Category Archives: Nutrition

Future of Medicine

cocaine1In time everything we do to treat injuries, prevent disease, or reverse disease will eventually change. Think of all the things we used to do in medicine. Cocaine was used for toothaches. In the 1600’s, “hydrotherapy” was used to would wash away insanity in mental patients. Jan Baptist van Helmont would literally drown people to death and then resuscitate, believing that water would cleanse and the near drowning would snap people back to reality. In the 1800’s ketchup was used to treat athletes foot. In rehabilitation science, we use a myriad of techniques that we think is proper today, but overtime, the way we treat will drastically change and I believe it will come sooner rather than later.  Continue reading

The Hydration Nation: Hyper-Hydration vs. Dehydration

20140501“Are you drinking water?” “Drink water!” “Hydrate!” “If you’re thirsty it is too late, you are already dehydrated.”  This craze of hydrate, hydrate, hydrate has gone overboard and could be causing more harm than good. Who is more at risk for serious medical complications, the hyper-hydrated or dehydrated. For performance, is it best to be overly hydrated, dehydrated or euhydrated? What follows might surprise you. Continue reading

Multivitamins: A Multibillion Dollar Waste of Money

Pills Pouring out of BottleIt’s a shame that a multibillion dollar industry is fueled by misleading people. The business of supplementation is championed by big businesses who utilize fear-mongering tactics to influence the public. These companies disseminate biased data and purport ridiculous claims. ‘We are a nation of rising chronic disease, take this multivitamin.’ ‘We are a nation of malnourished kids, take this multivitamin.’ ‘Autism linked to vitamin deficiency, take this multivitamin.’ ‘Agriculture has ruined our soil; it is depleted of nutrients, take this multivitamin.’ It is an infestation of pseudoscience propaganda that gets delivered daily to our email inbox and shared via social media.

Last night, I was in my normal geek mode and came across a news story on my Flipboard feed; Are multivitamins a waste of money?  I was glad to see an article disputing the inaccurate claims made by the industry. The article quotes an editorial published in this week’s Annals of Internal Medicine to support the claim that using supplements and multivitamins to prevent chronic conditions is a waste of money.

Hallelujah! Continue reading

Curry Anyone? Turmeric Supports Brain and Heart

Are you foodie and love to chow down? Well, I do, and if you are like me, you also love savory foods with a little kick. I came across this very interesting blog post written by Inspirit Physical Therapy. After reading through the post I felt behooved to share with my subscribers.
Turmeric – commonly known as curry powder – is a popular spice used in Middle Eastern and Asian foods. Apparently, turmeric Pananghas some very good health benefits. The compound Curcumin found in turmeric has been shown to interfere with many cellular signaling pathways including inflammation. Over the years it has been linked to protection against Alzheimer’s, prostate cancer, arthritis and various metabolic syndromes. In addition a study also found Curcumin to retard age-related arterial stiffening. Going out for dinner this week? If you are, maybe you should swing by the local Thai restaurant. Panang Curry anyone?

 

Postpartum Weight Loss

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One of the most common inquires I get is from new moms looking to lose that postpartum belly. How is it possible that celebrities like Heidi Klum can drop 30-40 pounds in just 4 months?  Anna Paquin goes from twins to 6-pack abs in 5 months. For new moms, that is frustrating, when you work so hard to lose stubborn body weight. What do they do that you don’t? Trust me, there is no super-secret information or magic formula that only they are privy to. You have the same physiology and weight loss capabilities as Hollywood superstars.

Normal weight gain during pregnancy is 30-35 pounds. Roughly 10 pounds is lost immediately after birth – seven pounds for the baby, plus two-three for blood, amniotic fluid and other. Through the first week your body will flush another 5 pounds of reserved water weight.  Optimal weight loss should be 1-2 pounds per week. If you do the math, you will find that Anna Paquin and Heidi Klum lost about 2 pounds per week.  Suddenly, Heidi and Anna’s weight loss isn’t so dramatic, does it? A loss of 1-2 pounds per week is easily attainable if you are diet compliant and dedicated to exercise. Continue reading

Post-exercise Nutritional Tips for Improving Performance and Recovery

My former co-worker giving me a stretch during the Spartan race after cramps set in.

My former co-worker giving me a stretch during the Spartan race after cramps set in.

A couple of weeks ago, I participated in a 5k and a 10k challenge that was scheduled 12 hours apart. Fitness enthusiasts would consider a back to back 5k / 10k as just another training session. I, on the other hand, am quite the opposite. I have developed a hate-hate relationship with aerobic exercise –specifically, running. I like speed, agility, quickness, strength, and power – arrg arrg arrg! I am five foot nothin’ and a hundred somethin’ (emphasis on the nothin’ and somethin’).  I would rather pluck my eyelashes than run. But, I do love the exercise science.

You’d think I’d use my knowledge for exercise science as a useful tool. Unfortunately, my continued pursuit of knowledge does not translate to practical utility. What follows is what I should have done to enhance recovery and optimize performance during this short 12 hour recovery period between races. Since, I won’t listen to myself, maybe you will!

First, we must understand the physiology of producing energy, fatigue and recovery. I do not want to turn this in to an advanced exercise physiology session on metabolic pathways but this general background is helpful. When we exercise energy (ATP) is needed.  This energy is created by our body using three systems:  ATP-PCr system, the glycolytic system and the oxidative system. Each energy system has its own method of generating energy. Likewise, each energy system becomes fatigued after an imbalance occurs in its system.

In the ATP-PCr system our body uses stored Phosophocreatine and through a series of reactions quickly generates ATP. Unfortunately, this system gets depleted of stores rather quickly. This is why you can only perform and all out sprint for 10 – 20 seconds. After a 2 minute rest period the ATP resynthesizes giving you the ability to perform an all-out sprint again. If we going longer than 20 seconds our body must enter the glycolytic system. Here we begin to use glycogen to make energy. When glycogen is broken down without oxygen present, our cells becomes acidic (commonly known as lactic acid buildup or lactate threshold). This acidity inhibits enzyme activity. Since enzymes are the catalysts for almost all body functions, we fatigue when they stop working.

If intensity is low enough in the glycolytic system, our body has time to use oxygen to breakdown glycogen and prevent lactic acid build-up. This is the oxidative system. Using oxygen to breakdown glycogen is our long-term energy system, which we use to perform tasks like distance running. Carbohydrate is stored in our body as glycogen in muscle and liver. This is our preferred and primary energy source. However, when we exercise we deplete glycogen stores and sometimes have to call on fat to make energy. When we reach this phase our body will fatigue. So, in review, during high-intensity exercise we fatigue because we deplete ATP and Phosphocreatine stores. During moderate activity we fatigue due to lactate build-up. During long and steady state exercise we fatigue when glycogen stores become depleted.

To combat this fatigue we must train our body to adapt to these physiological changes, or provide opportunity for our body to recover through rest. You can also practice good post-exercise refueling habits. By eating and drinking macronutrients (carbohydrate, fat and protein) we replace what we just used. So, what do we eat and when do we eat to replenish?

A Study published by Howarth, et al., in 2009 found that ingesting a carbohydrate and protein mixture at a 4:1 ration provided the best benefits when compared to carbohydrates alone. Similarly, Koopman, et al., in 2005 found a 3:2 ration of carbohydrate to protein ingested post exercise was better than carbohydrate alone. The Koopman study also investigated the benefit of leucine – an essential amino acid found in soy, beef and salmon, known to facilitate muscle regeneration – and demonstrated an added benefit of this supplement. Even though some current data is contradictory most studies show that the amount of glycogen formed is significantly greater in athletes consuming the mixture of Carbohydrate and Protein.

Timing also plays an important role. You may have heard of nutrient timing – it’s getting a lot of attention lately. In order to compensate for protein loss during exercise, the timing of post-exercise protein supplementation is important. The efficiency of protein synthesis is improved by ingesting rapidly after exercise.  Another challenge is the refueling with carbohydrates. Bottom line, the sooner carbohydrate is consumed post-exercise; the greater the amount of muscle glycogen is resynthesized. When time is short between fuel-demanding events, it makes sense to start refueling as soon as possible.

Keep it simple, post-exercise meals should be built on a foundation of carbohydrate-rich foods plus a smaller amount of protein. Greek yogurt or cottage cheese with fruit or bananas with peanut butter are both good options. If you are a stickler for protein powder, switch it up – make yourself a fruit smoothie and add a scoop of protein.

My times for the 5k and 10k were 29:37 and 63:26 respectively; certainly not awesome.  Maybe if I’d apply what I know, I would have done better. Maybe if I replenished with a healthy carbohydrate protein drink instead of beer and pizza, I would have done better on day 2. If I’d just listen to my brain and not my fat cells I might have finished under 60 minutes. If I’d listen to my brain, not watch the ESPN, I could improve. If I chose to get up rather than drool on my pillow, I might approach 45 minutes. Someday I will get the hint and practice what I preach. Maybe I need the late Chris Farley’s famous character, Matt Foley, as my personal motivational speaker.

Eat This! Don’t Take That!

Multivitamins, fish oil, antioxidants, vitamin D, B-complex vitamins, conjugated linoleic acid, amino acids, protein powders, chromium, pyruvate, GuChomps/Gel Packs, creatine, fat burners, how many supplements do we need? You might be sick of hearing me say this, but let your body do its job. Why all of a sudden do we feel it is necessary to incorporate supplements in our diet? Our body has always been able to do its job.

Supplements are just that, designed to supplement, not overrun the diet. We only need enough to make up for shortfall of our recommended dietary allowance. RDA is the dietary intake level of a nutrient considered sufficient by the Food and Nutrition Board. These nutrient levels are set to meet the needs for over 95% of the population. The kicker is that most balanced diets of 2,000 calories will meet these needed levels. Eating more is not better.

Without a doubt, nutrients play an integral in human physiology, but over abundance of a particular nutrient may inhibit other physiological functions, creating a nutrient tug-o-war. There are Tolerable Upper Intake Levels (UL) that are set to caution against excessive nutrient consumption, because it can be harmful. Yet, despite eating a balanced meal, many still take additional supplements that can have significant adverse reactions.

There are a scant few in the population that actually need supplements. For example, nursing or pregnant women, those with strict calorie restrictions or nutritional deficits secondary food intolerance, seniors or those with medical illness and some athletes. But, these individuals need a select few supplements, not excessive amounts of unnecessary supplements.

For this blog, I wanted to talk about the most common nutritional supplements, share their toxicity effects and then provide a reasonable food source that is a better choice that the supplement of choice.

Don’t Take That: Multivitamin

Really, is your body deficient in 30 plus vitamins and minerals? You might be deficient in 1 or 2, but not all. Many times the vitamin / mineral intake level of a the standard multivitamin far exceeds RDA levels and sometimes certain vitamins or minerals are near the UL. Now, add this with normal eating and you are certain to go beyond the UL in many of your vitamins and minerals. This creates toxic effects, which can alter normal body physiology, cause illness, and inhibit other minerals from doing their job.

Eat This! A Well-balance meal

This is easy, to get all of your vitamins and minerals in adequate levels eat a well-balanced meal that meets your caloric needs. This will prevent toxicity and get all vitamins and nutrients for optimal human functioning.

Don’t Take That: Vitamin D

Vitamin D certainly has a positive impact on the body, including increased bone mineral density. Unfortunately, chronic overdose of Vitamin D can lead to hyperparathyroidism and hypercalcemia, which can lead to nausea, weakness, insomnia, and even renal failure.

Eat This! Mushrooms, fish, and sunlight.

Most of the Vitamin D needed for you body can be achieved through our own internal synthesis. In just 10-15 minutes of sunlight your skin will begin to synthesize vitamin D. However, if you live in a cave, or are nocturnal, eat fish – catfish, salmon, mackerel with a side of mushrooms to get your vitamin D needs.

Don’t Take That: Omega-3

Omega-3 fatty acids or fish oils are the absolute best fat one can have. They are best known for the significant cardiovascular benefits. Unfortunately, excessive amounts cause excessive bleeding, stroke, headaches,  increased blood glucose levels, and Gastrointestinal disorders.

Eat This! Fish, avacados, nuts, flax seeds, oils

There are many foods that are rich in Omega-3 fatty acids. It is easy to get the recommended amount in the typical diet. In addition, to the richness of Omega-3 content you also get all the other nutrients that accompany these foods, making food a much better option than the supplement.

Don’t Take That: B-Complex Vitamins

A water soluble vitamin that has many positive effects such as reduced stress, increased energy, and higher metabolic rates. Since B vitamins are water soluble toxic effects are rare as the excess is typically excreted in urine. However, Vitamin B6 (pyridoxine) is linked to peripheral neuroathy, and B12 is linked to pernicious anemia disease, but these are rare. Others have been linked to skin and neurological disorders. The biggest factor here is that we rarely need them

Eat This! Most foods

Found in most unprocessed foods, plants, dairy products, meats and fortified cereals, it is rare that we have a deficiency in B-vitamins. If you are stressed, or lacking energy, go exercise – don’t take a pill, you will just excrete it all in a few hours anyway.

Don’t Take That: Vitamin C

Known for it’s ability to boost the immune system, vitamin C is widely used and found as an additive to many foods. That said the research to support these claims are suspect at best. Vitamin C is also known as an effective antioxidant for its ability to reduce oxidative stress, through removal of free radicals. As a water soluble vitamin, excess Vitamin C is excreted in the urine, however, there is a  risk for diarrhea and in rare cases the formation of kidney stones is possible.

Eat This! Citrus Fruits

Rich sources include oranges, peppers, grapefruits, peaches, papayas, pineapples, broccoli, strawberries, tomatoes, and melons.

Don’t Take That: Protein Supplement

Protein supplements, particularly, meal replacement shakes with a 4:1 carbohydrate to protein ratio taken 15-45 minutes after exercise, has significant benefits for refueling lost energy stores. Sadly, most will take protein supplements throughout the day – even when not exercising. Very little quality evidence exists showing positive effects of more than 2 grams/kg body weight of protein per day. Most literature recommends 1.2-1.8 grams / kg of body weight per day.  Then there is the other theory that our body can only digest a certain amount of protein per hour – so excessive amounts gets converted or is passed through. So why spend the money?

Eat This! Meat, dairy, some plants

If you are exercising a post workout protein shake might be beneficial. If you are skipping meals, a protein shake might be beneficial. Otherwise save your money, eat  lean meats such as turkey, chicken, pork, and fish. In addition, dairy products, and beans are good protein sources. It’s cheaper and tastes better than chalk flavored milk.

Don’t Take That: Energy Gummies

These have become the rage for long distance endurance athletes. Energy gummies are filled with electrolytes, antioxidants, and amino acids to combat breakdown, fatigue and provide long lasting energy. Great right? Sure, but why spend the money if something cheaper works just as well or better.

Eat This! Raisins

A study published a few years ago compared raisins vs. energy gummies. There was no difference in performance between the raisin group and the gummy group. In addition, the raisin group showed a lower insulin spike when compared to the gummy group, a win for the raisin. Plus, the raisin group demonstrated higher free fatty acid content in the blood post activity. What does this mean, for the same performance gains, raisins allowed for more fat metabolism vs. gummy candy – most of us could stand to lose fat.

I know I will catch flack for this. Many of my friends are big supplement supporters. Yes, supplements do serve a purpose, but only in moderation and only if you need it. If you question whether or not you need a supplement, seek consultation from a registered dietitian – they will evaluate your diet and tell you exactly what you need.

Is the US Government Responsible for the American Obesity and Chronic Disease Epidemic?

Chronic medical conditions is the leading cause of death in the United States. Nearly half of all adults have at least one chronic medical condition. Over the past 20 years there has been a significant rise in chronic disease. Over the past 15 years childhood obesity and diabetes is growing at an astronomical rate. Who is to blame? Nobody can really state exactly who, but  is it possible that the US government, specifically the United States Department of Agriculture (USDA) is responsible?

1992 Food Guide Pyramid

In 1992, the USDA released the first Food Guide Pyramid. The USDA obviously had good intentions, through heavy research the pyramid was developed to prevent, chronic disease, obesity, and dental carries. Over the years the Food Guide Pyramid evolved to in to more user-friendly versions, MyPyramid (2005) and MyPlate (2011). Despite making the guides more user-friendly, the USDA did little to evaluate data and change the science supporting the pyramid.  Unfortunately, the USDA got it completely wrong. Since the ’92 Food Guide Pyramid was released there has been a dramatic increase in chronic disease and obesity. Has the Food Guides failed the American people?

Let us evaluate the guides. The ’92 version has grains, fruits, and vegetables filling the bottom two rows of the pyramid, accounting for 20 of 26 possible servings. The 2005 version is much of the same, with a large portion dedicated to carbohydrates, but like the ’92 version, the largest portion is dedicated to grains. The 2011, MyPlate is simplified for the consumer, but again indicates most of your plate be comprised of carbohydrates. In fact, when you breakdown the percentages the guides recommend the consumer eat approximately 75% of calories from carbohydrate sources. What is wrong with this you ask? Well, below I have outlined 5 reasons why the USDA might be responsible for the rise in chronic disease and obesity.

Five Reasons Why the USDA Might Be Responsible for the American Obesity and Chronic Disease Epidemic

Reason #1: Misleading information

The guides suggest grains (bread, pasta, rice) account for the largest portion of carbohydrate consumption. The guides do not state 100% whole-grain. To the average consumer, this gives the impression that refined breads and pasta is a fantastic option.  So, the lay person, goes to a restaurant orders a plate of spaghetti and a side of garlic bread, and thinks -‘this is a healthy low-fat meal’. After all, according to the guides this meal is well within the guidelines set forth by the USDA.

Additionally, the original guide said 6-11 servings of breads, grains, and pasta / day. Servings is key, because most individuals, myself included, grossly overestimate what constitutes a serving. Another note on servings: it gives a range of servings; 6-11 servings. This tells the consumer that you must have a minimum of 6 servings of grains. This misleading information has led to over-eating and over-eating of the wrong foods.

Reason #2: Satiety

Countless studies have correlated carbohydrate intake to increased hunger, specifically foods with high glycemic index (1, 2, 3). Primarily because of the insulin and blood glucose spike caused following the ingestion of carbohydrates. Newer research indicates that a higher than normal protein diet may actually be the reason for their partial success in inducing weight loss (4). Weigle, et al, found that the subjects felt more satiated with high-protein diet (5). In addition, Weigle’s team found total caloric intake decreased with when consuming more protein (5). There are two theories behind protein’s ability to increase satiety: 1 – High protein foods take longer to digest and leave the gut. 2 – Protein may impact our the hunger and satiety hormones of ghrelin and leptin. So the USDA is telling us to eat foods, that physiologically trigger us to eat more.

Reason #3: Insulin

When we eat carbohydrates insulin is released by the pancreas to begin glucose uptake from the blood. Insulin’s job is to take blood glucose and facilitate storage of glycogen  – our primary energy source. Insulin is also an indirect gate-keeper to fat metabolism, by inhibiting the release of glucagon. Glucagon is a hormone that has the opposite role of insulin. Glucagon is designed to take glycogen and convert it to glucose. Glucagon also creates glucose through lipolysis (the breakdown of fat). If we eat carbohydrates, the insulin response inhibits glucagon – thus prevents us from burning fat.

Reason #4: Elevated Inflammatory Markers

Chronic inflammation is a primary cause of most chronic diseases (6). Excessive consumption of refined carbohydrates, low dietary fiber intake, and a high omega-6 to omega-3 ratios are strongly associated with the production of proinflammatory molecules (7). One large study compared a Western diet and high protein diet. In this study, the western diet group had greater levels of inflammatory markers, including CRP and E-selectin, whereas those on the high protein diet had a significant decrease of inflammatory markers (8).

Reason #5: Importance Fat

In the original food guide pyramid it is stated that fats should be used sparingly. In both the 2005 version and 2011 version, the USDA’s guide says nothing about fat. This gives the impression that fat should be avoided. This is a huge mistake. Fat, specifically, Omega-3 fats – found in nuts, fish, and seeds – is very important. Clinical studies in adults with high cholesterol have shown that nuts lower LDL-cholesterol and improve the overall blood lipid profile (9). Additionally, frequent nut and seed consumption is associated with lower levels of inflammatory markers such as C-reactive protein (CRP), IL-6 and fibrinogen(10).

Does this indicate the USDA got it wrong and led the American people down the wrong path? I believe the aforementioned reasons have led to an increase in obesity and chronic disease in America. Is it really a coincidence that following the release of the guides there has been a dramatic rise in obesity and chronic disease? That being said, I believe in personal responsibility – I think it is up to the individual to make wise decisions. The USDA is not telling people to stop exercising. So, although I believe the USDA may have been a contributor – some blame should be put on the people.

What do you think? Can we blame the USDA’s Food Guides for steering the American people in the wrong direction?

References:

  1. Wien M A, et al. Almonds vs complex carbohydrates in a weight reduction program. Int J Obes 2003. 27:1365-1372
  2. Roberts SB. High-glycemic index foods, hunger, and obesity: is there a connection? Nutrition Review 2000. 58:163-169
  3. Arumugam V, et al. A high-glycemic meal pattern elicited increased subjective appetite sensations in overweight and obese women. Appetite. July, 2007.
  4. Astrup A, Meinert Larsen T, Harper A. Atkins and other low-carbohydrate diets: hoax or an effective tool for weight loss? Lancet 2004;364:897
  5. Weigle DS, Breen PA, Matthys CC, et al. A high-protein diet induces sustained reductions in appetite, ad libitum caloric intake, and body weight despite compensatory changes in diurnal plasma leptin andghrelin concentrations. Am J Clin Nutr 2005;82:41–8.
  6. Stehouwer CDA, Gall M-A. Twisk JWR, Knudsen E. Emeis JJ. Parving H-H. Increased urinary albumin excretion, endothelial dysfunction and chronic low-grade inflammation in type 2 diabetes: progressive, interrelated, and independently associated with risk of death. Diabetes.2002;51(4): 1157-1165.
  7. Neustadt J. Western Diet and Inflammation. IMCJ. Vol. 10: 2  Apr/May 2011.
  8. Lopez-Garcia E, Schulze MB, Fung TT, et al. Major dietary patterns are related to plasma concentrations of markers of inflammation and endothelial dysfunction. Am JClin Nutr.2004;80(4):1029-1035.
  9. Mukuddem-Petersen J, Oosthuizen W & Jerling J. A systematic review of the effects of nuts on blood lipid profiles in humans. J Nutr. 135: 2005. 2082–2089.
  10. Rajaram, S, Connell, KM, and Sabate´ J. Effect of almond-enriched high-monounsaturated fat diet on selected markers of inflammation: a randomised, controlled, crossover study. BR J of Nut.  2010: 103, 907–912.

Arthritis: Causation, Symptomalogy, and Management

According to the CDC approximately 1 in 5 adults and 50% of older adults (> 65 yrs of age) have been diagnosed with some form of arthritis (1). The physical pain associated with arthritis is well documented, however, there is a large social impact on arthritis suffers. From an outsiders perspective, arthritis goes undetected. Outsiders do not see the pain or suffering that arthritic patients must suffer through. They are often labeled as weak, malingerer’s, or even lazy. Point is, many people with arthritis are having difficulty performing simple activities of daily living.

The purpose of this blog is to provide a high-level overview of the disease and share basic exercise and dietary guidelines that can provide a holistic approach to reducing symptoms, improve quality of life, and functional outcomes.

Disease Overview: 

There are more than 100 rheumatic diseases and conditions that affect joints, the tissues which surround the joint and other connective tissue (1). It is the most common chronic musculoskeletal condition in older adults. The two most common forms of arthritis include osteoarthritis (caused by damage or wear and tear) and rheumatoid arthritis (autoimmune causes).

Osteoarthritis:

Osteoarthritis (OA) is characterized by the gradual deterioration of cartilage within a joint (2). It is commonly developed in load-bearing or highly mobile joints, such as the knee, hips, fingers, lower back, and feet. Often, those who suffered a significant injury to a joint are at an increased risk of developing OA. For example, knee OA is very common following ACL tears and surgery. The internal joint damage caused by the injury compounded by incomplete rehabilitation (prolonged inflammation and muscle weakness) are the perfect ingredients for OA development.

The synovium of a joint produces the lubricating substance, synovial fluid. Healthy cartilage functions much like a sponge, it is receives nourishment by absorbing synovial fluid during joint movement. As we age, the synovium decreases its production of synovial fluid, we move less, and inflammation the articular cartilage increases resulting in dehydrated / malnourished cartilage). This creates a vicous inflammatory cycle.

Inflammation causes pain, loss of function, which eventually leads to muscle wasting and cartilage deterioration. Overtime, the poor cartilage condition can result in the formation of exotosis (bone spurs) that further damage the joint structures, increases pain, and creates a loss of function.

The most common symptoms of OA are pain, inflammation, reduced range of motion, and grinding sensations upon movement. As cartilage continues to detoriorate, pieces of cartilage my break free and float withing the joint (osteochondritis dissecans). The floating bodies will sometimes lock or catch the joint during movement. This locking or catching is very uncomfortable and sometimes painful.

There is no cure for osteoarthritis. Since pain is alleviated with rest, many of those afflicted tend to avoid regular exercise for fear of pain or flare-ups. Despite this, a recent study demonstrated that older adults who regularly participate in aerobic and resistance exercise are effectively able to relieve arthritic pain and improve joint function (4, 5). This creates a paradox for optimal treatment (movement vs. rest).

Rheumatoid arthritis:

Rheumatoid arthritis affects approximately 1% of Americans. It is an autoimmune disease where by the body’s own immune system attacks joint structures, including cartilage, synovial membrane, and ligaments. Rheumatoid arthritis is a systemic condition characterized by periods of activity and remission where affected joints are painful and swollen in addition to whole body symptoms of fever and malaise. Currently, there is no cure of rheumatoid arthritis, but there are medications designed to relieve symptoms.

Rheumatoid arthritis of the hands

 

Holistic Approach to Arthritis Treatment and Prevention:

Although I have great respect for western medicine and the research that pharmaceutical companies do to help cure chronic diseases, I have always been a believer in the holistic approach. The body is a self-healer – its own internal mechanic.

As I mentioned previously, cartilage gets nourishment through dynamic pressure gradients caused by movement and joint loading. Most people with arthritis can safely participate in physical activity programs to help the disease. Many studies have shown physical activity to have a positive effect on the reduction of arthritic pain. A 2010 agenda released by CDC lists physical activity as a priority intervention to improve arthritis symptoms and prevent arthritis-related limitations in activity (6). Unfortunately, there is a fine line; arthritis causes pain and subsequently, sufferers will not move due to pain. The perpetuates the disease and worsens symptoms. So movement is prudent, however we must be careful and be cognizant of exacerbating the issue. Below are some exercise guidelines.

Exercise Guidelines:

Things to avoid:

  • Rheumatoid arthritis results in early morning stiffness, so avoid early morning exercise.
  • Avoid end ranges of motion exercise as extreme cases may allow you to move in a small mid-range of motion only.
  • Be certain to distinguish between exertional pain in the muscles and pain in the joints.
  • If any movement causes moderate pain in a joint, stop immediately and modify or regress the exercise.
  • Always move joints through a slow and controlled range of motion.
  • Avoid fast or jerky movements.
  • Progress and increase exercise intensity very slowly.

Exercise tips and suggestions:

  • Exercise sessions should be relatively short and of low to moderate intensity.
    • Use circuit training (to give body parts a rest between exercises)
  • Aerobic exercise should be comprised of multiple sessions of using various cardio equipment (treadmill, to bike, to rower, etc)
  • Flexibility:
    • Self myofascial release (foam rolling) might be painful, but try it.
    • Static stretching as tolerated but avoid end range of motion for the joint
  • Resistance:
    • Low intensity
    • 1–3 sets of 10–12 repetitions 2–3 days per week
    • Work on core musculature
    • Use a circuit or peripheral heart action training system.
    • Avoid high reps or high loads.
  • Use thera-bands or cuffs when possible to avoid gripping if hand and grip strength is a problem.
  • In severe cases training sessions maybe have to be limited to short bouts (8-10 minutes at a time).
  • Emphasize the development of functional flexibility and eccentric control through simple reactive training exercises.
    • forward lunge with emphasis on lowering.
    • Eccentric training will improve soft tissue to absorb ground reaction forces and reduce the force transmission to damaged joint structures.
  • Water aerobics or swimming may be the best environment for clients with severe arthritis.

Dietary Considerations:

Arthritis is a chronic inflammation cycle, where inflammatory mediators remained elevated and a continued process of degradation ensues. Individuals with chronically elevated inflammatory markers are at high risk of chronic disease and now research shows that poor diet can also contribute to increased inflammatory markers. I wrote about this in a previous blog entry titled “Is Your Diet Making You Sick?”.

Excessive consumption of refined carbohydrates and low dietary fiber intake is strongly associated with the production of proinflammatory molecules (7). One large study compared a western diet, which contained more red meat, refined carbohydrates and saturated fat to a paleolithic diet (8). The Western diet group had greater levels of inflammatory markers, including C- reactive protein (CRP) and E-selectin when compated to those following a paleo-like diet (8).

Clinical studies in found frequent nut and seed consumption is associated with lower levels of CRP, Insulin-like growth factor (IL-6) and fibrinogen(9). Consuming an almond-enriched diet for four weeks significantly decreased serum E-selectin compared with the control diet in healthy men and women (9).

The rise of these inflammatory diseases over the past few decades may be linked to the Western diet of saturated fats, low antioxidants, and refined carbohydrates. A diet rich in omega-3 fatty acids such as fish and nuts as well as whole grains and high fiber have been shown to reduce chronic inflammation markers in the blood.

Summary:

Arthritis is a serious chronic inflammatory disease which has both physiological and psychological effects on overall health. Pharmaceutical companies continue to search for a magical cure for arthritic conditions, but to date nothing has been found. Thankfully, we can do something to help relieve the pain and symptoms of arthritis. Creating a safe and systematic physical activity program can help prevent cartilage deterioration and improve overall function. In addition, a dietary change can also help. By limiting intake of refined carbohydrates, excessive sugar, and foods high  in saturated fat we can lower chronically elevated inflammatory markers that are responsible for chronic diseases such as arthritis. I hope these tips help you or someone you know improve quality of life.

 References:

  1. http://www.cdc.gov/arthritis/data_statistics/arthritis_related_stats.htm. retrieved August, 23, 2012
  2. Ferrini AF, Ferrini RL. Health in the Later Years. 4th ed. New York, NY: McGraw-Hill; 2008.
  3. Hills, B. A., Ethell, M. T., and Hodgson, D. R. Release of Lubricating Synovial Surfactant By Intra-Articular Steroid.  Br J of Rheum. 1998;37:649–652.
  4. Petrella RJ. Is exercise an effective treatment of osteoarthritis of the knee? West J Emerg Med.2001; 174(3): 191-196.
  5. Ettinger WH, Burns R, Messier SP, et al. A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST). JAMA. 1997: 277(1): 25-31
  6. Centers for Disease Control and Arthritis Foundation. A National Public Health Agenda for Osteoarthritis. 2010
  7. Neustadt J. Western Diet and Inflammation. IMCJ. Vol. 10: 2  Apr/May 2011.
  8. Lopez-Garcia E, Schulze MB, Fung TT, et al. Major dietary patterns are related to plasma concentrations of markers of inflammation and endothelial dysfunction. Am JClin Nutr.2004;80(4):1029-1035.
  9. Rajaram, S, Connell, KM, and Sabate´ J. Effect of almond-enriched high-monounsaturated fat diet on selected markers of inflammation: a randomised, controlled, crossover study. BR J of Nut.  2010: 103, 907–912.

ENOUGH! Weight Loss is NOT Rocket Science

This blog should more appropriately be titled my rant of the month:

How many diet fads come out every year? Atkins, Zone, Paleo, Low-fat, South Beach, Intermittent Fasting are some of the most popular, but there are hundreds more pumped out every year. Why do we have new diets every year? Because there is not, nor will there ever be, a diet that can guarantee weight loss. Researchers keep making weight loss a scientific endeavor. The researchers then publish the findings, sell books, get rich and then the diet fades. Enough already, weight loss is not rocket science. It’s simple: balance energy by eating better and getting off of your ass. To prove my point let’s compare the data on a controversial issue: high-protein, low-carbohydrate vs. low-fat diets.

In 2002 a study done from Duke University researchers comparing a high protein low carb diet versus a traditional low-fat diet. The results of this study became much publicized and launched the Atkins Diet revolution. It hit mainstream media with a left and right hook. The diet quickly became one of the best-selling diet plans of all-time. But pundits refuted the data stating unreliable and invalid data. Today, there is valid points of discussion made by both sides.

Like most research and controversial issue, the data is for and against the high-protein diet is equivocal. In 2003, the New England Journal of Medicine published two studies which compared a low-carbohydrate diet to a calorie-restricted, low-fat diet in obese adults (1, 2). After six months both studies showed that low-carbohydrate subjects lost more weight and had significant reductions in markers for cardiovascular disease. This includes decreased triglyceride levels. However, after one year of performing the diets, weight loss and triglyceride levels were similar. But like many diets, compliance is an issue and in both studies there was a high dropout rate – thus data is unreliable.

As I had mentioned, pundits refuted the data. Most stated, that carbohydrate restriction was not the reason for weight loss, rather it was attributed to calorie deficit. This is similar to the systematic literature review done by Bravata, et al concluded that participant weight loss on low-carbohydrate diets was a result of caloric restriction, but carbohydrate restriction (3).

So Atkins, does yield weight loss, but why? Can I really eat a bacon cheeseburger (with no bun) and lose weight? Physiologically, carbohydrates are the body’s primary fuel source. When we eat carbohydrates the food is broken down and stored in skeletal muscle tissue and liver as glycogen, an easy to use energy source. When we eliminate carbohydrates from our diet we also eliminate glycogen stores.  Without glycogen, our body must use fat as energy. Subsequently, our body enters a state of ketosis – a state where ketone bodies are produced when fatty acids are broken down for energy. The loss of glycogen stores – and associated water loss – coupled with increased fat metabolism creates weight loss. In addition, the breakdown of fat is much more difficult than breaking down glycogen. Thus, our body must expend more energy to convert fat to energy (4) – burn energy to create energy.

But there are risks to eating a high-protein, low carbohydrate diet, right? The answer is yes and no. Many have stated a high-protein diet causes kidney and liver issues as well as abnormal insulin metabolism. Levine et al performed a research review  on low-carbohydrate diets and found little data to say a high-protein, low-carbohydrate diet causes health concerns (5). However, many studies have found that the diet does cause common side effects such as constipation, nausea, weakness, dehydration, and fatigue.

Is there a winning diet method? Simply put – the answer is no. While South Beach, the Zone, Atkins and others have all remained the most popular, there is not winner. If there were some magical remedy we would never again have new diet fads. After reviewing all of the data there is one constant: all weight loss is associated with negative energy balance. Meaning, you are burning more calories than you are consuming.

Remember Super-Size Me? The guy who ate McDonald’s everyday and gained weight. Well have you heard of Doug Logeais? He ate McDonald’s everyday for 30 days and lost weight! How, he exercised. He trained most days of the week at a high intensity – he burned more calories than he consumed.  Has anyone seen Michael Phelps’ diet? Big Mac, Pizza, soda, ice cream, 10,000 calories per day in food, but nobody says he has a weight problem. He is a long, lean and the greatest Olympic athlete of all time. Does he need to change his diet? Can you honestly say that he is doing something wrong? He is fit because his exercise off-sets calorie consumption.

My final opinion: regular physical activity combined with a well-balanced diet is paramount.  Weight maintenance requires permanent changes to eating habits and increased physical activity. The specific strategies for making those changes, and making them permanent, will vary from person to person. So, instead of a walking through the local book store of the best-selling diet book, save your money. Take a walk through your neighborhood. Instead of cheeseburger and fries – order a turkey burger and side salad. This is not rocket science – quit trying to make it more difficult than it is.

References: 

1      Samaha FF, Iqbal N, Seshadri P, et al. A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med. 2003;348:2074–2081.

2      Foster GD, Wyatt HR, Hill JO, et al. A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med. 2003;348:2082–2090.

3      Bravata DM, Sanders L, Huang J, et al. Efficacy and safety of low-carbohydrate diets: a systematic review. JAMA. 2003;289(14):1837–1850.

4      Buchholz AC, Schoeller DA. Is a calorie a calorie? Am J Clin Nutr. 2004;79(suppl):899S–906S.

5      Levine MJ, Jones JM, Lineback DR. Low-carbohydrate diets: assessing the science and knowledge gaps, summary of an ILSI North America workshop. J Am Diet Assoc. 2006;106:2086–2094.

 

 

Stop Destroying your Body!!

Have you ever wondered why the ankle swells after a sprain or why we get a fever or why you get allergies around pollen? This does not happen because our body is weak; it happens because our body is strong and functioning as it should. Swelling after a sprain is needed to heal damaged tissue. Fever from flu is because our immune system is attacking a virus. Runny nose, watery eyes from allergies is a histamine response from your body to protect. Our body is designed to protect itself – we are robots that have specific programs in place to counteract disease or illness. Unfortunately, we are preventing our body from doing its job.

In the cells of your body is a class of proteins called Sirtuins. These have specific jobs that are designed to help the body function, live, and heal. SIRT1 is a specific type of Sirtuin that is specifically designed to facilitate metabolism. Yes this little guy helps breakdown and utilize the food you eat. Previously, Leonard Guarente of MIT found that this protein has many benefits including protection against Alzheimer’s, and Parkinson’s diseases. Most recently, they found that when mice were fed high-fat diets a myriad of metabolic disorders developed when the protein was absent.  These proteins are helping to keep cells alive and healthy.

We are killing these proteins and preventing them from doing their job. Research has proven that diets high in fat produce inflammation (see my blog). During the inflammation process an enzyme called Capase-1 is released. The specific job of Capase-1 is to go out and cleave (destroy) proteins and ultimately alter the primary objective of the protein. Are you following me?

When we eat a high-fat diet SIRT1 wants to begin metabolism, however the Capase-1 enzyme destroys SIRT1 before it can do its job. What happens next? Well, fatty deposit storage increases, followed by multiple metabolic and cardiovascular disorders such as diabetes, obesity, and hypertension (to name a few). By limiting high-fat intake and foods that initiate inflammation, we can allow our body’s natural protective mechanisms to go to work.

Stop Destroying your Body.
Reference:
Massachusetts Institute of Technology. “Protein that boosts longevity may protect against diabetes: Sirtuins help fight off disorders linked to obesity.” ScienceDaily, 8 Aug. 2012. Web. 11 Aug. 2012.

Weight Loss Challenges? Have You Tried Intermittent Fasting?

How many diets have you tried? How many times have you failed? The term ‘fad diet’ is a gross understatement, all diets are fads. I cannot think of a single diet that has been around for years, can you? Most diets are difficult to follow – bland, costly, and inconvenient – subsequently, there is a high rate of non-compliance to the diet strategy.   What if a diet asked you to eat a little healthier and take 1 day off per week? That doesn’t sound that hard does it?

The concept of Intermittent Fasting has been around for many years. In fact, our ancestors were forced to occasionally fast. Recently, I learned about intermittent fasting by John Berardi, Founder of Precision Nutrition System and leading nutritional scientist. I read his book and became hooked on the concept. In the simplest explanation, one day a week, you fast for an entire day (20-24 hours). For example, eat regular meals Tuesday through Sunday. On Sunday night eat dinner at your normal time (7 pm). Then don’t eat until Monday evening at dinner time.  During the fasting period, drink water and take a multivitamin if you want to. When you resume eating, don’t run to a fast-food chain and order 3 double cheeseburgers, an extra large fry, and a milkshake. Just, resume normal, healthy eating.

“I’ll Starve to death”, is the immediate response. No, you won’t. Our ancestors went 2-3 days without eating, they survived. Second, you will quickly learn that you are less hungry at hour 20 than you were at hour 4. We have hormones in our body, which trigger the feeling of hunger, but once you get past the initial hunger phase, the hormone response is suppressed and hunger subsides.

A single day of fasting creates a negative energy balance (expending more calories than consuming) of 2000-3000 calories. Consider that one-pound of fat is equivalent to 3,500 calories, you can see how easy it is to reach the negative energy balance and weight loss. There are physiological benefits that go beyond negative energy balance and weight loss:

  • Improved blood lipid profile (decreased LDL, increased HDL)
  • Reduced blood pressure
  • Reduction of inflammatory markers such as C-Reactive Protein
  • Improved fat metabolism
  • Increased insulin sensitivity (blood sugar control)
  • Enhanced Autophagocytosis (cellular repair)

It should be noted, that the above is based on fasting for 18-24 hours. Fasting for longer periods or more frequently does not enhance or expedite these results. Improving health is never quick and easy. Exercise or diet alone will not create life lasting health improvements.  The improvements noted above are a result of intermittent fasting, combined with overall healthier eating and regular exercise. Ultimate health and wellness come from a combination of diet and exercise.

Two months ago I started a paleolithic diet after doing my own independent research on diet and inflammation (I blogged about it). The data was so overwhelming I had to try it for 30 days. I loved it. Now I am combining a less strict version of Paleo with John Berardi’s intermittent fasting program. After 45 days, I lost 15 pounds and feel fantastic.  Easiest diet I have tried.

Is Your Diet Making You Sick?

Inflammation is the body’s biological response to repair tissue and initiate healing after injurious stimuli has damaged tissue. When an irritant begins to damage tissue, a chemical response ensues. This response causes significant signs: Pain, Heat, Redness, Swelling and loss of function. Inflammation is how we survive and heal. Without this natural response, disease would take over our body. Inflammation is necessary; however, it can also be a serious problem, especially when the condition becomes chronic.

The inflammatory response is the same regardless of the location or the stimulus that caused injury. After trauma occurs hemodynamic changes occur along with the production of exudate or edema. In acute inflammation, the tissue initiates a repair and remodeling event to return tissue to a normal state. If the inflammation fails to resolve, or inflammatory mediators remained elevated, the tissue will begin a cyclical process of a continued inflammatory response; this is when chronic inflammation occurs.

Chronic inflammation is a common factor that may contribute to development of chronic diseases (1). Many diseases are now classified as inflammatory diseases, such as, vasculitis, atherosclerosis, diabetes, and arthritis. Elevated C-reactive protein (CPR) in the blood is a sign of inflammation. Individuals with chronically elevated CRP are three times more likely to have a heart attack than those who have low –levels. Now, studies are finding a correlation between chronic inflammation, chronic disease and poor diet.

Researchers have found the diet has an influence on inflammation. Specifically, excessive consumption of refined carbohydrates, low dietary fiber intake, and a high omega-6 to omega-3 ratios are strongly associated with the production of proinflammatory molecules (2). Additionally, antioxidant’s decrease inflammation, and the low intake of antioxidants contributes to a proinflammatory state exacerbates disease (2). One large study compared a Western diet and a paleo-like diet. The western diet contained more red meat, refined carbohydrates and saturated fat. The Western diet group had greater levels of inflammatory markers, including CRP and E-selectin (3). Those following the paleo-like diet had a significant decrease of inflammatory markers (3).

In addition, the Mediterranean diet, which is comprised of whole grains and omega-3 fatty acids was found to reduce inflammatory markers compared to baseline levels and eliminate metabolic syndrome after two years of following a Mediterranean diet and exercise (4).   Cytokines, which are another key for chronic inflammation, are released by adipocytes. Thus general fat loss can reduce the expression of cytokines.

Clinical studies in adults with high cholesterol have shown that nuts lower LDL-cholesterol while improving the overall blood lipid profile (5). Frequent nut and seed consumption is associated with lower levels of inflammatory markers such as C-reactive protein (CRP), IL-6 and fibrinogen, even after adjusting for confounding factors(6). Consuming a high-almond diet (68 g/d per 8386 kJ) for four weeks significantly decreased serum E-selectin compared with the control diet in healthy men and women (6).

Chronic inflammation is linked to chronic diseases such as coronary heart disease, diabetes, atherosclerosis, and arthritis. The rise of these diseases over the past few decades may be linked to the Western diet of saturated fats, low antioxidants, and refined carbohydrates. A diet rich in omega-3 fatty acids such as fish and nuts as well as whole grains and high fiber have been shown to reduce chronic inflammation markers in the blood. Diet plays a much larger role than previously thought in the prevention of chronic disease. Are you ready to change your diet?

References:

  1. Stehouwer CDA, Gall M-A. Twisk JWR, Knudsen E. Emeis JJ. Parving H-H. Increased urinary albumin excretion, endothelial dysfunction and chronic low-grade inflammation in type 2 diabetes: progressive, interrelated, and independently associated with risk of death. Diabetes. 2002;51(4): 1157-1165.
  2. Neustadt J. Western Diet and Inflammation. IMCJ. Vol. 10: 2  Apr/May 2011.
  3. Lopez-Garcia E, Schulze MB, Fung TT, et al. Major dietary patterns are related to plasma concentrations of markers of inflammation and endothelial dysfunction. Am JClin Nutr. 2004;80(4):1029-1035.
  4. Neustadt J. The food pyramid and disease prevention. Integr Med. 2005;4(6):14-19.
  5. Mukuddem-Petersen J, Oosthuizen W & Jerling J. A systematic review of the effects of nuts on blood lipid profiles in humans. J Nutr. 135: 2005. 2082–2089.
  6. Rajaram, S, Connell, KM, and Sabate´ J. Effect of almond-enriched high-monounsaturated fat diet on selected markers of inflammation: a randomised, controlled, crossover study. BR J of Nut.  2010: 103, 907–912.