Conflicting Back Pain Information

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It’s easy to get confused when reading and listening to information about health, wellness, fitness, and exercise. We are often caught in the collision between valid science and pseudoscientific snake oil mumbo jumbo. Even when good research is discussed in the press it’s often reported without nuance by reporters who don’t understand the statistical methodology.

With that in mind, here are three recent articles which overlap in their coverage of back pain. Two reflect the current evidence on back pain. The other, in my opinion, is off the mark and may actually help reinforce back pain and the fear of pain.

Posture has little to do with pain

I like the article titled Are you sitting comfortably: the myth of good posture. I recommend you read it because the sources discuss the current evidence around posture and back pain. Pain researcher Dr. Peter O’Sullivan is one source. He says,

“O’Sullivan says that rather than focus on the right posture, the ability to vary it and shift easily may be more important: ‘While it is appealing to think that if you sit up straight you will not get back pain, this is not supported by big studies across many countries.’ Indeed, while many websites swear that bad posture (usually defined as slumping, leaning forwards or standing with a protruding belly) causes everything from back pain to varicose veins and indigestion, there is no evidence that it causes general health problems.”

“…If you don’t have back pain, then do not give your posture one second’s thought – think about being healthy. Sleep deprivation and stress are more important than the lifting you do. Stress has a strong inflammatory role; it can make muscles tense. Most people don’t get that their back can become sore if they are sleep deprived.”

One thing to think about is the chicken-or-egg paradigm. That is, does “bad” posture cause back pain? (Evidence suggests it doesn’t.) Or could pain force us to adopt a certain type of posture that looks bad? My bet is on the latter. Related to low-back pain misinformation is the fearmongering around the myth of “text neck.”

Misguided treatment

If our concept of what causes back pain is misguided then it’s no surprise that many diagnostic and treatment strategies are ineffective. An article from the BBC titled Many back pain patients ‘getting wrong care’ discusses guidelines from a series of papers written by pain experts for the Lancet, a British medical journal. Several points to consider:

  • Strong drugs, injections and surgery are generally overkill, they say, with limited evidence that they help.
  • Most back pain is best managed by keeping active, they advise.
  • UK guidelines recommend a mix of physical exercise, advice, and support to help patients cope with symptoms and enjoy a better quality of life.
  • Health staff should not treat back pain or sciatica with equipment such as belts, corsets, foot supports or shoes with special soles.
  • They should not offer acupuncture, traction (stretching the back using weights or machines), or electrotherapy (passing electric current or ultrasound waves through the body), says the National Institute for Health and Care Excellence.

My favorite is this list of 10 Things You Should Know About Your Back:

1) Your back is stronger than you may think – the spine is strong and not easily damaged, so in most instances, the pain will be down to a simple sprain or strain.

2) You rarely need a scan.

3) Avoid bed rest and get moving (but avoid aggravating activities).

4) Do not fear bending or lifting – do it in a way that is comfortable, using the hips and knees.

5) Remember that exercise and activity can reduce and prevent back pain.

6) Painkillers will not speed up your recovery.

7) Surgery is rarely needed.

8) Get good quality sleep if you can, because it will help you feel better overall.

9) You can have back pain without any damage or injury.

10) If it doesn’t clear up, seek help but don’t worry – book an appointment to see your doctor or physiotherapist if the pain persists.

Questions about bending and lifting

Lost Art Of Bending Over: How Other Cultures Spare Their Spines comes from National Public Radio. I am a little bit conflicted about it.

The article suggests that we in the US bend forward “incorrectly” and thus we suffer more back pain than agrarian societies where they bend forward “correctly” and thus suffer less back pain. Is this claim true? Do we suffer more back pain than less-developed countries? Do people in other cultures bend forward differently than we do? The article offers no evidence beyond the writer’s casual observations to support the claims. Ironically, the article shows a picture of two rice farmers in Madagascar. One is bent forward “correctly” with a hip hinge, the other is bent “incorrectly” more through the low-back. I’m not sure how to interpret that picture.

My problem with the article is that it suggests there is a wrong way to lift and implies that doing so is a direct cause of back pain. Such fears lead to fear-avoidance beliefs (FABs).  I’ve experienced this phenomenon and I’ve seen it in others.

With FABs, we tend to believe that adopting certain “bad” postures or using “unsafe” lifting strategies will certainly equal pain. As a result, we brace our backs with extreme rigidity and we use a super-strict technique to lift everything from heavy objects down to something small and light like a pair of shoes. The irony of FABs and the resulting extreme diligence is that we are actually at greater risk of incurring more pain. In other words, the fear of pain is more of a problem than the biomechanics of lifting.

Recall that in the first article I discussed, we learned that sitting posture doesn’t relate much to back pain and that in fact emotions and lack of sleep were stronger predictors of back pain. My bet is that we might see a similar dynamic with regard to lifting posture.

Some of the information is useful, specifically the instructions on hip-hinging (a technique I regularly teach to clients) are worth knowing. By using a hip-hinge method to lift things from the ground, you will engage the glutes and hamstrings which are big, strong muscles. The hip hinge should allow a lifter to generate more force so he or she can lift a heavier object. The hip hinge also effectively distributes the forces of the lifting of a heavy object throughout the body rather than concentrating it in one place.

As a counterpoint to my own statement though, look at this. It’s Austrailian strong-woman Sue Metcalf picking up 246 lb. atlas stone with a technique that the NPR article would call unsafe.

I think that if lifting a heavy object, then it’s prudent to use as many muscles as possible to do the job and to generally be careful. Nothing wrong with that. But if bending down to pick up a pen, a shoe, a ball — or possibly a giant atlas stone— and if there’s no underlying acute injury, then we should feel free to move the spine. The spine is comprised of 33 bones, 24 of which are moveable. So why not move them? I wish the press were better at discussing these nuances.

Extra credit

If the problems inherent to bad science interest you, then you might want to pay attention to the words of  Dr. Ben Goldacre, epidemiologist, has to say.

Fructose and Liver Damage

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Diabetes and obesity-related illnesses are rife in the modern world. What we eat and how much we eat seem to be culprits. Recent research suggests that specifically, too much fructose is a significant problem for the human digestive system. An article from The Economist titled How too much fructose may cause liver damage discusses research in the journal Cell Metabolism.  

The article states:

“Specifically, Dr Rabinowitz’s work suggests that fructose, when consumed in large enough quantities, overwhelms the mechanism in the small intestine that has evolved to handle it. This enables it to get into the bloodstream along with other digested molecules and travel to the liver, where some of it is converted into fat. And that is a process which has the potential to cause long-term damage.” 

It seems that small amounts of fructose are digested safely. Too much fructose consumption is a problem. If you look around you, you’ll see A LOT of food sweetened with high-fructose corn syrup. Think that might be a problem?

You may also know that fructose is the primary sugar in fruit. So is fruit dangerous? The article doesn’t discuss fruit but I have a couple of thoughts on any potential harm posed by fructose from fruit:

First, my bet is the amount of fructose one would get while eating fruit is far less than one would get while drinking soda or eating processed food sweetened with fructose. Who among us would sit and gorge on fruit? Ever eaten more than one apple or orange? Doesn’t happen very often. (I’d like to meet the person who managed to become unhealthy by eating too much fruit.)

Second, the fiber in the fruit slows the digestion and thus probably slows the release of fructose. That results in less fructose to deal with per unit of time. That dynamic should help make fructose digestion tolerable. In contrast, most fructose-sweetened foods have little to no fiber, (soda and fruit juice are liquids) and thus creates a big turbo-shot of fructose which is something with which the human digestive system doesn’t have much experience. To that point…

Humans haven’t had access to refined sugar until recently in our long history on earth. Fruit is seasonal. It doesn’t sit around for long. In our past, we had to compete with all the other animals in the forest and the jungle to eat the stuff. Either that or it would fall off the tree and rot. Honey, as you know, is guarded by little stinging monsters which makes acquiring that source of sugar a bit costly.

The candy business started in the early 20th century. A hundred years may sound like a long time but in terms of evolution and the human digestive system, it’s an incredibly short amount of time. So our digestive system—a system refined over millennia of natural selection—has suddenly been deluged by sugar. We’re unequipped to deal with this recent development, so we see the problems described above.

Strength Training Fights Cancer

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“The study shows exercise that promotes muscular strength may be just as important for health as aerobic activities like jogging or cycling,” said Associate Professor Stamatakis.

“And assuming our findings reflect cause and effect relationships, it may be even more vital when it comes to reducing risk of death from cancer.”

That statement comes from Associate Professor Emmanuel Stamatakis of the School of Public Health and the Charles Perkins Center at the University of Sydney. He’s the lead researcher in a study titled Does strength promoting exercise confer unique health benefits? A pooled analysis of eleven population cohorts with all-cause, cancer, and cardiovascular mortality endpoints. The study appears in the American Journal of Epidemiology.

I’m surprised and delighted by this finding. Most of us have known for a quite a while that exercise of some variety or another helps reduce cancer risk. Most of the research has looked at exercise with a cardiovascular emphasis such as walking, cycling, and swimming. This study is novel in that it looks at strength training.

This is great news to those of us who like to lift heavy stuff! However…

Strength training has a negative connotation for some people. Some people say, “I don’t wan to get too big,” “I don’t want to get hurt.” Other people associate strength training with the bizarre bodybuilding steroid stereotype. None of this needs to be true! Lifting heavy stuff can be very safe, it can be done by normal people in an enjoyable way — and now we know it’s the smart, healthy thing to do. If you’re not lifting, then you should be and I’ll be glad to help you do it right.

 

Read These: I Became Obsessed & the 7 Pillars of Running

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Two recent articles are worth reading. If you have time then definitely have a glance.

Has extreme fitness gone too far?

‘It’s intoxicating – I became obsessed’: has fitness gone too far? comes from the Guardian. It discusses some negative consequences for novice trainees caught up in extreme fitness fads. These hopeful gym-goers are lured into inappropriately brutal workout routines by attractive online fitness celebrities who may have no idea what they’re doing. In this world, boring concepts like patients, persistence, and gradual progress is replaced by more-is-better high-intensity punishment. Bad idea. I like this statement:

It is a sentiment echoed by one health and beauty magazine editor, who asks to remain anonymous because her views don’t tally with that of her employer. “These days, a strong Instagram following, good gene pool and even better spray tan can make you a fitness star, regardless of what qualifications you have. Not only do many of these ‘fitness stars’ know little about what constitutes safe exercise (the truth is that no amount of likes come in handy when you need to solve a gym-induced injury), they also create a false sense of what fit and healthy looks like – and it doesn’t always look 21 and great in a bikini. Add to that the fact that these social media stars get paid to shift fitness gadgets, gimmicks and protein shakes, and you’ve a whole load of dangerously misguided followers.”

So many of of these and similar workouts cater to the desperate hopes of people who want to be in cover-model shape right now!  Unfortunately, that isn’t the best mindset for gaining true health and fitness. The enduring fitness facts are there is no magic, there are no miracles, there is nothing new under the sun. The only path to long-term fitness and health is through persistent hard work, patience and (this is highly undervalued) self-acceptance. Read the entire article to gain all the insights.

Running wisdom from a wise man

In contrast to fitness extremism, we have the sober, reasonable, and frequently skeptical voice of Alex Hutchinson who writes the Sweat Science column for Runner’s World. His latest, and sadly, his final piece is titled The Seven Pillars of Running Wisdom.

I always appreciate his writing in that he discusses the science behind many of the latest running and fitness trends, strategies, and equipment. We are often told with certainty that some latest-and-greatest tech will revolutionize our running or that some extreme type of diet will cure all of our ills. Hutchinson discusses the actual science behind many of these claims The truth is typically far less exciting than the sales pitches we hear from the snake oil sales force. Big surprise here: most of the magic silver bullets are some familiar ideals: persistent hard work (sometimes very hard work), generally healthy diet, lots of patience. These are the best routes take for peak performance and lifelong health. The seven pillars are:

  1. Running is good for you “in moderation,” which is defined as “a lot more than you’re doing.”
  2. If it comes in a bottle, it’s probably not going to make you faster or healthier.
  3. The best technology for tracking and guiding your runs is the device between your ears.
  4. You probably got injured from doing too much, too soon.
  5. The magic workout, shoe, or superfood is whichever one you’ve been ignoring lately or have never tried.
  6. You can probably run better; start by running more.
  7. You’re capable of more than you think, but it will take time to get there.

Read the whole shebangabang to learn much and more!

The Best Know How to Rest

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Our popular culture is filled with admonitions to “Just Do It” and “Push your limits.” We hear aggressively pompous questions like “What’s your excuse?” aimed at people who don’t adhere to some sort of arbitrary exercise pattern. A lot of this is good marketing but it’s not reflective of the reality behind truly great sports performance, career longevity, creativity, and good health. We don’t hear much about the massive importance of rest.

I’m very happy to see a discussion of rest in Sports IllustratedHow extended breaks in training help elite athletes—and why you should take them too is an excerpt from a book titled Peak Performance: Elevate Your Game, Avoid Burnout, and Thrive with the New Science of Success by Steve Magness and Brad Stulberg. They offer the example of 42-year-old Bernard Legat the multiple Olympic medalist and world champion runner:

But here’s the thing: If we never take “easy” periods, we are never able to go full throttle and the “hard” periods end up being not that hard at all. We get stuck in a gray zone, never really stressing ourselves but never really resting either. This vicious cycle is often referred to by a much less vicious name—“going through the motions”—but it’s a huge problem nonetheless. That’s because few people grow when they are going through the motions. In order to give it our all, and do so over a long time horizon without burning out, we’ve got to be more like Bernard Lagat: Every now and then, we’ve got to take it really easy. In addition to his year-end break, Lagat also takes an off-day at the end of every hard training week. On his off-days, Lagat doesn’t even think about running. Instead, he engages only in activities that relax and restore both his body and mind such as massage, light stretching, watching his favorite TV shows, drinking wine, and playing with his kids.

Every hard-exercising, hard-working person should read this and take this advice to heart. This doesn’t just pertain to high-end elite athletes. In fact, the article does a very good job discussing how the need for regular and at times extended rest periods applies to everyone in any field of work. Learn it. Know it. Live it.

What to Read: Advocating for the 5k, New Fitness Trends, Chemicals in your Food (Aren’t Always Bad)

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Big benefits from the 5k

“Everyone thinks the marathon is the Holy Grail, when a lot of people should really be doing the 5K,” Jason Karp, exercise physiologist.

In the running world, many of us want to progress from the 5k to the 10k, half-marathon all the way to the marathon—and maybe beyond!  More is always better, right? We think 5ks are for beginners and marathons are for the truly fit and powerful among us. And ultra-marathons? Those are for the real champions.

Well, I suggest that more isn’t always better. Sometimes more is just more. Maybe we should reconsider our view of the 5k. (Remember, the 5000m is an Olympic event. It’s not always easy.)

The 5K, Not The Marathon, Is The Ideal Race argues that for most people and most fitness goals, the 5k is the optimal distance.

The latest fitness trends

“Below are the newest and niftiest fitness programs that have been gaining in popularity, and the odds that they will attract the most disciples in 2016.”

In terms of fitness, exercise and strength training, I believe there is very little new under the sun. Lift heavy things. Sweat often. Eat right most of the time. Rest, recover, repeat. Those are the big-picture concepts that have built healthy humans since forever.

That said, if someone wants to make money in the fitness business, presenting this picture in new packaging is a wise idea. Further, if some sort of new fitness trend grabs someone’s attention then all the better. I believe that anything that gets someone to exercise and stick with it is probably a good thing.

Who’s afraid of chemicals?

“If you can’t pronounce an ingredient, then you shouldn’t eat it, right? Unfortunately, it appears that idea may not be the best advice nor very accurate.”

Those of us who value good nutrition tend to avoid processed foods in favor of those in a more “natural” state. The idea sounds reasonable. Many processed foods are unhealthy garbage. Cookies, crackers, breakfast cereal, many frozen meals and all sorts of packaged foods come with lots of calories but very little nutrition. If you look at food labels you often see a laundry list of strange-sounding substances that bear no resemblance to any sort of food we’ve ever heard of. These types of foods often go hand-in-hand with obesity and poor health. In contrast, we know that fruits, vegetables, minimally processed dairy, meat, beans and whole grains are generally healthier for us.

Internet gurus and quacks such as Vani “Food Babe” Hari, Dr. Oz, and Joseph Mercola have engaged in fear-mongering and misinformation which has led to confusion among consumers. (They’ve made a lot of money doing it too.) These people have told us that we must avoid all chemicals at all cost lest we be struck dead at any moment! The horror!

Here’s news for you: Everything is a chemical, including water, aka dihydrogen monoxide. Further, the central tenet of toxicology is “the dose makes the poison.” This means that a wide array of substances from alcohol to sugar to formaldehyde to chlorine to even water can become deadly at a certain dosage. Meanwhile lower dosages may pose no threat at all.

With these concepts in mind, I like the article from Science Driven Nutrition titled The truth about food ingredients. It’s brief and gives a rational breakdown of why many (but perhaps not all) chemicals in our foods are safe.

 

 

 

Exercise, Stress, Work, Injury, Life… & Crossfit

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A couple of recent articles have me thinking…

Unfortunately for many of us, exercise and injury (or just pain) live very close to each other. I’ve heard a lot of people say things like “I can’t run anymore because of my knees,” or, “The bench press hurts my shoulders.”

Something that’s supposed to be healthy hurts us? That doesn’t sound right.

Exercise and the big picture

When “Healthy” Habits Aren’t comes from Whole 9. It’s written by Kate Galliett of Fit for Real Life. She gives discusses a big-picture view of our exercise habits within the context of our often stressful, unbalanced lives.

She says:

“Exercise is not meant to break you. Exercise habits are not meant to suck other important aspects of your health dry. Exercising is not meant to be a numbing agent to things your body is telling you.”

Seems obvious, right? Who would argue that we exercise in order to feel bad and get hurt? Yet the reality is that multitudes of gym goers, runners, and all sorts of recreational athletes inhabit a world in which their chosen activity puts them in pain every day. This picture is out of whack. Pain is a way of telling us that something needs to change. (Remember though, pain doesn’t always equal injury, but pain is not to be ignored.)

I like this:

“Chronic stress is not helpful for fat loss, muscle gain, or performance improvement. It’s also not helpful for any of the health factors that keep you alive & kicking well into your later years. And many habits society deems ‘healthy’ are much less so when looked at in context to modern, busy, stressed lives.”

And to the previous point, this is extremely important to remember:

“Stress is stress. It’s the same to your body whether you define where it comes from as ‘good’ or ‘bad.'”

Living organisms need a certain level of stress to flourish. With the right amount of stress applied in a progressive way plus rest, plus food, that organism gets stronger. Too much stress of any type plus inadequate rest and/or inadequate food and that organism breaks down. We don’t want that but that’s where a lot of us are.

Why exercise?

A lot of us identify in part by our physical activity. “I’m a runner,” I’m a cyclist,” “I’m a powerlifter,” or “I’m a Crossfitter.” Self-image matters a lot, whether or not you want to admit it. This paradigm can get a little out of control.

Sometimes it seems we get to where we’re working out just to work out. And sometimes we push harder thinking we’ll get stronger yet in reality we’ve dug ourselves a hole and we’re digging harder to get out.

“Take a break? Back off? Are you insane? That’s for losers! I HAVE TO WORK OUT! THAT’S WHAT I DO!”

Well… Okay… But are you realizing a benefit?

Not if your workout hurts you. And if you’re piling stress on top of stress on top of stress, and you’re working harder despite the fact that you’re not sleeping enough, your job is killing you and your family is driving you crazy—all during allergy season—then don’t be surprised if you feel like a wreck. It might be time to try something different.

To me, the takeaway message of the article is that the actions and habits we practice in the pursuit of health and fitness don’t exist in isolation. These practices exist alongside a wide range of other influences in our lives. There are times when we need to take a step back, look at the big picture and at times modulate our beloved running, swimming, weight training or what-have-you. Read the full article for the whole discussion.

The Wellness Continuum

To expand a bit, this article reminded me of something I learned about in grad school, something called the Wellness Continuum.

The Wellness Continuum

The Wellness Continuum

I’ve talked with a lot of people who view health exclusively through the diet and exercise lens. In this view, diet and exercise are separate and distinct from all other aspects of health. To me, this view is like looking through a microscope.

With the Wellness Continuum, we can examine our lives with a telescope. We can see an amazing range of interrelated factors that contribute to or take away from our overall health. Most of us, myself included, probably do very well in some of these categories while other categories deserve extra attention.

To reiterate, none of these factors exist in isolation. These conditions all blend together to determine our well being. If we ignore one aspect of health then the whole operation is diminished.

Crossfit & Injuries

High-intensity workout injuries spawn cottage industry comes from the Washington Post. The article discusses not only injuries that may be generated from Crossfit workouts but also the businesses that have sprung up to treat said injuries.

One observation of the article is this:

“Many people who do the high-intensity workouts aren’t adequately conditioned for such rigorous workouts, or have back and spine conditions that could worsen, said Dr. Marc Umlas, chief of orthopedic surgery at Mount Sinai Medical Center in Miami, who said his office has seen an increase in injuries from workouts at CrossFit and similar programs.

“’They plunge headfirst into a high intensity workout and they get injured,’ Umlas said.”

The article describes various business that offer treatment strategies for such injuries. A trainer, Lauren Roxburgh said something related to the theme of the previous article on healthy habits:

“’In our lifestyle it’s been very much about the doing. … It’s all about pushing through, doing, doing, doing, and it hasn’t been enough about the yin, which is the being, being in the moment, being present in our bodies,’ she said.”

That sounds like yoga-speak for respecting the need for rest and recovery. More more more harder harder harder exercise isn’t always better better better. There’s a time for hard work and a time for backing away from hard work.

“It depends…”

“What do you think of Crossfit?”

I’m often asked that. As with most questions, the most accurate answer is “It depends….” on a lot of things.

(To be clear, I’m not a Crossfit coach. I’ve never worked out in a Crossfit gym.  I’ve met lots of Crossfitters and I’m aware of a lot of what I’ll call the Crossfit culture and its components.)

I love that Crossfit has re-popularized free-weights, the Olympic lifts and body weight training. I love that in many Crossfit facilities there is a supportive community that bonds through tough workouts. I’ve met good Crossfit coaches who recognize the need for proper technique and proper progression in doing these workouts.

I’ve also seen some horrendous exercise technique displayed by Crossfitters. I’m aware of a mentality in many (maybe not most) Crossfitters that the harder and faster the workout the better. Some in the Crossfit culture view this mentality with pride. I think it’s a questionable approach.

My answer is it depends on the condition of the individual participant. Is this a raw beginner or an experienced lifter? How well does the person move? Who’s coaching him or her? Does the culture at a particular Crossfit facility emphasize good technique and proper rest and recovery strategies? Or is it all “Go! Go! Go! Ignore the pain!”

Adaptation to imposed demands

Human beings can adapt to all sorts of stresses and conditions. As it relates to exercise; if we work in a progressive manner; gradually applying stress to our bones, muscles and connective tissue; consuming appropriate calories and nutrients; and resting appropriately then our structures will adapt to those imposed demands. (Read up on Davis’s law and Wolff’s law for more on how this process works.)

If, on the other hand, we go hell-bent-for-leather into a new workout routine (particularly if we don’t spend time on learning good exercise technique) then we may outrace our body’s ability to adapt.

To compound issues, if we undertake some sort of intense Crossfit-type workout, and our personal Wellness Continuum is out of balance then it’s highly likely that aches and pains will soon follow.

Discipline

With exercise, most people equate discipline with getting up early, working out hard every day and “pushing your limits.” I would offer that “discipline” really means doing what you need to do, not just what you want to do.

For we who love exercise, working out isn’t the problem! We love being in the gym, on the road, on the trail or in the pool. Sweating and lifting heavy things isn’t the hard part. It’s taking a break that’s near impossible! Taking easy days, letting injuries heal, doing our rehab exercises, tapering for a race, taking off-days or god-forbid, taking an off-season?! …That’s discipline.

So… There’s that.

Health & Fitness Information: Fitness for Entrepreneurs, Dean Ornish is Wrong, Pesticides in Produce, Performance Enhancement Methods

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Here are several articles with some interesting information that you may find helpful.

Dean Ornish is wrong

Scientific American offers a critique of the ideas of Dr. Dean Ornish in Why Almost Everything Dean Ornish Says about Nutrition Is Wrong.

Dean Ornish, MD is a very bright guy. He is the founder and president of the nonprofit Preventive Medicine Research Institute in Sausalito, Calif. He is a professor of medicine at the University of California, San Francisco. He received his medical training in internal medicine from the Baylor College of Medicine, Harvard Medical School, and the Massachusetts General Hospital. He received a BA in humanities summa cum laude from the University of Texas in Austin.

Ornish insists that a very low-fat, high-carb vegetarian diet is the best way to good health. The problem is, he cites low-quality studies and draws conclusions that aren’t quite supported by the available evidence. The article states:

“Ornish goes to argue that protein and saturated fat increase the risk of mortality and chronic disease. As evidence for these causal claims, he cites a handful of observational studies. He should know better. These types of studies—which might report that people who eat a lot of animal protein tend to develop higher rates of disease—“only look at association, not causation,” explains Christopher Gardner, a nutrition scientist at the Stanford Prevention Research Center. They should not be used to make claims about cause and effect; doing so is considered by nutrition scientists to be “inappropriate” and “misleading.” The reason: People who eat a lot of animal protein often make other lifestyle choices that increase their disease risk, and although researchers try to make statistical adjustments to control for these ‘confounding variables,’ as they’re called, it’s a very imperfect science. Other large observational studies have found that diets high in fat and protein are not associated with disease and may even protect against it. The point is, it’s possible to cherry-pick observational studies to support almost any nutritional argument.”

And:

“The recent multicenter PREDIMED trial also supports the notion that fat can be good rather than bad. It found that individuals assigned to eat high-fat (41 percent calories from fat), Mediterranean-style diets for nearly five years were about 30 percent less likely to experience serious heart-related problems compared with individuals who were told to avoid fat. (All groups consumed about the same amount of protein.) Protein, too, doesn’t look so evil when one considers the 2010 trial published in The New England Journal of Medicine that found individuals who had recently lost weight were more likely to keep it off if they ate more protein, along with the 2005 OmniHeart trial that reported individuals who substituted either protein or monounsaturated fat for some of their carbohydrates reduced their cardiovascular risk factors compared with individuals who did not.”

Also, regarding Dean Ornish’s research:

“So there’s little evidence to suggest that we need to avoid protein and fat. But what about the claims Ornish makes about the success of his own diet—do they hold up to scrutiny? Not exactly. His famous 1990 Lifestyle Heart trial involved a total of 48 patients with heart disease. Twenty-eight were assigned to his low-fat, plant-based diet and 20 were given usual cardiac care. After one year those following his diet were more likely to see a regression in their atherosclerosis.

But here’s the thing: The patients who followed his diet also quit smoking, started exercising and attended stress management training. The people in the control group were told to do none of these things. It’s hardly surprising that quitting smoking, exercising, reducing stress and dieting—when done together—improves heart health. But the fact that the participants were making all of these lifestyle changes means that we cannot make any inferences about the effect of the diet alone.

So when Ornish wrote in his op–ed that ‘for reversing disease, a whole-foods, plant-based diet seems to be necessary,’ he is incorrect. It’s possible that quitting smoking, exercising and stress management, without the dieting, would have had the same effect—but we don’t know; it’s also possible that his diet alone would not reverse heart disease symptoms. Again, we don’t know because his studies have not been designed in a way that can tell us anything about the effect of his diet alone. There’s also another issue to consider: Although Ornish emphasizes that his diet is low in fat and animal protein, it also eliminates refined carbohydrates. If his diet works—and again, we don’t know for sure that it does—is that because it reduces protein or fat or refined carbohydrates?”

I’m not paying a lot of attention to what Ornish says.

Exercise is more important than business

Why Exercising Is a Higher Priority Than My Business is an article in the Personal Health section of Entrepreneur magazine. The writer Joshua Steimle explains why he puts exercise above such things as client meetings. He says:

“I schedule my workouts during the workday and prioritize exercise over all my work activities. There is some flexibility, but if there is a conflict between a trail run I need to get in, and a meeting with a client, I’ll reschedule the client meeting first. I do this because I and my business can survive the consequences of rescheduling a client meeting, even if it means losing that client. But as soon as I start pushing workouts off, I’ll start missing workouts, and once I start missing workouts, I’m close to stopping workouts altogether.

Exercise must come first, or it’s unlikely to happen at all.

If exercise stops, then my health goes downhill. With the loss of physical health my productivity at work goes down. I become depressed. I lose motivation to do the things that makes my business successful. I’ve learned firsthand that excellence in one area of my life promotes excellence in all other areas of my life. Exercise is the easiest area of my life to control. It’s easy to measure. Either I get it in, or I don’t. When I do, it lifts up all other areas of my life, including my business.”

Smart man!

Avoiding pesticides in produce from Consumer Reports

To this point, I haven’t been fully convinced that organic produce is better for me. Though there’s a lot of fear-mongering and weird conspiracy theories around organic (and GMO) food, I haven’t found overwhelming evidence that organic produce is a) more nutritious or b) safer. An article in Consumer Reports has made me reconsider that stance.

Eat the Peach, Not the Pesticide recommends that we always buy organic whenever possible:

“Experts at Consumer Reports believe that organic is always the best choice because it is better for your health, the environment, and the people who grow our food. The risk from pesticides on conventional produce varies from very low to very high, depending on the type of produce and on the country where it’s grown. The differences can be dramatic. For instance, eating one serving of green beans from the U.S. is 200 times riskier than eating a serving of U.S.-grown broccoli.”

The article provides an interactive guide so you can see where various fruits and vegetables lie on the spectrum from high- to low-risk:

“If you want to minimize your pesticide exposure, see our risk guide. (Download our full scientific report, ‘From Crop to Table.’) We’ve placed fruits and vegetables into five risk categories—from very low to very high. In many cases there’s a conventional item with a pesticide risk as low as organic. Below, you’ll find our experts’ answers to the most pressing questions about how pesticides affect health and the environment. Together, this information will help you make the best choices for you and your family.

This short video from Consumer Reports summarizes their findings.

Gaining a competitive edge

I’m a fan of Alex Hutchinson’s Sweat Science colum in Runner’s World. Hutchinson is a former physicist, an award-winning science journalist and a runner. (Check out his bio.) He always does a good job of discussing the research that’s available on any number of fitness and sports related topics from training methods to diet to whatever else you can think of.

Recently he wrote Advice to a Young Athlete. The article started as a response to a cyclist who wrote to him asking for advice on getting to the elite level. Hutchinson insists first and foremost that talent and hard work are the essentials. Beyond that there are a galaxy of things (supplements, training methods, etc) that may or may not work.

In this piece he discusses the following:

  • caffeine
  • acidity buffers: baking soda, sodium citrate and beta-alinine
  • beet-root juice
  • creatine
  • recovery methods: massage, ice baths, compression garments, sleep
  • nutrition: fruits/veggies (Eat more.), fat vs. carbs, “training low,” and hydration
  • brain training
  • race preparation: warm-up, taper, heat training

If you’re an endurance athlete or a trainer/coach the you should read the column.

Activity is Better Than Rest for Overcoming Lingering Pain

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I’m glad to see Outside Magazine delivering a message that may be very useful to anyone suffering from pain. (This is from 2009, but I just saw it.) The article mirrors my recent experience with my ACL rehabilitationThe Real Heal: Overcoming Athletic Pain says two things essentially:

  1. Rest usually doesn’t cure what hurts us. (In fact, too much rest makes us deconditioned and contributes bad feelings in general.)
  2. Moving and using our sore parts–confronting the pain–is essential to getting rid of pain.

The writer discusses his journey following a bike crash which hurt his knee (an acute injury). He rested and took pain medicine. He states (emphasis is mine):

“It turns out my belly-up approach was dated. New research is proving that the best way to treat nagging pain is to eschew pampering in favor of tough love. Doctors at the University of Pittsburgh are doing ongoing research showing that stretching irritated tendons actually reduces inflammation. And the principle extends beyond rickety wiring. Every expert I spoke with told me variations of the same thing: ‘Rest and ibuprofen cure few injuries,‘ said Dr. Jeanne Doperak, a sports-medicine physician at the University of Pittsburgh. ‘During rest you’re in a non-healing zone,‘ offered Dr. Phelps Kip, an orthopedic surgeon and U.S. Ski Team physician. ‘The body was designed to move.'”

Pain is very much a psychological thing. I can relate to this:

“And it just so happens that tendinopathy chronic tendinitis is the most diabolical of recurring injuries. Give me a broken foot over tendon trouble any day when something snaps, at least you know what you’re in for. My injury dragged on into winter, deep-sixing my mood. This is not uncommon: The link between pain and depression is so well established that sports psychologists use a tool called a Profile of Mood States to monitor injured athletes. (This is a graph evaluating tension, depression, anger, vigor, fatigue, and confusion. People in pain score extremely high in every category except for vigor.) I was five years removed from being a college athlete and I was Long John Silvering it up stairs at work. Strange questions crept into my head: Could I consider gardening exercise?”

I like the overall message of the article but I don’t agree with all the information:

  • The writer says, “… or imbalances in the body’s kinetic chain of movement (a weak core can cause lower-back pain).”

Though this is a popular concept, there is significant evidence that “core strength” (which can be defined and measured in a multitude of ways) has nearly nothing to do with back pain.

  • For runner’s knee, the writer suggests this: “Lie sideways on a table, legs straight, and slowly raise and lower the upper leg ten times. Do three sets. Easy? Ask your PT for a light ankle weight.”

I think this might be part of an effective strategy to address runner’s knee (if the problem is rooted in the hip which it often is; however it could be rooted in poor control of the foot and ankle), but there are several dots that I think need connecting between this exercise and full-on running. This exercise is very different from running in which the foot impacts the ground and the runner must control motion at the foot, ankle, knee and hip. If this is the only exercise given to a runner’s knee patient then I’m skeptical that the runner will fully overcome the issue.

  • A caption under a photo reads, “Preventive Measures: Recovering from a nagging injury? Next time you go for a run or a ride, try taking ibuprofen beforehand. As long as you’re cleared for activity by your doctor, inhibiting swelling prior to a workout can dramatically reduce post-exercise inflammation and pain.”

This is an interesting idea but I have strong reservations. Pain is a signal that should be respected. Even though pain doesn’t equal injury it’s still a message from our brain that there is a perceived threat that needs to be addressed. The pain could be signaling a threat related to poor movement control and tissue stress is leading toward injury. By taking a pain-blocking drug, we might simply be turning down that signal as we continue with what may turn into an acute injury. I would compare this to driving a car with a damaged muffler that needs replacing and instead of replacing the muffler, we turn up the stereo loud: No noise!!–but have we fixed the problem?

On the other hand, I understand that even if the movement problem is addressed, we may still feel pain. Taking a drug may help the brain experience the new, better movement in a painless way which might help break the chronic pain cycle. I’m curious to what degree this has been method has been investigated.

For me, as a personal trainer, I would never suggest someone take a drug and just keep going. Rather, I would speak with the person’s PT. If he or she OKs it, I would then advise someone to move and work below the pain threshold or at a very manageable level of pain.

Colon Cancer & Sitting

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The New York Times Well Blog discusses an alarming trend:

Incidences of colorectal cancer have been decreasing by about 1 percent a year since the mid 1980s, but incidences among people under 50 — the recommended screening age — has been increasing sharply, and these younger patients are more likely to present with advanced disease.

evolution-of-sitting

The article discusses findings published in JAMA. This information strikes close to my wife and I. Someone in her professional world has been diagnosed with advanced colon cancer. He is relatively young, not overweight and he has been moderately active. This has been a shock to a lot of people and we’re very sad for him and his family.

This situation makes me think about the research on sitting. Prolonged Sitting May Increase Risk of Certain Cancers is an article in Scientific American. The article states:

“The more time people spend sitting, the higher their risk of certain types of cancer, according to a new review of previous studies.

Researchers found that, with each 2-hour increase in people’s sitting time per day, their risk of colon cancer increased by 8 percent, and women’s risk of endometrial cancer increased by 10 percent.”

The person we know with colon cancer is a successful computer guy and he is very passionate and dedicated to his field of expertise and that’s dictated that he sits a lot. (I’m not placing blame on him, simply noting my observations as they relate to this data.) The Scientific American article also says,

“The results were independent of physical activity, showing that sedentary behavior represents a potential cancer risk factor, distinct from physical inactivity,” study author Dr. Daniela Schmid, of the University of Regensburg in Germany, told Live Science in an email.

So it seems that we can’t out-exercise our sitting habit. Sitting is a hazardous activity in and of itself. I am morbidly fascinated that modern humans have virtually eliminated threats such as animal predators and infectious disease from our lives, only to replace them with something like sitting. To me that’s solid proof that the creator of the universe is possessed of a real wacko sense of humor.

I have one question about the sitting-causes-cancer factor: What about bicycling? Is it literally putting my butt on a solid object that increases my risk or is it the staying still for hours on end? What if desk-bound workers were to somehow lay down for their work. Would the cancer risk also rise? My guess is that it’s being sedentary for hours and hours that’s the problem and that riding a bike is not carcinogenic. I’m also betting that someone is researching all of this and we’ll get some sort of answer soon.