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New legislation is making “gluten-free” labelling more stringent. This marks the end of a year-long period of adjustment that companies were given to reduce the gluten content in food items labelled “gluten-free” to 20 parts per million. The rationale behind 20 parts per million is at this density, the majority of individuals with celiac disease or gluten sensitivity will not suffer an inflammatory reaction.
Despite iron being a key mineral in the formation of oxygen-binding molecules within the body, iron deficiency is the most common nutrient deficiency in the world. In fact, approximately 30-50% of the adult female population is believed to be iron deficient. Dietary iron comes in two natural forms; non-heme iron found in plant-based foods (2-10% absorption rate), and heme-iron found in animal products (10-30% absorption rate). Heme-iron is known to have the highest bioavailability, even when compared to iron supplements.
The phrase “dog years” is often used by veterinarians and pet lovers. When used it is intended to refer to the correlation between a dog reaching maturity and aging – providing an easy comparison to human aging. But when it comes to your heart, is there such a thing as “heart years”? Cardiovascular research has pointed to the use of carotid intima-media thickness (IMT) scores to indicate heart age. The IMT (measured in mm) is based on average plaque thickness, and has been directly correlated with age. For example, average scores start at 0.56 mm, at age 40, and subsequently increase to 0.65 mm, 0.74 mm and 0.80 mm as age increases to 50, 60 and 65 years respectively. However, lifestyle factors can greatly increase or decrease an individual’s IMT score at any age.
Flexibility is technically defined as the ability of a joint to move through a full range of motion (ROM) around its axis. However, a lack of flexibility at a given joint can negatively impact all the surrounding tissues. Mechanics are based on moving parts and stabilizing segments, and when dysfunction occurs it affects the kinetic chain. Flexibility plays a major role in posture, joint function, muscle recovery, reducing the risk for injury, and optimal performance during physical activity. Static, dynamic, ballistic, active-assisted and proprioceptive neuromuscular facilitation (PNF) stretches as well as various myofascial release techniques can be used to enhance ROM. Fitness professionals unfamiliar with the science behind flexibility will not understand how each technique functions as a potential tool for improvement, and may find themselves making poor decisions based on a client’s needs.
Numerous public health initiatives have been implemented throughout the US in recent years aimed at potentially reducing the prevalence of obesity. Most have focused on either promoting increased physical activity levels or educating the general population on how to make better nutritional choices. A well-known example implemented at the state level was the recent attempt to ban the selling of oversized sugary beverages by restaurants and businesses in New York City - aptly recognized as the “soda-ban”. According to new updates, New Yorkers can now sip their super-sized sodas without concern if they choose. Former NYC Mayor Michael Bloomberg's plan to limit the sale of large sugary drinks was recently rejected by the state's highest court, which ruled the local health board overstepped its authority in approving the regulation.
It may be argued that almost any positive behavior can be taken to an extreme that actually ends up impacting physical and psychological health in a negative manner. Exercise is one of those behaviors, as regular engagement is beneficial and can contribute to health, disease prevention, and mental well-being; but it can also become an addiction. “Exercise addiction is a process addiction in which a person engages in compulsive, mood-altering behaviors with the intention of avoiding painful feelings,” said Kim Dennis, MD, CEO and medical director of Timberland Knolls Residential Treatment Center. “Those addicted to exercise chase the ‘high,’ and this behavior ultimately becomes unmanageable and destructive.”
In a culture that seeks instant gratification, personal trainers must often cater to clients who desire to lose weight and lose it now. Clients requesting assistance in rapid weight loss must be educated on how the body functions as well as its adaptation responses. Clients must also be made aware of the processes behind physiological changes and the increasing potential for negative physical and psychological side-effects once the safe threshold of 1-2 lbs lost per week is surpassed. Remember, losing just one pound in a week requires a negative caloric balance of at least 500 kcals per day. Let’s consider the request of losing 10 lbs in a month – what is the client really asking to accomplish? In theory, he or she can only attain this goal if a 35,000 kcal deficit is expedited over the course of that month. This equates to ~1,166 kcals per day; even if split evenly between exercise and nutritional modification, daily demands would stand at limiting food consumption by ~580 kcals while also burning ~580 kcals via structured exercise. One less meal per day could be consumed while performing additional voluntary work equal to about a 6-mile run.
Since Wikipedia’s launch in 2001, it has become the most popular general reference site on the Internet. It is a widely used resource for health care information among not only the general public but also physicians and medical students; 47-70% of whom admit to using it as a reference. Wikipedia’s fundamental design as a “collaborative database” allows users the ability to add, delete and edit information. This characteristic has raised concern in the medical community regarding the reliability and accuracy of the information on the website. A recent study published in the in Journal of the American Osteopathic Association has substantiated these concerns, finding numerous factual errors in 9 out of 10 Wikipedia articles when compared to recognized peer-review journals.
Consider this: your best friend tells you that she is going to audition for American Idol and performs her try-out song for you… and it’ s terrible. She can’t carry a tune. What do you do? Do you risk hurting her feelings and tell her the truth; that she is a terrible singer and has no chance of winning? Or, do you play it safe and tell her she sounded great and wish her luck? Unfortunately, most people opt for the latter.
Safe driving makes the road better for everyone; buying homes, having children and going to school are activities that encourage economic growth. These behaviors provide relatively clear benefits, from both monetary and ethical standpoints, to society as whole. In return, safe drivers receive discounts and cash bonuses from their auto insurance companies and Americans are able to deduct expenses related to the above activities from their annual taxes. Essentially, when people participate in activities or behaviors that save money, they are being financially rewarded. These rewards provide motivation and appear to strongly encourage the continuance of such behaviors. This begs the question then, why is this same principle not applied more heavily to preventative health measures?
In February, researchers at the Centers for Disease Control and Prevention (CDC) announced a 43% drop in the obesity rate among 2- to 5-year old children over the past decade, suggesting that young Americans are making strides in the fight against obesity. According to this report, about 8% of this population was obese in 2011-2012, down from 14% in 2003-2004. Headlines in The New York Times touting this new information read, “Obesity Rate for Young Children Plummets 43% in a Decade”. Cynthia Ogden, a researcher for the CDC and lead author for the report, cautioned that while this research was “exciting”, these young children make up a very small fraction of the American population and that the figures for the broader society had remained flat or had even increased; perhaps suggesting that this headline may be sending an inaccurate message about obesity in America. Nonetheless, many theories arose to explain this decline in childhood obesity.
The supplement industry has always been a buyer-beware market due to a lack of manufacturer oversight and regulation before products reach the marketplace. The weight-loss supplement, OxyElite Pro, manufactured by USPLabs, illustrates a recent example of this risk. The product claims to be a thermogenic fat-burner to aid in weight loss, but it seems to have the potential to negatively impact organ cells outside of adipose tissue. It has been directly linked to 97 cases of hepatitis; nearly half of which required hospitalization, three created the need for liver transplantations and one resulted in death. These findings were presented in a paper authored by Dr. Pieter Cohen, an assistant professor of medicine at Harvard Medical School and a general internist at Cambridge Health Alliance in the New England Journal of Medicine (April 2014). Hepatitis is a serious medical condition defined by inflammation of the liver caused by a range of viruses; or less commonly, bacteria, funguses or parasites. Non-pathogenic causes include tainted drug/supplement intake, excessive alcohol consumption, fatty liver disease as well as autoimmune or metabolic disorders.
Clients who regularly compete in events from 5Ks to marathons and beyond will agree that steps must be taken to reduce the risk for gastrointestinal (GI) tract problems during both races and training sessions. It is well-known that long-duration endurance training can directly damage the GI tract and cause debilitating symptoms, especially when combined with inappropriate nutritional intake. Research indicates the 30-50% of endurance athletes experience some sort of GI issues related to their training.
Current statistics show that obesity rates amongst individuals in the US have remained relatively stable over the last 10 years. Meaning, little progress and little loss seems to have been attained in the battle against this epidemic which impacts society at every level. According to a new study recently published in the Journal of the American Medical Association by the Centers for Disease Control (CDC), 8.1% of infants and toddlers, 16.9% of 2- to 19-year-olds and 34.9% of adults aged 20 years or older were obese. These values were attained from 9,120 participants who took part in the 2011-2012 nationally-representative National Health and Nutrition Examination Survey (NHANES). Overall, there have been no significant changes from 2003-2004 through 2011-2012 in high weight (for recumbent length) among infants and toddlers, obesity among 2- to 19-year-olds, or obesity among adults. However, there was a significant decrease in obesity among 2- to 5-year-old children (from 13.9% to 8.4%) and a significant increase in obesity among women aged 60 years and older (from 31.5% to 38.1%).
In 2014 heart disease has remained the leading cause of death for both men and women in the U.S. Interestingly, most people fear dying of cancer rather than suffering a fatal cardiac event; and according to a new report from the Cleveland Clinic about three-quarters (74%) of Americans do not fear dying from this most likely cause. The Cleveland Clinic conducted a survey of 1,005 adults (502 men and 503 women 18 years of age and older) living in the continental United States as part of their consumer awareness campaign coined “Love Your Heart”, in recognition of Heart Month. In addition to the seeming apathy Americans have for heart disease, the survey also identified that most people are generally misinformed concerning heart disease prevention and symptoms. Among Americans with high risk, such as those with a family history of the disease (39%), 26% do not take any preventative steps to protect their heart health. This may be no surprise as the majority (70%) of Americans are unfamiliar with the symptoms of heart disease; yet 64% of those surveyed have or know someone who has the disease.
Do you suffer from Caffeine Use Disorder? Caffeine is the most widely-used drug in the world, and with social acceptance a key driver, many people are demonstrating clear signs of addition. Caffeine is found in many beverages including coffee, tea, and soda; but is also common in over-the-counter pain relievers as well as a whole host of dietary supplements (including food and beverage-based products) branded with some form of the word "energy." Products like 5-hour energy and caffeine shots are very common items at most convenience stores and remain available to all consumers including children; demonstrating the casualty of the drug.
Physical activity is a key component to maintaining a person’s physical and mental well-being – so why do doctors not use it as a vital sign? In the past, independent measures have been used including blood pressure and resting heart rates as indicators of health with the assumption that these measures are indicative of a healthy lifestyle. But without using participation or assessment of physical activity as a relevant component to health, how can a physician gauge all of the other attributes associated with active lifestyles; including positive effects on musculoskeletal function, systemic inflammation, stress, and psychological wellbeing.
The fitness industry is constantly giving birth to new methods of training. Many of these methods are not supported by scientific research but are rather fueled by anecdotal claims and flashy marketing. While some stand the test of time others fall to the wayside once associated infomercials run their course. Occasionally, a new training method arises which seems to have true merit the fitness industry - one such method is Whole Body Vibration Training (WBV). The idea behind WBV is to overload both the muscular and nervous systems to expedite adaptation responses within the body. The body’s ability to produce force is calculated by multiplying the mass of an object by the acceleration of that same object (F = m x a). Traditional resistance training helps to improve force by increasing the mass component of the equation while WBV training functions be increasing the acceleration component of the equation.
New Year resolutions in theory are about a behavior change. It may be towards a change in social, emotional, or physical actions, but the latter seems to always get the most attention. Gaining a better understanding of what people are thinking in the pre-action phase leading to January 1st, may help provide insight as to (personal) motivational factors and key drivers to decisions by consumers. Participants from Lifetime Fitness programs were surveyed and over 1,400 individual respondents provided data on resolutions drivers and personal goals in support of the January 1, Commitment Day. Commitment Day is a broad social movement with a charge of establishing a commitment to healthy eating, exercise, family, respect, giving and a healthy planet. The Jan 1, 2014 event encompasses 5K fun walk/run events in 34 cities across the country, with tens of thousands of individuals participating. Interestingly, the data found that the majority of respondents (75%) placed their overall fitness as the priority in the New Year; twelve percent identified their work or career as the main emphasis of their behavior change, while ten percent placed family as the priority for 2014.
In early-mid December fitness enthusiasts start to succumb to the holiday season and those fully committed to training year-round find they have a little extra room in most fitness facilities. Many less-adherent people find themselves busy with the Holidays and unable to stick to their normal exercise regimens with the thoughts of “I’ll really get serious after the holidays”. Then January comes along…. and gyms once again quickly fill up with masses of people having followed through with the first step of their New Year’s resolution. According to a study in the Journal of Clinical Psychology top resolutions include weight loss, exercise, stopping smoking, better money management and debt reduction.
Problem 1 Many people experience a feeling of sluggishness during the holiday season, and activity status is often replaced with stress, sedentary behaviors and high caloric intake. There is no doubt participation frequency and total training volume decrease over the Holidays. The fitness centers are still open but people’s routines are altered and regular workouts often take a backseat to holiday events, planning, and shopping.
In today’s supplement market there are many products a consumer could buy that contains compounds which are harmful, undisclosed to the buyer, or just plain dangerous. This is evident by the relatively frequent recalls of supplement compounds in US and other markets following negative consequences among those who used it. Thankfully there is a degree of oversight over staple food products and licensed medicines, and the entities involved in this oversight take charge when products have clearly been shown to be unsafe to the average consumer. On that note, the Food and Drug Administration (FDA) recently took steps toward eliminating trans fats from foods purchased at your local grocery store. The agency states that a major source of trans fats, being partially hydrogenated oils, is no longer "generally recognized as safe”. If this determination is finalized, partially hydrogenated oils will be categorized as food additives that cannot be included in a food product without approval.
According to new guidelines from the American Heart Association (AHA), physical activity should be considered a vital health measurement and tracked on a regular basis just like other modifiable cardiovascular risk factors such as blood pressure, resting heart rate, and smoking. "The deleterious effects of physical inactivity are associated with many of the most common chronic diseases and conditions, including heart disease, type 2 diabetes mellitus, hypertension, obesity, osteoporosis, depression, and breast and colorectal cancers," Scott J. Strath, PhD, chair of the AHA's Physical Activity Committee and colleagues wrote in a scientific statement published in Circulation. "Risk identification, benchmarks, efficacy and evaluation of physical activity behavior change initiatives for clinicians and researchers all require a clear understanding of how to assess physical activity."
How many decisions does a person make a day? Some say thousands if all things are considered. According to researchers at Cornell people make an average of 227 decisions per day about food alone. According to researchers every decision we make potentially affects the next; and that the accumulative process of making decisions progressively depletes the integrity of the process. This explains why when we are under stress we tend to react rather than consider options. It is suggested the body actually experiences “decision fatigue.” Under situations of “decision management” the brain is thought to function automatically causing us to make automatic decisions based on prior orientation. This may explain why we gravitate to the same foods and beverages, and find ourselves in the same places. This lends itself to the question – if you want to change for the better what is the process of making better decisions?
In the fitness industry there seems to exist an overabundance of opinion. Fitness enthusiasts, self-proclaimed gurus and even TV doctors chime in on what, according to them, is the best technique for an exercise, the best modality for training, the best dietary strategy, the best program for fitness and the list goes on…. An issue with the health and fitness industry is opinion should have a very limited place in any given decision-making process. Specifically, decisions regarding one’s health and fitness behaviors should be fact-based not opinion-based.
It is well known that stress can promote positive or negative hormonal and metabolic responses within the body, and new research clarifies that perceived happiness (in its various forms/categories) may follow a similar pattern. Happiness, specifically the neuroendocrine responses associated with the sensation, can promote explicit reactions and adaptations at the molecular level within cells including DNA. According to new research led by Barbara L. Fredrickson, Kenan Distinguished Professor of Psychology in the College of Arts and Sciences at the University of North Carolina at Chapel Hill, the sense of well-being derived from "a noble purpose" may provide cellular health benefits whereas "simple self-gratification" may have negative effects - despite an overall perceived sense of happiness. >
“You are what you eat” is a phrase supporting the numerous effects food and drink play within our physiology. Food stuff can affect how we feel, how effectively we engage mental or physical work, and even how we look. Not all sources of edible products are created equal and they all can have different effects on the systems of our body and even impact our organs, bones, connective tissues, fat stores and muscle. While some nutrients provide age-protecting benefits and assist in improving many aspects of health, others function to the contrary. There exist a few nutrient sources that seem to accelerate the aging process through a number of means when over-consumed in the diet. These foods consequently provide the consumer with the risk of aging more rapidly than their chronological age would indicate. Regular consumption and high doses increase the effects, so consumers should be aware of the types and quantities of food they are consuming.
Resistance training is an integral component to any comprehensive fitness program. The benefits are numerous: increased muscular strength, power and/or endurance, muscle hypertrophy, maintenance of lean mass, metabolic improvements, optimized body composition, enhanced bone mineral density, improved athletic performance, flexibility and/or functional movement economy, improved insulin sensitivity, and an overall better quality of life (to name a few). With any resistance training program, the lifts selected can create desirable physiological/psychological improvements – if the activities match the goal(s).
Personal trainers know that the average client desiring to lose weight or optimize body composition can make just a few nutritional modifications to create a significant impact on total caloric intake. One of these simple changes includes negating excess beverage calories. For example, replacing three regular sodas each day with a calorie-free beverage or water can provide for an estimated caloric deficit of 2,500 kcals (assuming 120 calories/beverage) over the course of a single week. After a month, this equals a theoretical equivalent of 2.85 pounds. Considering the impact of this simple (intake) modification it would be prudent of personal trainers to educate their clients on beverages that they should strategically avoid if attempting to lose weight. The major issue with calorically-dense beverages is that they are usually rich in simple sugar and fat and do not provide the same level of satiation as calorically-equivalent foods. Many beverages serve as a surplus of empty calories with limited nutritional value, which likely explains New York’s efforts at reducing sugary beverage intakes.
If you have not had a chance to read the recent New York Time’s piece on Personal Training from Frank Bruni it is worth the three minutes. Not because it seems like a humorous attempt by the author to use every word from his thesaurus, nor because the author makes many valid points, or even paints an accurate picture of personal training as a whole; the real value of the read is in understanding people’s perceptions and, whether accurate or not, how those perceptions form opinion and how opinion is used in free press.
It seems like anywhere you look in the media today fitness enthusiasts are embracing the next “extreme” exercise challenge. Traditional safe and effective exercise techniques have lost some luster, in exchange for “guru”-driven workouts that burn a purported >1000 calories an hour. To put it in perspective, a 200-lb man would have to train at 100% VO2max for the full hour to attain that value – sadly identifying once again the false advertising associated with many of these programs.
It’s a common occurrence - you want to perform compound exercises in the squat rack and someone is performing curls. Whereas Monday seems to be a national chest day in most gyms – everyday is seemingly the ideal time to perform more curls. This likely explains the trend toward minimalist tank tops and cover-up sweat pants. While leg training is a popular activity for women, men tend to spend much more time on their upper physique leading to the so-called “chicken legs”. Certainly pants can quickly cover up the deficiency, but what many upper body enthusiasts fail to realize is the lower body is the key to total body improvements.
Perhaps it is a cultural phenomenon or just a common character flaw, but Americans seem to demonstrate an ongoing overconfidence in their knowledge and abilities. This has clearly been established by the ongoing skill gap surveys, but also in the average American’s perception of their education and capabilities relative to other countries. On average, 16 other industrialized countries scored above the United States in science, and 23 scored above the U.S. in math. Interestingly though, America’s self assessment places the country in the top 3, suggesting that while Americans are performing in a subpar manner compared the rest of the World, surveys indicate the U.S. population rates themselves as outstanding. This is not only a problem in manufacturing, technologies and work skill readiness across disciplines, but has also bled into the average citizen’s everyday interactions.
The American Thoracic Society (ATS) released new official clinical practice guidelines on the diagnosis and management of exercise-induced bronchoconstriction (EIB) published in the American Journal of Respiratory and Critical Care Medicine. EIB is the acute airway narrowing that occurs as a result of exercise-induced stress. According to Jonathan Parsons, MD, associate professor of internal medicine and associate director of The Ohio State University Asthma Center and chair of the committee that drafted the statement, "While a large proportion of asthma patients experience exercise-induced respiratory symptoms, EIB also occurs frequently in subjects without asthma." Among asthma suffers EIB is currently unknown, however it is estimated that 20% of those not diagnosed with asthma do suffer from EIB. That number jumps to a range between 30% and 70% for Olympic and elite-level athletes.
Would it help consumers if they could actually make an educated decision on what to eat at restaurants? Would people actually select a breakfast muffin if they knew it had 600 kcal? Unlike cooking at home, diners are subject to menus without complete transparency. While the restaurant industry looks to implement new rules requiring chains with 20 or more locations to post caloric content information, wouldn’t it be reasonable for all restaurants to provide consumers with the nutritional content of their products? With the new federal rules approximately 50% of the nation's restaurant locations but will be exempt from review requirements. To underscore the real concern, researchers at the Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) at Tufts University analyzed meals from independent and small-chain restaurants. They found that on average, per portion size, caloric density was two to three times the estimated calorie needs of an individual adult at a single meal and 66% of typical daily calorie requirements.
According to the American Heart Association if you cannot run or jog you can just as easily lower your risk of high blood pressure, high cholesterol and diabetes by taking a brisk walk. Recent findings reported in the American Heart Association journal Arteriosclerosis, Thrombosis and Vascular Biology suggest that when walking and running are matched for energy expenditure, the benefits for disease prevention become similar.
Many health conscious consumers already remove the yolk from the high-protein whites of eggs (between 5-7g per serving depending on size) to reduce the fat and cholesterol content. Recent findings suggest that there may be additional benefit to consuming more egg whites; specifically the positive effects it may have on blood pressure. University professors presented their findings at the 245th National Meeting & Exposition of the American Chemical Society (ACS).
The increased popularity of social interaction in guided exercise instruction has allowed personal training to take on an expanded role into small group coaching. This training style allows participants to enjoy instruction from a qualified professional, which in turn provides a greater reach to client markets who otherwise would be unable to participate due to lack of resources or an interest in the one-on-one model. The added benefit, documented from data on participation rates, suggest that the small group model may be superior in terms of retention, weekly participation and overall motivation. There seems to be a matrix between professional instruction, social interaction/inadvertent competition, and the collective motivation of the combined peer and instructor support. This bodes well for all stakeholders and defines an important evaluative component of one’s program. Ensuring it meets these criteria warrants an audit of weekly participation rates, participant perceived value (enjoyment and motivation), as well as the average tenure of participation.
Inherently the fitness industry is subject to trends, as exercise enthusiasts tend to gravitate toward novel products and activities. Not surprisingly, when the minimalist trend in shoe wear hit the retail stores many runners and cross trainers quickly hopped on the bandwagon. The popularity of the new shoe features created a rapid market shift with minimalist shoes now making up 15% of the $6.5 billion running shoe market.
Similar to the case of androstendione found in Mark McGwire’s locker, the media surrounding Ray Lewis’ miraculous recovery of a normally season-ending injury, due to a simple spray of deer antler extract, once again has stimulated huge attention to a performance supplement. In the case of McGwire, the prohormone was likely being used to mask the later admitted steroid use as research indicated no efficacy and actually an unintended side effect of increased estrodiol among males. Currently the jury is still out on whether the deer antler provides any benefit as a performance enhancing agent, purported to heal cartilage and tendon injuries more quickly while boosting strength and endurance.
During the first few months of any new year many struggle to maintain their exercise compliance. Initial motivations are not sustained to support the demands of lifestyle changes. Commonly, the main complaint is not the exercise but the minimal time available to keep up their “ideal” exercise regimen. This perception is often is due in part to the real and perceived occupational, family and social factors that affect our daily lives. For those citing a lack of time as a true determent to fitness, newly-published research may provide some comfort as well as solutions.
As schools continue to cut physical education from the mandatory curriculum to reduce costs, research is progressively showing the importance of daily physical activity in the development of young children’s cognitive abilities.
At one time or another, most people have trained with a friend or colleague who was in better physical condition and found themselves achieving impressive results. Common sense suggests that this is due to the motivation to “keep up” with the experienced individual by the weaker counterpart. The mental aspect of falling behind drives them to push harder than they would when left to their own accord. Scientists cite different drivers of motivation including negative/positive reinforcement, support, the availability of spotting assistance, or the sense of accountability and camaraderie that comes with working out in pairs. New research from Kansas State University reinforces this assumption by demonstrating that the key to motivation are the feelings of inadequacy experienced by the less-fit individual.
People suffering from Type 2 diabetes have chronically high blood glucose due to insulin resistance. The exact cause of Type 2 diabetes is not known, but research commonly attributes it to obesity and a lack of activity. Recent research estimates that 6.4% of the world population is diabetic. By 2030, the estimate is projected to reach 7.7%, with developing countries experiencing the most significant increases. Complications from Type 2 diabetes include blindness, dementia, gum disease, cardiovascular disease, and a greater risk of lower limb amputations. Furthermore, sufferers typically have a 10-year shorter life span than the general population. A new study conducted by University of Southern California (USC) and University of Oxford research teams indicates that consuming large amounts of high fructose corn syrup (HFCS) may be one of the major contributing factors associated with this rising global epidemic of Type 2 diabetes.