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The Biggest Loser trainer Erica Lugo reveals how she lost 160 lbs. and its something we all can do – HOLA! USA

Posted: March 27, 2020 at 3:50 am

HOLA! USA: First, we want to know how you lost the weight? Erica Lugo: I never knew anything about fitness or nutrition whatsoever growing up, so I just started with those basics of moving more and eating less, and then it's kind of a spiral from there. I mean it was five years in the making of me getting from that point to where I am now, and I still learn new tricks and tips all the time.

You mention you didnt know about nutrition or fitness growing up. What was your childhood like?My parents worked really hard, and we didn't always have gourmet meals on the table at dinner time. It was quick fixes or pizza or fast food with snacks in the cupboard because that's what was the easiest thing for my mom at the time. I grew up knowing zero boundaries or zero portion control of food, and I just carried that on through my life. When I got to college, it was more like the freshman 50 instead of the freshman 15. Then you get married and put on the happy pounds. Then I had my son and had postpartum depression. It seems like every stage of my life the weight just kept piling on.

Are you teaching your son about a well-balanced diet and fitness?Big time. Connor is nine now, but he's grown up with a mother who exercises weekly, who cooks healthy, who talks about nutrition openly. He thinks of working out like brushing your teeth; he just thinks it's a daily necessity that adults do. He doesn't think it's something that you have to carve out time for. And the same with food, he thinks cooking with vegetables and eating fruit and eating colorful things is normal and a part of life. I'm so thankful because he's not going to have to start in his twenties like I did or fight to struggle to get his weight off like I did. It's just going to be a natural thing for him to be able to lead a healthy lifestyle.

Has your family also changed how they approach food?One thing I've learned is people will change when they want to change, and it's not my job to force change on them. My family has looked at food and fitness a little bit different. They may take more time to think about their options versus just eat whatever. They used to get a little offended when I wouldn't eat the food that they cooked at holidays or special events and when I would bring my own. Now it's much different in that aspect where they are thinking, Okay, Erica, what could we get for you? What do you want to bring? Is there something special I need to get for you?

Do you allow yourself to indulge in your favorite foods?I always have my surplus meal once a week. I hate using the word cheat because it makes me feel bad. Sometimes it's donuts or sometimes it's hamburgers and pizza. It changes all the time, but I definitely don't deprive myself once a week. I look forward to that Friday or Saturday meal, for sure.

Many people may be discouraged to start to make a positive change in their life. How long did it take you to really get in a routine?It takes 20 days to build or to break a habit and to build a new one. It seems simple, but realistically I can say I've been doing this for five years, and it's still a habit that I have to work on every single day. Just because I lost the weight or just because I am a trainer on The Biggest Loser does not mean I wake up every day motivated to kick booty in the gym and to eat the healthiest I've ever eaten. We are human at the end of the day, but we have to rely on habits and building those habits take time. It's more about consistency versus being perfect all the time.

What advice do you have for someone who is ready to start?Start with goals that are achievable. It's called the smart goals. Are they sensible, what's the timeline? Are they attainable, are they measurable? And be realistic with it. When I started on the treadmill, it was let me jog for 30 seconds. And then it became let me jog for the whole length of this song. Eventually, it became for the whole length of my playlist. It was those baby steps that I took to get me where I am.

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The Biggest Loser trainer Erica Lugo reveals how she lost 160 lbs. and its something we all can do - HOLA! USA

What is the fastest bicycle tubeless wheel and tire setup? – VeloNews

Posted: March 27, 2020 at 3:50 am

Lennard Zinn went in search of the most aerodynamic combination of rim and tubeless tire. Here's what he found.

Of all of the forces opposing your efforts at propelling your bike down the road, those working on the wheels and tires comprise a significant percentage. Tubeless tires and rims can be part of the equation to maximize speed, as they have improved to the point that there is now no faster road tire/wheel setup. Get the combination of the tubeless tire, wheel, and pressure right, and youll have free speed.

Optimizing speed from your tubeless wheels and tires also requires hitting the tire diameter, tread compound, tread pattern, and rim shape as well as spoke count and shape.

Aerodynamic drag increases exponentially with speed. It doesnt take twice as much power to go twice as fast relative to the air; it takes four or more times as much power. Since rider power is limited, going faster without producing more of it requires improving the aerodynamic shape of the object moving through it.

The 1960s solution was fewer spokes in the wheels. It took a dramatic turn in 1984, when Francesco Moser broke the world hour record riding disc wheels. Steve Hed then created the aerodynamic innovation that every pro bike racer now depends on: the deep-section rim.

Hed once again pioneered the next step, a wider rim that took the tire shape into account. This gets the rim and tire together to more closely approximate a National Advisory Committee for Aeronautics (NACA) airfoil shape for aircraft wings. The tire is wider than first-generation deep-section wheels, but the nose of a NACA airfoil is significantly narrower than the thickness of the wing further back. To approximate this shape, a bicycle rim not only needs to be wider than the tire where they meet, but it also needs to continue to get wider before it tapers toward its spoke bed.

Friction within a rolling tire slows it down, and like aerodynamic drag, friction increases with speed. Unlike aerodynamic drag, however, rolling resistance only goes up in a linear relationship to speed, so the slower the rider is going, the more important rolling resistance is relative to aerodynamic drag, and vice versa. The graph below illustrates how below about 12 mph, rolling resistance exceeds aerodynamic drag.

On a smooth surface, the tire can be hard and lose little energy when rolling, like a steel ball bearing rolling on glass. Since it rolls on surfaces much rougher than glass and requires traction for propulsion, braking, and cornering, compressed air inside cushions impacts, and rubber tread provides traction.

Friction within the tire results from chafing of the inner tube against the inside of the tire casing and of the threads in the casing against each other as the tire flexes; on top of that, internal energy losses within the rubber itself result from hysteresis the lag between the application of a force on a material and its deflection in response. Overcoming this lag absorbs energy.

Until recently, road racers generally believed that smaller, harder tires were fastest and rode races other than Paris-Roubaix on 22 or 23mm tubulars, using yet narrower tires in time trials. Greg LeMond illustrated the cost of this in the final time trial of the 1986 Tour de France. Racing on 19mm tires pumped up high, he slid out and crashed on a sharp corner. Wider, softer tires would have not only given him more traction for that corner, but also would have rolled with less resistance. LeMond then had to change bikes and worry about losing his yellow jersey to teammate Bernard Hinault, who did win that time trial.

A shorter contact area deflects less deeply into the tire. A wider tire will have a shorter, wider contact patch on the road than will a narrower tire at the same pressure, because the surface area of the contact patch must be the same to support the same load. Less deflection will result in less internal friction/hysteresis loss in the wider tire.

With reduced pressure, the tire must support the same load with fewer pounds per square inch to do it, so the surface area of its contact patch will increase. Tire deflection will deepen with the longer contact patch, resulting in more internal friction and hysteresis loss. This makes the case that higher pressure reduces rolling resistance, but only on a smooth surface.

On a rough road, the internal friction/hysteresis losses due to the larger contact patch of the softer tire is counterbalanced by the fact that deflecting the entire bike and rider on each bump costs more energy than does absorbing the bump into the tire. Only the tiny mass of a small part of the tire moves up and down on each bump, rather than the entire bike and rider. This is the sprung weight vs. unsprung weight argument explaining why suspension vehicles are faster on rough roads than ones without suspension. Lower pressure is faster on rough roads, and bigger tire diameters then protect the rim.

Its safe to run a tubeless tire at lower pressure than a tubed tire since theres no tube to pinch when hitting sharp bumps. This in turn reduces rolling resistance on rough roads. Eliminating the inner tubes hysteresis and its friction against the inner tire casing further reduces a tubeless tires rolling resistance. First-generation tubeless road tires, which were completely airtight and designed to be used without sealant, had so much rubber coating their insides that their weight was the same as a comparable tire and tube, and the frictional rolling losses were similar. Modern, tubeless-ready tires with sealant are lighter and do have lower rolling resistance than tubed tires.

To improve aerodynamics, Hed went to the wind tunnel and caulked the edge of the rim where it meets the tires sidewall so the air flowing from tire to rim meets no edges to create turbulence. Caulking tires to rims is unrealistic as well as inadmissible by UCI rules, so the key is to smooth this transition without it.

Until the advent of tubeless tires, handmade tubular tires were the rolling resistance champions. The edges of their thick base tape and the glue sticking out along the rim edge is not aerodynamic, however. Specialized lead engineer Dr. Chris Yu says, From a speed and performance standpoint, weve known for a while that clinchers are superior to tubulars. They allow for better control of the shape interface between the rim and tire casing and when paired with the right inner tube, offer lower rolling resistance. This is the reason why all our pro athletes have raced TTs on clinchers for the last several years. With tubeless, if done properly, we can amplify those performance advantages. More importantly, by CT-scanning the inflated tire bead and rim interface in-house, were able to design a system that is secure, and we also gain the insight on how to optimize the shape transition from rim to tire.

Like automobile rims, hookless rims lack the crochet hooks at the inner edges of the rim walls to grasp the tire beads, so they can better optimize this shape transition from rim to tire. A standard hook-bead rim squeezes the clincher sidewall further inward than does a hookless rim, rendering the tire/rim combination less aerodynamic.

Aero carbon hookless rims have many advantages. A hook-bead rim mold requires a soft outer ring, or the hooks of the hardened rim lock to it. This single-use soft mold top is less accurate and less sustainable than the long-lasting solid-metal mold for hookless rims. The edges of hookless rims are thicker, stronger, and less easily damaged when hitting bumps than the fragile edges of hook-bead rims.

To work safely with tubeless tires, hookless rims require precise rim wall dimensions, a bead lock (a raised inner edge of the shelf the tire bead sits on), bead-shelf diameter, and central valley diameter, width and ramp slope. If youve ever watched installation of a car tire on a rim, you know that the compressed air blasted in through the valve must not escape from under the bead even before its seated; it must instead push the tire beads up the ramps of the rim valley, over the bead lock, onto the bead seat, and firmly up against the rim walls.

Specialized Tire Product Manager Wolf Vorm Walde made solid-steel rims that dont change dimensions as tire pressure increases, in order to test tire retention. He says, Straight-wall (hookless) rims show lower burst pressure compared to hooked rims. We do not recommend using any tires with a max pressure above 5.5bar (80psi) on straight-wall rims.

Tire dimension would depend on factors like road surface condition as well as how technical the course is, says Yu, regarding the fastest tire setup. We can quantify time lost or gained through turns based on G-loads and rider confidence, which is admittedly subjective but correlated to tire width. And rim profile would depend on course profile and wind profile.

According to Specializeds tire product manager Oliver Kiesel, Typically, if we measure rolling resistance, we have three factors that vary: tire load, air pressure, and rolling speed. The graphs show how rolling resistance changes by changing one of these factors.

Schwalbe product manager Felix Schfermeier says, Our general recommendation for individual competitions against the clock is a tire width of 25mm in the front and a 28mm tire on the back wheel.We recommend that the external rim width is at least 1mm wider than the (front) tire. Twenty-five millimeters in front is the best choice to reduce the aerodynamic drag on the majority of aero rims with an internal width between 19 and 22mm. Since the frame is covering the rear wheel, the wider 28mm tire doesnt have any negative impact on aerodynamics, and it saves a few wattsof rolling resistanceand provides more traction.

ENVEs marketing manager Jake Pantone says, The athlete should be riding a low-rolling-resistance tubeless clincher tire on a rim that is roughly 5 percent wider than the tire. As tire and rim volume increases, the need for a rim to be wider than the tire diminishes, because the increased radius of the larger tire allows for the air to attach to the rim more easily at yaw. When paired with a 28mm tire (inflated will measure around 30-31mm), an SES AR rim and tire are essentially the same width.

Tread compound has no aerodynamic effect, but plays a big role in rolling resistance, traction, and durability. Tread compounds are generally proprietary to the manufacturers.

We redesigned the tread pattern of the new Pro One model range to reduce the aerodynamic drag in sidewind conditions, says Schwalbes Schfermeier. Under headwind conditions, differences between tread patterns are really minor. The impact of a road-racing tire tread design on rolling resistance is not really relevant.

Specializeds Kiesel says, Slick-center road tires are the lowest in rolling resistance that we normally measure in our drum tests. He adds that Continentals Grand Prix 4000 tread pattern (slick with interspersed areas of cross-hatching within shark fin shapes coming up from the edges of the tread) tests the fastest in aerodynamic wind tunnel tests. Since this was designed much earlier than comprehensive aero tunnel testing became a realistic method in the bicycle industry, this design performance was a fluke.

Tubeless tires now best tubulars in rolling resistance, and their clean transition with the rim, particularly with hookless rims, beats tubulars aerodynamically as well. The optimal width of the tire has grown by 2-5mm since the standards at the turn of this century, and the rim widths for optimal speed have grown by more than double that.

A 27-30mm (external width) rim mated to a 25-26mm-wide front tubeless tire creates an aerodynamically optimal setup, assuming the tire width is measured when installed on the wheel, since the tire label only gives a rough guide. On the rear, use a 25-28mm wide tubeless tire on the same rim. Its possible to gain a bit more aero advantage with a hookless rim.

Of course, the final answer depends on X-factors like mating the tire pressure to the weight of you and the bike for the particular road surface, course profile, and much more. Dialing it in optimally requires scientific study that only the most well-funded teams could undertake. As a general rule, however, you will be in the ballpark with the above setup and tire pressure for a 150-pound rider around 70psi for a 25mm tire and 60psi for 28mm (80psi and 65psi, respectively, for a 170-pound rider).

Get your VeloNews 2020 Gear Issue now.

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What is the fastest bicycle tubeless wheel and tire setup? - VeloNews

This TV classic helps people live healthier by secretly filming them – Channel 24

Posted: March 27, 2020 at 3:50 am

07:06 27/03/2020 Graye Morkel

Has anyone ever watched Secret Eaters? It's about people who are genuinely baffled by their weight-gain, but when secretly filmed are exposed for eating greasy meals in their driveway, and hiding their eating habits from their families.

Hosted by Anna Richardson, the UK series first aired in 2012 and ran for three seasons until 2014. But Amazon Prime has resurrected the classic, and all 21 episodes are available to stream here.

Full episodes are also available to watch on YouTube.

In each episode, Anna meats her unsuspecting guests, usually friends, siblings or partners - who can't seem to explain their weight-gain. They are perplexed and frustrated because they genuinely believe that their food intake doesn't justify their size, and even keep a calorie log, often coming in well below their recommended daily allowance.

The guests agree to be filmed in their home for a week, with the cameras rolling, the pair go about their daily routine and viewers are privy to their mealtimes and often mindless munching.

But what guests aren't told is that they are being followed by two 'private investigators' Cameron Gowlett and Duncan Mee who monitor their every move and record everything they eat outside of the home. When they think no one is watching...

And this is where the show gets exciting when guests think they are off-camera and sneak in a Cinnabon at the mall, scoff down a burger in the work parking lot and indulge in a sneaky post-gym slice of pizza.

The investigators go as far as to follow the guests through the fast-food drive-through or sit at the restaurant table right next to their unsuspecting targets, before submitting their findings to evidence.

Who knew? Cheaters,diet edition!

At the end of the week, they are confronted with the true extent of their secret eating, which includes hiding their poor food choices from their friends, family and even themselves.

They are then also given dietary advice by expert Lynne Garton about what they should be eating, and given a plan forward.

The team then meet up with their guests after several weeks, and the pair then step on the scale once more, only to reveal an impressive weight-loss.

One of my favourite episodes featured sisters Precious and Florence, from Sidcup (season 2, episode 8). Florence insisted that she is a healthy home cook and enjoys low-carb meals. But it's later revealed that the sisters were under the impression that pap was a vegetable, when in fact it's a carbohydrate, and would pile 3/4 of their plate with maze meal.

Precious is a dedicated gym bunny and goes to the gym every day, doing cardio and strength training. According to Precious she too follows a low-calorie diet, but Precious has a theory: After she works out, she believes she can eat whatever she wants for an hour because her "metabolism is still running" and that's when she goes for the takeout and sweet treats. After speaking to the experts, Precious learns that this is not true, and makes better choices for her post-gym snack.

The girls also hid their chocolate and croissant eating habits from each other, because they didn't like sharing, and were mortified to learn that private investigators followed them into the burger joint, and even filmed then eating chicken wings in the parking lot!

After Precious and Florence learnt that they were eating more than double their daily calorie allowance, the pair made some healthy changes, and the weight started melting off.

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This TV classic helps people live healthier by secretly filming them - Channel 24

Navratri fast 2020: Things to do and avoid during Navratri fast – Times of India

Posted: March 26, 2020 at 4:46 am

With the onset of spring, we have Chaitra Navratri, an auspicious 9-day long festival celebrated by Hindus all around the world. Paying homage to Goddess Durga, many worshippers fast and keep away from certain food items in their diet. This year the Chaitra Navratri will start from 25 March and end on 2 April. While fasting is a very traditional and customary ritual, there is no denying that if you do it correctly, fasting can be therapeutic for the body. It can act as a form of detox and keep you healthy as well.So, if you are going to observe a fast this year, here are some dietary precautions you must follow.

Hydration is importantWhether you are fasting or not, you mustn't ignore your water intake. Hydration is vital for proper body functioning. When you fast, there are a lot of restrictions on what you can eat and drink. So, stocking up on refreshing and hydrating drinks like coconut water, milk or fruit juices can help you stay replenished through the day. Plus, with the risk of catching infections as it is, staying hydrated is a must. Avoid drinking too much tea or coffee.

Avoid overeatingFasting also means feasting on delicacies. Plus, you may go overboard to ensure that we stay full but this will only lead to digestion and other stomach ailments. As with any kind of diet, here also, moderation matters. Remember, if you don't watch what you eat, you contradict the very purpose of fasting.

Avoid sugarStay away from refined sugar and avoid it as much as you can. Sugar is quite unhealthy and processed. Opt for natural sugar products like sugarcane, jaggery which are quite healthy for you.

Choose healthy snacksBecause you are fasting, you tend to get hungry at odd times. When you crave for something fried, go for healthy snacking options like makhana (foxnuts), sweet potato fries, nuts and fruits! They are also very nutritious and low on calories.

Eat fibre-rich foodBecause you tend to eat lesser food than usual, or at unusual intervals, eating fibre rich food can help you keep fuller for longer as they take longer to digest and break down.

Good fibre content can be found in veggies like pumpkin, colocasia root (arbi), bananas and even potatoes, which are all fast-friendly food.

Stay away from processed foodWith the variety available in the market, we tend to binge on market bought sweets, namkeens which are not healthy and made out of sub-standard, refined oil. Similarly, greasy food which can make you feel bloated should be avoided. This is not how you should be fasting in Navratras!

We wish you a happy and pious Navratri!

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Navratri fast 2020: Things to do and avoid during Navratri fast - Times of India

Ensure That You Eat Healthy And Stay Fit While In Isolation – Femina

Posted: March 26, 2020 at 4:45 am

So youve stocked up (not hoarded!) on essentials, to reduce your trips to the supermarket. This means shelf-stable foods like rice, dals, beans and so on are on hand, while fruits and vegetables need to be bought more frequently depending on safety and the situation. The upside is that more people will have no choice but to opt for home-cooked meals. But that doesnt mean there arent any downsides! Here are three ways to ensure you eat healthy while in isolation.

Resist The Urge To Stock Up On Processed Food

When you cant step out for a freshly-prepared snack at a restaurant, and your cook cant come in to make it for you, its so tempting to resort to easily available packaged foods deep-fried mixtures, or cream biscuits or chips. Not only do these keep you going, theyre also trigger foods that help you cope with the stress of staying home and in isolation. Instead, buy snacks like Greek yoghurt, mixed nuts, toasted seeds, eggs (which can be hard-boiled flavoured nicely with spices) or popcorn.

Also Read: All Things You Need To Stock Up On During The Coronavirus OutbreakPractice Portion Control

If youre bored out of your wits, it is likely that youll turn to food to kill the extra time. Youll be eating more than you need, and piling on the extra calories. Try and stick to the portions you were eating before you were in isolation, and dont give in to boredom as an excuse to eat extra.

Stay Hydrated

Very often, hunger pangs increase because we forget to drink enough water or fluids when indoors. Make sure you get at least 2.5 litres of water, especially because summer is just around the corner. Add a glass of coconut water to your diet; if you cant get procure fresh tender coconuts safely, there are bottled versions.

Exercise

Its easy to let exercise fall to the wayside if youre confined at home, especially if youre the kind who needs a trainer or exercise companions. But this is key in maintaining wellness and supplementing a healthy diet. Try and do some yoga at home if youre proficient enough. Else opt for simple exercises like on-the-spot jogging, jumping jacks, free dancing to music (this is fun too!) or a walk if youre lucky to own a private spot of garden or terrace.

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Ensure That You Eat Healthy And Stay Fit While In Isolation - Femina

Coronavirus: Supplements that could boost your immune system during COVID-19 pandemic – Express

Posted: March 26, 2020 at 4:45 am

If a person contracts coronavirus their immune system will work overtime to protect the body and fight off the infection. What a person eats will either help or hinder if this does become a reality. Dr Michael Barnish, head of nutrition and genetics at REVIV offers his advice on how we can keep our bodies in tip top shape should the worst happen.

The immune system is responsible for fighting foreign invaders in the body, like pathogenic bacteria and viruses, and to destroy cells within the body when they become cancerous.

Poor nutrition results in increased infections, slow healing from injury and infections, and increases susceptibility to symptoms and complications from immune system dysfunction.

Studies show that immune function often decreases with age, and recent research suggests this decrease is also related toHow can you protect your body during these troubling times?

READ MORECoronavirus named: What does COVID-19 stand for? Coronavirus name meaning

Dr Jacek Hawiger, researcher at Vanderbilt University, who studies the evolving paradigms of inflammation for threeLike the Allies during World War II, we want to intercept the code and change it to our benefit.

"Inflammations arsenal is packed with powerful weapons. Inflammation is the bodys response to microbial, autoimmune, metabolic or physical insults.

"White blood cells, including granulocytes and macrophages are the first responders to sites of infections and injury.

"They emit waves of chemicals that can kill germs outright and protein messengers called cytokines to carry out a bewilderingly wide array of duties. When these weapons misfire, however, they can wreak havoc.

DONT MISS

An anti-inflammatory diet is widely regarded as healthy, so even if it doesnt help with a condition, it can help lower the chances of having other problems.

Anti-inflammatory foods are those that any mainstream expert would encourage you to eat.

They include lots of fruits and vegetables, whole grains, plant-based proteins, fatty fish and fresh herbs and spices.

Anything which is highly processed, overly greasy, or super sweet isnt a good choice when it comes to choosing the best kinds of foods to not only nourish the body but protect it from foreign invaders.

Dr Michael Barnish, head of nutrition and genetics at REVIVsaid: Vitamin D deficiency has become a modern problem. The reasons are due to poorer diets, sunscreen use during the day, avoiding the sun and spending most of our lives indoors, to name a few.

"It is extremely important for normal immune function and you should try to up your intake of eggs, mushrooms and oily fish.

"Also try and go for a walk if you can, not only will you get a dose of this sunshine vitamin but even a small amount of exercise can boost your immunity.

There are numerous studies underway regarding the healing and preventative powers of mega doses of vitamin C.

Vitamin C is an important immune system player and powerful antioxidant. Eating fresh organic fruit and vegetables containing vitamin C obviously helps but to really boost immunity think about taking a supplement.

"Many clinics around the world now offer intravenous vitamin C, to utilise much higher concentrations, very safely, to bypass gut bioavailability, flooding the bloodstream with this powerful antioxidant.

"In terms of antioxidants, these are essential for our bodies to neutralise toxins and to keep ourselves fighting fit. Consider taking an antioxidant supplement and eat foods high in beta-carotene, selenium and lycopene such as carrots, tomatoes, spinach, apricots, lean meat and watermelon.

"Electrolytes are also highly beneficial. They are tiny charged particles which are responsible for so many processes in the body.

"They are essential for normal functioning of the immune system and an imbalance which can leave us vulnerable.

"You may want to consider taking a magnesium supplement or a restorative salts solution if you have recently been ill.

"And dont underestimate the power of a banana."

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Coronavirus: Supplements that could boost your immune system during COVID-19 pandemic - Express

Testosterone Replacement Therapy Market: Rise in Geriatric Population with High Risk of Testosterone Deficiency Boost Market Growth – BioSpace

Posted: March 26, 2020 at 4:44 am

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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Growing Awareness about Testosterone Replacement Therapy to Drive Market

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North America to Dominate Global Market

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Competitive Landscape

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Our reports are single-point solutions for businesses to grow, evolve, and mature. Our real-time data collection methods along with ability to track more than one million high growth niche products are aligned with your aims. The detailed and proprietary statistical models used by our analysts offer insights for making right decision in the shortest span of time. For organizations that require specific but comprehensive information we offer customized solutions through adhoc reports. These requests are delivered with the perfect combination of right sense of fact-oriented problem solving methodologies and leveraging existing data repositories.

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Testosterone Replacement Therapy Market: Rise in Geriatric Population with High Risk of Testosterone Deficiency Boost Market Growth - BioSpace

ACR Recommendations for Managing Reproductive Health in Rheumatic and Musculoskeletal Diseases – Rheumatology Advisor

Posted: March 26, 2020 at 4:44 am

Based on emerging evidence and expert consensus, a panel assembled by the American College of Rheumatology (ACR) released recommendations for the management of reproductive health in patients with rheumatic and musculoskeletal diseases (RMD). This report was published in Arthritis & Rheumatology.

Investigators performed a systematic review of studies relating to contraception, assisted reproductive technologies, fertility preservation, menopausal hormone therapy, pregnancy and lactation, and medication use in patients with RMD. They developed recommendations using Grading of Recommendations Assessment, Development, and Evaluation methodology to rate evidence quality.

Recommendations for Contraception

The ACR strongly recommends the use of effective contraceptives, including hormonal contraceptives and intrauterine devices (IUDs), over no contraception in reproductive-age women with RMD without systemic lupus erythematosus (SLE) or antiphospholipid antibodies (aPLs). Long-acting reversible contraceptives such as IUDs or subdermal progestin implants are encouraged as first-line contraceptive methods because of their real-world effectiveness. The use of emergency contraception should be discussed with all patients because the risk for unplanned pregnancy in RMD outweighs the risk related to emergency contraception.

Patients With SLE

In patients with SLE with low or stable disease activity and who are not aPL-positive, the panel recommends the use of effective contraceptives over no contraception and encourages the use of highly effective IUDs or subdermal progestin implants as first-line contraceptive methods. However, the ACR recommends against the use of the transdermal estrogen-progestin patch as it results in greater estrogen exposure compared with oral or transvaginal methods, which potentially increase risk for flare or thrombosis.

In patients with SLE with moderate or severe disease activity, progestin-only or IUD contraception is recommended over combined estrogen-progestin contraceptive methods, as the latter has not been studied in this patient population.

aPL-Positive Patients

In aPL-positive women, the panel strongly recommends IUDs (levonorgestrel or copper) or the progestin-only pill and recommends against combined estrogen-progestin contraception because estrogen increases the risk for thromboembolism.

Other RMD Situations

In women with RMD who are receiving immune-suppressive therapy, copper or progestin IUDs are recommended as the most effective contraceptive option.

In women at risk for osteoporosis from glucocorticoid use or underlying disease, the ACR recommends against using depot medroxyprogesterone acetate (DMPA) injections as long-term contraception because DMPA is associated with declines in bone mineral density and fracture risk.

In women with RMD taking mycophenolate mofetil/mycophenolic acid, an IUD alone or 2 other contraceptive methods used together are suggested, as mycophenolate mofetil may reduce estrogen and progesterone levels and hence reduce the efficacy of oral contraceptives.

Recommendations for Assisted Reproductive Technology

The ACR strongly recommends women with uncomplicated RMD (stable/quiescent disease activity and without aPLs) who are receiving pregnancy-compatible medications proceed with assisted reproductive technology. However, rheumatologists should discuss with their patients the risks associated with assisted reproductive technology, especially lupus flare and thrombosis.

Patients With SLE

In patients with RMD who experience moderate to severe disease activity, assisted reproductive technology procedures should be deferred, as RMD disease activity may increase pregnancy-associated risks.

In women with SLE undergoing assisted reproductive technology procedures, the panel recommends against an empiric dosage increase of prednisone and recommends monitoring the patient carefully and treating a flare if it occurs.

aPL-Positive Patients

The ARC recommends assisted reproductive technologies with anticoagulation therapy in patients with RMD and stable/quiescent disease activity and who have asymptomatic positive aPLs, obstetric antiphospholipid syndrome, or treated thrombotic antiphospholipid syndrome.

Use of prophylactic anticoagulation therapy with heparin or low-molecular-weight heparin are strongly suggested for women with RMD undergoing assisted reproductive technology procedures who report asymptomatic positive aPLs or obstetric or treated thrombotic antiphospholipid syndrome.

Embryo and Oocyte Cryopreservation

Continuation of necessary immunosuppressive and/or biologic therapies (other than cyclophosphamide) are strongly encouraged in patients with stable disease activity who undergo ovarian stimulation for the purpose of oocyte retrieval or embryo cryopreservation.

Recommendations for Fertility Preservation

The ACR recommends monthly gonadotropin-releasing hormone agonist co-therapy to prevent primary ovarian insufficiency in premenopausal women with RMD who receive a monthly intravenous cyclophosphamide dose. However, men with RMD who receive cyclophosphamide should not receive testosterone co-therapy, as it does not help preserve fertility in men. Sperm cryopreservation is a strongly suggested practice for men before being treated with cyclophosphamide.

Recommendations for Menopause and Hormone Replacement Therapy

Hormone replacement therapy is strongly suggested in postmenopausal women with RMD without SLE or positive aPLs. In patients with SLE without positive aPLs, hormone replacement therapy is recommended conditionally because a small increase in risk for mild to moderate lupus flares is associated with oral hormone replacement therapy.

Hormone replacement therapy is not recommended in women with asymptomatic aPLs, or obstetric or thrombotic antiphospholipid syndrome. Furthermore, patients receiving anticoagulation treatment for antiphospholipid syndrome even patients who are negative for aPL should not use hormone replacement therapy.

In patients with a history of positive aPLs but who currently test negative for aPL and have no history of clinical antiphospholipid syndrome, hormone replacement therapy may be considered if desired.

Recommendations for Pregnancy

The ACR strongly suggests counseling women with RMD who are considering pregnancy, in which improved maternal and fetal outcomes have been associated with entering pregnancy with quiescent or low disease activity. Maintaining concurrent care with obstetricians-gynecologists, neonatologists, and other appropriate specialists is recommended as good practice.

Women with RMDs planning pregnancy should switch to pregnancy-compatible medications with enough time to assess efficacy and tolerability of the new medication.

For women with RMD who are currently pregnant and whose active disease requires continuous medication, pregnancy-compatible steroid-sparing treatment is strongly recommended, as high-dose glucocorticoids can potentially cause maternal or fetal harm.

Patients With SLE

Women with SLE or similar disorders (Sjgren syndrome, systemic sclerosis, rheumatoid arthritis) should be tested for anti-Sjgren syndrome-related antigen A (RO/SSA) and anti-Sjgren syndrome-related antigen B (La/SSB) antibodies in early pregnancy. However, because of the antibodies relative persistence, repeat testing during pregnancy is not needed.

In pregnant patients with active scleroderma renal crisis, the ACR strongly recommends the use of angiotensin-converting enzyme inhibitor or angiotensin receptor blockade therapy because the risk for maternal or fetal death outweighs the risk associated with these medications.

The ACR strongly suggests that pregnant women with SLE be closely monitored with clinical history, examination, and laboratory tests at least once per trimester as disease activity can affect pregnancy outcomes. If possible, all women with SLE should take hydroxychloroquine during pregnancy. Pregnant patients with SLE are also recommended to begin a daily low-dose aspirin (81 mg or 100 mg) regimen during their first trimester.

aPL-Positive Patients

Pregnant women with positive aPLs (but who do not meet criteria for obstetric or thrombotic antiphospholipid syndrome) should be treated with daily prophylactic aspirin; however, these women are advised against the combined use of aspirin and prophylactic-dose heparin as well as prophylactic hydroxychloroquine treatments.

In women who meet the criteria for obstetric antiphospholipid syndrome, the ACR strongly recommends a combined low-dose aspirin and prophylactic-dose heparin. Furthermore, these patients should be treated with prophylactic-dose anticoagulation for 6 to 12 weeks postpartum.

In women who meet the criteria for thrombotic antiphospholipid syndrome, a regimen of low-dose aspirin and therapeutic-dose heparin is strongly recommended throughout pregnancy and postpartum.

The ACR recommends against treatment with intravenous immunoglobulin or increased low-molecular-weight heparin doses. The panel also recommends against the addition of prednisone to a low-dose aspirin/prophylactic-dose heparin combination; however, the addition of hydroxychloroquine therapy to low-dose aspirin/prophylactic-dose heparin is conditionally recommended.

Anti-Ro/SSA or Anti-La/SSB Antibodies

Serial fetal echocardiography is recommended in pregnant women with anti-Ro/SSA or anti-La/SSB antibodies and should be performed starting between 16 and 18 weeks and continue through week 26. In women with a history of having an infant with complete heart block or neonatal lupus erythematosus, fetal echocardiography is recommended weekly during this time period.

If fetal first- or second-degree heart block is shown on echocardiography, daily treatment with oral dexamethasone (4 mg) is recommended; however, if a complete heart block without cardiac inflammation is shown on echocardiography, then the panel recommends against dexamethasone treatment.

All women who are positive for anti-Ro/SSA or anti-La/SSB antibodies should be treated with hydroxychloroquine during pregnancy, as hydroxychloroquine is associated with lowering risk for the fetus developing complete heart block.

Recommendations for Medication Use

Paternal Medication Use

In men with RMD planning to father a pregnancy, the panel recommends against the use of cyclophosphamide and thalidomide before attempting conception; however, continuation of hydroxychloroquine, azathioprine, 6-mercaptopurine, colchicine, and tumor necrosis factor (TNF) inhibitors are strongly recommended.

Continuation of methotrexate, mycophenolate mofetil, leflunomide, sulfasalazine, calcineurin inhibitors, and nonsteroidal anti-inflammatory drugs (NSAIDs) is conditionally recommended on the basis of limited evidence, as is the use of anakinra and rituximab.

Maternal Medication Use

The ACR recommends discussing medication use in women with RMD well before attempting conception as standard good practice. The panel further suggests discussing pregnancy plans before initiating treatment with medications that affect gonadal function.

Discontinuation of methotrexate, mycophenolate mofetil, and thalidomide is strongly recommended within 3 months before attempting conception, as these medications are known teratogens, or agents that disrupt fetal development. Cholestyramine washout is recommended for women treated with leflunomide before pregnancy or as soon as pregnancy is confirmed, as detectable serum levels of metabolite risk pregnancy loss and birth defects. If life-threatening conditions occur in the second or third trimester, the panel recommends treatment with cyclophosphamide.

An observation period without medication or transition to pregnancy-compatible medication is recommended to ensure disease stability. In women with exposure to teratogenic medications during or shortly before pregnancy, the panel recommends immediate referral to the appropriate specialist or genetic counselor.

Compatible pregnancy medications commonly recommended for use in patients with RMD include hydroxychloroquine, azathioprine/6-mercaptopurine, colchicine, and sulfasalazine. Calcineurin inhibitors (tacrolimus and cyclosporine) and NSAIDs are also considered compatible with pregnancy; nonselective NSAIDs are recommended over cyclooxygenase 2-specific inhibitors during the first 2 trimesters.

If the patient is having difficulty conceiving, the panel recommends discontinuing use of NSAIDs because of the possibility of NSAID-induced unruptured follicle syndrome. NSAID use should also be discontinued in the third semester to avoid risk for premature closure of the ductus arteriosus.

If indicated, the ACR recommends continuing low-dose glucocorticoid treatments (10 mg daily of prednisone or nonfluorinated equivalent) during pregnancy. Higher doses of nonfluorinated glucocorticoids should be tapered, and a pregnancy-compatible glucocorticoid-sparing agent should be added if necessary. Administration of stress-dose glucocorticoids during vaginal delivery is not recommended; however, such treatment may be indicated during cesarean delivery.

TNF inhibitor therapy with infliximab, etanercept, adalimumab, or golimumab may be continued before and during pregnancy, as these therapies have minimal placental transfer and fetal exposure. Similarly, continuation of certolizumab therapy is strongly recommended.

The panel recommends women continue treatment with anakinra, belimumab, abatacept, tocilizumab, secukinumab, and ustekinumab while attempting conception but should discontinue use once pregnancy is confirmed. Women may continue rituximab treatment while trying to conceive and if life-threatening or organ-threatening maternal disease warrant use during pregnancy.

Medication Use During Breastfeeding

Women with RMD are encouraged to breastfeed if they desire and are able to do so, and the ACR recommends lactation-compatible medications in order to control disease. Hydroxychloroquine, sulfasalazine, rituximab, and TNF inhibitors are strongly recommended as compatible with breastfeeding. A prednisone daily dose <20 mg is also compatible with breastfeeding; however, women who use prednisone doses 20 mg are recommended to delay breastfeeding or discard breast milk accumulated in 4 hours after administration.

Treatment with azathioprine/6-mercaptopurine, calcineurin inhibitors, NSAIDS, and non-TNF inhibitor biologics (anakinra, rituximab, belimumab, abatacept, tocilizumab, secukinumab, and ustekinumab) is conditionally recommended during breastfeeding.

The panel recommends against the use of cyclophosphamide, leflunomide, mycophenolate mofetil, thalidomide, and methotrexate while breastfeeding.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors disclosures.

Reference

Sammaritano LR, Bermas BL, Chakravarty EE, et al. 2020 American College of Rheumatology Guideline for the management of reproductive health in rheumatic and musculoskeletal diseases [published online February 23, 2020]. Arthritis Rheumatol. doi:10.1002/art.41191

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ACR Recommendations for Managing Reproductive Health in Rheumatic and Musculoskeletal Diseases - Rheumatology Advisor

Everyone Else Is Dealing with COVID-19. Idahos Pushing an Anti-Trans Bill – VICE

Posted: March 26, 2020 at 4:44 am

Lindsay Hecox was looking forward to finally running track in college. Hecox, a 19-year-old freshman at Boise State University, ran cross country in high school and said it was the only place where she felt like she could be herself. In addition to describing herself as a shy introvert, Hecox has attention deficit hyperactivity disorder, which made it difficult to make friends. Running provided her a shared experience to bond with her classmates.

Even though I definitely wasn't the most social, I still felt accepted, Hecox told VICE. I was a pretty good runner and everyone likes you if youre nice and you can run fast.

Hecox, who came out as transgender at the end of her senior year of high school, took the year off from running competitively to start transitioning and focus on her studies. Guidelines established by the NCAA state that trans female athletes must take medications that suppress their testosterone levels for a year before they are allowed to compete, and she started hormone replacement therapy last September. That means she could have been eligible for the 2020-2021 school year. (The NCAA told The Hill last month that it was monitoring the bills progress.)

If she had made the team, Hecox would have made history: No transgender student athlete has ever competed openly on a collegiate track team in Idaho. Hecox said she wasnt looking to break records, though. She just wanted to feel at home again.

Running really helps stabilize me, as I sometimes have mood fluctuations, Hecox said. If I go out for a run, it cleans the slate, and I feel like I can release a little bit of stress after that. If you have a friend and youre running alongside them, it feels like youre losing track of time and it gets your mind off things, as you just look forward to the next mile marker.

But Hecox could soon be banned from the sport she loves if Idaho signs a bill into law that would prohibit transgender women and girls from participating in school athletics in alignment with their gender identity. House Bill 500, also known as the Fairness in Womens Sports Act, applies to student-athletes playing in K-12 sports and at the collegiate level, no matter if the university is public or private. The legislation is headed to Gov. Brad Littles desk after passing the Idaho Senate last Monday by a 24-11 vote and the House last month, both of which are dominated by Republicans.

HB 500 isnt the only anti-trans bill awaiting the governors proverbial pen. Just days after the Senate overwhelmingly approved the trans sports ban, it also passed House Bill 509, which prevents transgender people from updating their birth certificates to match their lived gender. In a Thursday vote, all but six Senators approved the legislation, also called the Idaho Vital Statistics Act.

Little has yet to state whether he intends to support either of the two proposals, but when asked about them last month, the governor was quoted in the Idaho Press as saying hes not a big discrimination guy.

The bills have been met with virulent opposition from civil rights groups. Kathy Griesmyer, policy director for the American Civil Liberties Union of Idaho, said their passage would set a really dangerous precedent that would likely be used as a model for discriminating against transgender people in other states. Although the ACLU estimated that 17 states in the U.S. have introduced bills in the 2020 legislative session that would restrict the ability of trans students to compete in school sports, none have passed. HB 500 would be the first bill of its kind in the nation.

There are really devastating consequences if HB 500 becomes law, Griesmyer told VICE. This has the potential to harm intersex people, women who present too masculine, or anybody who wants to use this law to go after a competitor.

Among the most glaring issues with HB 500 is that it stipulates that a student athletes biological sex would have to be determined by one of three factors before they are allowed to compete. These options are a test of the individuals internal and external reproductive anatomy, normal endogenously produced levels of testosterone, or genetic makeup.

But as in the case of a similar bill introduced in Arizona, the legislation does not establish a process for bringing about these claims, meaning that any student or their parent could accuse an athlete on an opposing team of being transgender. Accused students, many of whom as likely to be cisgender, would thereby be forced to undergo costly DNA testing or an invasive genital exam. The proposal also does not state what body would be responsible for looking into complaints or how a students private medical information would be protected.

Notably, the Arizona bill was watered down to remove the genital testing components following public backlash. The Idaho legislation has remained unchanged, despite the concerns of LGBTQ advocacy groups.

This bill is not based on science, Kate Oakley, senior counsel for the Human Rights Campaign, told VICE. It is legislation that is based purely in misinformation about trans youth, and it is targeting trans youth for discriminatory treatment. For any trans person in Idaho, they are now on notice that their government is willing to make laws that are based on fear and not facts.

The anti-trans bills are likely to be met with immediate legal action should they be signed into law, as five former Idaho attorneys general argued in a March 17 letter addressed to Little. In particular, critics said HB 509, the birth certificate bill, would violate a court order from U.S. District Court Magistrate Judge Candy W. Dale, who ruled in March 2018 that Idahos policy of denying birth certificate corrections on the basis of gender identity was unconstitutional. Prior to that time, Idaho was one of three statesalong with Ohio and Tennesseethat did not allow trans people to update their birth records.

When that policy was overturned in district court, Emilie Jackson-Edney was one of the first people in Idaho to apply for a corrected birth certificate. Jackson-Edney, who sits on the board of the Pride Foundation in Boise, said she had started her application process eight years earlier but that the long wait was worth it.

Its necessary to navigate safely through society with minimal harassment and minimal scrutiny, Jackson-Edney told VICE, noting that a third of trans people without a corrected birth certificate report experiencing mistreatment and even physical violence as a result. Its a safety issue. For trans people having concurrent identity documents that reflect their gender identity is really critical, and not being able to have them would be very difficult.

What makes these bills particularly hurtful for trans people in Idaho is the timing of the legislation. They were pushed through the state Senate during the same week that municipalities across the country took measures to curb the spread of coronavirus, also known as COVID-19. And yet in Idaho, little has been done to stop its citizens from contracting coronavirus.

I havent seen one thing from the [state] government other than telling us to wash our hands, and I honestly don't think that were taking it very seriously, said Yarit Rodriguez, who runs a support group for trans youth in Idaho, told VICE. He added that it doesn't make sense to him why passing anti-trans bills is more important than an outbreak affecting multiple communities.

The lack of statewide action on coronavirus is particularly personal for Hecox, who was being forced out of her dorm at Boise State as she spoke over the phone on Thursday. The university sent an email to students earlier the same day ordering anyone who hadnt already abandoned campus housing to evacuate the premises within the week. Although many students who have family in the area have the option to simply move back home, it wasnt so easy for her.

I was living with my grandparents in California before, she said. They don't want another person living with them because of their age. They are susceptible to having a bad reaction to the virus or dying.

To keep Hecox from being homeless, her mother is uprooting her life in California to move to Boise. Even as the federal government debates a trillion-dollar stimulus package that would provide greater assistance to families like hers, which have been forced into impossible situations, Hecox noted that Idaho lawmakers had yet to make any similar moves. The Senate wrapped for the year on Thursday, while the House finished up the following day.

They have not passed any legislation for that, she said of a statewide coronavirus relief effort. They dont have their priorities straight.

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Everyone Else Is Dealing with COVID-19. Idahos Pushing an Anti-Trans Bill - VICE

Green coffee and how it aids weight loss – AZ Big Media

Posted: March 26, 2020 at 4:42 am

We all know that losing weight can be extremely difficult and challenging, with many struggling to get themselves into shape. For some people, the lack of success with losing weight means that they lose hope and simply go back to their old lifestyle, which can prove to be dangerous is you are very overweight due to the linked health problems.

There are lots of people who try different solutions to help then to lose weight with greater ease and success. Some decide to try a new type of diet, some join weight loss groups, and some turn to products such as supplements and green coffee. According to reports, green coffee helps in weight loss in a variety of ways, although you do have to ensure you use it correctly. In this article, we will look at some of the ways it can help.

So, how is green coffee meant to help those who are trying to lose weight? Well, there are various ways in which it can help when taken correctly. It is important to remember that research into green coffee and its effectiveness as a weight loss aid are still ongoing, but there are certain ways in which it is thought to help. Some of the main ones are:

Green coffee contains chologenic acid, and this could help to boost your metabolic rate. It can help to increase the Balsamic Metabolic Rate, which then means glucose release from the liver into the blood is minimized. This leads to the body burning fat stores more effectively.

Hunger pangs can be a big problem for those who are keen to lose weight. This can then lead to excess calorie intake and leads to weight gain. The chologenic acid in green coffee can help to suppress the appetite naturally, so you are less likely to reach for snacks between meals or have larger portions at mealtimes.

Proper blood circulation is important in terms of removing toxins from the body, and when there is a build-up of toxins, it can result in feeling lethargic and drained, which then means you are less active. This then affects the metabolism and slows it down, making it more difficult to burn off calories and fat effectively.

Green coffee can also reduce the absorption of sugar in the small intestine, which means that it will be more difficult for your body to store it as fat. This makes it easier for your body to use your fat stores for energy and enables you to burn calories and fat more easily.

These are some of the key ways in which green coffee may help you when it comes to losing weight. For maximum effect, it is advisable to have green coffee right after your meals, as this is when your blood sugar levels are likely to be high. Drinking the coffee will help to reduce blood sugar spikes and provide greater control of blood sugar levels.

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Green coffee and how it aids weight loss - AZ Big Media


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