruit Street already delivers.

Fruit Streets investment model is what sets the company apart from the myriad of telemedicine companies on the market. Rather than utilize venture capital firms for funds, the company focuses on physician angel investors, who also function as advisers.

I realized that I enjoyed working with the physicians that had invested and they were the ones who were more focused on having a social impact, says Girard. I wanted Fruit Street to be a grassroots effort of physicians who want to have a social impact in public health through the power of telemedicine. I wanted to focus on physician investors rather than venture capitalists because physicians know more about healthcare products than a venture capital firm. What if a physician could use my product or tell me how I should design it based on their experience working with patients?

Asif Ali was the companys first physician-investor, a cardiologist at the University of Texas in Houston.

Physicians tend to invest between $25,000 to $50,000. Girard noted that many tap an IRA/401k to invest in the business. Recently, Fruit Street launched a crowdfunding campaign on StartEngine to offer a wider range of investment points for a wider variety of physician investors, demonstrating the companys value for its physician community, as well as its dedication to improving Fruit Streets program for patients and user experience for physicians.

Physicians develop clinical protocols, but they also talk to each other. I dont start every discussion a physician can post an idea and other physicians can respond in real time. So its really kind of like a collegiate forum where we discuss everything and anything. And then well have weekly updates on Zoom, where well share progress made on the product and the business impact in the chat box or just share their comments on product design and clinical protocols. They might make helpful introductions to potential customers; they might recommend colleagues to invest. Some of them use our telemedicine software in their practice. Some of them are actually telemedicine providers.

Girard has had a long journey in the telemedicine industry. He noted that his idea started on a napkin which has now grown into three telemedicine products that are having a social impact on diabetes prevention and providing medical care online.

Looking ahead, Girard envisions building a physician community of 10,000 that will serve as a hub for expert insights on product development and solidify the companys position for future growth.

Photo Credit: Zoom Video Communications

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Cultivated by physician investors, Fruit Street Health's evolution as a telehealth business - MedCity News


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