Total Results Blog

Barbara H. Roberts, M.D., is the Director of The Women's Cardiac Center at the Miriam Hospital in Providence, Rhode Island. Before that, she spent two years at the National Heart. Lung, and Blood Institute at the National Institutes of Health. During her time at N.I.H., she studied the beneficial effect of lowering cholesterol and the occurrence of heart disease. Dr. Roberts earned her undergraduate degree from Barnard College of Columbia University, and obtained her medical degree from the Case Western Reserve University School of Medicine. The author published "The Truth About Statins" in 2012. Regular readers of this blog will note that last summer I read and reviewed a book called "The Statin Damage Crisis", and a lot of the information in this book is similar, but I learned a few things in this book that I did not already know. I think the additional details in this book are useful for the reader, in the event that their doctor wants to put them on a statin drug, plus going over the same concepts again helps with absorption of facts.

Statin drugs were first approved to lower cholesterol in 1987. The way that these drugs work is by inhibiting an enzyme that is integral for the manufacturing of cholesterol by the body, and statins also increase the uptake of LDL (low-density lipoprotein, the so-called "bad" cholesterol) by the liver. Unfortunately, statins also inhibit the production of HDL (high-density lipoprotein, the so-called "good" cholesterol). Many different statins have hit the market over the last three-plus decades, such as Crestor, Zocor, and Lipitor, and all of them have the same properties. However, cholesterol is a naturally occurring substance in our bodies, and it serves many important functions. As the author says, "It's an integral part of the cell membrane that surrounds every cell in our bodies, keeping all the structures inside the cell from leaking out. It is a building block of other molecules that our bodies need to function, such as vitamin D, and many hormones. Cholesterol is used to make bile acids, which assist in digestion." Dr. Roberts goes further, saying, "But cholesterol, far from being the villain it's said to be, is a vital part of every cell in our bodies. This waxy fat, primarily produced by the liver, is absolutely crucial for the normal functioning of muscles, nerve cells, and the brain-and it's also the building block that our bodies use to manufacture many hormones, including the reproductive hormones estrogen and testosterone." These are facts that are rarely discussed by the pharmaceutical companies.

Statin drugs also carry some pretty significant side effects. Reported side effects from statins include muscle pain and muscle damage, nerve damage, cognitive dysfunction, tendonitis and tendon rupture, joint pain and stiffness, liver damage, mitochondrial dysfunction, ALS, diabetes, and congenital defects in children of women who took statins during pregnancy. Sounds pretty nasty, right? Myopathy is the most common side effect, which can result in mild muscle pain and progress to cramps, tenderness, weakness, and even a life-threatening condition called rhabdomyolysis. Unfortunately, all of these risks do not even translate into much benefit if you take a statin. According to Dr. Roberts, "So even though statins do not decrease the risk of dying when given to people without vascular disease, they do lower the risk of dying in people with vascular disease, albeit by only a few percentage points." It doesn't sound like the juice is worth the squeeze.

If your doctor notes that your cholesterol is elevated and wants to prescribe a statin, Dr. Roberts lists a series of questions that you should ask your physician. The first thing she suggests is to advocate for dietary changes to see if it improves the cholesterol numbers. Another recommendation is to ask for an explanation from your doctor about what the numbers mean and, based on the current guidelines, why they think it is the right course of action to take. The author describes in detail during chapter four the differences between women and men with statin use. Statins are far less effective in women than they are for men, in large part because elevated LDL cholesterol is much less harmful for women than it is for men. The good doctor concludes the chapter by stating, "In women under the age of sixty-five who don't have established vascular disease, we have zero evidence (her emphasis) that statin treatment lowers their risk of having a cardiac event&And women experience more side effects from statins than men do."

Dr. Roberts shares some patient experiences of being on statins, and she offers several alternatives to taking these drugs. There is a drug that she has prescribed called Questran, which is part of a family of drugs that are bile acid sequestrants, and she has also recommended Niaspan, which is a B vitamin that in high doses lowers LDL cholesterol and triglycerides and raises HDL cholesterol. Neither of these options have the awful side effects of statins. There is also an entire section of the book that deals with dietary recommendations, rare counsel for most doctors. The author espouses a variation of the Mediterranean Diet, and suggests hearty consumption of olive oil, vegetables, fruit, seafood, beans, nuts, and whole grains. She even includes several recipes in the last section of the book. Dr. Roberts warns us of the dangers of the traditional Western diet and cautions us to avoid processed foods and sugar.

Overall, I enjoyed this book. Some of the information was a little repetitive for me, but that is only because I have read about the subject before. The doctor's writing style is engaging, and I liked the alternative treatment suggestions that I mentioned in the previous paragraph. She does an excellent job of exposing the limitations of clinical trials and shining a light on how the pharmaceutical companies not only pay for the studies, but also manipulate how the results of the trials are released to the public. This has been going on for years, and not just with statin medications. Particularly useful is the discussion of metabolic syndrome risk factors, which are rarely mentioned by most mainstream outlets and are far more problematic than high levels of LDL cholesterol for people with atherosclerosis. My only disappointment with the book is that there was no mention of intermittent fasting as an alternative strategy/treatment. It could be that the doctor is (or was) not familiar with the concept, or that because this book was published in 2012 it did not garner as much attention then as it does today.

Books like "The Truth About Statins" give you more information to act as your own health advocate. You cannot rely solely upon your doctor to help you, and you do not want to be under the thumb of Big Pharma. Use this opportunity to take control of your own destiny. Knowledge is power.

There is that old and clever maxim that declares beauty to be in the eye of the beholder. Many things in life that are beautiful, are in fact very simple. I have never been much of an art enthusiast, but I can appreciate talent when I see it. Several years ago on a visit to Philadelphia, I decided to check out the Philadelphia Museum of Art, in no small part because I wanted to run up the steps that were an iconic part of the Rocky movie franchise. Many of the works of art inside the museum were way over my head, but I found that I liked the pieces that were the most simple and did not require a curator to understand. One does not often think of classic rock music as beautiful, but give me AC/DC all day long. Critics of the band often say that many of their songs sound the same, but they have created a signature sound that has endured for 50 years. I would much rather hear a song with a simple and powerful backbeat and Angus Young's blues-based guitar work over the latest complicated techno-sampled poly-rhythm any day of the week.

Exercise does not need to be complicated, contrary to what the last fitness "experts" might have you believe. You can try to jazz up an exercise philosophy that is poorly-rooted in the classical sciences, but that is just putting lipstick on a pig. Don't overthink it, and don't listen to the purported exercise gurus who tell you all kinds of nonsense. A simple, straightforward, and balanced exercise regimen will be far more productive than the latest split routine found in bodybuilder magazines. You do not need or want the complicated (and dangerous) movements that are a part of participating in CrossFit. It is far better to keep things simple. Learn a handful of exercises but perform them correctly and with great effort. Variety may help stave off boredom for some people, but from a physiological perspective it is overrated and unnecessary.

Because I instruct exercise for a living, I see beauty in everything that it entails. Our machines are so meticulously engineered that my appreciation for their design grows by the year. The Total Results exercise protocol can be performed on many types of equipment, but it is most effective when Super Slow Systems and MedX equipment are used in a clinically controlled environment. I find beauty in a properly paced ten second positive and ten second negative, with a carefully executed turnaround. That is the creation of a work of art. It is the culmination of a desire to learn on the part of the client and solid teaching by the instructor. That is my reward.

Some clients will have difficulty mastering the particulars of proper form, and that's perfectly normal. Mastery takes a lifetime, and consistently applied effort will pay dividends. Our workouts are not easy, and they require patience, diligence, effort, and a learning mindset in order to maximize results. Find beauty and satisfaction in performing the process, as this is a journey rather than a destination. See the benefit in giving your best possible effort for 20 minutes, once or twice per week. Experience the satisfaction of squeezing out one more repetition or pushing on the movement arm for just a few more seconds when you didn't think you were capable. It is about quality over quantity. A few compound exercises (which are more simple to learn and perform) will cover more ground. Again, do a few things, but do them well.

If you want to achieve excellence, you must be prepared to sacrifice comfort. Even though our workouts involve twenty minutes of consistent hard work, there is a certain inherent beauty in their simplicity. When your mind and body are working in concert and you are giving 100 percent of your focus, it is a beautiful thing to watch. Think of each exercise as your blank canvas, and believe that you are creating a work of art with every repetition that you perform. The reward comes at the very end when you know that you have given everything you have in order to accomplish something meaningful. That is a special gift.

We have had many long-term success stories here at Total Results. Off the top of my head, I can think of at least three current clients who have been with us for over 20 years. I believe that is a testament to the dedication and determination of these clients to incorporate our exercise philosophy into their lifestyle for such a long period of time. We would love to have all of our clients stay with us for that long, but we understand that life happens and sometimes priorities and situations can change. There can be many reasons why clients leave us: they move, their financial situation takes a turn, or they simply get bored and want to try something else. I have had several clients over the years decide that they would like to take what they have learned at Total Results and attempt to apply it in a different exercise setting (either in a traditional gym environment or at home). Sometimes these clients return to us and sometimes they do not. Through talking with the clients who have left and then later returned, I have compiled a list of the most common mistakes that people make when working out on their own. Some of these might surprise you, while others may not.

They do not exercise with a high enough level of intensity. I discuss the concept of intensity during an initial consultation with a prospective client. Intensity can be defined as muscular inroad/time. Since the body is fairly resistant to change, you must provide a strong stimulus to induce positive physical improvements. Working out intensely is uncomfortable, and most people simply will not put forth the requisite effort without someone to teach them, monitor them, or hold them accountable. Left to their own devices, most people are satisfied with "just good enough." Don't be okay with just being okay! Pushing (or pulling) to muscular failure and then performing a thorough inroad is the best way to ensure you have given the optimal level of effort.

Trainees use too fast a movement speed during exercises. If you have ever walked into a gym, you have likely seen what amounts to throwing and catching of the weights. Even standard Nautilus protocol ( two seconds lifting and four seconds lowering) would be a vast improvement over typical gym behavior. Most people will move much faster than they should, even if they have been a Total Results client in the past. It is very difficult to self-monitor speed of movement, pace, and turnaround technique on your own, especially if you are trying to have a meaningful workout in a place fraught with numerous distractions.

Not moving quickly enough between exercises. Most people will sit around for several minutes between exercises, look in the mirror, chat, play on their phone, or stall in a multitude of ways. Even those with good intentions can be thwarted by having to wait several minutes for a machine to become available. This will diminish not only your systemic inroad, but also impede a quality metabolic and cardiovascular experience.

All that is available is poorly engineered equipment. I have talked about this at length in the past, but most equipment found in commercial and home gyms is utter garbage. It is poorly designed and inherently dangerous, especially if it contains independent movement arms. Strength training equipment should be designed to conform to the exercise protocol, and most commercial equipment has poorly engineered cams (or none at all), which translate into a less than ideal stimulus. Barbells and dumbbells are difficult to control and use safely. MedX and Super Slow Systems equipment (which we have at Total Results) help you to achieve a safe and effective stimulus.

Most people overtrain. This ties in nicely with my first point about intensity of effort. Since most people are simply not willing to put in the degree of effort on their own that is necessary to maximize results, they try to compensate with a greater volume of activity. They would much rather perform a greater number of exercises more frequently to feel good about themselves and avoid the temporary discomfort that is associated with intelligent exercise. The false reasoning is, "If some is good, more is better." I would also suggest that a mistake people make is to try and incorporate too much additional activity into their lifestyles. We must understand that our bodies' recovery ability is much more fragile than people realize, and if you try to do too much you can, at best, short-circuit your progress, and at worst, encounter injury and illness. Don't fall into the bodybuilder or exercise enthusiast mentality. Nothing beats high-intensity strength training in a clinically-controlled environment on specially engineered equipment.

Not listening to your body. I just finished discussing overtraining, and overtraining is a likely recipe for an overuse or acute injury. The human body is a wonderfully intuitive and logical organism, and nothing happens without a reason. If you feel sharp and/or sudden pain, there is a good chance you are experiencing an injury. However, it is important to differentiate that from the dull ache that is representative of normal exertional discomfort. If a sharp pain continues for a few days, a layoff from training is likely in order, so do not try to be a hero. At Total Results we make modifications when necessary to work around joint problems or injuries.

Not accurately tracking progress or machine settings. For people who train without an instructor, I have found that progression is mostly guesswork or done "by feel." What is the point of putting in meaningful effort if you have no idea what you have accomplished? Early in my career, I worked for a man who kept no charts on his clients and made things up as he went along. He claimed that it was all in his head, but that was a joke. Knowledge of results is the only way that one can progress and improve, as it provides reinforcement. On top of that, if you don't write down your machine settings you could set yourself up for injury and waste valuable time.

Total Results takes the guesswork out of exercise. I believe that exercise instruction is as much an art as it is a science, and in order to make your exercise experience meaningful you need to be a learner, focus on giving your best effort, and allow your instructor to handle everything else. Don't fall into the traps that have derailed the casual exercise enthusiast. Get it right the first time with Total Results.

Life is full of distractions. We are constantly bombarded with emails that need to be read, flooded with social media posts and advertisements, and have family and professional responsibilities that must be met. With all of these different stimuli floating about, it is enough to make your head spin. This makes time management and defining your values incredibly important, especially if you have exercise goals that you want to achieve. Most people want to achieve great things, but are they truly willing to do what is necessary to accomplish these goals? Striving for and attaining excellence means that we must sacrifice some comfort. Sure, a warm bed on a cold February morning feels comfortable, but is that extra half hour of sleep worth canceling your workout? Sometimes you need to step outside of yourself and see the big picture. Time is the commodity that seems to always be in short supply, and in order to maximize not just our workouts but all the wonderful things that life brings us, we need to be present.

What does that mean? I can't remember the famous quote verbatim, but it is often said that a large part of success in life is about just showing up. I believe that to be true, but I also think it goes beyond that. If you simply show up and don't give great effort, or if you show up but your mind is elsewhere, are you really striving for excellence? Sometimes people are physically present, but they simply go through the motions. If that is the case, you are really cheating yourself. I am amazed at how many people float through life without a sense of urgency. Complacency is the enemy of excellence! Nobody ever said a Total Results workout was either easy or comfortable, because it is not. Sure, there are other places that you might want to be other than a chilly exercise studio, and you might even have some fun activities planned for after your workout. Part of being an adult means delaying gratification. You have control over the choices that you make, and what matters is right now. Nothing can be done to change the past and while the future is important, if you do not take care of business right now the future will hold far less significance. All that will eventually happen is directly affected by what you do at this moment.

What are some strategies you can implement in order to be present in mind, body and spirit?

• Arrive a few minutes early for your workout. It is very difficult to be present and focused on the task at hand if you are running late. Leave early for your workout. Think about what you are about to undertake, and try to shut the rest of the world out for the next half hour. Visualize success. This can be done in your car or even in our lobby.

• Silence your phone. A ringing phone is the perfect instrument to break your concentration and lose positive momentum during a workout. It is also a distraction for your instructor. Please silence your phone before entering the workout area. The only audible sounds should be the breathing of the client and the cues of the instructor.

• Focus on the main exercise objective. Contrary to what most exercise enthusiasts believe, exercise is not about lifting as much weight as possible for as many repetitions as you can complete. It is about inroad - fatiguing the musculature deeply enough to bring about a stimulus. Proper form is the key to every exercise.

• Embrace discomfort. Yes, high-intensity exercise is challenging and does involve both localized and systemic discomfort. Remember, positive change is never comfortable! The fear of the discomfort is far worse than what it really is. As uncomfortable as workouts are, they are also brief and infrequent. Do not lose sight of the significance that the discomfort is a sign that you are achieving something meaningful.

Shut out the rest of the world for 15-20 minutes once or twice per week so that you can focus on yourself and what is important to you. Do not worry about the next exercise, the next workout, or even the previous workout. All that matters is right now - this exercise, this repetition, this positive or negative excursion. Break time down to its smallest element; every second counts and you don't want to waste a moment. Develop this mindset and it will pay dividends not only in your workout, but in other aspects of your life. The ancient Greek philosopher Aristotle once said, "We are what we repeatedly do. Excellence then is not an act, but a habit." Those are words to live by.

Dr. Gabrielle Lyons is a board-certified family physician who earned her undergraduate degree in nutritional sciences from the University of Illinois. She completed a research and clinical fellowship in geriatrics and nutritional sciences from Washington University in St. Louis. Her first book, "Forever Strong", was published in 2023. It is a significant departure from the typical health advice and information that you will hear from the mainstream medical establishment. The main thrust of her approach is something that she calls Muscle-Centric Medicine, which stresses treating the skeletal muscle as an organ. She believes that, "Your ability to survive and thrive - no matter your age - is directly related to muscle tissue health."

In the very first chapter, Dr. Lyons sets the table for the rest of the book by discussing the need to shift from a fat-focused paradigm to one centered around building muscle. She notes all of the conditions that poor muscle health can influence, from cancer to sarcopenia and even Alzheimer's. The author highlights the importance of skeletal muscle and its role in your immune system, saying, "Training also boosts your immune function via peptides - small molecules composed of amino acids - released during muscle contraction. Key peptides can send signals in the body that help fight off germs and reduce inflammation." Later in the same chapter, she discusses myokines, which are hormone-like proteins released by the skeletal muscles that circulate in the bloodstream and help regulate other body functions, particularly glucose metabolism. One myokine in particular, BDNF (brain-derived neurotrophic factor), boosts the formation of new brain neurons, which can facilitate learning and memory.

When discussing disease, Dr. Lyon correctly points out the limitations of traditional Western medicine, saying that it, "...Skews its emphasis toward what's making us sick while overlooking prevention. This tendency leads many doctors to focus on fat and glucose while disregarding the skeletal muscle that could correct the imbalance." The author is right; when is the last time your family physician ever talked about lifestyle changes, weight training, or nutrition? I would add the over-reliance on pharmacology to the doctor's assessment. She goes on in chapter four to discuss nutritional science and is quite critical of the government's recommended guidelines. Dr. Lyons says, "To repeat, it's critical to recognize that the goal of government-funded nutritional guidelines was never (her emphasis) to help individuals achieve exceptional health. Instead, setting forth minimum (her emphasis) intake values was intended to prevent deficiencies." Ignore the RDA; it won't help you to live your best life and be disease-free. The author believes that most people do not consume enough protein, which makes it hard for them to maximize muscle growth even if they regularly strength train. Eating one gram of protein per pound of body weight is the starting point that she recommends.

There is a lot of good information in this book, and it speaks to the overall attitude that each one of us controls our own destiny. Dr. Lyons details five fundamental attributes that all of us have inside of us, which are courage, perseverance, self-discipline, adaptability, and resilience. We will all face adversity at some point in life, and developing these qualities will help us to succeed when the going gets tough. Building muscle is your best ally in the larger plan of fighting off chronic disease, and the author does a commendable job in emphasizing the importance of weight training. The good doctor lists all of the essential amino acids, the ones that our bodies cannot make and must be obtained through our diet. I won't go through all of them, but she mentions that leucine is the most important amino acid for muscle health. There is a terrific understanding of nutrition (as one would expect from someone who earned a degree in nutritional sciences, but not generally common in the medical field), and I was pleased to see that she dismissed the myth of the connection between dietary fat and body fat. Again, her anti-establishment approach was wonderful to see.

Unfortunately, I was disappointed by the exercise advice given in this book. Much of what is prescribed here constitutes overtraining in my opinion, and there are references to steady-state activities that are high-force in nature and can lead to overuse injuries. The author has a poor understanding of several concepts that are quite relevant to proper exercise, namely the dose-response relationship of exercise, which explains that just like in pharmacology, you want the minimum dose necessary to stimulate optimum benefit. She seems to be unaware that you cannot segregate the aerobic metabolic pathway from the anaerobic pathway, and that while you may use more of one pathway than another in a given activity, both are always in play. Dr. Lyons recommends exercises that involve the use of dumbbells as well as unilateral and alternating movements, which leads me to believe she doesn't appreciate the dangers they pose to the pelvis and spine. There is no mention of speed of movement, so I can only infer that she doesn't fully acknowledge the dangers of excessive force on joints and connective tissue. Finally, when Dr. Lyons talks about "cardio training" she makes reference to VO2 Max, which most regular readers of this blog know doesn't actually measure anything, and has been called "the Monopoly money of exercise" by Dr. Doug McGuff. The scientific stuff in this book is great; the exercise advice, not so much.

In spite of my criticisms, I enjoyed this book. As I mentioned before, very few medical doctors really go to these lengths to espouse the importance of skeletal muscle and the benefits of regular strength training. In my own experience, I can now include Dr. Lyons with Dr. McGuff, Dr, Carol Currier, and Dr. Michael Hasz as physicians who "really get it ". There is a positive message in the book and an underlying theme of self-empowerment that can serve as a convincing inspiration to spring into action. I encourage you to read the book and decide for yourself.