My transformation: I cannot remember the last time I had a fever

The two photos below (click to enlarge) were taken 4 years apart. The one on the left was taken in 2006, when I weighed 210 lbs (95 kg). Since my height is 5 ft 8 in, at that weight I was an obese person, with over 30 percent body fat. The one on the right was taken in 2010, at a weight of 150 lbs (68 kg) and about 13 percent body fat. I think I am a bit closer to the camera on the right, so the photos are not exactly on the same scale. For another post on my transformation, see this post.

My lipids improved from borderline bad to fairly good numbers, as one would expect, but the two main changes that I noticed were in terms of illnesses and energy levels. I have not had a fever in a long time. I simply cannot remember when it was the last time that I had to stay in bed because of an illness. I only remember that I was fat then. Also, I used to feel a lot more tired when I was fat. Now I seem to have a lot of energy, almost all the time.

In my estimation, I was obese or overweight for about 10 years, and was rather careless about it. A lot of that time I weighed in the 190s; with a peak weight of 210 lbs. Given that, I consider myself lucky not to have had major health problems by now, like diabetes or cancer. A friend of mine who is a doctor told me that I probably had some protection due to the fact that, when I was fat, I was fat everywhere. My legs, for example, were fat. So were my arms and face. In other words, I lot of the fat was subcutaneous, and reasonably distributed. In fact, most people do not believe me when I say that I weighed 210 lbs when that photo was taken in 2006; but maybe they are just trying to be nice.

If you are not obese, you should do everything you can to avoid reaching that point. Among other things, your chances of having cancer will skyrocket.

So, I lost a whopping 60 lbs (27 kg) over about 2-3 years. That is not so radical; about 1.6-2.5 lbs per month. There were plateaus with no weight loss, and even a few periods with weight gain. Perhaps because of that and the slow weight loss, I had none of the problems usually associated with body responses to severe calorie restriction, such as hypothyroidism. I remember a short period when I felt a little weak and miserable; I was doing exercise after long fasts (20 h or so), and not eating enough afterwards. I did that for a couple of weeks and decided against the idea.

There are no shortcuts with body fat loss, it seems. Push it too hard and the body will react; compensatory adaptation at work.

My weight has been stable, at around 150 lbs, for about 15 years now.

What did I do to lose 60 lbs? I did a number of things at different points in time. I measured various variables (e.g., intake of macronutrients, weight, body fat, HDL cholesterol etc.) and calculated associations, using a prototype version of HealthCorrelator for Excel (HCE). Based on all that, I am pretty much convinced that the main factors were the following:

- Complete removal of foods rich in refined carbohydrates and sugars from my diet, plus almost complete removal of plant foods that I cannot eat raw. (I do cook some plant foods, but avoid the ones I cannot eat raw; with a few exceptions like sweet potato.) That excluded most seeds and grains from my diet, since they can only be eaten after cooking.

- Complete removal of vegetable oils rich in omega-6 fats from my diet. I cook primarily with water. I also use butter and organic coconut oil. I occasionally use olive oil, often with water, for steam cooking.

- Consumption of plenty of animal products, with emphasis on eating the animal whole. All cooked. This includes small fish (sardines and smelts) eaten whole about twice a week, and offal (usually beef liver) about once or twice a week. I also eat eggs, about 3-5 per day.

- Practice of moderate exercise (2-3 sessions a week) with a focus on resistance training and high-intensity interval training (e.g., sprints). Also becoming more active, which does not necessarily mean exercising but  doing things that involve physical motion of some kind (e.g., walking, climbing stairs, moving things around), to the tune of 1 hour or more every day.

- Adoption of more natural eating patterns; by eating more when I am hungry, usually on days I exercise, and less (including fasting) when I am not hungry. I estimate that this leads to a caloric surplus on days that I exercise, and a caloric deficit on days that I do not (without actually controlling caloric intake).

- A few minutes (15-20 min) of direct skin exposure to sunlight almost every day, when the sun is high, to get enough of the all-important vitamin D. This is pre-sunburn exposure, usually in my backyard. When traveling I try to find a place where people jog, and walk shirtless for 15-20 min.

- Stress management, including some meditation and power napping.

- Face-to-face social interaction, in addition to online interaction. Humans are social animals, and face-to-face social interaction contributes to promoting the right hormonal balance.

When I was fat, my appetite was a bit off. I was hungry at the wrong times, it seemed. Then slowly, after a few months eating essentially whole foods, my hunger seemed to start “acting normally”. That is, my hunger slowly fell into a pattern of increasing after physical exertion, and decreasing with rest. Protein and fat are satiating, but so seem to be fruits and vegetables. Never satiating for me were foods rich in refined carbohydrates and sugars – white bread, bagels, doughnuts, pasta etc.

Looking back, it almost seems too easy. Whole foods taste very good, especially if you are hungry.

But I will never want to each a peach after I have a doughnut. The peach will be tasteless!

Could grain-fed beef liver be particularly nutritious?

There is a pervasive belief today that grain-fed beef is unhealthy, a belief that I addressed before in this blog (1) and that I think is exaggerated. This general belief seems to also apply to a related meat, one that is widely acknowledged as a major micronutrient “powerhouse”, namely grain-fed beef liver.

Regarding grain-fed beef liver, the idea is that cattle that are grain-fed tend to develop a mild form of fatty liver disease. This I am inclined to agree with.

However, I am not convinced that this is such a bad thing for those who eat grain-fed beef liver.

In most animals, including Homo sapiens, fatty liver disease seems to be associated with extra load being put on the liver. Possible reasons for this are accelerated growth, abnormally high levels of body fat, and ingestion of toxins beyond a certain hormetic threshold (e.g., alcohol).

In these cases, what would one expect to see as a body response? The extra load is associated with high oxidative stress and rate of metabolic work. In response, the body should shuttle more antioxidants and metabolism catalysts to the organ being overloaded. Fat-soluble vitamins can act as antioxidants and catalysts in various metabolic processes, among other important functions. They require fat to be stored, and can then be released over time, which is a major advantage over water-soluble vitamins; fat-soluble vitamins are longer-acting.

So you would expect an overloaded liver to have more fat in it, and also a greater concentration of fat-soluble vitamins. This would include vitamin A, which would give the liver an unnatural color, toward the orange-yellow range of the spectrum.

Grain-fed beef liver, like the muscle meat of grain-fed cattle, tends to have more fat than that of grass-fed animals. One function of this extra fat could be to store fat-soluble vitamins. This extra fat appears to have a higher omega-6 fat content as well. Still, beef liver is a fairly lean meat; with about 5 g of fat per 100 g of weight, and only 20 mg or so of omega-6 fat. Clearly consumption of beef liver in moderation is unlikely to lead to a significant increase in omega-6 fat content in one’s diet (2). By consumption in moderation I mean approximately once a week.

The photo below, from Wikipedia, is of a dish prepared with foie gras. That is essentially the liver of a duck or goose that has been fattened through force-feeding, until the animal develops fatty liver disease. This “diseased” liver is particularly rich in fat-soluble vitamins; e.g., it is the best known source of the all-important vitamin K2.



Could the same happen, although to a lesser extent, with grain-fed beef liver? I don’t think it is unreasonable to speculate that it could.

Growth hormone: The fountain of youth

Growth hormone, also known as human growth hormone, seems to be implicated in a number of metabolic conditions associated with aging, and, more generally, poor health.

In adults, growth hormone deficiency is associated with: decreased calcium retention and osteoporosis, loss of muscle mass, increased fat deposition, decreased protein synthesis, and immunodeficiency. In children, growth hormone deficiency is associated with stunted growth.

Levels of growth hormones decline with age, and their decrease is believed to contribute to the aging process. Abdominal obesity is associated with low levels of growth hormone, and is also associated with the onset of the metabolic syndrome, a precursor of diabetes and cardiovascular disease.

While there are many treatments in the market that include exogenous administration of growth hormones (e.g., through injection), there are several natural ways in which growth hormone levels can be increased. These natural ways can often lead to more effective and sustainable results than prescription drugs.

For example, fasting stimulates the natural production of growth hormone. So does vigorous exercise, particularly resistance exercise with a strong anaerobic component (not cardio though). And, to the surprise of many people, deep sleep stimulates the natural production of growth hormone, perhaps more than anything else. (Although only once every 24 hours; sleeping all day does not seem to work.)

In fact, during a 24-hour period, growth hormone typically varies in pulses, or cycles. The pulses are somewhat uniformly distributed during the day, with a peak occurring at night. The graph below (source: Fleck & Kraemer, 2004) plots the typical variation of growth hormone during a 12-hour period, including the deep sleep period.

As you can see, growth hormone peaks during deep sleep; which is achieved a few hours after one goes to bed, and not too long before one wakes up.

By the way, if you want to know more about human physiology and metabolism, forget about popular diet and exercise books. Next to peer-reviewed academic articles (which are often hard to read), the best sources are college textbooks used in courses on physical education, nutrition, endocrinology, and related topics. The book from which the graph above was taken (Fleck & Kraemer, 2004), is a superb example of that.

Reference:

Fleck, S.J., & Kraemer, W.J. (2004). Designing resistance training programs. Champaign, IL: Human Kinetics.

The man who ate 25 eggs per day: What does this case really tell us?

Many readers of this blog have probably heard about the case of the man who ate approximately 25 eggs (20 to 30) per day for over 15 years (probably well over), was almost 90 years old (88) when the case was published in the prestigious The New England Journal of Medicine, and was in surprisingly good health (1).

The case was authored by the late Dr. Fred Kern, Jr., a widely published lipid researcher after whom the Kern Lipid Conference is named (2). One of Kern’s research interests was bile, a bitter-tasting fluid produced by the liver (and stored in the gallbladder) that helps with the digestion of lipids in the small intestine. He frames the man’s case in terms of a compensatory adaptation tied to bile secretion, arguing that this man was rather unique in his ability to deal with a lethal daily dose of dietary cholesterol.

Kern seemed to believe that dietary cholesterol was harmful, but that this man was somehow “immune” to it. This is ironic, because often this case is presented as evidence against the hypothesis that dietary cholesterol can be harmful. The table below shows the general nutrient content of the man’s daily diet of eggs. The numbers in this and other tables are based on data from Nutritiondata.com (3), in some cases triangulated with other data. The 5.3 g of cholesterol in the table (i.e., 5,300 mg) is 1,775 percent the daily value recommended by the Institute of Medicine of the U.S. National Academy of Sciences (4).

As you can see, the man was on a very low carbohydrate diet with a high daily intake of fat and protein. The man is described as an: “… 88-year-old man who lived in a retirement community [and] complained only of loneliness since his wife's death. He was an articulate, well-educated elderly man, healthy except for an extremely poor memory without other specific neurologic deficits … His general health had been excellent, without notable symptoms. He had mild constipation.”

The description does not suggest inherited high longevity: “His weight had been constant at 82 to 86 kg (height, 1.87 m). He had no history (according to the patient and his personal physician of 15 years) of heart disease, stroke, or kidney disease … The patient had never smoked and never drank excessively. His father died of unknown causes at the age of 40, and his mother died at 76 … He kept a careful record, egg by egg, of the number ingested each day …”

The table below shows the fat content of the man’s daily diet of eggs. With over 14 g of omega-6 fat intake every day, this man was probably close to or in “industrial seed oils territory” (5), as far as daily omega-6 fat intake is concerned. And the intake of omega-3 fats, at less than 1 g, was not nearly enough to balance it. However, here is a relevant fact – this man was not consuming any industrial seed oils. He liked his eggs soft-boiled, which is why the numbers in this post refer to boiled eggs.

This man weighed between 82 to 86 kg, which is about 180 to 190 lbs. His height was 1.87 m, or about 6 ft 1 in. Therefore his body mass index varied between approximately 23 and 25, which is in the normal range. In other words, this person was not even close to obese during the many years he consumed 25 eggs or so per day. In the comments section of a previous post, on the sharp increase in obesity since the 1980s (6), several readers argued that the sharp increase in obesity was very likely caused by an increase in omega-6 fat consumption.

I am open to the idea that industrialized omega-6 fats played a role in the sharp increase in obesity observed since the 1980s. When it comes to omega-6 fat consumption in general, including that in “more natural” foods (e.g., poultry and eggs), I am more skeptical. Still, it is quite possible that a diet high in omega-6 fats in general is unhealthy primarily if it is devoid of other nutrients. This man’s overall diet might have been protective not because of what he was not eating, but because of what he was eating.

The current debates pitting one diet against another often revolve around the ability of one diet or another to eliminate or reduce the intake of a “bad thing” (e.g., cholesterol, saturated fat, carbohydrates). Perhaps the discussion should be more focused on, or at least not completely ignore, what one diet or another include as protective factors. This would help better explain “odd findings”, such as the lowest-mortality body mass index of 26 in urban populations (7). It would also help better explain “surprising cases”; such as this 25-eggs-a-day man’s, vegetarian-vegan “ageless woman” Annette Larkins’s (8), and the decidedly carnivore De Vany couple’s (9).

The table below shows the vitamin content of the man’s daily diet of eggs. The vitamin K2 content provided by Nutritiondata.com was incorrect; I had to get what seems to be the right number by triangulating values taken from various publications. And here we see something interesting. This man was consuming approximately the equivalent in vitamin K2 that one would get by eating 4 ounces of foie gras (10) every day. Foie gras, the fatty liver of overfed geese, is the richest known animal source of vitamin K2. This man’s diet was also high in vitamin A, which is believed to act synergistically with vitamin K2 – see Chris Masterjohn’s article on Weston Price’s “activator X” (11).

Kern argued that the very high intake of dietary cholesterol led to a sharp increase in bile secretion, as the body tried to “get rid” of cholesterol (which is used in the synthesis of bile). However, the increased bile secretion might have been also been due to the high fat content of this man’s diet, since one of the main functions of bile is digestion of fats. Whatever the case may be, increased bile secretion leads to increased absorption of fat-soluble vitamins, and vitamins K2 and A are fat-soluble vitamins that seem to be protective against cardiovascular disease, cancer and other degenerative diseases.

Finally, the table below shows the mineral content of the man’s daily diet of eggs. As you can see, this man consumed 550 percent the officially recommended daily intake of selenium. This intake was slightly lower than the 400 micrograms per day purported to cause selenosis in adults (12). Similarly to vitamins K2 and A, selenium seems to be protective against cardiovascular disease, cancer and other degenerative diseases. This man’s diet was also rich in phosphorus, needed for healthy teeth and bones.

Not too many people live to be 88 years of age; many fewer reach that age in fairly good health. The country with the highest average life expectancy in the world at the time of this writing is Japan, with a life expectancy of about 82 years (79 for men, and 86 for women). Those who think that they need a high HDL cholesterol and a low LDL cholesterol to be in good health, and thus live long lives, may be surprised at this man’s lipid profile: “The patient's plasma lipid levels were normal: total cholesterol, 5.18 mmol per liter (200 mg per deciliter); LDL, 3.68 mmol per liter (142 mg per deciliter); and HDL, 1.17 mmol per liter (45 mg per deciliter). The ratio of LDL to HDL cholesterol was 3.15.”

If we assume that this man is at least somewhat representative of the human species, and not a major exception as Kern argued, this case tells us that a diet of 25 eggs per day followed by over 15 years may actually be healthy for humans. Such diet has the following features:

- It is very high in dietary cholesterol.

- It involves a high intake of omega-6 fats from animal sources, with none coming from industrial seed oils.

- It involves a high overall intake of fats, including saturated fats.

- It is fairly high in protein, all of which from animal sources.

- It is a very low carbohydrate diet, with no sugar in it.

- It is a nutritious diet, rich in vitamins K2 and A, as well as in selenium and phosphorus.

This man ate 25 eggs per day apparently due to an obsession tied to mental problems. Repeated attempts at changing his behavior were unsuccessful. He said: “Eating these eggs ruins my life, but I can't help it.”

The megafat could be the healthiest

Typically obesity leads to health problems via insulin resistance (1). Excess calories are stored as fat in fat cells up to a certain point. Beyond this point fat cells start rejecting fat. This is the point where fat cells become insulin resistant.

When they become insulin resistant, fat cells no longer respond to the insulin-mediated signal that they should store fat. Fat then increases in circulation and starts getting stored in tissues other than fat cells, including organ tissues (visceral fat). When the organ in question is the liver, this is called non-alcoholic fatty liver disease.

This progression happens with most people, but not with those who can progress to extremely high body fat levels (2). Those people are the “megafat-prone” (MP). In the MP, fat cells take a long time to start rejecting fat. So the MP can keep on gaining body fat, often with no sign of diabetes at body fat levels that would have caused serious harm to most people.

One could say that the MP are extremely metabolically resilient. By not becoming insulin resistance as they gain more and more body fat, the MP are somewhat similar to sumo wrestlers (photo below from Nationalgeographic.com); although the main reason why sumo wrestlers do not develop insulin resistance is vigorous exercise. Visceral fat is very easy to "mobilize" through vigorous exercise; this being the basis for the "fat-but-fit" phenomenon (3). There are two interesting, and also speculative, inferences that can be made based on all of this.



One is that the MP could potentially be the healthiest people among us. This is due to their extreme metabolic resilience, which should be fairly protective if they can avoid getting up to the unhealthy point of body fat for them. In fact, they could be overweight or even obese and fairly healthy, at least in terms of degenerative diseases. This is a genetic predisposition, which is likely to run in families.

The other inference is that the MP would probably not look “ripped” at relatively low weights. Since their body fat cells have above average insulin sensitivity at high body fat levels, one would expect that high insulin sensitivity to remain at low body fat levels. Insulin sensitivity is strongly associated with longevity (4).

So, bringing all of this together, here are two apparent paradoxes. That person who already gained a lot of body fat and is an MP, showing no health problems at or near obesity, could be the healthiest among us. And that person who cannot look ripped at low body fat levels, no matter how hard he or she tries, may be one of the 2 percent or so of the population who will live beyond 90.

Unfortunately it is hard to tell whether someone is MP or not until the person actually becomes megafat. And if you are MP and actually become megafat, the afterlife will very likely arrive sooner rather than later.

Want to make coffee less acidic? Add cream to it

The table below is from a 2008 article by Ehlen and colleagues (1), showing the amount of erosion caused by various types of beverages, when teeth were exposed to them for 25 h in vitro. Erosion depth is measured in microns. The third row shows the chance probabilities (i.e., P values) associated with the differences in erosion of enamel and root.

As you can see, even diet drinks may cause tooth erosion. That is not to say that if you drink a diet soda occasionally you will destroy your teeth, but regular drinking may be a problem. I discussed this study in a previous post (2). After that post was published here some folks asked me about coffee, so I decided to do some research.

Unfortunately coffee by itself can also cause some erosion, primarily because of its acidity. Generally speaking, you want a liquid substance that you are interested in drinking to have a pH as close to 7 as possible, as this pH is neutral (3). Tap and mineral water have a pH that is very close to 7. Black coffee seems to have a pH of about 4.8.

Also problematic are drinks containing fermentable carbohydrates, such as sucrose, fructose, glucose, and lactose. These are fermented by acid-producing bacteria. Interestingly, when fermentable carbohydrates are consumed as part of foods that require chewing, such as fruits, acidity is either neutralized or significantly reduced by large amounts of saliva being secreted as a result of the chewing process.

So what to do about coffee?

One possible solution is to add heavy cream to it. A small amount, such as a teaspoon, appears to bring the pH in a cup of coffee to a little over 6. Another advantage of heavy cream is that it has no fermentable carbohydrates; it has no carbohydrates, period. You will have to get over the habit of drinking sweet beverages, including sweet coffee, if you were unfortunate enough to develop that habit (like so many people living in cities today).

It is not easy to find reliable pH values for various foods. I guess dentistry researchers are more interested in ways of repairing damage already done, and there doesn't seem to be much funding available for preventive dentistry research. Some pH testing results from a University of Cincinnati college biology page were available at the time of this writing; they appeared to be reasonably reliable the last time I checked them (4).

Body fat and disease: How much body fat can I lose in one day?

Body fat is not an inert deposit of energy. It can be seen as a distributed endocrine organ. Body fat cells, or adipocytes, secrete a number of different hormones into the bloodstream. Major hormones secreted by adipose tissue are adiponectin and leptin.

Estrogen is also secreted by body fat, which is one of the reasons why obesity is associated with infertility. (Yes, abnormally high levels of estrogen can reduce fertility in both men and women.) Moreover, body fat secretes tumor necrosis factor, a hormone that is associated with generalized inflammation and a number of diseases, including cancer, when in excess.

The reduction in circulating tumor necrosis factor and other pro-inflammatory hormones as one loses weight is one reason why non-obese people usually experience fewer illness symptoms than those who are obese in any given year, other things being equal. For example, the non-obese will have fewer illness episodes that require full rest during the flu season. In those who are obese, the inflammatory response accompanying an illness (which is necessary for recovery) will often be exaggerated.

The exaggerated inflammatory response to illness often seen in the obese is one indication that obesity in an unnatural state for humans. It is reasonable to assume that it was non-adaptive for our Paleolithic ancestors to be unable to perform daily activities because of an illness. The adaptive response would be physical discomfort, but not to the extent that one would require full rest for a few days to fully recover.

Inflammation markers such as C-reactive protein are positively correlated with body fat. As body fat increases, so does inflammation throughout the body. Lipid metabolism is negatively affected by excessive body fat, and so is glucose metabolism. Obesity is associated with leptin and insulin resistance, which are precursors of diabetes type 2.

Some body fat is necessary for survival; that is normally called essential body fat. The table below (from Wikipedia) shows various levels of body fat, including essential levels. Also shown are body fat levels found in athletes, as well as fit, “not so fit” (indicated as "Acceptable"), and obese individuals. Women normally have higher healthy levels of body fat than men.

If one is obese, losing body fat becomes a very high priority for health reasons.

There are many ways in which body fat can be measured.

When one loses body fat through fasting, the number of adipocytes is not actually reduced. It is the amount of fat stored in adipocytes that is reduced.

How much body fat can a person lose in one day?

Let us consider a man, John, whose weight is 170 lbs (77 kg), and whose body fat percentage is 30 percent. John carries around 51 lbs (23 kg) of body fat. Standing up is, for John, a form of resistance exercise. So is climbing stairs.

During a 24-hour fast, John’s basal metabolic rate is estimated at about 2,550 kcal/day. This is the number of calories John would spend doing nothing the whole day. It can vary a lot for different individuals; here it is calculated as 15 times John’s weight in lbs.

The 2,550 kcal/day is likely an overestimation for John, because the body adjusts its metabolic rate downwards during a fast, leading to fewer calories being burned.

Typically women have lower basal metabolic rates than men of equal weight.

For the sake of discussion, we expect each gram of John’s body fat to contribute about 8 kcals of energy, assuming a rate of conversion of body fat to calories of about 90 percent.

Thus during a 24-hour fast John burns about 318 g of fat, or about 0.7 lbs. In reality, the actual amount may be lower (e.g., 0.35 lbs), because of the body's own down-regulation of its basal metabolic rate during a fast. This down-regulation varies widely across different individuals, and is generally small.

Many people think that this is not much for the effort. The reality is that body fat loss is a long term game, and cannot be achieved through fasting alone; this is a discussion for another post.

It is worth noting that intermittent fasting (e.g., one 24-hour fast per week) has many other health benefits, even if no overall calorie restriction occurs. That is, intermittent fasting is associated with health benefits even if one fasts every other day, and eats twice one's normal intake on the non-fasting days.

Some of the calories being burned during John's 24-hour fast will be from glucose, mostly from John’s glycogen reserves in the liver if he is at rest. Muscle glycogen stores, which store more glucose substrate (i.e., material for production of glucose) than liver glycogen, are mobilized primarily through anaerobic exercise.

Very few muscle-derived calories end up being used through the protein and glycogen breakdown pathways in a 24-hour fast. John’s liver glycogen reserves, plus the body’s own self-regulation, will largely spare muscle tissue.

The idea that one has to eat every few hours to avoid losing muscle tissue is complete nonsense. Muscle buildup and loss happen all the time through amino acid turnover.

Net muscle gain occurs when the balance is tipped in favor of buildup, to which resistance exercise and the right hormonal balance (including elevated levels of insulin) contribute.

One of the best ways to lose muscle tissue is lack of use. If John's arm were immobilized in a cast, he would lose muscle tissue in that arm even if he ate every 30 minutes.

Longer fasts (e.g., lasting multiple days, with only water being consumed) will invariably lead to some (possibly significant) muscle breakdown, as muscle is the main store of glucose-generating substrate in the human body.

In a 24-hour fast (a relatively short fast), the body will adjust its metabolism so that most of its energy needs are met by fat and related byproducts. This includes ketones, which are produced by the liver based on dietary and body fat.

How come some people can easily lose 2 or 3 pounds of weight in one day?

Well, it is not body fat that is being lost, or muscle. It is water, which may account for as much as 75 percent of one’s body weight.

References:

Elliott, W.H., & Elliott, D.C. (2009). Biochemistry and molecular biology. New York: NY: Oxford University Press.

Fleck, S.J., & Kraemer, W.J. (2004). Designing resistance training programs. Champaign, IL: Human Kinetics.

Large, V., Peroni, O., Letexier, D., Ray, H., & Beylot, M. (2004). Metabolism of lipids in human white adipocyte. Diabetes & Metabolism, 30(4), 294-309.