Saturday, July 28, 2012

New Swimming Stroke Information

A recent Reuters article by Sharon Begley says it better than I could say it:


Olympics: Faster Swimmers Paddle Like a Duck
By Sharon Begley
NEW YORK (Reuters) Jul 18 - Olympic swimmers need to ignore their intuition when it comes to the best ways to propel themselves through the water to glory next week.
Scientists have made several discoveries about the mechanics of swimming since the last summer Games four years ago, refuting some seemingly obvious assumptions.
Take freestyle swimming. It seems that forming each hand into a tight cup maximizes the force it exerts on the water, while keeping the fingers apart produces a wimpier stroke.
Not so, explains Adrian Bejan, professor of mechanical engineering at Duke University in Durham, N.C. Inspired by animal locomotion, he and colleagues analyzed the force that fingers and toes generate when pulled through the water.
When the digits are separated by between one-fifth and two-fifths of their diameter, the force exerted is 50 percent greater than when they are pressed together with no spaces in between, Bejan and his team will report in an upcoming issue of the Journal of Theoretical Biology.
The reason involves something called a boundary layer. When fingers move through water, viscosity causes a thin stream of fluid to stick to (and move with) them rather than flow between them. As a result, slightly separating the fingers creates a wider surface than keeping them close together. Just as a wider oar pulls with greater force than a narrower one, so does a wider hand.
The greater force pulls the swimmer both forward and, on the down stroke, upward. The higher the body is above the water, the faster forward it can go, since air resistance is less than water resistance.
In addition, the higher you are, the faster forward you fall. Since the swimmer's fall from above the water's surface has a horizontal component as well as a vertical one, the greater height achieved with a more powerful stroke translates into greater forward velocity.
PADDLES OR PROPELLERS?
When it comes to arm positioning, coaches and swimmers spent decades debating the best technique for freestyle and backstroke. Conventional wisdom views the propeller-like "sculling" motion as superior, but new studies show that a paddle- like "deep catch" stroke is the quicker route to the medals podium.
In the sculling stroke, the elbow of a freestyle swimmer is raised high as the hand enters the water as vertically as possible. The arm moves inward toward the body and then outward, making an S shape.
"The arm stays bent, the hand enters the water in line with the shoulder, and after moving to the center of the body it moves out again," explained Rajat Mittal, professor of mechanical engineering at Johns Hopkins University in Baltimore.
Whether in a boat or a plane, a propeller also moves perpendicular to the direction of motion - that is, right and left. Perpendicular motion creates a lift force that pushes the boat forward.
The sculling stroke was popularized in the 1960s by the late James "Doc" Counsilman, an American Olympic and college swimming coach who was among the first to apply science to the mechanics of swimming. Counsilman reasoned that just as a propeller-driven boat can move faster than a paddle boat by generating lift, so the sculling stroke can produce lift that is more effective than the paddle stroke, in which the swimmer simply drives the hand into the water and pulls it back as hard as possible.

To see whether the sculling stroke deserved its popularity, USA Swimming provided Mittal and his graduate student, Alfred von Loebbecke, with underwater videos of America's elite swimmers using either the sculling or paddle stroke. The scientists used animation software to scan the swimmers' arms, from which they created computer simulations.
From the simulations, the scientists determined the lift forces and drag forces the swimmers' strokes produced. They describe the findings in a paper scheduled for publication in the Journal of Biomechanical Engineering.
Bottom line? "The deep catch stroke is more efficient and effective than the sculling stroke," said Mittal. In the backstroke, the deep catch stroke produced 18 percent more thrust than the sculling stroke. How much extra speed a swimmer can get from the extra thrust depends on factors such as a swimmer's shape and technique.
That is not to say the sculling stroke should be retired. Long-distance swimmers prefer it because it's easier to maintain for long periods.
Sprinters, however, generally favor the deep catch stroke, as can be seen in American Michael Phelps, who won a record eight gold medals in Beijing. He employs a modified version, keeping his elbow slightly bent as it pulls against the water. The straighter the arm, the greater the shoulder strength required to drag it back through the water. A slight elbow bend conserves energy for a last-yards power sprint.
Mittal also analyzed the dolphin kick, performed at the start and after each turn in the freestyle, backstroke, butterfly and breast stroke.
Contrary to expectations that the largest leg muscles would be the source of the kick's power, it turns out that 90 percent of the thrust in a dolphin kick comes from the ankles and feet. "The more you can make the lower part of your leg floppy like a dolphin fluke, the better your thrust," Mittal said.
SOURCES: http://bit.ly/Mt0zLf J Theor Biol 2012. http://bit.ly/MwNKU0
J Biomech Eng 2012.
Reuters Health Information © 2012 

Blood Pressure and 10 Minute Walks

A study published in the July 2012 issue of Medicine and Science in Sports and Exercise found that in individuals with pre-hypertension, breaking aerobic exercise up into several sessions throughout the day reduced their risk for hypertension and other cardiovascular disease. As an example, 3 ten-minute aerobic sessions, such as brisk walking, had a greater effect than a single 30-minute exercise session on maintaining a lower ambulatory blood pressure. Other studies have pointed out the ill effects of sitting for prolonged periods of time. Seems like more and more studies are indicating that we need to get up and move around throughout the day. 


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Dim Light and Depression

The July 24 issue of Molecular Psychiatry contains an animal study that showed that hamsters exposed to dim light at night for 4 weeks showed signs of depression, changes to their hippocampus found in depression, and an increase in the inflammatory marker tumor necrosis factor (TNF). Previous research has shown an association between dim light at night and breast cancer and obesity. Both of these conditions, along with depression, are associated with an increase in inflammation. The good news here is that the symptoms of depression were reversible when the animals were returned to a normal light-dark cycle. 


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How Protein Suppresses Appetite

High protein diets are successful, at least in the short term. Recent research published in the July 5 issue of Cell proposes a mechanism showing how protein suppresses appetite. When protein is ingested, it is broken down into peptides, or chains of amino acids. As an aside, stomach acid is necessary for this to occur optimally. People on acid-blocking or proton-pump inhibitor drugs do not break down proteins well. These peptides are also referred to as oligo-peptides. These oligo-peptides travel through the intestinal cells to the portal vein. There they act upon u (mu) receptors found in the portal vein nervous system at the intestinal outlet. Messages are sent to the brain, which in turn sends messages that trigger messages to begin gluconeogenesis, or the conversion of protein to glucose. This process itself causes an appetite suppressing message to be sent to the brain. 
I recommend that my patients eat some protein with every meal, including breakfast. It does help suppress the appetite, so that by the time the next meal comes along, you're not so ravenous and likely to overeat. 


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Cranberries

Cranberries are often recommended in order to prevent or help treat urinary tract infections. They are also known for their high flavonoid content (anthocyanin and proanthocyanidin). A recent study published in the July issue of the Journal of Food Science compared anthocyanin and proanthocyanidin content of processed and whole cranberries. Freeze drying resulted in loss of flavonoid content. Flavonoids were nearly twice as high in whole fruit juice than in juice made from concentrate. Homemade cranberry sauce contained far higher levels of flavonoids than did canned cranberry juice. It is easy to make and doesn't need to be eaten only at Thanksgiving. Sweetened-dried cranberries were low in anthocyanins but did retain proanthocyanidins. Bottom line: better to consume fresh or freeze-dried cranberries than processed. Juice from whole cranberries superior to juice made from concentrate. 


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Improving Your Memory

Recent research suggests that in order to retain new information, a period of wakeful rest after learning the information is optimal. Research published in the recent Psychological Science by psychological scientist Michaela Dewar showed that new information was retained much better when subjects rested after learning the new information, rather than play a computer game. It seems that consolidating memories is a several stage process that requires peace and quiet. While this isn't always possible, you can optimize retention at seminars by walking and relaxing in the breaks rather than play with your phone or pick up e-mails. 


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Tuesday, July 17, 2012

Weight Training and Walking Improve Cognition

Four new randomized trials were presented at the Alzheimer's Association International Conference that showed that physical activity such as resistance training and walking, can increase cognitive functioning in various types of elderly adults, including those already diagnosed with mild cognitive impairment. Both resistance and aerobic training improved different types of memory. To improve executive function and functional plasticity, a higher level of aerobic exercise was required. Even a program of moderate walking in older people without demential showed an increased growth in memory brain regions as well as increased levels of brain-derived neurotrophic factor (BDNF). 


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Strawberries are a Superfruit

The term super fruit is usually linked with exotic fruit, not strawberries. Recent research out of the University of Warwick has found that strawberries impact so many aspects of our metabolism that affects good health, that they should be considered a super fruit. Most recently they found that strawberry extracts activate a protein in our bodies called Nrf2 that has been shown to increase antioxidant and other protective activities. This protein also helps decrease blood lipids (fats) and cholesterol. Strawberries have been shown to decrease the rise in post-meal glucose and LDL cholesterol (the "bad" cholesterol). So let's hear it for strawberries for dessert!


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Organic Tomatoes Are Healthier

Not only do organic tomatoes taste better, they are healthier and contain more anti-oxidants than conventionally grown tomatoes. This research was published in the recent Journal of Agricultural and Food Chemistry and the studies were conducted in Spain. Organic tomatoes contain more phenols than conventionally grown tomatoes. Phenols are anti-oxidants that the plant produced under more stressed conditions. The more the plant is stressed, the more phenols. Various phenols and polyphenols have been shown to prevent cardiovascular and degenerative diseases, as well as some forms of cancer. Tomatoes also contain lycopene and other carotenoids, and vitamin C, so overall they pack a healthy punch. 


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Sitting Too Much Reduces Lifespan

A new study published online in the journal BMJ Open examined data from the National Health and Nutrition Examination Survey (NHANES) and found that more sitting is associated with an earlier death. In particular cutting television time to less than two hours every day might extend life by almost 1.4 years. Keeping "down time" to less than three hours a day might make us live an extra two years. Something to think about while walking!


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Food Journal Important for Weight Loss

A study published online July 13 in the Journal of the Academy of Nutrition and Dietetics found that keeping a food journal improved weight loss over a 12 month period on post-menopausal women. Weight loss was also helped by preparing meals at home and eating meals at regular intervals. There are several online programs and apps that can help you keep a journal. Calorie King and Livestrong.com are two that come to mind. 


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Revisiting HDL Cholesterol

A recent study published in the July 11, 2012 edition of the Journal of the American college of Cardiology confirmed that the way HDL, the "good cholesterol," is evaluated in clinical practice is not that meaningful. Currently most doctors evaluate how much cholesterol each HDL protein is carrying. It is more significant to measure the number of HDL protein particles and sizes than the amount of cholesterol these particles contain. These tests currently can be done by specialty labs such as Spectracell and Berkeley Heart Lab. At the end of May I attended the 2012 Institute for Functional Medicine's annual symposium. This year the topic was on Cardiometabolic diseases, which include heart disease and diabetes. The way HDL and LDL are measured and evaluated was discussed in detail, with the recommendation to evaluate particle size and number. 


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Wednesday, July 11, 2012

Soy and Breast Cancer

Soy contains very weak estrogens and has therefore been discussed a great deal in regards to breast cancer. The results of early Chinese studies were not relevant to American women in the same way, as American women, at least at that time, were generally not raised eating an abundance of soy products. A new study looking at these issue was published online May 30 in the American Journal of Clinical Nutrition. The researchers found by pooling both American and Chinese data that soy seems to have a protective role as far as breast cancer is concerned. And it seems the more the better, and especially so for women with estrogen receptor negative cancers. Women with estrogen receptor positive cancers also had a decreased risk of recurrence with increased soy intake if they were also on Tamoxifen. It would be interesting to know if these results would be changed in any way looking at organic versus non-organic soy. 


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Non-Aspirin NSAID Use and Kidney Cancer

The September 12 issue of the Archives of Internal Medicine have a study that showed that long-term use of non aspirin anti-inflammatory drugs (NSAIDs) are linked to an increased risk of kidney cancer, or renal cell cancer. The data was gathered from the Nurses' Health Study (77,525 nurses followed up to 16 years) and the Health Professionals Follow-up Study (49,403 men followed for 20 years). The study also suggests that the longer one uses these NSAIDs, the higher the risk. These drugs include ibuprofen (Advil, Motrin, etc.), naproxen, cox-2 inhibitors, etc. 


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Exercise Reduces Neuropathic Pain

The June issue of Anesthesia & Analgesia has an animal study that shows that exercise can reduce neuropathic pain. The study was performed on rats that were given an injury to their sciatic nerve.  A group was then progressively trained to either swam or run on the treadmill. Compared with non-exercising rats, the exercising rats experienced less pain. Exercise also reduced the expression of inflammation-promoting cytokines in the sciatic nerve tissue. Other studies have shown that inflammatory cytokines contribute to pain. For years exercise has been recommended for people with chronic pain. This was the first study that looked at neuropathic pain. 


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Vitamin D and Fractures

A new paper published in the July 5 edition of the New England Journal of Medicine examined the data from a dozen large double-blind, randomized controlled studies and found that an average daily intake of at least 800 IU per day reduced the risk of a fracture significantly, and specifically a 30% reduction in the risk of hip fracture. Lower doses of vitamin D do not have this effect. In the adult population it is difficult to get enough vitamin D through the diet--you can only eat so much oily fish--and adults have less direct sun exposure. The authors recommend 1000 to 2000 IU of vitamin D per day, as adults sometimes forget their supplements, and this amount would ensure adequacy. Other studies have shown vitamin D3 (cholecalciferol) to be superior vitamin D2 (ergocalciferol). 


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Long Working Hours and Pre-Diabetes

A study published in the May BMC Public Health journal found that 10-hour working days in Japanese men over 40 years old was associated with metabolic syndrome, or pre-diabetes. This is no big surprise, as consistently working 10 hour days does not leave a lot of time for exercise and down-time. Also, working those kind of hours requires more vigilance in order to eat right. Eating right, moderate consistent exercise, 7-8 hours of sleep per night, and some down-time are essential for optimal health. 


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Tuesday, July 10, 2012

Meditation and Multitasking in the Workplace

Some interesting research is being done at the University of Washington on the effects of a mindfulness meditation practice and real-world multitasking at work. Three groups of 12-15 human resource managers were recruited for this study. One group was enrolled in an 8-week mindfulness meditation training, another in a relaxation training, and the third was not enrolled in anything. The third, or control group, was enrolled in the mindfulness meditation group after the first 8 weeks of the study. Before and after each 8-week period participants were given a stressful test of their multitasking abilities, requiring them to use email, calendars, instant messaging, telephone, and word-processing tools. The researchers measured their speed, accuracy, and the extent to which they switched tasks. The also noted self-reported levels of stress and memory while performing the tasks. The mindfulness meditation group reported lower levels of stress, tended to stay on task longer, but completed the job in the same amount of time as the other groups. The relaxation training did not have a reduction in stress but did, as did the meditation group, have an improvement in memory. When the control group was finally trained in mindfulness meditation, it, too, enjoyed all the same benefits noted above. 


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Stress and the Immune System

Researchers at Stanford University have been studying acute stress and the immune system's response. The body responds to acute stress by mobilizing the immune system in order to prepare for healing a possible injury. This is a good thing and short term stress, minutes or a few hours, is good for the body and can boost the immune system. this is perhaps one way exercise helps prevent infections. Chronic, unrelenting stress has the opposite effect. A wonderful book on the effects of chronic stress is Why Zebras Don't Get Ulcers by Robert Sapolsky. He is also on the faculty at Stanford. 


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Popeye Was Right

Popeye was right: spinach does make you stronger--as do beets and chard. These foods are high in nitrates, which have been associated with stronger muscles. A recent study published in the Journal of Physiology found that mice given the mouse equivalent of a 200-300 gram serving of spinach a day had considerably stronger muscles than mice not fed spinach. The mice with the higher nitrate levels also had higher levels of two particular proteins, CASQ1 and DHPR, that are crucial in calcium balance and ultimately muscle contraction.  The researchers now want to apply what they've learned in mice and apply it to people. Spinach, beet, and chard have so many health benefits, that it wouldn't hurt to include them in your diet one way or another. 


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Depressing Fact

Researchers writing in PLoS Medicine have found "there is significant penetration by multinational processed food manufacturers such as Nestle, Kraft, PepsiCo, and Danone into food environments in low-and-middle income countries, where consumption of unhealthy commodities is reaching--and in some cases exceeding--a level presently observed in high income countries." The authors from the UK, US, and India also found that higher intake of unhealthy foods correlates strongly with higher tobacco and alcohol sales. Think of the chronic diseases of the Western world that are soon to follow....


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Low Carb Diets and Cardiovascular Risk

The recent British Medical Journal published an international study conducted on 44,000 Swedish women between 30 and 49 years old from 1991-1992 with an average 15 year follow-up. Diet was assessed using an extensive dietary and lifestyle questionnaire. The researchers found that those on high protein, low carbohydrate diets for an extended period of time had more cardiovascular incidents. It is difficult to know what to make of this study. What was the quality of the carbohydrates (whole grains or white flour), the quality of the protein (animal, vegetable, organic), how much did each person's diet vary over the time period? Were the people eating the most carb health-conscious vegetarians, which would certainly make them look better than meat eaters? I am a firm believer in moderation. If you have a blood sugar issue or are at risk for having one, you need to cut down on your carbs. That doesn't mean no carbs, just fewer than what you're eating and make them healthy, whole grain, or starchy vegetable or non-starchy vegetable carbs. Also increasing your legume intake gives you healthier carbs and more protein. People who are doing a lot of endurance exercise need more carbs than people doing primarily resistance training. Everyone needs protein, be it from an animal or vegetable source. Healthy fats are also crucial. 


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Meditation, Exercise, and Cold Symptoms

The July/August issue of the Annals of Family Medicine has an interesting study looking at 149 adults older than 50 following either an 8-week mindfulness meditation practice or moderately intense exercise program, or neither. Those in the exercise and meditation groups had half the number of acute respiratory infections than those in the control group during the 8 week intervention: 257 days of illness in the meditation group, 241 days of illness in the exercise group, and 453 days of illness in the control group. The severity of the infections were least in the meditation group and worst in the control group, with the exercise group falling somewhere in-between. The meditation group also lost the least days of work. 


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Sleep Deprivation and the Immune System

Previous studies have shown that sleep deprivation is associated with diseases such as obesity, diabetes, and hypertension. A new study looked at how sleep deprivation affects the immune system, in particular white blood cells. 15 healthy young men had their blood drawn under normal and severely sleep deprived conditions. Normal circumstances were 8 hours of sleep every night, exposure to at least 15 minutes of outdoor light within the first 90 minutes of waking, and no caffeine, alcohol, or medication during the final three days. All of this was in order to stabilize their circadian clocks. A particular type of white blood cell, granulocytes, reacted immediately and were increased. This response is much the same as had these young men been under physical stress. 


The study, "Diurnal Rhythms in Blood Cell Populations and the Effect of Acute Sleep Deprivation in Healthy Young Men," was a collaborative effort between the Department of Forensic Molecular Biology at Erasmus MC University Medical Center Rotterdam and Chronobiology, Faculty of Health and Medical Sciences at the University of Surrey, United Kingdom. The laboratory study was conducted at the University of Surrey Clinical Research Centre.


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Monday, July 9, 2012

Cancer Cells Need Sugar to Thrive

If cancer cells need sugar to thrive, it would seem that a low sugar diet would inhibit cancer cells. Recent research performed at UCLA showed that cells that require glucose to function, which cancer cells do, die when deprived of glucose. Diet recommendations for people living with cancer include low sugar/low glycemic index diets. 
Mol Syst Biol. 2012 Jun 26;8:589. doi: 10.1038/msb.2012.20.


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Calorie Restriction and Longevity

New research published in the July 3 edition of Cell Metabolism shows that, at least in the fruit fly, a restricted calorie diet only prolongs life if there is physical activity as well. There has been a lot of research on how calorie restriction can prolong life, a sacrifice that most people do not want to make. This research points out that calorie restriction alone is not enough. Movement is also necessary. They speculated that part of the reason could have to do with fat metabolism, and that enhanced fat metabolism could slow aging. 


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Monday, July 2, 2012

Not All Calories the Same

In an earlier article I pointed out that diets with 15% or 25% protein resulted in the least amount of loss of lean muscle mass while dieting. An article published June 27, 2012 in the Journal of the American Medical Association showed that the optimal diet for weight loss is a low-glycemic load diet. The study itself was quite interesting. Between June 2006 and June 2010 21 overweight and obese young adults were put on a diet so that they would lose 10-15% of their body weight. This run-in phase primed them: once a heavy person loses weight, they are much more likely to gain weight than someone of the same weight who was never heavy. So it truly takes less for them to gain weight. The participants were than randomly put on one of three diets for 4 weeks and then moved onto the next diet for another 4 weeks and so on. One diet was typical low fat diet (20% fat, 60% carbohydrate, 20% protein), another was very low carbohydrate (10% carbohydrate, 60% fat, and 30% protein), and the third was the high glycemic index diet (20-30% protein, 40-50% carbs, 30% fat). People expended the most energy while on the very low carbohydrate diet and the least energy on the low fat diet. The high glycemic index diet split the difference, burning 150 calories more at rest than did those on the low fat diet. The low fat diet exacerbated risk factors for metabolic syndrome, such as insulin resistance, triglycerides, and lower HDL and higher CRP, a measure of chronic inflammation. Stress hormones were also elevated on the low fat diet. 


Studies such as these show that calories are not all created equal from a metabolic perspective. The low glycemic index is the one most recommended by Functional Medicien practitioners. 


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Low Testosterone and Weight Loss

Research presented at ENDO 2012: The Endocrine Society 94th Annual Meeting showed that pre diabetic, overweight men with hypogonadism (low testosterone) showed improvements in testosterone levels after lifestyle modifications consisting of calorie and fat reduction and exercise. This was a three armed study of about 900 men with about one third getting lifestyle and exercise modification, another receiving the drug metformin, and a third receiving a placebo. Only in the lifestyle group did testosterone rise. Ideally testosterone is not given in a vacuum, but in conjunction with positive lifestyle program, which alone may raise levels sufficiently. This is the Functional Medicine approach. 


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Weight as a Risk Factor for Cancer

A new report from the Cancer Research UK group, title Cancer Prevention: Stacking the Odds in Your Favour showed that after smoking, excess weight is the next biggest factor associated with cancer. Extra weight around the middle, or visceral fat, is far more active than subcutaneous fat. Some of the many substances released by this fat include chemicals that can make cells in the body divide far more often than usual, thus increasing the risk for cancer. Less than one third of the people surveyed for this report ate the recommended 5 fruits and vegetables daily. Only 23% managed to do the recommended 150 minutes of moderate exercise per week. While think people who exercise regularly also get cancer, improving one's risk profile decreases the odds. Genetics play a surprisingly small role. Various cancer-causing genes get turned on or off by the environment, including nutrition and exercise. 


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Walking and Diabetes

A rent study published in the June 20 issue of Diabetes Care found that in people who are at risk for getting diabetes, those who walked the most were less likely to get diabetes than those who walked the least. Native Americans are at high risk for diabetes. 243 Native Americans from Arizona, Oklahoma, and North and South Dakota were the subjects of this study. They wore pedometers for a week and were then followed for 5 years. Those who walked more than 7,800 steps per day were less likely to get diabetes than those who walked less than 3,500 steps per day. An obvious weakness of this study is that a lot can change in the course of 5 years, so the one week of monitoring may or may not be representative. 


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Vitamin D and Weight Gain

A newly published study in the Journal of Women's Health showed that among post-menopausal non-Hispanic white women having levels of 25-hydroxyvitamin D above 30 ng/dL resulted in less weight gain over an 8 year span of time. It did not result in a weight loss. Other observational studies have also found this association. An association is not causation. The women with adequate vitamin D levels might have spent more time outdoors being active and gotten their vitamin D from the sun. However, vitamin D is important for preventing osteoporosis, heart disease, optimizing the immune system, and more


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Protein and Weight Gain

More and more studies are now being published that show that weight gain is far more complex than calories and calories out. In the big scheme of things calories still matter. However, whether the calories come mainly from protein or carbohydrates can make a difference. A recent study using 25 adults, 16 men and 9 women, ages 18-35 years, with body mass index (BMI) 19-30/kg/m2 (normal weight and overweight) were paid to live a tightly controlled metabolic unit for 10-12 weeks. Their food and exercise were tightly controlled. For the first 2-4 weeks they ate a normal diet with 15% of the calories coming from protein. Then 1000 calories were added to their diets. At this point they were randomized to either a low (5%), normal (15%), or high (25%) protein diet . Some people wouldn't consider a high protein diet "high" until it was around 30% protein. Regardless, everyone in this study gained weight, about 8 lb., with the extra calories. However the low protein group only gained half as much. The catch is, the low protein group lost lean body mass or muscle. Lean body mass also gives one a metabolic boost so that one's resting energy is higher. Aside from adequate protein intake, resistance exercise is also very important in maintaining lean body mass, although this study did not address this. It is important to monitor lean body mass when losing weight. This can be done with a Bioelectric Impedance Analyzer, or BIA unit, such as the one I have in my office. 
Bray GA, Smith SR, de Jonge L, et al. Effect of dietary protein content on weight gain, energy expenditure, and body composition during overeating: a randomized controlled trial. JAMA. 2012;307:47-55. Abstract


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