Gain the Holiday Spirit not the Holiday Weight

Can a little too much holiday cheer add to holiday weight gain?  Holiday weight gain is a relative myth, it’s not the 5-10 pounds like we often hear.  The average American only gains 1 pound over the holiday season, but that does not mean it is nothing to worry about.  Studies have shown that when we follow individuals after their 1 pound holiday weight gain, they typically don’t lose that pound over the next year leading into the next holiday season.  So do this over the next 20 years and you’ll find yourself carrying an extra 20 pounds around and some negative health risks that go with that weight gain.

Another concern is that overweight people tend to put on an average of 5 pounds for the holidays.  So if you are overweight to start with, you are more likely to put on more weight then an individual that is not.  Not a good thing if you already have weight to lose, because you will end up with those 20 extra pounds in just 4 years.

While eating all of those Christmas cookies and treats on top of our normal calorie intake is usually the thing blamed for the added weight gain, don’t forget that added alcohol consumption with holiday parties can be partially to blame.  An average alcoholic beverage contains between 100-150 calories and if you are having only one drink per day that is not a problem.  But remember that alcohol calories come primarily from sugar.  We should take in only 5-15% of our calories from solid fats or added sugars.  So if you are at the average calorie intake for most women, which is just over 1900 calories or for men it is 2550; you can see how you can easily exceed this amount with a couple drinks and then throw in some food with extra sugars added to them.  Plus alcohol does impair our thinking and our willpower to say no to an extra cookie and some fudge.  This can create a double whammy with the added calories of the alcohol along with decreased willpower to say no to over eating. 

Unfortunately the added stress of the holidays can be to blame as well.  A short acute stress response from our body is helpful when we have a true emergency that should last a few minutes.  Long chronic stress is not good, which is what many of us live with daily and especially over the holidays.  When we get into a chronic stressed state we often tend to use poor strategies to relieve that stress such as drinking and eating compared to good strategies like meditation, prayer and exercise.  Also our willpower is decreased in a stressed state, just like it is under the influence of alcohol.  A time of acute stress is not a time to worry about your waist line in upcoming years; it is a time of survival to get through to the next day. But when that acute stress becomes chronic daily stress you can start to see how that can derail us and our future health needs.

So control your eating over the holidays, it is okay to have a few tasty holiday treats, but remember to try and do it with some moderation.  Also be careful with your alcohol intake, as it can lead to extra calories and decreasing your willpower.  Also try to meditate on the “reason for the season” to help decrease a little stress.  Get away from the TV and watching reruns of “It’s a Wonderful Life” and get out for a walk and some exercise to make it a wonderful life.  And after the New Year begins, start working to take off any weight that you might have put on so you start next holiday season where you began this one or a little less if needed.

Being social is good for your health

We are wired to be connected together with strong social ties for better health that much we know. Why this is, is still a bit of a mystery. There has been a pretty substantial amount of research showing that having a healthy social life is vital to improved health, maybe as much as avoiding cigarette smoking. A comprehensive analysis of 148 research studies was done in 2010 by researchers from Brigham Young University and University of North Carolina at Chapel Hill. The research review showed that having lots of strong social ties gave a boost to longevity as well as not smoking and even better than regular exercise and maintaining a healthy weight.

How these increased social ties works to improve our long term health have been demonstrated in a few studies. One such study showed how our heart rate and blood pressure will increase less during a stressful situation when we are accompanied by someone close to us. Our body seems to be able to handle and cope with the stress better with fewer extremes when we are able to be connected with those important to us. This is also seen in studies demonstrating that our immune system seems to work better to fight off illness when we have more social connections. Our immune system reacts to stress hormones, such as catecholamines and glucocorticoids. Strong social support reduces these stress hormones allowing our immune system to work more efficiently to keep us healthy.

Obviously not all relationships are healthy, so promoting healthy good relationships is important. One method to help with this is building our relationships with others around physical activity. The list of long term benefits of being physically active is long, but we forget that it also has immediate benefits of improving our mood. As soon as you start exercising you get a boost of neurotransmitters in the brain (dopamine and serotonin) that give us pleasure and boost our mood. So, if our mood is better it will help with building healthy relationships. Look for opportunities to combine adding social connections along with physical activity such as: joining a team sport (such as volleyball, soccer or biking club), do activities with friends and family (such as going for a walk, playing tennis or bike riding together), or take part in group fitness activities (such as an exercise or dance class).

So make sure you are working to build and maintain your social connections. Having a strong healthy social support system will add years and quality to your life.

Present self versus future self Part 3, Getting to a healthier/happier you

You have seen that future self is often doomed to choices made by present self. Also how commitment devices can help future self battle the immediate gratification needs of present self. But even these tools have their limitations, so how do you overcome present self and help future self become who you want to become (a healthier and happier you)?

First realize its hard work! Yes, it does require more energy. So realize when you’re fatigued and tired you probably are not going to overcome present self wishes. It’s okay; don’t beat yourself up about it. Just get some rest and get ready for future self to battle the next day. Understand also that you are motivated by emotions, both present and future self. You need to find the emotions that motivate future self and keep those front and center as much as possible, but at times let present self emotions get what they need as well. Future self emotions maybe the joy that comes when you are able to play with your grandkids, the relief of not suffering a heart attack at 50 like a parent, or the excitement be able to travel when you get older and not be limited, or what ever might work for you. You all have different emotions and different emotions that motivate you; you need to find that emotion that is going to be your motivator for your future self.

Also realize the environment and culture you put yourself in does help, so use some commitment devices and wise choices when motivation and will power is at its peak performance to make that environment a little easier for future self. They did a neat study with college students. One group of students had to sit in a room full of fresh baked chocolate chip cookies and they were told they could not eat them. The other group was allowed to eat as much as they pleased. After 15 minutes in the room each was taken to a different room to do a math problem. This math problem was unsolvable, so eventually students from both groups gave up. The ones that had to use more will power to not eat the cookies gave up a lot sooner then those that were allowed to eat as many cookies as they wished. Moral of the story, don’t put yourself in situations that are going to make you use up your will power energy source. You need to create a healthy culture to help future self battle present self.

Some of you will have less will power then others, but it can be built up in all of us by being aware of its limitations and improving the culture that it works in. This increases your self-efficacy in knowing that you have some control over working to becoming the future self you want to be.

Do you kiss your mother with that mouth?

I recently had an editorial in the ISPI Newsletter (I am an instructor with International Spine and Pain Institute).  I wanted to reprint it here as well for readers.


I’m sure many of us used the phrase, “sticks and stones may break my bones, but words will never hurt me” as a child, heck maybe you still use it as an adult. This catchy phrase may be slightly inaccurate based on current pain neuroscience understanding and I propose we offer this more correct version in the future: “sticks and stones may break my bones and words will never harm me, but they can hurt me”. This is of course a play on the popular pain neuroscience metaphor of “hurt does not always mean harm”. We have a good understanding that harm (physical injury or illness producing nociception) is not the same as hurt (the brains output of pain). We actually have evidence showing that the words we use can change the hurt people experience.

In a recent study (Ott J, 2012) researchers found that words associated with pain increase the perception of pain during venous blood sampling. The authors came to the conclusion that words have an impact on the individual evaluation of external stimuli. This finding has been found in other research and fits into Melzack’s pain and the neuromatrix in the brain theory with cognitive related brain areas being inputs into the body-self neuromatrix that can produce outputs of pain perception.

Another interesting study (Beck JG, 2001) used a modified Stroop procedure to assess processing of threat
words in motor vehicle accident (MVA) survivors. The traditional Stroop color-word interference test looks
at reaction time while a participant is asked to name the color the word is printed in, but ignore the word itself. For example the word “red” might be printed in blue ink and your job is to say blue. You will see if
you do this you are inclined to say red and your response of blue is slowed, thus you experience interference.
You can check out Wikipedia for more on Stroop Effect, it’s kind of fun to do (well that is if you’re a nerdy nerve head like myself). So back to the study, they had three groups of MVA survivors one had no problems, the other had persistent pain and the third group had persistent pain and post-traumatic stress disorder (PTSD). The PTSD and pain group had slowed responses with both accident and pain words. While those with just pain had slowed response with just pain words not accident words and those individuals that had no symptoms saw no changes in their responses for either pain or accident words.
This study shows that there was some specificity to processing of words by an individual based on their condition.

So what can we, and should we, take away from such studies? The words we use can “hurt” our patients more than they already are. As health care providers we need to be aware of the choice of words that we use on a regular basis with our patients in pain. While using threat words such as herniation, rupture, tore, etc. with a person in no pain may not affect their neuromatrix to produce pain, but for those in pain it actually could.

Adriaan, along with Ina, David and Louie recently finished a paper that is waiting for submission (Louw, 2012) looking at the difference in the words we use with pain patients with pre-operative education. They looked at two different post-surgery pain education booklets. Booklet A had been shown to have no added benefit to outcomes or cost from previous research with surgical patients. Patients receiving Booklet B have
shown initial signs (from a case series and preliminary multi-center RCT data) to have improvement in function and decrease in pain catastrophization upon using pain neuroscience education approach (Yes, this is Adriaan’s PhD project and the same booklet you are aware of “Your Nerves are Having Back Surgery”).
They had a group of seventeen expert PT’s compare the use of provocative terms in each booklet. What was found that Booklet A had three times the use of provocative terms associated with fear, pain and anxiety compared to Booklet B that utilized the latest pain neuroscience education. The original study of Booklet A did not list the use of pain words as a possible reason why the study failed to show a difference in outcomes with or without the additional patient education. This study suggests that possibly the words we use during our patient education may make a difference in the outcomes we get.

So understanding this important piece of information, that words can hurt our patients, I get a little agitated with the choices some of my fellow health care providers choose to use when it comes to their words. Have you ever seen a patient that reports to you that the physician or some other health care provider stated that their back, shoulder or knee was the worst they had ever seen. Isn't it amazing how patient after patient we here this from, is each patient actually getting worse than the one before? After almost 20 years of practice it is amazing that patients somehow consistently seem to be progressively become the worst case month after month. A statement like this does not help a patient in pain in any way and only has downside as it is laden with fear and anxiety (two of the things we should be trying to reduce). While this kind of statement does give us, the health care provider, with lots of upside. Consider if they don’t get better it’s not our fault because it was the worst case ever; and if they do get better it only shows how good we must be to help the worst case ever. I think we can and should be able to do better for our patients.

As physical therapists we need to be aware and improve the therapist portion of our care just as much, if not more, then the physical portion of our interventions. One area of this can be done by paying attention to the words we use during our interaction with our patients. Avoid using threatening words in our explanations to patients in regards to diagnosis, etiology and prognosis from their current condition. These terms only provide the opportunity for the individual to perceive greater threat through the fear and anxiety interwoven into the meaning of them and enhancing the defender response (pain) from the patient.

Proper interaction and education can instill positive expectations and hope through the use of our language to our patients and not create negative connotations or threatening inputs to their body-self neuromatrix. The choice of the non-threatening language and words we use may be another avenue to provide input into the neuromatrix as an adjunct to our management and treatment of their painful condition.



References

1. Beck JG, F. J., Shipherd JC, Hamblem JL, Lackner JM. (2001). Specificity of Stroop Interference in Patients with Pain and PTSD. Journal of Abnormal Psychology, 110(4), 536-543. 
2. Ott J, A. S., Nouri K, Promberger R. (2012). An Everyday Phrase May Harm Your Patients: The influence of Negative Words on Pain During Venous Blood Sampling. Clin J Pain, 28, 324-328.
3. Louw A, Diener I, Butler D, Puentedura L. (2012). The Lanugage of Patient Education for Lumbar Radiclopathy. unsubmitted research.

Commitment devices - helpful but still limited

Commitment devices have been around for centuries. One of the most famous is how Odysseus, as recalled in Homer’s the Odyssey, had himself tied to the mast of the ship while the crew had beeswax in their ears. This allowed Odysseus to hear the Siren’s enchanting music and voices but he could not shipwreck the boat because he was tied up and the crew could not hear his cries to release him or the Sirens because they had beeswax in their ears.

It has been well studied that using will-power is hard work. Your brain and nervous system uses glucose, one of the main power sources of the body, to help us consciously overcome temptations by using our cognitive abilities to help us with what some call “free won’t”. Because if left to do things freely, we will often do the wrong thing for present self’s gain at the expense of future self, thus the term “free won’t” as compared to “free will”. The actual increase energy expenditure has been measured and thus we realize that will-power is an expendable resource. Just like going for a run, at some point everyone will deplete their energy source and not be able to continue.

Commitment devices are used to help create a better environment for us to function and reduce the energy needed for our will-power to have to work. Commitment devices are used to avoid akrasia. Akrasia is a big fancy word that you probably have never seen used before, but unfortunately have done what it means many times. Akrasia is the state of acting against one’s better judgment.

One example of a commitment device is not buying unhealthy snacks when at the grocery store. When you are tired and exhausted at night and your will-power energy stores are minimal you won’t do akrasia, by choosing an unhealthy snack because it is not in the house. It requires more energy to get in the car and drive to grocery store to get a bag chips or some ice cream so you are more prone to choose what you do have in the house. Which if you set up your commitment device properly is some fruits or vegetables. If our will-power is really low we may still drive to the store and get an unhealthy snack. In that case we may need a new commitment device such as having someone hid your car keys at night.

This brings us to a problem with commitment devices – we can almost always weasel our way around them. Also they are a reminder that we lack some self control and this takes away from our self-efficacy. So while commitment devices can be helpful, we also need to understand their limitations. Next week we will look how to help future self beyond just using commitment devices.

Is your present self working for your future self?

Everyday we make decisions about choices we have that will have good or bad consequences for our present and future self. Often times we make decisions that benefit our “present self” with great expense to our “future self”, especially when these choices are repeated. Many of our decisions are emotionally based and taking care of our immediate emotional state of present self, this often time trumps future self potential needs.

Let’s look at a few simple examples in regards to health that many of us can relate to.

• I go to the fridge for a bed time snack. I can choose an apple or some chocolate cake with ice cream. Present self will be much more satisfied with the decedent taste of the cake and ice cream over the apple. Future self will appreciate the apple as it provides many valuable nutrients to assist in keeping your self healthy long term.
• I get home from work and make dinner, after dinner the decision of what to do comes up. I can go for a walk and get my daily cardiovascular exercise in or begin watching “The Office” on TV. Present self sees the importance and simplicity of sitting and watching the TV program (it is the last season of “The Office”, can you imagine missing an episode during its last season!). Future self would much more appreciate the walk and all the health benefits it provides.

Present self likes to consume things and looks for immediate pleasure and gratification at the least amount of effort. Future self on the other hand is more concerned with health and safety and willing to forgo some instant gratification to ensure that it can enjoy long term health even at the expense of some increased effort. Present self many times will neglect future self due to beliefs that may be inaccurate or rationalize that one time doing it doesn’t make a difference to future self. One piece of chocolate cake while watching the office just this once isn’t really going to make me obese and won’t make me get a serious disease latter in life. While present self is correct that doing something once most often will not have a significant affect on future self, but if present self repeats daily this choice then future self is in trouble. When present self repeats habits that are not good for future self, it walks us down a path of obesity and increasing risk for significant diseases. Pretty soon cake and ice cream is our bed time snack as we watch 4 hours of TV every night, and future self is doomed.

Next week we will look at commitment devices, tools to help future self overcome present self. Also at the potential pitfalls and concerns with commitment devices.

Your getting sleepy, very sleepy...

One important health habit that often gets overlooked is getting enough sleep. Some surveys reveal that upwards of 60% of Americans have some sleep difficulties at least a few nights a week or more. Writing about sleep is always an interesting topic, because if it is uninteresting it might put you to sleep. So we will see if we can keep your interest just long enough to learn why getting enough sleep is so important to your health.

So why is sleep so important? Of course there is the obvious, the day after not sleeping enough you will experience moments of drowsiness and may fall asleep or have slowed performance while doing important tasks. According to the DOT (Department of Transportation) 25% of all highway crashes are due to sleepiness. It is estimated that there is around $50-100 billion in indirect costs each year due to sleepiness with decreased productivity and other related costs. But there are other physiological changes that happen when we don’t sleep enough. A research report that came out in the July issue of the journal of Sleep showed that a decrease in sleep also affects our immune system. Our immune system will react to various physical stresses (i.e. flu virus, strained muscle, etc.) that are placed on it. Lack of sleep acts as a physical stress to our bodies and thus kicks in our stress response by increasing activation of our immune system with the granulocytes. This long term increase in immune system stress response has been linked to future health problems such as: obesity, diabetes and high blood pressure.

So how much sleep do you need? On average most people will require 7-8 hours of sleep, but some can do fine with as little as 6 hours and others need up to 10 hours. After a nights rest you should be able to work the next day without any bouts of sleepiness or drowsiness. If you do experience this then it would be a sign that you may not be getting enough sleep and starting to kick in your immune system a little extra as a response to the extra physical stress you’re placing upon it. If you do have difficulty sleeping you may want to consult a health professional to look at treatment for it. Often times our thought is that getting a sleeping pill is all we need. But a research article in The Archives of Internal Medicine published in October of 2004 showed that Cognitive Behavioral Therapy (CBT) actually outperformed the sleeping pill. So keep that in mind when looking at treatment options.

So hopefully you were able to make it to the end of this and not fall asleep and learned why getting good rest is so important. If you did fall asleep, it may be a sign you are not getting enough sleep at night; or we need to make the article more interesting.

Superman's cape vs. Batman's utility belt

Another guest post on my blog.  Today's post comes from John Rounds, SPT.  John currently is doing one of his eight week clinical rotations with me as part of his final year of Doctor of Physical Therapy schooling through the University of South Dakota.  As with any guest post I want writers to write what they think, not what they think I want them to think, think about that!!!  Enjoy, I like his thinking...

A common theme being displayed among health gurus and marketing agencies is the term "superfood." But what are we really getting with these that we aren't with everyday "regular" healthy foods? Many media outlets have been filling our minds with ideas that by consuming "these 7 foods regularly, you can reduce your look of aging or lose 10 pounds in 10 days." Unfortunately, what holds true for most things that sound too good to be true, so are a lot of these.

Now don't get me wrong, if you are researching "superfood" lists (which I have) you will find apples, oranges, broccoli, avocados, nuts, salmon, etc. But you will also find other items like acai berries, raspberry ketones, mangosteen and noni berries, and supplements such as fish oil. A lot of these foods and supplements also claim to have scientific research backing them. However, the validity behind this research is lacking in practical use.

According to a study published in the Hawaii journal of medicine and public health, it looked at the research backing these "superfoods" and supplements, and discovered that much of the research done was comparing their product to a placebo group, and not revealing the side effects noted by the participants in these studies. Most side effects were minor, with the occasional headache, dizziness, or fatigue being noted; however, one study found in a follow up study, that the amount of the supplement needed to produce the beneficial effects in these commercialized products was leading to hepatotoxicity in some people taking them. This would be reason enough for me to avoid these foods, let alone I can eat an apple for lunch and feel more energized rather than fatigued and not have to worry about getting a headache.

Additionally, on a recent Dr. Oz episode they were pushing raspberry ketones as a "miracle" fat loss supplement. Fortunately, a member of the audience asked why they can't just eat fresh raspberries, and we're answered with, “it will take 90 pounds of raspberry to get the same amount of ketones that you will get in this one small supplemental pill." As far as I know, if it is going to take me 90 pounds of raspberries to get the amount of ketones in these pills, there may be a reason for that. Potentially, that amount of the supplement at one given time may not be healthy.

Thus, if you are looking for that new miracle pill to make you look younger or thinner, it's simple, EAT HEALTHY! Remember the old adage, "an apple a day, keeps the doctor away"? Well, that may be true, but it has been shown to give you just as much if not more energy than a cup of coffee, not to mention, that apples along with most fruits and vegetables actually have negative calories, meaning that you burn more calories eating them, than they actually contain.

Therefore, I return to how I began, "Superman's cape" or "Batman's utility belt." As hard as it is for me to say, as I prefer Superman, in this case I'd go with the "regular" utility belt. Just because these foods have been dubbed "super," there still isn't sufficient scientific evidence that show they are better than a "regular" apple or celery stalk. Essentially, the choice is yours; however, know your choices.

Exercise: Have your cake and eat it!

We have all heard the benefits of exercise for long term health: reduce risk of heart disease, certain cancers, type 2 diabetes, stroke, and the list goes on. But let’s be honest the immediate gratification of sitting on couch with a bag of potato chips a large ice cold pop and vegetating out for a couple hours while watching a marathon of Pawn Stars seems a lot more enticing. Here in lies the challenge we face every day: the immediate gratification of poor health choices over long term benefits of exercising.

We live in a mostly immediate gratification society here in America. If I want to watch a good movie I can go to the Movie Theater and pick from 12 different flicks each having 3 or 4 different times to pick from. If I want a bigger selection and don’t want to wait for the times it is offered, I can go to the video rental store and pick from 100’s of titles. Heck I don’t even have to go out of my house or worry the movie I want is being rented by someone else; I can just get Netflix and have the movie delivered instantly right to my TV. I don’t even need to be tied to my TV to watch the movie I can get it on my phone and go where ever I want and still get the movie I want when I want it. Now that is instant gratification at its best.

So we can see that we are used to instant gratification and benefits from the things we do these days and exercise doesn’t seem to fit into that category, so no wonder we like to skip past it. But actually it does give us some instant benefits!

Immediately following your 30 minute walk (or whatever form of exercise you choose) you will start to experience some very enjoyable effects to your body and brain. You will produce an increase in the “happy” neurotransmitters serotonin and dopamine. These neurotransmitters will improve your mood and reward/pleasure centers of the brain and reduce stress and anxiety feelings you may have. Insulin sensitivity improves so your muscle cells take in glucose (the energy molecule your body uses) floating through the blood stream. This makes your pancreas (what produces insulin) happy since it doesn’t have to work as hard to produce as much insulin (the chemical that allows for the absorption of glucose into the muscle cells). You will also get an increase in HDL-cholesterol, which is the good cholesterol that we want. You will see a reduction in blood pressure immediately following your exercise bout. Heck even your bowels will move better after you exercise.

So if immediate gratification is what you like, then exercise may be just the thing you need instead of being a couch potato and eating junk food. Immediate and long term benefits with exercise, how cool is that. Maybe I can have my cake and eat it too, as long as that cake comes in the form of exercise.

Exercise, sclerostin and bone health what do they have in common?

Exercise is probably one, if not the greatest medicine, we can give our bodies. The benefit list is almost endless and the side effects are minimal to none when done appropriately. This week we will highlight one specific benefit that some new research showing how exercise benefits bone health in pre-menopausal women.

A study that will be coming out in the October issue of Journal of Clinical Endocrinology and Metabolism details some of the specific effects of how exercise improves bone health in pre-menopausal women. Bone, just like your muscles and other tissues in your body, is living tissue and constantly changing. Also just like muscles the more you exercise the stronger and healthier they become. Bone loss is a major concern with pre-menopause and menopause for women, which can lead to osteopenia and osteoporosis. Weakened bones (osteopenia and osteoporosis) can play a role in increasing your fracture risk as you age; they are not the only factor but an important one we need to be aware of. Sclerostin is a known bone growth inhibitor, by its action on a hormone IGF-1 (Insulin-like growth factor 1). Our bodies when working properly have a steady balance of hormones and proteins to assist metabolic pathways to keep our various systems in check and balance between anabolism and catabolism. Anabolism is the process of building up new tissue; while catabolism is the breaking down older tissue. During injuries, illnesses or other body changes such as menopause these systems might not stay as balanced and we can get an increase in catabolism.

The study showed that over an 8 week period those pre-menopausal women that performed in a supervised exercise routine of more than 2 hours per week had "significantly" lower sclerostin levels and higher IGF-1 levels. So even relatively low levels of exercise, normal exercise guidelines of 30 minutes a day 5-6 days per week, was enough to start seeing biological changes in crucial markers in just 2 months’ time to assist with normalizing hormonal controls of bone formation.

So what type of exercise do you need to do? Simple weight bearing exercises (any exercise that you move against gravity) such as walking and weight lifting. Things like swimming and bike riding; while great exercises for your cardiovascular system are not weight bearing exercises so will not help as much to build your bones.

So the research shows that exercise is an important part of long term bone health, but don’t forget some of the other things you can do for a complete program. Make sure you have a good diet rich in calcium and Vitamin D along with avoiding lifestyle choices such as smoking and excessive alcohol intake.

Ergonomics

Ergonomics is defined as: the applied science of equipment design, as for the workplace, intended to maximize productivity by reducing operator fatigue and discomfort. It is interesting how posture, lifting techniques and body mechanics have often times drifted into ergonomic analysis. There have actually been a fairly large number of research articles that point out there is no causality relationship between awkward postures in the work place to pain or injury and that training on lifting techniques and body mechanics have no reduction on injuries or pain in the work place. So if ergonomics is truly about applying science, then we need to get rid of old dogma and established beliefs about posture and body mechanics that have not held up to the rigors of science and study.

How can that be you might ask? You mean I won’t get pain in my neck or hands if I sit at the computer with poor posture, and that if I lift with poor body mechanics that I won’t injure my back? No, what the research/science is telling us is that for the entire population of people those that use proper posture and body mechanics have just as much risk for injury or pain as those that don’t. This is in part because the entire population of people has large variability (tall/short, thin/wide, strong/weak, etc.) we cannot predict what "proper" posture or body mechanics are for any one specific individual and thus relate that to a direct cause of their pain or injury. There are lots of variables that come into play with injury or pain and picking out just posture or body mechanics is rather useless in preventing pain or injury.

So what should you do when it comes to posture and lifting techniques when it comes to the ergonomics of your job? Do I need good posture or not? Do I need to lift with good body mechanics or not? Dr. Nortin Hadler, an expert in work related musculoskeletal disorders and author of many research articles and books including Occupational Musculoskeletal Disorders puts it best:

“Work should be comfortable when you are well and accommodating when you are ill.”

Basically the posture or lifting mechanics you choose to do your job should be comfortable to you. If they are not then you need to adjust and accommodate to a new position that you find comfortable. If good posture and body mechanics feels comfortable, use it. But if it is uncomfortable, accommodate to something different. If what some call poor posture or body mechanics feels comfortable to you, use it. But if it starts to be uncomfortable, accommodate to something different.

We have all seen the posters and info on “proper” lifting or sitting posture, which can work for many and probably a good starting point if you don’t know how to set up a work station. But remember even if those “proper” positions feel uncomfortable or awkward to you; then change them to a new more comfortable less awkward position for you. If your work station is comfortable, even if you have what some might consider poor posture or body mechanics, don’t worry about. That set up is right for you, even though it might not be right for someone else. But realize also, what feels right today, may not be right tomorrow and if something becomes uncomfortable then change to a new position.

Macronutrient extreme diets may not be healthy.

How our bodies use and store the energy of the calories of the macronutrients (carbohydrates, proteins and fats) we put into it is a complex process. The diet industry has been pretty good at confusing most of us by its use of these complexities to justify their method. We have every end of the spectrum when it comes to diets touting specific diet ratios of these macronutrients to help us lose weight: low-fat/high carbohydrate, low carbohydrate/high protein, low carbohydrate/high fat, etc. They all claim they work and show scientific research they work, how can that be?

With calorie control, most diets will work to lose weight, for a short time. Also some people, no matter what macro nutrient ratio they use can lose weight (hint: it’s not the diet, but the genetics their mom and dad gave them that is working for them). Also remember when most people talk about diet success, they are referring to weight loss. Weight loss is healthy for us, if it is the excess body fat above a healthy range we carry around. But what if I just lost muscle mass? I would be losing weight, but do you see where this is not healthy. So a diet successful in losing weight may not always be healthy for us. Also understand even if we do lose some of the excess storage fat with our diet, it may still not be healthy for us due to increase in other health risk factors.

A recent study in the June 27, 2012 issue of the Journal of Medical Association demonstrated some of the ill health effects of these restriction type diets. Those people on these restriction diets have been found to have increase in heart disease risk factors, chronic inflammatory markers and stress hormone production (none of those are good things if you want to live a long healthy life). Senior author Dr David S Ludwig (New Balance Foundation, Obesity Prevention Center) told heartwire in an interview (this may be some of the best suggestions about diet in just a few sentences I have ever read):

"Extreme restriction of fat or carbs can have bad effects. The best long-term approach will be to avoid restriction of any major nutrient--either fat or carbohydrate--and instead focus on the quality of nutrients. This is not to say that the number of calories isn't important, but it's now saying we should also pay attention to the quality of those calories. So the argument that the food industry likes to make--that all foods can be part of a healthful diet as long as you watch calories--is really misleading at best. Relatively unprocessed, low-glycemic-index foods are best, things that our grandmother would recognize. Choose relatively unprocessed foods whenever you can and cut back on white bread, white rice, potato products, prepared breakfast cereals, and, of course, concentrated sugars."

So as we can see that restriction diets may help us lose weight, but they may be making us unhealthier. What is the proper ratio of macronutrients one should be using? This is going to vary for all of us (again due to that genetic thing mom and dad passed on to you). Typically a general range to start with is 50% carbohydrates, 30% proteins, and 20% fats. But remember each calorie of the macronutrient is not the same. Carbohydrates should come from low glycemic index foods (think the natural stuff not the processed stuff that comes in a box or a bag). Proteins should be from lean sources and from multiple sources (think fish, chicken, turkey, and some red meat). Fats need to be of the monounsaturated, polyunsaturated and Omega 3 fatty acid type, while avoiding the saturated and trans fat types. Then you can play with the ratios “a little” to see if it helps you feel better and get a little better weight control. When we say “a little”, we mean probably no more the 5-10% any one direction with any one macronutrient. Extremes of anything usually are never healthy for us and a diet pushing the macronutrient ratios to extremes are no exception to this simple healthy rule to follow.

Smoking or inactivity, which is worse?

Voluntary physical inactivity now tops smoking for association to non-communicable diseases tied to premature death. This recent report was published (July 2012) in a series of articles in the journal The Lancet looking at the global problem of inactivity and obesity. Amazingly our self-selection and decision to be inactive is causing disease and shortening our lives slightly more than one’s choice to smoke. I know some will say; they have the right to choose to do with their body what they want. While this is true, unfortunately those choices our costing our society billions of dollars in unneeded health care costs. And that choice is taking days away from our loved ones with premature death. While it may be difficult to get many inactive people to change their ways, the research report showed that if we could get just 1 person active out of every 4 inactive people then 1.3 million deaths could be prevented every year.

The risks associated with smoking have been known for a long time and heavy media and public awareness campaigns have been under way for many years to alert people to these risks. You can’t buy cigarettes without seeing the large warning label on it. You see billboards and TV ads on a regular basis alerting us and trying to get people never to start or stop smoking if they already have. Also many good programs and efforts are in place to assist those that do smoke to help them break the addiction and try and become smoke free. The money spent on these things is well worth it, because we know the expense of taking care of health related problems with smoking far outweighs the cost of these awareness campaigns. Maybe it is time to start some campaigns similar to those when it comes to inactivity?

We here in America have always been known for our innovation and bringing many things to the rest of the world; democracy, space travel and now…inactivity. According to the latest information 31.1% of the world’s adults are sedentary and do not meet the minimum recommendations for activity in a week. Current minimum requirements are 150 minutes of moderate activity (i.e. walking) per week. Here in America we top the scales at 43.4% of us not meeting these requirements, and it looks as if the rest of world is following our example with increased inactivity in many other parts of the world.

Are you getting in 30 minutes of physical activity a day? Did you realize a choice to be inactive carries just as much risk for disease and premature death as someone who smokes? Exercise and being physically active has substantial health benefits, just 30 minutes a day is all it takes to become a healthier you. Maybe we here in America we can reverse our trendsetting with inactivity and look to become more active. Being a world leader is usually a good thing; leading it to an earlier death is not so good.

Understanding calcium supplementation for bones

Bone health is important to all of us and it gets lots of press and publicity on how to maintain it throughout our life span. Sometimes this info can be confusing to say the least. We know that bones need calcium to stay strong and healthy, as this is one of the primary building blocks to build bones. Bone is a living tissue just like all of your other tissues, so it needs a constant supply of nutrients and activity to keep rebuilding. When we lack these nutrients (such as calcium) and activity we can develop osteoporosis, where your bone mineral density decreases and increases your risk for fractures. Calcium supplementation is a common treatment for this, but it has come under some scrutiny lately because of potential side effects from it. Let’s try to separate the fact from the fiction with some of the reporting that has gone on.

New research has shown potential increased heart attack risk with calcium supplementation. Don’t panic and stop your supplementation just yet, but do read on to understand pro’s and con’s. First lets clarify what you may have read or heard from the press or others. Some reports have gone so far as to say calcium supplementation increases heart attack risk by 50%. While this is true, it is a stretch, realize that heart attack risk in the study went from just over 1% for those that didn’t supplement, to a little over 2% if you do. So the risk is 50% more, but still very small overall. But don’t be fooled in thinking that if you take calcium it will solve all your problems with osteoporosis and fall risk. Some studies show that supplementation only reduces your fall risk by 10%. So taking a calcium supplement helps, just don’t fool yourself to thinking you are out of the woods when it comes to fall risk. Research has been pretty consistent to show that if you get your calcium naturally (milk based products, broccoli, cabbage to name a few good sources) through diet you will get greater benefits and no side effects as to if you get it through supplementation. Another thing research has shown that if you hit your later years low on calcium and bone density it is hard if not almost impossible to catch up. You might slow the decline of bone density loss with improved diet or supplementation, but you are better off getting enough in your younger years then trying to play catch up.

So what’s the take home? If you supplement calcium, do it under a physician’s care to look at benefits and risks for you. Better yet, get enough calcium through a proper diet and start early in life to limit risks of osteoporosis throughout your life. Also don’t forget other things that can help: exercise, don’t smoke, avoid excessive alcohol, have an overall healthy diet and maintain proper weight control. Sounds like good advice for lots of health issues your bones included.

It’s getting HOT out here.

As we get into the prime heat of summer there are a few precautions one should take to avoid potential heat illnesses. The most important thing is keep hydrated, primarily with plain old water. While sports drinks offer some electrolytes that may be helpful to replace, they also contain extra calories. So be aware that they will add to your total calorie count for your daily intake. Also our usual American diet is not lacking in salt, so we usually have a pretty good store of electrolyte storage in our bodies already. Unless you are exercising for more than 1 hour or working outside for a full 8 hour day and sweating the majority of time then you probably only need water and not the sports drink. Be careful with caffeinated drinks or those with high amounts of sugar, as they do not add to your fluid intake as much as good old water.


A couple other precautions to be on alert for potential increase heat illness risk based on your medications and body weight. If you are on medications that act as a diuretic that you may be taking for blood pressure control or heart problems, be aware this will limit your body’s ability to regulate heat as well through sweating. Also if you are overweight you will be more prone to heat illnesses because of the insulation effect of the adipose (fat) tissue that helps retain heat. This is may be helpful in January, not so good in July.

Along with taking in adequate fluids, make sure you take breaks inside or under shade to help your body temperature stay under control. Wear light colored and loose clothes to help with heat control when you are outside. If you have to work or exercise outside, use a “buddy system” to help monitor each other. With heat illnesses it is easy to become confused or lose consciousness and not be aware that you are in trouble, a “buddy” can get help if needed.

The primary heat illnesses you should be aware of are:

• Heat stroke happens when you lose the ability to control its own temperature. Your body temperature can elevate to dangerous levels potentially causing death or permanent disability. This elevated body temperature can happen rapidly (10-15 minutes) as soon as your body stops sweating and is unable to cool down. Signs to watch for are: red, hot, dry skin, a rapid and strong pulse, a throbbing headache, dizziness, nausea and confusion. If these signs show up, cool the person with cold water, but do not let them drink anything and get them medical care immediately.
• Heat exhaustion is a milder form of heat illness that develops over days of heat exposure and lack of adequate fluid intake. Symptoms include heavy sweating, paleness, muscle cramps, fatigue, dizziness, headache, nausea, vomiting or fainting. The skin may be cool and moist, and the pulse rate fast and weak while breathing may be fast and shallow. Get this person to a cool place and gradually restore some fluids. If symptoms do not decrease in one hour seek medical attention. 
• Heat cramps typically occur with strenuous activity. These may be a sign of heat exhaustion, so follow the same care guidelines, by stopping activity and get to a cool place and slowly replenish fluids.

So during the summer heat make sure to take in adequate fluids by not ignoring your thirst if outside working, playing or exercising. Monitor one another of possible heat illness signs and take appropriate action if any of the signs show themselves, as heat illnesses can be a very serious medical problem.

Over-training can be a problem too

Well for most us worrying about over-training is the furthest from our concerns. We tend to be very good at under-training our bodies to their fullest potential. But for some of you, in the pursuit of health and athletic accomplishment, over-training can be a significant problem that can rob you of your fullest potential. Over-training occurs when someone trains beyond their body’s ability to recover and thus resulting in decreased performance and increased health risks such as injury or illness.

How do you know if you are over-training? Some common signs that show up are repeated little overuse injuries, increased aches and pains. Also you may notice that you have more frequent illnesses, such as colds and general fatigue feeling that just don’t seem to go away. Other signs might be drop in performance and training intensity, mood shifts and irritability, loss of enjoyment with training activity, insomnia or decreased appetite.

Here are some tips to monitor your status to reduce the risk of moving into over-training. One of the best is to record your resting heart rate. The best way to do this is to take your heart rate first thing in the morning when you get up. As you get healthier you should see this resting heart rate decrease, this is a sign of a healthier cardiovascular system. Eventually it will level off as you near your optimal health level. If this resting heart rate starts to increase, that is often a sign you need to take some of the steps to let your body recover to reduce over-training. But the tricky part is you may notice this number continues to fall lower and lower as well, and not increase, with some people that are becoming more over-trained. If the number continues to fall and you feel fatigued or some of the other symptoms of over-training, then don’t let the falling number trick you into thinking you are doing good. Another is to record your training workouts and to watch for changes in intensity or if you feel more fatigued with doing them and not as energized after. Also you may notice some decrease hydration, so watch your pee (as gross as that sounds it can tell you if you are hydrated properly or not).

Some steps to avoid overtraining. Include at least one recovery day each week with no exercise. Alternate and change up your exercise routine to add in variability to it. When you are increasing intensity with your workout make sure to do so gradually over time. If you notice you are suffering the effects of over-training make sure to decrease exercise level and rest to allow your body the chance to recover. You can still exercise but decrease intensity and frequency of exercise. Get lots of water to help rehydrate your body along with getting plenty of healthy food to refuel your body to assist in the recovery process. Let this recovery process happen over several weeks depending on the severity of the over-training you are suffering from. Then SLOWLY get back to your exercise routine and try to find the sweet spot in your training.

We have to remember that more is not always better. Sometimes too much exercise can not be healthy for us either. But please don’t be fearful of overtraining or use that as an excuse to not exercise.

Dark chocolate has benefits, but be careful

A new study shows potential that consumption of dark chocolate could be an effective strategy for prevention of cardiovascular events in high risk patients, due to it’s blood pressure lowering and lipid effects. How cool is that you might be thinking, let’s run out and overload on dark chocolate to prevent a heart attack or stroke. Hold on not so fast my friend!

Just as with any research we need to look at it critically and in context of other research of what we already know. First this study only was found effective for high risk patients, those with metabolic syndrome that were not diabetic. Obviously if you have diabetes you need to control your sugar/carbohydrate intake appropriately and taking extra dark chocolate will probably not help that. Also if you are not a high risk cardiovascular person, the extra dark chocolate will not reduce your risk, so you get no added benefit. Additionally we know that frequent chocolate consumption can lead to increased BMI. That increased BMI has lots of bad health risks involved with it, as you are probably well aware of. This means if you are not a high risk patient then you are getting no added benefit from cardiovascular risk reduction, but you are gaining increased obesity risks. That’s not a good trade off.

Where does this lead us to understand the research better and how to use it? If you are a high risk patient with metabolic syndrome and no diabetes, adding some dark chocolate to your diet may be beneficial. Talk to your doctor about this as a potential strategy to assist your current medical intervention. But remember this study also showed the benefits of dark chocolate were not as profound as drug interventions, so it will not be a substitute for your current treatment. Be aware that you could see increased BMI, so adjust your total diet to make sure you are not adding additional calories with the added dark chocolate. If you are not a high risk patient, enjoying some occasional chocolate is okay, but don’t think it is giving you any added health benefits just some added taste benefits. Remember just as in almost all food choices, enjoy in appropriate moderation for the best health benefits.

Obesity is a chronic inflammatory disease: An evolving paradigm

The following is my first guest post.  Dr. Joseph Gentzel is a recent graduate from USD tDPT program that I do adjunct faculty work for.  He has done extensive study in the area of obesity and chronic diseases, especially related to diet and exercise (you can see why I thought he would have some great insights to share on this blog).  He graciously offered to do a post (after a little begging and pleading with him).  Here it is and you can follow more of his post at his blog Senior Physical Therapist's Blog.

Obesity is a chronic inflammatory disease:
An evolving paradigm

Dr. Joseph B. Gentzel, PT, DPT

With the most recent announcement that by 2030 forty-two percent of us will be obese¹ that translates to 9 out of ten ² of us being overweight or obese by 2030; it is imperative that we dismiss the information cascades that have failed so completely these past 40-50 years. There are many information cascades, but none bigger than the notion that obesity is caused by consuming too many calories in relation to the calories we burn; thus resulting in the deposition of fat stores in our body. Science has documented for us sufficiently that the weight reduction benefits of exercise is not restricted to calories burned³, but to other dramatic physiological changes made to the body’s physiology by a diet low in advanced glycation end products ( AGE poor diet)⁴  and exercise^5,6.

In 2001 Das asked the rhetorical question: Is obesity an inflammatory condition? ⁷ Ronca & Folco⁸ plus many others have indicated via their works how science supports obesity as an inflammatory condition. Calder et all⁴ describe many dietary factors associated with chronic disease inflammation that includes obesity. Roncal-Jimenez et all drive one of the many nails in coffin of the calories in calories out paradigm.⁹ May it rest in peace to never return again. By employing a model that fails so completely, we insure failure in addressing this mammoth public health problem. Failure, by any rational measure, has occurred in dramatic fashion with this paradigm.

Rayssiguier¹⁰ et all note that “studies have been published that implicate subclinical chronic inflammation as an important pathogenic factor in the development of metabolic syndrome”.  With multiple components comprising metabolic syndrome, this is an important point. Metabolic syndrome is comprised of combinations of visceral obesity, dyslipidaemia, hyperglycaemia, and hypertension.¹¹

So what? The clinical picture over these past 10 plus years seems to be clearing up to support that obesity is at least associated with and potentially caused by systemic inflammation. This is inflammation that we can measure with inflammatory markers such a C reactive protein, interleukin 6, possibly tumor necrosis factor, and many others. Being able to quantify the systemic inflammation offers objective measures of the condition and our interventions with same.¹²

This presents some novel approaches to addressing the disease that somehow we always knew worked but never understood how/why and too often got sidetracked by the clutter and noise that has bombarded the scene these past 40-50 years. The Centers for Disease Control and Prevention (CDC) appear to have little understanding of this and continue to apply invalid models. Nowhere is this more glaring that the USDA food pyramid that misses the point as illustrated by its continued advocacy of the toxin sugar¹³ and other nutritional areas that have ignored the science of the past 10 years.¹⁴ The Harvard School of Public Health agrees.¹⁵ The science is in and piling up to lead us away from the old information cascades. Information cascades that need to take their place alongside bloodletting and the like.

Sugar creates inflammation.⁴ Sugar causes injury to kidneys¹⁶, liver⁹, pancreas¹⁷, GI system^4,18,19, and virtually every system in the body. We should therefore not be surprised to find that obesity induced chronic inflammation damages the brain circuits that are involved with reward and feeding behaviors.²⁰

References

1.         Finkelstein EA, Khavjou OA, Thompson H, Trogdon JG, Pan L, Sherry B. Obesity and severe obesity forecasts through 2030. Am J Prev  Med. June 2012;42(6).

2.         Melville K. 9 out of 10 americans obese or overweight by 2030. [ONLINE]. 2008; 29 July, 2008:http://www.scienceagogo.com/news/20080629010344data_trunc_sys.shtml. Accessed May 7, 2012.

3.         Cannon B, Nedergaard J. Thermogenesis challenges the adipostat hypothesis for body-weight control. Proc Nutr Soc. Nov 2009;68(4):401-407.

4.         Calder P, Ahluwalia N, Brouns F, et al. Dietary factors and low-grade inflammation in relation to overweight and obesity. Br J Nutr. Dec 2011;106(Suppl 3):s5-s78.

5.         Kawanishi N, Yano H, Yokogawa Y, Suzuki K. Exercise training inhibits inflammation in adipose tissue via both suppression of macrophage infiltration and acceleration of phenotypic switching from M1 to M2 macrophages in high-fat -diet-induced obese mice. Exerc Immunol Rev. 2010;16:105-118.

6.         Petersen A, Pedersen B. The. anti-inflammatory effect of exercise. J Appl Physiol. Apr 2005;98(4):1154-1162.

7.         Das U. Is obesity an inflammatory condition? Nutrition. Nov-Dec 2001;17(11-12):953-966.

8.         Rocha V, Folco E. Inflammatory concepts of obesity. Int J Inflam. 2011 2011;2011:529061.

9.         Roncal-Jimenez C, Lanaspa M, Rivard C, et al. Sucrose induces fatty liver and pancreatic inflammation in male breeder rats independent of excess energy intake. Metabolism. Sep 2011;60(9):1259-1270.

10.       Rayssiguier Y, Gueux E, Nowacki W, Rock E, Mazur A. High fructose consumption combined iwth low dietary magnesium intake may increase the incidence of the metabolic syndrome by inducing inflammation. Magnes Res. Dec 2006;19(4):237-243.

11.       Alberti K, Zimmet P, Shaw J, IDF_Epidemiology_Task_Force-Consensus_Group. The metabolic syndrome--a new worldwide definition. Lancet. Sep 24-30 2005;366(9491):1059-1062.

12.       Ploeger H, Takken T, Greef Md, Timmons B. The effects of acute and chronic exercise on inflammatory markers in children and adults with a chronic inflammatory disease: a systematic review. Exerc Immunol Rev. 2009;15:6-41.

13.       Johnson R, Sanchez-Lozada L, Nakagawa T. The effect of fructose on renal biology and disease. J am Soc Nephrol. Dec 2010;21(12):2036-2039.

14.       Chiuve S, Willett W. The 2005 food Guide Pyramid: an opportunity lost? Nat Clin Pract Cardiovasc Med. Nov 2007;4(11):610-620.

15.       Willett W, McCullough M. Dietary pattern analysis for the evaluation of dietary guidelines. Asia Pac J Clin Nutr. 2008;17(Suppl 1):75-78.

16.       Nakayama T, Kosugi T, Gersch M, et al. Dietary fructose causes tubulointerstitial injury in the normal rat kidney. Am J Physiol Renal Physiol. Mar 2010;298(12-20).

17.       Ryu S, Ornoy A, Samuni A, Zangen S, Kohen R. Oxidative stress in Cohen diabetic rat model by high-sucrose, low copper diet: inducing pancreatic damage and diabetes. Metabolism. Sep 2008;57(9):1253-1261.

18.       Ding S, Lund P. Role of intestinal inflammation as an early event in obesity and insulin resistance. Curr Opin Clin nutr Metab Care. Jul 2011;14(4):328-333.

19.       Kawada M, Anihiro A, Mizpguchi E. Insights from advances in research of chemically induced experimental models of human inflammatory bowel disease. World J Gastroenterol. 2007;13(42):5581-5593.

20.       Cazettes F, Cohen J, Yau P, Talbot H, Convit A. Obesity-mediated inflammation may damage the brain circuit that regulates food intake. Brain Res. 2011;Feb 10(1373):101-109.