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Getting in Great Shape For Life

Getting in Great Shape For Life

Pamela A. Popper, President

Wellness Forum Health

Physical activity is an important key to health, and should include aerobic activity, strength training, and stretching which can include yoga. In my experience, most people will stretch considerably more in a structured yoga class than they will on their own, which is just one important benefit of taking yoga classes at a studio.

Important disclosure: I own a yoga studio so it’s obviously difficult to be completely objective on this point. 

There is considerable published research describing the benefits of stretching and specifically yoga.

Let’s start with the definition of stretching for purposes of health improvement, which is to get into and hold a position that challenges a muscle or group of muscles, and which over time can improve range of motion of joints. Performing stretching exercises properly often involves some discomfort, but health improvement requires physical discomfort and avoidance does not make things better – ever.

There are many mechanisms by which stretching – and yoga – improves health. Stretching builds strength, particularly when combined with weight training. Stretching lengthens muscles, and strength training involves contracting muscles. Both result in applying tension to muscles and connective tissue which, over time, results in muscles getting bigger and stronger.[1] Ideally you should do both – stretch and strength train.

Stretching in the form of yoga reduces chronic low back pain. One study showed that pain was reduced after just eight classes.[2] Stretching also reduces injuries by improving balance.[3] These are outcomes we observe regularly in our studio. Within a short time, people gain the ability to stand on one leg, and they report that their physical discomfort is dissipating. It’s one of the reasons why the student population at our studio is so stable – people feel better when they regularly attend classes and worse when they do not.

Stretching also has benefits beyond physical fitness. It has been shown to reduce arterial stiffness, improve vascular endothelial function, and decrease heart rate and blood pressure.[4]

Ideally, and for best outcomes (and by best outcomes I mean living independently for the rest of your life and having a great life) you should complete two tough and challenging strength training workouts, a couple of aerobic workouts (running, power walking, cycling), and at least one yoga class each week.

I can almost hear the sighs, moans and groans, and claims of time limitations as you are reading this. But this is a fact: achieving great health requires work and some discomfort – at least until you get to the place where your habits are so ingrained that it is almost impossible to fathom that you would not do the right things – almost every day.

For example, I’ve been practicing optimal habits for decades and I cannot conceive of any situation in which I would eat a hot dog or cheese pizza, or skip a workout or not take a yoga class because I was too busy or just did not feel like it. The pathways in my brain are deep and ingrained for these habits and it’s more uncomfortable to not do the right things than to just get them done. So get started and just do it!

For those of you who do not live in central Ohio, I am planning to teach another virtual yoga series soon. This involves four group classes, one private lesson and access to an online platform for a year. Email pampopper@msn.com if you are interested in being notified when I schedule this series.

[1] Wackerhage H, Schoenfeld BJ, Hamilton DL, Lehti M, Hulmi JJ. “Stimuli and sensors that initiate skeletal muscle hypertrophy following resistance exercise.” J Appl Physiol 2019 Jan;126(1):30-43

[2] Marotta N, de Dire A, Lippi L et al. “Impact of yoga asanas on flexion and relaxation phenomenon in women with chronic low back pain: Prophet model prospective study.” Orthopaedic Res. 2024 Feb https://doi.org/10.1002/jor.25790

[3] Behm DG, Kay D, Trajano GS, Alizadeh S, Blazevich AJ. “Effects of Stretching on Injury Risk Reduction and Balance.” J Clin Exerc Physiol 2021 Sep;10(3):106-116

[4] Kato M, Green FN, Hotta K et al. “The Efficacy of Stretching Exercises on Arterial Stiffness in Middled Aged and Older Adults: A Meta-Analysis of Randomized and Non-Randomized Controlled Trials.” Int J Environ Res Publid Health 2020 Aug;17(16):5643

Important Information About Alzheimer’s Disease

Important Information About Alzheimer’s Disease

Pamela A, Popper, President

Wellness Forum Health

I have been reporting for many years that amyloid plaque and other physical brain abnormalities are not the cause of Alzheimer’s disease – they are likely markers for other things that are. I’ve posted considerable data to support this stance in our library, and also created an entire course about the causes and effective treatments for AD. Recent developments reinforce my ideas about this very important topic.

First, neuroscientist Karen Ashe is retracting her landmark study on Alzheimer’s Disease (AD), which suggested that AD could be caused by amyloid protein.[1] This article has been cited almost 2500 times, and this theory is the basis for many useless drugs the FDA has approved to treat it. The reason for the retraction: it contains manipulated images.[2]

An FDA committee recently and unanimously voted to approve a new drug for AD patients called donanemab.[3] [4] The drug does not improve cognition for those who take it, and 7% of patients experienced neurodegeneration after taking the drug for 18 months. But 76.4% of patients showed clearing of amyloid plaques. The drug was useless for improving symptoms of AD, in spite of clearing the amyloid deposits.[5]

The clinical trial was originally designed to test the drug’s ability to improve cognition and memory. But the endpoint was changed during the study to measure reduction in amyloid plaque. This was likely done because it was already apparent that the drug did not work. Another issue was excess mortality for those taking the drug. Lilly claims that death was an adverse event related to the breaking up of amyloid in the brain.[6]

Another red flag was the dropout rate was high. This might have been because microhemorrhage events were twice as high in the drug group as compared to the placebo arm.[7]

Will the FDA approve this drug for its business partner, Eli Lilly? Probably. It’s useless, harmful, and expensive – what’s not to like?

Drugs that target amyloid plaque have proven to be incredibly ineffective; donanemab is not the first. On the other hand, while conducting research and preparing our online course on Alzheimer’s Disease, I discovered that the causes of cognitive decline are well-understood and documented, and that there are many strategies that really do prevent and sometimes even reverse cognitive decline.

A new study conducted by Dean Ornish showed that a combination of diet, exercise, stress reduction, and social interaction slowed cognitive decline and even resulted in improvement for some people. Forty-nine patients with mild cognitive impairment were enrolled in the study, with half assigned to make lifestyle changes for 20 weeks while the other half continued their current habits. Those in the control group were offered the opportunity to join the intervention arm at the end of the study.

Vegan meals and snacks were provided by the research team. Exercise consisted of 30 minutes of aerobic exercise – mostly walking – every day; and strength training at least three times per week. A stress management specialist helped with meditation, yoga, stretching, and relaxation exercises for one hour per day. Subjects and their partners participated in a support group three times per week to discuss and resolve problems. Several supplements were also included in the protocol. In my opinion, the supplements were useless, except for the probiotic.

By the end of 20 weeks, those in the intervention group had statistically significant improvement in three out of four cognitive tests, and borderline statistically significant improvement in the fourth. Control participants showed worsening scores on all four.

The improvements were small, but 20 weeks is a short period of time. When we work with families of people with early AD, our plan is permanent change to new habits, not just a few weeks, and improvement usually continues over a long period of time.

One important aspect of the findings was the dose-dependent effect of the intervention. The more closely the subjects adhered to the changes, the more improvement they showed. Another was that blood markers for amyloid protein were reduced.[8] This reinforces my long-time stance that amyloid is a marker for things that matter – like diet and exercise. 

Ornish stated that he plans to continue following the patients. I was disappointed to read that he is also interested in seeing if this intervention can be combined with FDA-approved useless drugs.[9]

Bottom line: AD is a chronic degenerative condition that is almost always caused by years – even decades – of poor diet, lack of exercise, dehydration and other factors which become complicated with less social interaction and fewer cognitive activities in older age. On the surface the idea that a pill can resolve this is absurd, so it’s not surprising that efforts to develop a quick fix have failed.  

[1] Lesne S, Koh MT, Kotilinek L et al. “A specific amyloid-β protein assembly in the brain impairs memory.” Nature 2006 Mar;440:352-357

[2] https://www.nature.com/articles/d41586-024-01699-w#:~:text=Neuroscientist%20Karen%20Ashe%20plans%20to,been%20cited%20nearly%202%2C500%20times.

[3] Megan Redshaw. FDA Advisors Unanimously Recommend New Drug for Alzheimer’s Disease. Epoch Times June 10 2024 https://www.theepochtimes.com/health/fda-advisors-unanimously-recommend-new-drug-for-alzheimers-disease-despite-safety-concerns-5666123?utm_source=Morningbrief&src_src=Morningbrief&utm_campaign=mb-2024-06-11&src_cmp=mb-2024-06-11&utm_medium=email&est=AAAAAAAAAAAAAAAAceMmZRwc2cTazL4dsCtaBLl2ma6GX3Q8stKrGzm2ICrL

[4] https://www.youtube.com/live/LPdOPydM18E

[5] FDA Briefing Document. BLA# 761248 chrome-extension: //efaidnbmnnnibpcajpcglclefindmkaj/https://www.fda.gov/media/179166/download

[6] IBID

[7] IBID

[8] Ornish D, Madison C, Kivipelto M et al. “Effects of intensive lifestyle changes on the progression of mild cognitive impairment or early dementia due to Alzheimer’s disease: a randomized, controlled clinical trial.” Alz Res Ther 2024 Jun;16:122

[9] Alice Park. Changing Your Diet and Lifestyle May Slow Down Alzheimer’s. Time June 7 2024 https://time.com/6986373/how-to-slow-alzheimers-lifestyle/?fbclid=IwZXh0bgNhZW0CMTEAAR1GaJIjI15wBdxE6-Ap5F0XL-3EAErwMbsMdGbYSRxwKN77bABpaFOaqvk_aem_ZmFrZWR1bW15MTZieXRlcw

Are Supplements Safe and Effective?

Are Supplements Safe and Effective?

Pamela A. Popper, President

Wellness Forum Health

Due to many factors, including the events of the last almost four years, people are looking for alternatives to traditional healthcare. This is justified, as the conventional healthcare system is highly flawed, care is expensive and sometimes difficult to access, and a growing body of evidence shows that some of the most common treatments for some of the more common conditions aren’t very effective. For example, evidence shows that patients who receive stents are not better off than patients who are instructed to take medication and change their lifestyles;[1] and that surgically repairing meniscal tears is no better than physical therapy for reducing pain.[2] There are many more examples. In fact, a 2019 meta-analysis identified 396 common medical practices that researchers stated should be reduced or eliminated.[3] However, this has not resulted in significant change.

As more of this type of information circulates, we can expect more people to look for better options. There are some better options available, but alternative medicine  practices are not necessarily better. Many protocols are useless, and some are harmful. The decision to take more responsibility for one’s health and look for better options is a good one, but only if one commits to investigating thoroughly before committing to a practice or practitioner – and this is also true for alternative medicine.

A good example is supplements, which can be useful for some purposes. But many people think that supplements are better and safer than drugs, and that the choice to take them involves no risk. This is not true. The supplements to be most concerned about are the ones that “work” since if there is an effect, there must be a side effect. You cannot manipulate one pathway in the body without impacting others. In the case of drugs, we usually know what those “others” are. Sometimes we do, sometimes we don’t with supplements. I do understand the limitations of testing products that cannot be patented, but this does not change the fact that a lot is not known. But even in cases in which there are known risks, people often don’t know about them because they don’t think to look.

One common purpose for taking supplements is prevention – preventing cardiovascular disease and cancer, for example. The US Preventive Services Task Force evaluated vitamin and mineral supplements for prevention of both conditions, and all-cause mortality in healthy adults, and posted the results in 2021.

Here is what the Task Force reported:

  • Multivitamin use may be associated with a reduced risk of cancer. But there were significant limitations for making this claim which included that there were only three adequately powered trials, one of which had a median follow-up time of 3.6 years.
  • Vitamin D with or without calcium showed no benefit for all-cause mortality, CVD events, cancer incidence, or cancer outcomes.
  • Beta-carotene, with or without vitamin A – was associated with increased risk of cardiovascular mortality.
  • There was some evidence that folic acid increased the risk of cancer.
  • There was no benefit for vitamin E with or without vitamin C for all-cause mortality, cancer, or CVD events.
  • There was no impact from taking multivitamins, vitamin A (with or without beta-carotene), vitamin C, calcium (with or without vitamin D), and selenium on all-cause mortality, or risk of cancer or CVD.
  • Some weak evidence showed that supplements can increase the risk of some serious harms. These included an association with vitamin A and hip fracture, vitamin E and hemorrhagic stroke, and vitamin C and calcium and kidney stones.

The task force concluded that vitamin and mineral supplements provide little to no benefit for preventing cancer, CVD, and death. The exception was a possible small benefit for multivitamins and cancer, particularly lung cancer. Beta-carotene was associated with increased risk of lung cancer, particularly for people at higher risk for it. There were not sufficient data to draw conclusions for B vitamins, iron, zinc, or magnesium.[4]

Over $38 billion dollars was spent on multivitamins in 2022, and vitamin D sales are expected to hit almost $2 billion annually by 2027.[5] Assuming that people are purchasing these products because they think they are helpful, there is a big gap between their beliefs and what the current body of evidence shows.

One of my pet peeves concerning the use of supplements for the prevention of disease is that doing so can distract people from paying attention to things that do make a difference – such as diet, exercise, hydration, stress reduction, and weight loss.

The bottom line: The good news is that consumers are starting to take more responsibility for their health. But they need to become much more discerning when evaluating alternatives for both prevention and care.

[1] Boden WE, O’Rourke RA, Teo KK et al. “Optimal Medical therapy with or without PCI for Stable Coronary Disease.” NEJM 2007 Apr;356:1503-1516

[2] Herrea-Perez D, Haslam A, Crain T et al. “A comprehensive review of randomized clinical trials in three medical journals reveals 396 medical reversals.” eLife 2019 Jun;8:e45183

[3] IBID

[4] O’Connor E, Evans C, Ivlev I, Thomas R, Martin A, Lin J. “Vitamin, Mineral and Multivitamin Supplementation for the Primary Prevention of Cardiovascular Disease and Cancer: A Systematic Evidence Review for the U.S. Preventive Service Task Force.” Evidence Synthesis No 209 Agency for Healthcare Research and Quality (US); 2021 Jun. Report No:21-05278-EF-1

[5] https://www.marketsandmarkets.com/Market-Reports/vitamin-d-market-22034298.html

How To Avoid Knee Replacement

How to Avoid Knee Replacement

Pamela A. Popper, President

Wellness Forum Health

According to the American College of Rheumatology (ACR), about 790,000 total knee replacements and over 450,000 hip replacements are performed every year in the U.S. This number is expected to increase due to our aging population. The ACR states that total joint replacement is one of the safest and most reliable treatments in medicine.[1] But are these replacements really necessary? Maybe not.

According to a presentation delivered at the annual meeting of the Radiological Society of North America, muscle strength in the leg is a major factor in determining if a knee replacement will be necessary.

Two muscle groups – the quadriceps and hamstrings – act as counter forces that facilitate a wide range of motion while protecting the knee joint. Exercises that strengthen these muscles and maintain the balance between them can prevent the progression of osteoarthritis that results in the need for knee replacement in over 50% of patients.[2]

The cost of a knee replacement in the U.S. ranges from $30,000 to $50,000,[3] and the procedure is a major revenue source for orthopedic practices and medical institutions. Diet change, exercise, and weight loss are low-cost and better interventions and can usually prevent joint replacement, but there is no economic incentive to recommend these. Instead, the diagnosis of osteoarthritis is usually the beginning of monitoring the progression of the condition until joint replacement is the only option.

There are many reasons to recommend diet and lifestyle improvement to prevent the need for knee replacement. A study including 100 older patients who were eligible for knee replacement surgery showed that over a 2-year period, all of them improved including those who only were given non-surgical interventions such as exercise, dietary advice, and pain medication. While the patients who had the surgery fared better initially, they had four times as many complications such as infections, blood clots, or knee stiffness that were severe enough that another surgery requiring anesthesia was required.[4] Complications are more common and more serious than many people realize – one in every 100-200 patients who has a knee replacement dies within 90 days of the procedure.[5] And as many as one third of those who undergo the procedure continue to experience pain.[6]

There are situations in which knee replacement is the right thing to do, or the only viable option. However, in many cases, other options are both safer and better. There are many causes of knee pain. Being overweight and obese is probably the most common, and lifestyle change leading to weight loss not only relieves knee pain, but addresses many other health issues too. In some cases, the knee is not tracking properly, due to muscle imbalances or injuries. When this is the case, a replacement knee does not help because the new knee will also not track properly. Strategies such as yoga and physical therapy with a competent PT are the best options in these cases.

The bottom line: Joint replacement can be avoided in most cases by eating well, exercising, and maintaining a healthy weight.

[1] https://rheumatology.org/patients/joint-replacement-surgery

[2] Ed Sussman. Stronger Quads May Lower Risk for Knee Replacement Surgery. MEDPAGE Today Nov 29 2023 https://www.medpagetoday.com/meetingcoverage/rsna/107579?xid=nl_mpt_DHE_2023-11-29&eun=g1881756d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%20Evening%202023-11-29&utm_term=NL_Daily_DHE_dual-gmail-definition

[3] https://www.healthpartners.com/blog/cost-of-a-knee-replacement-surgery/

[4] Skou ST, Roos EM, Laursen MB et al. “Total knee replacement and non-surgical treatment of knee osteoarthritis: 2-year outcome from two parallel randomized controlled trials.” Osteoarthritis and Cartilage 2018 Sept;26(9):1170-1180

[5] Katz JN, “Parachutes and Preferences – A Trial of Knee Replacement.” NEJM 2015 Oct;373:1668-1669

[6] Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. “What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients.” BMJ 2012 Feb 22;2(1):e000435.

American Children and Adolescents Are Dehydrated

American Children and Adolescents Are Dehydrated

Pamela A. Popper, President

Wellness Forum Health


According to a recent study, American children and teens do not consume enough water, which affects both their physical and mental health status. Harvard researchers analyzed data from 4,134 children and adolescents between ages 6 and 19 participating in the National Health and Nutrition Examination Survey (NHANES). About half the  children were not taking in enough fluids of any type. Dehydration was 76.0% higher in boys than girls, and 34.0% higher in blacks than whites. Almost 25.0% of the kids reported drinking no water at all.

The bad news is that so many children are dehydrated. The good news is that this could be an easier problem to solve than many diet-related issues with children, since there is likely to be less controversy and argument about getting kids to drink more water. Here are a few ways in which kids could be helped to do better with minimal expense and disruption at school. 

First, all children could be given water bottles at school. This would cost a small amount of money, but if budgets are so tight that schools cannot spend $1.00 per child to make sure water intake is adequate, perhaps the PTA could step in to help.

Second, children could be allowed to drink water during the school day. It is appalling to me the number of children of members of Wellness Forum Health who are forbidden to drink water during the school day, and also forbidden to use the restroom except at specified breaks like recess (I assume that the reason water drinking is prohibited is to lessen the number of times children need to use the restroom during the day). While there are many reasons to keep kids from running around the school building during the school day, stopping them from using the restroom is not one of them.

Third, water could be served with meals at school. While it would be great if water replaced milk, the milk lobby won’t let that happen anytime soon, so water in addition to milk would be a step in the right direction.

Fourth, water could replace caloric beverages like milk, soft drinks, and sports drinks in the vending machines.  Some schools have already made this change. While schools have become reliant on revenue from vending machines, this does not mean that junk foods, including caloric beverages, need to be offered for sale. 

Last but not least, coaches could encourage kids to drink more water and require water bottles at practice. While many coaches push protein and sports drinks, most coaches would agree that kids need to drink more water and that water drinking is a good habit to form.

The result of this focus on water would most likely carry over to home. Kids who become used to drinking water at school would most likely also do so at home, which might encourage parents to drink more water too.

Kenney E, Long M, Cradlock A, Gortmaker S. “Prevalence of Inadequate Hydration Among US Children and Disparities by Gender and Race/Ethnicity: National Health and Nutrition Examination Survey, 2009–2012.”  Am J Public Health. 2015 Aug;105(8):e113-118