More Nails In the Saturated-Fat-Is-Bad Coffin

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“The new findings are part of a growing body of research that has challenged the accepted wisdom that saturated fat is inherently bad for you and will continue the debate about what foods are best to eat.”
– New York Times

The New York Times Well Blog posted an article recently called Study Questions Fat and Heart Disease Link. The article reports on a study in the Annals of Internal Medicine. This is a literature review of 75 different studies that examined the relationship between saturated fat and coronary disease. The study’s conclusion:

“Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats.”

Beyond the saturated fat factor, the discussion on cholesterol and the different types of low-density lipoproteins (LDLs) is pertinent and echos the information in this post. Note also the comments on carbs and sugar from Dr. Rajiv Chowdhury, lead author of the new study and a cardiovascular epidemiologist in the department of public health and primary care at Cambridge University:

“The primary reason saturated fat has historically had a bad reputation is that it increases low-density lipoprotein cholesterol, or LDL, the kind that raises the risk for heart attacks. But the relationship between saturated fat and LDL is complex, said Dr. Chowdhury. In addition to raising LDL cholesterol, saturated fat also increases high-density lipoprotein, or HDL, the so-called good cholesterol. And the LDL that it raises is a subtype of big, fluffy particles that are generally benign. Doctors refer to a preponderance of these particles as LDL pattern A.

The smallest and densest form of LDL is more dangerous. These particles are easily oxidized and are more likely to set off inflammation and contribute to the buildup of artery-narrowing plaque. An LDL profile that consists mostly of these particles, known as pattern B, usually coincides with high triglycerides and low levels of HDL, both risk factors for heart attacks and stroke.

The smaller, more artery-clogging particles are increased not by saturated fat, but by sugary foods and an excess of carbohydrates, Dr. Chowdhury said. ‘It’s the high carbohydrate or sugary diet that should be the focus of dietary guidelines,’ he said. ‘If anything is driving your low-density lipoproteins in a more adverse way, it’s carbohydrates.’”

NPR also reported on this research in Don’t Fear the Fat: Experts Question the Saturated Fat Guidelines. This article offers a timeline leading up to the current research:

“So, let’s walk through this shift in thinking: The concern over fat gathered steam in the 1960s when studies showed that saturated fat increases LDL cholesterol — the bad cholesterol — the artery-clogging stuff. The assumption was that this increased the risk of heart disease.

But after all this time, it just hasn’t panned out, at least not convincingly. When researchers have tracked people’s saturated fat intake over time and then followed up to see whether higher intake increases the risk of heart attacks and strokes, they haven’t found a clear, consistent link.

In fact, the new study finds ‘null associations’ (to quote the authors) between total saturated fat intake and coronary risk. And a prior analysis that included more than 300,000 participants came to a similar conclusion.”

Both articles include caveats and reservations by other researchers. Read the articles to see those. I’m not sure they’re anything but what’s been said in the past, and this new research seems like a strong basis to refute the old advice.

A Life Long Fight Against Trans Fats

Dr. Fred Kummerow is a researcher who has no reservations about consuming saturated fat. He was one of the first researchers to lead the charge against trans fats. The New York Times profiled Dr. Kummerow in A Lifelong Fight Against Trans Fats. He observed in the 1950s a link between the man-made trans fats and coronary disease. It took decades for the rest of the food science world to accept his findings. He’s 99 years-old and still working. Some of his findings on vegetable oil and cholesterol are worth considering:

“In the past two years, he has published four papers in peer-reviewed scientific journals, two of them devoted to another major culprit he has singled out as responsible for atherosclerosis, or the hardening of the arteries: an excess of polyunsaturated vegetable oils like soybean, corn and sunflower — exactly the types of fats Americans have been urged to consume for the past several decades.

The problem, he says, is not LDL, the ‘bad cholesterol’ widely considered to be the major cause of heart disease. What matters is whether the cholesterol and fat residing in those LDL particles have been oxidized. (Technically, LDL is not cholesterol, but particles containing cholesterol, along with fatty acids and protein.)

‘Cholesterol has nothing to do with heart disease, except if it’s oxidized,’ Dr. Kummerow said. Oxidation is a chemical process that happens widely in the body, contributing to aging and the development of degenerative and chronic diseases. Dr. Kummerow contends that the high temperatures used in commercial frying cause inherently unstable polyunsaturated oils to oxidize, and that these oxidized fatty acids become a destructive part of LDL particles. Even when not oxidized by frying, soybean and corn oils can oxidize inside the body.

LDL’s and Kummerow’s own eating habits are discussed:

If true, the hypothesis might explain why studies have found that half of all heart disease patients have normal or low levels of LDL.

“You can have fine levels of LDL and still be in trouble if a lot of that LDL is oxidized,” Dr. Kummerow said.

This leads him to a controversial conclusion: that the saturated fat in butter, cheese and meats does not contribute to the clogging of arteries — and in fact is beneficial in moderate amounts in the context of a healthy diet (lots of fruits, vegetables, whole grains and other fresh, unprocessed foods).

His own diet attests to that. Along with fruits, vegetables and whole grains, he eats red meat several times a week and drinks whole milk daily.

He cannot remember the last time he ate anything deep-fried. He has never used margarine, and instead scrambles eggs in butter every morning. He calls eggs one of nature’s most perfect foods, something he has been preaching since the 1970s, when the consumption of cholesterol-laden eggs was thought to be a one-way ticket to heart disease.

“Eggs have all of the nine amino acids you need to build cells, plus important vitamins and minerals,” he said. “It’s crazy to just eat egg whites. Not a good practice at all.”

(Contrast that statement with the recent news of a poorly designed study that suggested eating eggs were as bad as smoking.)

I’m glad to see this type of information getting out. I think the giant lumbering battleship that is our nutritional advice is slowly turning another direction. Real food trumps processed food every time it seems, even if it’s loaded with fat and cholesterol.

 

 

NSCA Endurance Clinic Summary: Day 3

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David Barr: Nutritional Supplements & Ergogenic Aids

  • NSCA CSCS, USA Track & Field, Precision Nutrition Certified, participated in research with NASA
  • High Return On Investment Supplements
    • Caffeine
      • blocks adenosine which results in
      • less fatigue and
      • lower feeling of exertion during activity
      • concerns include GI distress and diuresis (exessive urination)
    • Carbs
      • type: glucose, fructose, maltodextrin
      • timing: during exercise
      • beneficial in events lasting >2.5 hrs
      • dosing by duration: 60g/hr for 2-3 hrs, 30g/hr if <2 hrs
    • Fish oil
      • effects
        • increased muscle anabolism
        • may enhance recovery
      • Don’t look at total Omega 3s
        • You want EPA = 180 and
        • DHA = 120
      • If eating a high-fat diet (me) then up the Omega 3s.
      • potential synergy with Vitamin E
    • Protein (He seems to be a big protein guy.)
      • Don’t use during exercise (but what about Accelerade?  No good?  Didn’t get a chance to ask.)
      • Consume up to 2 g per kg of body weight or 1 g per lb.
      • Whey post workout: 20-25 g is the limit
    • Nutrient timing:
      • Protein pulse feeding
        • multiple protein feedings per day of 20-30 g
        • ups protein storage
        • Seems the effect of this is separate from the training effects from the workout.
      • Take about 40 g of casein before sleep to help blunt catabolism
      • Carb timing:
      • If you need rapid glycogen replenishment then consume carbs soon.
      • If you have 24 hrs before the next workout then it’s not an issue.
      • Protein and the workout
        • If you’ve eaten soon before a workout then don’t worry.
        • If you haven’t eaten in a while then eat protein pre-workout.
    • Keys to hydration
      • specific prescription better than ad libitum or drinking at will.
      • (Dr. Tim Noakes disagrees and I side with Noakes.)
      • flavor enhances consumption
      • cold increases palatability
      • drink early/often
    • Building the optimal endurance drink
      • 200 ml water/15 minutes
      • sodium: 450 mg/L
      • Carbs: 8-10%, 90 g/hr: glucose and fructose
      • Protein (potentially): 7%
      • You must “train the gut” or use this stuff while training in order to condition the digestive system to put up with it.
    • Antioxidants
      • mitigate free radical damage and aid recovery
      • Don’t take directly after workouts.
      • May be a case for taking antioxidants during activity
    • Lactate
      • Lactate is used as energy.
      • Doesn’t cause burn/fatigue
      • Cytomax makes some sort of drink w/lactate in it.
    • Buffers
      • bicarbonate
        • 300 mg/kg
        • potential GI trouble
      • Beta alanine
      • Theoretically: use both for a systemic effect
    • Nitrates
      • may help power output
      • may mitigate effects of altitude
      • Improved time trial performance in cyclists
    • Immunity
      • CHO
      • Vit C
      • Vit D
      • Zinc
    • Common deficiencies
      • Vit D
        • No toxicity
        • 6000-10,000 IU/day
      • Iron: Test for it.
      • Magnesium
    • Experimental considerations
      • hyperhydration
      • “train low” (carbs): unclear if this benefits performance
      • echinacea: increases EPO
      • ketones: novel energy source
    • Future prospects
      • cobalt chloride
      • guanidinopropionic acid
    • Other resources

Tim CrowleyProgram Design: Strength Training for Endurance Athletes

  • CSCS, NASM-PES, USA Cycling Elite Level Coach, 2008 US Olympic Triathlon Coaching Staff, USAT Elite Coach of the Year and Development Coach of the Year, Owner TC2 Coaching, Head Strength Coach at Montverde Academy
  • Huge need for endurance strength & conditioning coach
  • “Great swimmers are great athletes that swim fast and great athletes are strong.” – Richard Shoulberg, Germantown Academy
  • STRENGTH MUST BE THERE FOR SPEED!
  • Program Goals
    • Reduce injury incidence
    • Reduce injury severity
    • Increase athletic performance
    • Improve athleticism
  • If you can read/learn 1 hr per day then you’re way ahead of the crowd.
  • Try stuff out before we give it to athletes: workouts, tools, food
  • Book: Endurance Training Science & Practice, Mujika
  • He covered various research evidence showing that strength training aids runners, cyclists and other endurance athletes
    • Reasons strength training works for endurance athletes:
      • conversion of type IIX fibers into fatigue resistant type IIA fibers
      • improves strength (like money in the bank)
      • rapid force production
      • improved neuromuscular function
      • tendon stiffness (essential for running)
      • improved max speed for fast starts or finishes
    • Common myths
      • Heavy weights make you big
      • Weight training hurts young athletes
      • Endurance athletes need light weight/high reps
      • Heavy weight training reduces ROM
      • Lifting equals bodybuilding
      • Squats hurt knees
      • Only for use in off-season
      • Endurance training will build strength
    • Important considerations
      • Strength work often isn’t to improve the engines of endurance (legs for running for example) but rather to address weaknesses, increase overall athleticism, and avoid injury
      • As pressure mounts on an athlete, find ways to coach less and simply get them to perform at their ability.
      • Time:
        • an obstacle for endurance athletes
        • goal is 30-40 min 2x per week
        • Try high-intensity/low-volume workout to increase muscle activation prior to a track workout
      • Energy
        • finite amount of energy for training
        • can’t interrupt endurance sport training
        • DOMS can be a problem
        • physical effects of high-vs low-volume
        • psychological effects
      • Reciprocal Inhibition
        • Reduced neural drive to opposing muscles
        • Areas of concern
          • scapula/thoracic spine
          • hip flexors/glutes
          • hip adductors/glute medius
          • anterior core/low back
      • Pattern Overload
        • Endurance sports are cyclical
        • high incidence of overuse injury
        • lots of “itises”
      • Force Couplings
        • Key body regions for multisport athletes
          • internal vs. external shoulder rotators
          • hips in saggital plane (flexors vs. extensors)
          • hips in frontal plane (glute medius and quadratus lumborum)
        • Eliminate power leaks
        • Improve movement economy = free speed
      • Masters athletes
        • strength development/maintenance is vital to success
        • loss of power declines faster than strength
        • mobility is crucial
        • compensation patterns
        • slower recovery from injuries
      • Program design
        • foam rolling/movement prep
        • mobility
        • corrective exercise
        • strength
        • keep it simple
        • less is more
        • quality over quantity
        • develop power
      • Self-myofacial release (SMR)
        • foam rollers
        • tennis/LAX balls
        • golf balls
        • the Stick
      • Mobility
        • May be the most important component in the beginning
        • a must for masters athletes
        • Vital concerns:
          • hip mobility
          • thoracic spine
          • ankles
          • 1-leg squat
          • split squat every workout
          • His ACL injury rate is almost 0.
      • Overuse injuries
        • Be proactive
        • shoulders
        • low back
        • glutes/glute medius
        • lower leg/ankle
      • His go-to exercises
        • inverted/TRX rowing
        • anterior core
        • core dynamic stabilization
        • single-leg squatting (priority goes to 1-leg over 2-leg work)
        • glute/hamstring and glutes
        • trap bar deadlifts
        • ankle band walking
        • eccentric calf raises
      • Mobility and Stability
        • Mobility is the combination of muscle flexibility, joint ROM, and the body segment’s freedom of movement
        • 2 types of stability
          • static 1-leg stance
          • dynamic core stabilization during athletic movement
        • Example: Hips are stiff so lumbar spine becomes too mobile/unstable and injury is incurred.
      • 10 exercises to include
        • Cook hip lift

      • Hip flexor stretch
        •  X Lat pull (couldn’t find a video)
        • Reverse cable fly

        • single-leg squat

        • single-leg deadlift

        • stability ball pushup or TRX pushup (unstable surface)

        • lawnmower row

        • cable and tubing lifts and chops (and other similar exercises)

      • single-leg heel raise
  • Resources

Nick Clayton, Power Training for Endurance Athletes

  • Objectives
    • Explain how training with explosive movements benefits endurance performance
    • Correctly perform variations of the Olympic lifts and plyometrics specific to performance in endurance activities
    • Lecture
    • Practical
      • dynamic warm-up
      • Olympic lift variations
      • Plyometrics
    • Why train for power?
      • Rate of force development
      • eccentric strength
    • Non-barbell Olympic lifting
      • Clean, snatch, jerk variations
        • kettlebells
        • dumbbells
        • medicine balls
      • Plyometrics: various 1 and 2 leg jumps, hops, skips
      • Nick said he would create videos of all the exercises and post them.  When/if they’re available I plan to post them here.
      • This was a fantastic session from warm-up to all exercises.
      • It was very much in line with the idea of creating athleticism.
      • These drills exposed a lot of weaknesses and lack of athleticism in a lot of the participants.
      • Exposing these weaknesses could be a huge opportunity to improve athletic performance.

Conclusion:

This clinic was just excellent!  It far surpassed my high expectations and that’s a rare thing.  The combination of theoretical/academic/”sciencey-type” stuff, practical application of the science, and physical participation kept the whole thing extremely interesting.  I came away with my mind overflowing with ideas.

Several things are prominent in my mind right now:

  1. I was re-introduced to some of Gary Gray’s concepts.  I’ve returned to doing the 3D lunge matrix with much greater understanding of hip, spine and knee position, plus how to tweak the lunge matrix in all sorts of ways.  I’m doing it again and all my clients are doing it now.
  2. The concept of athleticism as a necessary foundation is a HUGE concept to me.  We tend to specialize too much.  We devote ourselves to endurance sports which go one direction (saggital plane) and we neglect 3D movement.  We avoid crawling, climbing, rolling, hopping, jumping and engaging in unpredictable movement situations.  Check out the people going into and out of Spinning classes and you’ll see a lot of broke-down people who can barely hobble.  They aren’t athletic.  And I have been one of those people–but not anymore! Every one of my workouts now has a dedicated 3D movement component, power component and I try to do something that I don’t typically do.  Athleticism deserves a blog post of its own.
  3. I’m going to contact Jay Johnson for some coaching.  He did such a fantastic job of distilling academic information into practical application.  I can only coach myself so far.  I need someone who’s been through the process both as a runner and a running coach.

Summary of the NSCA Endurance Clinic: Day 1

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Part of what I love about the Denver area is that it’s home to numerous very good athletes and coaches–particularly of the endurance variety. We’re also not far from Colorado Springs which is home to both the Olympic Training Center and the headquarters for the National Strength & Conditioning Association (NSCA), one of the top certification bodies in the world of health, fitness and sports conditioning.

I was at the NSCA from last Friday to Sunday attending an endurance clinic. It was SUPERB! It far exceeded my already high expectations. All the speakers had volumes of valuable information. Not only did they present valuable academic information, they also told us how they applied this information in the trenches with their athletes. These guys weren’t just born as successful coaches. They’ve gone through a lot of trial, error and very hard work to get where they are. It’s very helpful to hear that type of information.

We didn’t just sit and listen though. Saturday and Sunday had us getting out on the field and into the performance center to learn about strength exercises, mobility drills, and plyometric drills. I got to meet a lot of my very capable peers and I got to work out in what is likely one of the top lifting facilities on earth. It was a fantastic weekend.

I’m going to give a rundown of some of the pearls of wisdom I collected on Day 1. I can’t do each presentation thorough justice, but I’ll try to highlight some of the most important things that I heard.  I’ll follow up with days 2 and 3 as soon as I can.

Day 1:
Dr. Carwyn Sharp – Intro to Endurance Training

  • Exercise scientist, triathlete and ultra-runner who’s worked with NASA and has 14 years coaching experience.
  • Endurance athletes are often averse to resistance training thinking it will bulk them up.
  • He presented several studies which demonstrate that strength training enhances speed and endurance performance.
  • Sand, snow, wind, and hills can all contribute to the athlete’s resistance training.
  • On recovery from intervals: if you feel the effects of previous interval → you didn’t recover sufficiently.
  • The basis of speed is strength. Several studies demonstrate that heavy resistance training and explosive training improves performance.
  • 1-leg training is very important.
  • Progression
    • Move well on 2 legs (squat, deadlift) and get strong.
    • transition to split squat
    • then to 1 leg stability
    • 1 leg squat and deadlift
    • 2 leg plyos
    • 1 leg plyos

Bob Seebohar: – Nutrition for the Endurance Athlete

  • Registered Dietitian and USAT coach who has coached and advised Olympic triathletes
  • Metabolic efficiency – use more lipids/less carb/preserve glycogen
  • Nutrition periodization – “Eat to train. Don’t train to eat.”
  • Food First – Don’t use supplements to make up for poor eating.
  • moderate supplement use; only part of the season
  • prevent weight gain in off-season – no sport supplements during
  • He supports the lower-carb/higher-fat approach. I was very happy to see that.
  • Food log
    • Doesn’t as about amount of food eaten but rather…
    • What?
    • When?
    • Why? I love that he asks “why” someone ate something.

Dr. Randall Wilber – Overtraining: Causes, Recognition, Prevention & Illness

  • Physiologist to the US Olympic team.
  • Overtraining–or “underperformance” as he calls it–often isn’t due to too much training.
  • nutrition
  • blood work
    • Iron is often low in women.
    • Vitamin D deficiency is common
  • endocrine panel
  • urinalysis
  • Physiological and psychological metrics for tracking fatigue/recovery
    • overnight heart rate
    • blood chemistry
    • sleep quality
    • Salimetrics – He said look for the price to come down on this.
  • Take the athlete back to active recovery. Progress very gradually back to regular workouts.
  • If they perform well and feel good at their first LT workout then they’re on the right road back.
  • Coach Bobby McGee: “More performances are spoiled by slight overtraining than by slight lack of fitness. An athlete who is 90% conditioned for an event will do better than an athlete who is 0.5% overtrained.”

Dr. Peter Attia & EatingAcademy.com

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A lot of recent posts on this blog have been about the high-fat/low-carb ketogenic diet. Along these lines, is the fantastic blog called the Eating Academy from Dr. Peter Attia, MD. Attia is a former surgical oncologist. He spent time at Johns Hopkins Hospital in Baltimore as well as the National Institutes of Health in the National Cancer Institute. (Go here to read more about him.)

Those are pretty impressive credentials and he’s a major reason why I’ve become convinced that much of our conventional low-fat/high-carb government-sponsored nutritional advice is bad news, and that a high-fat (including saturated fat) low-carb strategy is the ideal.

He left surgery because:

“During the fifth year of my residency I became a bit frustrated with certain aspects of medicine and health care, in general. In particular, I grew tired of the notion that we (doctors) did little to keep patients healthy, and were basically the last line of defense against, well, death, once patients become ill. The concept of “preventative medicine” received some lip service, but didn’t really have any chops as far as I could tell. In addition to this frustration (and others), I really missed quantitative and analytical problem solving.”

(I love his observation that doctors do little to prevent ill health and that they’re the last line of defense. That’s a huge issue to me. The best way to address a disease–particularly lifestyle/obesity-related illnesses like diabetes, cancer and cardiovascular disease–is to never get it. No matter how well we’re cared for, once we’re ill, we’re in trouble.)

Attia is also a fairly decent swimmer, cyclist and avid weight trainer. Thus he has an interest in nutrition not only for health but also for athletic performance. He discusses his personal nutrition journey in four parts: why he decided to lose weight, how he lost weight (ketogenic diet), how he reduced his heart disease risk, and how a low-carb diet affected his athletic performance. It’s all very detailed and very compelling.

Attia’s blog is an incredibly detailed ongoing discussion on nutrition, cholesterol, fat, weight loss, eating for athletic performance, disease avoidance, etc. He really delves into the science and some of his posts are quite a bit over my head. I love though that he discusses things like what he actually eats (here and here.) He also discusses a fascinating new sports supplement UCANN Superstarch (look here and here; I’ve been using this stuff recently and I like it A LOT.)

If any of this sounds interesting to you, go to the Start Here link and read more.

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.

A Ketogenic Diet Experience: the Savage Man Triathlon Double

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Guest blog post from Mike Piet

Mike Piet is a former client of mine and a very good friend. He’s also an elite-level triathlete, multiple-Ironman finisher, participant in many strange and grueling adventure races, marathons and all types of long bike excursions. We speak often of endurance activities, weight training, nutrition, and mobility and restoration work. I was very happy when he offered to write about his experience in two recent triathlons while fueling himself via the low-carb/high-fat approach. This is his tale…

Two triathlons back-to-back

On September 14-15, I participated in the SavageMan double triathlon, a tough weekend of racing in Western Maryland that includes an Olympic distance triathlon on Saturday and then a half-iron distance triathlon on Sunday.  While the Olympic is tough, it is the half- that has earned a reputation as one of the hardest races around: It features a bike course with over 6000 feet of climbing, including two uncategorized climbs.  The first of these, the Westernport Wall is 1.2 miles long with an average grade of 12% and a max grade of 31%.  Stand there long enough and you are bound to see someone literally start rolling backward.  Watch this video and you’ll get a feel for the brutal nonsense.

I have done the double two years now, but this year was different.  This year I was going to try it on a high-fat/low-carb eating protocol – I was going to use a ketogenic diet to race in a state of dietary ketosis.

I won’t get into the nuts and bolts of the ketogenic diet but in the big picture, the diet has me burning fat instead of carbs for the vast majority of the race.  This is in contrast to the typical high-carb diet favored by most endurance athletes.  The limitation of the high-carb approach is that you must continually consume bars, gels, sports drinks and all kinds of food in order to avoid running out of fuel.  This means carry lots of additional fuel and tweaking the fuel mix just right so you don’t undergo dietary distress.

For more information, I highly recommend the work of Dr. Peter Attia at the Eating Academy, Ben Greenfield, and Drs. Stephen Phinney and Jeff Volek at the Art and Science of Low-Carb.  Each of these resources explain the ideas and science behind ketosis and the ketogenic diet much better than I, but the basic premise is that in going into ketosis, your body burns fat for fuel instead of carbohydrate.  Given that fat stores are significantly (20x) larger than glycogen stores, it is a compelling experiment for long distance athletes.

A ketogenic state can’t be achieved overnight, so in the eight weeks leading up to the Savage Double, I started to change my diet over.  Approximately 70% of my daily caloric intake came from fats (olive and coconut oils, butter, heavy cream, natural peanut butter), 20% from protein and 10% from carbs.  Think Paleo or Atkins, but with dairy.  My daily carb intake was generally between 50-100 grams per day, depending on training volume, which equates to two medium bananas (48 grams), one cup of rice (45 grams), or four slices of wheat bread (52 grams).  In other words, not the typical American diet. The table below shows a typical day’s food intake. I tended to be less exacting on the weekends, but did not stray far from the guidelines:

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The numbers in the table are in grams.  As you can see, a majority was in fat – on this day I actually overshot my fat goal and was short on my carb and protein goals.  You will also notice that my sodium is high – this is a crucial aspect to doing keto right.  When carbs are minimized, the kidneys leach out sodium faster than normal, so it is important to increase sodium intake to maintain healthy blood pressures and the muscles’ electrical impulses. Going into the race, my plan was to rely on this protocol and not use my usual pre- and mid-race fueling strategies.  I was going to minimize my calories taken in, typically on the bike, because I was going to fuel my race with my own fat stores.  Going into the race, my diet remained much the same in terms of the ratios above.  On race morning both days, I had a cup of upgraded Bulletproof Coffee – a recipe borrowed shamelessly from Ben Greenfield.  One cup of coffee, 2 tablespoons each of butter and coconut oil, 4 tablespoons of heavy cream, a packet of Stevia, ¼ teaspoon of cinnamon, and a ½ teaspoon of cocoa.  I put all this in a blender until it was foamy on the top and completely mixed.  This totaled 650 calories with 72 grams of fat, 4 grams of carbs, and 1 gram of protein.  If nothing else, not sitting down to eat a meal and having all my calories contained in a cup saved a ton of time and a lot of hassle.  Thirty minutes prior to the race, I sipped a cup of chicken bouillon, with 1 gram of sodium in it.  Five minutes before the race, I used a packet of Vespa Jr., a product that helps tap into fat burning (www.vespapower.com).

Both days I carried a drink mix on the bike that was a mixture again borrowed from Ben Greenfield.  Here’s the recipe:

It calls for UCAN Superstarch, a gluten free complex carbohydrate that stabilizes blood sugar; electrolyte pills, and various other ingredients.  In short, it’s not the usual bike bottle full of sugar based energy drink.  However, on Saturday the mouth of my bottle was clogged and I couldn’t get anything out.

I rode the entire bike course without taking in any calories.

Coming off the bike I felt pretty good, so took off on the 10K run – felt good through the first aid station where I didn’t take anything, and then the second aid station.  In the interest of continuing the experiment, while I probably should have taken something at mile four, I ate nothing. I finished the Olympic tri without ingesting a single calorie since the Bulletproof Coffee in the morning, and I felt good! So good, in fact, that I was able to run a second 10K with my dad, who was also doing the race and finished the bike just as I had finished the run.  I consumed three pretzel sticks at one aid station while running with him, but otherwise water.

Results: 1st place in my age group and 12th place overall. My finishing time was 2:25 on a notoriously difficult course.

The next day was the half-iron and the protocol was the same. Same coffee, broth, Vespa pre-race.  I made sure both bottle tops were functioning because the half is such a long day.  I have only gone under 6 hours twice on this course, even though on a “normal course” my half-iron PR is 4:45.  It was a hard day right from the start and I didn’t feel like I had good legs for the ride.  I used both bottles of my drink, but no other calories – for this race, I am usually a buffet on two wheels throwing back gels, bars, and energy drinks.  Going into the run, I was not feeling good – a hard bonk was setting in and I had struggled the last 20 miles on the bike.  The first five miles of the run were mostly walk, but I came away from the low carb protocol (and you may have noticed, very little sugar), and started drinking Coke from the very first aid station.  It was all I took – no water, no food, no energy drinks.  One or two cups at each aid station – my body was craving the sugar – and interestingly, slowly, I was able to recover the back half.  The last seven miles I was able to run an honest race, something that did not seem possible when I first came off the bike.

The whole race was an incredible learning experience, and while the second day did not go as well as the first, I raced a half ironman on the heels of an Olympic (plus an extra 10K) on very few total race calories.  My recovery and refueling time on Saturday was compressed, and I think if done differently, I would have focused on that more – putting in more calories, ensuring that I stayed in ketosis, and doing more recovery and mobilization.  On Sunday, given the type of effort it is, I would have ingested more carbs earlier in the day on the bike – as Peter Defty of Vespa says, with the high fat diet, when carbs are ingested properly, they work better than if following a normal eating protocol.

Like any eating protocol, I advocate following something that works for the individual, and is sustainable.  Going keto has worked well for me. It is allowing me to go farther on much less, but may not be right for everyone.  Despite the misconception that eating a lot of fat will beget fat, I lost about 5 pounds and raced at about 165.  My body fat remained between 6-8%.

I am awaiting my blood work from Wellnessfx.com. I purchased their baseline panel and got tested prior to going keto and will be interested to see where and if the numbers have changed. I am really interested in seeing my cholesterol number.  My LDLs were a little high. The rest of my numbers were low.

Interestingly, the science suggests that contrary to medical guidelines and popular thinking, this ketogenic protocol could help lower cholesterol. I’ll post those numbers once they’re available.  For anyone interested in the hard science behind ketosis, I again recommend Drs. Phinney and Volek’s books – while technical, they provide excellent information based on science and research.

Thanks to Kyle for letting me guest post on his blog.  If anyone has specific questions about my experience and going keto, I can be reached at mdpiet@aol.com.

Stuart McGill, Born to Run & Ketogenic Eating

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Here’s what I’m into right now:

Stuart McGill

I recently finished Stuart McGill’s Ultimate Back Fitness & Performance.  It has definitely contributed to how I view conditioning and care of the spine.  For instance:

  • I’m very careful to avoid much if any bending or twisting at the lumbar spine.
  • According to McGill, the core musculature responds best to endurance-type training, so I now go for time rather than out-and-out strength.
  • McGill makes the observation that excellent athletes tend to have a very rigid core–but very mobile hips and shoulders.
  • Here are two videos with McGill.  The first has McGill discussing several myths regarding low back pain and core strength.  In the second video we see demonstrations of three exercises often prescribed by McGill.  These are often called the Big 3: the curl up, side plank and bird dog.?

Born to Run

I’m a little late to the party but I recently finished Chris McDougal’s Born to Run. This book has done more than almost anything to push the popularity of minimalist running.

Born to Run is more than a book about running.  Much of the book concerns the history and culture of the Tarahumara people who live in the isolated Copper Canyon region of Mexico.  Non-runners with any interest in other cultures will find this book very interesting.

The book and author have generated some controversy. Any runner knows about the hot debate over minimalist/barefoot-type running.  I won’t go into all that.  (For just about the most thorough discussion on minimalist running, you can’t do better than the Sports Scientists dissection of the subject.)

Here are some thoughts on both the book and discussions that have followed:

  • The story is quite entertaining.  It’s possible that the entertainment value of the book and a subsequent New York Times article from McDougal have somewhat overshadowed some facts.
  • Alex Hutchinson who writes the Sweat Science blog for runner’s world describes an interview with McDougal that clashes with later statements from McDougal.
  • Hutchinson brings up several points in his response to McDougal’s article titled The Once and Future Way to Run.  One is this:

“4. The one part of the article that made me kind of angry was this passage, about McDougall’s visit to the Copper Canyon in Mexico that led to Born to Run:

I was a broken-down, middle-aged, ex-runner when I arrived. Nine months later, I was transformed. After getting rid of my cushioned shoes and adopting the Tarahumaras’ whisper-soft stride, I was able to join them for a 50-mile race through the canyons. I haven’t lost a day of running to injury since.

I actually interviewed McDougall back in 2009, shortly before Born to Run came out. And that’s not the story he told me. Here’s what I wrote then:

Long plagued by an endless series of running injuries, he set out to remake his running form under the guidance of expert mentors, doctors and gurus. He adjusted to flimsier and flimsier shoes, learning to avoid crashing down on his heel with each stride and landing more gently on his midfoot. It was initially successful, and after nine months of blissful training, he achieved the once-unthinkable goal of completing a 50-mile race with the Tarahumara. But soon afterwards, he was felled by a persistent case of plantar fasciitis that lingered for two years. “I thought my technique was Tarahumara pure,” he recalls ruefully, “but I had regressed to my old form.” Now, having re-corrected the “errors” in his running form, he is once again running pain-free.

I’m in New York right now, and won’t be back home until Monday night, otherwise I’d see if I can dig up my actual notes from the interview. But I remember McDougall telling how stressed out he’d been, because he’d spent all this time working on a book about the “right” way to run — but as the publication date loomed ever nearer, he’d been chronically injured for two years. It was only shortly before publication that he was able to get over the injuries and start running again.”

McDougal responds to Hutchinson’s post here and Hutchinson replies back.

Personally this doesn’t do much to bother me or take away from a) a great story that’s told in Born to Run or b) the value and importance of minimalist running. I think it does suggest that McDougal is not a scientist and that the need to create a compelling story may persuade a writer to drift towards a bit of exaggeration.

What’s your take on this back-and-forth?

Ketogenic Diet (high-fat/low-carb/moderate protein intake)

Here’s another party to which I’m a bit late: the high-fat ketogenic diet.  In fact, most people who’ve tried it probably abandoned it back in the early 2000s. (I think they should’ve have.) You’ve heard of the Atkins diet.  That’s largely what I’m doing now.

In reality, I’m becoming more focused and precise with this type of eating.  I switched to a higher-fat diet when I became familiar with the Perfect Health Diet.My current efforts are informed by the Art & Science of Low-Carbohydrate PerformanceJeff Volek, PhD, RD & Stephen Phinney, MD, PhD are the authors. I like their credentials and their experience. To me, it lends weight to their words. Here’s a rundown of the main points of the book:

  • Their book is well-referenced and fairly easy to understand.
  • They present convincing evidence (to me) in favor of a) greatly reducing carbohydrate and b) greatly increasing fat intake and c) why this strategy can be very effective for athletes.
  • How?
    • Burning fat for fuel (aka ketogenesis) is a cleaner process.
    • Inflammatory stress is lower compared to using carbs for fuel
    • You’ll be less damaged from exercise and you’ll recover faster
    • You have a nearly limitless supply of fat for fuel compared to a limited supply of glycogen.
    • By shifting your metabolism to prefer fat, you’ll avoid bonking.
    • Also, by shifting your metabolism to prefer fat you’ll improve your body composition.  Besides the aesthetic appeal of a lean physique, if you’re lighter then you’ll have a better ability to produce power.  If you’re lighter then you should be able to run and bike faster.
    • Endurance athletes who experience GI distress may do very well on the high-fat diet.

I was motivated to dig into this type of eating after I spoke with my former client and friend Mike Piet.  He’s moved in the low-carb direction after his friend and accomplished ultra-distance runner  Jon Rutherford.  Jon’s experience as an athlete who’s increased his performance is described in  the Art & Science of Low-Carbohydrate Performance. Thus far, I like the results. I’ll talk more about them as this experiment continues.

Look for Mike Piet’s guest blog post as he describes his very interesting low-carb/high-fat experience during the Savage Man Olympic and half-Iron distance triathlons–done on consecutive  days.

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.