As I get older, I find myself frequently wondering how it is that I continue to do so well with my original lungs? I’m 52, and my lung function has remained fairly stable for many, many years. I’m actually quite superstitious about this subject and am almost afraid to write about it, lest somehow this causes things to change drastically as soon as I hit “publish.” But the reason I’ve decided to discuss it is I happen to know that there is at least one factor that has greatly contributed to my health and has been totally under my control. I’m under no illusion that I am in absolute control of everything CF related…I know that my DNA must contain some serious modifier genes working for me, for instance. I also know that, unlike my older siblings who didn’t do as well with their CF, my parents had stopped smoking by the time I rolled around, and this most definitely helped my little lungs when I was a wee thing. These things are totally out of my control, and have certainly contributed to my run of good fortune. But there are also a few things that I think I can (and should) take credit for and I feel like I almost have a responsibility to share them so that others will benefit as well.
Nobody forced me to get strong. It was entirely my idea, and an odd one at the time. It didn’t just come to me through good genetics, either. It took consistent, patient, diligent hard work on my part. It was 1980, and the big craze was to do “cardio” to get fit. I drank the jogging Kool Aid and ran miles and miles to get my cardio in. I will admit that my motivation to jog had absolutely nothing to do with CF back then; it had everything to do with vanity. I wanted to be slim…if not downright skinny. I absolutely hated running. It was hard to breathe and I found nothing about it enjoyable except the feeling that I had when it was over for the day! That feeling kept me hooked, though, and I kept at it. Of course, this was an awesome way to treat my CF back then, and I’m sure it played a huge part my not requiring IV’s until my mid-30’s. I did nothing else in terms of respiratory care…it was before the days of the Vest or flutter. Pulmozyme wasn’t invented, and hypertonic saline was only discussed in chemistry classes. So, I jogged with the other lemmings, and cleared my lungs out this way.
But vanity (I must have had a lot of this) also led me to another form of exercise that was less popular, especially for 20-year-old women. I started lifting weights. And, I got strong…very strong. I first became hooked when I noticed after a few weeks of arm weights that my shirt sleeves were tighter. At first I thought the shirt had shrunk, but then my hand brushed against my upper arm and I noticed it was hard…as in muscular. Whoa, I thought, this stuff works! Then I started buying books about “women’s weight training.” I learned all the exercises and started doing them. Pretty soon, I was bench pressing my weight, and there would be times where I’d look around and realize that I was the strongest woman in the gym. Now, this was a pretty amazing concept to wrap my “I have CF and will never be an athlete” brain around. I still ran, because I started to realize it was good for more than just my pant size, but my fitness passion was all about weight training.
In my experience, there is nothing more empowering than realizing that I can do something physical as well as, or even better than, CFTR-able gym rats. Lifting weights and the resulting strength gains did this for me. The gym became my “CF can’t touch this” happy place. Mind you, I am not talking about the “cardio” area of the gym. CF most definitely ruled in that place. I’m talking about free weights, squat racks, and yes, even the dreaded barbell deadlift platform. Strutting around the gym doing my thing three or four days a week was and still is a very effective coping mechanism I’ve fine-tuned after thirty-plus years of lifting while living with a nasty disease.
But beyond the immense psychological benefits, the absolute strength derived from weightlifting has provided countless physical assists in dealing with CF. I think it was the legendary strength coach, Dan John, who developed the metaphor of absolute strength being like a glass (the drinking kind). The bigger the glass, the easier it will be to achieve your fitness goals, whatever they are. He likens absolute strength to a container which holds everything else fitness related (mobility, strength endurance, flexibility, etc). The bigger the container, the more of these other qualities fit. For example, if I can bench press 100 lbs, there is a very good chance that I can do many more push ups than someone who can only press 50 lbs. I also likely have better shoulder flexibility and mobility.
I like to expand on his metaphor here, and say that the strength container holds many CF care related items as well. If I have developed abs of steel by doing heavy front squats, I am willing to bet that my cough is stronger and I am able to clear more crap from my lungs than someone who has minimal abdominal strength. If I have increased my thoracic mobility by doing heavy Turkish get ups, or jerks, I know that my chest wall mechanics are optimized for full lung expansion. If I have built up some serious lean mass by lifting for hypertrophy, I know I have improved my glucose metabolism. See what I mean? Strength is a tremendous benefit, not just for your psyche, but also for your ninja CF fighting skills.
Do cardio, by all means. It shakes you up and makes you breathe faster and deeper. This is great for airway clearance. But do NOT neglect weight training and fail to take advantage of the amazing benefits of just being bad ass strong!
If you’ve followed the last few posts, you know that I have been focusing on a problem that many people with cystic fibrosis face as they get older. First, let me say that it’s not just us! Even a “normal” person with no lung disease begins to lose muscle mass at a rate of about 1% per year in his or her 40’s. This loss (also called sarcopenia) then speeds up and can reach 2% per year in the 50’s and beyond. Of course, the more you start off with at year 40, the better off you will be at age 60 or 70. The causes of this muscle loss are numerous, and include lack of exercise, poor diet, inflammation, and hormonal changes. To this list, cystic fibrosis patients can add steroid use, poor absorption of nutrients, and numerous hospitalizations leading to even further lack of movement. So what’s a body to do?
Well, this is exactly why I am writing this series. It is important to take muscle gain seriously and in a timely fashion. Don’t wait until you are a skinny fifty year old! However, if you ARE a skinny fifty year old, first of all, congratulations! Second of all, it’s not too late. Get going now! At least you can slow the loss of muscle tissue by using it.
Alright, off the soapbox. On to the content… As you read here and here, rule number one if you want to gain muscle is to pick a good, well designed weight training program and follow it. Rule number two was to increase your caloric intake; specifically, to increase your protein intake. The last rule is to allow your muscles to recover!
There is no faster way to sabotage yourself that to decide that more must be better. More is definitely not better when it comes to lifting weights as a weight gain strategy. It is definitely the way to go if you want to overtrain and get so burned out that you either 1) get sick, or 2) end up hating the gym.
Your muscle tissue needs two things to recover from a resistance workout. It needs food, specifically carbohydrate and protein. It is best to get these in a ratio of 3 or 4 to 1. So for example, I drink a protein shake with 20 gm of whey protein and 60 to 80 gm of carbs in the form of berries, coconut milk and a banana. A simpler option is a big glass of chocolate milk. Ideally, you want to feed this delicacy to your starving muscles as soon as you can after a workout. I shoot for drinking my shake within 30 to 60 minutes after my last set. The reason for this is that the muscle cells are primed to transport both glucose and amino acids immediately following exercise. They are primed because they need these nutrients to recover; glucose to replace the lost glycogen stores, and amino acids to rebuild the contractile proteins that were damaged by the exercise (don’t worry, the damage is a good thing as the muscle is rebuilt stronger and bigger).
The other thing your muscle tissue needs is time off. This is why good programs tell you to rest at least one day between sessions that work the same muscles. You cannot work a muscle every day and expect it to grow. Muscle is built while you rest, not while you train. Therefore, no rest = no building…only tearing down. If you work legs on Monday, rest them on Tuesday. If you must do something, work your upper body instead. If you have a hard, full-body workout on Monday, take Tuesday completely off. It’s ok! Go for a walk. Walking doesn’t count…it is not resistance exercise. It is simply moving…which we are made for and need to do. Finally, if you do not get enough good quality sleep, forget it. Sleep is right up there with food. Sleep is when the cellular trash is taken out, and new proteins are built. It is the time to grow. It is also necessary to get enough sleep so that all of your hard work is not completely overruled by increased stress hormones as a result of too little sleep. Eight hours is a minimum!
Here’s the formula in a nutshell: Workout. Eat to recover. Chill out the next day (but go for a walk!). Sleep a TON. Repeat.
In the last post, I discussed the first of three very important essentials of gaining not just weight, but aesthetically pleasing and healthy weight, AKA muscle. If you missed that post, you can read it here. In part II, I’ll reveal the very basic and obvious second essential ingredient. While obvious, this is the one that I personally have the most trouble with. It’s another case of a habit being very simple, but not necessarily easy.
You have probably guessed Rule Number Two by now. If you are going to work your muscles with a well-designed resistance training program, you also need to feed them! Muscle tissue is largely protein, and to build it up, you need to consume…wait for it…protein! You very likely need to consume more protein than you are now. The target I shoot for is 0.8 to 1.0 grams of protein per pound of weight. But the weight number I will use is the weight that I’m aiming to reach. So if I want to weigh 115 lbs, I would eat 90-110 gms of protein each day.*
But it’s not just protein that is important. You also need to consume calories in the form of fat and carbohydrate. Basically, you need to eat more calories if you want to gain weight. It is not complicated. Sometimes, people get fancy, and calculate their exact resting energy expenditure, then multiply this by a factor that accounts for activity level, then add the exact amount that they expend in their workout, and then add the square root of the distance to the moon divided by pi. Are you dizzy yet?
These methods may work fairly well for the general population, but as you know, people with cystic fibrosis don’t follow the rules. Our resting energy expenditure is way higher than normal, so I have a better method. Write down EXACTLY what you eat for three straight days. These should be days where you are not trying to gain or lose weight, but are simply in maintenance mode. Record not just the type of food, but how much. Then find a good online calorie calculator and add up the calories for each day. Don’t forget to include what you drink as well! Those sodas add up. Now calculate your average daily calorie consumption. If the days are wildly different from each other, you may want to do this for a whole week to get a more accurate average intake.
Got it? Now add 500 calories per day, and this is your new target. So if I calculated that I eat 2000 calories per day, and I want to gain muscle in order to weigh 115 lbs, here is what I need to do. First, my new target is 2500 calories, and of those, 440 are going to be in the form of protein (110gm x 4 calories per gram of protein). So I also need to eat about 2000 calories—I’m rounding here–of fat (9cal/gm) and carbohydrate (4cal/gm). OK, no more math.
The reason I am bad at this, and something that you, too, might struggle with, is that it is HARD to eat this much. If you skip a meal, you get way behind on calorie intake and it can be nearly impossible to catch up. So, eat early and eat often. Never skip breakfast, or lunch, or dinner. Have a snack before bed. Drink calories. Read the “How to lose weight” articles and break every rule.**
It’s also hard to do this on the fly. I’ve figured out that if I plan what I’m going to eat and make sure my strategy includes enough calories beforehand, I am much more likely to be successful.
Finally, the bane of my existence…pancreatic supplementation has to be fine-tuned for this to work. Also, if you have CFRD, you will also have to figure out if and when you might need to adjust insulin dosages. Close monitoring of blood glucose and, in my case, er…..digestion capacity, will help. Bon appétit.
*Ask your CF nutritionist if this amount of protein is safe for you.
** Don’t break the rule about not eating junk food. You are what you eat. So eat real, whole, healthy food.
One of the drawbacks to not digesting nutrients very well is that people with CF are often small. Male or female, we tend to run on the petite side if we are pancreatic insufficient. With earlier diagnosis and better enzyme replacement therapy, this is slowly improving, of course. But for those of us who are already full grown, it can be a constant struggle to keep weight on. Not only do we want to maintain weight, it is often encouraged to have a few extra (I said, “a few”) pounds on board to stay strong and resilient to lung infections.
I don’t know about you, but when I need to gain weight—which is pretty much always—I would rather put on lean muscle tissue than fat. This is not just an aesthetic issue, either. The amount of lean body mass (LBM) you have (this includes everything but fat and water) correlates with disease severity. The less LBM a CF patient has, the more severe their disease tends to be. Additionally, LBM decreases with age, so as we get older it becomes more and more important to try to increase muscle mass.
So, what does it take to gain muscle? Three things, well…maybe four. If you are pancreatic sufficient, it takes doing three things, regularly. If not, it takes four (the fourth being, obviously, sufficient supplementation with pancreatic enzymes). This post is all about thing number one: Resistance Training.
First, you have to lift weights. Muscle tissue does not grow unless you impose a stress to it that it cannot handle. When you do that, the muscle adapts by healing and coming back bigger and stronger. In my opinion you should lift weights at least three times per week if you are serious about gaining muscle mass, and it is everyone’s opinion that you must lift heavy weights (for you). So ladies, forget about the purple Barbie weights. Soup cans will not work for long. Sure, you may have to start there, but within a couple of weeks, you will be strong enough that you will have to put some energy into finding heavier resistance. I realize most people are not training program junkies like me, and that you might not have a clue what to do with those heavy weights. One great resource is The New Rules of Lifting for Life, by Lou Schuler and Alwyn Cosgrove. You can probably find about a million training programs online, but the reason that I like this one is that it is scalable…you get to decide what level you begin at in each of the basic movements, and progress from that point. So, brand new lifters or old pros have something to gain from this book. I am also working on my own CF-specific training program, which will hopefully be available in a couple of months. Don’t wait for me though…get started now.
So, in summary, if you want or need to gain weight, do it in style—by adding muscle. There are three keys to doing this. First, find a weight lifting program that works for you, and commit to it for at least three months. If you do this, in addition to the two remaining steps outlined in the following posts, you will increase your lean body mass, and with it, your chances for a longer and healthier life. When you see the progress that you have made in the three months, I’m betting that you will be hooked for life.