Cardio Or Weights First? Exercise Order Sometimes Matters

"Is there an order to working out? In other words, should I do weights first and then cardio?"
-- Karen 

Working out is always good for you. The good news is that, whether you do it before or after weight training, cardiovascular exercise like running, swimming, biking or machine-work will improve everything from your heart health to your mood to your chance of avoiding many cancers. And lifting weights helps with everything from bone density to metabolism.
But according to exercise physiologists and personal trainers we spoke with, the order of operation can change depending on a person's goal.
"This question is one of the biggest questions on people's minds when they go to the gym," says personal trainer and HuffPost blogger Jeff Halevy. For those who are seeking weight loss, cardio should come first, but if gaining muscle mass is the goal, it's time to hit the weight room first. But why?

Let's start with the muscle-building scenario. "Doing cardio first will induce fatigue that may compromise technique and possibly increase risk of injury," explains Fabio Comana, director of Continuing Education for the National Academy of Sports Medicine. Exhausting oneself with a big run right before weights and resistance training doesn't just up the risk of injury, it also means you'll have less energy to throw into a really good weight training session.
On the other hand, if you're looking to lose fat, Halevy recommends doing interval cardio training before getting started on weights. As he explains, the cardio will deplete your body's supply of glycogen -- the stored form of glucose in muscle cells and a primary material in our energy storage. Once glycogen is depleted, the body turns to more long-term storage sources, like fat.
"If your goal is strictly a lean body -- not to be strongest, or most powerful, but achieve maximal leanness -- I always recommend implementing high-intensity interval training at the beginning of each workout," says Halevy.
But that doesn't mean weights aren't important for fat loss. In fact, when it comes to analyzing the percentage weight loss that's comprised of fat versus lean tissue like muscle, weights have cardio beat overall.
"Resistance training should always be a consideration," explains Comana in an email. "Mother nature will help us lose lean tissue naturally (23 percent in women between ages 30 and 70), that we need to preserve. Diet and cardio also results in lean tissue losses (68 percent fat, 22 percent muscle / lean tissue). Whereas diet and resistance leads to 97 percent fat loss, and only 3 percent lean tissue loss."
There may be other reasons for doing cardio first. As Comana points out, many more people are familiar with cardiovascular exercise, so it will seem less intimidating and is thus more likely to happen. If the weight room is daunting enough to prevent a workout session, it's worth getting started on cardio and working your way up. And if another health goal -- say Type 2 diabetes or hypertension prevention or treatment -- is the priority, Comana recommends cardio over resistance. "Some diseases are better managed with cardio first, then introducing resistance training later," he told Healthy Living.
It's important to get the opinion of a doctor and certified personal trainer or exercise professional before proceeding, but the takeaway is simple: if you're exercising, no matter the order, you aren't doing anything wrong. Depending on your goal, you may want to choose one type of exercise over the other. Of course, you could alternate days and avoid the question entirely.

Should You Take A Multivitamin?

Is there a daily multivitamin that you would recommend to help boost energy for exercise?
-- Johnny, 23, East Bay, CA.

There are actually two parts to this question. The first is silent: should healthy adults be taking a daily multivitamin at all? If you believe the latest research, the answer is no.

The first thing to acknowledge is that, for the most part, Americans are not deficient in vitamins. A recent CDC survey found that we're sufficiently nourished in essential nutrients like vitamins A, D and folate. But just because we aren't deficient, doesn't necessarily mean that our vitamin levels are optimal. The question is, how important are optimal levels?

"You get your nutrients through your food. Through the milenia, that’s what the case was and we survived as a species -- in fact, we thrived," says Alice Lichtenstein, DSc, senior scientist and director of the Cardiovascular Nutrition Laboratory at the Jean Mayer U.S. Department of Agriculture (USDA) Human Nutrition Research Center on Aging at Tufts University and the author of a position paper on the usefulness of multivitamins. "To assume that we suddenly have lost this ability doesn't quite make sense."

While whole foods are a good source of nutrients, many public health researchers actually credit processed, packaged foods that have been fortified with vitamins for the nutrient-rich American diet. "Most people, if they are eating a generally healthy diet -- not a perfect diet, but a generally healthy diet, don't need a multivitamin," says Katherine Zeratsky, a registered dietician at the Mayo Clinic. "With things like breakfast cereals, nutrition bars, foritified grains and bread, because all those foods are fortified with other minerals, we are getting more than we realize and more than we need."

That doesn't make a multivitamin just redundant, it could make it dangerous: Lichtenstein points out to Healthy Living that a large surplus of supplemental folate may have an adverse effect on colon cancer and other research has found a relationship between folic acid supplements and prostate and breast cancers as well. Lichtenstein adds that an overabundance of vitamin A, to levels of toxicity, can manifest in accelerated bone loss.

Some vitamins are water-soluble and others are fat-soluble, explains Zeratsky. While water-soluble vitamins will pass right through the body and are expelled in urine (the inspiration for the popular "expensive urine" quip among physicians), fat-soluble vitamins are stored and build up over time, making it a bit easier to reach toxicity. Fat-soluble vitamins include D, E and A -- common inclusions in both fortified foods and in multivitamins.

What's more, a longitudinal study of women who took multivitamins and those who did not found that taking a regular multivitamin was actually associated with a shorter overall life expectancy. Critics of the study suggested that a bias may exist -- namely, that people who take a multivitamin may be doing so in response to overall health problems that reduce their life spans.

Although, according to Lichtenstein, the profile of the average multivitamin user is this: a middle-aged woman who eats healthfully and exercises and has an above-average education level. “The population who takes them is most often the population who is least likely to need them,” she says.

But there are people who can benefit from a multivitamin or certain supplements. One example that all of the experts we spoke with gave was women of child-bearing age -- and especially those trying to get pregnant -- who should ensure that they get enough folate to prevent birth defects like spina-bifida. Additionally, women who are going through or have gone through menopause might need a boost in certain nutrients, and those on specialized diets that are lacking in nutrition might also benefit. Because it’s so highly individualized, a supplement regime should be planned with a doctor.

Still, there remains no evidence that multivitamins are useful to overall or long-term health -- and some, albeit inconclusive evidence that they are harmful.

If you are going to take a multivitamin, Zeratsky says that she doesn't believe it will hurt. To ensure purity, she recommends looking for a brand that has been certified by a third party testing agency, like U.S. Pharmacopeal. Since vitamins and supplements are not regulated at the same level as food, it's important to know the source of what you're taking.

But long-term health isn't the primary concern at the center of this question. Johnny asked if there was a particular multivitamin associated with energy. Some people report, in a clinical setting (as opposed to a significant study) that the family of B vitamins gives them extra energy, reports Zaretsky. Though B vitamins are prevalent enough in our diet to maintain basic levels, it's possible that people who have an energy response to B vitamins may be low in these nutrients without being deficient. The extra boost may also increase energy, as the vitamins play a role in regulating metabolism.

Beyond that, when it comes to exercise, important vitamins for energy, muscle function, recovery and bone strength include vitamin D, vitamin C and electrolytes like potassium and sodium. Calcium is also really important -- not only for bone health, but for regulating how our muscles contract, according to Zaretsky.
That said, it's better to get these nutrients from sunlight (in the case of the hormone, vitamin D) and whole foods. "Our healthy diet goes so far beyond what a pill can offer -- known and unknown," says Zaretsky, pointing to the fiber and phytonutrients that foods contain and pills lack.

Agrees Lichtenstein: "The data generally supports better outcomes who are eating well-balanced diet. It's not particularly exciting, but from the perspective of what we can support in the research, that’s the best information we have."

What Is Metabolism: How Long After I Eat Is Weight Added To My Body?

"How long does it take for the food I ate to add weight to my body?" -- Bunter122 

Today's question comes from a reader who would prefer to stay anonymous, but it is certainly a thought that many people have had. Given that we all have different metabolic speeds, what is the average amount of time it takes food to be digested and then shunted off to its various purposes?
"We have a pretty good indication about the timeline from the sequence of ingestion, digestion, and egestion. The whole thing plays out over a span of roughly 12 hours on average," says Dr. David Katz, a HuffPost Healthy Living contributor and director of the Yale University Prevention Research Center. "By the time the residual waste of food is passing out of us, the useable parts have all been put to use -- for energy expenditure, as heat generation, or placed into storage, as either glycogen [from carbohydrate], or fat."
After you eat, the food passes through your stomach and small intestine in about six to eight hours, according to the Mayo Clinic. Then, it enters the large intestine where it is further digested. Putting it as delicately as possible, Mayo Clinic gastroenterologist Dr. Michael F. Picco writes: "Elimination of undigested food residue through the large intestine usually begins after a total of 24 hours. Complete elimination from the body may take several days."
For a complete understanding of what the body does to digest food, the National Institutes of Health has a great explainer. For our purposes, it is essential to understand that as food is digested, enzymes and hormones are secreted by the stomach and small intestines (as well as fat cells) and work to break down the carbohydrates, protein and fat we've eaten into usable material for our cells.

A growing number of endocrinologists -- those who study our hormone system -- are beginning to see the hormone response as far more complicated than previously thought, as well as far more individualized: there is a wider variance in how people respond to food, they suspect.
"While the question posed seems extraordinarily simple, I don't think that there can be a simple answer to it," says Dr. Kaveh Ashrafi, an associate professor of physiology at the University of California, San Francisco School of Medicine who studies fat metabolism. "The prevailing view essentially considers feeding behavior/exercise as the sole determinants of body weight. For this to be true, one has to assume that the body itself is simply an inert vessel; if you put more food in it, it must get fat, if you move it, it must lose weight."

Why Am I Hungry After A Big Meal?

"The day after a big meal, I go to bed feeling stuffed and wake up hungrier than ever. Why is that? Is my stomach actually expanding?"
-- Jessi, 30, New York 

"I must admit that I get this sensation," says Dr. W. Timothy Garvey, Chair of the Department of Nutrition Sciences at the University of Alabama at Birmingham and Chairman of the Obesity Scientific Committee for the American Association of Clinical Endocrinologists. Several Healthy Living staffers also related. So the good news is that you aren't alone.
But there's bad news too. You stumped our experts. "The truth is, we don't have a rigorous scientific answer for this," Dr. Garvey told Healthy Living, echoing a common sentiment among all the researchers with whom we spoke. There were several plausible theories.
But first, more good news: it's not your stomach expanding. "There’s no truth to that at all," says Dr. David Greenwald, Associate Director of the Division of Gastroenterology at Montefiore Medical Center in New York. "It's more likely that the stuff they ate didn't fill them up properly. People who eat a lot, but don't eat good things are likely to feel hungry again [soon]."

Big meals are often celebratory, which means they may include foods that are decadent rather than nutritious: starchy vegetables like mashed potatoes, white dinner rolls, cake. Foods that fall high on the glycemic index can make your blood sugar spike, causing a surge of insulin to drag it back down. The quick vacillation in blood sugar can cause a disruption to the normal cycle of leptin -- a hormone secreted by the fat cells that signals to the brain when you've had enough to eat. Foods that cause this type of response can encourage what is sometimes termed "fullness resistance."
In other words, that big pasta festival for your birthday? It'll just make you hungrier. But meals full of veggies, whole grains and lean protein may not create the same effect. Then again, "people who are eating vegetables, leafy salads are probably not overeating," adds Greenwald.
Still, Garvey wasn't convinced that leptin and insulin were the culprits here. It takes weeks for leptin production to respond to a dietary change because it's related to the size of fat cells, rather than the contents of a single meal. Instead, he suspected that ghrelin, a completely different hunger hormone that controls short-term regulation might be responsible.
"Leptin is a long-term regulatory hormone. It increases overall the amount of calories you take in. If your fat cells get bigger, they make more leptin and that suppresses appetite. If fat cells shrink, they make less leptin and that stimulates appetite," he explains.
"But ghrelin is a hormone that is secreted by the stomach. When you eat something, ghrelin is suppressed, making you not want to eat more. As time progresses after meal, after several hours, ghrelin rises," he says. "Some people have more rapid and pronounced rises in ghrelin in response to what they eat and that makes them want to eat more."
So what can a person do to avoid the dreaded after-binge binge? Of course, the most obvious advice is to avoid it in the first place: reasonable portions can be celebratory too. Choose foods that will keep you full longer: things that are high-volume and low-calorie, like leafy greens, and full of protein and fiber, like beans.
Beyond that, all you can do is some damage control: eat a sensible, filling breakfast (oatmeal! egg-veggie scrambles!) and know that the increased hunger will pass.

What Is Excessive Sweating?

Why do I sweat so bad when I exercise?
-- Denise, 56, Mokena, IL

We've gotten some variation of this question from several readers: why do some people sweat more than others? Why do some people sweat from their faces, while others mostly sweat from their hands? When is sweating considered excessive and why am I sweating anyway?
So we spoke with Dr. Lyall Gorenstein, surgical director at the Columbia University Hyperhidrosis Center in New York and Dr. Noel Perin, director of minimally invasive spinal surgery, Department of Neurosurgery at NYU Langone Medical Center and an expert in treating complex hyperhidrosis.
Let's start with the basics: the primary purpose of sweating is to cool your body down. "Sweating is the body’s natural, neurological response to cool the body by stimulating the sweat glands to produce moisture that cools the body by drawing heat from the body during evaporation," Perin tells HuffPost Healthy Living. "Because everyone’s body is different, the response differs from one individual to another, producing varying levels of perspiration."

When your body temperature rises, whether because of sweltering external temperatures, exercise or hormonal changes (often associated with menopause), it stimulates the two to five million sweat glands that are distributed under your skin. These glands exist throughout the body, though they have higher concentrations in certain areas like the palms of the hands and the soles of the feet.
Perspiration works because it carries the heat generated by your body to the skin's surface, where it evaporates into the atmosphere, lowering overall internal temperature. Think of a bead of sweat as a vehicle for heat conducted by your body: it transports body heat to the surface, where it can diffuse into the external world. And that protects the integrity of your cells and organs from the dangers of overheating.
A secondary, less pronounced purpose to sweating is to help shed the body of waste that occurs as a natural byproduct of cell metabolism, according to Gorenstein.
But why do some people sweat more than others? Among the range of sweating that is considered normal -- that is, functional, predictable and not associated with a medical condition -- there is no known reason for the variation in sweating. "If we're talking about otherwise healthy individuals, which is to say not people who are obese or have another condition that could contribute, it's simply a physiological variation," Gorenstein tells HuffPost Healthy Living. "Just like how the average resting body temperature is 98.6, but many people exist on a bell curve around that."
Since sweating is a normal, physiological response to exercise, chances are that sweating during exercise -- even if you are sweating more profusely than your neighbors on the treadmill -- is not an indication of a problem. When in doubt, it's always better to have that confirmed by a doctor.
However, if the sweating occurs not just during exercise, but at random -- as a stress response or when you are at rest or in a controlled temperature environment -- it could indicate a condition known as hyperhidrosis. One telltale sign of hyperhidrosis is that you'll often sweat profusely from one specific area of the body, most often the palms of your hands or soles of your feet, but also sometimes the armpits.
"It can reach a point of socially uncomfortable results," says Perin. "Everything from minor annoyances such as smudged writing paper to much greater issues like difficulty holding a pen or the social discomfort caused by soaked clothing and wet handshakes."
Sometimes excessive sweating can be caused by another condition in what is called secondary hyperhidrosis. Infectious disease, hyperthyroidism, menopause and some cancers can cause hyperhidrosis, according to the Mayo Clinic, though Gorenstein has found that obesity is the most common cause of secondary hyperhidrosis.
But people with primary hyperhidrosis very often begin to experience it in early childhood or even infancy, according to Gorenstein. "Patients will tell me stories about leaving tracks on the floor as toddlers," he says. Primary hyperhidrosis is to some extent hereditary. In fact, WebMD reported that about 50 percent of hyperhidrosis cases can be traced to family history.
No one is sure what the mechanism for primary hyperhidrosis is, beyond the understanding that it is a neurological response. Gorenstein has conducted a series of clinical studies comparing hyperhidrosis patients to a control group of normal sweaters: monitoring the brains of study participants using an fMRI machine, he and his colleagues showed the group visually disturbing images to cause anxiety and stress response. They demonstrated that when patients with primary hyperhidrosis looked at the pictures, their hands began to sweat. The control group did not sweat, though they did have other measures of sympathetic response, such as quickened pulse.
For hyperhidrosis patients, treatment options vary: while some mild forms respond to prescription-strength topical antiperspirants, other options include water iontoforesis, botox injections in the armpits (an FDA-approved use) or, in extreme cases, surgical intervention.
While hyperhidrosis can be debilitating, especially socially, it is not dangerous on its own. It can, in some rare instances, be associated with a dangerous condition and should be diagnosed properly for that reason. Likewise, exercise-induced sweat, even at above average volume, isn't anything to worry about.

Muscle Soreness, Explained

I've been working out fairly consistently for about 1.5 years. I do strength training about twice per week and cardio 5 times per week. I've noticed that my thighs, particularly my quads, burn all the time with a small amount of exertion, such as ascending a flight stairs.
Why do my thighs burn so much with minimal exertion?
-- Kim, 29 Texas

Let's talk about muscle soreness. Delayed-onset muscle soreness, or DOMS as it is often called, is the common -- one could even say requisite -- result of a workout. If you do an activity you're not used to, such as taking a new type of fitness class, attacking a hill on your bike when you're used to riding on flat ground, or running a far longer distance than you are accustomed to -- the difference in muscle use can cause micro-tears in muscle fibers and connective tissue. As your body works to repair itself, you may feel some low-grade pain in the area.
But this is where the phrase "no pain, no gain" comes in: those tears and the subsequent repair help make the muscle stronger -- and that improves overall fitness. But it comes with some ache along the way.

In particular, movements that include "eccentric muscle contractions," which occur when the muscle must contract even as it is being elongated (running downhill or walking downstairs, for example) might cause some delayed onset pain. But why?
"Think of it like the weakest link," says Allan Goldfarb, Ph.D., a professor in the Department of Kinesiology at the University of North Carolina, Greensboro and a fellow of the American College of Sports Medicine. "Muscle proteins hold that weaker bit together and if there is too much force or tension [from exercise] on those muscle fibers or proteins, they are vulnerable to getting slightly damaged."
In an effort to repair the damage, the body can actually over repair explains Goldfarb, and that can activate pain receptors. What's more, the muscles can suffer from some low-level inflammation that can add to the pain.
DOMS can be mitigated by slow, steady stretching exercises, says Goldfarb. And recent studies have suggested that ice baths can also help improve soreness.
But that doesn't necessarily sound like what's going on in the case of this question. For starters, it seems as if you're experiencing muscle pain concurrent with the activity, rather than hours after. We asked Dr. Lynn Snyder-Macker, PT, ATC, SCS, ScD, a professor in the Department of Physical Therapy and the Center for Biomedical Engineering Research's Interdisciplinary Graduate Program in Biomechanics and Movement Sciences at the University of Delaware for her opinion.
"It doesn't sound muscular to me (one flight of stairs!)," she wrote in an email to HuffPost Healthy Living, pointing to the burning sensation, which is different than a sore muscle's ache. "It sounds more like nerve or patellofemoral pain or referred pain from the hips." That combined with your young age make her believe that this isn't exercise-related after all.
Many illnesses could cause this type of pain: fibromyalgia is one diagnosis that fits in with unexplained muscle soreness, according to Goldfarb. That's not to say that unexplained muscle burning or soreness is a sign of serious illness, but it may be worth further evaluation by a medical specialist, like a sports medicine doctor.

Why Does My Face Flush When I Exercise?

Ask Healthy Living: Why Does My Face Flush When I Exercise? 

Why does my face get so flushed after I workout and why does this seem to happen to some people (me!) more than others? Is there anything I can do about it?
-- Sarah, 29, Brooklyn, NY
The first thing you can do about it is relax! There’s nothing wrong with getting red -- or even fuschia -- in the face.
When you exercise, capillaries in your face and throughout your body dilate and blood flows through them in an effort to move the heat your body is generating to the skin's surface, where it can be radiated off. This effort helps to keep you cool while you work out, but it can also make your skin look flushed -- especially in the face.
“Patients who get pink in the face following exercise usually have more superficial blood vessels in the skin of the cheeks and chin,” Dr. James Marotta, a dual board certified facial plastic surgeon in practice in Long Island, NY tells HuffPost Healthy Living. “The result is that temporarily more blood is flowing through these superficial vessels resulting in a pink or ruddy complexion.”

But Dr. Naila Malik, a dermatologist in practice in Southlake, Texas and the creator of the Naila MD Skincare line disagrees. "It is less likely that the 'red blushers' have more capillaries under the skin of their faces than their 'pinkish glower' counterparts in the physiologic range of blushing."
Instead, she offers this explanation to:
"Some people blush more than others and this is more likely due to the fact that these people have a more significant dilatation of the capillaries than the ones who merely get a pinkish glow; Plus the dilatation is more prolonged in these 'blushers' hence they stay redder for longer periods of time."
Dr. Bobby Buka, a dermatologist based in New York City says that both Malik and Marotta are right; while some people -- often those of Anglo-Saxon heritage -- have more capillaries in their faces to begin with, others may have one of several conditions that can cause more blood to flow through the same number of capillaries.
If you have more capillaries in your face to begin with (i.e. those of Anglo-Saxon heritage), then exercising will cause them to fill (how we shunt heat from our bodies by redistributing blood closer to the skin’s surface) and give you a flush-face. On the other hand, several conditions can cause more blood to flow through the same number of capillaries.

"If you suffer from rosacea or other 'vasomotor' dysfunction (i.e. the way your skin’s nerve fibers are wired to your blood vessels), then even though you may have the same number of capillaries as your neighbor, those caps will inappropriately dilate to give you a flushed face," Buka wrote in an email to HuffPost Healthy Living. "Which is more common? Probably the former."
Of course, if you’re exercising in extreme heat, a red face could indicate the onset of heatstroke. Other symptoms of heatstroke include excessive sweating, nausea and lightheadedness, according to the Mayo Clinic. Heatstroke requires immediate medical attention, as it causes your body's temperature to exceed 104 degrees Fahrenheit and can lead to brain, heart, kidney and muscle damage.
But if the cause is simply exertion, there is little you can do without surgical intervention. “Intense pulsed light or laser treatments can diminish the overall number of blood vessels, rid patients of unwanted spider veins, and diminish overly ruddy or reactive facial skin,” says Marotta.
Or you can just enjoy a temporary rosy glow -- and a face that announces to the world that you've been living healthfully.