Muscle Growth and Hypertrophy

Muscle Growth and Hypertrophy

Muscle Growth and Hypertrophy

Muscle growth and hypertrophy are essential when you want to stay fit. Everyone has muscles, but many want them to be a bit bigger. Did you know there are over 600 muscles in your body? Muscles are responsible for actions like movement, digestion, circulation, and respiration. There are different muscles for each job in the body. 

Injuries, diseases, and various disorders affect the way your muscles function. These issues can be muscle pain spasms or more severe like paralysis and cardiomyopathy. 

Living a healthy lifestyle through good nutrition and adequate exercise prevents early deterioration of muscle and function and improves endurance, size, and strength.

Muscles

Muscles’ function is to contract and relax. It doesn’t matter if that muscle is voluntary or involuntary. It is going to contract in one-way shape or another. 

The somatic nervous system is responsible for the voluntary movement of skeletal muscle, while the autonomic nervous system is responsible for involuntary action like that of smooth muscle [1].

3 Different Types of Muscle Tissue

There are three different types of muscle tissues. Each type of muscle also functions differently within different areas of the body. These are: 

  • Skeletal: As part of the musculoskeletal system, these muscles work with your bones, tendons, and ligaments. Tendons attach skeletal muscles to bones all over your body. Together, they support the weight of your body and help you move. You control these voluntary muscles. Some muscle fibers contract quickly and use short bursts of energy (fast-twitch muscles). Others move slowly, such as your back muscles that help with posture.
  • Cardiac: These muscles line the heart walls. They help your heart pump blood that travels through your cardiovascular system. You don’t control cardiac muscles. The heart tells them when to contract.
  • Smooth: These muscles line the insides of organs such as the bladder, stomach, and intestines. Smooth muscles play an essential role in many-body systems. These include the female reproductive system, male reproductive system, urinary system, and respiratory system. Different types of muscles work without you having to think about them. They do essential jobs like moving waste through your intestines and helping your lungs expand when you breathe.

Skeletal Muscle

Skeletal muscles consist of flexible muscle fibers that range from less than half an inch to just over three inches in diameter. These fibers usually span the length of the muscle. The fibers contract or tightens, allowing the muscles to move bones so you can perform lots of different movements.

Skeletal Muscles Structure

Each muscle can contain thousands of fibers. Different types of sheaths, or coverings, surround the fibers:

  • Epimysium: The outermost layer of tissue surrounding the entire muscle.
  • Perimysium: The middle layer surrounding bundles of muscle fibers.
  • Endomysium: The innermost layer surrounding individual muscle fibers.

Actin and myosin are both proteins that are found in every type of muscle tissue. Thick myosin filaments and thin actin filaments work together to generate muscle contractions and movement. 

Myosin is a type of molecular motor that converts chemical energy released from ATP into mechanical energy. 

This mechanical energy is then used to pull the actin filaments along, causing muscle fibers to contract and, thus, generate movement.

What does skeletal muscle look like?

Skeletal muscle fibers are red and white. They look striated, or striped, so they’re often called striated muscles. Cardiac muscles are also striated, but smooth muscles aren’t.

How healthy is skeletal muscle?

Although skeletal muscles typically make up roughly 35% of your body weight, this can vary from person to person. Men have about 36% more skeletal muscle mass than women. People who are tall or overweight also tend to have higher muscle mass. Muscle mass decreases with age in both men and women.

Hypertrophy

In simple terms, hypertrophy just means “to make bigger.” It is the opposite of atrophy which is to make smaller. When we talk about hypertrophy in muscles, we mean muscle growth. Muscle growth and hypertrophy is the primary goal of why people work out and train. 

When you talk about muscular hypertrophy, it is different from just gaining strength. Although with hypertrophy comes more strength, it is a different concept and different mode of work than strength training [2].

  • Hypertrophy is done to increase the size of a muscle
  • Strengthening is done to increase the ability to produce force

2 Different Types of Hypertrophy

1. Myofibrillar hypertrophy

  • This type of muscular hypertrophy involves increasing the number of protein filament bundles known as myofibrils. Myofibrils help the muscle contract and relax. Increasing myofibrils boost muscular strength. With myofibril hypertrophy, the muscle also becomes denser [3].
  • Growth of muscle contraction parts.

2. Sarcoplasmic hypertrophy

  • You can also increase the volume of fluid within the muscle. This is called sarcoplasmic hypertrophy. The fluid provides the energy the muscle needs during weight training. Similar to how adding water to a balloon makes the balloon grow, more fluid in the muscle makes it look bigger [4].
  • Increased muscle glycogen storage.

How to Build Muscle?

There are many ways to muscle growth and hypertrophy and strengthen muscle, but we want to focus on how to maximize hypertrophy. 

1. Diet and Sleep 

You need proper fuel and rest to build muscle. There has always been a debate between carbs, proteins, and fats.  With so many diets out there, you should not solely rely on one of them. 

The main thing to always keep in mind when it comes to the human diet is that we need all the macronutrients. It would help if you ate carbs, proteins, and fats. Neglecting any one of those will directly impact not only your muscle growth but your overall health.

Proteins get broken down into amino acids that are the building blocks of all our cells. Carbs are your body’s primary source of fuel. Fats are required for hormone function. Many studies show the benefit of eating a higher amount of protein when trying to build muscle. 

Research indicates that achieving muscle hypertrophy requires balancing muscle protein synthesis and muscle protein breakdown. Additionally, consuming protein within 24 hours of weight training can provide a positive net balance. 

This net balance supports muscle growth. Follow your workouts with higher protein meals or shakes to give the body the nutrients to achieve maximum hypertrophy.

Carbs are beneficial for:

  • Carbs prevent muscle weakness
  • It can prevent muscle degradation
  • Carbs help muscles recover from exercise

Recommended Protein Intake for Muscle Growth and Hypertrophy

  • Individuals in Energy Balance
  • Consume ~0.4 g/kg body mass (i.e., 0.24 plus 0.06 with protein added to account for the influence of other macronutrients in meals and protein quality), to maximally stimulate muscle protein synthesis (MPS) following a period of rest or exhaustive resistance exercise.
  • Spacing protein-containing meals ~3–5 h throughout the day maximizes MPS rates over the course of a 12 h (i.e., waking) period.
  • Practice pre-sleep protein ingestion (1–3 h prior to sleep) to offset declines in MPS that would occur during an overnight fasting period.
  • To maximize muscle protein accretion with resistance exercise, daily protein intakes should be ~1.6 g/kg/day and up to 2.2 g/kg/day. This intake can be achieved by ingesting 3 meals, each containing ~0.53 g/kg protein, or 4 meals containing ~0.4g/kg protein.
  • Individuals in Energy Restriction
  • Daily protein requirements are greater than they are during periods of energy balance to promote the maintenance or increase in lean body mass.
  • Resistance exercise should be performed during energy restriction to promote the retention of lean body mass if desired.
  • For athletes cutting weight over an extended period, high-quality protein sources such as whey and casein, or a blend of each, should be chosen to optimize appetite control and ensure dietary compliance.
  • Protein intakes of ~2.3–3.1 g/kg/day have been advocated to promote leaner body mass retention during weight loss. Exercise-naive adults who have a more significant body fat percentage should aim to achieve the lower end of this range. However, leaner individuals with resistance-training experience who are more vulnerable to losing lean body mass during energy restriction should aim for the higher end of this range [5].

2. Exercise

With exercise, muscle growth and hypertrophy are induced. What causes it is “as calcium is released in higher quantities with each contraction induced by the neuron, calcium binds to calmodulin, which activates calmodulin kinases (CaMKs), and in turn, activates Akt, which activates protein synthesis via mTOR and the inhibition of glycogen synthase pathways.”

Muscle growth is achieved when a combination of things occurs: muscle damage and repair, mechanical tension through stretch and force, and the build-up of metabolites like lactate, hydrogen ions, creatine, and others. 

Metabolite accumulation can occur as lactate, hydrogen ions (lowering pH), and phosphate molecules accumulate within the cell. The collection of these, and likely others (like creatine), metabolites in the cell shows an increased expression of Insulin Growth Factor-1 (IGF-1).

This increases the proliferation of satellite cells and increases protein synthesis via the Akt pathway. Also, the increase in growth hormone (GH) further increases the release of IGF and the release of Interleukin-6 (IL-6) for different effects on satellite cell recruitment.

How Muscles Work During Exercise

To be able to return for another bout of exercise, the trauma to the muscle leads the cell to release calcium (likely due to damage to the sarcoplasmic reticulum) into the surrounding extracellular area; this release of calcium leads to the activation of an immune response.

As soon as one hour after this event, neutrophils go through phagocytosis and clean up the debris of dislodged and broken organelle proteins caused by the stress put on the myocyte. 

24-48 hours after myocyte damage, macrophages are the dominant immune cells finishing phagocytosis and releasing cytokines and growth factors to activate other immune clean-up cells and the repair process.

These cytokines, Interleukin-1, 6, and tumor necrosis factor (TNF), are the regulators of inflammatory response and communicate more or less the need for further necrosis and inflammation between immune cells. 

Growth factors such as growth hormone (HGH), insulin-like growth factor (IGF), fibroblast growth factor (FGF), and hepatocyte growth factor (HGF) are released to begin the repair process.

Main Concepts and Strategies When Exercising

To accomplish muscle growth and hypertrophy you have to induce some kind of physical activity. The main concepts and strategies to think about when creating a program or just in exercise are:

1. Engage in strength training regularly.

You can’t just work a muscle once and expect it to grow. It needs to be stressed repeatedly over time. Resistance training at least three times per week can provide the tension necessary for the muscle to adapt and grow. Constantly doing the same exercise over again is an excellent place to start. Over time repeating the same workout does lead to fewer results, so it is essential to switch up the routine.  

2. Increase resistance over time.

Starting with lighter weights gives the muscle time to adjust to a new weight training program. But once that weight becomes easy to lift, it needs to be increased if the goal is hypertrophy. The general rule is to increase your weight by about 5-10% to prevent injury.

3. Aim to overload the muscle or muscle group.

If you walk out of your weight training sessions feeling as if you could go through the sets and reps again, you’re not overloading your muscle enough. While you don’t want to go to the point of pain, growing muscle requires a certain level of overload. During your workout, aim to push your muscle as much as possible while still being safe.

4. Lift heavy for higher reps.

A hypertrophy workout involves lifting fairly heavy weights. You also want to shoot for higher reps than if your goal was strength. Again, you have to overload the muscles to a certain extent if you want them to grow [6].

5. Sets and repetitions.

Start muscle growth and hypertrophy with two to three sets of ten to 15 reps, completing repetitions at a manageable but challenging weight. So if you are doing three sets of 12 repetitions, the weight you use should be heavy enough that you cannot do more than 12 reps, but not so heavy that you cannot get to 12. If you know your one-rep max and have the basics of working out down, you should be looking to lift between 65%-75% of your 1RM for eight to 12 reps for three to six sets.

6. Reduce your rest periods.

The rest time between sets changes based on whether the goal is to increase muscle size or strength. The recommended rest period is generally between two and five minutes for strength increases. This period is shortened to 30 to 90 seconds to increase muscle size.

7. Allow adequate time for muscle recovery.

Getting enough recovery time is critical to building bigger muscles. It is during this recovery that muscle damage is repaired. Therefore, if you don’t allow enough time for this repair to occur, not only will muscles not reach their maximum size, but you also risk injuring them. Allow 24 to 48 hours before working for the same muscle group again [7]

Muscle Soreness

Many people have sore muscles after working out. The soreness results from tiny tears (microtears) occurring when you put stress on a muscle. Usually, muscle soreness sets in a day or two after vigorous exercise. This condition is why providers call this condition delayed onset muscle soreness (DOMS).

The muscle tissue becomes inflamed as the muscles repair themselves and the tiny tears heal. Your muscles recover within a few days, and the inflammation goes away. With continued exercise, the muscle tissue tears and rebuilds again and again.

To watch the full episode on Muscle Growth and Hypertrophy, click here for more 👇

TIME STAMPS:

00:00 Intro
00:49 Plugs
02:11 Episode Introduction
06:05 Different types of muscle tissue
07:20 The skeletal muscle structure
11:48 What is hypertrophy?
15:55 How to build muscles and maximize hypertrophy?
18:43 Building muscles: Carbohydrates
20:33 Building muscles: Protein
24:42 Protein recommendations for building muscles
29:32 A Scientific explanation of how hypertrophy works
34:06 Things you can do to maximize hypertrophy.

EP 158: Ventilator Settings for Nurses

EP 158: Ventilator Settings for Nurses

Ventilator Settings for Nurses

In today’s episode, we will talk about ventilators and how they can help healthcare professionals treat patients. Not every nurse will have a patient on a ventilator or work directly with it, but most emergent situations require one. It is always good to at least know the basics of a ventilator, so as a nurse, you know how you can use it if a situation arises. 

Mechanical Ventilation

Mechanical ventilation is an invasive way to provide oxygen to someone who is unconscious or needs help breathing. This machine is usually seen around ICUs or hospice care settings.

A mechanical ventilator is a machine that assists with oxygenation and directly inflates and deflates the lungs. It is used in a variety of situations like surgery and emergencies. 

Ventilator settings are inputs on a machine that determines how much support the patient needs. When we program a ventilator to a specific setting, we account for two things: oxygenation and ventilation.

  • Ventilation is the process of inhaling and exhaling.
  • Oxygenation is the process of adding oxygen to the body [1].

When is Mechanical Ventilation Needed?

  • Respiratory failure
  • failure to oxygenate
  • Failure to ventilate
  • Airway protection
  • Concerning findings include:
    • Respiratory rate > 30/minute
    • Inability to maintain arterial oxygen saturation > 90% pH < 7.25
    • PaCO2 > 50 mm Hg (unless chronic and stable)

Respiratory Mechanics

The normal inspiration generates negative intrapleural pressure. In return, this creates a pressure gradient between the atmosphere and the alveoli that result in airflow. In mechanical ventilation, the pressure gradient results from increased (positive) pressure of the air source.

Peak airway pressure

  • The peak airway pressure is measured at the airway opening and is routinely displayed by mechanical ventilators.
  • It represents the total pressure needed to push a volume of gas into the lungs and is composed of pressures resulting from inspiratory flow resistance (resistive pressure).
  • The elastic recoil of the lung and chest wall (elastic pressure), and the alveolar pressure present at the beginning of the breath (positive end-expiratory pressure, PEEP)
  • Peak airway pressure = resistive pressure + elastic pressure + PEEP

Resistive pressure

  • Resistive pressure is the pressure from the circuit resistance and airflow. In the mechanically ventilated patient, resistance to airflow occurs in the ventilator circuit, the endotracheal tube, and, most importantly, the patient’s airways.

Elastic pressure

  • The pressure of the elastic recoil of the lungs and chest wall and the volume of gas delivered. For a given volume, elastic pressure is increased by increased lung stiffness (as in pulmonary fibrosis) or restricted excursion of the chest wall or diaphragm (eg, intense ascites or massive obesity). Because elastance is the inverse of compliance, high elastance is the same as low compliance.

End-expiratory pressure 

  • The end-expiratory pressure In the alveoli is normally the same as atmospheric pressure. However, when the alveoli fail to empty completely because of airway obstruction. It could be airflow limitation, or shortened expiratory time, end-expiratory pressure may be positive relative to the atmosphere. 
  • This pressure is called intrinsic PEEP or autoPEEP to differentiate it from externally applied (therapeutic) PEEP. It is created by adjusting the mechanical ventilator or by placing a tight-fitting mask. This mask applies positive pressure throughout the respiratory cycle.
    • The pressure is given in the expiratory phase to prevent the closure of the alveoli and allow increased time for O2 exchange.
    • Used in pts who haven’t responded to treatment and are requiring a high amount of FiO2.
    • PEEP will lower O2 requirements by recruiting more surface area.
    • Normal PEEP is approximately 5cmH20. Can be as high as 20cmH20.

Intrinsic PEEP (auto-PEEP) 

  • Intrinsic PEEP or auto-PEEP can be measured in the passive patient through an end-expiratory hold maneuver. Immediately before a breath, the expiratory port is closed for 2 seconds. Flow ceases, eliminating resistive pressure. Thus resulting pressure reflects alveolar pressure at the end of expiration (intrinsic PEEP). 
  • Accurate measurement depends on the patient being completely passive on the ventilator. It is unwarranted to use neuromuscular blockade. Solely for the purpose of measuring intrinsic PEEP. 
  • A non-quantitative method of identifying intrinsic PEEP is to inspect the expiratory flow tracing. Check if the expiratory flow continues until the next breath of the patient. If the patient’s chest fails to come to rest before the next breath, intrinsic PEEP is present. 
  • The consequences of elevated intrinsic PEEP are increased inspiratory work of breathing and decreased venous return. This may result in decreased cardiac output and hypotension.

Airway Management

  • Airway cuffs
    • An inflated cuff helps with holding the airway in place
    • Reduces tidal volume loss
    • Decreases chance of aspiration
    • If a patient can speak, makes a weird noise from the cuff, or loses tidal volume, the cuff most likely needs more air. 

Ventilator Settings and Modes

When you’re looking at the ventilator screen it can be a little overwhelming at first. There are a lot of numbers, letters, and words. It is important to also not change any of those settings if you are unsure about operating it [2]. 

Ventilator Settings

Tidal volume

The tidal volume is the amount of air moving in and out of the lungs. The average adult breathes about 7 milliliters per kilogram of body weight. For males, the average Vt is 500 ml and for females about 400 ml.

  • Minute ventilation
    • The amount of volume inhaled and exhaled over 60 seconds. The average range is between 4 and 6 liters.
    • VE can be increased by taking deeper breaths or increasing the respiratory rate.
  • Alveolar ventilation
    • VA is similar to VE but without including dead space. Dead space is the air that is not undergoing active gas exchange. 
    • VA can be increased by breathing harder.

When the volume is too high, there is a risk of overinflation. However, when the volume is too low, it allows atelectasis. 

Frequency (Rate)

Respiratory rate is the number of breaths per minute. The average amount of breaths a person takes is 16. The vent can be programmed to deliver x amount of breaths a minute. 

FiO2

The FiO2, or fraction of inspired oxygen, is the concentration of oxygen that is being inhaled by the patient. The FiO2 of room air is about 21%. It is good to know that when you use a flow rate of 1 as it increases the FiO2 to 24%. For every liter, after that, it increases FiO2 by 4%. 

  • For patients with severe hypoxemia, a FiO2 of 100% may be required when mechanical ventilation is initiated. But your goal should be to wean the FiO2 down to the lowest possible level. That way, it provides adequate oxygenation. If a patient receives a FiO2 > 60% for a prolonged period of time, it increases their chances of oxygen toxicity.

Flow Rate

The inspiratory flow rate is a rate that controls how fast a tidal volume is then delivered. The ventilator setting can also adjust depending on the patient’s inspiratory demands
 
The normal inspiratory flow rate should be set at around 60 L/min. With that said, most ventilators can deliver up to 120 L/min if a patient needs a prolonged expiratory time. This is necessary when obstructive diseases are present.
  • If the flow rate is set too low, it could result in patient-ventilator dyssynchrony and an increased work of breathing. 
  • If the flow rate is set too high, it could result in decreased mean airway pressures.

I:E Ratio

The I:E ratio refers to a ratio of the inspiratory portion compared to the expiratory portion of the breathing cycle.

  • For patients on the ventilator, the normal I:E ratio is between 1:2 and 1:4. A larger I:E ratio may be delivered if a patient is in need of a longer expiratory time. It could be due to the possibility of air trapping.
  • The I:E ratio can be adjusted by making changes to the flow rate, inspiratory time, expiratory time, tidal volume, and frequency settings. 

Sensitivity

The sensitivity control determines how much effort (negative pressure) the patient must generate. This sensitivity can trigger a breath from the machine.
 
A normal sensitivity setting should be set between -1 and -2 cmH2O. If the sensitivity is set too high, it will cause the ventilator to start auto-triggering.
 
In return, it will increase the total frequency of breaths. If it’s set too low, the patient could have a difficult time initiating a breath.

Differences between PEEP, Pip, Pplat, and Alarms

PEEP

​​PEEP is a positive pressure delivered during the expiratory phase of the breathing cycle. It delivers breathing to prevent the closure of alveoli. It also allows increased time for oxygen exchange to occur.
 
It’s indicated for patients with refractory hypoxemia, and those who have not responded well to a high FiO2.

Peak Insp. Pressure (Pip)

Pip is the maximum pressure during inspiration. The goal is to have it under 35, with the goal of preventing lung injury. 

Plateau Pressure (Pplat)

Pplat measures lung compliance. This is measured at the end of inspiration with a hold, the goal is to have it under <30. 

Alarms

A ventilator alarm is a safety mechanism on a mechanical ventilator. It uses set parameters to provide alerts whenever there is a potential problem. This problem could be related to the patient-ventilator interaction.

  • High Pressure
  • Low Pressure
  • Low Expired Volume
  • High Frequency
  • Apnea
  • High PEEP
  • Low PEEP

Primary Control and Modes

In mechanical ventilation, there are two primary control variables [3]:

1. Volume Control

Volume Control means that you can set (or control) the patient’s tidal volume.
 
So with a set tidal volume and a set respiratory rate, this means that there is minute ventilation. This is good when it comes to making adjustments to achieve the desired PaCO2.
  • The cons of using Volume Control are, that the tidal volume is preset, and a patient’s lung is weak. It can result in high peak pressures.
  • Another drawback of Volume Control is patient-ventilator dyssynchrony.

2. Pressure Control

Pressure Control means that you can set (or control) the patient’s pressure to achieve a desired tidal volume.
 
As with Volume Control, a Pressure-Controlled tidal volume and set rate can help you reach the desired PaCO2.
 
  • The main disadvantage of using pressure control is the patient’s tidal volume. It can be unstable if there are changes in the patient’s lung compliance or airway resistance.
 
Volume Control and Pressure Control — are the two control variables. When initiating mechanical ventilation on a patient. Once you select the control variable, you can now choose the actual operational mode. It will determine the pattern of breathing for the patient.
 
Assist/Control (A/C) Mode
In this mode, the smallest number of preset mandatory breaths is delivered by the ventilator. However, the patient can also trigger assisted breaths. The patient makes an effort to breathe and the ventilator assists in delivering it. 
 
With that said, this mode of ventilation does not allow the patient to take spontaneous breaths. In this mode, the operator can set either a controlled pressure or a controlled volume.
 
  • The sensitivity control can also be adjusted to make it easier or harder for the patient to start a breath.

When to use a Ventilator

This mode is most often used when mechanical ventilation is first initiated for a patient. It provides full ventilatory support for the patient.
  • One of the advantages of using Assist/Control is that it keeps the patient’s breathing needs very low.
One of the major complications of Assist/Control is hyperventilation. This complication results in respiratory alkalosis. It is also the result when the patient has too many breaths. This is whether patient-triggered or machine-triggered.

Synchronous Intermittent Mandatory Ventilation (SIMV) Mode

In this mode, the ventilator delivers a preset small number of mandatory breaths. But, it also allows the patient to start spontaneous breaths between the mandatory breaths. This mode also allows the operator to set either a controlled pressure or a controlled volume

When to Use SIMV?

The primary sign of SIMV is when a patient needs partial ventilatory support. Since the patient can now take spontaneous breaths, they can also contribute to some of their minute ventilation. SIMV is a mode that is often used for weaning as well.

Advantages of Using SIMV

Because the patient can do spontaneous breaths, their respiratory muscle strength returned. It also helps the patient avoid muscular atrophy.
 
It distributes tidal volumes throughout the lung fields, which reduces V/Q mismatching. Besides that, it also helps to decrease the patient’s mean airway pressure.

To catch up on the full episode of Ep. 158, click here for more 👇

TIMESTAMP

00:00 Intro
00:45 Plugs
02:04 Podcast Introduction
04:19 When is Mechanical Ventilation Needed?
07:59 Respiratory Mechanics
10:14 Peak Airway Pressure
12:41 End-expiratory pressure
13:31 Intrinsic PEEP (auto-PEEP)
15:21 Air management Tips
17:42 Mode & Settings: Tidal Volume Mode
21:56 Mode & Settings: Frequency (Rate)
22:59 Mode & Settings: FiO2 – Fraction of Inspired Oxygen
26:27 Mode & Settings: Flow Rate
27:53 Mode & Settings: I:E Ratio
30:12 Mode & Settings: Sensitivity
32:27 Mode & Settings: PEEP
34:51 Primary Control and Modes: Volume Control
37:13 Primary Control and Modes: Pressure Control
38:23 Primary Control and Modes: Assist/Control (A/C) Mode
39:23 Primary Control and Modes: Synchronous Intermittent Mandatory Ventilation (SIMV)
42:56 Learn the basics
45:45 Dealing with ventilator alarms
46:28 Criteria for weaning off the ventilator
54:16 Wrapping up the episode

Men Talk: The Decline of Serum Testosterone Levels

Men Talk: The Decline of Serum Testosterone Levels

The Decline of Serum Testosterone Levels 

In this episode, we will talk about the decline of serum testosterone levels among young Adult Men in the USA. Testosterone is a sex hormone that plays a vital role in the body. It regulates the sex drive, bone mass, and fat distribution.

In addition to that, testosterone is responsible for muscle mass and strength. It is also in charge of sperm production and red blood cells. And small circulating testosterone is converted by the body to estradiol, a form of estrogen.

Mammals have >95% of T fused by Leydig’s cells of the testes and are regulated through the hypothalamic-pituitary-testicular (HPT) axis.

The adrenal glands also produce testosterone but in small amounts. However, the amount produced depends on gender. So, it means different areas have different amounts.

A Decline of Serum Testosterone Levels in Men

A study from 1999 to 2016 showed that the testosterone levels in young adult men and adolescent males with an average body mass index resulted in a decline, as presented in the 2020 American Urological Association Virtual Experience

The reason for this decline in testosterone level is attributed to age. It means that the decrease in these levels is time-dependent. However, the overall reduction in testosterone levels is caused by multiple etiologies. 

Researchers used data from the National Health and Nutrition Examination Surveys (NHANES) dating from 1999 to 2016 to analyze serum testosterone level changes in 40-45 AYA males. 

This study found a few factors affecting the decline of serum testosterone levels. These are as follows:

  • Age
  • Race
  • BMI
  • Comorbidity status
  • Alcohol intake
  • Smoking
  • Physical activity levels

Here are acceptable testosterone levels for men by age group

  • Early Teens: Between 12 to 13 years old, a person should have 7-800 ng/dL. But by 15 to 16 years old, the ng/dL should be 100-1,200.
  • Late Teens: Anyone between 17 to 18 years old have normal testosterone levels between 300 and 1,200 ng/dL.
  • Adults: An adult (19 years and older) should have anywhere between 240 and 950 ng/dL.

Mean Total Testosterone Decrease: 

  • 1999-2000 (605.39 ng/dL)
  • 2003-2004 (567.44 ng/dL)
  • 2011-2012 (424.96 ng/dL)
  • 2013-2014 (431.76 ng/dL)
  • 2015-2016 (451.22 ng/dL)

An increased BMI is associated with decreased total testosterone levels (P < .0001), with the mean BMI increasing from 25.83 in 1999-2000 to 27.96 in 2015-2016 (P = 0.0006). 

It was noted that even men with an average BMI of 18.5-24.9 had declining total testosterone levels of P < .05 during the same time frames.

Limitations of the Study

The study was a cross-sectional study design, a type of observational study. It is self-reported activity leading to potential bias and testosterone levels are only measured once. However, there were no results given on the participant’s symptoms. It is also the most extensive study of its kind.

Potential Causes Of Decline of Serum Testosterone

  • Increased Obesity/BMI
  • Diet/phytoestrogens 
  • Declined physical activity
  • Fat percentage
  • Marijuana use 
  • Environmental toxins

Increased Obesity/BMI

People with moderate obesity have decreased total testosterone. This decrease could be due to insulin resistance that is associated with reductions in sex hormone-binding globulin. Severe obesity connects with reductions in free testosterone levels.
 
Researchers believe it is due to a suppressed hypothalamic-pituitary-testicular axis. Obesity also affects iron metabolism and overactivity. It can further contribute to low circulating total T levels.

Diet

A small study conducted in 2016 investigated the dietary patterns associated with serum total T levels and their predictive effect on hypogonadism (low sex drive) and body composition.

Anthropometry, blood biochemistry, and food frequency questionnaires were collected for 125 adult men [1].

People whose diet is mainly composed of bread, pastries, and dairy products and those who rarely eat homemade food or dark green vegetables are most likely at risk for unhealthy body composition.

When the body composition suffers, it can increase visceral fat and decrease skeletal muscle mass. This result can also lead to lower serum total T levels.

How do endocrine disruptors affect the body?

When absorbed in the body, an endocrine disruptor can decrease or increase normal hormone levels, mimic the body’s natural hormones, or alter the natural production of hormones.

Examples: BPA, PFAS, Phytoestrogens, Phthalates, Triclosan &, etc.

Stress Levels Contributes to Decline of Serum Testosterone Levels

Stress can raise your cortisol, which is a hormone that can lower your testosterone once elevated. Reducing stress also reduces testosterone production. So if you want to reduce stress, you must get enough sleep and live a more balanced lifestyle. Exercising also helps and so does proper nutrition in your diet. 

Doing Physical Activity

A 2016 study of men with obesity found that regular exercise increased T levels than even losing weight. 41 overweight and obese men completed a 12-week lifestyle modification program (aerobic exercise training and calorie restriction).

They measured serum testosterone levels, the number of steps, and the total energy intake [2]. The best exercises to increase T levels are resistance and high-intensity interval training (HIIT). 

One study in men found that interval training helps in boosting T levels. The training consists of 90 seconds of intense treadmill running interspersed with 90 seconds recovery periods.

Results show a significant increase in T levels compared to running on the treadmill for 45 minutes straight [3]. So, to rise the T levels in your body, you must do intense exercises for half an hour or so. Running on the treadmill helps but it might slow down your T-level production. 

Doing cardio has no evidence that it can impact your T-levels, no matter the gender. However, too much cardio may lower your T-levels. 

Can Marijuana Cause a Decline of Serum Testosterone Levels?

A study from 2020 using National Health and Nutrition Examination Survey (NHANES) data from 2011-2016 had some interesting outcomes. They have studied men who are regular marijuana users and how it had impacted their testosterone levels.

This study had identified all men 18 years old and above who answered the substance use questionnaire and underwent laboratory testing for T levels.

In addition to that, regular THC users were defined as those who use THC at least once per month, every month for at least a year. Does this mean marijuana helps increase the T levels? 

Among 5,146 men who met inclusion, 3,027 endorsed using THC at least once in their lives (ever-user). Nearly half of the THC ever-users (49.3%) were regular THC users.

THC use is associated with small increases in testosterone. This means that the rise in T appears to decline as THC use increases. However, T is still higher with any amount of regular use when compared to T in non-users.

Furthermore, this increase was represented by an inverse U-shaped trend with Regular THC users using two-three times per month. It demonstrates the most significant increase in T (+ 66.77 ng/dL) over non-users [4].

Men who smoke it regularly are twice as likely to have sperm with abnormal shape and size. According to one study, males who smoke marijuana at least once a week experienced a reduced sperm count.

Conclusion: 

What you believe you believe is what you become. If you think you’ll lose intelligence by basking in the sun, you probably will. The hippocampus is 90% affected by what you believe and your confidence, in my case, at least.

If you believe that you’re smarter than Einstein, your neurons will fire corresponding signals, and you’ll be seriously reading and studying. It’s all about self-discipline and determination. 

To watch the full episode of Ep. 94, check out our latest by clicking here 👇

TIME STAMPS:

00:00 Intro
00:52 Plugs
02:11 Episode Introduction
04:02 What is testosterone?
06:00 The fun and exciting time of puberty
07:47 The Decline of Serum Testosterone Levels
11:01 The acceptable testosterone levels for men by age group
13:17 Testosterone decreased by 150 points
15:34 Potential cause of testosterone decrease
15:57 1. Obesity
18:39 2. Diet
20:48 3. Environmental Toxins
22:21 4. Stress
23:19 5. Physical Activity
25:26 6. Marijuana use
29:13 Conclusion
31:54 Wrapping up the episode

EP 156: How to Overcome Imposter Syndrome With Crystal Grant

EP 156: How to Overcome Imposter Syndrome With Crystal Grant

How to Overcome Imposter Syndrome

Have you ever felt like you are never good enough or good at something? Did you ever feel like you are not doing as much as others thought you to be? If you feel like a fraud or do not belong anywhere, you might be suffering from Imposter Syndrome. 

No matter your social status, race, background, skill, level of expertise are, anyone can suffer from this. We must arm ourselves with knowledge and educate others to help those who are struggling with impostor syndrome. 

Overcome Imposter Syndrome

But what is imposter syndrome anyway? How do you know if you are suffering from one? In this new episode, we would like to introduce our guest, Crystal Grant. She is a CRNA, CEO of Superscript Wellness, and author of several books. 

Crystal has also worked in the healthcare system for over 20 years and now coaches nurses and CRNAs about imposter syndrome and how to overcome it. 

She currently has a new book coming out called A CRNA’S Guide to Overcoming Imposter Syndrome. Besides working with nurses and CRNAs, she also has her line of Vitamin gummies. 

So, sit back, relax and enjoy another great episode with your favorite Cup of Nurses! 

QUESTIONS FOR OUR GUEST:

  1. Can you give some background about yourself and how you got to the position you are in today?
  2. How was life growing up? What were some of your goals in life? How have they varied over the years?
    – When we finished nursing school we were making a decent amount of money, we came out with minimal loans and we were making more money than a lot of our friends. When we looked back at where we were at the age of 21/22 compared to a lot of other people it felt like night and day. It still feels that way to this day.
  3. What is Imposter Syndrome? Do you think it comes with success?
    – Imposter Syndrome is a psychological pattern in which an individual doubts their skills, talents, or accomplishments and has a persistent internalized fear of being exposed as a “fraud”.
  4. With many psychological issues like depression and anxiety, is there a genetic predisposition to imposter syndrome? Or is there something that happens in childhood that makes people more susceptible to imposter syndrome?
  5. With the age of neuroplasticity, we can almost reprogram our brain to react differently. How can we use the concept of neuroplasticity to help us with imposter syndrome or other negative thinking?
    – Neuroplasticity is the ability of the brain to form and reorganize synaptic connections, especially in response to learning or experience or following injury. 
  6. We are holistic beings which means how we feel physically affects us mentally and how we treat ourselves mentally reflects on us physically.
    – How important is physical health? The importance of nutrition, exercise, and supplementation. 
  7. What are some of the ingredients in the gummies you’ve created and what are the benefits of micronutrients? 

To watch the full episode about How to Overcome Imposter Syndrome, click here and learn more 👇

 

You can also find Crystal on Instagram at @thecrystalgrant. Her book titled Overcoming Imposter Syndrome is currently available at thecrystalgrant.com. And to those interested to buy her vitamin gummies, check out superscriptwellness.com and walmart.com for more. 

TIMESTAMP:

00:00 Intro
00:47 Plugs
02:03 Episode Introduction
02:35 About Crystal
04:47 Can imposter syndrome be beneficial to someone who has it?
06:38 What happens to a person who has imposter syndrome?
09:32 Imposter Syndrome: The Perfectionist
11:28 How and when did Crystal know that she had imposter syndrome?
15:02 The 5 Types of Imposter Syndrome
17:19 How does a person get imposter syndrome?
21:26 Ways to Overcome Imposter Syndrome?
24:04 Neuroplasticity: Rewiring the brain
26:44 The best investment is in yourself.
32:53 Mindfulness and meditation can help fight Imposter Syndrome.
35:27 The lack of self-belief
37:29 How did Crystal become an entrepreneur?
39:32 How to get into the supplement business?
42:58 Built for nursing, built for success.
47:32 Where to find Crystal?

 

 

Understanding Disorders of Consciousness

Understanding Disorders of Consciousness

Understanding Disorders of Consciousness

Encephalopathy, delirium, and coma are disorders of consciousness (DOCs) frequently encountered by critical care nurses. 

For nurses in the hospital setting being able to have knowledge of encephalopathy, delirium, and coma is important in improving patient outcomes. Furthermore, it is also vital to perform standardized assessments and interventions that are consistent with the cue-response theory. 

What is the State of Consciousness? 

Plum and Posner’s Diagnosis book define consciousness, that is, being fully aware of the self and the environment, as having 2 aspects, content and arousal. 

The content of consciousness is defined as “the sum of all functions mediated at a cerebral cortical level.” The content of consciousness includes cognition, which reflects how well information is processed and stored across the 2 cerebral hemispheres.

Arousal, on the other hand, refers to the level of consciousness or state of being awake. Consciousness and responsiveness are separate phenomena. Some patients may be aware but not able to respond (eg, locked-in syndrome), and patients may respond to stimuli but not be aware of their surroundings.

Based on current research the thalamocortical interactions are crucial for consciousness experience and voluntary action. The thalamocortical system is made up of the Thalamus and Cerebral Cortex.

For Refresher: 

Thalamus – the primary function of the thalamus is to relay motor and sensory signals to the cerebral cortex.

Cerebral cortex – many areas of the cerebral cortex process sensory information or coordinate motor output necessary for control of movement. 

The Brain

The brain, like other organs, has a limited capacity to withstand injury. The brain reacts to acute stress that can result from:

  • Toxins
  • Infections
  • Inflammations
  • Metabolic or nutritional derangements
  • Use of nutrients, glucose, electrolyte level, hydration, or structural damage

 

A stress response results in multiple cellular-level processes and neurochemical changes that disrupt equilibrium.

This disequilibrium initiates multiple cascades that become a vicious cycle of competition between supply and demand, which are depicted as neuroelectrical changes on an electroencephalogram (EEG).

When the brain can no longer compensate, behavioral symptoms such as altered levels of arousal and disorganized thinking begin to develop.

Progression of Disorders of Consciousness

  1. Delirium 
    1. Delirium is a neurocognitive disorder that presents as an acute change in behavior secondary to impairments in consciousness and cognition. There are 3 types of delirium: hyperactive, hypoactive, and mixed.
    2. Regardless of delirium type, individuals are often disoriented to place and time and have impairments in cognitive and visual-motor functions.
    3. Patients with hyperactive delirium tend to have greater disturbances in their circadian rhythm (ie, sleep-wake cycle) and mood lability. Conversely, patients with hypoactive delirium are more likely to be inattentive, have a flat affect, and face challenges with language.
  2. Coma
    1. Like delirium, coma is on the continuum of altered states of consciousness. However, with a coma, there is a loss of both awareness and wakefulness
  3. Minimal consciousness state
  4. Persistent vegetative state 

ICU Synposis of Consciousness

When a patient has an altered consciousness, after 2 to 4 weeks, the individual will either progressively recover, die, or transition to a minimally conscious or more persistent vegetative state.

Encephalopathy 

The term encephalopathy is derived from 2 ancient Greek words: “enkephalin”, which means “brain,” and pathos, which means “suffering” and is associated with the disease.

Encephalopathy is defined as any diffuse disease of the brain that alters brain function or structure with the “hallmark feature being altered mental status.”

Although the phrases altered level of consciousness and altered mental status are often used interchangeably with encephalopathy, they are not the same. For example, sleep is an altered level of consciousness but is not caused by injury or disease.

Chronic Encephalopathy

Chronic encephalopathy is the result of permanent, usually irreversible, structural changes within the brain. The characteristics of chronic encephalopathy are prolonged alterations in mental status that usually progress slowly.

Examples of these are brain conditions such as Alzheimer’s disease and other dementias or anoxic brain injury. Acute encephalopathy results from the rapid development of abnormalities in cerebral structure and/or function.

Level of Function
Function Coma Minimally 

conscious

Vegetative state
Self-aware No Very limited No
Motor Not purposeful Severely limited Not purposeful
Respiratory Variable but depressed Variable but Depressed Normal
Sleep-wake cycles No Yes Yes
Feels pain No No

Yes 

 

 

The Mechanism Responsible (DOC’s)

  • Interruptions in the delivery or use of oxygen
  • Changes in neuronal excitability
  • Signaling alterations and changes in brain volume. 

Potential Causes

  • Hypoxia
  • Ischemia
  • Toxic and metabolic disturbances
  • Acute organ failure
  • Seizures
  • Drugs and/or alcohol
  • Infection
  • Electrolyte imbalances.

Hypothalamic-pituitary-adrenal Axis 

Disorders of consciousness and illness severity are linked by the activity of the hypothalamic-pituitary-adrenal axis, which response to stress by impairing glucocorticoid and glucose metabolism.

The severity of the DOC is directly proportional to the levels of glucocorticoids and glucose in the blood that enters the brain (Stress response). In addition to that, the levels of these substances are directly proportional to the strength of the hypothalamic-pituitary-adrenal response, and that response is directly proportional to the severity of the illness.

Early  First Signs of Delirium Are Often:

  • Subtle changes in focus and attention, including distractibility, 
  • Delays in responding to stimuli
  • Short-term memory deficits
  • Disorientation

Prevention of Delirium in the Hospital

Nurses should pay particular attention to the following to prevent and resolve delirium:

  • Resuming home medications
  • Minimizing the use of chemical and physical restraints,
  • Providing adequate pain management and high-quality basic nursing care. 
  • Practice habits such as nighttime bathing, promoting uninterrupted sleep as well as day-time activity 
  • Hydration
  • Nutrition
  • Early mobility

Nursing Care for Comatose Patients in the ICU

  • Enteral tube feeding
  • Promotion of regularity of bowel and bladder functions
  • Airway management such as suctioning tracheostomy tube
  • Management of muscle tone (excessive tightness of muscles)
  • Prevention of infections such as pneumonia and urinary tract infection
  • Management of other medical concerns such as fever, seizures, etc

 

Source:
https://www.aacn.org/docs/cemedia/c2161.pdf

If you want to know more about the disorders of consciousness, check out our full episode here 👇

TIME STAMPS:

00:00 Intro
00:44 Plugs
02:31 Episode Introduction
04:35 What exactly is consciousness?
06:37 What happens to the brain?
11:38 Progression of disorders of consciousness
17:24 What is encephalopathy?
19:58 The mechanism responsible for the disorder
20:37 The Potential Causes of Consciousness Disorder
24:57 FUN FACT: How does DOC severity determine?
25:52 What are the early signs of delirium
28:54 How to prevent and resolve delirium
32:23 Nursing care for comatose patients in the ICU
33:55 Area management
35:10 Wrapping up the episode