Sleep: Think You Can Do Without It?

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This is the cutting edge of health!

A recent TED Talk has grabbed my attention. The topic is sleep. (I’ve written before about this vastly under-appreciated component of health here and here.) The presenter is Dr. Kirk Parsley. Dr. Parsley is a former Navy Seal. He’s been a member of the American Academy of Sleep Medicine since 2006 and served as Naval Special Warfare’s expert on sleep medicine.  In other words, he’s familiar with lack of sleep and its effects. 

Among other things, he discusses our cultural view of sleep which is one that I’ve observed as well. It seems that a lot of us recognize the necessity of good eating and vigorous exercise as part of getting in top-notch shape but sleep seems to be a footnote. It’s often dismissed without much thought. We look at sleep as an obstacle to productivity. It’s like a leisure activity done only by babies and the weak. The productive go-getters hardly sleep–they work!

I’ve had a lot of people say something along the line of, “Oh well, I can’t ever get to bed that early,” or “Yeah… I know… I just wind up staying up late.” Some people seem to think they don’t need sleep.  “I feel fine with five hours of sleep,” or something like that. Here, from the National Institutes of Health, are a few of the negative health effects of lack of sleep:

In the past 10 or more years, research has overturned the dogma that sleep loss has no health effects, apart from daytime sleepiness. The studies discussed in this section suggest that sleep loss (less than 7 hours per night) may have wide-ranging effects on the cardiovascular, endocrine, immune, and nervous systems, including the following:

  • Obesity in adults and children
  • Diabetes and impaired glucose tolerance
  • Cardiovascular disease and hypertension
  • Anxiety symptoms
  • Depressed mood
  • Alcohol use

The evidence suggests strongly that if you’re not sleeping enough then you’re not performing as well as you’d like and your health is suffering. In my totally anecdotal experience, the days when I get to bed early and sleep in for a little while results in my feeling phenomenal. I’m going to try and do that more often. Here’s the TED talk:

Tiger Woods’ Back Pain Mythology

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For effective management of persistent pain, provide a clear understanding of the factors that drive pain, develop graduated strategies to normalise and optimise movement patterns while controlling pain, and couple these steps by prescribing sports specific conditioning and a graduated return to sport. Addressing psycho-social stressors and unhealthy lifestyle factors is part of this process, especially where ‘central’ pain features are dominant. Magic bullets don’t exist, so don’t promise them.
– Dr Peter O’Sullivan, Curtin University, West Australia

Tiger Woods received a lot of coverage earlier this month for withdrawing from a golf tournament due to back pain. Tiger mentioned back spasms in interviews and made the following statement:

“It was a different pain than what I had been experiencing, so I knew it wasn’t the site of the surgery. It was different and obviously it was just the sacrum,” Woods said. “The treatments have been fantastic. Once the bone was put back in the spasms went away, and from there I started getting some range of motion. My physio is here. If it does go out (again), he’s able to fix it.”

So the implication here is that the sacrum can in fact pop out and be put back in place. And that once the sacrum is back where it belongs–presto!–the pain was gone. This is the type of statement that perks up the ears of numerous therapists, coaches and trainers. This is also the type of information that grabs the attention of multitudes of back-pain sufferers. There’s hope! A magic treatment is at hand!

First, can a sacrum pop out? For that question, I like these words from UK physiotherapist Adam Meakins aka the Sports Physio:

“The notion of anyone’s sacrum just ‘popping out’ is complete and utter nonsense, let alone the sacrum of a fit athletic professional male golfer without any past risk factors or history of significant trauma…

SACRUMS DONT JUST POP IN AND OUT…

The robust pelvis.  Made to last.

All that white webbing-type stuff are ligaments. Very strong stuff.  The sacrum is underneath it between the hip bones at the bottom of the spine.

For starters the pelvis is an incredibly strong and stable structure with many, many strong ligaments and muscles across it. The sacroiliac joint does have some small amount of movement, and yes some have more or less than others, but the variation is minimal and the ridiculous belief that many therapists have in thinking that they can 1) feel this joint move 2) decide if it’s in the right or wrong position and 3) adjust it with manipulations is just again complete and utter nonsense based in pseudo science and nothing more than palpation pareidolia as I have discussed before in my previous blog here and on the assessment of the painful SIJ here and its management here.”

So why did Tiger think his sacrum had ‘popped out’ well there are two possible reasons.”

One very competent and observant trainer is Boulder’s Mike Terborg. He sent me an informative article from the British Medical Journal Blogs called Common misconceptions about back pain in sport: Tiger Woods’ case brings 5 fundamental questions into sharp focus. It was written by physiotherapist Dr. Peter O’Sullivan. I won’t go into every detail of the article but I’ll summarize the big pieces. (Emphasis is mine.) O’Sullivan lists five quotes related to Tiger’s pain and then asks questions of those observations. He cites research to support his answers. Go to the article to read the whole shebangabang.

  1. “Tiger has a pinched nerve in his back causing his pain.”
    What is the role of imaging for the diagnosis of back pain?

    O’Sullivan: “Disc degeneration, disc bulges, annular tears and prolapses are highly prevalent in pain free populations, are not strongly predictive of future low back pain and correlate poorly with levels of pain and disability. (Deyo 2002, Jarvik JG 2005).”

  2.  “Tiger had a micro-discectomy for a pinched nerve which had lasted for several months.”
    What is the role of microdiscectomy for the management of back pain?

    O’Sullivan: “The role of decompressive surgery (micro-discectomy) should be limited to nerve root pain associated with progressive neurological loss (e.g., leg weakness)… (O’Sullivan and Lin 2014).  Micro-discectomy is not a treatment for back pain.”

  3. “My sacrum was out of place and was put back in by the physio.”
    What role do manual therapies play to treat back pain?

    O’Sullivan: “Passive manual therapies can provide short-term pain relief. Beliefs such as ‘your sacrum, pelvis or back is out place’ are common among many clinicians.

    These beliefs can increase fear, anxiety and hypervigilance that the person has something structurally wrong that they have no control over, resulting in dependence on passive therapies for pain relief (possibly good for business, but not for health). These clinical beliefs are often based on highly complex clinical algorithms associated with the use of poorly validated and unreliable clinical tests (O’Sullivan and Beales 2007). Apparent ‘asymmetries’ and associated clinical signs relate to motor control changes secondary to sensitised lumbo-pelvic structures, not to bones being out of place (Palsson, Hirata et al. 2014). In contrast, there is strong evidence that movements of the sacroiliac joint is associated with minute movements, which are barely measurable with the best imaging techniques let alone manual palpation (Kibsgård, Røise et al. 2014).”

  4. “I need to strengthen my core to get back to playing golf again.”
    What is the role of core stability training?

    O’Sullivan: “’Working the core’” has become a huge focus of rehabilitation of athletes and non athletes in recent years.

    Recent studies have also demonstrated that positive outcomes associated with stabilisation training are best predicted by reductions in catastrophising rather than changes in muscle patterning (Mannion, Caporaso et al. 2012), highlighting that non-specific factors such as therapeutic alliance and therapist confidence may be the active ingredient in the treatment – rather than the desired change in muscle.

  5. What should clinicians do? The paradigm shift required for managing a complex multidimensional problem like back pain.

    O’Sullivan: “Firstly, clinicians need to realise that back pain does not mean that spinal structures are damaged – it means that the structures are sensitised…There is growing evidence that low back pain is associated with a combination of genetic, pathoanatomical, physical, neurophysiological, lifestyle, cognitive and psychosocial factors for each domain. The presence and dominance of these factors varies for each person, leading to a vicious cycle of tissue sensitisation, abnormal movement patterns, distress and disability (O’Sullivan 2012, Rabey, Beales et al. 2014).”

O’Sullivan makes these recommendations to clinicians:

To adopt this new approach clinicians require at least two things:

  • Change of mindset: Abandon old unhelpful biomedical beliefs, and embrace the evidence to change the narrative to help people with pain understand the underlying mechanisms linked to their disorder.
  • New and broader skills for examining the multiple dimensions known to drive pain, disability and distress. These assessment skills need to be complemented by the skill of developing innovative interventions that enhance self management, allow the patient to engage in relaxed normal movement. The clinician also needs to encourage the patient to adopt healthy lifestyles and positive thinking about backs (O’Sullivan 2012).

The change he advocates for is sloooowly happening in some areas of health care. The strictly biomechanical model (pain = injury) is still king.

Size Matters Not: Part I

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I’m very grateful to Jamie Atlas of Bonza Bodies for giving me the opportunity to write a guest post for his blog. He runs one of the big group bootcamps at Red Rocks. He’s been featured in 5280 and has been voted one of the top trainers on Denver’s A-List. Jamie also contributes a fitness column to the Denver Post. So, he’s a fairly big-time presence in the Denver health & fitness scene. He’s also been very generous to me with his time and his sharing of information. So head over to his blog for my post titled Size Matters Not. A Case for Strength Part I.  Parts II and III will appear on my blog.

Worth Reading: What Makes a Great Personal Trainer? Recovery, Pronation, Bringing Up Your Weak Spots

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What makes a great trainer?

The Personal Training Development Center (PTDC) has a lot of useful, informative articles for personal trainers.  Are Personal Trainers Missing the Point is a recent piece with which I agree. The key observation is this:

“The ability to correctly coach exercises is slowly becoming a lost art in the training world, despite that it’s the most fundamental component of being a personal trainer/coach.”

The article advocates for trainers to teach the squat, deadlift, bench press, standing press and pull-up.  (I would ad the push-up to the list.) It’s also suggested that trainers learn to teach regressions and progressions of these exercises. These exercises are the essentials. They have been and still are the basic building blocks of effective exercise programs and they offer the most return on investment of a client’s training time. Read the article to learn three steps to becoming a better coach.

Running recovery

Alex Hutchinson writes for Runner’s World and the Running Times. He recently wrote an article called the Science of Recovery.  He briefly discusses six methods: antioxidants, jogging (as during a cool down), ice bath, massage, cryosauna and compression garments. Anyone who trains hard–runner or not–may find the article interesting.

Pronation

Pete Larson at Runblogger.com gives us Do You Pronate? A Shoe Fitting Tale. Here, he describes overhearing a conversation between a confused shoe store customer and the mis-informed employee who tries to educate her on pronation. Contrary to what many of us believe, pronation is not a dire evil problem to be avoided at all costs. Larson says it well:

 “The reality is that everybody pronates, and pronation is a completely normal movement… We might vary in how much we pronate, but asking someone if they pronate is like asking them if they breathe. I’d actually be much more concerned if the customer had revealed that no, she doesn’t pronate. At all. That would be worrisome.”

If you’re a runner then I highly suggest you learn about the realities of pronation.

Supplemental strength

I love strength training. I love all the subtleties and ins & outs of getting stronger. One area that I’m learning about is supplemental work (aka accessory work). This is weight training used to bring up one’s strength on other lifts (typically the squat, deadlift, bench press or standing press).  With supplemental work, we’re looking to find weak areas and make them stronger.
Dave Tate at EliteFTS is one of the foremost experts on all of this. Thus, his article Dave Tate’s Guide to Supplemental Strength is very much up my alley, and it should be up yours if you’re serious about getting stronger. He discusses several categories of exercises and how to incorporate them into a routine. Below, the term “builders” refers to exercises that build the power lifts (squat, bench press, deadlift):
  1. Always start with the builders. Do not start with the main lift.
    Examples: Floor press, box squat. Sets: 3-5. Reps: 3-5.
  2. Move to supplemental exercises — exercises that build the builders.
    Examples: 2-board press, safety-bar close-stance squat. Sets: 3. Reps: 5-8.
  3. Accessories — Either muscle-based (for size) or movement-based (for strength). Use supersets and tri-sets, as needed.
    Examples: DB presses, biceps curls. Sets: 3. Reps: 10-20.
  4. Rehab/Pre-hab — Whatever you need, nothing more or less. Examples:
    External rotation, face pulls. Sets: 2-3. Reps: 20-30.
This is just a little bit of the article. It’s very detailed. There may not be much here for recreational lifters but for coaches and those of us who have gotten a little deeper into our lifting, it’s a superb article.

Summary of the NSCA Endurance Clinic: Day 2

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Day 2:

  • Dr. Carwyn Sharp – Role of Strength Training & the Endurance Athlete
    • Factors determining successful endurance performance
      • VO2Max – Not nearly as important as we’ve thought for years
      • Lactate/Anaerobic Threshold
      • Economy of Movement
      • Velocity at onset of blood lactate accumulation (vOBLA) – This may be the most important.
      • We need to think of ways to increase performance, not just measurements like VO2Max.
    • Improving Running Economy (RE)/Economy of Movement (EM):
      • strength
      • speed
      • power
      • More force into the ground/pedals/water = speed
      • More force comes from more strength
      • Heavy strength training and plyometrics are best
      • Both are shown to improve vOBLA
      • Plyometrics need to look like running: 1-leg hops, bounds, skipping.  This is SPORT SPECIFIC TRAINING.
    • Good idea to cut strength training during a taper.
    • Strength training guidelines
      • heavy weight training:
      • 3-5 sets of 3-6 RM
      • with 3-5 minutes rest between sets
    • Plyometrics: most convincing performance results.
      • varies depending on training status, mode and intensity
      • work: rest of 1:5 to 1:10
      • 80-140 foot contacts per session; fewer for beginners
        • 2-foot landing counts as 2 contacts
        • 1-foot landing is 1 contact
      • FIRST THERE MUST BE A SOLID STRENGTH BASE!
      • Donald Chu, Jumping Into Plyometrics
  • Coach Jay Johnson, MS – The Strength & Conditioning Coach Meets the Running Coach
    • former collegiate runner and running coach at CU Boulder
    • coached 3 U.S. Track & Field champions
    • 6 main points
      • Athleticism
      • Runners (and everyone else) need to first have a base of athleticism
      • good movement in 3 planes of movement
      • full ROM at the joints
      • strength
      • He builds aerobic metabolism on top of this foundation of athleticism.
      • The idea of athleticism is massively important!
    • Why did your athlete/client get better?
      • Did they simply go from being sedentary to being active?
      • Or did they get better because of the program you designed?
    • Understand the role of glycogen
      • The body must be trained to use lipids as fuel
      • This syncs with Seebohar’s discussion on glycogen.
    • Development of the aerobic metabolism is the most important factor for peak running performance.
    • Runners must  do non-running work to stay healthy.
      • GSM (General Strength & Mobility Work)
      • Gary Gray’s 3D lunge matrix.  I’ve played with this in the past.  I’ve returned to it.  Here’s a video

  • Keep the easy days easy and the hard days hard.
    • Do the intense strength/plyometric work on the hard running days.
    • Take it easy on the off days.
    • This is a key part of the periodized plan
    • His discussion on periodization was very helpful to me
    • Macrocycle
      • When it’s time to progress the runs, do so on the hard days.
      • Run easy or rest on the easy days.  Never up the intensity of easy days.
      • A complete day off every 14 days is a good idea
      • Take an active rest week after every 5k, 10k, and half-marathon
      • He takes three weeks after a marathon.
    • Microcycle
      • 4 days/week running
      • Monday – recovery day: Do strides on Monday; 4-5 x 20-30 seconds at 5k pace with 1 minute easy jogging between reps.
      • Tuesday – workout: High level aerobic workout or race pace workout.  Can include:
        • Threshold/tempo run or
        • Fartlek run or
        • Progression run or
        • Long repetitions or
        • Alternate the above with race pace workouts week to week
      • Wednesday – aerobic cross-training
      • Thursday – off or cross-training
      • Friday – easy run day w/strides
      • Saturday – long run
      • Sunday – brisk walk
    • The lunge matrix is done before every run
    • Runs follow with general strength and mobility work and Active Isolated Stretching
    • Here’s a link to Johnson’s 8-week strength progression.
    • This may have been my favorite lecture.  Johnson did a fantastic job of taking academic information (physiology, periodization, race pace training) and telling us in simple terms how he implements these things.  His point on athleticism was HUGE to me. I plan to contact him for coaching this coming season.
  • Nick Clayton, MS, MBA, CSCS,*D, RSCC – Functional Training for the Endurance Athlete
    • This was an active demonstration in the performance center, not a lecture.
    • Sport specific movement that mimics body position, speed of contraction contraction type of said sport
    • trains the body as an integrated unit
    • Primal movement patterns
      • squat
      • lunge
      • lift
      • push
      • pull
      • twist
      • Squat progression
        • 1-leg balance
        • 1-leg squat
        • 1-leg squat in multiple planes and with other body movement
        • 1-leg squat jump to deceleration
      • Lunge progression
        • stationary with narrow base
        • multi-planar
        • multi-planar with reaching
        • split squat jumps with focus on quiet deceleration
      • Lift (deadlift related movements)
        • hip hinge and balance progression
        • 1-leg Romanian deadlift/deadlift
        • kettlebell swings
      • Push/Press: Discussed mainly addressing the postural and scapular considerations of safe and effective pushing in sport training
      • Pull:
        • Shoulder stability patterns:
        • Y, T, I, W, stability ball roll-out
        • I liked these patterns.  I’m using them now as part of the warm-up or as correctives as needed.
      • split stance dumbbell row
      • cable “lawnmower”
        • It’s a single-leg cable row with a hip hinge.
        • This is a running pattern. Here’s a demo

Prior to the strength and plyo demos, we went through a really cool walking/lunging mobility process. Nick said he was going to email out videos of the warm-up and when/if he does, I’ll post them here.  I may video it myself.

Getting out on the floor to play with these exercises was a lot of fun.  I really liked the 1-leg plyo work.  I definitely got some valuable ideas that I’ll implement in my own training and with my clients. I also liked the shoulder patterns a lot.  I’ve seen the Y, T, I, W patterns before but I understand them better now.  I think it’s key to KEEP THE SHOULDERS AWAY FROM THE EARS WHILE YOU DO THESE.

  • Randall Wilber – Training and Competing in a Hot and Humid Environment
    • Dr. Wilber discussed in great detail how he helped Deena Castor (bronze) and Meb Keflezighi (silver)  prepare for the Athens Olympic marathons in 2004.
    • While not terribly important to my goals, some of this information was new and very interesting.
    • 2 ways to prepare for heat/humidity:
      • Natural acclimatization
      • Arrive 10 days to two weeks out
      • Gradually adjust timing of high-intensity and low-intensity workouts (two-a-days)
      • Gradually creep the workouts towards the heat of the day such that the final day has a HI workout near noon and a LI intensity workout in the evening.
      • Pre-acclimatization (Deena and Meb both did this prior to Athens.)
        • Very simple: Train in more clothing to make the body hot and thus approximate the hot conditions in which you’re to compete.
        • Arrive a few days ahead of the event and do your final workouts.
      • Cooling strategies
      • clothing
        • no cotton
        • lightweight and light color
      • sunscreen: avoid it as much as possible as it clogs pores and inhibits sweating
      • ice packs/towels
      • ice vest
      • Apply cold/ice to hands and feet: I’ve noticed on my own how  in cold weather, I can put on gloves or take off gloves and experience a significant change in my overall temperature.
      • whole body immersion: showers, tubs
      • ice drinks (like Slurpees)
      • Stay as cool as possible right up to the event.
      • Consume more sodium while training in the heat.
  • David Bertrand – Managing the Endurance Athlete
    • MS, USA Triathlon Level II Coach, lectures at SMU in the Applied Physiology Dept, head of DFI Tri Club, Dallas
    • Athlete selection:
      • Very important to coach people with whom you mesh
      • You may not be the best coach for everyone
      • Curiosity: He needs to feel curious about his clients and their goals.
      • “Training with David” document: This was very insightful
        • What does training with David bring…
        • coaching philosophy
        • requirements
        • rates
        • weekly training availability
        • how training is delivered
        • training jargon and abbreviations
        • I need to develop a document like this w/my name in place of David’s
    • Coaching styles and methodologies
      • autocratic: best for groups with both high and low cohesion
      • democratic: best for groups with moderate cohesion
      • Display a vision.  Express belief in the athlete
      • Buy-in: “Here’s how were going to do it.”
    • Communication
      • How am I most effective?  1-on-1?  Small groups?  Big groups?  Ask my clients.
      • LISTENING IS VITAL!
    • Training intensities
      • Most people go too hard.
      • This is in sync with Wilber’s advice that a little undertrained is far better than a little overtrained.
      • HR monitor can help keep athletes in check.
    • Writing and adjusting the plan
      • Adjusting the plan: This is your greatest value to them.  This separates you from the cookie cutter programs.
      • Most people need MORE RECOVERY, not more work.
    • Best practices
      • Don’t over-coach: Take 1 or 2 things and ask, “What did we focus on today?”  Less is more
      • Strive to learn.  Stay curious.  He told a great story about Jon Wooden.
      • Select days of the week for specific tasks.  Get organized.
      • Help athletes with something beyond just training.  Can you inspire them?
    • David gave a really superb lecture on what I call “filling in the cracks.”  That is, he spoke to issues beyond just physiology, heart rate, strength programs and other science. He talked about his time in the trade and how to actually work with human beings. I got a lot out of the lecture even though I’m not a tri coach nor do I plan on becoming one.

 

An LDL is an LDL is an LDL… Or is it?

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“We may be medicating many people who have no clear need for medication, using drugs that don’t target the right particles, and replacing foods that are benign with foods that are anything but.”

Recent posts (here and here) have dealt with the ketogenic way of eating.  So fat and all things related have been on my mind. And what terrifying substance enters our thoughts right on the heels of fat?  Cholesterol, obviously. We often think that eating more fat means more cholesterol in our bodies. (That may or may not be true and even if it is it may not be bad at all.  I know that sounds like heresy crossed with insanity but a lot of research out there strongly suggests it.) I found an interesting article recently that comes from Men’s Health by way of NBC News.

It’s called Bad cholesterol: It’s not what you think. It suggests the idea that even the so-called “bad” cholesterol isn’t all bad, and that elevated levels of a certain type of “bad” cholesterol may be no danger at all.

Most of us are fairly familiar with cholesterol.  We’re told it’s bad and that generally we should strive for a low cholesterol count. Beyond the simple cholesterol count, there is our cholesterol ratio, that is your total cholesterol count divided by your HDL count.  Most of us know about the “good” cholesterol known as HDL or high-density lipoprotein; and the “bad,” LDL aka low-density lipoprotein. We’re told that LDLs are dangerous, come from eating high-fat foods and if we have too many of them then we may need some tasty cholesterol-lowering drugs!

Well, much like characters in Game of Thrones, these LDL’s are complex and not all of them are pure evil. Here’s a description from the article (emphasis is mine.):

LDL comes in four basic forms: a big, fluffy form known as large LDL, and three increasingly dense forms known as medium, small, and very small LDL. A diet high in saturated fat mainly boosts the numbers of large-LDL particles, while a low-fat diet high in carbohydrates propagates the smaller forms. The big, fluffy particles are largely benign, while the small, dense versions keep lipid-science researchers awake at night.

So it seems we can relax a little when it comes to our view on LDLs. And we should adjust our take on what foods are truly dangerous as it pertains to cholesterol.

What often happens when we’re told we have high cholesterol or high LDLs? We’re given pills (statins) to lower our cholesterol. On that issue, the article states:

Some of these forms of LDL are relatively safe and some are dangerous, and treating them all as one and the same — the way we do every time we pay our clinic for a three-part lipid panel that simplistically says “LDL: 125” — is telling us little about the LDL cholesterol that matters, all the while sending health costs through the roof. We may be medicating many people who have no clear need for medication, using drugs that don’t target the right particles, and replacing foods that are benign with foods that are anything but.

Let’s remember that while the word “cholesterol” carries negative connotations for a lot of people, this substance actually has important physiologic functions. Our cell membranes are built from cholesterol. The myelin that wraps around our neurons and acts as a vital insulator is made of cholesterol. So cholesterol is there for a reason. (One possible impetus for increased cholesterol production in, say a hard-exercising athlete, is that tissues are being damaged from exercise and are in need of repair.  Thus we make more cholesterol to build more cells. Doesn’t sound bad does it?) So we may be stepping in the way of a not just a perfectly normal process (the manufacture of cholesterol) but a vital and healthy process that if impeded may endanger our health. I wonder if that’s why statins have so many ugly side effects.  (By the way, why do we call them “side effects?” There are only effects, right?)

Here’s some more interesting information from the article regarding HDLs vs. LDLs (emphasis is mine):

A 1977 NIH study — an early set of papers from the now legendary Framingham Heart Study — confirmed that high HDL is associated with a reduced risk of heart disease. It also confirmed that LDL and “total cholesterol” tells us little about the risk of having a heart attack, language that heart-disease authorities would downplay years later. Given this finding, as Gary Taubes writes in “Good Calories, Bad Calories,” we would have been better off to start testing for HDL — or even triglycerides — and nothing else.”

Ronald M. Krauss, M.D., the director of the department of atherosclerosis research at Children’s Hospital Oakland Research Institute, is interviewed in this article. Here makes some important observations and statements:

“Everyone doesn’t necessarily have the same amount of very small LDL in their LDL,” Dr. Krauss explains. Some people have mostly large LDL, a group Dr. Krauss would describe as “pattern A,” while others have mostly small LDL (and usually, low HDL and high triglycerides), a group Dr. Krauss would label “pattern B.” The second group has an increased risk of heart disease (a finding suggested again this year through the use of ion mobility). Large LDL, on the other hand — and large LDL is usually the majority of the LDL that shows up in a standard blood profile — is mostly benign.

The heart-disease community was not impressed. “It took me 4 years to publish that paper,” he says, recalling his early work on subparticles in the late 1970s. “That’s beginning to tell you some of the obstacles I was going to face.”

The cost of that resistance had become apparent by the mid-1980s and into the 1990s as Dr. Krauss began to test whether changes in diet could change a person’s LDL profile from good to bad, or from pattern A to pattern B. Using data from the Framingham Heart Study — the longest-running study of its kind — health organizations had begun to roll out the message of “good” and “bad” cholesterol, a message that in turn created the concept of good fats and bad fats. But during experiments, Dr. Krauss discovered that while a diet high in saturated fat from dairy products would indeed make your LDL levels rise, “saturated fat intake results in an increase of larger LDL rather than smaller LDL particles,” as he wrote in an American Journal of Clinical Nutrition review he co-authored in 2006. A diet heavy in full-fat cheese and butter — but not overloaded in calories — triggered the relatively harmless health profile described as pattern A. (Having demonstrated the benign consequences for cholesterol from consuming dairy fat, he is currently conducting studies to find out if the same holds true for diets high in saturated fat from beef.)

Did you notice those last few sentences? It’s further evidence that the high-fat/low-carb ketogenic diet is entirely safe. (Beyond just safe, there’s ample evidence of the powerful neuroprotective properties of keto diet.  It’s been used for years to treat epilepsy and may be useful in combating Alzheimer’s and Parkinson’s. I’m not sure to what degree it’s a significant component but remember, cholesterol is a key component of our neurological tissues.)

I also love this observation:

“Not only is dairy fat unlikely to increase heart-disease risk, Dr. Krauss and others have learned, but reducing saturated fat in a way that increases carbohydrates in a diet can shift a person’s LDL profile from safe to dangerous. That’s pretty much what happens whenever some well-meaning person with “high LDL” starts eating “low-fat” frozen dinners filled out with corn-derived additives, all the while engaging in the customary ravaging of a basket filled with dinner rolls.”

Here’s the big takeaway (emphasis is mine):

So with small-LDL testing far from standard (your doctor can request an ion mobility analysis from Quest Diagnostics), the surest way you can reduce your numbers of the LDL that matters is to rely on time-tested advice. Eating fewer carbohydrates, losing weight, and engaging in more physical activity have all been shown to reduce small LDL. Weight loss, in fact, has been demonstrated to reverse the dreaded pattern B all by itself. In other words, worry less about eggs or butter and their effect on LDL, and focus more on eating fewer processed foods and staying in motion. “I am very much an advocate of starting with lifestyle first,” Dr. Krauss says.”

Go here to read the full article.

Interesting and Informative Information: Fat Isn’t So Bad, Skimpy Research on Injury Prevention in Runners

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Read this!  Learn things!

What if bad fat isn’t so bad?

“Ronald Krauss, M.D., won’t say saturated fats are good for you. ‘But,’ he concedes, ‘we don’t have convincing evidence that they’re bad, either.'”

I’ve written here that I’ve been persuaded that not only is fat good for us, that “bad” saturated fat is also at the very least not as bad for us as we’ve been led to believe.  I found another article to further support my thoughts.  What if fat isn’t so bad? is a 2007 article from NBC News.  In it, we get a good dissection of the various flawed studies by which we’ve arrived at the idea that fat–particularly saturated fat–is pure evil.

The article discusses among other things Ancel Keys’s landmark Seven-Countries Study from 1970. This study did more to advance the fat/cholesterol/heart disease link than anything else around. This study went on to frame our current low-fat guidelines. Seems the conclusions that were drawn were quite inaccurate.  From the article (emphasis is mine):

“The first scientific indictment of saturated fat came in 1953. That’s the year a physiologist named Ancel Keys, Ph.D., published a highly influential paper titled “Atherosclerosis, a Problem in Newer Public Health.” Keys wrote that while the total death rate in the United States was declining, the number of deaths due to heart disease was steadily climbing. And to explain why, he presented a comparison of fat intake and heart disease mortality in six countries: the United States, Canada, Australia, England, Italy, and Japan.

The Americans ate the most fat and had the greatest number of deaths from heart disease; the Japanese ate the least fat and had the fewest deaths from heart disease. The other countries fell neatly in between. The higher the fat intake, according to national diet surveys, the higher the rate of heart disease. And vice versa. Keys called this correlation a “remarkable relationship” and began to publicly hypothesize that consumption of fat causes heart disease. This became known as the diet-heart hypothesis.

At the time, plenty of scientists were skeptical of Keys’s assertions. One such critic was Jacob Yerushalmy, Ph.D., founder of the biostatistics graduate program at the University of California at Berkeley. In a 1957 paper, Yerushalmy pointed out that while data from the six countries Keys examined seemed to support the diet-heart hypothesis, statistics were actually available for 22 countries. And when all 22 were analyzed, the apparent link between fat consumption and heart disease disappeared. For example, the death rate from heart disease in Finland was 24 times that of Mexico, even though fat-consumption rates in the two nations were similar.”

The large-scale Women’s Health Initiative is discussed:

“We’ve spent billions of our tax dollars trying to prove the diet-heart hypothesis. Yet study after study has failed to provide definitive evidence that saturated-fat intake leads to heart disease. The most recent example is the Women’s Health Initiative, the government’s largest and most expensive ($725 million) diet study yet. The results, published last year, show that a diet low in total fat and saturated fat had no impact in reducing heart-disease and stroke rates in some 20,000 women who had adhered to the regimen for an average of 8 years.”

Several other studies are discussed.  The comment from the article on these studies is this:

“These four studies, even though they have serious flaws and are tiny compared with the Women’s Health Initiative, are often cited as definitive proof that saturated fats cause heart disease. Many other more recent trials cast doubt on the diet-heart hypothesis. These studies should be considered in the context of all the other research.”

The article goes on to discuss the subtle differences between the types of LDL or “bad” cholesterol.  Seems that all LDLs aren’t created equally:

“But there’s more to this story: In 1980, Dr. Krauss and his colleagues discovered that LDL cholesterol is far from the simple “bad” particle it’s commonly thought to be. It actually comes in a series of different sizes, known as subfractions. Some LDL subfractions are large and fluffy. Others are small and dense. This distinction is important.

A decade ago, Canadian researchers reported that men with the highest number of small, dense LDL subfractions had four times the risk of developing clogged arteries than those with the fewest. Yet they found no such association for the large, fluffy particles. These findings were confirmed in subsequent studies.

Link to heart disease
Now here’s the saturated-fat connection: Dr. Krauss found that when people replace the carbohydrates in their diet with fat — saturated or unsaturated — the number of small, dense LDL particles decreases. This leads to the highly counterintuitive notion that replacing your breakfast cereal with eggs and bacon could actually reduce your risk of heart disease.”

In much of the medical community, this talk of fat being healthy (or at least not un-healthy) is heresy. There seems to be a strong bias against openly discussing evidence to the contrary.:

“Take, for example, a 2004 Harvard University study of older women with heart disease. Researchers found that the more saturated fat these women consumed, the less likely it was their condition would worsen. Lead study author Dariush Mozaffarian, Ph.D., an assistant professor at Harvard’s school of public health, recalls that before the paper was published in the American Journal of Clinical Nutrition, he encountered formidable politics from other journals.

“‘In the nutrition field, it’s very difficult to get something published that goes against  established dogma,’ says Mozaffarian. ‘The dogma says that saturated fat is harmful, but that is not based, to me, on unequivocal evidence.’ Mozaffarian says he believes it’s critical that scientists remain open minded. ‘Our finding was surprising to us. And when there’s a discovery that goes against what’s established, it shouldn’t be suppressed but rather disseminated and explored as much as possible.'”

Go here to read the full article.

Injury prevention in runners – “skimpy research”

The smart people at Running-Physio have done a good job of summarizing a research review of studies looking into injury prevention in runners. In all, 32 studies involving 24,066 participants were examined. The relationship between injury and running frequency, volume, intensity and duration were examined. The results? I’ll let the writers tell you;

“Regular followers of RunningPhysio will know of the ongoing debate we have with those staunch supporters of research who insist we must be evidence based. Surely this shows us just how unhelpful research can be in reality – over 30 studies, involving 24,000 runners and no firm conclusions on injury prevention! No wonder Verhangen (2012) described it as “skimpy published research” and went on to conclude,

‘Specifically for novice runners knowledge on the prevention of running injuries is practically non-existent.’

Nielsen et al. isn’t the first review of its kind in this field – a Cochrane Review in 2001 reached a very similar outcome and was updated in 2011 with equally negative conclusions; Yeung, Yeung and Gillepsie (2011) completed a review of 25 studies, including over 30,000 particpants and concluded,

‘Overall, the evidence base for the effectiveness of interventions to reduce soft-tissue injury after intensive running is very weak.’

They go on to make the very wise observation that, “More attention should be paid to changes in training charactisitcs rather than the characteristics themselves.”  Based on their reading of the research review, Running-Physio makes the following suggestions:

Novice runners should be especially cautious with increasing volume or intensity of training.

Increase in weekly mileage should be done gradually. The higher the weekly mileage the more caution needs to be applied in increasing this distance. Running expert Hal Higdon talks about runners having a ‘breaking point’ – a weekly mileage above which they start to develop injuries. For every runner this is different but with experience you can find your breaking point and aim to work below it. A gradual increase in mileage helps avoid crossing this point and picking up an injury.

Changes in intensity of training should be added in isolation, rather than combined with increase in distance. Be cautious when adding interval training or hill work and use each training session for its specific goal (i.e.long slow runs at an appropriately slow pace).

Be aware of signs of injury – look out for persistent or severe pain, swelling, restricted movement or sensations of giving way.

Use rest sensibly – don’t be afraid to rest or replace running with cross training when your body needs it.

Seek help – the right GP, Physio or health care professional can make a real difference!

Something I observe here is that we’re often looking for the  (training variable) that causes the one thing (an injury).  In reality, it’s typically many variables (some of them unseen) that bring on an injury. Also, nowhere in the article or the research is the discussion of running technique. I would think that how someone runs probably has a big effect on whether or not he or she becomes injured. I’ve mentioned previously that where the foot lands in relation to one’s center of mass is quite important as it pertains to impact and running efficiency.  I’d be interested in an analysis of the foot placement (and stride length and cadence) in the role of injury.

 

Small Frequent Meals? Bad Idea for Weight Loss.

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Bloomberg News is reporting on some very interesting weight-loss news. (I guess there’s not much going on in the financial world…) Two Large Meals a Day Tops Six Mini-Meals for Weight-Loss reveals evidence that contradicts the hallowed advice to eat several small meals per day if you want to lose weight.

Here’s what’s important:

“Over 12 weeks, people with Type 2 diabetes who ate just breakfast and lunch lost an average of 1.23 points in body mass index, or BMI, compared with a loss of 0.82 point for those who ate six smaller meals of the same nutritional and energy content. The data, in a small study involving 54 patients, were presented today at the American Diabetes Association meeting in Chicago.

The study builds on previous results disproving the theory that eating more frequently improves weight loss. That pattern, thought to work because it helps control appetite, was shown to produce no more weight loss than three regular meals in a 2010 study published in the British Journal of Nutrition. The latest report eliminates one additional meal.

In today’s study, sponsored by the Czech Republic’s Ministry of Health, both the frequency of the meals and the timing were important, according to Kahleova. Eating earlier in the day — just breakfast, between 6 a.m. and 10 a.m., and lunch, between 12 p.m. and 4 p.m. — is associated with better results than skipping breakfast, she said.

Two meals a day also led to a greater decrease in liver fat content and a bigger increase in insulin sensitivity than six smaller meals.”

I find it very interesting that the researchers recommend skipping dinner instead of breakfast. That counters what I’ve been doing and what I’ve learned as a good fasting strategy. As I’ve said in recent posts (here and here), I like the idea of continuing the nighttime fast well into the day, then eating later in the day.  In fact, in recent weeks I’ve been trying to eat two big meals on my fast days: a mid-day meal and an evening meal. Perhaps I’m doing this less than optimally if this recent study is accurate.

I think the big picture is that we should spend several hours not putting food in our mouths. There is mounting evidence that being hungry for a while is a good thing. Clearly in this country we eat too much food.  It seems we not only eat too much–we eat too often. Further, the weight-loss gospel that a small-frequent-meal strategy aka “grazing” may be entirely wrong.

If you’re interested in this topic, there are a couple of worthwhile articles from Dave Tate’s site EliteFTS.com.  Logic Does Not Apply Part I: Meal Frequency and Part II: Breakfast are well-referenced and interesting. Both discuss and support the idea of a) skipping breakfast and b) spacing out our meals by several hours.  The writer notes though that small frequent meals throughout the day may be best for putting on weight.  So if you’re looking to gain a bunch of muscle then eat often!

 

 

Things to Read: Taking on Dr. Oz, Don’t Take Your Vitamins, Questions About Barefoot Running,

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There are several interesting things out there to check out.  Here are a few:

The New Yorker on Dr. Oz

Scientists often argue that, if alternative medicine proves effective through experimental research, it should no longer be considered alternative; at that point, it becomes medicine. By freely mixing alternatives with proven therapies, Dr. Oz makes it nearly impossible for the viewer of his show to assess the impact of either; the process just diminishes the value of science.
the New Yorker

Dr. Mehmet Oz is hugely popular.  I don’t know how many people watch his show but it’s a lot. We all know who he is. He’s a Harvard- and University of Pennsylvania-trained heart surgeon and he directs Columbia Hospital’s Cardiovascular Institute and Integrative Medicine Program. He knows a few things. An article in the New Yorker titled The Operator: Is the most trusted doctor in America doing more harm than good? takes Dr. Oz to task for perhaps crossing a line from science and good doctoring to entertainment.

I agree with a lot of what the article suggests. He seems to veer from scientific-based factual information into entertaining yet scientifically questionable material. He’s had psychics on his show and he often discusses “miracle cures,” and “breakthrough fat-burning this-and-that.” I haven’t seen much of him but what I do see and hear sounds very sensational. He seems to promise miracles to desperate people. Sounds a little kooky to me. From the article:

“The Dr. Oz Show” frequently focuses on essential health issues: the proper ways to eat, relax, exercise, and sleep, and how to maintain a healthy heart. Much of the advice Oz offers is sensible, and is rooted solidly in scientific literature. That is why the rest of what he does is so hard to understand. Oz is an experienced surgeon, yet almost daily he employs words that serious scientists shun, like “startling,” “breakthrough,” “radical,” “revolutionary,” and “miracle.” There are miracle drinks and miracle meal plans and miracles to stop aging and miracles to fight fat. Last year, Oz broadcast a show on whether it was possible to “repair” gay people (“From Gay to Straight? The Controversial Therapy”), despite the fact that Robert L. Spitzer, the doctor who is best known for a study of gay-reparation therapy, had recanted. (Spitzer last year apologized to “any gay person who wasted time and energy” on what he conceded were “unproven claims.”) Oz introduced a show on the safety of genetically modified foods by saying, “A new report claims they can damage your health and even cause cancer.” He also broadcast an episode on whether the apple juice consumed daily by millions of American children contains dangerous levels of arsenic. “Some of the best-known brands in America have arsenic in their apple juice,” he said at the outset, “and today we are naming names.” In each of those instances, and in many others, Oz has been criticized by scientists for relying on flimsy or incomplete data, distorting the results, and wielding his vast influence in ways that threaten the health of anyone who watches the show. Last year, almost as soon as that G.M.O. report was published, in France, it was thoroughly discredited by scores of researchers on both sides of the Atlantic.

Dr. Eric Rose was interviewed for the article.  Rose is a professor of surgery at the Mount Sinai medical school.  Rose and Oz worked together, most notably on Frank Torre’s 1996 heart transplant.  (Frank Torre is the brother of former Yankee manager Joe Torre.) He said this:

“I want to stress that Mehmet is a fine surgeon,” Rose said, as he did more than once during our conversation. “He is intellectually unbelievably gifted. But I think if there is any criticism you can apply to some of the stuff he talks about it is that there is no hierarchy of evidence. There rarely is with the alternatives. They have acquired a market, and that drives so much. At times, I think Mehmet does feed into that.”

I asked if he would place his confidence in a heart surgeon, no matter how gifted, who operated just once a week, as Oz does. “Well,” he replied, “in general you want a surgeon who lives and breathes his job, somebody who is above all devoted to that.” Again he mentioned Oz’s experience, but when I asked if he would send a patient to Oz for an operation, he looked uncomfortable. “No,” he said. “I wouldn’t. In many respects, Mehmet is now an entertainer. And he’s great at it. People learn a lot, and it can be meaningful in their lives. But that is a different job. In medicine, your baseline need has to be for a level of evidence that can lead to your conclusions. I don’t know how else you do it. Sometimes Mehmet will entertain wacky ideas—particularly if they are wacky and have entertainment value.”

And there is this observation from researcher Eric Topol:

“Mehmet is a kind of modern evangelist,” Eric Topol said when I called him at the Scripps Research Institute, where he is a professor of genomics and the director of the Translational Science Institute. Topol, one of the nation’s most prominent cardiologists, founded the medical school at the Cleveland Clinic and led its department of cardiovascular medicine. “He is keenly intelligent and charismatic,” Topol said. “Mehmet was always unique, but now he has morphed into a mega-brand. When he tells people the number of sexual encounters they need each year to improve their lives in a specific way, or how to lose weight in three days—this is simply lunacy. The problem is that he is eloquent and talented, and some of what he says clearly provides a service we need. But how are consumers to know what is real and what is magic? Because Mehmet offers both as if they were one.”

Dr. Oz seems like the latest in a long line of American snake-oil salesmen.  The best ones mix truth with fantasy and it sounds like Dr. Oz is doing just that.  On the positive side, the article tells us that Dr. Oz is pro-vaccine.  Read the full article on the cult doctor here.

The New York Times: Don’t Take Your Vitamins

The likely explanation is that free radicals aren’t as evil as advertised. (In fact, people need them to kill bacteria and eliminate new cancer cells.) And when people take large doses of antioxidants in the form of supplemental vitamins, the balance between free radical production and destruction might tip too much in one direction, causing an unnatural state where the immune system is less able to kill harmful invaders.
the New York Times

I’ve discussed various questions about supplements. Now, a recent opinion piece called Don’t Take Your Vitamins is in the New York Times and it goes into more information on the topic.  Here’s a bit:

“Antioxidation vs. oxidation has been billed as a contest between good and evil. It takes place in cellular organelles called mitochondria, where the body converts food to energy — a process that requires oxygen (oxidation). One consequence of oxidation is the generation of atomic scavengers called free radicals (evil). Free radicals can damage DNA, cell membranes and the lining of arteries; not surprisingly, they’ve been linked to aging, cancer and heart disease.

To neutralize free radicals, the body makes antioxidants (good). Antioxidants can also be found in fruits and vegetables, specifically in selenium, beta carotene and vitamins A, C and E. Some studies have shown that people who eat more fruits and vegetables have a lower incidence of cancer and heart disease and live longer. The logic is obvious. If fruits and vegetables contain antioxidants, and people who eat fruits and vegetables are healthier, then people who take supplemental antioxidants should also be healthier. It hasn’t worked out that way.

The likely explanation is that free radicals aren’t as evil as advertised. (In fact, people need them to kill bacteria and eliminate new cancer cells.) And when people take large doses of antioxidants in the form of supplemental vitamins, the balance between free radical production and destruction might tip too much in one direction, causing an unnatural state where the immune system is less able to kill harmful invaders. Researchers call this the antioxidant paradox.

Because studies of large doses of supplemental antioxidants haven’t clearly supported their use, respected organizations responsible for the public’s health do not recommend them for otherwise healthy people.

So why don’t we know about this? Why haven’t Food and Drug Administration officials made sure we are aware of the dangers? The answer is, they can’t.”

The article goes into how the supplement makers have tied the hands of the FDA.  Seems this sort of thing happens in many different arenas from food and drugs to environmental regulations.  It seems over and over again we’re shown that we should get our nutrition from real food, not pills and powders.

The New York Times: Is Barefoot-Style Running Best? New Studies Cast Doubt.

(Somehow all these article came from the great city of New York. Wasn’t really intentional but… there it is anyway.)  I’m a big fan of minimalist or barefoot-style running.  I believe in my case it has helped me regain proper mobility and strength, and has helped me overcome pain and regain my running ability.  That said, simply donning a pair of Vibram 5-Fingers and hitting the road WAS NOT a cure-all for me. A lot more work went into my efforts to fix my running.  The New York Times discusses things in this direction in this recent post in the Well Blog section.

The article discusses research from the Journal of Applied Physiology that looked at forefoot vs. heel striking in runners.  (Advocates of barefoot-style running suggest that barefoot running promotes forefoot striking which is suggested by some to reduce injuries.)  The pertinent findings are these:

In the end, this data showed that heel-striking was the more physiologically economical running form, by a considerable margin. Heel strikers used less oxygen to run at the same pace as forefoot strikers, and many of the forefoot strikers used less oxygen — meaning they were more economical — when they switched form to land first with their heels.

Most of the runners also burned fewer carbohydrates as a percentage of their energy expenditure when they struck first with their heels. Their bodies turned to fats and other fuel sources, “sparing” the more limited stores of carbohydrates, says Allison Gruber, a postdoctoral fellow at the University of Massachusetts Amherst, who led the study. Because depleting carbohydrates results in “hitting the wall,” or abruptly sagging with fatigue, “these results tell us that people will hit the wall faster if they are running with a forefoot pattern versus a rear-foot pattern,” Dr. Gruber says.

That covers running efficiency of two different foot-strike styles.  The article says this about injuries:

The news on injury prevention and barefoot-style running is likewise sobering. Although many barefoot-style runners believe that wearing lightweight shoes or none at all toughens foot muscles, lessening the likelihood of foot-related running injuries, researchers at Brigham Young University did not find evidence of that desirable change. If foot muscles become tauter and firmer, the scientists say, people’s arches should consequently grow higher. But in a study also presented at the sports medicine meeting, they found no changes in arch height among a group of runners who donned minimalist shoes for 10 weeks.

Other researchers who presented at the meeting had simply asked a group of 566 runners if they had tried barefoot-style shoes and, if so, whether they liked them. Almost a third of the runners said they had experimented with the minimalist shoes, but 32 percent of those said that they had suffered injuries that they attributed to the new footwear, and many had switched back to their previous shoes.

This isn’t terribly surprising considering that from a biomechanics standpoint, running is a complicated task. There are numerous joints and muscles involved in the kinetic chain. If any part of that chain isn’t functioning properly then we may get a problem. If we’re conditioned to running in one type of shoe then abruptly change to another shoe, then conditions are very different under our feet and thus the way we run will be altered.

Minmal shoes have been a component of my overcoming various chronic aches and pains–which I should say were acquired while running in conventional “good” running shoes. I initially simply running in my old, bad style in my new minimal shoes.  It didn’t work!  I had to regain competency in my feet, hips, and torso to fix my running issues.  Minimal shoes allowed me to become more aware of my feet and more aware of how I land on the ground. So again, I think minmal shoes can be a very good idea so long as they’re not looked to as a be-all-end-all cure to running injuries.

PBS’s The Truth About Exercise

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“The chair is a killer.”
– Michael Mosley, PBS, The Truth About Exercise

Attention all exercise geeks and anyone fond of learning about the ins and outs of regaining or maintaining your health: You must check out the new series from PBS called The Truth About Exercise with Michael Mosley.  (Actually, it seems that each episode has it’s own title “… with Michael Mosley.”)  I watched the first episode and it’s tremendously interesting.  The second episode is titled “Eat, Fast and Live Longer.”  I just started it.

(Thanks to my mom for telling me about this show.)

Mosley uses himself as an experimental subject as he delves into some of the following topics:

  • How to reduce your insulin response with 3 minutes of (very) intense exercise per week.
  • How and why exercise can help remove fat from the blood stream.
  • The very deadly perils of sitting too much.
  • Why some people are “non-responders” to some aspects of exercise (and why exercise is still healthy for “non-responders.)

I know very little about Mosley but that he seems to be a fairly common sort of guy who’s not in particularly good shape.  He has the questions about his health that many of us have.  He talks to various exercise physiologists, nutrition scientists and coaches as he searches for answers and examines several exercise myths.  I love it because much of what he discovers is informed by the latest science.  He’s not rehashing the “common knowledge” (which is commonly stale and fairly inaccurate.)  It’s a very entertaining show that moves quickly and isn’t overly science-y.  It has a pretty decent soundtrack as well.  I highly recommend it to anyone reading this right now.  Previews of each episode are below.  Go here to watch the full episodes.

Watch The Truth About Exercise with Michael Mosley – Promotion on PBS. See more from Michael Mosley.

Watch Guts with Michael Mosley – Preview on PBS. See more from Michael Mosley.