Running Injuries and Running Performance: A Podcast and an Article

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Injury and performance exist on a sliding scale. At one end we are completely broken down, hurt, and unable run/bike/swim/lift/fight/hike/etc. At the other end we’re performing at our peak. Probably every active person has been injured and I’m willing to bet that every active person would like to perform their very best. This post is for runners in either or both camps.

Runners are often injured. According to a review of literature in the British Journal of Sports Medicine, rates of lower-leg injury ranged from 19.4% to 79.3% among study subjects. The magic questions are 1)Why do we get injured? and 2) How do we overcome injuries?

I think it stands to reason that if we hurt while running then very likely it’s the way we run that’s the problem. Running requires complex coordination among many parts and systems. It is mind boggling to try and dissect running form, find the problems and then either teach or learn new, helpful techniques.

Meanwhile, if we’re not injured and we’re able to run, then we probably want to know how to run faster and more efficiently. How do we we achieve these goals? These questions aren’t easily answered. With all that in mind, I found two resources that may offer some very valuable information on these issues.

The first is the Physio Edge Podcast 049, Running From Injury with Dr. Rich Willy. At about the 20:30 mark Dr. Willy gives some good external cues to help promote running form that may help with IT band pain. The cues involve the knees and the hips:

  1. If the knees cave in too much while running: He puts brightly colored tape on the outside He has the patient run on a treadmill facing a mirror. He tells the patient to push the tape out toward the walls.
  2. If the hips are adducting too much: The runner runs on a treadmill facing a mirror with the waistband of their shorts clearly visible. He instructs the runner to keep the pelvis level by keeping their waistband level.

Listen to the podcast to get all the details.

Next is an article from the always informative Alex Hutchinson at the Sweat Science column at Runner’s WorldWhat Makes a Running Stride Efficient? Hutchinson discusses a study from Loughborough University in England that looked at biomechanical factors

“For running economy, three variables stood out: vertical oscillation (measured by the up-and-down motion of the pelvis; less is better); how bent your knee is when your foot hits the ground (more bent is better); and braking (also measured by looking at the motion of your pelvis; less slowdown as your foot hits the ground is better).

“Overall, these three variables explained 39.4 percent of the individual differences in running economy—and the vast majority of that (27.7 percent) came from vertical oscillation.

“For running performance, four variables stood out: braking (as above); the angle of the shin when your foot hits the ground (closer to vertical is better); duty factor (basically a measure of how long your foot stays on the ground relative to your overall stride; quicker is better); and the forward lean of your trunk (more upright is better).

Overall, these four variables explained 30.5 percent of individual variation in race times, with shin angle (10 percent) and braking (9.9 percent) as the biggest contributors.”

Something I always appreciate about Hutchinson’s writing is that he lays out some of the errors in thinking that we might encounter when we assume that employing new running techniques will automatically equal better, faster, pain-free running. Are these characteristics of efficient runners chickens or eggs?

“For example, you could imagine a study that compared elite runners to ‘regular’ runners and found that the elite tend to have more highly defined calf muscles. It doesn’t necessarily follow that doing a whole bunch of hardcore calf exercises will make you faster. It’s more likely that a whole lot of training, combined with some genetics, has given elites more defined calves. Fixating on getting better calf muscles would be distraction that’s unlikely to help you, and takes away from things that really would make you faster, like running more.”

That said, (and he mentions this) it may well investigating new strategies based on these findings. From my experience in helping people with their running, aiming to achieve these biomechanical outcomes can help. (This post offers a few cues that I’ve found useful to use with runners.)

Ideally, you should be videoed while running.Trying to adjust your gait without knowing how you’re currently running might be near impossible. Video is a very powerful tool when it comes to making adjustments to sporting techniques and I highly recommend it.

Definitely read the article and listen to the podcast if you think you need help with your running or if you’re a coach who works with runners. And if doing it yourself isn’t getting you the results you want then I strongly suggest you employ some sort of running coach to help.

Sometimes It’s Simple

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I’ve taken lots of courses, read lots of books and articles, listened to podcasts, and attended seminars dedicated to helping my clients move better and get out of pain. I’ve spent time and money learning about so-called corrective exercises. I’ve learned that rarely is the site of pain the site of the problem. I recognize that the body is a highly interconnected system of systems and that what happens at one end can have powerful effects way out at the other end. I’ve tried to absorb and apply all sorts of complex information and sometimes, my brain gets in the way and I overlook simple solutions.

Patty is one of my senior clients. We’ve worked together for several years. She has intermittent knee pain on both, but mostly her left knee. It’s not terrible but it bothers her after tennis games and often while climbing and descending stairs.

It’s important to recognize that the knee is caught between the hip and the ankle. Rarely is it the fault of the knee that’s causing the knee pain. (An obvious exception would be an acute injury like a ligament sprain or some sort of impact to the knee.)

I’ve had her do all sorts of exercises and mobility drills for her hips. We’ve done glute drills in all three planes of motion. We’ve done all sorts of lunges in all sorts of directions. We’ve done a bunch of ankle and foot mobility work too. In the past, I spent way too much time giving her a bunch of instructions to squeeze the glutes when she walks and to try and make her leg do this or that as she moves. (These are examples of intrinsic cues. They’re usually not the best cues.)

Sometimes her knee(s) feel better but for the past several weeks she’s reported fairly consistent knee pain, particularly on stairs. This was frustrating to me in that last week we did a variety of drills and exercises such that she was able to take the stairs without pain. I was hopeful though. If we could eliminate her pain last week then we could do it again.

We went to the stairs. I planned to review a couple of things we did the prior week. My mind filled with cornucopia of lunges, stepping drills, and ankle mobility exercises. How would I tweak the exercises? How would I load them? There were many options. My brain started to overheat as I tried to contemplate them all.

Then I paused and thought, “What’s the simplest possible way to find success?”

Coach her to walk the stairs differently. No drills, no exercises, nothing special. I would give her a minimum of instructions on how to walk the stairs in a different way than when she arrived.

There were two tactics from last week I wanted to try. If those didn’t work then we could move to all the wacky, exotic stuff. The two main instructions were these:

  1. Ascending: Lean forward a little. By leaning forward I expected the glutes to work more than if she stood fully upright. It didn’t need to be a big lean forward, just somewhat of a lean. Don’t think about the glutes either. Jus lean forward.
  2. Descending: Let the heel of the rear foot stay flat longer. That way the ankle would dorsiflex more thus taking some of the load from the knee. Also, try and descend softly. Try not to slam and clunk down to the next step. My hope was that this would prompt a controlled descent as opposed to a sort of lurching slam into the step.

(I’ve seen this ankle/knee relationship several times in the past. A few of my clients have presented with knee pain and limited ankle dorsiflexion. The knee pain diminished or vanished once dorsiflexion was restored and then used during gait.)

Both strategies worked immediately! How cool! For the next 5-10 minutes I had her practice the new stair walking strategies. The only time the knee pain popped up was when she let the heel rise too early during the descent.

I didn’t tell her anything about her glutes or her knee or any other muscles or joints. Just, “lean forward,” and “keep your heel down longer.” I need to remember that sometimes giving simple cues can do world of good. I don’t always need to go through a rigamarole of creative exercises to help someone move and feel better.

Reading & Learning: “Real Movement” by Adam Wolf, PT

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I am reading with much enthusiasm the book Real Movement by physical therapist and massage therapist Adam Wolf, aka the Biomechanical Detective. In a big way, it’s like re-reading a very good book that I’ve enjoyed in the past. I am familiar with a lot of the concepts discussed by Adam and what I enjoy immensely is coming back and examining those concepts through his eyes and his experiences.

Wolf is among other things, a Fellow of Applied Functional Science (FAFS) by way of the Gray Institute. I also study and apply Gary Gray’s material. I always like to see how other practitioners apply the principles of 3D movement. I love gaining new perspectives on how to create functional exercises, or exercises that most translate to real life. You can see a lot of examples of this at the Adam Wolf, PT, Biomechanical Youtube Channel.

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If you ain’t got that sling then you ain’t got that swing.

Something I just learned is that Adam’s dad is Chuck Wolf, another functional exercise and movement professional. Many years ago I was introduced to the concept of Flexibility Highways at one of Chuck’s seminars. These highways aka muscle slings, aka myofascial lines, are networks of muscle and fascia that often  work together during real-world, whole-body movements. (“Real-life” movements are in contrast to many of the artificially isolated movements that we see in gyms, especially those performed on machines.) One example is the posterior oblique sling as used in a golf swing. Another example is the anterior oblique sling used when throwing.

The anterior X sling is a big part of throwing, batting, golfing, running, punching and all sorts of things.

The anterior X sling is a big part of throwing, batting, golfing, running, punching and all sorts of things.

The fascial sling system was an interesting concept to me at the time but it has sort of faded from my thinking in recent years. Now, reading Adam’s book and watching his videos has brought those flexibility highways or slings to the front of my mind. These sling concepts are informing both the mobility work I’m doing with clients as well as my exercise selection. In working along and within these sling systems I feel like I’m capturing just about all of the movement we humans are capable of. Check out the following videos from Adam Wolf where he discusses how you can move better by following these fascial lines.

I’m Training Like A Mother.

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That title doesn’t make a lot of sense. Or, it does make some sense and that last word denotes something that shouldn’t be said in polite company.

What I’m really saying is that I’ve connected with a running coach. Mary-Katherine (MK) Flemming, an RRCA-certified running coach, reached out to me after my last blog post. She’s a mom who trains moms. Other than being a humanoid-type creature with two arms, two legs, and a head, I may not be her standard client/athlete. I’m not sure who/what I had in mind for a running coach but I probably wasn’t thinking about joining a mom-related sort of organization. Call me a backward chauvinist caveman—but what can I say?—my brain just wasn’t tuned in that direction. I’m very glad I kept an open mind though.

We talked and I was very pleased and impressed with what she had to say. I respected and admired her intense curiosity about running, management of planning, strength training, rest & recovery, and how to coach dedicated runners who also live normal lives. MK, like me, has been through various setbacks to her running career yet she persevered. I was excited to see someone who shares my passion about physical activity and performance. You can read about Mary-Katherine’s background and credentials here.

Further, she was able to answer all my questions and she helped me realize there were a lot of questions that I’d never thought to ask. Questions such as:

  • How does one incorporate both road and trail running when training for trail races?
  • How should runs be progressed based on heart rate? (She’s very much into HR training.)
  • How does one manage biking, hiking, and weight training while running?
  • I’d read Steve Magness’ Science of Running and I wanted to talk with a coach who was familiar with those methods. She follows his work and spoke on his methods..

Heart-rate training is a cornerstone of MK’s training plan. You can read about her approach here and you can hear her discuss heart-rate training here. Her training approach is influenced heavily by Coach Phil Maffetone. The essence of the strategy is that by spending a lot of time training at a fairly low heart rate (determined by this formula), you train your engine to burn fat for fuel and you build a significant and broad aerobic base. A strong aerobic base then allows for trainees to better develop anaerobic power and speed, avoid injury, and ultimately race their best.

I’m about a week into the plan and I feel good. If I hadn’t had the experiences that I have, then I would say I’m surprised at how easy the runs have been thus far. It seems that a lot of us runners need to ease down a little, run a bit slower and rest more. MK discusses this interesting and very common phenomenon in this podcast interview.

I’ve seen similar challenges with some of my clients. For some of us, sweating and picking up heavy things is fun and we love it.  We plan our day around or workouts. Or weekends feature extra long bouts of exertion. Even our vacations are built around strenuous activity which we enjoy.

But rest? That’s a tough one. We think that if we don’t lift/run/ride/swim enough then we’ll get weak and fat. The truth is that we CANNOT get stronger/faster/better if we don’t rest enough and recovery adequately. This is one huge reason to employ a coach. You may think you can do it on your own, but very often professional help is absolutely a great investment. To learn more about employing a coach, check out the training programs of the Train Like A Mother Club.

 

Sport Metabolism Testing at the CU Anschutz Health & Wellness Center

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Doing my best Bane impersonation. Might be good for Halloween.

I’m currently training for some road and trail races. Part of that training process is running at different paces to elicit various training effects. Those paces are built around such factors as the aerobic threshold and the lactate or anaerobic threshold. (The definition of those terms are beyond the scope of this blog post. To understand them I suggest you read this from endurance coach Joel Friel.)

Up to this point I’ve used pre-made running plans such as the Run Less, Run Faster and the Hanson’s Marathon and Half-Marathon Method. Those books prescribe paces based on 5k and 10k race finish times. From those race times it’s possible to

I bet its hard to run in that coat.

The Batman villain Bane. I don’t know what his VO2 max is.

predict race finish times of distances up to the half marathon and marathon. Along with race finish times, training paces for speed, tempo, and long distance runs are also derived. I’ve discovered

those training paces, particularly tempo run paces, are too fast for me. Rather than blunder around trying to solve the problem by myself, I sought help.

Testing at Anschutz

A few days ago I visited the sports performance lab at the Colorado University Anschutz Health & Wellness Center in Denver. I underwent the sport metabolism assessment. The test started with a 12-minute warm-up on a treadmill that went from walking to jogging to slow running and running up to a 9:10/mile pace. That was followed by a five-minute rest. (The test conductor explained the whys and hows of the warm-up and rest period. I won’t go into all the information but now I use that process before all my runs. Essentially it enables me to perform better.)

The fun began after the rest period. I ran in two minute intervals. Speed was increased after every two minutes. This process was repeated until I was nearly blue in the face and I couldn’t run anymore. It took about 12 or 14 minutes to hit my limit.

As you see in the pictures, I wore a mask connected by a tube to

Running & bleeding

Running & bleeding

a computer. The computer measured my O2 intake and CO2 expiration. This gas analysis allowed us to see at what paces my aerobic and anaerobic thresholds exist.

Not only did we analyze my breathing, but we also analyzed my blood via a finger prick delivered near the end of each two minute stage. I can’t tell you what joy it is to combine bleeding with intense running…

(For cycling performance testing, the same test is done on a type of stationary bike.)

What did I learn?

I NEED TO SLOOOOW DOWN.

From my speed workouts to my tempo runs to my long runs I should run slower. Running faster isn’t just about running faster — and I knew that! Countless running articles and books preach the idea and I thought I had it figured but I was wrong. The big points and the factors that need improving are these:

Fat metabolism:

I need to spend 80% of my time running for base endurance. In this zone, I use mostly fat for fuel. This works out to a pace of about 11:30/mile. Prior to the test I thought this pace was about 10:00 to 10:30/mile. The good news is that an 11:30 pace is really easy!

Anaerobic Threshold:

My AT occurs at a 7:45 pace. I should be able to maintain that pace potentially for a full marathon. But right now, when I hit my AT I crap out quick! I need to gradually nudge my ability along. If I run at or over my AT (which I have been doing) then I overwhelm my ability to function at that pace. So now my tempo runs are 9:10/mile.

Anaerobic training:

This is speed work and this is where I will improve my VO2 or my ability to utilize oxygen. The pace for this work is 8:40/mile. I had been running my speed work at about 8:00/mile.

What else?

First, the idea that I can get my tempo/race pace down to 7:45/mile is fairly exciting to me. It means I might be able to hit a 3:30 marathon! That’s a powerful motivator for me. All the slow miles I’ll need to put in won’t be done aimlessly.

I’ve said it for the past few years and I’m saying it again: I need to work with a coach. I’m a certified running coach but it’s not something I practice much. As the saying goes, “The lawyer who represents himself in court has a fool for a client.” I need an objective set of eyes on me. A good coach can adjust my training schedule where a book or a pre-made running plan cant. It makes sense to work with someone who coaches runners on a regular basis. I am considering several resources:

Hip Adduction Part II: Solutions to Mobility and Stability

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In Part I of this series, I discussed what hip adduction is and why it’s crucial for good movement, balance and sports performance. In this post I’ll give some ways to self-assess your hip adduction and increase your hip adduction mobility, stability and power.

There are many ways to investigate and train hip adduction. I do not propose to cure what ails you with any of these exercises. If you’re in real pain then you need to see a physician.

(I realize now in watching the videos that I use the term “frontal plane” more than I say “hip adduction.” Please consider the terms interchangeable for the purpose of this post.)

Check your ability to move into hip adduction. Check both right and left sides. How do they compare?

Now check your stability. Can you control your hip adduction?

Try this mobility matrix to gain more hip adduction. You may need more on both sides. The great thing about this matrix is that you’re not only address the hip but you’ll also be mobilizing other joints in concert with the hip.

This movement series is a more aggressive way to challenge hip adduction while at the same time getting an upper body workout.

The next three exercises are a few ways to challenge and develop hip adduction mobility, stability and power. These can be used for athletic training purposes or simply as fun ways to tweak familiar exercises. All sorts of implements can be used:

Gluttony Season is Almost Here. What’s Your Plan?

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Halloween kicks off several months of partying, gobbling, and guzzling. Very soon, swirling all around you there will be a galaxy of the richest and tastiest food and drink. Not only do you have a list of occasions for feasting, but also the days grow cold and dark. That means you’re less likely to be active and more likely to huddle in your warm, cozy home.

Is it any surprise that you tend to gain unhealthy weight under these conditions?

In all truth, it’s not a done deal that your health and fitness must suffer. You’re a grown-up. You can make good decisions. With some forethought, planning and awareness, you can avoid the slide backwards into feeble flabbiness.

Here’s an idea: Start your New Year’s Resolution early. Put in some thought and effort before you’re beset on all sides by wicked temptations. If you start building just a few healthy habits now, you can do a lot to minimize the usual holiday temptations and pitfalls. With some thinking and a plan in place, you can feel confident and you can avoid the guilt that often comes with holiday over-indulgence. Here are a few examples:

  • Will you exercise 3-5 days per week? For 30 minutes? (Or if you’re not currently exercising, can you start with just one day per week?)
  • Will you eat 1-2 fist-size servings of vegetables at each meal?
  • Will you limit sweets and/or booze to one day a week?
  • Will you talk to a friend or loved one about eating better and exercising together?
  • Will you consider hiring a trainer now instead of in January or February?

If it’s important then why wait?

 

Achilles Pain. Time to Take Action!

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I’ve had periodic issues with my left Achilles tendon. I’ve never had trouble with my right Achilles until just lately. I felt a bit of soreness one morning and found some swelling. I knew it probably wouldn’t “work itself out” (I sort of hate when someone says that about something. Nothing “works itself out.” Someone has to put in work in order to see progress.) The upside to having had this problem before is that I know how to address it now.

I believe my trouble may have started because of the long trail run/hike I did a couple of weekends ago in Telluride. It was about 12 miles which was a sizable jump from my prior long run of 7 miles. (Sometimes I’m not smart.)

I have attacked the injury with a fairly conventional strategy of slow and controlled heel raises. Here’s what it looks like:

I’m doing these exercises frequently throughout the day. If I can hit 15 reps then I add weight. Fifteen reps isn’t a magic number by the way. Most importantly I work to a high level of exertion, pretty much to failure.

I’ve run several times since feeling pain and doing the calf raises and I feel fine. That’s a good sign. I probably don’t need to take time off from running.

This exercise is boring and I hate doing it. (Sounds like what a lot of people say about going to the gym.) I have shown a propensity for weakness in my Achilles tendons in the past though. This is exactly the type of thing I need to do and I should be doing continually. It’s easy to skip this stuff because I don’t enjoy it. My body doesn’t  though even though there are potential negative consequences to this course of non-action.

There are lots of things in life like that.

Training Both Ends of the Spectrum: Strength & Endurance

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For years I’ve been faced with a question to which I have yet to find the answer. The more I Iook for the answer, the louder I hear the question, and that is this:

Which do I love most, strength training or endurance training? Do I love lifting heavy stuff or spending hours running and biking? It’s as much of a question now as it’s ever been.

The truth is I love both activities. I love to lift weights and I love endurance activity. I can’t choose one. Periodically my interest swings more to one or the other but I have yet to find a way to de-emphasize one and specialize in the other. Why does this matter?

Concurrent training likely causes some conflict at the cellular level in terms of trying to achieve gains. That is, lifting a lot may interfere with endurance adaptations and significant endurance work my inhibit strength, power and muscle-growth adaptations.

From what I’ve come to understand, aerobic conditioning seems to inhibit gains in strength, power and muscular hypertrophy more so than the other way around. As regards endurance performance, carrying around extra muscle mass makes running and biking more difficult—especially when going uphill.

(Want to read more about this? StrengthandConditioning.com has a good discussion of research on the topic titled Should we avoid concurrent training to maximize hypertrophy?)

If nothing else, I often feel like a party of one. Sometimes it seems like I’m the only person who is enthusiastic about both lifting for five reps and under as well as suffering, sweating and panting for over an hour. I don’t meet many others who share my enjoyment of both types of activity.

Because of all of the above, I’m excited about an ebook from Juggernaut Training Systems called the Hybrid Athlete. I’ve been following a sample program from the book for a couple of weeks now and I’m enjoying it. I’m lifting more than I have in a while and at the same time I’m running, biking, and hiking a lot.

There are several different sample programs but it’s not a book of cookie cutter workout templates. The book discusses the underlying mechanisms at work during both strength and endurance training.

Most important, this book discusses recovery and the need to strategize lifting and endurance workouts. For someone trying to train hard on both ends of the exercise spectrum, managing recovery is crucial. Thus, there are ways to train for strength while resting the endurance systems and vice versa such that the athlete won’t be overwhelmed, burned out, and possibly injured. The Hybrid Athlete discusses all of this.

Finally, what makes me respect this work is that the writer, Alex Vada, has walked the walk. He’s competed in Ironman traithlons as well as put up impressive numbers in the power lifts.  He’s relied on academic learning and experience in the gym, on the road, and in the pool to develop this book.

Follow this link to learn more about essentials of the hybrid athlete training.

 

 

Diets Don’t Work. So What Should You Do?

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A NY Times story from May popped up on my Facebook feed and it got me thinking. (I’m not sure why a story from May would come up now but I’m glad it did.) Why You Can’t Lose Weight on a Diet is a worthwhile discussion of the biological and neurological mechanisms of weight-loss, weight-gain and what happens when we diet.

(Though it’s not defined in the article, the term “diet” seems to refer to a strict, restrictive type of eating plan which causes prolonged hunger and feelings of deprivation. “Diet” implies the use of white-knuckle willpower. “Diets” are almost never sustainable over the long-haul.)

I won’t go into all the information but here are some important details:

Diets and weight-gain seem closely related.

“Long-term studies show dieters are more likely than non-dieters to become obese over the next one to 15 years. That’s true in men and women, across ethnic groups, from childhood through middle age. The effect is strongest in those who started in the normal weight range, a group that includes almost half of the female dieters in the United States.

“Why would dieting lead to weight gain? First, dieting is stressful. Calorie restriction produces stress hormones, which act on fat cells to increase the amount of abdominal fat. Such fat is associated with medical problems like diabetes and heart disease, regardless of overall weight.

“Second, weight anxiety and dieting predict later binge eating, as well as weight gain. Girls who labeled themselves as dieters in early adolescence were three times more likely to become overweight over the next four years. Another study found that adolescent girls who dieted frequently were 12 times more likely than non-dieters to binge two years later.”

Weird huh? The question is do diets cause weight gain, or do weight-gain-prone people tend to diet? The chick-or-egg question is discussed in the article.

Diets change the brain. Not for the better.

“In the laboratory, rodents learn to binge when deprivation alternates with tasty food — a situation familiar to many dieters. Rats develop binge eating after several weeks consisting of five days of food restriction followed by two days of free access to Oreos. Four days later, a brief stressor leads them to eat almost twice as many Oreos as animals that received the stressor but did not have their diets restricted. A small taste of Oreos can induce deprived animals to binge on regular chow, if nothing else is available. Repeated food deprivation changes dopamine and other neurotransmitters in the brain that govern how animals respond to rewards, which increases their motivation to seek out and eat food. This may explain why the animals binge, especially as these brain changes can last long after the diet is over.

“In people, dieting also reduces the influence of the brain’s weight-regulation system by teaching us to rely on rules rather than hunger to control eating. People who eat this way become more vulnerable to external cues telling them what to eat. In the modern environment, many of those cues were invented by marketers to make us eat more, like advertising, supersizing and the all-you-can-eat buffet. Studies show that long-term dieters are more likely to eat for emotional reasons or simply because food is available. When dieters who have long ignored their hunger finally exhaust their willpower, they tend to overeat for all these reasons, leading to weight gain.”

I LOVE the part about diets teaching us to eat by rules rather than paying attention to hunger. More on that in a bit.

Diets don’t improve health:

“In addition, the evidence that dieting improves people’s health is surprisingly poor. Part of the problem is that no one knows how to get more than a small fraction of people to sustain weight loss for years. The few studies that overcame that hurdle are not encouraging. In a 2013 study of obese and overweight people with diabetes, on average the dieters maintained a 6 percent weight loss for over nine years, but the dieters had a similar number of heart attacks, strokes and deaths from heart disease during that time as the control group. Earlier this year, researchers found that intentional weight loss had no effect on mortality in overweight diabetics followed for 19 years.”

That’s surprising to me. Read more of the article to learn why this might be the case.

What should you do?

The research discussed in the article tells us that diets aren’t only ineffective, they’re actually harmful. Is it time to give up hope? I don’t think so. There are other, better strategies to weight-loss and health than the Spartan drudgery of the typical diet. Here are some suggestions:

Eat when you’re hungry. Stop when you’re no longer hungry.

My client Dorothy had a great insight. She made the distinction between being truly hungry vs. saying “I could eat.”

Question: “Are you hungry?”

Answer: “I could eat.”

If you’re eating ask yourself why. Is it hunger or something else? Are you eating out of boredom, sadness, happiness or some similar emotion? Are you eating because food is in front of you? We eat for all kinds of reasons that have nothing to do with actual hunger.

Further, as you’re eating, continue to pay attention to your hunger. Is it still there? If not, then it’s time to stop eating. We often keep eating until we’re stuffed. You may have been taught to clean your plate. Food often tastes great — so we keep eating!

I suggest that you wait to eat until you are truly, definitely hungry. I’m not saying you should walk around famished but rather know for certain that your stomach is definitely signaling you that it’s time to put something in there.

The idea of eating when hungry and stopping when no longer hungry seems like an obvious and easy concept but make no mistake, it’s a skill. (I say “no longer hungry” rather than “full” because to me, “full” is too much like stuffed.) It requires mindfulness, awareness and deliberate action. Many of us are probably out of practice on this front.

Eat protein

Eating protein at each meal is a very good idea for anyone looking to lose weight. Three reasons, as mentioned in this article from the American Journal of Clinical Nutrition

“1) increased satiety—protein generally increases satiety to a greater extent than carbohydrate or fat and may facilitate a reduction in energy consumption under ad libitum dietary conditions;

“2) increased thermogenesis—higher-protein diets are associated with increased thermogenesis, which also influences satiety and augments energy expenditure (in the longer term, increased thermogenesis contributes to the relatively low-energy efficiency of protein); and

“3) maintenance or accretion of fat-free mass—in some individuals, a moderately higher protein diet may provide a stimulatory effect on muscle protein anabolism, favoring the retention of lean muscle mass while improving metabolic profile.”

Precision Nutrition recommends men eat two palm-sized servings of protein at each meal while women should get one palm of protein.

Lift weights.

Lifting weights (or any kind of resistance training) helps build and preserve muscle mass. Why is that good? Glad you asked:

Further advocacy for weight training is found in a recent interview with Dr. Wayne Westcott, professor of exercise science at Quincy College. The interview stemmed in part from research and news that contestants from the Biggest Loser seem to gain back all their weight and then some in the years following their weight loss. The article discusses several issues, but as it pertains this blog post, this is pertinent:

“But the key isn’t fat, it’s muscle: His [ Dr. Westcott’s] central point is that loss of muscle mass — whether through inactivity or aging or dieting — helps lead to many of our ills, from regaining weight to developing diabetes.

“But it doesn’t have to be that way, if only we’ll do a modicum of strength training — defined as any exercise that uses resistance to build muscle, from weightlifting to push-ups —  and keep doing it.”

Sleep.

I’ve written about the link between lack of sleep and obesity. Dr. Westcott also emphasizes the role of sleep in staying trim. He says, “Sleep is probably more important than all the other put together.”

The journal Current Opinion in Clinical Nutrition & Metabolic Care conducted a review of research on the sleep/obesity link. The key points:

  • The worldwide increase in the prevalence of obesity in the last several decades has been paralleled by a trend of reduced sleep duration in adults, as well as in children.
  • Evidence from both longitudinal and prospective epidemiological studies suggests that chronic partial sleep loss is associated with an increase in the risk of obesity.
  • Laboratory studies show that sleep restriction leads to hormonal alterations, which may favor an increase in calories intake and a decreased energy expenditure and ultimately lead to weight gain.
  • In addition to short sleep duration, evidence suggests that also sleep disturbance, such as obstructive sleep apnea and poor sleep quality, may increase obesity risk.
  • Prospective interventional studies are needed to clarify whether increasing sleep duration or improving sleep quality protects from weight gain or even favors weight loss.
  • Until results from such studies are available, the current evidence supports recommending sufficient amounts of habitual sleep and good sleep hygiene in patients at risk of obesity.

Want to lose weight? Sleep well.

Finally

Diets aren’t just a depressing drag, they may in fact facilitate the exact type of weight-gain you’re trying to avoid. In other words, they don’t work!  Rather than diet, tune into your hunger. Eat when you’re hungry and stop when you’re no longer hungry. Eat protein at each meal, lift weights and get solid, regular sleep.