MRIs & Docs May Not Have All the Answers

We’d like to think that our modern medical technology and treatment methods can diagnose and heal any problem. PET scans, CAT scans, MRIs and X-Rays allow us to peer inside the body and examine tissues and organs. Our MDs and surgeons are the beneficiaries of hundreds of years of evolving medical education. But guess what! Not every ache and pain has an obvious cause and many docs are as mystified by our ailments as we are.

New Study Finds 70 Percent of Able-Bodied Hockey Players Have Abnormal Hip and Pelvis MRIs comes from Science Daily. The piece explains the findings of a study conducted by the American Orthopedic Society for Sports Medicine. The study used the MRIs of the pelvis and hips of 39 collegiate and professional hockey players. Seventy percent of the images showed abnormalities yet only two players reported pain. In other words, most of the players had what we might identify as “injuries” yet only two of them were “hurt.” So this goes to the issue of just how valuable are these sorts of diagnostic tools.

Matthew Silvis, MD, Assistant Professor, Department of Family Medicine and Orthopedics at Hershey Medical Center at Penn State University College of Medicine stated,

“Unexpectedly, the majority of players had some abnormality in their MRI, but it didn’t limit their playing ability. The study raises many questions, but its value to surgeons is to recognize that imaging doesn’t replace good clinical judgment, which includes a detailed history and complete physical exam. This study might make you hesitate to read too much into an MRI.”

A lot of us probably assume the MRI is very precise and can show us exactly why our back, knee or shoulder is in pain. Yet we may need to think about whether or not we’re looking at chickens or eggs here. Do these abnormalities cause pain, or are they simply coincidental to pain?

Obviously the only reason anyone gets an MRI outside of a study like this is because we’re in pain and we need to know why. (I have yet to meet anyone who had an MRI simply out of curiosity about what they look like on the inside.) So automatically we have a self-selected group to study. If this study is any indication then in fact it’s entirely likely that people who feel healthy may indeed appear to be injured according to their MRI. Thus what is seen on an MRI and attributed to our pain–bone spurs, a torn labrum, or a herniated disks for instance–may or may not be the cause of our pain. Perhaps the source of our pain is something else entirely. The point is the MRI is not always as precise as we’d like to believe.

I’ve had personal experience with this sort of situation. Several years ago I was performing a barbell snatch and I felt a pop followed by very sharp pain in my left shoulder. A cortisone shot helped only temporarily. I underwent an MRI and according to the image there was no serious injury. It wasn’t until a surgeon had a look inside my shoulder and saw that my supraspinatus tendon was about 90% detached. After he reattached the tendon he later explained how MRIs can be helpful but they’re not always very precise.

On a simiar theme, a recent New York Times story examines to what degree doctors sought medical attention for their aches and pains. You might be surprised to learn that docs who were interviewed rarely visted other docs when they’re hurting. (The Times story also references the MRI story mentioned above.) Doctor-athlete, Paul D. Thompson, a marathon runner and a cardiologist at Hartford Hospital in Hartford said the following:

“I think most folks should not go, because most general doctors don’t know a lot about running injuries,” he said, adding, “Most docs, often even the good sports docs, then will just tell you to stop running anyway, so the first thing is to stop running yourself.”

So all-and-all, as much as we’d love to believe that the modern mainstream medical profession has all the answers–or at least the tools to find all the answers, it simply ain’t so in a lot of cases. The fact of the matter is most MDs don’t fully understand human movement and how all the parts of the body–bones, muscles, organs, and most importantly the nervous system–act together in a 3-D world governed by gravity. Just look at how many specialists there are around us. There are podiatrists for the feet, spine specialists, knee specialists, shoulder specialists, low-back doctors, etc. There are surgeons that specialize in opening us up and tinkering about. There are docs to analyze blood, the eyes, reproductive organs, the heart, our minds…. But guess what, we’re all one big system! If we or the people who are assessing us believe that we’re just a bunch of separate parts then we’re way off the mark. And if your doc just wants to feed you pain medicine–definitely go get another opinion. (As one acquaintance put it, “Your pain wasn’t caused by an ibuprofen deficiency.”)

(BTW, please don’t take this as my hating on the entire medical profession. If I’m in a car crash and I’ve got a piece of steel stuck in me, please go get me a surgeon and not a massage therapist or chiro.)

Recognize that the arms and neck are highly affected by the feet. Weak eye muscles can cause bad posture and thus neck pain. Medication for our high cholesterol may cause low-back pain. Shoulder pain may be rooted in poor wrist and hand mechanics. Even if the tissue of a years-old injury has healed, the ability to move and control the limb may not have been restored–and that may be causing pain in any number of areas. The bad mood you’re in may be driving that aggravating hip pain.

The body and the nervous system is tremendously complex and all its parts are highly interactive at all times. Always keep this in mind if you’re in pain and looking for relief.

The Role of Exercise in Weight Loss

Want to lose weight? The tried and true advice has always been “Exercise and eat right.” Hard to argue with that. Burn calories via exercise and eat less and/or eat better quality food. Done and done. Recently however, the role of exercise in this process has been questioned. Time magazine went so far as to tell us Why Exercise Won’t Make You Thin. Other research has suggested that the eating part of the equation is more powerful than the exercise part. Further, from experience as a personal trainer, I’ve seen many a gym member tell themselves “Hey, I’m exercising. I can eat whatever I want!” I have yet to see anyone succeed following that route. So what if any role does exercise play in shaping our physique?

The New York Times has weighed in with a very interesting, nuanced and informative article on the topic. Weighing the Evidence on Exercise tells us among other things that exercise alone may not make you lean, but that it will likely help keep you thin if and when you get there. Further, it seems exercise has a different effect on the appetites of men vs. women.

“When you look at the results in the National Weight Control Registry,” Harvard researcher Barry Braun says, “you see over and over that exercise is one constant among people who’ve maintained their weight loss.”

The article cites two studies to this effect One by the American College of Sports Medicine demonstrated that appetite was blunted in men who ran on a treadmill for 1.5 hrs. In another study by Harvard researchers reported in the American Journal of Physiology, men and women walked on treadmills and their appetites were monitored. The men showed similar results to the ACSM study. The women however showed increased appetite. It seems that female physiology is very favorably given over to storing energy (as fat–eeeeeeech!!!)

The Harvard study found other very valuable information which I’ll get to in a moment but first, more about who was studied. The weight-change history of 34,000 women was tracked for 13 years. (The large sample size and length of the study are two strengths.) The average age of the women at the start of the study was 54 years. Now the important information as reported by the Times:

“During that time, the women gained, on average, six pounds. Some packed on considerably more. But a small subset gained far less, coming close to maintaining the body size with which they started the study. Those were the women who reported exercising almost every day for an hour or so. (emphasis is mine) The exercise involved was not strenuous.”

Finally, the Times article discusses a study from the University of Colorado. In this study, rats were fattened and allowed to be sedentary for a time. The rats’ diets were then switched to low-calorie fare and half of them were made to run on treadmills for about 30 minutes a day. (Strangely, Jillian Michaels was not involved.) The results of the study as reported by the Times are as follows:

“Then the fun began. For the final eight weeks of the experiment, the rats were allowed to relapse, to eat as much food as they wanted. The rats that had not been running on the treadmill fell upon the food eagerly. Most regained the weight they lost and then some.”

But the exercising rats metabolized calories differently. They tended to burn fat immediately after their meals, while the sedentary rats’ bodies preferentially burned carbohydrates and sent the fat off to be stored in fat cells. The running rats’ bodies, meanwhile, also produced signals suggesting that they were satiated and didn’t need more kibble. Although the treadmill exercisers regained some weight, their relapses were not as extreme. Exercise ‘re-established the homeostatic steady state between intake and expenditure to defend a lower body weight,’ the study authors concluded. Running had remade the rats’ bodies so that they ate less. (emphasis is mine)

To reinforce the message from all this, Science Daily reports on another study not mentioned in the Times article: Diet Alone Will Not Likely Lead to Significant Weight Loss, Study Suggests. Here, Oregon Health & Science University studied monkeys that were fed a high-fat diet for several years. They then were placed on a low-fat diet for a month. The important information is this:

“Surprisingly, there was no significant weight loss at the end of the month,” explained OHSU post-doctoral fellow Elinor Sullivan, Ph.D. “However, there was a significant change in the activity levels for these monkeys. Naturally occurring levels of physical activity for the animals began to diminish soon after the reduced-calorie diet began. When caloric intake was further reduced in a second month, physical activity in the monkeys diminished even further.”

So what’s the take-home message from all this? First, as a personal trainer, I find it highly interesting the actual role that exercise seems to play in weight loss. It’s not so much a direct influence as it is something that changes our bodies over the long haul, and sets the stage for us to stay trim. Beyond that, think of this evidence in light of research (here, and here for instance) showing that exercise alone won’t do the trick when it comes to weight loss and we have a very familiar message: To lose weight we must eat right and exercise.

Recommended Products

I’ve realized recently that there are a lot of books, nutritional products and other such things that I think highly of. Because of that I’ve added to this blog a Recommended Products page. I’ll add to it periodically as I come across stuff that I think is worth owning and using. If you have suggestions for such items, please contact me and let me know.

Beating Obesity

The latest edition of the Atlantic features an excellent article on our nation’s struggle with obesity. Beating Obesity is written by Marc Ambinder and it’s a thoughtful, in-depth look at the political and social ramifications of this seemingly losing battle. We learn about the major players including First Lady Michelle Obama, the food industry and the insurance companies. (Ambinder himself struggled with obesity and eventually underwent bariatric surgery as a solution.) Ambinder does a very good job in discussing the issues of individual responsibility and the environmental challenges we face such as food at every checkout line (not just at the grocery store), ever growing portion sizes, and junk food that is cheaper than fresh fruits and vegetables.

Most importantly he examines the moral and demographic issues of obesity. He notes the following:

“Black children are more at peril of becoming obese than white children; black women are more than 50 percent more likely to be obese than white women. ‘At the current rate of increase,’ epidemiologists noted in a recent article in Obesity, ‘it will take less than 30 years for all black women to become overweight or obese.’ Obesity rates are above average among Mexican American boys, as they are among Hispanics generally. Obesity rates among young American Indians tend to be nearly twice the national average.

Please check out the article. It’s an excellent piece.

Personal Running Experiment: Brooks vs. Vibrams

I’ve been dealing with Achilles pain since the end of last summer. (The Achilles pain is very likely the latest symptom of a variety of dysfunctions which seem to be rooted in foot and glute function.) This week I’ve gone on the first couple of what you might call “runs.” One day I wore my Brooks then the next day I ran in my Vibrams. There were very interesting and different results. Overall, I felt far more comfortable in the Vibrams. I experienced less shock and impact and I felt better at the end of the run. Running in the Brooks seemed to bother my left hamstring and my low back. Not everything was perfect in the Vibrams. I seem to have some irritation in part of the medial plantar nerve which results in a bit of burning/numbness type feelings in the big toe and 2nd/3rd toe area. It wasn’t too terrible though. I will continue to play around back and forth with footwear and see what happens.

Thus far, I love my Vibrams for work and gym exercise. I hiked in them this past weekend and I felt very good in them. I’m wearing them more and more and I encourage most exercise enthusiasts to experiment with wearing minimal footwear.

Try cherries before and after your next long ride, run or grueling workout.

Here’s another weapon to add to your endurance training recovery arsenal: cherries. Marathon Runners Should Pick Cherries for a Speedy Recovery comes from Science Daily and it profiles a recent study out of Northumbria University in England. Marathoners who ran the London Marathon were split into two groups. Twenty marathon runners drank either a tart cherry blend juice or a placebo drink twice a day for five days before taking part in the London Marathon and for two days afterward. The story summarizes the research findings as follows:

“The findings indicated that the group who drank the cherry juice recovered their strength more rapidly than the control group over the 48-hour period following the marathon. Inflammation was also reduced in the cherry juice group, as was oxidative stress, a potentially damaging response that can be caused by strenuous physical activity, particularly long distance endurance exercise.”

It might be reasonable to conclude that cherries could aid cyclists, swimmers, cross-country skiers and maybe strength & power athletes as well. More research will be needed to confirm this guess. In any event, adding cherries to any or all of your recovery strategies may be a simple and tasty idea. (For more recovery methods, check out recovery nutrition, cold water immersion, and caffeine.)

Sounds like good news! However I can see it now… Sports nutrition stores will soon be stocking and promoting cherry juice extract–in a pill!! The stuff will cost more than cherries and probably won’t work. Warm weather is coming and cherries will soon be in the grocery stores. Buy ’em and eat ’em.

Compulsive Eating is Similar to Drug Addiction

Obesity-related eating issues are in the news again. This time new research indicates that the physiological dynamics of overeating are the same as drug addiction. Compulsive Eating Shares Addictive Biochemical Mechanism With Cocaine, Heroin Abuse, Study Shows comes from Science Daily. The article summarizes a Scripps Research Institute study that was published recently in the journal Nature Neuroscience.

The study examined the brain chemistry of rats that were fed high-fat, high-sugar diets similar to human junk food. The rats quickly became obese and at the same time their brain chemistry showed striking changes. Pleasure centers in their brains changed and became less responsive. The result was the rats had to eat more and more in order to stimulate these regions. These dynamics of food addiction mirror those of rats addicted to cocaine and heroin. Paul J. Kenny, one of the scientists who conducted the study said,

“It presents the most thorough and compelling evidence that drug addiction and obesity are based on the same underlying neurobiological mechanisms. In the study, the animals completely lost control over their eating behavior, the primary hallmark of addiction. They continued to overeat even when they anticipated receiving electric shocks, highlighting just how motivated they were to consume the palatable food.”

A fascinating development in the study came when researchers replaced the junk food with nutritious food: the rats refused to eat. They starved for nearly two weeks after the change.

What seems to be happening to these rats (and likely to obese humans) is that consumption of highly pleasurable food overstimulates and dulls the reward centers of the brain. More food (or drugs) are needed to stimulate feelings of reward and pleasure. Without getting too technical, the neurotransmitter dopamine and it’s receptors in the brain are the key elements here. Dopamine is released in the brain by pleasurable experiences such as drug or food consumption. Consume too much of either and the brain is flooded with dopamine which is essentially bad for dopamine receptors. Over time the brain actually undergoes physical changes and addictive behavior becomes normal and very difficult to change.

The big issue to me is that overeating and obesity are very complex and not at all simple matters of will power. Personal trainers and nutritionists must realize that the brain function of the obese person is very different from the non-obese person. Simply instructing someone to eat differently rarely works and now we know very specifically why.

To that point, I’m skeptical of our various efforts to educate the public on the caloric content in our food (first in NYC and most recently on a national level.) Similarly, it seems that small taxes on soda do little to curb consumption of the sugary junk. Simply putting the information in front of our eyes or enacting a slight monetary penalty isn’t enough and I don’t believe there are many ways government can affect our food choices. (I would be curious though to see the effects of eliminating subsidies for corn, wheat and soybeans. These subsidies keep the price of junk food–which is actually quite complex if you look at the ingredients–artificially low. So this addictive food is also dirt cheap. You and I are paying for this with our taxes!) That said, my hope is that those battling to lose weight won’t give up and resign themselves to poor health by saying “I’m addicted. There’s nothing I can do.”

From what I’ve seen of successful weight loss seems very similar to what I know of overcoming addiction. That is, the individual must decide to make a change for him or herself. Until the individual knowingly makes a firm decision to change no amount of preaching, pushing or cajoling by friends, a spouse, or parents will make the difference. And it is hard work. Perhaps now by recognizing the brain chemistry of over eating we can develop more effective strategies to slim down.

More Magical Fitness Nonsense: Part II

The first post of this series looked at a new weight loss pill being developed by General Nutrition Centers. It’s something containing caffeine, black pepper and an ingredient in hot peppers. Who knows? Maybe this thing actually is weight-loss in a pill. I doubt it though. Most likely this is just the latest version of fitness snake oil–and there’s plenty more out there.

If you’re any sort of follower of popular culture then you may know of the TV show the Biggest Loser. If so, then you know of Jillian Michaels, one of the show’s trainers. Michaels was sued in February by a fan of the show. The woman claims she bought a fat loss supplement sold by Michaels–and guess what!! It didn’t work. The suit further claims the product contains a tasty item called citrus aurantium (aka bitter orange). This substance contains amphetamine compounds which are similar to those found in ephedrine. These compounds are stimulants and they act to restrict blood vessels and to increase blood pressure and heart rate. This bitter orange stuff has been used to replace ephedra in many fat-loss products. Ephedra was linked to the 2003 death of Baltimore Orioles pitcher David Bechler.

More news on this topic came out in January of this year when the Abbott Laboratories’ weight-loss drug sibutramine was cited by European offiicials as being potentially harmful to heart disease patients. The F. D. A. added a warning to the drug, known as the products Reductil, Meridia and Sibutrex. (Wow, take a look at the contraindications and side effects of this stuff! Doesn’t look fun.)

What other kooky chemicals are in the news? The article F. D. A. Finds ‘Natural’ Diet Pills Laced With Drugs appeared in the New York Times Business section back in February of 2009. The story discusses a product called StarCaps. StarCaps were promoted by celebrities and touted as a “natural” weight loss product that used papaya as an active ingredient. Seems perhaps the true active ingredient was something called bumetanide, a diuretic that can cause all sorts of ugly side effects. The article further states:

“In a continuing investigation that has prompted consumer warnings and recalls by some distributors, the F.D.A. has determined that dozens of weight-loss supplements, most of them imported from China, contain hidden and potentially harmful drugs.”

These stories remind me of the Fen-phen episode of several years ago. Fen-phen was a combination of two weight-loss drugs marketed and sold by Wyeth. The drug combination was very popular and seemingly effective. Problem was Fen-phen caused heart conditions such as valvular heart disease, severe hypertension and even death in some users. The product is no longer available and as of 2005, there were about 50,000 liability cases still to be resolved with an estimated total of $14 billion in liability. Seems that we may be eager to repeat history.

So what is the big picture? Americans want to lose weight and there’s big money in that concept. We’re not too good at exercising and eating right though. If weight loss can come in a pill then a lot of us are very likely to spend plenty of cash on the product–nevermind the idea of “too-good-to-be-true” plays prominently in the background. Thanks to the supplement industry-friendly DSHEA act of 1994 these supplements live in a gray area between food and drugs, and they don’t undergo the same scrutiny. (Quackwatch gives a good commentary.) Therefore some supplements may be just as powerful and potentially dangerous to many users as any other prescription drug. (In fact, the risks posed by these weight-loss formulas may be more dangerous than simply being overweight!) As in the case of StarCaps, the ingredient label may not tell us everything that’s in a supplement. These are murky waters for the consumer.

Should these products be banned outright? I’m not sure. Can these products be used safely? Maybe. Clearly for some people these products are dangerous and possibly deadly. This stuff must be seen through the same lens as any other medication. Don’t let a label like “all-natural” fool you (BTW, black widow venom is all-natural too) and don’t let a celebrity face make you a sucker. A healthy lifestyle has yet to come in a pill and it never will. Get up, go walk around, and eat something that grew in the ground.

Denver Fitness Journal

All Things Health and Fitness by Kyle Norman, MS, CSCS, FMS, RRCA Running Coach

Month: April 2010